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AN inquiry into the influence of physical causes upon 

the moral faculty 1 

Observations upon the cause and cure of pulmonary 

consumption 59 

Observations upon the symptoms and cure of dropsies 151 
Inquiry into the cause and cure of the internal dropsy 

of the brain 191 

Observations upon the nature and cure of the gout 225 
Observations on the nature and cure of the hydro- 
phobia 299 
An account of the measles, as they appeared in Phila- 
delphia in the spring of 1789 335 
An account of the influenza, as it appeared in Phila- 
delphia in the years 1790 and 1791 351 
An inquiry into the cause of animal life 369 











IT was for the laudable purpose of exciting a 
spirit of emulation and inquiry, among the mem- 
bers of our body, that the founders of our society 
instituted an annual oration. The task of prepar- 
ing, and delivering this exercise, hath devolved, 
once more, upon me. I have submitted to it, not 
because I thought myself capable of fulfilling your 
intentions, but because I wished, by a testimony of 
my obedience to your requests, to atone for my 
long absence from the temple of science. 

The subject upon which I am to have the ho- 
nour of addressing you this evening is on the in- 
fluence of physical causes upon the moral faculty. 



By the moral faculty I mean a capacity in th< 
human mind of distinguishing and chusing good 
and evil, or, in other words, virtue and vice. It is 
a native principle, and though it be capable of im- 
provement by experience and reflection, it is not 
derived from either of them. St. Paul and Cicero 
give us the most perfect account of it that is to be 
found in modern or ancient authors. " For when 
" the Gentiles (says St. Paul), which have not the 
" law, do by nature the things contained in the 
" law, these i having not the law, are a law unto 
" themselves; which show the works of the law 
" written in their hearts, their consciences also 
" bearing witness, and their thoughts the mean 
M while accusing, or else excusing another*. " 

The words of Cicero are as follow : " Est igi- 
B< tur hsec, judices, non scripta, sed natalex, quam 
" non didicimus,accepimus,legimus, verum ex na- 
" tura ipsa arripuimus, hausimus, expressimus, ad 
" quam non docti, sed facti, non instituti, sed im- 
" buti sumusf ." This faculty is often confounded 
with conscience, which is a distinct and indepen- 
dent capacity of the mind. This is evident from 
the passage quoted from the writings of St. Paul, 
in which conscience is said to be the witness that 

* Rom. i. 14, 15. f Gratio pro Milone. 


accuses or excuses us, of a breach of the law writ- 
ten in our hearts. The moral faculty is what the 
schoolmen call the " regula regulans ; " the con- 
science is their " regula regulata ;" or, to speak in 
more modern terms, the moral faculty performs the 
the office of a law-giver, while the business of con- 
science is to perform the duty of a judge. The 
moral faculty is to the conscience, what taste is to 
the judgment, and sensation to perception. It is 
quick in its operations, and, like the sensitive plant, 
acts without reflection, while conscience follows 
with deliberate steps, and measures all her actions, 
by the unerring square of rignt and wrong. The 
moral faculty exercises itself upon the actions of 
others. It approves, even in books, of the virtues 
of a Trajan, and disapproves of the vices of a Ma- 
rius, while conscience confines its operations only 
to its own actions. These two capacities of the 
mind are generally in an exact ratio to each other, 
but they sometimes exist in different degrees in 
the same person. Hence we often find conscience 
in its full vigour, with a diminished tone, or total 
absence of the moral faculty. 

It has long been a question among metaphysi- 
cians, whether the conscience be seated in the will 
or in the understanding. The controversy can 
only be settled by admitting the will to be the seat 


of the moral faculty, and the understanding to be 
the seat of the conscience. The mysterious na- 
ture of the union of those two moral principles with 
the will and understanding, is a subject foreign to 
the business of the present inquiry. 

As I consider virtue and vice to consist in action, 
and not in opinion, and as this action has its seat in 
the nv ill, and not in the conscience, I shall confine 
my inquiries chiefly to the influence of physical 
causes upon that moral power of the mind, which 
is connected with volition, although many of these 
causes act likewise upon the conscience, as I shall 
show hereafter. The state of the moral faculty is 
visible in actions, which affect the well-being of 
society. The state of the conscience is invisible, 
and therefore removed beyond our investigation. 

The moral faculty has received different names 
from different authors. It is the " moral sense" 
of Dr. Hutchison; the " sympathy" of Dr. Adam 
Smith; the " moral instinct" of Rousseau; and 
" the light that lighteth every man that cometh in- 
" to the world" of St. John. I have adopted the 
term of moral faculty from Dr. Beattie, because I 
conceive it conveys with the most perspicuity, the 
idea of a capacity in the mind, of chusing good and 


Our books of medicine contain many records of 
the effects of physical causes upon the memory, 
the imagination, and the judgment. In some in- 
stances we behold their operation only on one, 
in others on two, and, in many cases, upon the 
whole of these faculties. Their derangement has 
received different names, according to the number 
or nature of the faculties that are affected. The 
loss of memory has been called " amnesia;" false 
judgment upon one subject has been called " me- 
lancholia ;" false judgment upon all subjects has 
been called " mania ;" and a defect of all the three 
intellectual faculties that have been mentioned, has 
received the name of " amentia. ' ? Persons who 
labour under the derangement, or want of these 
faculties of the mind, are considered, very pro- 
perly, as subjects of medicine ; and there are many 
cases upon record that prove, that their diseases 
have yielded to the healing art. 

In order to illustrate the effects of physical 
causes upon the moral faculty, it will be neces- 
sary first to show their effects upon the memory, 
the imagination, and the judgment; and at the 
same time to point out the analogy between their 
operation upon the intellectual faculties of the mind, 
and the moral faculty. 


1. Do we observe a connection between the 
intellectual faculties, and the degrees of consistency 
and firmness of the brain in infancy and childhood? 
The same connection has been observed between 
the strength, as well as the progress of the moral 
faculty in children. 

2. Do we observe a certain size of the brain, 
and a peculiar cast of features, such as the pro- 
minent eye, and the aquiline nose, to be connected 
with extraordinary portions of genius ? We ob- 
serve a similar connection between the figure and 
temperament of the body, and certain moral quali- 
ties. Hence we often ascribe good temper and 
benevolence to corpulency, and irascibility to san- 
guineous habits- Cassar thought himself safe in 
the friendship of the " sleek-headed" Anthony and 
Dolabella ; but was afraid to trust to the profes- 
sions of the slender Cassius. 

3. Do we observe certain degrees of the intel- 
lectual faculties to be hereditary in certain families? 
The same observation has been frequently extend- 
ed to moral qualities. Hence we often find certain 
virtues and vices as peculiar to families, through 
all their degrees of consanguinity, and duration, as 
a peculiarity of voice, complexion, or shape. 


4. Do we observe instances of a total want of 
memory, imagination, and judgment, either from 
an original defect in the stamina of the brain, or 
from the influence of physical causes ? The same 
unnatural defect is sometimes observed, and proba- 
bly from the same causes, of a moral faculty. The 
celebrated Servin, whose character is drawn by the 
Duke of Sully in his Memoirs, appeal's to be an 
instance of the total absence of the moral faculty, 
while the chasm, produced by this defect, seems to 
have been filled up by a more than common ex- 
tension of every other power of his mind. I beg 
leave to repeat the history of this prodigy of vice 
and knowledge. " Let the reader represent to 
" himself a man of a genius so lively, and of an 
" understanding so extensive, as rendered him 
" scarce ignorant of any thing that could be known; 
" of so vast and ready a comprehension, that he 
" immediately made himself master of whatever 
" he attempted ; and of so prodigious a memory, 
u that he never forgot what he once learned. He 
" possessed all parts of philosophy, and the ma- 
M thematics, particularly fortification and drawing. 
" Even in theology he was so w r ell skilled, that 
" he was an excellent preacher, whenever he had 
" a mind to exert that talent, and an able dispu- 
" tant, for and against the reformed religion indif. 
" ferently. He not only understood Greek, He-, 



brew, and all the languages which we call 
learned, but also all the different jargons, or 
modern dialects. He accented and pronounced 
them so naturally, and so perfectly imitated the 
gestures and manners both of the several nations 
of Europe, and the particular provinces of 
France, that he might have been taken for a 
native of all, or any of these countries : and this 
quality he applied to counterfeit all sorts of per- 
sons, wherein he succeeded wonderfully. He 
was, moreover, the best comedian, and the great- 
est droll that perhaps ever appeared. He had a 
genius for poetry, and had wrote many verses. 
He played upon almost all instruments, was a 
perfect master of music, and sang most agree- 
ably and justly. He likewise could say mass, 
for he was of a disposition to do, as well as to 
know all things. His body was perfectly well 
suited to his mind. He was light, nimble, and 
dexterous, and fit for all exercises. He could 
ride well, and in dancing, wrestling, and leap- 
ing, he was admired. There are not any re- 
creative games that he did not know, and he 
was skilled in almost all mechanic arts. But 
now for the reverse of the medal. Here it ap- 
peared, that he was treacherous, cruel, cowardly, 
deceitful, a liar, a cheat, a drunkard and a glut- 
ton, a sharper in play, immersed in every species 


*' of vice, a blasphemer, an athiest. In a word, 
" in him might be found all the vices that are con- 
" trary to nature, honour, religion, and society, the 
" truth of which he himself evinced with his latest 
" breath ; for he died in the flower of his age, in 
" a common brothel, perfectly corrupted by his 
" debaucheries, and expired with the glass in his 
£ hand, cursing and denying God*." 

It was probably a state of the human mind such 
as has been described, that our Saviour alluded 
to in the disciple, who was about to betray him, 
when he called him " a devil.' ' Perhaps the es- 
sence of depravity, in infernal spirits, consists in 
their being wholly devoid of a moral faculty. In 
them the will has probably lost the power of chus- 
ingf, as well as the capacity of enjoying moral 
good. It is true, we read of their trembling in a 
belief of the existence of a God, and of their antici- 
pating future punishment, by asking, whether they 
were to be tormented before their time t but this is 

* Vol. III. p. 216, 217. 

t Milton seems to have been of this opinion. Hence, 
after ascribing repentance to Satan, he makes him declare, 

** Farewel remorse : all good to me is lost, 

** Evily be thou my good." 

Paradise Lost, Book IV. 


the effect of conscience, and hence arises another 
argument in favour of this judicial power of the 
mind, being distinct from the moral faculty. It 
would seem as if the Supreme Being had preserved 
the moral faculty in man from the ruins of his fall, 
on purpose to guide him back again to Paradise, 
and at the same time had constituted the conscience, 
both in men and fallen spirits, a kind of royalty in 
his moral empire, on purpose to show his property 
in all intelligent creatures, and their original resem- 
blance to himself. Perhaps the essence of moral 
depravity in man consists in a total, but temporary 
suspension of the power of conscience. Persons 
in this situation are emphatically said in the Scrip- 
tures to be " past feeling," and to have their con- 
sciences seared with a " hot iron;" they are like- 
wise said to be " twice dead," that is, the same 
torpor or moral insensibility, has seized both the 
moral faculty and the conscience. 

5. Do we ever observe instances of the existence 
qf only one of the three intellectual powers of the 
mind that have been named, in the absence of the 
other two ? We observe something of the same 
kind with respect to the moral faculty. I once 
knew a man, who discovered no one mark of rea- 
son, who possessed the moral sense or faculty in so 
high a degree, that he spent his whole life in acts 


of benevolence. He was not only inoffensive 
(which is not always the case with idiots), but he 
was kind and affectionate to every body. He had 
no ideas of time, but what were suggested to him 
by the returns of the stated periods for public wor- 
ship, in which he appeared to take great delight. 
He spent several hours of every day in devotion, 
in which he was so careful to be private, that he 
was once found in the most improbable place in 
the world for that purpose, viz. in an oven. 

6. Do we observe the memory, the imagina- 
tion, and the judgment, to be affected by diseases, 
particularly by madness ? Where is the physician 
who has not seen the moral faculty affected from 
the same causes ! How often do we see the tem- 
per wholly changed by a fit of sickness ! And 
how often do we hear persons of the most deli* 
cate virtue, utter speeches in the delirium of a fe- 
ver, that are offensive to decency or good manners ! 
I have heard a well -attested history of a clergyman 
of the most exemplary moral character, who spent 
the last moments of a fever which deprived him 
both of his reason and his life, in profane cursing 
and swearing. I once attended a young woman 
in a nervous fever, who discovered, after her reco- 
very, a loss of her former habit of veracity. Her 
memory (a defect of which might be suspected of 


being the cause of this vice) was in every respect 
as perfect as it was before the attack of the fever*. 
The instances of immorality in maniacs, who were 
formerly distinguished for the opposite character, 
are so numerous, and well known, that it will not 
be necessary to select any cases, to establish the 
truth of the proposition contained under this head. 

7. Do we observe any of the three intellectual 
faculties that have been named, enlarged by dis- 
eases ? Patients, in the delirium of a fever, often 
discover extraordinary flights of imagination, and 
madmen often astonish us with their wonderful 
acts of memory. The same enlargement, some- 
times, appears m the operations of the moral fa- 
culty. I have more than once heard the most sub- 
lime discourses of morality in the cell of an hospi- 
tal, and who has not seen instances of patients in 
acute diseases, discovering degrees of benevolence 
and integrity, that were not natural to them in the 
ordinary course of their livesf ? 

* I have selected this case from many others, which have 
come under my notice, in which the moral faculty appeared 
to be impaired by diseases, particularly by the typhus of Dr. 
Cullen, and by those species of palsy which affect the brain. 

t Xenophon makes Cyrus declare, in his last moments, 
" That the soul of man, at the hour of death, appears most 
*' divine^ and then foresees something of future events." 


8. Do we ever observe a partial insanity, or false 
perception on one subject, while the judgment is 
sound and correct, upon all others ? We perceive, 
in some instances, a similar defect in the moral fa- 
culty. There are persons who are moral in the 
highest degree, as to certain duties, who neverthe- 
less live under the influence of some one vice. I 
knew an instance of a woman, who was exemplary 
in her obedience to every command of the moral 
law, except one. She could not refrain from steal- 
ing. What made this vice the more remarkable 
was, that she was in easy circumstances, and not 
addicted to extravagance in any thing. Such was 
her propensity to this vice, that when she could 
lay her hands upon nothing more valuable, she 
would often, at the table of a friend, fill her pock- 
ets secretly with bread. As a proof that her judg- 
ment was not affected by this defect in her moral 
faculty, she would both confess and lament her 
crime, when detected in it. 

9. Do we observe the imagination in many in- 
stances to be affected with apprehensions of dan- 
gers that have no existence ? In like manner we 
observe the moral faculty to discover a sensibility 
to vice, that is by no means proportioned to its de- 
grees of depravity. How often do we see persons 
labouring under this morbid sensibility of the mo- 


ral faculty, refuse to give a direct answer to a plain 
question, that related perhaps only to the weather, 
or to the hour of the day, lest they should wound 
the peace of their minds by telling a falsehood ! 

10. Do dreams affect the memory, the imagina- 
tion, and the judgment ? Dreams are nothing but 
incoherent ideas, occasioned by partial or imperfect 
sleep. There is a variety in the suspension of the 
faculties and operations of the mind in this state of 
the system. In some cases the imagination only is 
deranged in dreams, in others the memory is affec- 
ted, and in others the judgment. But there are 
cases, in which the change that is produced in the 
state of the brain, by means of sleep, affects the 
moral faculty likewise ; hence we sometimes dream 
of doing and saying things when asleep, which we 
shudder at, as soon as we awake. This supposed 
defection from virtue, exists frequently in dreams 
where the memory and judgment are scarcely im- 
paired. It cannot therefore be ascribed to an ab- 
sence of the exercises of those two powers of the 

11. Do we read, in the accounts of travellers, 
of men, who, in respect of intellectual capacity and 
enjoyments, are but a few degrees above brutes? 
We read likewise of a similar degradation of our 


species, in respect to moral capacity and feeling. 
Here it will be necessary to remark, that the low 
degrees of moral perception, that have been disco- 
vered in certain African and Russian tribes of men, 
no more invalidate our proposition of the universal 
and essential existence of a mural faculty in the 
human mind, than the low state of their intellects 
prove, that reason is not natural to man. Their 
perceptions of good and evil are in an exact pro- 
portion to their intellectual faculties. But I will go 
further, and admit with Mr. Locke*, that some 
savage nations are totally devoid of the moral fa- 
culty, yet it will by no means follow, that this 
was the original constitution of their minds. The 
appetite for certain aliments is uniform among all 
mankind. Where is the natron and the individual, 
in their primitive state of health, to whom bread 
is not agreeable ? But if we should find savages, 
or individuals, whose stomachs have been so disor- 
dered by intemperance, as to refuse this simple and 
wholesome article of diet, shall we assert that this 
was the original constitution of their appetites ? By 
no means. As well might we assert, because sa- 
vages destroy their beauty by painting and cutting 
their faces, that the principles of taste do not exist. 

* Essay concerning the Human Understanding, book I*. 
chap. 3. 



naturally in the human mind. It is with virtue as 
with fire. It exists in the mind, as fire does in 
certain bodies, in a latent or quiescent state. As 
collision renders the one sensible, so education 
renders the other visible. It would be as absurd 
to maintain, because olives become agreeable to 
many people from habit, that we have no natural 
appetites for any other kind of food, as to assert 
that any part of the human species exist without a 
moral principle, because in some of them, it has 
wanted causes to excite it into action, or has been 
perverted by example. There are appetites that 
are wholly artificial. There are tastes so entirely 
vitiated, as to perceive beauty in deformity. There 
are torpid and unnatural passions. Why, under 
certain unfavourable circumstances, may there not 
exist also a moral faculty, in a state of sleep, or sub- 
ject to mistakes ? 

The only apology I shall make, for presuming to 
differ from that justly- celebrated oracle*, who first 
unfolded to us a map of the intellectual world, 
shall be, that the eagle eye of genius often darts 
its views beyond the notice of facts, which are ac- 
commodated to the slender organs of perception 
of men, who possess no other talent than that of 

* Mr. Locke. 


It is not surprising, that Mr. Locke has con- 
founded this moral principle with reason, or that 
Lord Shaftsbury has confounded it with taste, 
since all three of these faculties agree in the objects 
of their approbation, notwithstanding they exist 
in the mind independently of each other. The fa- 
vourable influence which the progress of science 
and taste has had upon the morals, can be ascribed 
to nothing else, but to the perfect union that sub- 
sists in nature between the dictates of reason, of 
taste, and of the moral faculty. Why has the spi- 
rit of humanity made such rapid progress for some 
years past in the courts of Europe ? It is because 
kings and their ministers have been taught to rea- 
son upon philosophical subjects. Why have inde- 
cency and profanity been banished from the stage 
in London and Paris? It is because immorality 
is an offence against the highly cultivated taste of 
the French and English nations. 

It must afford great pleasure to the lovers of 
virtue, to behoid the depth and extent of this mo- 
ral principle in the human mind. Happily for the 
human race, the intimations of duty and the road 
to happiness are not left to the slow operations or 
doubtful inductions of reason, nor to the precarious 
decisions of taste. Hence we often find the moral 
faculty in a state of vigour, in persons in whom 


reason and taste exist in a weak, or in an unculti- 
vated state. It is worthy of notice, likewise, that 
while second thoughts are best in matters of judg- 
ment, first thoughts are always to be preferred in 
matters that relate to morality. Second thoughts, 
in these cases, are generally parlies between duty 
and corrupted inclinations. Hence Rousseau has 
justly said, that " a well regulated moral instinct is 
" the surest guide to happiness." 

It must afford equal pleasure to the lovers of 
virtue to behold, that our moral conduct and hap- 
piness are not committed to the determination of a 
single legislative power. The conscience, like a 
wise and faithful legislative council, performs the 
office of a check upon the moral faculty, and thus 
prevents the fatal consequences of immoral actions. 

An objection, I foresee, will arise to the doc- 
trine of the influence of physical causes upon the 
moral faculty, from its being supposed to favour 
the opinion of the materiality of the soul. But I 
do not see that this doctrine obliges us to decide 
upon the question of the nature of the soul, any 
more than the facts which prove the influence of 
physical causes upon the memory, the imagination, 
or the judgment. I shall, however, remark upon 
this subject, that the writers in favour of the im- 


mortality of the soul have done that truth great 
injury, by connecting it necessarily with its imma- 
teriality. The immortality of the soul depends 
upon the will of the Deity, and not upon the sup- 
posed properties of spirit. Matter is in its own 
nature as immortal as spirit. It is resolvable by 
heat and mixture into a variety of forms ; but it 
requires the same Almighty hand to annihilate it, 
that it did to create it. I know of no arguments to 
prove the immortality of the soul, but such as are 
derived from the Christian revelation*. It would 
be as reasonable to assert, that the bason of the 
ocean is immortal, from the greatness of its capa- 
city to hold water ; or that we are to live for ever 
in this world, because we are afraid of dying, as 
to maintain the immortality of the soul, from the 
greatness of its capacity for knowledge and happi- 
ness, or from its dread of annihilation., 

I remarked, in the beginning of this discourse, 
that persons who are deprived of the just exercise 
of memory, imagination, or judgment, were proper 
subjects of medicine ; and that there are many 
cases upon record which prove, that the diseases 
from the derangement of these faculties, have yield- 
ed to the healing art. 

* " Life and immortality are brought to light only through 
" the gospel." 2 Tim. i. 10. 


It is perhaps only because the diseases of the 
moral faculty have not been traced to a connection 
with physical causes, that medical writers have ne- 
glected to give them a place in their systems of no- 
sology, and that so few attempts have been hitherto 
made, to lessen or remove them by physical as well 
as rational and moral remedies. 

I shall not attempt to derive any support to my 
opinions, from the analogy of the influence of phy- 
sical causes upon the temper and conduct of brute 
animals. The facts which I shall produce in favour 
of the action of these causes upon morals in the 
human species, will, I hope, render unnecessary 
the arguments that might be drawn from that quar- 

I am aware, that in venturing upon this subject, 
I step upon untrodden ground. I feel as iEneas 
did, when he was about to enter the gates of Aver- 
nus, but without a sybil to instruct me in the mys- 
teries that are before me. I foresee, that men who 
have been educated in the mechanical habits of 
adopting popular or established opinions will revolt 
at the doctrine I am about to deliver, while men of 
sense and genius will hear my propositions with 
candour, and if they do not adopt them, will com- 


mend that boldness of inquiry, that prompted me 
to broach them. 

I shall begin with an attempt to supply the de- 
fects of nosological writers, by naming the partial 
or weakened action of the moral faculty, microno- 
mi a. The total absence of this faculty, I shall call 
anomia. By the law, referred to in these new 
genera of vesanise, I mean the law of nature writ- 
ten in the human heart, and which I formerly quot- 
ed from the writings of St. Paul. 

In treating of the effects of physical causes upon 
the moral faculty, it might help to extend our ideas 
upon this subject, to reduce virtues and vices to 
certain species, and to point out the effects of par- 
ticular species of virtue and vice ; but this would 
lead us into a field too extensive for the limits of 
the present inquiry. I shall only hint at a few 
cases, and have no doubt but the ingenuity of my 
auditors will supply my silence, by applying the rest. 

It is immaterial, whether the physical causes that 
are to be enumerated, act upon the moral faculty 
through the medium of the senses, the passions, 
the memory, or the imagination. Their influence 
is equally certain, whether they act as remote, pre- 
disposing, or occasional causes. 


1. The effects of climate upon the moraf 
faculty claim our first attention. Not only indivi- 
duals, but nations, derive a considerable part of 
their moral, as well as intellectual character, from 
the different portions they enjoy of the rays of the 
sun. Irascibility, levity, timidity, and indolence, 
tempered with occasional emotions of benevolence, 
are the moral qualities of the inhabitants of warm 
climates, while selfishness, tempered with sincerity 
and integrity, form the moral character of the inha- 
bitants of cold countries. The state of the weather, 
and the seasons of the vear also, have a visible ef- 
feet upon moral sensibility. The month of No- 
vember, in Great Britain, rendered gloomy by con- 
stant fogs and rains, has been thought to favour the 
perpetration of the worst species of murder, while 
the vernal sun, in middle latitudes, has been as ge- 
nerally remarked for producing gentleness and be- 

2. The effects of diet upon the moral faculty 
are more certain, though less attended to, than 
the effects of climate. " Fulness of bread," we 
are told, was one of the predisposing causes of the 
vices of the cities of the plain. The fasts so often 
inculcated among the Jews, w^ere intended to les- 
sen the incentives to vice ; for pride, cruelty, and 
sensuality, are as much the natural consequences 


of luxury, as apoplexies and palsies. But the 
quality as well as the quantity of aliment, has an 
influence upon morals ; hence we find the moral 
diseases that have been mentioned, are most fre- 
quently the offspring of animal food. The pro- 
phet Isaiah seems to have been sensible of this, 
when he ascribes such salutary effects to a tempe- 
rate and vegetable diet. " Butter and honey shall 
" he eat," says he 7 " that he may know to refuse 
" the evil, and to chuse the good." But we have 
many facts which prove the efficacy of a vegetable 
diet upon the passions. Dr. Arbuthnot assures 
us, that he cured several patients of irascible tem- 
pers, by nothing but a prescription of this simple 
and temperate regimen. 

3. The effects of certain drinks upon the 
moral faculty are not less observable, than upon 
the intellectual powers of the mind. Fermented 
liquors, of a good quality, and taken in a mode- 
rate quantity, are favourable to the virtues of can- 
dour, benevolence, and generosity ; but when they 
are taken in excess, or when they are of a bad 
quality, and taken even in a moderate quantity, 
they seldom fail of rousing every latent spark of 
vice into action. The last of these facts is so noto- 
rious, that when a man is observed to be ill-na- 
tured or quarrelsome in Portugal, after drinking, 



it is common in that country to say, that " he has 
" drunken bad wine." While occasional fits of in- 
toxication produce ill-temper in many people, ha- 
bitual drunkenness (which is generally produced 
by distilled spirits) never fails to eradicate veracity 
and integrity from the human mind. Perhaps 
this may be the reason why the Spaniards, in an- 
cient times, never admitted a man's evidence in a 
court of justice, who had been convicted of drunk- 
enness. Water is the universal sedative of tur- 
bulent passions ; it not only promotes a general 
equanimity of temper, but it composes anger. I 
have heard several well-attested cases, of a draught 
of cold water having suddenly composed this vio- 
lent passion, after the usual remedies of reason had 
been applied to no purpose. 

4. Extreme hunger produces the most un- 
friendly effects upon moral sensibility. It is imma- 
terial, whether it act by inducing a relaxation of 
the solids, or an acrimony of the fluids, or by the 
combined operations of both those physical causes. 
The Indians in this country whet their appetites 
for that savage species of war, which is peculiar 
to them, by the stimulus of hunger ; hence, we 
are told, they always return meagre and emaciated 
from their military excursions. In civilized life 
we often behold this sensation to overbalance 


the restraints of moral feeling ; and perhaps this 
may be the reason why poverty, which is the most 
frequent parent of hunger, disposes so generally to 
theft ; for the character of hunger is taken from 
that vice : it belongs to it " to break through stone 
■' walls." So much does this sensation predomi- 
nate over reason and moral feeling, that Cardinal 
de Retz suggests to politicians, never to risk a 
motion in a popular assembly, however wise or 
just it may be, immediately before dinner. That 
temper must be uncommonly guarded, which is not 
disturbed by long abstinence from food. One of 
the worthiest men I ever knew, who made his 
breakfast his principal meal, was peevish and disa- 
greeable to his friends and family, from the time 
he left his bed, till he sat down to his morning re- 
past, after which, cheerfulness sparkled in his 
countenance, and he became the delight of all 
around him. 

5. I hinted formerly, in proving the analogy 
between the effects of diseases upon the intel- 
lects, and upon the moral faculty, that the latter 
was frequently impaired by madness. I beg leave 
to add further upon this head, that not only mad- 
ness, but the hysteria and hypocondriasis, as well 
as all those states of the body, whether idiopathic 
or symptomatic, which are accompanied with pre- 


ternatural irritability, sensibility, torpor, stupor, 
or mobility of the nervous system, dispose to vice, 
either of the body or of the mind. It is in vain 
to attack these vices with lectures upon morality. 
They are only to be cured by medicine, particu- 
larly by exercise, the cold bath, and by a cold or 
warm atmosphere. The young woman, whose 
case I mentioned formerly, that lost her habit of 
veracity by a nervous fever, recovered this virtue, 
as soon as her system recovered its natural tone, 
from the cold weather which happily succeeded 
her fever*. 

* There is a morbid state of excitability in the body during; 
the convalescence from fever, which is intimately connected 
with an undue propensity to venereal pleasures. I have 
met with several instances of it. The marriage of the cele- 
brated Mr. Howard to a woman who was twice as old as 
himself, and very sickly, has been ascribed, by his biogra- 
pher, Dr. Aiken, to gratitude for her great attention to him 
in a fit of sickness. I am disposed to ascribe it to a sudden 
paroxysm of another passion, which, as a religious man, he 
could not gratify in any other, than in a lawful way. I have 
heard of two young clergymen who married the women 
who had nursed them in fits of sickness. In both cases there 
was great inequality in their years, and condition in life. 
Their motive was, probably, the same as that which I have 
attributed to Mr. Howard. Dr. Patrick Russel takes notice 
of an uncommon degree of venereal excitability which fol- 
lowed attacks of the plague at Messina, in 1743, in all ranks 


6. Idleness is the parent of every vice. It is 
mentioned in the Old Testament as another of the 
predisposing causes of the vices of the cities of the 
plain. Labour, of all kinds, favours and facili- 
tates the practice of virtue. The country life is 
happy, chiefly because its laborious employments 
are favourable to virtue, and unfriendly to vice. 
It is a common practice, I have been told, for the 
planters, in the southern states, to consign a house 
slave, who has become vicious from idleness, to 
the drudgery of the field, in order to reform him. 
The bridewells and workhouses of all civilized 
countries prove, that labour is not only a very se- 
vere, but the most benevolent of all punishments, 
inasmuch as it is one of the most suitable means 
of reformation. Mr. Howard tells us, in his His- 
tory of Prisons, that in Holland it is a common 
saying, " Make men work, and you will make 
" them honest." And over the rasp and spin- 
house at Groeningen, this sentiment is expressed 
(he tells us) by a happy motto : 

" Vitiorum semina — otium — labore exhauriendum." 

The effects of steady labour in early life, in creating; 

of people. Marriages, he says, were more frequent after 
it than usual, and virgins were, in some instances, violated, 
who died of that disease, by persons who had just recovered 
from it. 


virtuous habits, is still more remarkable. The late 
Anthony Benezet, of this city, whose benevolence 
was the centinel of the virtue, as well as of the 
happiness of his country, made it a constant rule, 
in binding out poor children, to avoid putting them 
into wealthy families, but always preferred mas- 
ters for them who worked themselves, and who 
obliged these children to work in their presence. 
If the habits of virtue, contracted by means of 
this apprenticeship to labour, are purely mechani- 
cal, their effects are, nevertheless, the same upon 
the happiness of society, as if they flowed from 
principle. The mind, moreover, when preserved 
by these means from weeds, becomes a more mel- 
low soil afterwards, for moral and rational im- 

7. The effects of excessive sleep are inti- 
mately connected with the effects of idleness upon 
the moral faculty : hence we find that moderate, 
and even scanty portions of sleep, in every part of 
the world, have been found to be friendly, not 
only to health and long life, but in many instances 
to morality. The practice of the monks, who of- 
ten sleep upon a floor, and who generally rise with 
the sun, for the sake of mortifying their sensual 
appetites, is certainly founded in wisdom, and has 
often produced the most salutary moral effects. 


8. The effects of bodily pain upon the moral, 
are not less remarkable than upon the intellectual 
powers of the mind. The late Dr. Gregory, of 
the university of Edinburgh, used to tell his pupils, 
that he always found his perceptions quicker in a 
fit of the gout, than at any other time. The pangs 
which attend the dissolution of the body, are often 
accompanied with conceptions and expressions up- 
on the most ordinary subjects, that discover an 
uncommon elevation of the intellectual powers. 
The effects of bodily pain are exactly the same in 
rousing and directing the moral faculty. Bodily 
pain, we find, was one of the remedies employed 
in the Old Testament, for extirpating vice, and 
promoting virtue : and Mr. Howard tells us, that 
he saw it employed successfully as a means of re- 
formation, in one of the prisons which he visited. 
If pain has a physical tendency to cure vice, I sub- 
mit it to the consideration of parents and legislators, 
whether moderate degrees of corporal punishments, 
inflicted for a great length of time, would not be 
more medicinal in their effects, than the violent 
degrees of them, which are of short duration. 

9. Too much cannot be said in favour of 
cleanliness, asa physical means of promoting 
virtue. The writings of Moses have been called 
by military men, the best " orderly book" in the 


world. In every part of them we find cleanliness 
inculcated with as much zeal, as if it was part of 
the moral, instead of the Levitical law. Now, it is 
well known, that the principal design of every pre- 
cept and rite of the ceremonial parts of the Jew- 
ish religion, was to prevent vice, and to promote 
virtue. All writers upon the leprosy, take notice 
of its connection with a certain vice. To this dis- 
ease gross animal food, particularly swine's flesh, 
and a dirty skin, have been thought to be predis- 
posing causes : hence the reason, probably, why 
pork was forbidden, and why ablutions of the 
body and limbs were so frequently inculcated by 
the Jewish law. Sir John Pringle's remarks, in 
his Oration upon Captain Cook's voyage, deli- 
vered before the Royal Society, in London, are 
very pertinent to this part of our subject. " Clean- 
M liness (says he) is conducive to health, but it is 
44 not so obvious, that it also tends to good order and 
44 other virtues. Such (meaning the ship's crew) 
44 as were made more cleanly, became more sober, 
44 more orderly, and more attentive to duty." 
The benefit to be derived by parents and school- 
masters from attending to these facts, is too obvi- 
ous to be mentioned. 

10. I hope I shall be excused in placing soli- 
tude among the physical causes which influence 


the moral faculty, when I add, that I confine its 
effects to persons who are irreclaimable by rational 
or moral remedies. Mr. Howard informs us, that 
the chaplain of the prison at Leige, in Germany, 
assured him, " that the most refractory and turbu- 
" lent spirits became tractable and submissive, by 
" being closely confined for four or five days." 
In bodies that are predisposed to vice, the stimulus 
of cheerful, but much more of profane society and 
conversation, upon the animal spirits, becomes an 
exciting cause, and, like the stroke of the flint upon 
the steel, renders the sparks of vice both active and 
visible. By removing men out of the reach of this 
exciting cause, they are often reformed, especially 
if they are confined long enough to produce a suf- 
ficient chasm in their habits of vice. Where the 
benefit of reflection and instruction from books can 
be added to solitude and confinement, their good 
effects are still more certain. To this philosophers 
and poets in every age have assented, by describing 
the life of a hermit as a life of passive virtue. 

11. Connected with solitude, as a mechanical 
means of promoting virtue, silence deserves to 
be mentioned in this place. The late Dr. Fother- 
gill, in his plan of education for that benevolent 
institution at Ackworth, which was the last care 
of his useful life, says every thing that can be said 



in favour of this necessary discipline, in the follow- 
ing words : " To habituate children from their 
early infancy, to silence and attention, is of the 
greatest advantage to them, not only as a prepa- 
rative to their advancement in religious life, but 
as the groundwork of a well cultivated under- 
standing. To have the active minds of children 
put under a kind of restraint ; to be accustomed 
to turn their attention from external objects 5 
and habituated to a degree of abstracted quiet, 
is a matter of great consequence, and lasting be- 
nefit to them. Although it cannot be supposed, 
that young and active minds are always engaged 
in silence as they ought to be, yet to be accus.- 
tomed thus to quietness, is no small point gained 
towards fixing a habit of patience, and recollec- 
tion, which seldom forsakes those who have 
been properly instructed in this entrance of the 
school of wisdom, during the residue of their 

For the purpose of acquiring this branch of edu- 
cation, children cannot associate too early, nor too 
often with their parents, or with their superiors in 
age, rank, and wisdom. 

12. The effects of music upon the moral faculty, 
have been felt and recorded in every country. 


Hence we are able to discover the virtues and vir 
ces of different nations, by their tunes, as certainly 
as by their laws. The effects of music, when sim- 
})ly mechanical, upon the passions, are powerful 
and extensive. But it remains yet to determine 
the degrees of moral ecstacy, that may be produc- 
ed by an attack upon the ear, the reason, and the 
moral principle, at the same time, by the combined 
powers of music and eloquence. 

13. The eloquence of the pulpit is nearly 
allied to music in its effects upon the moral faculty. 
It is true, there can be no permanent change in the 
temper, and moral conduct of a man, that is not 
derived from the understanding and the will ; but 
we must remember, that these two powers of the 
mind are most assailable, when they are attacked 
through the avenue of the passions ; and these, we 
know, when agitated by the powers of eloquence, 
exert a mechanical action upon every power of the 
soul. Hence we find in every age and country, 
where Christianity has been propagated, the most 
accomplished orators have generally been the most 
successful reformers of mankjnd. There must be 
a defect of eloquence in a preacher, who, with the 
resources for oratory, which are contained in the 
Old and New Testaments, does not produce in 
every man who hears him, at least a temporary 


love of virtue. I grant that the eloquence of the 
pulpit alone cannot change men into christians, but 
it certainly possesses the power of changing brutes 
into men. Could the eloquence of the stage be 
properly directed, it is impossible to conceive the 
extent of its mechanical effects upon morals. The 
language and imagery of a Shakespeare, upon mo- 
ral and religious subjects, poured upon the passions 
and the senses, in alf the beauty and variety of dra- 
matic representation ; who could resist, or des^ 
cribe their effects ? 

14. Odours of various kinds have been observ- 
ed to act in the most sensible manner upon the mo- 
ral faculty. Brydone tells us, upon the authority 
of a celebrated philosopher in Italy, that the pecu- 
liar wickedness of the people who live in the neigh- 
bourhood of ./Etna and Vesuvius, is occasioned 
chiefly by the smell of the sulphur and of the hot 
exhalations which are constantly discharged from 
those volcanos. Agreeable odours seldom fail to 
inspire serenity, and to compose the angry spirits. 
Hence the pleasure, and one of the advantages of 
a flower garden. The smoke of tobacco is likewise 
of a composing nature, and tends not only to pro- 
duce what is called a train in perception, but to 
hush the agitated passions into silence and order. 


Hence the practice of connecting the pipe or segar, 
and the bottle together, in public company. 

15. It will be sufficient only to mention light 
and darkness, to suggest facts in favour of the 
influence of each of them upon moral sensibility. 
How often do the peevish complaints of the night 
in sickness, give way to the composing rays of 
the lie:ht of the morning: ? Othello cannot murder 
Desdemona by candle-light, and who has not felt 
the effects of a blazing fire upon the gentle pas- 
sions ? 

16. It is to be lamented, that no experiments 
have as yet been made, to determine the effects 
of all the different species of airs, which chemistry 
has lately discovered, upon the moral faculty. I 
have authority from actual experiments, only to 
declare, that dephlogisticated air, when taken in- 
to the lungs, produces cheerfulness, gentleness, and 
serenity of mind. 

17. What shall we say of the effects of medi- 
cines upon the moral faculty ? That many sub- 
stances in the materia medica act upon the in- 
tellects, is well known to physicians. Why should 
it be thought impossible for medicines to act in 
like manner upon the moral faculty ? May not the 


earth contain, in its bowels, or upon its surface, an- 
tidotes ? But I will not blend facts with conjec- 
tures. Clouds and darkness still hang upon this 
part of my subject. 

Let it not be suspected, from any thing that I 
have delivered, that I suppose the influence of phy- 
sical causes upon the moral faculty, renders the 
agency of divine influence unnecessary to our mo- 
ral happiness. I only maintain, that the opera- 
tions of the divine government are carried on in 
the moral, as in the natural world, by the instru- 
mentality of second causes. I have only trodden 
in the footsteps of the inspired writers ; for most 
of the physical causes I have enumerated, are con- 
nected with moral precepts, or have been used as 
the means of reformation from vice, in the Old 
and New Testaments. To the cases that have 
been mentioned, I shall only add, that Nebuchad- 
nezzar was cured of his pride, by means of soli- 
tude and a vegetable diet. Saul was cured of his 
evil spirit, by means of David's harp, and St. Paul 
expressly says, " I keep my body under, and bring 
" it into subjection, lest that by any means, when 
" I have preached to others, I myself should be a 
" cast-away." But I will go one step further, and 
add in favour of divine influence upon the moral 
principle, that in those extraordinary cases, where 


bad men are suddenly reformed, without the in- 
strumentality of physical, moral, or rational causes, 
I believe that the organization of those parts of the 
body, in which the faculties of the mind are seated, 
undergoes a physical change* ; and hence the ex- 
pression of a " new creature," which is made use 
of in the Scriptures to denote this change, is pro- 
per in a literal, as well as a figurative sense. It is 
probably the beginning of that perfect renovation 
of the human body, which is predicted by St. Paul 
in the following words : " For our conversation 
" is in heaven, from whence we look for the Savi- 
" our, who shall change our vile bodies, that they 
" may be fashioned according to his own glorious 
" body." I shall not pause to defend myself 
against the charge of enthusiasm in this place ; for 
the age is at length arrived, so devoutly wished for 
by Dr. Cheyne, in which men will not be deterred 
in their researches after truth, by the terror of odi- 
ous or unpopular names. 

* St. Paul was suddenly transformed from a persecutor in- 
to a man of a gentle and amiable spirit. The manner in 
which this change was effected upon his mind, he tells us 
in the following words: " Neither circumcision availeth 
; ' any thing, nor uncircumcision, but a new creature. From 
** henceforth let no man trouble me ; for I bear in my body y 
A the marks of our Lord Jesus." Galatians, vi. 15, 17. 


I cannot help remarking under this head, that if 
the conditions of those parts of the human body 
which are connected with the human soul, influence 
morals, the same reason may be given for a virtu- 
ous education, that has been admitted for teaching 
music and the pronunciation of foreign languages, 
in the early and yielding state of those organs which 
form the voice and speech. Such is the effect of 
a moral education, that we often see its fruits in 
advanced stages of life, after the religious princi- 
ples which were connected with it, have been re- 
nounced ; just as we perceive the same care in a 
surgeon in his attendance upon patients, after the 
sympathy which first produced this care, has ceas- 
ed to operate upon his mind. The boasted mora- 
lity of the deists, is, I believe, in most cases, the 
offspring of habits, produced originally by the prin- 
ciples and precepts of Christianity. Hence appears 
the wisdom of Solomon's advice, " Train up a 
" child in the way he should go, and when he is 
" old he will not," I had almost said, he cannot 
" depart from it." 

Thus have I enumerated the principal causes 
which act mechanically upon morals. If from the 
combined action of physical powers that are oppo- 
sed to each other, the moral faculty should become 
stationary, or if the virtue or vice produced by 


them, should form a neutral quality, composed of 
both of them, I hope it will not call in question the 
truth of our general propositions. I have only- 
mentioned the effects of physical causes in a simple 

It might help to enlarge our ideas upon this 
subject, to take notice of the influence of the dif- 
ferent stages of society, of agriculture and com- 
merce, of soil and situation, of the different degrees 
of cultivation of taste, and of the intellectual pow- 
ers, of the different forms of government, and last- 
ly, of the different professions and occupations of 
mankind, upon the moral faculty ; but as these act 
indirectly only, and by the intervention of causes 
that are unconnected with matter, I conceive they 
are foreign to the business of the present inquiry. 
If they should vary the action of the simple physi- 
cal causes in any degree, I hope it will not call in 
question the truth of our general propositions, any 
more than the compound action of physical powers, 
that are opposed to each other. There remain but 
a few more causes which are of a compound na- 

* The doctrine of the influence of physical causes on mo- 
rals is happily calculated to beget charity towards the fail- 
ings of our fellow-creatures. Our duty to practise this vir- 
tue is enforced by motives drawn from science, as well as 
From the precepts of Christianity. 

VOL, IT. 3 


ture, but they are so nearly related to those which 
are purely mechanical, that I shall beg leave to 
trespass upon your patience, by giving them a 
place in my oration. 

The effects of imitation, habit, and association 
upon morals, would furnish ample matter for in- 
vestigation. Considering how much the shape, 
texture, and conditions of the human body, influ- 
ence morals, I submit it to the consideration of the 
ingenious, whether, in our endeavours to imitate 
moral examples, some advantage may not be de- 
rived, from our copying the features and external 
manners of the originals. What makes the suc- 
cess of this experiment probable is, that we gene- 
rally find men, whose faces resemble each other, 
have the same manners and dispositions. I infer 
the possibility of success in an attempt to imitate 
originals in a manner that has been mentioned, 
from the facility with which domestics acquire a 
resemblance to their masters and mistresses, not 
only in manners, but in countenance, in those cases 
where they are tied to them by respect and affec- 
tion. Husbands and wives also, where they pos- 
sess the same species of face, under circumstances 
of mutual attachment, often acquire a resemblance 
to each other. 


From the general detestation in which hypocrisy- 
is held, both by good and bad men, the mechani- 
cal effects of habit upon virtue have not been suf- 
ficiently explored. There are, I am persuaded, 
many instances where virtues have been assumed 
by accident, or necessity, which have become real 
from habit, and afterwards derived their nourish- 
1 lent from the heart. Hence the propriety of 
HanJet's advice to his mother : 

" Assume a virtue, if you have it not. 

66 That monster, Custom, who all sense doth eat 

" Of habits evil, is angel yet in this, 

" That to the use of actions fair and good 

" He likewise gives a frock or livery, 

" That aptly is put on. Refrain to-night, 

" And that shall lend a kind of easiness 

" To the next abstinence ; the next more easy : 

" For use can almost change the stamp of nature, 

" And master even the devil, or throw him out, 

" With wondrous potency." 

The influence of association upon morals, 
opens an ample field for inquiry. It is from this 
principle, that we explain the reformation from 
theft and drunkenness in servants, which we some- 
times see produced by a draught of spirits, in which 
tartar emetic had been secretly dissolved. The 
recollection of the pain and sickness excited by 
the emetic, naturally associates itself with die spi- 


rits, so as to render them both equally the objects 
of aversion. It is by calling in this principle only, 
that we can account for the conduct of Moses, 
in grinding the golden calf into a powder, and 
afterwards dissolving it (probably by means of 
hepar sulphuris) in water, and compelling the 
children of Israel to drink of it, as a punishment 
for their idolatry. This mixture is bitter and nau- 
seating in the highest degree. An inclination to 
idolatry, therefore, could not be felt without be- 
ing associated with the remembrance of this disa- 
greeable mixture, and of course being rejected, 
with equal abhorrence. The benefit of corporal 
punishments, when they are of a short duration, 
depends in part upon their being connected, by 
time and place, with the crimes for which they 
are inflicted. Quick as the thunder follows the 
lightning, if it were possible, should punishments 
follow the crimes, and the advantage of association 
would be more certain, if the spot where they 
were committed, were made the theatre of their 
expiation. It is from the effects of this association, 
probably, that the change of place and company, 
produced by exile and transportation, has so often 
reclaimed bad men, after moral, rational, and 
physical means of reformation had been used to no 


As sensibility is the avenue to the moral fa- 
culty, every thing which tends to diminish it tends 
also to injure morals. The Romans owed much 
of their corruption to the sights of the contests of 
their gladiators, and of criminals, with wild beasts. 
For these reasons, executions should never be pub- 
lic. Indeed, I believe there are no public punish- 
ments of any kind, that do not harden the hearts 
of spectators, and thereby lessen the natural horror 
which all crimes at first excite in the human mind. 

Cruelty to brute animals is another means of 
destroying moral sensibility. The ferocity of sa- 
vages has been ascribed in part to their peculiar 
mode of subsistence. Mr. Hogarth points out, in 
his ingenious prints, the connection between cru- 
elty to brute animals in youth, and murder in man- 
hood. The emperor Domitian prepared his mind, 
by the amusement of killing flies, for all those 
bloody crimes which afterwards disgraced his 
reign. I am so perfectly satisfied of the truth of 
a connection between morals and humanity to 
brutes, that I shall find it difficult to restrain my 
idolatry for that legislature, that shall first establish 
a system of laws, to defend them from outrage and 


In order to preserve the vigour of the moral 
faculty, it is of the utmost consequence to keep 
young people as ignorant as possible of those crimes 
that are generally thought most disgraceful to hu- 
man nature. Suicide, I believe, is often propa- 
gated by means of newspapers. For this reason, 
I should be glad to see the proceedings of our 
courts kept from the public eye, when they expose, 
or punish monstrous vices. 

The last mechanical method of promoting mo- 
rality that I shall mention, is to keep sensibility 
alive, by a familiarity with scenes of distress from 
poverty and disease. Compassion never awakens 
in the human bosom, without being accompanied 
by a train of sister virtues. Hence the wise man 
justly remarks, that " By the sadness of the coun- 
" tenance, the heart is made better." 

A late French writer, in his prediction of events 
that are to happen in the year 4000, says, " That 
" mankind in that aera shall be so far improved by 
" religion and government, that the sick and the 
" dying shall no longer be thrown, together with 
" the dead, into splendid houses, but shall be re- 
M lieved and protected in a connection with their 
' ' families and society. ' ' For the honour of huma- 


nity, an institution*, destined for that distant pe- 
riod, has lately been founded in this city, that shall 
perpetuate the year 1786 in the history of Penn- 
sylvania. Here the feeling heart, the tearful eye, 
and the charitable hand, may always be connected 
together, and the flame of sympathy, instead of 
being extinguished in taxes, or expiring in a soli- 
tary blaze by a single contribution, may be kept 
alive, by constant exercise. There is a necessary 
connection between animal sympathy, and good 
morals. The priest and the Levite, in the New 
Testament, would probably have relieved the poor 
man who fell among thieves, had accident brought 
them near enough to his wounds. The unfortunate 
Mrs. Bellamy was rescued from the dreadful pur- 
pose of drowning herself, by nothing but the dis- 
tress of a child, rending the air with its cries for 
bread. It is probably owing, in some measure, to 
the connection between good morals and sympathy 
that the fair sex, in every age and country, have 
been more distinguished for virtue, than men; 
for how seldom do we hear of a woman, devoid of 
humanity ? 

Lastly, attraction, composition, and DE- 
COMPOSITION, belong to the passions as well as 

* A public dispensary. 


to matter. Vices of the same species attract each 
other with the most force : hence the bad conse- 
quences of crowding young men, whose propensi- 
ties are generally the same, under one roof, in our 
modern plans of education. The effects of com* 
position and decomposition upon vices, appear in 
the meanness of the school-boy being often cured 
by the prodigality of a military life, and by the pre- 
cipitation of avarice, which is often produced by 
ambition and love. 

If physical causes influence morals in the man- 
ner we have described, may they not also influence 
religious principles and opinions? I answer in 
the affirmative ; and I have authority, from the 
records of physic, as well as from my own obser- 
vations, to declare, that religious melancholy and 
madness, in all their variety of species, yield with 
more facility to medicine, than simply to polemical 
discourses, or to casuistical advice. But this sub- 
ject is foreign to the business of the present in- 

From a review of our subject, we are led to 
contemplate with admiration, the curious structure 
of the human mind. How distinct are the num- 
ber, and yet how united ! How subordinate, and 
yet how co-equal are all its faculties ! How won- 



derful is the action of the mind upon the body ! 
of the body upon the mind ! and of the Divine 
Spirit upon botji ! What a mystery is the mind 

of man to itself! O ! Nature ! or, to speak 

more properly, O! thou God of Nature ! in 
vain do we attempt to scan thy immensity, or to 
comprehend thy various modes of existence, when 
a single particle of light, issued from thyself, 
and kindled into intelligence in the bosom of man, 
thus dazzles and confounds our understandings ! 

The extent of the moral powers and habits in 
man is unknown. It is not improbable, but the 
human mind contains principles of virtue, which 
have never yet been excited into action. We be- 
hold with surprise the Versatility of the human 
body in the exploits of tumblers and rope-dancers. 
Even the agility of a wild beast has been demon- 
strated in a girl of France, and aft amphibious na- 
ture has been discovered in the human species, in 
a young man in Spain. We listen with astonish- 
ment to the accounts of the memories of Mithri- 
dates, Cyrus, and Servin. We feel a veneration 
bordering upon divine homage, in contemplating 
the stupenduous understandings of lord Verulam 
and sir Isaac Newton ; and our eyes grow dim, 
in attempting to pursue Shakespeare and Milton in 
their immeasurable flights of imagination. And if 

VOL. II. c 


the history of mankind does not furnish similar in* 
stances of the versatility and perfection of our spe- 
cies in virtue, it is because the moral faculty has 
been the subject of less culture and fewer experi- 
ments than the body, and the intellectual faculties 
of the mind. From what has been said, the rea- 
son of this is obvious. Hitherto the cultivation 
Of the moral faculty has been the business of pa- 
rents, schoolmasters, and divines*. But if the 
principles, we have laid down, be just, the im- 
provement and extension of this principle should 
be equally the business of the legislator, the na- 
tural philosopher, and the physician ; and a phy- 
sical regimen should as necessarily accompany a 
moral precept, as directions with respect to the 
air, exercise, and diet, generally accompany pre- 
scriptions for the consumption, and the gout. To 
encourage us to undertake experiments for the 

* The people commonly called Quakers and the Metho- 
dists, make use of the greatest number of physical remedies 
in their religious and moral discipline, of any sects of Chris- 
tians; and hence we find them every where distinguished 
for their good morals. There are several excellent physical 
institutions in other churches ; and if they do not produce 
the same moral effects that we observe from physical insti- 
tutions among those two modern sects, it must be ascribed 
to their being more neglected by the members of those 


improvement of morals, let us recollect the suc- 
cess of philosophy in lessening the number, and 
mitigating the violence of incurable diseases. The 
intermitting fever, which proved fatal to two of 
the monarchs of Britain, is now under absolute 
subjection to medicine. Continual fevers are 
much less fatal than formerly. The small-pox is 
disarmed of its mortality by inoculation, and even 
the tetanus and the cancer have lately received a 
check in their ravages upon mankind. But medi- 
cine has done more. It has penetrated the deep 
and gloomy abyss of death, and acquired fresh ho- 
nours in his cold embraces. Witness the many 
hundred people who have lately been brought back 
to life by the successful efforts of the humane so- 
cieties, which are now established in many parts of 
Europe, and in some parts of America. Should 
the same industry and ingenuity, which have pro- 
duced these triumphs of medicine over diseases 
and death, be applied to. the moral science, it is 
highly probable, that most of those baneful vices, 
which deform the human breast, and convulse the 
nations of the earth, might be banished from the 
world. I am not so sanguine as to suppose, that 
it is possible for man to acquire so much perfection 
from science, religion, liberty, and good govern- 
ment, as to cease to be mortal ; but I am fully 
persuaded, that from the combined action of causes., 


which operate at once upon the reason, the moral 
faculty, the passions, the senses, the brain, the 
nerves, the blood, and the heart, it is possible to 
produce such a change in his moral character, as 
shall raise him to a resemblance of angels ; nay, 
more, to the likeness of God himself. The state 
of Pennsylvania still deplores the loss of a man, in 
whom not only reason and revelation, but many of 
the physical causes that have been enumerated, 
concurred to produce such attainments in moral 
excellency, as have seldom appeared in a human 
being. This amiable citizen considered his fellow- 
creature, man, as God's extract, from his own 
works ; and whether this image of himself was cut 
out from ebony or copper ; whether he spoke his 
own, or a foreign language ; or whether he wor- 
shipped his Maker with ceremonies, or without 
them, he still considered him as a brother, and 
equally the object of his benevolence. Poets and 
historians* who are to live hereafter, to you I com- 
mit his panegyric ; and when you hear of a law for 
abolishing slavery in each of the American states, 
such as was passed in Pennsylvania, in the year 
1780 ; when you hear of the kings and queens of 
Europe, publishing edicts for abolishing the trade 
in human souls ; and, lastly, when you hear of 
schools and churches, with all the arts of civilized 
life, being established among the nations of Africa, 


then remember and record, that this revolution in 
favour of human happiness, was the effect of the 
labours, the publications, the private letters, and 
the prayers of Anthony Benezet*. 

I return from this digression, to address my- 
self in a particular manner to you, venerable 

* This worthy man was descended from an ancient and 
honourable family that flourished in the court of Louis 
XIV. With liberal prospects in life he early devoted him- 
self to teaching an English school ; in which, for industry, 
capacity, and attention to the morals and principles of the 
youth committed to his care, he was without an equal. He 
published many excellent tracts against the African trade, 
against waf , and the use of spiritous liquors, and one in fa- 
vour of civilizing and Christianizing the Indians. He wrote 
to the queen of Great Britain, and the queen of Portugal, 
to use their influence in their respective courts to abolish 
the African trade. He also wrote an affectionate letter to 
the king of Prussia, to dissuade him from making war. 
The history of his life affords a remarkable instance how 
much it is possible for an individual to accomplish in the 
world ; and that the most humble stations do not preclude 
good men from the most extensive usefulness. He be- 
queathed his estate (after the death of his widow) to the 
support of a school for the education of negro children, which 
' he had founded and taught for several years before he died. 
He departed this life in May, 1784, in the 71st year of his 
age, in the meridian of his usefulness, universally lamented 
by persons of all ranks and denominations. 


sages and fellow citizens in the republic 
of letters. The influence of philosophy, we 
have been told, has already been felt in courts. 
To increase, and complete this influence, there is 
nothing more necessary, than for the numerous 
literary societies in Europe and America, to add 
the science of morals to their experiments and 
inquiries. The godlike scheme of Henry IV, of 
France, and of the illustrious queen Elizabeth, of 
England, for establishing a perpetual peace in Eu- 
rope, may be accomplished without a system of 
jurisprudence, by a confederation of learned men, 
and learned societies. It is in their power, by mul- 
tiplying the objects of human reason, to bring the 
monarchs and rulers of the world under their sub- 
jection, and thereby to extirpate war, slavery, and 
capital punishments, from the list of human evils. 
Let it not be suspected that I detract, by this de- 
claration, from the honour of the Christian religion. 
It is true, Christianity was propagated without the 
aid of human learning ; but this was one of those 
miracles, which was necessary to establish it, and 
which, by repetition, would cease to be a miracle. 
They misrepresent the Christian religion, who sup- 
pose it to be wholly an internal revelation, and ad- 
dressed only to the moral faculties of the mind. 
The truths of Christianity afford the greatest scope 
for the human understanding, and they will become 


intelligible to us, only in proportion as the human 
genius is stretched, by means of philosophy, to its 
utmost dimensions. Errors may be opposed to 
errors ; but truths, upon all subjects, mutually 
support each other. And perhaps one reason why 
some parts of the Christian revelation are still in- 
volved in obscurity, may be occasioned by our 
imperfect knowledge of the phenomena and laws of 
nature. The truths of philosophy and Christianity 
dwell alike in the mind of the Deity, and reason 
and religion are equally the offspring of his good- 
ness. They must, therefore, stand and fall toge- 
ther. By reason, in the present instance, I mean 
the power of judging of truth, as wellasthe power 
of comprehending it. Happy aera ! when the di- 
vine and the philosopher shall embrace each other, 
and unite their labours for the reformation and hap- 
piness of mankind ! 

Illustrious counsellors and senators 
of Pennsylvania* ! I anticipate your candid recep- 
tion of this feeble effort to increase the quantity of 
virtue in our republic. It is not my business to 

* The president, and supreme executive council, and the 
members of the general assembly of Pennsylvania, attended 
the delivery of the oration, in the hall of the university, by 
invitation from the Philosophical Society. 


remind you of the immense resources for great- 
ness, which nature and Providence have bestowed 
upon our state. Every advantage which France 
has derived from being placed in the centre of 
Europe, and which Britain has derived from her 
mixture of nations,* Pennsylvania has opened to her. 
But my business, at present, is to suggest the 
means of promoting the happiness, not the great- 
ness, of the state. For this purpose, it is abso- 
lutely necessary that our government, which unites 
into one, all the minds of the state, should possess, 
in an eminent degree, not only the understanding, 
the passions, and the will, but, above all, the moral 
faculty and the conscience of an individual. No- 
thing can be politically' right, that is morally 
wrong ; and no necessity can ever sanctify a law, 
that is contrary to equity. Virtue is the soul of 
a republic. To promote this, laws for the sup- 
pression of vice and immorality will be as ineffec- 
tual, as the increase and enlargement of jails. 
There is but one method of preventing crimes,, 
and of rendering a republican form of government 
durable, and that is, by disseminating the seeds of 
virtue and knowledge through every part of the 
state, by means of proper modes and places of edu- 
cation, and this can be done effectually only by the 
interference and aid of the legislature. I am so 
deeply impressed with the truth of this opinion,. 


that were this evening to be the last of my life, I 
would not only say to the asylum of my ancestors, 
and my beloved native country, with the patriot of 
Venice, " Esto perpetua," but I would add, as 
the last proof of my affection for her, my parting 
advice to the guardians of her liberties, u To esta* 
" blish and support public schools, in every 
" part of the state." 









IN an essay, entitled " Thoughts on the 
# Pulmonary Consumption*," I attempted to show 
that this disease was the effect of causes which 
induced general debility, and that the only hope of 
discovering a cure for it should be directed to such 
remedies as act upon the whole system. In the 
following inquiry, I shall endeavour to establish 
the truth of each of those opinions, by a detail of 
facts and reasonings, at which I only hinted in my 
former essay. 

The method I have chosen for this purpose, is 
to deliver, and afterwards to support, a few general 

* Vol. I. p. 199. 


I shall begin by remarking, 


I. That the pulmonary consumption is induced 
by predisposing debility. 

This I infer, 1st, From the remote and exciting 
causes which produce it. The remote causes are 
pneumony, catarrh, haemoptysis, rheumatism, gout, 
asthma, scrophula, chronic diseases of the sto- 
mach, liver, and kidneys, nervous and intermitting 
fevers, measles, repelled humours from the surface 
of the body, the venereal disease, obstructed men- 
ses, sudden growth about the age of puberty, grief, 
and all other debilitating passions of the mind; 
hypochondriasis, improper lactation, excessive eva- 
cuation of all kinds, more especially by stool*, 
cold and damp air, a cough, external violence act- 
ing upon the body f ; and finally, every thing that 

* Sir George Baker relates, in the second volume of the 
Medical Transactions, that Dr. Blanchard had informed 
him, that he had seen the consumption brought on ten per- 
sons out of ninety, by excessive purging used to prepare the 
body for the small-pox. I have seen a case of consumption 
in a youth of 17, from the spitting produced by the intem- 
perate use of segars. 

f Dr. Lind says, that out of 360 patients whom he at- 
tended between July 1st, 1758, and July 1st, 1760, in con- 
sumptions, the disease was brought on one fourth of them 


Lends, directly or indirectly, to diminish the strength 
of the system. 

The most frequent exciting cause of consump- 
tion is the alternate application of heat and cold to 
the whole external surface of the body ; but all the 
remote causes which have been enumerated, ope- 
rate as exciting causes of consumption, when they 
act on previous debility. Original injuries of the 
lungs seldom excite this disease, except they first 
induce a debility of the whole system, by a trou- 
blesome and obstinate cough. 

2. From the debilitating occupations and habits 
of persons who are most liable to this disease. 
These are studious men, and mechanics who lead 
sedentary lives in confined places ; also women, 
and all persons of irritable habits, whether of body 
or mind. 

3. From the period in which persons are most 
liable to be affected by this disease. This is ge- 
nerally between the 18th and 36th year of life, a 
period in which the system is liable, in a peculiar 
manner, to most diseases which induce it, and in 

by falls, bruises, and strains, received a year or two before 
the disease made its appearance. 


which there is a greater expenditure of strength, 
than in any other stage of life, by the excessive 
exercises of the body and mind, in the pursuits of 
business or pleasure. 

I have conformed to authors, in fixing the period 
of consumptions between the 18th and 36th year 
of life ; but it is well known that it sometimes ap- 
pears in children, and frequently in persons beyond 
the 40th, or even 60th year of life. 

II. The pulmonary consumption is a primary 
disease of the whole system. This I infer, 

1. From the causes which produce it, acting 
upon the whole system. 

2. From the symptoms of general debility which 
always precede the affection of the lungs. These 
symptoms are a quick pulse, especially towards 
evening ; a heat and burning in the palms of the 
hands ; faintness, head-ach, sickness at stomach, 
*md an occasional diarrhoea. I have frequently ob- 
served each of these symptoms for several months 
before I have heard of a single complaint in the 


3. From the pulmonary consumption alternating 
with other diseases which obviously belong to the 
whole system. I shall briefly mention these dis- 

The rheumatism. I have seen many cases 
in which this disease and the consumption have 
alternately, in different seasons or years, affected 
the system. In the winter of 1792, three clinical 
patients in the Pennsylvania hospital exemplified 
by their complaints the truth of this observation. 
They were relieved several times of a cough by 
rheumatic pains in their limbs, which seemed for a 
while to promise a cure to their pulmonic com- 

The gout has often been observed to alternate 
with the pulmonary consumption, especially in per- 
sons in the decline of life. Dr. Sydenham describes 
a short cough continuing through the whole win- 
ter, as a symptom of gouty habits. A gentleman 
from Virginia died under my care in the spring of 
1788, in the 45th year of his age, with all the 
symptoms of pulmonary consumption, which had 
frequently alternated with pains and a swelling in 
his feet. 


vol. ii. r 


The pulmonary consumption has been observed 
to alternate with madness. Of this I have seen 
two instances, in both of which the cough and 
expectoration were wholly suspended during the 
continuance of the derangement of the mind. Dr. 
Mead mentions a melancholy case of the same kind 
in a young lady, and similar cases are to be met 
with in other authors. In all of them the disease 
proved fatal. In one of the cases which came un- 
der my notice, the symptoms of consumption re- 
turned before the death of the patient. 

I have likewise witnessed two cases in which the 
return of reason after madness, was suddenly suc- 
ceeded by a fatal pulmonary consumption. Per- 
haps the false hopes, and even the cheerfulness 
which so universally occur in this disease, may be 
resolved into a morbid state of the mind, produced 
by a general derangement of the whole system. So 
universal are the delusion and hopes of patients, 
with respect to the nature and issue of this disease, 
that I have never met with but one man, who, up- 
on being asked what was the matter with him, an- 
swered unequivocally, " that he was in a consump- 
" tion." 

Ao;ain : Dr. Bennet mentions a case of "A 
" phthisical patient, who was seized with a violent 


H pain in the teeth for two days, and in 
" whom, during that time, every symptom of a 
" consumption, except the leanness of the body, 
" altogether vanished :" and he adds further, " that 
" a defluction on the lungs had often been relieved 


I have seen several instances in which the pul- 
monary symptoms have alternated with headach 
and dyspepsia ; also with pain and noise in one 
ear. This affection of the ears sometimes con- 
tinues throughout the whole disease, without any 
remission of the pulmonary symptoms. I have 
seen one case of a discharge of matter from the 
left ear, without being accompanied by either pain 
or noise. 

In all our books of medicine are to be found 
cases of consumption alternating with eruptions 


And who has not seen the pulmonary symptoms 
alternately relieved and reproduced by the appear, 
ance or cessation of a diarrhoea, or pains in the 


* Treatise of the Nature and Cure of Consumptions, 
Exercitation X, 


To these facts I shall only add, under this head, 
as a proof of the consumption being a disease of 
the whole system, that it is always more or less 
relieved by the change which is induced in the 
system by pregnancy. 

4. I infer that the pulmonary consumption is a 
disease of the whole system from its analogy with 
several other diseases, which, though accompanied 
by local affections, are obviously produced by a 
morbid state of the whole system. 

The rheumatism, the gout, the measles, small- 
pox, the different species of cynanche, all furnish 
examples of the connection of local affections with 
a general disease; but the apoplexy, and the 
pneumony, furnish the most striking analogies 
of local affection, succeeding a general disease of 
the system in the pulmonary consumption. 

The most frequent predisposing cause of apo- 
plexy is a general debility of the system, produced 
by intemperance in eating and drinking. The phe- 
nomena of the disease are produced by an effusion 
of blood or serum, in consequence of a morbid dis- 
tension, or of a rupture of the vessels of the brain. 
The pulmonary consumption begins and ends in 
the same way, allowing only for the difference of 


situation and structure of the brain and lungs. 
After the production of predisposing debility from 
the action of the remote causes formerly enumerat- 
ed, the fluids are determined to the weakest part of 
the body. Hence effusions of serum or blood take 
place in the lungs. When serum is effused, a 
pituitous or purulent expectoration alone takes 
place ; when blood is discharged, a disease is pro- 
duced which has been called haemoptysis. An 
effusion of blood in the brain, brought on by the 
operation of general debility, has been called by Dr* 
Hoffman, with equal propriety, a haemorrhage of 
the brain. The effusion of blood in the lungs, in 
consequence of the rupture of a blood-vessel, is less 
fatal than the same accident when it occurs in the 
brain, only because the blood in the former case is 
more easily discharged from the system. Where 
no rupture of a blood-vessel is produced, death is 
nearly as speedy and certain in the one case as in 
the other. Dissections show many cases of suffo- 
cation and death, from the lungs being preternatu- 
rally filled with blood or serum. From this great 
analogy between the remote and proximate causes 
of the two diseases which have been described, I 
have taken the liberty to call them both by the 
name of apoplexy. The only symptom which 
does not accord with the derivation of the term, is, 
that in the apoplexy of the lungs, the patient does 


not fall down as if by an external stroke, which is 
most frequently the case in the apoplexy of the brain. 

The history of the remote and proximate causes 
of pneumony will furnish us with a still more re- 
markable analogy of the connection between a lo- 
cal affection, and a general disease of the system. 
The pneumony is produced by remote exciting 
causes which act on the whole system. The whole 
arterial system is frequently agitated by a fever in 
this disease before a pain is perceived in the breast 
or sides, and this fever generally constitutes its 
strength and danger. The expectoration which 
terminates the disease in health, is always the ef- 
fect of effusions produced by a general disease, and 
even the vomicas, which sometimes succeed a de- 
ficiency of bleeding, always depend upon the same 
general cause. From this view of the analogy be- 
tween pneumony and pulmonary consumption, it 
would seem that the two diseases differed from 
each other only by the shorter or longer operation 
of the causes which induce them, and by the great- 
er or less violence and duration of their symptoms. 
The pneumony appears to be an acute consump- 
tion, and the consumption a chronic pneumony. 
From the analogy of the pulmonary consumption 
with the diminutive term of certain fevers, I have 
taken the liberty of calling it a pneumonicula. 


5. I infer that the pulmonary consumption is a 
disease of the whole system, from its existence 
without ulcers in the lungs. Of this there are 
many cases recorded in books of medicine. 

Dr. Leigh informs us, in his Natural History of 
Lancashire, that the consumption was a very com- 
mon disease on the sea coast of that country ; but 
that it was not accompanied either by previous in- 
flammation or ulcers in the lungs. It was gene- 
rally attended, he says, by an unusual peevishness 
of temper. 

6. I infer that the pulmonary consumption is a 
disease of the whole system, from its being reliev- 
ed, or cured, only by remedies which act upon the 
whole system. This will appear, I hope, here- 
after, when we come to treat of the cure of this 

Let us now enquire how far the principles I have 
laid down will apply to the supposed causes of con- 
sumption. These causes have been said to be, 
an abscess in the lungs, haemoptysis, tubercles, 
without and with ulcers, catarrh, hereditary diathe- 
sis, contagion, and the matter of cutaneous erup- 
tions, or sores repelled, and thrown upon the lungs. 
I shall make a few observations upon each of them. 


1. An abscess in the lungs is generally the con- 
sequence of a neglected, or half- cured pneumony. 
It is seldom fatal, where it is not connected with 
a predisposition to consumption from general debi- 
lity, or where general debility is not previously in- 
duced by the want of appetite, sleep, and exercise, 
which sometimes accompany that disease of the 
lungs. This explanation of the production of con- 
sumption by an abscess in the lungs, will receive 
further support from attending to the effects of 
wounds in the lungs. How seldom are they fol- 
lowed by pulmonary consumption ; and this only 
because they are as seldom accompanied by pre- 
disposing general debility. I do not recollect a 
single instance of this disease having followed a 
wound in the lungs, either by the bayonet, or a 
bullet, during our revolutionary war. The reco- 
veries which have succeeded such wounds, and 
frequently under the most unfavourable circum- 
stances, show how very improbable it is that a 
much slighter affection of the lungs should become 
the cause of a pulmonary consumption. 

A British officer, whom I met in the British 
eamp, a few days after the battle of Brandy wine, in 
September, 1777, informed me that the surgeon- 
general of the royal army had assured him, that 
out of twentv-four soldiers who had been admitted 


into the hospitals, during the campaign of 1776, 
with wounds in their lun^s, twentv-three of them 
had recovered. Even primary diseases of the 
lungs often exist with peculiar violence, or con- 
tinue for many years without inducing a consump- 
tion. I have never known but one instance of the 
whooping-cough ending in consumption, and all 
our books of medicine contain records of the 
asthma continuing for twenty and thirty years 
without terminating in that disease. The reason 
in both cases, must be ascribed to those two ori- 
ginal diseases of the lungs not being accompanied 
by general debility. One fact more will serve to 
throw still further light upon the subject. Millers 
are much afflicted with a cough from floating par- 
ticles of flour constantly irritating their lungs, and 
yet they are not more subject to consumptions 
than other labouring people. Hence " a miller's 
" cough" is proverbial in some places, to denote a 
cough of long continuance without danger. 

2. The haemoptysis is either a local disease, or 
it is the effect of general debility of the whole sys- 
tem. When it is local, or when it is the effect of 
causes which induce a temporary or acute debility 
only in the system, it is seldom followed by con- 
sumption. The accidental discharge of blood from 
the lungs, from injuries, and from an obstruction 



of the menses in women is of this kind. Many 
persons are aifected by this species of haemorrhage 
once or twice in their lives, without suffering any 
inconvenience from it afterwards. I have met 
with several cases in which it has occurred for 
many years every time the body was exposed to 
any of the causes which induce sudden debility, 
and yet no consumption lias followed it. The late 
kins: of Prussia informed Dr. Zimmerman that he 
had been frequently attacked by it during his seven 
years war, and yet he lived, notwithstanding, above 
twenty years afterwards without any pulmonary 
complaints. It is only in persons who labour under 
chronic debility, that a haemoptysis is necessarily 
followed by consumption. 

3. I yield to the popular mode of expression 
when I speak of a consumption being produced by 
tubercles. But I maintain that they are the effects 
of general debility communicated to the bronchial 
vessels which cause them to secrete a preternatural 
quantity of mucus. This mucus is sometimes 
poured into the trachea from whence it is discharg- 
ed by hawking, more especially in the morning ; 
for it is secreted more copiously during the languid 
hours of sleep than in the day time. But this 
mucus is frequently secreted into the substance of 
the lungs, where it produces those tumours we 


call tubercles. When this occurs, there is either 
no cough* or a very dry one. That tubercles are 
formed in this way, I infer from the dissections 
and experiments of Dr. Stark f , who tells us, that 
he found them to consist of inorganic matter ; that 
he was unable to discover any connection between 
them and the pulmonary vessels, by means of the 
microscope or injections ; and that they first opened 
into the trachea through the bronchial vessels. It 
is remarkable that the colour and consistence of 
the matter of which they are composed, is nearly 
the same as the matter which is discharged through 
the trachea, in the moist cough which occurs from 
a relaxation of the bronchial vessels, and which has 
been called by Dr. Beddoes a bronchial gleet. 

I am aware that these tumours in the lungs have 
been ascribed to scrophula. But the frequent oc- 
currence of consumptions in persons in whom no 
scrophulous taint existed, is sufficient to refute this 
©pinion. I have frequently directed my inquiries 
after this disease in consumptive patients, and have 
met with very few cases which were produced by 
it. It is probable that it may frequently be a pre* 

* See Med. Com. Vol. II. 

t Clinical and Anatomical Observations, p. 26, 27. See 
also Morgagni, letter xxii. 21. 


disposing cause of consumption in Great Britain, 
but I am sure it is not in the United States. Baron 
Humboldt informed me, that the scrophula is un- 
known in Mexico, and yet consumptions, he said, 
are very common in that part of North- America. 
That tubercles are the effects, and not the cause 
of pulmonary consumption, is further evident from 
similar tumours being suddenly formed on the in- 
testines by the dysentery, and on the omentum by 
a yellow fever. Cases of the former are to be met 
with in the dissections of Sir John Pringle, and 
one of the latter is mentioned by Dr. Mackittrick, 
in his inaugural dissertation upon the yellow fever, 
published in Edinburgh in the year 1766*. 

4. The catarrh is of two kinds, acute and chro- 
nic, both of which are connected with general de- 
bility, but this debility is most obvious in the 
chronic catarrh : hence we find it increased by 
every thing which acts upon the whole system, 
such as cold and damp weather, fatigue, and, above 
all, by old age, and relieved or cured by exercise, 
and every thing else which invigorates the whole 
system. This species of catarrh often continues 
for twenty or thirty years without inducing pulmo- 
nary consumption, in persons who pursue active 

* Pages 7, 8. 


5. In the hereditary consumption there is either 
a hereditary debility of the whole system, or a 
hereditary mal- conformation of the breast. In the 
latter case, the consumption is the effect of weak- 
ness communicated to the whole system, by the 
long continuance of difficult respiration, or of such 
injuries being done to the lungs as are incompati- 
ble with health and life. It is remarkable, that 
the consumptive diathesis is more frequently de- 
rived from paternal, than maternal ancestors. 

6. Physicians, the most distinguished charac- 
ters, have agreed, that the pulmonary consumption 
may be communicated by contagion. Under the 
influence of this belief, Morgagni informs us, that 
Valsalva, who was predisposed to the consumption, 
constantly avoided being present at the dissection 
of the lungs of persons who had died of that dis- 
ease. In some parts of Spain and Portugal, its 
contagious nature is so generally believed, that 
cases of it are reported to the magistrates of those 
countries, and the clothes of persons who die of it 
are burned by their orders. The doctrine of nearly 
all diseases spreading by contagion, required but a 
short and simple act of the mind, and favoured the 
indolence and timidity which characterized the old 
school of medicine. I adopted this opinion, with 
respect to the consumption, in the early part of my 


life ; but I have lately been led to call its truth in 
question, especially in the unqualified manner in 
which it has been taught. In most of the cases in 
which the disease has been said to be propagated 
by contagion, its limits are always confined to the 
members of a single family. Upon examination, 
I have found them to depend upon some one or 
more of the following causes : 

1. Mai- conformation of the breast, in all the 
branches of the diseased family. It is not neces- 
sary that this organic predisposition should be here- 

2. Upon the debility which is incurred by nurs- 
ing, and the grief which follows the loss of rela- 
tions who die of it. 

3. Upon some local cause undermining the con- 
stitutions of a whole family. This may be exhala- 
tions from a foul cellar, a privy, or a neighbouring 
mill-pond, but of so feeble a nature as to produce 
debility only, with an acute fever, and thus to ren- 
der the consumption a kind of family epidemic. I 
was consulted, in the month of August, 1793, by 
a Mr. Gale, of Maryland, in a pulmonary com- 
plaint. He informed me, that he had lost several 
brothers and sisters with the consumption, and 


that none of his ancestors had died of it. The 
deceased persons, five in number, had lived in a 
place that had been subject to the intermitting fever. 

4. Upon some peculiar and unwholesome arti- 
cle of diet, which exerts slowly debilitating effects 
upon ail the branches of a family. 

5. Upon a fearful and debilitating apprehension 
entertained by the surviving members of a family, 
in which one or two have died of consumption, 
that they shall perish by the same disease. The 
effects of all the passions, and especially of fear, 
acted upon by a lively imagination, in inducing 
determinations to particular parts of the body, and 
subsequent disease, are so numerous, as to leave 
no doubt of the operation of this cause, in pro- 
ducing a number of successive deaths in the same 
family, from pulmonary consumption. 

In favour of its depending upon one or more of 
the above causes, I shall add two remarks. 

1. There is often an interval of from two to ten 
years, between the sickness and deaths which o6r 
cur in families from consumptions, and this we 
know never takes place in any disease which is 
admitted to be contagious. 


2. The consumption is not singular in affecting 
several branches of a family. I was lately con- 
suited by a young physician from Maryland, who 
informed me, that two of his brothers, in common 
with himself, were afflicted with epilepsy. Mad* 
ness, scrophula, and a disposition to haemorrhage, 
often affect, in succession, several branches of the 
same family ; and who will say that any one of the 
above diseases is propagated by contagion ? 

The practice of the Spaniards and Portuguese, 
in burning the clothes of persons who die of con- 
sumptions, no more proves the disease to be con- 
tagious, than the same acts sanctioned by the ad- 
vice or orders of public bodies in the United 
States, establish the contagious nature of the yellow 
fever. They are, in both countries, marks of the 
superstition of medicine. 

In suggesting these facts, and the inferences 
which have been drawn from them, I do not mean 
to deny the possibility of the acrid and foetid va- 
pour, which is discharged by breathing from an 
ulcer or abscess in the lungs, nor of the hectic 
sweats, when rendered putrid by stagnating in 
sheets, or blankets, communicating this disease to 
persons who are long exposed to them, by sleep- 
ing with consumptive patients ; but that such cases 


rarely occur I infer, from the persons affected often 
living at a distance from each other, or when they 
live under the same roof, having no intercourse 
with the sick. This was the case with the black 
slaves, who w T ere supposed to have taken the dis- 
ease from the white branches of a family in Con- 
necticut, and which was mentioned, upon the 
authority of Dr. Beardsley, in a former edition of 
this inquiry. Admitting the above morbid mat- 
ters now and then to act as a remote cause of con- 
sumption, it does not militate against the theory I 
have aimed to establish, for if it follow the analogy 
of common miasmata and contagions, it must act 
by first debilitating the whole system. The ap- 
proach of the jail and bilious fevers is often indi- 
cated by general languor. The influenza and the 
measles are always accompanied by general debi- 
lity, but the small-pox furnishes an analogy to the 
ease in question more directly in point. The con- 
tagion of this disease, whether received by the 
medium of the air or the skin, never fails of pro- 
ducing weakness in the w T hole system, before it 
discovers itself in affections of those parts of the 
body on which the contagion produced its first 

7. I grant that cutaneous humours, and the mat- 
ter of old sores, when repelled, or suddenly healed, 

VOL. II. e 


have in some cases fallen upon the lungs, and pro- 
duced consumption. But I believe, in every case 
where this has happened, the consumption was 
preceded by general debility, or that it was not in- 
duced, until the whole system had been previously 
debilitated by a tedious and distressing cough. 

If the reasonings founded upon the facts which 
have been mentioned be just, then it follows, 

III. That the abscess, cough, tubercles, ulcers, 
and purulent or bloody discharges which occur in 
the pulmonary consumption, are the effects, and 
not the causes of the disease ; and, that all attempts 
to cure it, by inquiring after tubercles and ulcers, 
or into the quality of the discharges from the lungs, 
are as fruitless as an attempt would be to discover 
the causes or cure of dropsies, by an examination 
of the qualities of collections of water, or to find out 
the causes and cure of fevers, by the quantity or 
quality of the discharges which take place in those 
diseases from the kidneys and skin. It is to be 
lamented, that it is not in pulmonary consumption 
only, that the effects of a disease have been mistaken 
for its cause. Water in the brain, a membrane in 
the trachea, and a preternatural secretion of bile, 
have been accused of producing hydrocephalus in- 
temus, cynanche trachealis, and bilious fever, 


whereas we now know they are the effects of those 
diseases only, in the successive order in which each 
of them has been mentioned. It is high time to 
harness the steeds which drag the car of medicine 
before, instead of behind it. The earth, in our 
science, has stood still long enough. Let us at last 
believe, it revolves round its sun. I admit that 
the cough, tubercles, and ulcers, after they are 
formed, increase the danger of a consumption, by 
becoming new causes of stimulus to the system, but 
in this they are upon a footing with the water, the 
membrane, and the bile that have been alluded to, 
which, though they constitute no part of the dis- 
eases that produce them, frequently induce symp- 
toms, and a termination of them, wholly unconnect- 
ed with the original disease. 

The tendency of general debility to produce a 
disease of the lungs appears in many cases, as well 
as in the pulmonary consumption. Dr. Lind tells 
us, that the last stage of the jail fever was often 
marked by a cough. I have seldom been disap- 
pointed in looking for a cough and a copious ex- 
cretion of mucus and phlegm after the 14th or 15th 
days of the slow nervous fever. Two cases of hy- 
pocondriasis under my care, ended in fatal diseases 
of the lungs. The debility of old age is generally 
accompanied by a troublesome cough, and the de~ 


bility which precedes death, generally discovers it& 
last symptoms in the lungs. Hence most people 
die with what are called the rattles. They arc 
produced by a sudden and copious effusion of mu- 
cus in the bronchial vessels of the lungs. 

Sometimes the whole force of the consumptive 
fever falls upon the trachea instead of the lungs, 
producing in it defluxion, a hawking of blood, and 
occasionally a considerable discharge of blood, which 
are often followed by ulcers, and a spitting of pus. 
I have called it a tracheal, instead of a pulmonary 
consumption. Many people pass through a long 
life with a mucous defluxion upon the trachea, and 
enjoy in other respects tolerable health. In .such 
persons the disease is of a local nature. It is only 
when it is accompanied with debility of the whole 
system, that it ends in a consumption. Mr. John 
Harrison, of the Northern Liberties, died of this dis- 
ease under my care, in the year 1801, in conse- 
quence of the discharge of pus from an ulcer which 
followed a haemorrhage from the trachea being sud- 
denly suppressed. I have seen another case of the 
same kind in a lady in this city, in the year 1797. 
Dr. Spence, of Dumfries, in Virginia, in a letter 
which I received from him in June, 1805, describe* 
a case then under his care, of this form of consump- 
tion. He calls it, veiy properly, " phthisis trache- 


alis. ** I have met with two cases of death from this 
disease, in which there were tubercles in the tra- 
chea. The patients breathed with great difficulty, 
and spoke only in a whisper. One of them died 
from suffocation. In the other, the tubercle bursted 
a few days before his death, and discharged a large 
quantity of foetid matter. 

Should it be asked, why does general debility 
terminate by a disease in the lungs and trachea, ra- 
ther than in any other part of the body ? I answer, 
that it seems to be a law of the system, that gene- 
ral debility should always produce some local dis- 
ease. This local disease sometimes manifests itself 
in dyspepsia, as in the general debility which fol- 
lows grief; sometimes it discovers itself in a diarr- 
hoea, as in the general debility which succeeds to 
fear. Again it appeal's in the brain, as in the general 
debility which succeeds intemperance, and the con- 
stant or violent exercise of the understanding, or of 
stimulating passions; but it more frequently ap- 
pears in the lungs, as the consequence of general 
debility. It would seem as if the debility in the 
cases of consumption is seated chiefly in the blood- 
vessels, while that debility which terminates in dis- 
eases of the stomach and bowels, is confined chiefly 
to the nerves, and that the local affections of the 
brain arise from a debility, invading alike the ner- 


vous and arterial systems. What makes it more 
probable that the arterial system is materially affect- 
ed in the consumption is, that the disease most fre- 
quently occurs in those periods of life, and in those 
habits in which a peculiar state of irritability or ex- 
citability is supposed to be present in the arterial 
system ; also in those climates in which there are 
the most frequent vicissitudes in the temperature 
of the weather. It has been observed, that the de- 
bility in the inhabitants of the West-Indies, whe- 
ther produced by the heat of the climate or the ex- 
cessive pursuits of business or pleasure, generally 
terminates in dropsy, or in some disease of the ali- 
mentary canal. 

I have said, that it seemed to be a law of the sys- 
tem, that general debility should always produce 
some local affection. But to this law r there are 
sometimes exceptions : the atrophy appears to be 
a consumption without an affection of the lungs. 
This disease is frequently mentioned by the writers 
of the 16th and 17th centuries by the name of tabes. 
I have seen several instances of it in adults, but 
more in children, and a greater number in the chil- 
dren of black than of white parents. The hectic 
fever, and even the night sweats, were as obvious 
in several of these cases, as in those consumptions 


where general debility had discovered itself in an 
affection of the lungs. 

I come now to make a few observations upon 
the cure of consumption ; and here I hope it will 
appear, that the theory which I have delivered ad- 
mits of an early and very important application to 

If the consumption be preceded by general de- 
bility, it becomes us to attempt the cure of it be- 
fore it produce the active symptoms of cough, 
bloody or purulent discharges from the lungs, and 
inflammatory or hectic fever. The symptoms 
which mark its first stage, are too seldom observ- 
ed ; or if observed, they are too often treated with 
equal neglect by patients and physicians. I shall 
briefly enumerate these symptoms. They are a 
slight fever increased by the least exercise ; a burn- 
ing and dryness in the palms of the hands, more 
especially tow r ards evening; rheumy eyes upon 
waking from sleep ; an increase of urine ; a dry- 
ness of the skin, more especially of the feet in the 
morning* ; an occasional flushing in one, and some- 

* The three last-mentioned symptoms are taken notice of 
by Dr. Bennet, in his Treatise upon the Nature and Cure 
of the Consumption, as precursors of the disease. Dr. Boer- 
haave used to tell his pupils that they had never deceived 


times in both cheeks ; a hoarseness* ; a slight or 
acute pain in the breast ; a fixed pain in one side, 
or shooting pains in both sides ; head-ach ; occa- 
sional sick and fainty fits ; a deficiency of appetite, 
and a general indisposition to exercise or motion 
of every kind. 

It would be easy for me to mention cases in 
which every symptom that has been enumerated 
has occurred within my own observation. I wish 
them to be committed to memory by young prac- 
titioners ; and if they derive the same advantages 
from attending to them, which I have done, I am 
sure they will not regret the trouble they have 
taken for that purpose. It is probable, while a 
morbid state of the lungs is supposed to be the 
proximate cause of this disease, they will not de- 
rive much reputation or emolument from curing it 
in its forming stage ; but let them remember, that 
in all attempts to discover the causes and cures of 
diseases, which have been deemed incurable, a 
physician will do nothing effectual until he acquire 
a perfect indifference to his own interest and fame. 

* I have seen the hoarseness in one case the first symptom 
of approaching consumption. In this symptom it preserves 
the analogy of pneumony, which often comes on with a 
hoarseness, and sometimes with paraphoni?. 


The remedies for consumption, in this stage of 
the disease, are simple and certain. They consist 
in a desertion of all the remote and exciting causes 
of the disorder, particularly sedentaiy employ- 
ments, damp or cold situations, and whatever tends 
to weaken the system. When the disease has not 
yielded to this desertion of its remote and exciting 
causes, I have recommended the cold bath, steely 
and bark with great advantage. However impro- 
per, or even dangerous, these remedies may be 
after the disease assumes an inflammatory* or hectic 
type, and produces an affection of the lungs, they 
are perfectly safe and extremely useful in the state 
of the svstem which has been described. The use 
of the bark will readily be admitted by all those 
practitioners who believe the pulmonary consump- 
tion to depend upon a scrophulous diathesis. 
Should even the lungs be affected by scrophulous 
tumours, it is no objection to the use of the bark, 
for there is no reason why it should not be as use- 
ful in scrophulous tumours of the lungs, as of the 
glands of the throat, provided it be given before 
those tumours have produced inflammation ; and 
in this case, no prudent practitioner will ever pre- 
scribe it in scrophula, when seated even in the ex- 
ternal parts of the body. To these remedies 
should be added a diet moderately stimulating, and 
gentle exercise. I shall hereafter mention the dif- 



ferent' species of exercise, and the manner in which 
each of them should be used, so as to derive the 
utmost advantage from them. I can say nothing 
of the use of salt water or sea air in this stage of 
the consumption, from my own experience. I have 
heard them commended by a physician of Rhode- 
Island ; and if they be used before the disease has 
discovered itself in pulmonary affections, I can 
easily conceive they may do service. 

If the simple remedies which have been men- 
tioned have been neglected, in the first stage of the 
disease, it generally terminates, in different periods 
of time, in pulmonary affections, which show them- 
selves under one of the three following forms : 

1. A fever, accompanied by a cough, a hard 
pulse, and a discharge of blood, or mucous matter 
from the lungs. 

2. A fever of the hectic kind, accompanied by 
chilly fits, and night sweats, and a pulse full, 
quick, and occasionally hard. The discharges 
from the lungs, in this state of the disease, are fre- 
quently purulent. 

3. A fever with a weak frequent pulse, a trou- 
blesome cough, and copious purulent discharges 


from the lungs, a hoarse and weak voice, and chilly 
fits and night sweats alternating with a diarrhoea. 

From this short history of the symptoms of pul- 
monary consumption there are occasional devia- 
tions. I have seen four cases, in which the pulse 
was natural, or slower than natural, to the last day 
of life. Mrs. Rebecca Smith, the lovely and ac- 
complished wife of Mr. Robert Smith, of this city, 
passed through the whole course of this disease, in 
the year 1802, without a single chilly fit. Two 
other cases have come under my notice, in which 
there was not only an absence of chills, but of fever 
and night sweats. A similar case is recorded in 
the Memoirs of the Medical Society of London ; 
and lastlv, I have seen two cases which terminated 
fatally, in which there was neither cough nor fever 
for several months. One of them was in Miss 
Mary Loxley, the daughter of the late Mr. Benja- 
min Loxley, in the year 1785. She had com- 
plained of a pain in her right side, and had frequent 
chills with a fever of the hectic kind. They all 
gave way to frequent and gentle bleedings. In the 
summer of 1786, she was seized with the same 
complaints, and as she had great objections to 
bleeding, she consulted a physician who gratified 
her, by attempting to cure her by recommending 
exercise and country* air. In the autumn she re* 



turned to the city, much worse than when she left 
it. I was again sent for, and found her confined 
to her bed with a pain in her right side, but with- 
out the least cough or fever. Her pulse was pre- 
ternaturally slow. She could lie only on her left 
side. She sometimes complained of acute flying 
pains in her head, bowels, and limbs. About a 
month before her death, which was on the 3d of 
May, 1787, her pulse became quick, and she had 
a little hecking cough, but without any discharge 
from her lungs. Upon my first visit to her in the 
preceding autumn, I told her friends that I believed 
she had an abscess in her lungs. The want of 
fever and cough afterwards, however, gave me rea- 
son to suspect that I had been mistaken. The 
morning after her death, I received a message from 
her father, informing me that it had been among 
the last requests of his daughter, that the cause of 
her death should be ascertained, by my opening 
her body. I complied with this request, and, in 
company with Dr. Hall, examined her thorax. 
We found the left lobe of the lungs perfectly sound ; 
the right lobe adhered to the pleura, in separating 
of which, Dr. Hall plunged his hand into a large 
sac, which contained about half a pint of purulent 
matter, and which had nearly destroyed the whole 
substance of the right lobe of the lungs. 



I have never seen a dry tongue in any of the 
forms or stages of this disease. 

The three different forms of the pulmonary affec- 
tion that I have mentioned, have been distinguished 
by the names of the first, second, and third stages 
of the consumption ; but as they do not always 
succeed each other in the order in which they have 
been mentioned, I shall consider them as different 
states of the system. 

The first I shall call the inflammatory, the 
second the hectic, and the third the typhus 
state. I have seen the pulmonary consumption 
come on sometimes with all the symptoms of the 
second, and sometimes with most of the symptoms 
of the third state ; and I have seen two cases in 
which a hard pulse, and other symptoms of inflam- 
matory action, appeared in the last hours of life. 
It is agreeable to pursue the analogy of this dis- 
ease with a pneumony, or an acute inflammation of 
the lungs. They both make their first appearance 
in the same seasons of the year. It is true, the 
pneumony most frequently attacks with inflamma- 
tory symptoms ; but it sometimes occurs with 
symptoms which forbid blood-letting, and I have 
more than once seen it attended by symptoms 
which required the use of wine and bark. The 


pneumony is attended at first by a dry cough, and 
an expectoration of streaks of blood ; the cough in 
the consumption, in like manner, is at first diy, 
and attended by a discharge of blood from the 
lungs, which is more copious than in the pneu- 
mony, only because the lungs are more relaxed in 
the former than in the latter disease. There are 
cases of pneumony in which no cough attends. I 
have just now mentioned that I had seen the ab- 
sence of that symptom in pulmonary consumption. 

The pneumony terminates in different periods, 
according to the degrees of inflammation, or the 
nature of the effusions which take place in the 
lungs : the same observation applies to the pulmo- 
nary consumption. The symptoms of the different 
forms of pneumony frequently run into each other ; 
so do the symptoms of the three forms of consump- 
tion which have been mentioned. In short, the 
pneumony and consumption are alike in so many 
particulars, that they appear to resemble shadows 
of the same substance. They differ only as the 
protracted shadow of the evening does from that 
of the noon-day sun. 

I know that it will be objected here that the 
consumption is sometimes produced by scrophula, 
and that this creates an essential difference between 


it and pneumony. I formerly admitted scrophula 
to be one of the remote causes of the consumption; 
but this does not invalidate the parallel which has 
been given of the two diseases. The phenomena 
produced in the lungs are the same as to their 
nature, whether they be produced by the remote 
caube of scrophula, or by the sudden action of cold 
and heat upon them. 

No more happens in the cases of acute and chro- 
nic pneumony, than what happens in dysentery 
and rheumatism. These two last diseases are for 
the most part so acute, as to confine the patient to 
his bed or his room, yet we often meet with both 
of them in patients who go about their ordinal*} 
business, and, in some instances, carry their dis- 
eases with them for two or three years. 

The parallel which has been drawn between the 
pneumony and consumption, will enable us to un- 
derstand the reason w T hy the latter disease termi- 
nates in such different periods of time. The less 
it partakes of pneumony, the longer it continues, 
and vice versa. What is commonly called in this 
country a galloping consumption, is a disease com- 
pounded of different degrees of consumption and 
pneumony. It terminates frequently in two or 
three months, and without many of the symptoms 


which usually attend the last stage of pulmonary 
consumption. But there are cases in which pa- 
tients in a consumption are suddenly snatched away 
by an attack of pneumony. I have met with one 
case only, in which, contrary to my expectation, 
the patient mended after an attack of an acute in- 
flammation of the lungs, so as to live two years 

It would seem from these facts, as if nature had 
preferred a certain gradation in diseases, as well as 
in other pails of her works. There is scarcely a 
disease in which there is not a certain number of 
grades, which mark the distance between health 
and the lowest specific deviation from it. Each 
of these grades has received different names, and 
has been considered as a distinct disease, but more 
accurate surveys of the animal economy have 
taught us, that they frequently depend upon the 
same original causes, and that they are only greater 
or less decrees of the same disease. 

I shall now proceed to say a few words upon 
the cure of the different states of pulmonary con- 
sumption, The remedies for this purpose are of 
two kinds, viz. palliative and radical. I 
shall first mention the palliative remedies which 
belong to each state, and then mention those 


which are alike proper in them all. The palliative 
remedies for the 


I. Blood-letting. It may seem strange to 
recommend this debilitating remedy in a disease 
brought on by debility. Were it proper in this 
place, I could prove that there is no disease in 
which bleeding is prescribed, which is not induced 
by predisposing debility, in common with the pul- 
monary consumption. I shall only remark here, 
that in consequence of the exciting cause acting 
upon the system (rendered extremely excitable by 
debility) such a morbid and excessive excitement 
is produced in the arteries, as to render a diminu- 
tion of the stimulus of the blood absolutely neces- 
sary to reduce it. I have used this remedy with 
great success, in every case of consumption at- 
tended by a hard pulse, or a pulse rendered weak 
by a laborious transmission of the blood through 
the lungs. In the months of February and March, 
in the year 1781, I bled a Methodist minister, who 
was affected by this state of consumption, fifteen 
times in the course of six weeks. The quantity 
of blood drawn at each bleeding was never less 
than eight ounces, and it was at all times covered 
with an inflammatory crust. By the addition of 



country air, and moderate exercise, to this copious 
evacuation, in the ensuing spring he recovered his 
health so perfectly, as to discharge all the duties of 
his profession for many years, nor was he ever 
afflicted afterwards with a disease in his breast. I 
have, in another instance, bled a citizen of Phila- 
delphia eight times in two weeks, in this state of 
consumption, and with the happiest effects. The 
blood drawn at each bleeding was always sizy, and 
never less in quantity than ten ounces. Mr. Tra- 
cey of Connecticut informed me, in the spring of 
1802, that he had been bled eighty-five times in 
six months, by order of his physician, Dr. Sheldon, 
in the inflammatory state of this disease. He as- 
cribed his recovery chiefly to this frequent use of 
the lancet. To these cases I might add many 
others of consumptive persons who have been per- 
fectly cured by frequent, and of many others whose 
lives have been prolonged by occasional bleedings. 
But I am sorry to add, that I could relate many 
more cases of consumptive patients, who have died 
martyrs to their prejudices against the use of this 
invaluable remedy. A common objection to it is, 
that it has been used without success in this dis- 
ease. When this has been the case, I suspect 
that it has been used in one of the other two states 
of pulmonary consumption which have been men- 
tioned, for it has unfortunately been too fashion- 


able among physicians to prescribe the same re- 
medies in every stage and form of the same 
disease, and this I take to be the reason why the 
same medicines, which, in the hands of some phy- 
sicians, are either inert or instruments of mischief, 
are, in the hands of others, used with more or less 
success in every case in which they are prescribed. 
Another objection to bleeding in the inflammatory 
state of consumption, is derived from the apparent 
and even sensible weakness of the patient. The 
men who urge this objection, do not hesitate to 
take from sixtv to a hundred ounces of blood from 
a patient in a pneumony, in the course of five or six 
days, without considering that the debility in the 
latter case is such as to confine a patient to his bed, 
while, m the former case, the patient's strength is 
such as to enable him to walk about his house, 
and even to attend to his ordinary business. The 
difference between the debility in the two diseases, 
consists in its being acute in the one, and chronic 
in the other. It is true, the preternatural or con- 
vulsive excitement of the arteries is somewhat 
greater in the pneumony, than in the inflammatory 
consumption ; but the plethora, on which the ne- 
cessity of bleeding is partly founded, is certainly 
greater in the inflammatory consumption than in 
pneumony. This is evident from women, and 
even nurses, discharging from four to six ounces 


of menstrual blood every month, while they are 
labouring with the most inflammatory symptoms of 
the disease ; nor is it to be wondered at, since the 
appetite is frequently unimpaired, and the genera* 
tion of blood continues to be the same as in perfect 

Dr. Cullen recommends the use of bleeding in 
consumptions, in order to lessen the inflammation 
of the ulcers in the lungs, and thereby to dispose 
them to heal. From the testimonies of the re- 
lief which bleeding affords in external ulcers and 
tumours accompanied by inflammation, I am dis- 
posed to expect the same benefit from it in inflamed 
ulcers and tumours in the lungs : whether, there- 
fore, we adopt Dr. Cullen's theory of consumption, 
and treat it as a local disease, or assent to the one 
which I have delivered, repeated bleedings appear 
to be equally necessary and useful. 

I have seen two cases of inflammatory con- 
sumption, attended by a haemorrhage of a quart 
of blood from the lungs. I agreed at first with 
the friends of these patients in expecting a rapid 
termination of their disease in death, but to the 
joy and surprise of all connected with them, they 
both recovered. I ascribed their recovery wholly 
to the inflammatory action of their systems being 


suddenly reduced by a spontaneous discharge of 
blood. These facts, I hope, will serve to establish 
the usefulness of blood-letting in the inflammatory 
state of consumption, with those physicians who 
are yet disposed to trust more to the fortuitous 
operations of nature, than to the decisions of rea- 
son and experience. 

I have always found this remedy to be more 
necessary in the winter and first spring months, 
than at any other season. We obtain by means of 
repeated bleedings, such a mitigation of all the 
symptoms as enables the patient to use exercise 
with advantage as soon as the weather becomes so 
diy and settled, as to admit of his going abroad 
every day. 

The relief obtained by bleeding, is so certain 
in this state of consumption, that I often use it as 
a palliative remedy, where I do not expect it will 
perform a cure. I was lately made happy in find- 
ing, that I am not singular in this practice. Dr. 
Hamilton, of Lynn Regis, used it with success in 
a consumption, which was die effect of a most de- 
plorable scrophula, without entertaining the least 
hope of its performing a cure*. In those cases 

* Observations on Scrophulous Affections. 


where inflammatory action attends the last scene 
of the disease, there is often more relief obtained 
by a little bleeding than by the use of opiates, 
and it is always a more humane prescription, in 
desperate cases, than the usual remedies of vomits 
and blisters. 

I once bled a sea captain, whom I had declared 
to be within a few hours of his dissolution, in 
order to relieve him of uncommon pain, and diffi- 
culty in breathing. His pulse was at the same time 
hard. The evacuation, though it consisted of but 
four ounces of blood, had the wished for effect, 
and his death, I have reason to believe, was ren- 
dered more easy by it. The blood, in this case, 
was covered with a buffy coat. 

The quantity of blood drawn in every case of 
inflammatory consumption, should be determined 
by the force of the pulse, and the habits of the pa- 
tient. I have seldom taken more than eight, but 
more frequently but six ounces at a time. It is 
much better to repeat the bleeding once or twice 
a week, than to use it less frequently, but in larger 

From many years experience of the efficacy of 
bleeding in this state of consumption, I feel my- 


self authorised to assert, that where a greater pro- 
portion of persons die of consumption when it 
makes its first appearance in the lungs, with symp- 
toms of inflammatory diathesis, than die of ordi- 
nary pneumonies (provided exercise be used after- 
wards), it must, in nine cases out often, be ascribed 
to the ignorance, or erroneous theories of physi- 
cians, or to the obstinacy or timidity of patients. 

In speaking thus confidently of the necessity and 
benefits of bleeding in the inflammatory state of 
consumption, I confine myself to observations 
made chiefly in the state of Pennsylvania. It is 
possible the inhabitants of European countries and 
cities, may so far have passed the simple ages of 
inflammatory diseases, as never to exhibit those 
symptoms on which I have founded the indication 
of blood-letting. I suspect moreover that in most 
of the southern states of America, the inflammatory 
action of the arterial system is of too transient a 
nature to admit of the repeated bleedings in the 
consumption which are used with so much advan- 
tage in the middle and northern states. 

In reviewing the prejudices against this excel- 
lent remedy in consumptions, I have frequently 
wished to discover such a substitute for it as would 
with equal safety and certainty take down the mor- 


bid excitement, and action of the arterial system, 
At present we know of no such remedy ; and 
until it be discovered, it becomes us to combat the 
prejudices against bleeding ; and to derive all the 
advantages from it which have been mentioned. 

2. A second remedy for the inflammatory state 
of consumption should be sought for in a milk 
and vegetable diet. In those cases where the 
milk does not lie easy on the stomach, it should 
be mixed with waiter, or it should be taken with- 
out its cheesy or oily parts, as in whey, or butter- 
milk, or it should be taken without skimming ; 
for there are cases in which milk will agree with 
the stomach in this state, and in no other. The 
oil of the milk probably helps to promote the so- 
lution of its curds in the stomach. It is seldom in 
the power of physicians to prescribe ass' or 
goat's milk in this disease ; but a good substitute 
may be prepared for them by adding to cow's 
miik a little sugar, and a third or fourth part of 
water, or of a weak infusion of green tea. The 
quantity of milk taken in a day should not exceed 
a pint, and even less than that quantity when we 
wish to lessen the force of the pulse by the abstrac- 
tion of nourishment. The vegetables which are; 
eaten in this state of the disease, should contain as 
little stimulus as possible. Rice^ in all the ways in 


which it is usually prepared for aliment, should be 
preferred to other grains, and the less saccharine 
fruits to those which abound with sugar. In those 
cases where the stomach is disposed to dyspepsia, 
a little salted meat, fish, or oysters, also soft boiled 
eggs, may be taken with safety, mixed with vege- 
table aliment. Where there is no morbid affection 
of the stomach, I have seen the white meats eaten 
without increasing the inflammatory symptoms of 
the disease. The transition from a full diet to milk 
and vegetables should be gradual, and the addition 
of animal to vegetable aliment, should be made 
with the same caution. From the neglect of this 
direction, much error, both in theory and practice, 
has arisen in the treatment of consumptions. 

In every case it will be better for the patient 
to eat four or five, rather than but two or three 
meals in a day. A less stimulus is by this means 
communicated to the system, and less chyle is 
mixed with the blood in a given time. Of so much 
importance do I conceive this direction to be, that 
I seldom prescribe for a chronic disease of any kind 
without enforcing it. 

3. Vomits have been much commended by 
Dr. Read in this disease. From their indiscrimi- 
nate use in every state of consumption, I believe 

vol. ii« o 


they have oftener done harm than good. In cases 
where a patient objects to bleeding, or where a 
physician doubts of its propriety, vomits may al- 
ways be substituted in its room with great advan- 
tage. They are said to do most service when the 
disease is the effect of a catarrh. 

4. Nitre, in moderate doses of ten or fifteen 
grains, taken three or four times a day, has some- 
times been useful in this disease ; but it has been 
only when the disease has appeared with inflamma- 
tory symptoms. Care should be taken not to per- 
severe too long in the use of this remedy, as it is 
apt to impair the appetite. I have known one case 
in which it produced an obstinate dyspepsia, and a 
disposition to the colic ; but it removed, at the 
same time, the symptoms of pulmonary consump- 

5. Cold and dry air, when combined with 
the exercise of walking, deserves to be mentioned 
as an antiphlogistic remedy. I have repeatedly 
prescribed it in this species of the consumption with 
advantage, and have often had the pleasure of find- 
ing a single walk of two or three miles in a clear 
cold day, produce nearly the same diminution of 
the force and frequency of the pulse, as the loss of 
six or eight ounces of blood. 


I come now to treat of the palliative remedies 
which are proper in the 

II. Or hectic state of consumption. Here 
we begin to behold the disease in a new and more 
distressing form than in the state which has been 
described. There is in this state of consumption 
the same complication of inflammatory and typhus 
diathesis which occurs in the typhiod and puer- 
perile fevers, and of course the same difficulty in 
treating it successfully ; for the same remedies do 
good and harm, according as the former or latter 
diathesis prevails in the system. 

All that I shall say upon this state is, that the 
treatment of it should be accommodated to the 
predominance of inflammatory or typhus symp- 
toms, for the hectic state presents each of them 
alternately every week, and sometimes every day 
to the hand, or eye of a physician. When a hard 
pulse with acute pains in the side and breast occur, 
bleeding and other remedies for the inflammatory 
state must be used ; but when the disease exhi- 
bits a predominance of typhus symptoms, the re- 
medies for that state to be mentioned immedi- 
ately, should be prescribed in moderate doses. 
There are several palliative medicines which have 
been found useful in the hectic state, but they are 


such as belong alike to the other two states ; and 
therefore will be mentioned hereafter in a place as- 
signed to them. 

I am sorry, however, to add, that where bleed- 
ing has not been indicated, I have seldom been able 
to afford much relief by medicine in this state of 
consumption. I have used alternately the most 
gentle, and the most powerful vegetable and metal- 
lic tonics to no purpose. Even arsenic has failed 
in my hands of affording the least alleviation of the 
hectic fever. I conceive the removal of this fever 
to be the great desideratum in the cure of con- 
sumption ; and should it be found, after all our 
researches, to exist only in exercise, it will be no 
departure from a law of nature, for I believe there 
are no diseases produced by equal degrees of chronic 
debility, in which medicines are of any more effi- 
cacy, than they are in the hectic fever of the pul- 
monary consumption. 

I proceed now to speak of the palliative reme- 
dies which are proper in the 

III. Or typhus state of the pulmonary con- 


The first of these are stimulating medi- 
cines. However just the complaints of Dr. Fo- 
thergill may be against the use of balsams in the 
inflammatory and mixed states of consumption, 
they appear to be not only safe, but useful like- 
wise, in mitigating the symptoms of weak morbid 
action in the arterial system. I have therefore fre- 
quently prescribed opium, the balsam of copaivse, 
of Peru, the oil of amber, and different prepara- 
tions of turpentine and tar, in moderate doses, with 
obvious advantage. Garlic, elixir of vitriol, the 
juice of dandelion, a strong tea made of horehound, 
and a decoction of the inner bark of the wild cherry- 
tree*, also bitters of all kinds, have all been found 
safe and useful tonics in this state of consumption. 
Even the Peruvian bark and the cold bath, so often 
and so generally condemned in consumptions, are 
always innocent, and frequently active remedies, 
where there is a total absence of inflammatory dia- 
thesis in this disease. The bark is said to be most 
useful when the consumption is the consequence 
of an intermitting fever, and when it occurs in old 
people. With these remedies should be combined 

2. A cordial and stimulating diet. Milk 
and vegetables, so proper in the inflammatory, are 

* Prunus Virginiana. 


improper, when taken alone, in this state of con- 
sumption. I believe they often accelerate that 
decay of appetite and diarrhoea, which form the 
closing scene of the disease. I have lately seen 
three persons recovered from the lowest stage of 
this state of consumption, by the use of animal 
food and cordial drinks, aided by frequent doses of 
opium, taken during the day as well as in the night. 
I should hesitate in mentioning these cures, had 
they not been witnessed by more than a hundred 
students of medicine in the Pennsylvania hospital. 
The history of one of them is recorded in the 5th 
volume of the New- York Medical Repository, 
and of the two others in Dr. Coxe's Medical Mu- 
seum. Oysters, it has been said, have performed 
cures of consumption. If they have, it must have 
been only when they were eaten in that state of it 
which is now under consideration. They are a 
most savoury and wholesome article of diet, in all 
diseases of weak morbid action. To the cordial 
articles of diet belong sweet vegetable matters. 
Grapes, sweet apples, and the juice of the sugar 
maple tree, when taken in large quantities, have all 
cured this disease. They all appear to act by fill- 
ing the blood-vessels, and thereby imparting tone 
to the whole system. I have found the same ad- 
vantage from dividing the meals in this state of 
consumption, that I mentioned under a former 


head. The exhibition of food in this case, should 
not be left to the calls of appetite, any more than 
the exhibition of a medicine. Indeed food may- 
be made to supply the place of cordial medicines, 
by keeping up a constant and gentle action in the 
whole system. For this reason, I have frequently- 
advised my patients never to suffer their stomachs 
to be empty, even for a single hour. I have some- 
times aimed to keep up the influence of a gentle 
action in the stomach upon the whole system, by 
advising them to eat in the night, in order to ob- 
riate the increase of secretion into the lungs and 
of the cough in the morning, which are brought 
on in part by the increase of debility from the long 
abstraction of the stimulus of aliment during the 

However safe, and even useful, the cordial me. 
dicines and diet that have been mentioned may 
appear, yet I am sorry to add, that we seldom see 
any other advantages from them than a mitigation 
of distressing symptoms, except when they have 
been followed by suitable and long continued ex- 
ercise. Even under this favourable circumstance, 
they are often ineffectual ; for there frequently oc- 
curs, in this state of consumption, such a destruc- 
tion of the substance and functions of the lungs, as 
to preclude the possibility of a recovery by the use 


of any of the remedies which have been discovered. 
Perhaps, where this is not the case, their want of 
efficacy may be occasioned by their being given 
before the pulse is completely reduced to a typhus 
state. The weaker the pulse, the greater is the 
probability of benefit being derived from the use 
of cordial diet and medicines. 

I have said formerly, that the three states of 
consumption do not observe any regular course in 
succeeding each other. They are not only com- 
plicated in some instances, but they often appear 
and disappear half a dozen times in the course of 
the disease, according to the influence of the wea- 
ther, dress, diet, and the passions upon the system. 
The great secret, therefore, of treating this disease 
consists in accommodating all the remedies that 
have been mentioned to the predominance of any 
of the three different states of the system, as mani- 
fested chiefly by the pulse. It is in consequence 
of having observed the evils which have resulted 
from the ignorance or neglect of this practice, that 
I have sometimes wished that it were possible to 
abolish the seducing nomenclature of diseases alto- 
gether, in order thereby to ob ige physicians to 
conform exactly to the fluctuating state of the sys- 
tem in all th ir prescriptions; for it is not more 
certain, that, in all cultivated languages, every idea 



has its appropriate word, than that every state of 
a disease has its appropriate dose of medicine, the 
knowledge and application of which can alone con- 
stitute rational, or secure uniformly successful 

I come now to say a few words upon those pal- 
liative remedies which are alike proper in every 
state of the pulmonary consumption. 

The first remedy under this head isaDRY situ- 
ation. A damp air, whether breathed in a room, 
or out of doors, is generally hurtful in every form 
of this disease. A kitchen, or a bed-room, below 
the level of the ground, has often produced, and 
never fails to increase, a pulmonary consumption. 
I have often observed a peculiar paleness (the first 
symptom of general debility) to show itself very 
early in the faces of persons who work or sleep in 
cellar kitchens or shops. 

2. Country air. The higher and drier the 
situation which is chosen for the purpose of enjoy- 
ing the benefit of this remedy, the better. Situa- 
tions exposed to the sea, should be carefully avoid- 
ed ; for it is a singular fact, that while consumptive 
persons are benefited by the sea-air, when they 
breathe it on the ocean, they are always injured 

VOL. II. p 


by that portion of it which they breathe on the 
sea-shore. To show its influence, not only in ag- 
gravating consumptions, but in disposing to them, 
and in adding to the mortality of another disease of 
the lungs, I shall subjoin the following facts. From 
one fourth to one half of all the adults who die in 
Great Britain, Dr. Willan says, perish with this 
disease. In Salem, in the state of Massachusetts, 
which is situated near the sea, and exposed, during 
many months in the year, to a moist east wind, 
there died, in the year 1799, one hundred and 
sixty persons ; fifty-three died of the consumption, 
making in all nearly one third of all the inhabitants 
of the town. Eight more died of what is called a 
lung fever, probably of what is called in Pennsyl- 
vania the galloping grade of that disease. Con- 
sumptions are more frequent in Boston, Rhode- 
Island, and New-York, from their damp winds, 
and vicinity to the sea-shore, than they are in Phi- 
ladelphia. In the neighbourhood of Cape May, 
which lies near the sea-shore of New-Jersey, there 
are three religious societies, among whom the in- 
fluenza prevailed in the year 1790. Its mortality, 
under equal circumstances, was in the exact ratio 
to their vicinity to the sea. The deaths were most 
numerous in that society which was nearest to it, 
and least so in that which was most remote from 
it. These unfriendly effects of the sea air, in the 


above pulmonary diseases, do not appear to be 
produced simply by its moisture. Consumptions 
are scarcely known in the moist atmosphere which 
so generally prevails in Lincolnshire, in England, 
and in the inland parts of Holland and Ireland. 

I shall not pause to inquire, why a mixture of 
land and sea air is so hurtful in the consumption, 
and at the same time so agreeable to persons in 
health, and so medicinal in many other diseases, 
but shall dismiss this head by adding a fact which 
was communicated to me by Dr. Matthew Irvine, 
of South- Carolina, and that is, That those situations 
which are in the neighbourhood of bays or rivers, 
where the salt and fresh waters mix their streams 
together, are more unfavourable to consumptive 
patients than the sea- shore, and therefore should 
be more carefully avoided by them in exchanging 
city for country air. 

3. A change of climate. It is remarkable 
that climates uniformly cold or warm, which sel- 
dom produce consumptions, are generally fatal to 
persons who visit them in that disease. Countries 
between the 30th and 40th degrees of latitude are 
most friendly to consumptive people. 

116 on pulmonary consumption. 

4. Loose dresses, and a careful accom- 

weather. Many facts might be mentioned to 
show the influence of compression and of tight liga- 
tures of every kind, upon the different parts of the 
body; also of too much, or too little clothing, in 
producing, or increasing diseases of every kind, 
more especially those which affect the lungs. Tight 
stays, garters, waistbands, and collars, should alj 
be laid aside in the consumption, and the quality 
of the clothing should be suited to the weather. 
A citizen of Maryland informed me, that he twice 
had a return of a cough and spitting of blood, by 
wearing his summer clothes a week after the wea- 
ther became cool in the month of September. But 
it is not sufficient to vary the weight or quality of 
dress with the seasons. It should be varied with 
the changes which take place in the temperature of 
the air every day, even in the summer months, in 
middle latitudes. I know a citizen of Philadelphia, 
who has laboured under a consumptive diathesis 
near thirty years, who believes that he has lessened 
the frequency and violence of pulmonic complaints 
during that time, by a careful accommodation of 
his dress to the weather. He has been observ- 
ed frequently to change his waistcoat and small 
clothes twice or three times in a day, in a summer 


A repetition of colds, and thereby an increase 
of the disease, will be prevented by wearing flan- 
nel next to the skin in winter, and muslin in the 
summer, either in the form of a shirt or a waist- 
coat : where these are objected to, a piece of flan- 
nel, or of soft sheepskin, should be worn next to 
the breast. They not only prevent colds, but fre- 
quently remove chronic pains from that part of the 

5. Artificial evacuations, by means of 
blisters and issues. I suspect the usefulness 
of these remedies to be chiefly confined to the in- 
flammatory and hectic states of consumption. In 
the typhus state, the system is too weak to sustain 
the discharges of either of them. Fresh blisters 
should be preferred to such as are perpetual, and the 
issues, to be useful, should be large. They are 
supposed to afford relief by diverting a preternatu- 
ral secretion and excretion of mucus or pus from 
the lungs, to an artificial emunctory in a less vital 
part of the body. Blisters do most service when 
the disease arises from repelled eruptions, and when 
they are applied between the shoulders, and the 
upper and internal parts of the arms. When it 
arises from rheumatism and gout, the blisters 
should be applied to the joints, and such Other ex- 


temal parts of the body as had been previously 
affected by those diseases. 

6. Certain fumigations and vapours. An 
accidental cure of a pulmonary affection by the 
smoke of rosin, in a man who bottled liquors, raised 
for a while the credit of fumigations. I have tried 
them, but without much permanent effect. I think 
I have seen the pain in the breast relieved by re- 
ceiving the vapour from a mixture of equal parts 
of tar, bran, and boiling water into the lungs. The 
sulphureous and saline air of Stabiae, between 
Mount Vesuvius and the Mediterranean Sea, and 
the effluvia of the pine forests of Lybia, were sup- 
posed, in ancient times, to be powerful remedies 
in consumptive complaints ; but it is probable, the 
exercise used in travelling to those countries, con- 
tributed chiefly to the cures which were ascribed 
to foreign matters acting upon the lungs. 

7. Lozenges, syrups, and demulcent 
teas. These are too common and too numerous 
to be mentioned. 

8. Opiates. It is a mistake in practice, found- 
ed upon a partial knowledge of the qualities of 
opium, to administer it only at night, or to suppose 
that its effects in composing a cough depend upon 


its inducing sleep. It should be given in small 
doses during the day, as well as in larger ones at 
night. The dose should be proportioned to the 
degrees of action in the arterial system. The less 
this action, the more opium may be taken with 
safety and advantage. 

9. Different positions of the body have 
been found to be more or less favourable to the 
abatement of the cough. These positions should 
be carefully sought for, and the body kept in that 
which procures the most freedom from coughing. 
I have heard of an instance in which a cough, 
which threatened a return of the haemorrhage from 
the lungs, was perfectly composed for two weeks, 
by keeping the patient nearly in one posture in 
bed ; but I have known more cases in which relief 
from coughing w T as to be obtained only by an erect 
posture of the body. 

10. Considerable relief will often be obtained 
from the patient's sleeping between blan- 
kets in winter, and on a mattrass in summer. 
The former prevent fresh cold from night sweats ; 
the latter frequently checks them altogether. In 
cases where a sufficient weight of blankets to keep 
up an agreeable warmth cannot be borne, with- 
out restraining easy and full acts of inspiration. 


the patient should sleep under a light feather bed, 
or an eider down coveilet. Ihey both afford 
more warmth than double or treble their weight of 

However comfortable this mode of producing 
warmth in bed may be, it does not protect the 
lungs from the morbid effects of the distant points 
of temperature of a warm parlour in the day time, 
and a cold bed-chamber at night. To produce an 
equable temperature of air at all hours, I have 
frequently advised my patients, when going to a 
warm climate was not practicable, to pass their 
nights as well as days in an open stove room, in 
which nearly the same degrees of heat were kept 
up at all hours. I have found this practice, in 
several cases, a tolerable substitute for a warm cli- 

11. The moderate use of the lungs, in read- 
ING. The lungs, when debilitated, derive equal 
benefit with the limbs, or other parts of the body, 
from moderate exercise. I have mentioned, in an- 
other place*, several facts which support this opi- 

* An Account of the Effects of Common Salt in the Cure 
of Haemoptysis. 


siion. But too much pains cannot be taken to in- 
culcate upon our patients to avoid all excess in the 
use of the lungs, by long, or loud reading, speak- 
ing, or singing, or by sudden and violent bursts of 
laughter. I shall long lament the death of a fe- 
male patient, who had discovered many hopeful 
signs of a recovery from a consumption, who re- 
lapsed, and died, in consequence of bursting a 
blood-vessel in her lungs, by a sudden fit of laugh- 

12. Are there any advantages to be derived 
from the excitement of certain passions in the 
treatment of consumptions ? Dr. Blane tells us, 
that many consumptive persons were relieved, and 
that some recovered, in consequence of the terror 
which was excited by a hurricane in Barbadoes, 
in the year 1780. It will be difficult to imitate, 
by artificial means, the accidental cures which are 
recorded by Dr. Blane ; but we learn enough 
from them to inspire the invigorating passions of 
hope and confidence in the minds of our patients, 
and to recommend to them such exercises as pro- 
duce exertions of body and mind analogous to 
those which are produced by terror. Van Sweiten 
and Smollet relate cures of consumptions, by pa- 
tients falling into streams of cold water. Perhaps, 
in both instances, the cures were performed only 

VOL. II. o^ 


by the fright and consequent exertion produced by 
the fall. This is only one instance out of many 
which might be mentioned, of partial and unequal 
action being suddenly changed into general and 
equal excitement in every part of the system. The 
cures of consumptions which have been performed 
by a camp life*, have probably been much assist- 
ed by the commotions in the passions which were 
excited by the various and changing events of wan 

13. A salivation has lately been prescribed 
in this disease with success. An accident first 
suggested its advantages, in the Pennsylvania hos- 
pital, in the year 1800f . Since that time, it has 
performed many cures in different parts of the 
United States. It is to be lamented, that in a ma- 
jority of the cases in which the mercury has been 
given, it has failed of exciting a salivation. Where 


it affects the mouth, it generally succeeds in re- 
cent cases, which is more than can be said of any, 
or of all other remedies in this disease. In its 
hectic state, a salivation frequently cures, and even 
in its typhus and last stage, I have more than once 
prescribed it with success. The same regard to 
the pulse should regulate the use of this new reme- 

* Vol. I. p. 204. 

t Medical Repository of New-York. Vol. V. 


dy in consumption, that has been recommended in 
other febrile diseases. It should never be advised 
until the inflammatory diathesis of the system has 
been in a great degree reduced, by the depleting 
remedies formerly mentioned. 

During the use of the above remedies, great care 
should be taken to relieve the patient from the in- 
fluence of all those debilitating and irritating causes 
which induced the disease. I shall say elsewhere 
that decayed teeth are one of them. These should 
be extracted where there is reason to suspect they 
have produced, or that they increase the disease. 

I have hitherto said nothing of the digitalis as a 
palliative remedy in pulmonary consumption. I 
am sorry to acknowledge that, in many cases in 
which I have prescribed it, it has done no good, 
and in some it has done harm. From the oppo- 
site accounts of physicians of the most respectable 
characters of the effects of this medicine, I have 
been inclined to ascribe its different issues, to a dif- 
ference in the soil in which it has been cultivated, 
or in the times of gathering, or in the manner of 
preparing it, all of which we know influence the 
qualities of many other vegetables. If the theory 
of consumption which I have endeavoured to esta- 
blish be admitted, that uncertain and unsafe medi- 


cine will be rendered unnecessary by the remedies 
that have been enumerated, provided they are ad- 
ministered at the times, and in the manner that has 
been recommended. 

Before t proceed to speak of the radical cure 
of the consumption, it will be necessary to observe, 
that by means of the palliative remedies which 
have been mentioned, many persons have been re- 
covered, and some have had their lives prolonged 
by them for many years ; but in most of these 
cases I have found, upon inquiry, that the disease 
recurred as soon as the patient left off the use of 
his remedies, unless they were followed by neces- 
sary or voluntary exercise. 

It is truly surprising to observe how long some 
persons have lived who have been affected by a 
consumptive diathesis, and by frequent attacks of 
many of the most troublesome symptoms of this 
disease. Van Sweiten mentions the case of a man, 
who had lived thirty years in this state. Morton 
relates the history of a man, in whom the symp- 
toms of consumption appeared with but little varia- 
tion or abatement from his early youth till the 70th 
year of his age. The widow of the celebrated Se- 
nac lived to be 84 years of age, thirty of which 
she passed in a pulmonary consumption. Dr. Ni-. 

? ; 


cols was subject to occasional attacks of this dis- 
ease during his whole life, and he lived to be above 
eighty years of age. Bennet says he knew an in- 
stance in which it continued above sixty years. I 
prescribed for my first pupil, Dr. Edwards, in a 
consumption in the year 1769. He lived until 
1802, and seldom passed a year without spitting- 
blood, nor a week without a cough, during that long 
interval of time. The fatal tendency of his disease 
was constantly opposed by occasional blood-letting, 
rural exercises, a cordial, but temperate diet, the 
Peruvian bark, two sea voyages, and travelling in 
foreign countries. There are besides these instan- 
ces of long protracted consumptions, cases of it 
which appear in childhood, and continue for many 
years". I have seldom known them prove fatal under 

I am led here to mention another instance of the 
analogy between pneumony and the pulmonary 
consumption. We often see the same frequency 
of recurrence of both diseases in habits which 
are predisposed to them. I have attended a Ger- 
man citizen of Philadelphia, in several fits of the 
pneumony, who has been confined to his bed eight- 
and-twenty times, by the same disease, in the 
course of the same number of years. He has, for 
the most part, enjoyed good health in the inter- 


vals of those attacks, and always appeared, till 
lately, to possess a good constitution. In the cases 
of the frequent recurrence of pneumony, no one 
has suspected the disease to have originated exclu- 
sively in a morbid state of the lungs ; on the con- 
trary, it appears evidently to be produced by the 
sudden influence of the same causes, which, by 
acting with less force, and for a longer time, pro- 
duce the pulmonary consumption. The name of 
pneumony is taken from the principal symptom of 
this disease, but it as certainly belongs to the whole 
arterial system as the consumption ; and I add fur- 
ther, that it is as certainly produced by general 
predisposing debility. The hardness and fulness 
of the pulse do not militate against this assertion, 
for they are altogether the effects of a morbid and 
convulsive excitement of the sanguiferous system. 
The strength manifested by the pulse is moreover 
partial, for every other part of the body discovers, 
at the same time, sisrns of extreme debilitv. 

It would be easy, by pursuing this subject a 
little further, to mention a number of facts which, 
by the aid of principles in physiology and patho- 
logy, which are universally admitted, would open 
to us a new theory of fevers, but this would lead 
us too far from the subject before us. I shall 
only remark, that ail that has been said of the 


influence of general debilitating causes upon the 
lungs, both in pneumony and consumption, and 
of the alternation of the consumption with other 
general diseases, will receive great support from 
considering the lungs only as a part of the whole 
external surface of the body, upon which most of 
the remote and exciting causes of both diseases 
produce their first effects. This extent of the sur- 
face of the body, not only to the lungs, but to 
the alimentary canal, was first taken notice of by 
Dr. Boerhaave ; but was unhappily neglected by 
him in his theories of the diseases of the lungs and 
bowels. Dr. Keil supposes that the lungs, from 
the peculiar structure of the bronchial vessels, and 
air vesicles, expose a surface to the action of the 
air, equal to the extent of the whole external and 
visible surface of the body. 

Thus have I mentioned the usual palliative re- 
medies for the consumption. Many of these re- 
medies, under certain circumstances, I have said 
have cured the disease, but I suspect that most of 
these cures have taken place only when the disease 
has partaken of an intermediate nature between a 
pneumony and a true pulmonary consumption. 
Such connecting shades, appear between the ex- 
treme points of many other diseases. In a former 


essay*, I endeavoured to account for the transnlu* 
tation (if I may be allowed the expression) of the 
pneumony into the consumption, by ascribing it to 
the increase of the debilitating refinements of civi- 
lized life. This opinion has derived constant sup- 
port from every observation I have made connected 
with this subject, since its first publication, in the 
year 1772. 

I come now to treat of the radical remedies 
for the pulmonary consumption. 

In an essay formerly alluded tof , I mentioned 
the effects of labour, and the hardships of a camp 
or naval life, upon this disease. As there must 
frequently occur such objections to each of those 
remedies, as to forbid their being recommended or 
adopted, it will be necessary to seek for substitutes 
for them in the different species of exercise. These 
are, active, passive, and mixed. The active in- 
cludes walking, and the exercise of the hands and 
feet in working or dancing. The passive includes 
rocking in a cradle, swinging, sailing, and riding 

* Inquiry into the Diseases and Remedies of the Indians 
of North-America ; and a comparative view of their diseases 
and remedies with those of civilized nations. Vol. I. 

t Thoughts on the Pulmonary Consumption. Vol. I. 


in carriages of different kinds. The mixed is con- 
fined chiefly to riding on horseback. 

I have mentioned all the different species of ex- 
ercise, not because I think they all belong to the 
class of radical remedies for the consumption, but 
because it is often necessary to use those which are 
passive, before we recommend those of a mixed or 
active nature. That physician does not err more 
who advises a patient to take physic, without spe- 
cifying its qualities and doses, than the physician 
does who advises a patient, in a consumption, to 
use exercise, without specifying its species and de- 
grees. From the neglect of this direction, we 
often find consumptive patients injured instead of 
being relieved by exercises, which, if used with 
judgment, might have been attended with the hap- 
piest effects. 

I have before suggested that the stimulus of 
every medicine, which is intended to excite action 
in the system, should always be in an exact ratio to 
its excitability. The same rule should be applied 
to the stimulus of exercise. I have heard a well- 
attested case of a young lady, upon whose con- 
sumption the first salutary impression was made by 
rocking her in a cradle ; and I know another case 
in which a young lady, in the lowest state of that 

VOL. II. R x 


debility which precedes an affection of the lungs, 
was prepared for the use of the mixed and active 
exercises, by being first moved gently backwards 
and forwards in a chariot without horses, for an 
hour every day. Swinging appears to act in the 
same gentle manner. In the case of a gardener, 
who was far advanced in a consumption > in the 
Pennsylvania hospital, I had the pleasure of observ- 
ing its good effects, in an eminent degree. It so 
far restored him, as to enable him to complete his 
recovery by working at his former occupation. 

In cases of extreme debility, the following or- 
der should be recommended in the use of the dif- 
ferent species of exercise. 

1. Rocking in a cradle, or riding on an elastic 
board, commonly called a chamber-horse. 

2. Swinging. 

3. Sailing. 

4. Riding in a carriage,. 

5. Riding on horseback. 

6. Walking. 


7. Running and dancing. 

In the use of each of those species of exercise 
great attention should be paid to the degree or force 
of action with which they are applied to the body. 
For example, in riding in a carriage, the exercise 
will be less in a four-wheel carriage than in a single 
horse chair, and less when the horses move in a 
walking, than a trotting gait. In riding on horse- 
back, the exercise will be less or greater according 
as the horse walks, paces, canters, or trots, in pas- 
sing over the ground. 

I have good reason to believe, that an English 
sea-captain, who was on the verge of the grave 
with the consumption, in the spring of the year 
1790, owed his perfect recovery to nothing but the 
above gradual manner, in which, by my advice, he 
made use of the exercises of riding in a carriage 
and on horseback. I have seen many other cases 
of the good effects of thus accommodating exer- 
cise to debility ; and I am sorry to add, that I have 
seen many cases in which, from the neglect of 
this manner of using exercise, most of the species 
and degrees of it, have either been useless, or done 
harm. However carelessly this observation may 
be read by physicians, or attended to by patients, 
I conceive no direction to be more necessarv in the 


cure of consumptions. I have been thus particular 
in detailing it, not only because I believe it to be 
important, but that I might atone to society for 
that portion of evil which I might have prevented 
by a more strict attention to it in the first years of 
my practice. 

The more the arms are used in exercise the 
better. One of the proprietary governors of Penn- 
sylvania, who laboured for many years under a 
consumptive diathesis, derived great benefit from 
frequently rowing himself in a small boat, a few 
miles up and down the river Schuylkill. Two 
young men, who were predisposed to a consump- 
tion, were perfectly cured by working steadily at a 
printing press in this city. A French physician in 
Martinique cured this disease, by simply rubbing 
the arms between the shoulders and the elbows, 
until they inflamed. The remedy is strongly re- 
commended, by the recoveries from pulmonary 
consumption which have followed abscesses in the 
arm-pits. Perhaps the superior advantages of rid- 
ing on horseback, in this disease, may arise in part 
from the constant and gentle use of the arms in the 
management of the bridle and the whip. 

Much has been said in favour of sea voyages in 
consumptions. In the mild degrees of the disease 


they certainly have done service, but I suspect the 
relief given, or the cures performed by them, 
should be confined chiefly to seafaring people, who 
add to the benefits of a constant change of pure 
air, a share of the invigorating exercises of navigat- 
ing the ship. I have frequently heard of consump- 
tive patients reviving at sea, probably from the 
transient effects of sea sickness upon the whole 
system, and growing worse as soon as they came 
near the end of their voyage. It would seem as if 
the mixture of land and sea airs was hurtful to the 
lungs, in every situation and condition in which it 
could be applied to them. Nor are the peculiar 
and morbid effects of the first operation of land and 
sea airs upon the human body, in sea voyages, con- 
fined only to consumptive people. I crossed the 
Atlantic ocean, in the year 1766, with a sea captain, 
who announced to his passengers the agreeable 
news that we were near the British coast, before 
any discovery had been made of our situation by 
sounding, or by a change in the colour of the wa- 
ter. Upon asking him upon what he founded his 
opinion, he said, that he had been sneezing, which, 
he added, was the sign of an approaching cold, 
and that, in the course of upwards of twenty years, 
he had never made the land (to use the seaman's 
phrase) without being affected in a similar manner. 
I have visited many sick people in Philadelphia, 


soon after their arrival from sea, who have inform- 
ed me, that they had enjoyed good health during 
the greatest part of their voyage, and that they had 
contracted their indispositions after they came with- 
in sight of the land. I mention these facts only to 
show the necessity of advising consumptive pa- 
tients, who undertake a sea voyage for the recovery 
of their health, not to expose themselves upon deck 
in the morning and at night, after they arrive with- 
in the region in which the mixture of the land and 
sea airs may be supposed to take place. 

I subscribe, from what I have observed, to the 
bold declaration of Dr. Sydenham, in favour of 
the efficacy of riding on horseback, in the cure of 
consumption. I do not think the existence of an 
abscess, when broken, or even tubercles in the 
lungs, when recent, or of a moderate size, the least 
objection to the use of this excellent remedy. An 
abscess in the lungs is not necessarily fatal, and 
tubercles have no malignity in them which should 
render their removal impracticable by this species 
of exercise. The first question, therefore, to be 
asked by a physician who visits a patient in this 
disease should be, not what is the state of his lungs, 
but, is he able to ride on horseback-. 


There are two methods of riding for health in 
this disease. The first is by short excursions; 
the second is by long journies. In slight con- 
sumptive affections, and after a recovery from an 
acute illness, short excursions are sufficient to re- 
move the existing debility ; but in the more ad- 
vanced stages of consumption, they are seldom ef- 
fectual, and frequently do harm, by exciting an 
occasional appetite without adding to the digestive 
powers. They, moreover, keep the system con- 
stantly vibrating by their unavoidable inconstancy, 
between distant points of tone and debility*, and 
they are unhappily accompanied at all times, from 
the want of a succession of fresh objects to divert 
the mind, by the melancholy reflection that they 
are the sad, but necessary conditions of life. 

In a consumption of long continuance or of 
great danger, long journies on horseback are the 
most effectual modes of exercise. They afford a 
constant succession of fresh objects and company, 
which divert the mind from dwelling upon the dan- 
ger of the existing malady ; they are moreover at- 
tended by a constant change of air, and they are 
not liable to be interrupted by company, or transi- 

* The bad effects of inconstant, exercise have been taken 
notice of in the gout. Dr. Sydenham says, when it is used 
only by fits and starts in this disease, it does harm. 


ent changes in the weather, by which means ap- 
petite and digestion, action and power, all keep 
pace with each other. It is to be lamented that 
the use of this excellent remedy is frequently op- 
posed by indolence and narrow circumstances in 
both sexes, and by the peculiarity of situation and 
temper in the female sex. Women are attached 
to their families by stronger ties than men. They 
cannot travel alone. Their delicacy, which is in- 
creased by sickness, is liable to be offended at every 
stage ; and, lastly, they sooner relax in their ex- 
ertions to prolong then' lives than men. Of the 
truth of the last observation, sir William Hamil- 
ton has furnished us with a striking illustration. 
He tells us, that in digging into the ruins pro- 
duced by the late earthquake in Calabria, the wo- 
men who perished in it, were all found with their 
arms folded, as if they had abandoned themselves 
immediately to despair and death ; whereas, the 
men were found with their arms extended, as if 
they had resisted their fate to the last moment of 
their lives. It would seem, from this fact, and 
many others of a similar nature which might be re- 
lated, that a capacity of bearing pain and distress 
with fortitude and resignation, was the distinguish- 
ing characteristic of the female mind ; while a dis- 
position to resist and overcome evil, belonged in a 
more pecuiLr manner to the mind of man. I have 


mentioned this peculiarity of circumstances and 
temper in female patients, only for the sake of con- 
vincing physicians that it will be necessary for them 
to add all the force of eloquence to their advice, 
when they recommend journies to women in pre- 
ference to all other remedies, for the recovery of 
their health. 

Persons, moreover, who pursue active employ- 
ments, frequently object to undertaking journies, 
from an opinion that their daily occupations are 
sufficient to produce all the salutary effects we ex- 
pect from artificial exercise. It will be highly ne- 
cessary to correct this mistake, by assuring such 
persons that, however useful the habitual exercise 
of an active, or even a laborious employment may 
be to preserve health, it must always be exchanged 
for one which excites new impressions, both upon 
the mind and body, in every attempt to restore the 
system from that debility which is connected with 
pulmonary consumption. 

As travelling is often rendered useless, and even 
hurtful in this disease, from being pursued in an 
improper manner, it will be necessary to furnish 
our patients with such directions as will enable 
them to derive the greatest benefit from their jour- 
nies. I shall, therefore, in this place, mention the 



substance of the directions which I have given in 
writing for many years to such consumptive patients 
as undertake journies by my advice. 

1. To avoid fatigue. Too much cannot be said 
to enforce this direction. It is the hinge on which 
the recovery or death of a consumptive patient 
frequently turns. I repeat it again, therefore, that 
patients should be charged over and over when 
they set off on a journey, as well as when they use 
exercise of any kind, to avoid fatigue. For this 
purpose they should begin by travelling only a few 
miles in a day, and increase the distance of their 
stages, as they increase their strength. By neglect- 
ing this practice, many persons have returned from 
journies much worse than when they left home, 
and many have died in taverns, or at the houses of 
their friends on the road. Travelling in stage- 
coaches is seldom safe for a consumptive patient, 
They are often crowded ; they give too much mo- 
tion ; and they afford by their short delays and dis- 
tant stages, too little time for rest, or for taking the 
frequent refreshment which was formerly recom- 

2. To avoid travelling too soon in the morning, 
•and after the going down of the sun in the evening, 
and, if the weather be hot, never to travel in the 


middle of the day. The sooner a patient break- 
fasts after he leaves his bed the better ; and in no 
case should he leave his morning stage with an 
empty stomach. 

3. If it should be necessary for a patient to lie 
down, or to sleep in the day time, he should be 
advised to undress himself, and to cover his body 
between sheets or blankets. The usual ligatures 
of garters, stocks, knee-bands, waistcoats, and 
shoes, are very unfriendly to sound sleep ; hence 
persons who lie down with their clothes on, often 
awake from an afternoon's nap in terror from 
dreams, or in a profuse sweat, or with a head-ach 
or sick stomach ; and generally out of humour. 
The surveyors are so sensible of the truth of this 
remark, that they always undress themselves when 
they sleep in the woods. An intelligent gentle- 
man of this profession informed me, that he had 
frequently seen young woodsmen, who had refused 
to conform to this practice, so much indisposed hi 
the morning, that, after the experience of a few 
nights, they were forced to adopt it. 

Great care should be taken in sleeping, whe- 
ther in the day time or at night, never to lie down 
in damp sheets. Dr. Sydenham excepts the dan- 
ger from this quarter,, when he speaks of the ef- 


ficacy of travelling on horseback in curing the con- 

4. Patients who travel for health in this dis- 
ease should avoid all large companies, more espe- 
cially evening and night parties. The air of a 
contaminated room, phlogisticated by the breath of 
fifteen or twenty persons, and by the same number 
of burning candles, is poison to a consumptive pa- 
tient. To avoid impure air from every other 
source, he should likewise avoid sleeping in a 
crowded room, or with curtains around his bed, 
and even with a bed-fellow. 

5. Travelling, to be effectual in this disease, 
should be conducted in such a manner as that a 
patient may escape the extremes of heat and cold. 
For this purpose he should pass the winter, and 
part of the spring, in Georgia or South- Caro- 
lina, and the summer in New- Hampshire, Massa- 
chusetts, or Vermont, or, if he pleases, he may 
still more effectually shun the summer heats, by 
crossing the lakes, and travelling along the shores 
of the St. Laurence to the city of Quebec. He 
will thus escape the extremes of heat and cold, par- 
ticularly the less avoidable one of heat ; for I have 
constantly found the hot month of July to be as 
unfriendly to consumptive patients in Pennsylva- 


nia, as the variable month of March. By these 
means too he will enjoy nearly an equable tempe- 
rature of air in every month of the year ; and his 
system will be free from the inconvenience of the 
alternate action of heat and cold upon it. The 
autumnal months should be spent in New-Jersey 
or Pennsylvania. 

In these journies from north to south, or from 
south to north, he should be careful, for reasons 
before mentioned, to keep at as great a distance as 
possible from the sea coast. Should this inquiry 
fall into the hands of a British physician, I would 
beg leave to suggest to him, whether more advan- 
tages would not accrue to his consumptive patients 
from advising them to cross the Atlantic ocean, 
and afterwards to pursue the tour which I have 
recommended, than by sending them to Portugal, 
France, or Italy. Here they will arrive with such 
a mitigation of the violence of the disease, in con- 
sequence of the length of their sea voyage, as will 
enable them immediately to begin their journies 
on horseback. Here they will be exposed to fewer 
temptations to intemperance, or to unhealthy 
amusements, than in old European countries. 
And, lastly, in the whole course of this tour, they 
wili travel among a people related to them by 
a sameness of language and manners, and by an- 


cient or modern ties of citizenship. Long jour- 
nies for the recovery of health, under circumstances 
so agreeable, should certainly be preferred to tra- 
velling among strangers of different nations, lan- 
guages, and manners, on the continent of Europe. 

6. To render travelling on horseback effectual 
in a consumption, it should be continued with mo- 
derate intervals from six to twelve months. But 
the cure should not be rested upon a single jour- 
ney. It should be repeated every two or three years , 
till our patient has passed the consumptive stages 
of life. Nay, he must do more ; he must acquire 
a habit of riding constantly, both at home and 
abroad ; or, to use the words of Dr. Fuller, " he 
" must, like a Tartar, learn to live on horseback, 
6C by which means he will acquire in time the con- 
Ut stitution of a Tartar*." 

Where benefit is expected from a change of cli- 
mate, as well as from travelling, patients should 
reside at least two years in the place which is chosen 
for that purpose. I have seldom known a resi- 
dence for a shorter time in a foreign climate do 
much service. 

* Medicina Gymnastica, p. 1 16. 


To secure a perfect obedience to medical advice, 
it would be extremely useful if consumptive pa- 
tients could always be accompanied by a physician. 
Celsus says, he found it more easy to cure the 
dropsy in slaves than in freemen, because they 
more readily submitted to the restraints he im- 
posed upon their appetites. Madness has become 
a curable disease in England, since the physicians 
of that country have opened private mad-houses, 
and have taken the entire and constant direction of 
their patients into their own hands. The same 
successful practice would probably follow the treat- 
ment of consumptions, if patients were constantly 
kept under the eye and authority of their physi- 
cians. The keenness of appetite, and great stock 
of animal spirits, which those persons frequently 
possess, hurry them into many excesses which de- 
feat the best concerted plans of a recovery ; or, if 
they escape these irregularities, they are frequently 
seduced from our directions by every quack reme- 
dy which is recommended to them. Unfortunately 
die cough becomes a signal of their disease, at 
every stage of their journey, and the easy or plea- 
sant prescriptions of even hostlers and ferrymen, 
are often substituted to the self-denial and exertion 
which have been imposed by physicians. The 
love of life in these cases seems to level all capaci- 
ties ; for I have observed persons of the most cul- 


tivated understandings to yield in common with the 
vulgar, to the use of these prescriptions. 

In a former volume I mentioned the good effects 
of accidental labour in pulmonary consumptions, 
The reader will find a particular account in the first 
volume of Dr. Coxe's Medical Museum, of a cler- 
gyman and his wife, in Virginia, being cured by 
the voluntary use of that remedy. 

The following circumstances and symptoms, in- 
dicate the longer or shorter duration of this disease, 
and its issue in life and death : 

The consumption from gout, rheumatism, and 
scrophula, is generally of long duration. It is 
more rapid in its progress to death, when it arises 
from a half cured pleurisy, or neglected colds, 
measles, and influenza. It is of shorter duration 
in persons under thirty, than in those who are more 
advanced in life. 

It is always dangerous in proportion to the length 
of time, in which the debilitating causes, that pre- 
disposed to it, have acted upon the body. 


It is more dangerous when a predisposition to it 
has been derived from ancestors, than when it has 
been acquired. 

It is generally fatal when accompanied with a bad 
conformation of the breast. 

Chilly fits occurring in the forenoon, are more 
favourable than when they occur in the evening. 
They indicate the disease to partake a little of the 
nature of an intermittent, and are a call for the use 
of the remedies proper in that disease. 

Rheumatic pains, attended with an abatement of 
the cough, or pains in the breast, are always favour- 
able; so are 

Eruptions, or an abscess on the external parts of 
the body, if they occur before the last stage of the 

A spitting of blood, in the early, or forming stage 
of the disease, is favourable, but after the lungs be- 
come much obstructed, or ulcerated, it is most 
commonly fatal. 

A pleurisy, occurring in the low state of the dis- 
ease, generally kills, but I have seen a case in 

VOL. II. t 


which it suddenly removed the cough and hectic 
fever, and thus became the means of prolonging 
the patient's life for several years. 

The discharge of calculi from the lungs by 
coughing and spitting, and of a thin watery liquid, 
with a small portion of pus swimming on its sur- 
face, are commonly signs of an incurable consump- 

No prediction unfavourable to life can be drawn 
from pus being discharged from the lungs. We 
see many recoveries after it has taken place, and 
many deaths where that symptom has been ab- 
sent. Large quantities of pus are discharged in 
consumptions attended with abscesses, and yet few 
die of them, where they have not been preceded 
by long continued debility of the whole system. 
No pus is expectorated from tubercles, and how 
generally fatal is the disease, after they are formed 
in the lungs ! It is only after they ulcerate that 
they discharge pus, and it is only after ulcers 
are thus formed, that the consumption probably 
becomes uniformly fatal. I suspect these ulcers 
are sometimes of a cancerous nature. 

A sudden cessation of the cough, without a su- 
pervening diarrhoea, indicates death to be at hand. 


A constant vomiting in a consumption, is gene- 
rally a bad sign. 

Feet obstinately cold, also a swelling of the feet 
during the day, and of the face in the night, com- 
monly indicate a speedy and fatal issue of the dis- 

Lice, and the falling off of the hair, often precede 

A hoarseness, in the beginning of the disease, is 
always alarming, but it is more so in its last stage. 

A change of the eyes from a blue, or dark, to a 
light colour, similar to that which takes place in 
very old people, is a sign of speedy dissolution. 

I have never seen a recovery after an apthous 
sore throat took place. 

Death from the consumption comes on in some 
or more than one, of the following ways : 

1. With a diarrhoea. In its absence, 

2. With wasting night sweats, 


3. A rupture of an abscess. 

4. A rupture of a large blood-vessel in the lungs, 
attended with external or internal haemorrhage. 
Sudden and unexpected death in a consumption is 
generally induced by this, or the preceding cause. 

5. Madness. The cough and expectoration 
cease with this disease. It generally carries off the 
patient in a week or ten days. 

6. A pleurisy, brought on by exposure to cold. 

7. A typhus fever, attended with tremors, twitch- 
mgs of the tendons, and a dry tongue. 

8. Swelled hands, feet, legs, thighs, and face. 

£. An apthous sore throat. 

10. Great and tormenting pains, sometimes of a 
spasmodic nature in the limbs. 

In a majority of the fatal cases of consumption, 
which I have seen, the passage out of life has been 
attended with pain ; but I have seen many persons 
die with it, in whom all the above symptoms were 
so lenient, or so completely mitigated by opium, 


that death resembled a quiet transition from a wak- 
ing, to a sleeping state. 

I cannot conclude this inquiry without adding, 
that the author of it derived from his paternal an- 
cestors a predisposition to the pulmonary consump- 
tion, and that between the 18th and 43d years of 
his age, he has occasionally been afflicted with 
many of the symptoms of that disease which he 
has described. By the constant and faithful use 
of many of the remedies which he has recommend- 
ed, he now, in the 61st year of his age, enjoys 
nearly an uninterrupted exemption from pulmonary 
complaints. In humble gratitude, therefore, to 
that Being, who condescends to be called the pre- 
server of men, he thus publicly devotes this result 
of his experience and inquiries to the benefit of such 
of his fellow-creatures as may be afflicted with the 
same disease, sincerely wishing that they may be 
as useful to them, as they have been to the author, 







WHETHER we admit the exhaling and 
absorbing vessels to be affected in general dropsies 
by preternatural debility, palsy, or rupture, or by 
a retrograde motion of their fluids, it is certain that 
their exhaling and absorbing power is materially 
affected by too much, or too little action in the 
arterial system. That too little action in the arte- 
ries should favour dropsical effusions, has been 
long observed ; but it has been less obvious, that 
the same effusions are sometimes promoted, and 
their absorption prevented, by too much action in 
these vessels. That this fact should have escaped 
our notice is the more remarkable, considering how 
long we have been accustomed to seeing serous 
swellings in the joints in the acute rheumatism, 
and copious, but partial effusions of water in the 
voe. ir. u 


form of sweat, in every species of inflammatory 

It is nothing new that the healthy action of one 
part, should depend upon the healthy action of 
another part of the system. We see it in many of 
the diseases of the nerves and brain. The tetanus 
is cured by exciting a tone in the arterial system ; 
madness is cured by lessening the action of the ar- 
teries by copious blood-letting; and epilepsy and 
hysteria are often mitigated by the moderate use 
of the same remedy. 

By too much action in the arterial system, I 
mean a certain morbid excitement in the arteries, 
accompanied by preternatural force, which is ob- 
vious to the sense of touch. It differs from the 
morbid excitement of the arteries, which takes 
place in common inflammatory fevers, in being at- 
tended by less febrile heat, and with little or no 
pain in the head or limbs. The thirst is nearly 
the same in this state of dropsy, as in inflammatory 
fevers. I include here those dropsies only in 
which the whole system is affected by what is called 
a hydropic diathesis. 

That debility should, under certain circum- 
stances, dispose to excessive action, and that exces- 


sive action should occur in one part of the body, 
at the same time that debility prevailed in every 
other, are abundantly evident from the history and 
phenomena of many diseases. Inflammatory fe- 
ver, active haemorrhages, tonic gout, asthma, apo- 
plexy, and palsy, however much they are accom- 
panied by excessive action in the arterial system, 
are always preceded by original debility, and are 
always accompanied by obvious debility in every 
other part of the system. 

But it has been less observed by physicians that 
an undue force or excess of action occurs in the 
arterial system in certain dropsies, and that the 
same theory which explains the union of predis- 
posing and nearly general debility, with a partial 
excitement and preternatural action in the arterial 
system, in the diseases before- mentioned, will ex- 
plain the symptoms and cure of certain dropsies. 

That debility predisposes to every state of 
dropsy, is evident from the history of all the re- 
mote and occasional causes which produce them. 
It will be unnecessary to mention these causes, as 
they are to be found in all our systems of physic. 
Nor will it be necessary to mention any proofs of 
the existence of debility in nearly every pail of the 
body. It is too plain to be denied. I shall only 


mention the symptoms which indicate a morbid 
excitement and preternatural action of the arterial 
system. These are, 

1. A hard, full, and quick pulse. This symp- 
tom, I believe, is more common in dropsies than 
is generally supposed, for many physicians visit 
and examine patients in these diseases, without 
feeling the pulse. Dr. Home mentions the fre- 
quency of the pulse, in the patients whose cures 
he has recorded*, but he takes no notice of its 
force except in two cases. Dr. Zimmerman, in 
his account of the dropsy which terminated the life 
of Frederick II, of Prussia, tells us that he found 
his pulse hard and full. I have repeatedly found 
it full and hard in every form of dropsy, and more 
especially in the first stage of the disease. Indeed 
I have seldom found it otherwise in the beginning 
of the dropsy of the breast. 

2. Sizy blood. This has been taken notice of 
by many practical writers, and has very justly been 
ascribed, under certain circumstances of blood-let- 
ting, to an excessive action of the vessels upon the 

* Medical Facts. 


3. Alternation of dropsies 'with certain diseases 
which were evidently accompanied by excess of ac- 
tion in the arterial system, I have seen anasarca al- 
ternate with vertigo, and both ascites and anasarca 
alternate with tonic madness. A case of nearly 
the same kind is related by Dr. Mead. Dr. 
Grimes, of Georgia, informed me that he had seen 
a tertian fever, in which the intermissions were at- 
tended with dropsical swellings all over the body, 
which suddenly disappeared in every accession of 
a paroxysm of the fever. 

4. The occasional connection of certain dropsies 
with diseases evidently of an inflammatory nature \ 
particularly pneumony, rheumatism, and gout. 

5. Spontaneous hemorrhages from the lungs, 
hsemorrhodial vessels, and nose, cases of which 
shall be mentioned hereafter, when we come to 
treat of the cure of dropsies. 

6. The appearance of dropsies in the winter and 
spring, in habits previously affected by the intermit- 
ting fever. The debility produced by this state 
of fever, frequently disposes to inflammatory dia- 
thesis, as soon as the body is exposed to the alter- 
nate action of heat and cold, nor is this innamma- 
torv diathesis alwavs laid aside, bv the transition 


of the intermitting fever into a dropsy, in the sue- 
ceeding cold weather. 

7. The injurious effects of stimulating medicines 
in certain dropsies, prove that there exists in them, 
at times, too much action in the blood-vessels. 
Dr. Tissot, in a letter to Dr. Haller, " De Vario- 
" lis, apoplexia, et hydrope," condemns, in strong 
terms, the use of opium in the dropsy. Now the 
bad effects of this medicine in dropsies, must have 
arisen from its having been given in cases of too 
much action in the arterial system ; for opium, we 
know, increases, by its stimulating qualities, the 
action and tone of the blood-vessels, and hence we 
find, it has been prescribed with success in drop- 
sies of too little action in the system. 

8. The termination of certain fevers in dropsies 
in which blood-letting was not used. This has 
been ascertained by many observations. Dr. 
Wilkes relates*, that after " an epidemical fever, 
which began in Kidderminster, in 1728, and soon 
afterwards spread, not only over Great Britain, but 
all Europe, more people died dropsical in three 
years, than did perhaps in twenty or thirty years 

* Historical Essay on the Dropsy, p. 326. 



before," probably from the neglect of bleeding in 
the fever. 

But the existence of too much action in the 
arterial system in certain dropsies, will appear more 
fully from the history of the effects of the remedies 
which have been employed either by design or ac- 
cident in the cure of these diseases. I shall first 
mention the remedies which have been used with 
success in tonic or inflammatory dropsies ; and 
afterwards mention those which have been given 
with success in dropsies of a weak action in the 
arteries. I have constantly proposed to treat only 
of the theory and cure of dropsies in general, with- 
out specifying any of the numerous names it de- 
rives from the different parts of the body in which 
they may be seated ; but in speaking of the reme- 
dies which have been used with advantage in both 
the tonic and atonic states, I shall occasionally men- 
tion the name or seat of the dropsy in which the 
remedy has done service. 

The first remedy that I shall mention for drop- 
sies is blood-letting. Dr. Hoffman and Dr. Home 
both cured dropsies accompanied by pulmonic con- 
gestion by means of this remedy. Dr. Monroe 
quotes a case of dropsy from Sponius, in which 
bleeding succeeded, but not till after it had been 


used twenty times*. Mr. Cruikshank relates a 
casef of accidental bleeding, which confirms the 
efficacy of blood-letting in these diseases. He 
tells us that he attended a patient with dropsical 
swellings in his legs, who had had a hoarseness 
for two years. One morning, in stooping to buckle 
his shoes, he bursted a blood-vessel in his lungs, 
from which he lost a quart of blood ; in conse- 
quence of which, both the swellings and the hoarse- 
ness went off gradually, and he continued well two 
years afterwards. I have known one case in which 
spontaneous haemorrhages from the haemorrhodial 
vessels, and from the nose, suddenly reduced uni- 
versal dropsical swellings. In this patient there 
had been an uncommon tension and fulness in the 

I could add the histories of many cures of ana- 
sarca and ascites, performed by means of blood- 
letting, not only by myself, but by a number of 
respectable physicians in the United States. In- 
deed I conceive this remedy to be as much indi- 
cated by a tense and full pulse in those forms of 
dropsy, as it is in a pleurisy, or in any other com- 
mon inflammatory disease. 

* Treatise on the Dropsy. 

f Treatise on the Lymphatics. 


In those deplorable cases of hydrothorax, which 
do not admit of a radical cure, I have given tem- 
porary relief, and thereby protracted life, by taking 
away occasionally a few ounces of blood. Had 
Dr. Zimmerman used this remedy in the case of 
the king of Prussia, I cannot help thinking from 
the account which the doctor gives us of the diet 
and pulse of his royal patient, that he would have 
lessened his sufferings much more than by plenti- 
ful doses of dandelion ; for I take it for granted, 
from the candour and integrity which the doctor 
discovered in all his visits to the king, that he did 
not expect that dandelion, or any other medicine, 
would cure him. 

Although a full and tense pulse is always an 
indication of the necessity of bleeding ; yet I can 
easily conceive there may be such congestions, and 
such a degree of stimulus to the arterial system, as 
to produce a depressed, or a low or weak pulse. 
Two cases of this kind are related by Dr. Monroe, 
one of which was cured by bleeding. The same 
symptom of a low and weak pulse is often met 
with in the first stage of pneumony, and apoplexy, 
and is only to be removed by the plentiful use of 
the same remedy. 

vol. it. x 


II. Vomits have often been given with advan- 
tage in dropsies. Dr. Home says, that squills 
were useful in these diseases only when they pro- 
duced a vomiting. By abstracting excitement and 
action from the arterial system, it disposes the lym- 
phatics to absorb and discbarge large quantities of 
water. The efficacy of vomits in promoting the 
absorption of stagnating fluids is not confined to 
dropsies. Mr. Hunter was once called to visit a 
patient in whom he found a bubo in such a state 
that he purposed to open it the next day. In the 
mean while, the patient went on board of a vessel, 
where he was severely affected by sea- sickness and 
vomiting ; in consequence of which the bubo dis- 
appeared, and the patient recovered without the use 
of the knife. 

Mr. Cruikshank further mentions a ease* of a 
swelling in the knee being nearly cured by a pa- 
tient vomiting eight and forty hours, in Consequence 
of his taking a large dose of the salt of tartar instead 
of soluble tartar. 

III. Purges. The efficacy of this remedy, in 
the cure of dropsies, has been acknowledged by 
physicians in all ages and countries. Jalap, calo- 

* Letter to Mr. Clare, p. 166. 


mel, scammony, and gamboge, are often preferred 
for this purpose ; but I have heard of two cases 
of ascites being cured by a table spoonful of sweet 
oil taken every day. It probably acted only as a 
gentle laxative. The cream of tartar, so highly 
commended by Dr. Home, seems to act chiefly in 
the same way. Gherlius, from whom Dr. Home 
learned the use of this medicine, says, that all the 
persons whom he cured by it were in the vigour of 
life, and that their diseases had been only of a few 
months continuance. From these two circum- 
stances, it is most probable they were dropsies of 
great morbid action in the arterial system. He 
adds further, that the persons who were cured by 
this medicine, were reduced very low by the use 
of it. Dr. Home says that it produced the same 
effect upon the patients whom he cured by it, in 
the infirmary of Edinburgh. Dr. Sydenham pre- 
fers gentle to drastic purges, and recommends the 
exhibition of them every day. Both drastic and 
gentle purges act by diminishing the action of the 
arterial system, and thereby promote the absorption 
and discharge of water. That purges promote ab- 
sorption, we learn not only from their effects in 
dropsies, but from an experiment related by Mr. 
Cruikshank*, of a man who acquired several 

* Letter to Mr. Clare, p. 117. 


ounces of weight after the operation of a purge. 
The absorption in this case was from the atmo- 
sphere. So great is the effect of purges in pro- 
moting absorption, that Mr. Hunter supposes the 
matter of a gonorrhoea, or of topical venereal ul- 
cers to be conveyed by them in some instanced 
into every part of the body. 

IV. Certain medicines, which, by lessening the 
action of the arterial system, favour the absorption 
and evacuation of water. The only medicines of 
this class which I shall name are nitre, cream of 
tartar, and foxglove. 

1. Two ounces of nitre dissolved in a pint of 
water, and a wine-glass full of it taken three times 
a-day have performed perfect cures, in two cases 
of ascites, which have come under my notice. I 
think I have cured two persons of anasarca, by 
giving one scruple of the same medicine three 
times a-day for several weeks. The two last cures 
were evidently dropsies of violent action in the ar- 
terial system. Where nitre has been given in ato- 
nic dropsies it has generally been useless, and some- 
times done harm. I have seen one instance of an 
incurable diarrhoea after tapping, which I suspecte 3. 
arose from the destruction of the tone of the sto- 
mach and bowels, by large and long continued 


doses of nitre, which the patient had previously 
taken by the advice of a person who had been cured 
by that remedy. To avoid this, or any other in- 
convenience from the use of nitre in dropsies, it 
should be given at first in small doses, and should 
always be laid aside, if it should prove ineffectual 
after having been given two or three weeks. 

2. I can say nothing of the efficacy of cream of 
tartar in dropsies from my own experience, where 
it has not acted as a purge. Perhaps my want of 
decision upon this subject has arisen only from my 
not having persisted in the use of it for the same 
length of time which is mentioned by Dr. Home. 

3. There are different opinions concerning the 
efficacy of foxglove in dropsies. From the cases 
related by Dr. Withering, it appears to have done 
good ; but from those related by Dr. Lettsom* it 
seems to have done harm. I suspect the different 
accounts of those two gentlemen have arisen from 
their having given it in different states of the sys- 
tem, or perhaps from a difference in the quality of 
the plant from causes mentioned in another placef. 

* Medical Memoirs, vol. II. 

t Inquiry into the Causes and Cure of Pulmonary Con- 


I am sorry to add further, that after many trials of 
this medicine I have failed in most of the cases in 
which I have given it. I have discharged the wa- 
ter in diree instances by it, but the disease return- 
ed, and my patients finally died. I can ascribe 
only one complete cure to its use, which was in the 
year 1789, in a young man in the Pennsylvania 
hospital, of five and thirty years of age, of a robust 
habit, and plethoric pulse. 

Where medicines have once been in use, and 
afterwards fall into disrepute, as was the case with 
the foxglove, I suspect the cases in which they 
were useful, to have been either few or doubtful, 
and that the cases in which they had done harm, 
were so much more numerous and unequivocal, as 
justly to banish them from the materia medica. 

V. Hard labour ', or exercise in such a degree 
as to produce fatigue, have, in several instances, 
cured the dropsy. A dispensary patient, in this 
city, was cured of this disease by sawing wood. 
And a patient in an ascites under my care in the 
Pennsylvania hospital, had his belly reduced seven 
inches in circumference in one day, by the labour 
of carrying wood from the yard into the hospital. 
A second patient belonging to the Philadelphia 
dispensary was cured by walking to Lancaster, 66 


miles from the city, in the middle of winter. The 
efficacy of travelling in this disease, in cold weather, 
is taken notice of by Dr. Monroe, who quotes a 
case from Dr. Holler, of a French merchant, who 
was cured of a dropsy by a journey from Paris 
to England, in the winter season. It would seem, 
that in these two cases, the cold co-operated as a 
sedative with the fatigue produced by labour or 
exercise, in reducing the tone of the arterial sys- 

VI. Low diet. I have heard of a woman 
who was cured of a dropsy by eating nothing but 
boiled beans for three weeks, and drinking no- 
thing but the water in which they had been boiled. 
Many other cases of the good effects of low diet in 
dropsies are to be found in the records of medicine. 

VII. Thirst. This cruel remedy acts by de- 
bilitating the system in two ways : 1st, by abstract- 
ing the stimulus of distention ; and, 2dly, by pre- 
venting a supply of fresh water to replace that 
which is discharged by the ordinary emunctories of 

VIII. Fasting. An accidental circumstance, 
related by sir John Hawkins, in the life of Dr. 
Johnson, first led me to observe the good effects 


of fasting in the dropsy. If the fact alluded to 
stood alone under the present head of this essay, it 
would be sufficient to establish the existence of too 
much action, and the efficacy of debilitating reme- 
dies in certain dropsies. I am the more disposed 
to lay a good deal of stress upon this fact, as it was 
the clue which conducted me out of the labyrinth of 
empirical practice, in which I had been bewildered 
for many years, and finally led me to adopt the 
principles and practice which I am now endeavour- 
ing to establish. The passage which contains this 
interesting fact is as follows : " A few days af- 
ter (says sir John) he [meaning Dr. Johnson] 
sent for me, and informed me, that he had dis- 
covered in himself the symptoms of a dropsy, 
and, indeed, his very much increased bulk, and 
the swollen appearance of his legs, seemed to 
indicate no less. It was on Thursday that I 
had this conversation with him ; in the course 
thereof he declared, that he intended to devote 
the whole of the nex f day to fasting, humilia- 
tion, and such other devotional exercises as be- 
came a man in his situation. On the Saturday* 
following I made him a visit, and, upon entering 
his room, I observed in his countenance such a 
serenity as indicated, that some remarkable crisis 
of his disease had produced a change in his 
feelings. He told me that, pursuant to the reso- 


" lution he had mentioned to me, he had spent the 
" preceding day in an abstraction from all worldly 
" concerns ; that to prevent interruption he had in 
" the morning ordered Frank [his servant] not to 
" admit any one to him, and, the better to enforce 
" the charge, had added these awful words, for 
"your master is preparing himself to die. He 
" then mentioned to me, that in the course of this 
" exercise he found himself relieved from the dis- 
" ease which had been growing upon him, and was 
" becoming very oppressive, viz. the dropsy, by 
" the gradual evacuation of water, to the amount 
" of twenty pints, a like instance whereof he had 
" never before experienced." Sir John Hawkins 
ascribes this immense discharge of water to the 
influence of Dr. Johnson's prayers ; but he ne- 
glects to take notice, that these prayers were ans- 
wered, in this instance, as they are in many others, 
in a perfect consistence with the common and esta- 
blished laws of nature. 

To satisfy myself that this discharge of water, 
in the case of Dr. Johnson, was produced by the 
fasting only, I recommended it, soon after I read 
the above account, to a gentlewoman whom I was 
then attending in an ascites. I was delighted with 
the effects of it. Her urine, which for some time 
before had not exceeded half a pint a-day, amounted 

VOL. II. y 


to two quarts on the day she fasted. I repeated 
the same prescription once a week for several 
weeks, and each time was informed of an increase 
of urine, though it was considerably less in the last 
experiments than in the first. Two patients in an 
ascites, to whom I prescribed the same remedy, in 
the Pennsylvania hospital, the one in the winter 
of 1790, and the other in the winter of 1792, ex- 
hibited proofs in the presence of many of the stu- 
dents of the university, equally satisfactory of the 
efficacy of fasting in suddenly increasing the quan- 
tity of urine. 

IX. Fear. This passion is evidently of a de- 
bilitating nature, and, therefore, it has frequently 
afforded an accidental aid in the cure of dropsies, 
of too much action. I suspect, that the fear of 
death, which was so distinguishing a part of the 
character of Dr. Johnson, added a good deal to 
the efficacy of fasting, in procuring the immense 
discharge of water before-mentioned. In support 
of the efficacy of fear simply applied, in discharg- 
ing water from the body in dropsies, I shall men- 
tion the following facts. 

In a letter which I received from Dr. John 
Pennington, dated Edinburgh, August 3, 1790, I 
was favoured with the following communication. 


wt Since the conversation I had with you on the sub- 
'.* ject of the dropsy, I feel more and more inclined 
" to adopt your opinion. I can furnish you with 
" a fact which I learned from a Danish sailor, on 
:■' my passage to this country, which is much in fa- 
*' vour of your doctrine. A sailor in an ascites, fell 
" off the end of the yard into the sea ; the wea- 
" ther being calm, he was taken up unhurt, but, to 
" use the sailor's own words, who told me the 
" story, he was frightened half to death, and as 
" soon as he was taken out of the water, he dis- 
" charged a gallon of urine or more. A doctor on 
" board ascribed this large evacuation to sea bath- 
" ing, and accordingly ordered the man to be 
" dipped in the sea every morning, much against 
" his will, for, my informant adds, that he had not 
" forgotten his fall, and that in four weeks he was 
rt perfectly well. I think this fact can only be 
" explained on your principles. The sedative 
" operation of fear was, no doubt, the cause of his 

" cure." 

There is an account of an ascites being cured by 
a fall from an open chaise, recorded in the third 
volume of the Medical Memoirs, by M. Lowdell. 
I have heard of a complete recovery from dropsy, 
having suddenly followed a fall from a horse. In 


both these cases, the cures were probably the ef- 
fects of fear. 

Dr. Hall, of York- town, in Pennsylvania, in- 
formed me, that he had been called to visit a young- 
woman of 19 years of age, who had taken all the 
usual remedies for ascites without effect. He at 
once proposed to her the operation of tapping. 
To this she objected, but so great was the fear of 
this operation, which the proposal of it suddenly 
excited in her mind, that it brought on a plentiful 
discharge of urine, which in a few days perfectly 
removed her disease. 

On the 27th of August, 1790, 1 visited a gentle- 
woman in this city with the late Dr. Jones, in an 
ascites. We told her for the first time, that she 
could not be relieved without being tapped. She 
appeared to be much terrified upon hearing our 
opinion, and said that she would consider of it. I 
saw her two days afterwards, when she told me, 
with a smile on her countenance, that she hoped 
she should get well without tapping, for that she 
had discharged two quarts of water in the course 
of the day after we had advised her to submit to 
that operation. For many days before, she had 
not discharged more than two or three gills in 
twenty-four hours. The operation, notwithstand- 


ing, was still indicated, and she submitted to be 
tapped a few days afterwards. 

I tapped the same gentlewoman a second time, 
jn January, 1791. She was much terrified while 
I was preparing for the operation, and fainted im- 
mediately after the puncture was made. The se- 
cond time that I visited her after the operation was 
performed, she told me (without being interrogated 
on that subject), that she had discharged a pint 
and a half of urine, within twenty minutes after I 
left the room on the day I tapped her. What 
made this discharge the more remarkable was, she 
had not made more than a table spoonful of water 
in a day, for several days before she was tapped. 

I have seen similar discharges of urine in two 
other cases of tapping which have come under my 
notice, but they resembled so nearly those which 
have been mentioned, that it will be unnecessarv 
to record them. 

But the influence of fear upon the system, in the 
dropsy, extends far beyond the effects which I 
have ascribed to it. Dr. Currie, of this city, in- 
formed me that he called, some years ago, by ap- 
pointment, to tap a woman. He no sooner enter- 
ed the room than he observed her, as he thought. 


to faint away. He attempted to recover her, but 
to no purpose. She died of a sudden paroxysm 
of fear. 

It is a matter of surprise, that we should have 
remained so long ignorant of the influence of fear 
upon the urinary organs in dropsies, after having* 
been so long familiar with the same effect of that 
passion in the hysteria. 


X. A recumbent posture of the body. It is 
most useful when the dropsy is seated in the lower 
limbs. I have often seen, with great pleasure, the 
happiest effects from this prescription in a few days. 

XL Punctures, These, when made in the legs 
and feet, often discharge in eight and forty hours 
the water of the whole body. I have never seen a 
mortification produced by them. As they are not 
followed by inflammation, they should be preferred 
to blisters, which are sometimes used for the same 

I cannot dismiss the remedies which discharge 
water from the body through the urinary passages, 
without taking notice, that they furnish an addi- 
tional argument in favour of blood-letting in drop- 
sies, for they act, not by discharging the stagnating 


water, but by creating such a plentiful secretion 
in the kidneys from the serum of the circulating 
blood, as to make room for the absorption and con- 
veyance of the stagnating water into the blood- 

Now the same effect may be produced in all 
tonic or inflammatory dropsies, with more certainty 
and safety, by means of blood-letting. 

In recommending the antiphlogistic treatment 
of certain dropsies, I must here confine myself to 
the dropsies of such climates as dispose to diseases 
of great morbid action in the system. I am satis- 
fied that it will often be proper in the middle and 
eastern states of America ; and I have lately met 
with two observations, which show that it has 
been used with success at Vienna, in German v. 
Dr. Stoll tells us, that, in the month of January, 
1780, " Hydropic and asthmatic patients discover- 
" ed more or less marks of inflammatory diathesis^ 
" and that blood w*as drawn from them with a spar- 
" ing hand with advantage;" and in the month 
of November, of the same year, he says, " The 
" stronger diuretics injured dropsical patients in 
" this season ; but an antiphlogistic drink, compos- 
" ed of a quart of the decoction of grass, with two 
" ounces of simple oxymel, and nitre and cream 


" of tartar, of each a drachm, did service*." It 
is probable that the same difference should be ob- 
served between the treatment of dropsies in warm 
and cold climates that is observed in the treatment 
of fevers. The tonic action probably exists in the 
system in both countries. In the former it resem- 
bles the tides which are are suddenly produced by 
a shower of rain, and as suddenly disappear ; 
whereas, in the latter, it may be compared to those 
tides which are produced by the flow and gradual 
addition of water from numerous streams, and 
w r hich continue for days and weeks together to ex- 
hibit marks of violence in every part of their course. 

I come now to say a few words upon atonic 
dropsies, or such as are accompanied with a feeble 
morbid action in the blood-vessels. This morbid 
action is essential to the nature of dropsies, for we 
never see them take place without it. This is ob* 
vious from the absence of swellings after famine, 
marasmus, and in extreme old age, in each of which 
there exists the lowest degree of debility, but no 
morbid action in the blood-vessels. These atonic 
or typhus dropsies may easily be distinguished 
from those which have been described, by occur- 

* Ratio Medendi Nosocomio Practico Vindobonensi, vol, 
iv. p. 56 and 99. 


ring in habits naturally weak ; by being produced 
by the operation of chronic causes ; by a weak and 
quick pulse ; and by little or no preternatural heat 
or thirst. 

The remedies for atonic dropsies are all such 
stimulating substances as increase the action of the 
arterial system, or determine the fluids to the uri- 
nary organs. These are, 

I. Bitter and aromatic substances of all kinds, 
exhibited in substance or in infusions of wine, spi- 
rit, beer, or water. 

II. Certain acrid vegetables, such as scurvy- 
grass, horse-radish, mustard, water-cresses, and 
garlic. I knew an old man who was perfectly 
cured of an anasarca, by eating water- cresses, on 
bread and butter. 


III. Opium. The efficacy of this medicine in 
dropsies has been attested by Dr. Willis, and se- 
veral other practical writers. It seems to possess 
almost an exclusive power of acting alike upon the 
arterial, the lymphatic, the glandular, and the ner- 
vous systems. 

VOL. II. z 


IV. Metallic tonics, such as chalybeate medi* 
cines of all kinds, and the mild preparations of cop- 
per and mercury. I once cured an incipient ascites 
and anasarca by large doses of the rust of iron ; 
and I have cured many dropsies by giving mercury 
in such quantities as to excite a plentiful salivation. 
I have, it is true, often given it without effect, pro- 
bably from my former ignorance of the violent 
action of the arteries, which so frequently occurs 
in dropsies, and in which cases mercury must ne- 
cessarily have done harm. 

V. Diuretics, consisting of alkaline salts, nitre, 
and the oxymels of squills and colchicum. It is 
difficult to determine how far these medicines pro- 
duce their salutary effects by acting directly upon 
the kidneys. It is remarkable that these organs 
are seldom affected in dropsies, and that their dis- 
eases are rarely followed by dropsical effusions in 
any. part of the body. 

VI. Generous diet, consisting of animal food, 
rendered cordial by spices ; also sound old wine. 

VII. Diluting drinks taken in such large quan- 
tities as to excite the action of the vessels by the 
stimulus of distention. This effect has been pro- 
duced, sir George Baker informs us, by means of 


large draughts of simple water, and of cyder and 
water*. The influence of distention in promoting 
absorption is evident in the urinary and .gall blad- 
ders, which frequently return their contents to the 
blood by the lymphatics, when they are unable 
to discharge them through their usual emunctories. 
Is it not probable that the distention produced by 
the large quantities of liquids which we are directed 
to administer after giving the foxglove, may have 
been the means of performing some of those cures 
of dropsies, which have been ascribed to that re- 
medy ? 

VIII. Pressure. Bandages bound tightly around 
the belly and limbs, sometimes prevent the in- 
crease or return of dropsical swellings. The in- 
fluence of pressure upon the action of the lympha- 
tics appears in the absorption of bone which fre- 
quently follows the pressure of contiguous tumours, 
also in the absorption of flesh which follows the 
long pressure of certain parts of the body upon a 
sick bed. 

* The remark upon this fact by sir George, is worthy 
of notice, and implies much more than was probably intend- 
ed by it. " When common means have failed, success has 
** sometimes followed a method directly contrary to the esta- 
c< Wished practice." Medical Transactions, vol. II* 


IX. Frictions, either by means of a dry, or oiled 
hand, or with linen or flannel impregnated with 
volatile and other stimulating substances. I have 
found evident advantages from following the advice 
of Dr. Cullen, by rubbing the lower extremities 
upwards, and that only in the morning. I have 
been at a loss to account for the manner in which 
Sweet oil acts, when applied to dropsical swellings. 
If it act by what is improperly called a sedative 
power upon the blood-vessels, it will be more pro- 
per in tonic than atonic dropsies ; but if it act by- 
closing the pores, and thereby preventing the ab- 
sorption of moisture from the air, it will be very 
proper in the state of dropsy which is now under 
consideration. It is in this manner that Dr. Cullen 
supposes that sweet oil, when applied to the body, 
cures that state of diabetes in which nothing but 
insipid water is discharged from the bladder. 

X. Heat, applied either separately or combined 
with moisture in the form of warm or vapour baths, 
has been often used with success in dropsies of too 
little action. Dampier, in his voyage round the 
world, was cured of a dropsy by means of a copi- 
ous sweat, excited by burying himself in a bed of 
warm sand. Warm fomentations to the legs, ren- 
dered moderately stimulating by the addition of 
saline or aromatic substances, have often done ser- 


vice in the atonic dropsical swellings of the lower 
extremities. | 

XL The cold bath. I can say nothing in favour 
of the efficacy of this remedy in dropsies, from my 
own experience. Its good effects seem to depend 
wholly on its increasing the excitability of the 
system to common stimuli, by the diminution of 
its excitement. If this be the case, I would ask, 
whether fear might not be employed for the same 
purpose, and thus become as useful in atonic, as it 
was formerly proved to be in tonic dropsies ? 

XII. Wounds, whether excited by cutting in- 
struments or by fire, provided they excite inflam- 
mation and action in the arteries, frequently cure 
atonic dropsies. The good effects of inflammation 
and action in these cases, appear in the cure of hy- 
drocele by means of the needle, or the caustic. 

XIII. Exercise. This is probably as necessary 
in the atonic dropsy, as it is in the consumption, 
and should never be omitted when a patient is able 
to take it. The passive exercises of swinging, 
and riding in a carriage, are most proper in the 
lowest stage of the disease ; but as soon as the 
patient's strength will admit of it, he should ride 


on horseback. A journey should be preferred, in 
this disease, to short excursions from home. 

XIV. A recumbent posture of the body should 
always be advised during the intervals of exercise, 
when the swellings are seated in the lower extre- 

XV. Punctures in the legs and feet afford the 
same relief in general dropsy, accompanied with a 
weak action in the blood-vessels, that has been as- 
cribed to them in dropsies of an opposite character. 

In the application of each of the remedies which 
have been mentioned, for the cure of both tonic and 
atonic dropsies, great care should be taken to use 
them in such a manner, as to accommodate them 
to the strength and excitability of the patient's 
system. The most powerful remedies have often 
been rendered hurtful, by being given in too large 
doses in the beginning, and useless, by being given 
in too small doses in the subsequent stages of the 

I have avoided saying any thing of the usual 
operations for discharging water from different 
parts of the bod} T , as my design was to treat only 
of the symptoms and cure of those dropsies which 


affect the whole system. I shall only remark, that 
if tapping and punctures have been more success- 
ful in the early, than in the late stage of these dis- 
eases, it is probably because the sudden or gradual 
evacuation of water takes down that excessive 
action in the arterial system, which is most com- 
mon in their early stage, and thereby favours the 
speedy restoration of healthy action in the exhaling 
©r lymphatic vessels. 

Thus have I endeavoured to prove, that two 
different states of action take place in dropsies, 
and have mentioned the remedies which are proper 
for each of them under separate heads. But I 
suspect that dropsies are often connected with a 
certain intermediate or mixed action in the arterial 
system, analogous to the typhoid action which takes 
place in certain fevers. I am led to adopt this 
opinion, not only from having observed mixed 
action to be so universal in most of the diseases of 
the arterial and nervous system, but because I 
have so frequently observed dropsical swellings to 
follow the scarlatina, and the puerperile fever, two 
diseases which appear to derive their peculiar cha- 
racter from a mixture of excessive and moderate 
force, combined with irregularity of action in the 
arterial system. In dropsies of mixed action, where 
too much force prevails in the action of some, and 


too little in the action of other of the arterial fibres, 
the remedies must be debilitating or stimulating, 
according to the greater or less predominance of 
tonic or atonic diathesis in the arterial system. 


I shall conclude this history of dropsies, and of 
the different and opposite remedies which have 
cured them, by the following observations. 

1. We learn, in the first place, from what has 
been said, the impropriety and even danger of 
prescribing stimulating medicines indiscriminately 
in every case of dropsy. 

2. We are taught, by the facts which have been 
mentioned, the reason why physicians have differed 
so much in their accounts of the same remedies, 
and why the same remedies have operated so dif- 
ferently in the hands of the same physicians. It 
is because they have been given without a re- 
ference to the different states of the system, 
which have been described. Dr. Sydenham says, 
that he cured the first dropsical patient he was call- 
ed to, by frequent purges. He began to exult in 
the discovery, as he thought, of a certain cure for 
dropsies, but his triumph was of short duration. 
The same remedy failed in the next case in which 
he prescribed it. The reason probably was, the 


dropsy in the first case was of a tonic, but in the 
second of an atonic nature ; for the latter was an 
ascites from a quartan ague. It is agreeable, how- 
ever, to discover, from the theory of dropsies which 
has been laid down, that all the different remedies 
for these diseases have been proper in their na- 
ture, and improper only in the state of the system 
in which they have been given. As the discovery 
of truth in religion reconciles the principles of the 
most opposite sects, so the discovery of truth in 
medicine reconciles the most opposite modes of 
practice. It would be happy if the inquirers after 
truth in medicine should be taught, by such disco- 
veries, to treat each other with tenderness and res- 
pect, and to wait with patience till accident, or time, 
shall combine into one perfect and consistent sys- 
tem, all the contradictory facts and opinions, about 
which physicians have been so long divided. 

3. If a state of great morbid action in the arte- 
ries has been demonstrated in dropsies, both from 
its symptoms and remedies, and if these dropsies 
are evidently produced by previous debility, who 
will deny the existence of a similar action in certain 
haemorrhages, in gout, palsy, apoplexy, and mad- 
ness, notwithstanding they are all the offspring of 
predisposing debility? And who will deny the 
efficacy of bleeding, purges, and other debilitating 

vol. n. 2 A 


medicines in certain states of those diseases, that 
has seen the same medicines administered with suc- 
cess in certain dropsies ? To reject bleeding, purg- 
ing, and the other remedies for violent action in 
the system, in any of the above diseases, be- 
cause that action was preceded by general debility, 
will lead us to reject them in the most acute inflam- 
matory fevers, for these are as much the offspring 
of previous debility as dropsies or palsy. The 
previous debility of the former differs from that 
of the latter diseases, only in being of a more acute 5 
or, in other words, of a shorter duration. 

4. From the symptoms of tonic dropsy which 
have been mentioned, it follows, that the distinc- 
tion of apoplexy into serous and sanguineous, af- 
fords no rational indication for a difference in the 
mode of treating that disease. If an effusion of 
serum in the thorax, bowels, or limbs, produce a 
hard and full pulse, it is reasonable to suppose that 
the same symptom will be produced by the effusion 
of serum in the brain. But the dissections collect- 
ed by Lieutaud* place this opinion beyond all 
controversy. They prove that the symptoms of 
great and feeble morbid action, as they appear in 
the pulse, follow alike the effusion of serum and 

* Ilistoria Anatomico Mctlica, vol. II* 


blood in the brain. This fact will admit of an im- 
portant application to the disease, which is to be 
the subject of the next inquiry. 

5. From the influence which has been describ- 
ed, of the different states of action of the arterial 
system, upon the lymphatic vessels, in dropsies, we 
are led to reject the indiscriminate use of bark, 
mercury, and salt water, in the scrophula. When 
the action of the arteries is weak, those remedies 
are proper ; but when an opposite state of the ar- 
terial system occurs, and, above all, when scro- 
phulous tumours are attended with inflammatory 
ulcers, stimulating medicines of all kinds are hurt- 
ful. By alternating the above remedies with a 
milk and vegetable diet, according to the tonic, or 
atonic states of the arterial system, I have succeed- 
ed in the cure of a case of scrophula, attended by 
large ulcers in the inguinal glands, which had for 
several years resisted the constant use of the three 
stimulating remedies which have been mentioned. 

6. Notwithstanding I have supposed dropsies 
to be connected with a peculiar state of force in 
the blood-vessels, yet I have not ventured to 
assert, that dropsies may not exist from an exclu- 
sive affection of the exhaling and absorbing vessels. 
I conceive this to be as possible, as for a fever to 


exist from an exclusive affection of the arteries, or 
a hysteria from an exclusive affection of the nervous 
system. Nothing, however, can be said upon this 
subject, until physiology and pathology have 
taught us more of the structure and diseases of the 
lymphatic vessels. Nor have I ventured further to 
assert, that there are not medicines which may act 
specifically upon the lymphatics, independently of 
the arteries. This I conceive to be as possible as 
for asafoetida to act chiefly upon the nerves, or ipe- 
cacuanha and jalap upon the alimentary canal, 
without affecting other parts of the system. Until 
such medicines are discovered, it becomes us to 
avail ourselves of the access to the lymphatics, 
which is furnished us throusrh the medium of the 
arteries, by means of most of the remedies which 
have been mentioned. 

7. If it should appear hereafter, that we have 
lessened the mortality of certain dropsies by the 
theory and practice which have been proposed, 
yet many cases of dropsy must still occur in which 
they will afford us no aid. The cases I allude to 
are dropsies from enclosing cysts, from the ossifi- 
cation of certain arteries, from schirri of certain 
viscera from large ruptures of exhaling or lym- 
phatic vessels, from a peculiar and corrosive acri- 
mony of the fluids, and, lastly, from an exhausted 


state of the whole system. The records of medi- 
cine furnish us with instances of death from each 
of the above causes. But let us not despair. It 
becomes a physician to believe, that there is no 
disease necessarily incurable ; and that there exist 
in the womb of time, certain remedies for all those 
morbid affections, which elude the present limits of 
the healing art. 







HAVING, for many years, been unsuc- 
cessful in all the cases, except two, of internal 
dropsy of the brain, which came under my care, I 
began to entertain doubts of the common theory of 
this disease, and to suspect that the effusion of water 
should be considered only as the effect of a primary 
disease in the brain. 

I mentioned this opinion to my colleague, Dr. 
Wistar, in the month of June, 1788, and delivered 
it the winter following in my lectures. The year 
afterwards I w r as confirmed in it, by hearing that 
the same idea had occurred to Dr. Quin. I have 
since read Dr. Quin's treatise on the dropsy of the 
brain with great pleasure, and consider it as the 
first dawn of light which has been shed upon it. 
In pursuing this subject, therefore, I shall avail 

VOL. II, 2 B 


myself of Dr. Quin's discoveries, and endeavour 
to arrange the facts and observations I have col- 
lected in such a manner, as to form a connected 
theory from them, which I hope will lead to a new 
and more successful mode of treating this disease. 

I shall begin this inquiry by delivering a few 
general propositions. 

1. The internal dropsy of the brain is a disease 
confined chiefly to children. 

2. In children the brain is larger in proportion 
to other parts of the body, than it is in adults ; and 
of course a greater proportion of blood is sent to it 
in childhood, than in the subsequent periods of life. 
The effects of this determination of blood to the 
brain appear in the mucous discharge from the 
nose, and in the sores on the head and behind the 
ears, which are so common in childhood. 

3. In all febrile diseases, there is a preternatural 
determination of blood to the brain. This occurs 
in a more especial manner in children : hence the 
reason why they are so apt to be affected by con- 
vulsions in the eruptive fever of the small-pox, in 
dentition, in the diseases from worms, and in the 
first paroxysm of intermitting fevers. 


4. In fevers of every kind, and in eveiy stage, of 
life, there is a disposition to effusion in that part to 
which there is the greatest determination. Thus, 
in inflammatory fever, effusions take place in the 
lungs and in the joints. In the bilious fever they 
occur in the liver, and in the gout in every part 
of the body. The matter effused is always influ- 
enced by the structure of the part jn which it takes 

These propositions being premised, I should 
have proceeded to mention the remote causes of 
this disease ; but as this inquiry may possibly fall 
into the hands of some gentlemen who may not 
have access to the description of it as given by Dr. 
Whytt, Dr. Fothergill, and Dr. Quin, I shall intro- 
duce a history of its symptoms taken from the last 
of those authors. I prefer it to the histories by 
Dr. Whytt and Dr. Fothergill, as it accords most 
with the ordinary phenomena of this disease in the 
United States. 

" In general, the patient is at first languid and 
" inactive, often drowsy and peevish, but at inter- 
" vals cheerful and apparently free from complaint. 
" The appetite is weak, a nausea, and, in muny 
" cases, a vomiting, occurs once or twice in the 
" day, and the skin is observed to be hot and dry 



" towards the evenings : soon after these symp- 
" toms have appeared, the patient is affected with 
" a sharp head-ach, chiefly in the fore-part, or, if 
" not there, generally in the crown of the head: 
" it is sometimes, however, confined to one side 
" of the head, and, in that case, when the posture 
" of the body is erect, the head often inclines to 
M the side affected. We frequently find, also, 
" that the head-ach alternates with the affection 
" of the stomach; the vomiting being less trou- 
" blesome when the pain is most violent, and vice 
" versa; other parts of the body are likewise sub- 
" ject to temporary attacks of pain, viz. the ex- 
" tremities, or the bowels, but more constantly 
" the back of the neck, and between the scapulas ; 
" in all such cases the head is more free from un 
11 easiness. 

*' The patient dislikes the light at this period ; 
" cries much, sleeps little, and when he does sleep, 
" he grinds his teeth, picks his nose, appears to 
" be uneasy, and starts often, screaming as if he 
" were terrified ; the bowels are in the majority 
" of cases very much confined, though it some- 
" times happens that they are in an opposite state : 
" the pulse in this early stage of the disorder, does 
; ' not usually indicate any material derangement. 



" When the symptoms above-mentioned have 
continued for a few days, subject as they always 
are in this disease to great fluctuation, the axis of 
one eye is generally found to be turned in to- 
wards the nose ; the pupil on this side is rather 
more dilated than the other; and when both 
eyes have the axes directed inwards (which some- 
times happens), both pupils are larger than they 
are observed to be in the eyes of healthy persons : 
the vomiting becomes more constant, and the 
head-ach more excruciating ; every symptom of 
fever then makes its appearance, the pulse is fre- 
quent, and the breathing quick ; exacerbations 
of the fever take place towards the evening, and 
the face is occasionally flushed ; usually one 
cheek is much more affected than the other; 
temporary perspirations likewise break forth, 
which are not followed by any alleviation of dis- 
tress ; a discharge of blood from the nose, which 
sometimes appeal's about this period, ;s equally 

" Delirium, and that of the most violent kind, 
" particularly if the patient has arrived at the age 
" of puberty, now takes place, and with all the 
" preceding symptoms of fever, continues for a 
" while to increase, until about fourteen days, of- 
" ten a much shorter space of time, shall have elap- 



" sed since the appearance of the symptoms, which 
" were first mentioned in the above detail. 

" The disease then undergoes that remarkable 
change, which sometimes suddenly points out 
the commencement of what has been called its 
second stage : the pulse becomes slow but une- 
qual, both as to its strength, and the intervals 
between the pulsations ; the pain of the head, 
or of whatever part had previously been affected, 
seems to abate, or at least the patient becomes 
apparently less sensible of it; the interrupted 
slumbers, or perpetual restlessness which pre- 
vailed during the earlier periods of the disorder, 
are now succeeded by an almost lethargetic tor- 
por, the strabismus, and dilatation of the pupil 
increase, the patient lies with one, or both eyes 
half closed, which, when minutely examined, 
are often found to be completely insensible to 
light ; the vomiting ceases ; whatever food or 
medicine is offered is usually swallowed with ap- 
parent voracity ; the bowels at this period gene- 
rally remain obstinately costive. 

" If every effort made by art fails to excite the 
" sinking powers of life, the symptoms of what 
" has been called the second stage are soon suc- 
" ceeded by others, which more certainly an- 


" nounce the approach of death. The pulse 
" again becomes equal, but so weak and quick, 
c ' that it is almost impossible to count it ; a diffi- 
" culty of breathing, nearly resembling the ster- 
M tor apoplecticus, is often observed; sometimes 
" the eyes are suffused with blood, the flushing of 
" the face is more frequent than before, but of 
" shorter duration, and followed by a deadly pale- 
" ness; red spots, or blotches, sometimes appear 
" on the body and limbs; deglutition becomes 
iC difficult, and convulsions generally close the 
" scene. In one case, I may observe, the jaws of 
" a child of four years of age were so firmly lock- 
" ed for more than a day before death, that it 
" was impossible to introduce either food or me- 
" dicine into his mouth; and, in another case, a 
" hemiplegia, attended with some remarkable cir- 
" cumstances, occurred during the two days pre- 
" ceding dissolution. 

" Having thus given as exact a history of apo- 
" plexia hydrocephalica as I could compile from 
4C the writings of others, and from my own obser- 
" vations, I should think myself guilty of imposi- 
" tion on my readers, if I did not caution them 
" that it must be considered merely as a general 
" outline : the human brain seems to be so ex- 
u tremely capricious (if the expression may be al- 


" lowed) in the signals it gives to other parts of 
" the system, of the injury it suffers throughout 
" the course of this disease, that although every 
" symptom above-mentioned does occasionally oc- 
" cur, and indeed few cases of the disease are to 
" be met with, which do not exhibit many of 
" them ; yet it does not appear to me, that any 
" one of them is constantly and inseparably con- 
" nected with it." 

To this history I shall add a few facts, which 
are the result of observations made by myself, or 
communicated to me by my medical brethren. 
These facts will serve to show that there are many 
deviations from the history of the disease which 
has been given, and that it is indeed, as Dr. Quin 
has happily expressed it, of " a truly proteiform" 

I have not found the dilated and insensible pu- 
pil, the puking, the delirium, or the strabismus, to 
attend universally in this disease. 

I saw one case in which the appetite was un- 
impaired from the first to the last stage of the dis- 


I have met with one case in which the disease 
was attended by blindness, and another by double 

I have observed an uncommon acuteness in hear- 
ing to attend two cases of this disease. In one 
of them the noise of the sparks which were dis- 
charged from a hiccory fire, produced great pain 
and startings which threatened convulsions. 

I have seen three cases in which the disease ter- 
minated in hemiplegia. In two of them it proved 
fatal in a few days ; in the third it continued for 
nearly eighteen months. 

I have met with one case in which no preter- 
natural slowness or intermission was ever perceived 
in the pulse. 

I have seen the disease in children of nearly all 
ages. I once saw it in in a child of six weeks old. 
It was preceded by the cholera infantum. The 
sudden deaths which we sometimes observe in in- 
fancy, I believe, are often produced by this disease. 
Dr. Stoll is of the same opinion. He calls it, when 
it appears in this form, " apoplexia infantalis*." 

* Prrelectiones, vol. I. p. 254, 
VOL, II. 2 c 


In the month of March, 1771, I obtained a gill 
of water from the ventricles of the brain of a ne- 
gro girl of nine years of age, who died of this dis- 
ease, who complained in no stage of it of a pain 
in her head or limbs, nor of a sick stomach. The 
disease in this case was introduced suddenly by a 
pain in the breast, a fever, and the usual symptoms 
of a catarrh. 

Dr. Wistar informed me, that he had likewise 
met with a case of internal dropsy of the brain, 
in which there was a total absence of pain in the 

Dr. Carson informed me, that he had attended 
a child in this disease that discovered, for some 
days before it died, the symptom of hydrophobia. 

Dr. Currie obtained, by dissection, seven ounces 
of water from the brain of a child which died of 
this disease ; in whom, he assured me, no dilata- 
tion of the pupil, strabismus, sickness, or loss of 
appetite had attended, and but very little head-ach. 

The causes which induce this disease, act either 
directly on the brain, or indirectly upon it, through 
the medium of the whole system. 



The causes which act directly on the brain are 
Tails or bruises upon the head, certain positions of 
the body, and childish plays which bring on con- 
gestion or inflammation, and afterwards an effusion 
of water in the brain. I have known it brought on 
in a child by falling into a cellar upon its feet. 

The indirect causes of this disease are more 
numerous, and more frequent, though less suspect- 
ed, than those which have been mentioned. The 
following diseases of the whole system appear to 
act indirectly in producing an internal dropsy of 
the brain. 

1. Intermitting , remitting , and continual fevers. 
Of the effects of these fevers in inducing this dis- 
ease, many cases are recorded by Lieutaud*. 

My former pupil, Dr. Woodhouse, has furnish- 
ed me with a dissection, in which the disease was 
evidently the effect of the remitting fever. That 
state of continual fever which has been distin- 
guished by the name of typhus, is often the re- 
mote cause of this disease. The languor and 
weakness in all the muscles of voluntary motion, 
the head-ach, the inclination to rest and sleep, 

* Historia Anatomica-Meriica, vol. II. 


and the disposition to be disturbed, or terrified by 
dreams, which are said to be the precursors of 
water in the brain, I believe are frequently symp- 
toms of a typhus fever which terminates in an in- 
flammation, or effusion of water in the brain. The 
history which is given of the typhus state of fever 
in children by Dr. Butter*, seems to favour this 

2. The rheumatism. Of this I have known 
two instances. Dr. Lettsom has recorded a case 
from the same causef. The pains in the limbs, 
which are supposed to be the effect, I suspect are 
frequently the cause of the disease. 

3. The pulmonary consumption. Of the con- 
nection of this disease with an internal dropsy of 
the brain, Dr. Percival has furnished us with the 

following communication J : " Mr. C 's 

«' daughter, aged nine years, after labouring under 
" the phthisis pulmonalis four months, was affected 
" with unusual pains in her head. These rapidly 
" increased, so as to occasion frequent screamings, 

* Treatise on the Infantile Remitting Fever. 

f Medical Memoirs, vol. I. p. 174. 

. \ Essays, Medical, Philosophical, and Experimental, vol.\ 
II. p. 339, 340. 


"- The cough, which had before been extremely 
" violent, and was attended with stitches in the 
" breast, now abated, and in a few days ceased 
" almost entirely. The pupils of the eyes became 
" dilated, a strabismus ensued, and in about a week 
" death put an end to her agonies. Whether this 
" affection of the head arose from the effusion of 
" water or of blood, is uncertain, but its influence 
" on the state of the lungs is worthy of notice." 
Dr. Quin likewise mentions a case from Dr. Cul- 
len's private practice, in which an internal dropsy 
of the brain followed a pulmonary consumption. 
Lieutaud mentions three cases of the same kind*, 
and two, in which it succeeded a catarrhf . 

4. Ernpthe fevers. Dr. Odier informs us J, 
that he had seen four cases in which it had followed 
the small-pox, measles, and scarlatina. Dr. Lett- 
som mentions a case in which it followed the small- 
pox ||, and I have seen one in which it was obvi- 
ously the effects of debility induced upon the sys 
tern by the measles. 

* Historia Anatomica-Medica, vol. II. lib. tertius. obs. 
380, 394, 1121. 

t Obs. 383, 431. 

\ Medical Journal. 

|J Medical Memoirs, vol. I. p. 171. 


5. Worms, Notwithstanding the discharge of 
worms gives no relief in this disease, yet there is 
good reason to believe, that it has, in some in- 
stances, been produced by them. The morbid 
action continues in the brain, as in other cases of 
disease, after the cause which induced it, has ceased 
to act upon the body. 

6. From the dissections of Lieutaud, Quin, and 
others, it appears further, that the internal dropsy 
of the brain has been observed to succeed each of 
the following diseases, viz. the colic, palsy, melan- 
choly, dysentery, dentition, insolation, and scro- 
phula, also the sudden healing of old sores. I 
have seen two cases of it from the last cause, and 
one in which it was produced by the action of the 
vernal sun alone upon the system. 

From the facts which have been enumerated, 
and from dissections to be mentioned hereafter, it 
appears, that the disease in its first stage is the 
effect of causes which produce a less degree of that 
morbid action in the brain which constitutes phre- 
nitis, and that its second stage is the effect of a less 
degree of that effusion, which produces serous apo- 
plexy in adults. The former partakes of the na- 
ture of the chronic inflammation of Dr. Cullen, and 
of the asthenic inflammation of Dr. Brown. I 


have taken the liberty to call it phrenicula, from its 
being a diminutive species or state of phrenitis. It 
bears the same relation to phrenitis, when it arises 
from indirect causes, which pneumonicula does to 
pneumony ; and it is produced nearly in the same 
manner as the pulmonary consumption, by debili- 
tating causes which act primarily on the whole sys- 
tem. The peculiar size and texture of the brain 
seem to invite the inflammation and effusions which 
follow debility, to that organ in childhood, just as 
the peculiar structure and situation of the lungs 
invite the same morbid phenomena to them, after 
the body has acquired its growth, in youth and 
middle life. In the latter stage which has been men- 
tioned, the internal dropsy of the brain partakes 
of some of the properties of apoplexy. It differs 
from it in being the effect of a slow, instead of a sud- 
den effusion of water or blood, and in being the ef- 
fect of causes which are of an acute instead of a 
chronic nature. In persons advanced beyond 
middle life, who are affected by this disease, it 
approaches to the nature of the common apo- 
plexy, by a speedy termination in life or death. 
Dr. Cullen has called it simply by the name of 
" apoplexia hydrocephalica." I have preferred 
for its last stage the term of chronic apoplexy, for 
I believe with Dr. Quin, that it has no connection 
with a hydropic diathesis of the whole system. I 


am forced to adopt this opinion, from my having 
rarely seen it accompanied by dropsical effusions 
in other parts of the body, nor a general dropsy 
accompanied by an internal dropsy of the brain. 
No more occurs in this disease than takes place 
when hydrothorax follows an inflammation of the 
lungs, or when serous effusions follow an inflam- 
mation of the joints. I do not suppose that both 
inflammation and effusion always attend in this dis- 
ease ; on the contrary, dissections have shown 
some cases of inflammation, with little or no effu- 
sion, and some of effusion without inflammation. 
Perhaps this variety may have been produced by 
the different stages of the disease in which death 
and the inspection of the brain took place. Nei- 
ther do I suppose, that the two stages which have 
been mentioned, always succeed each other in the 
common order of inflammation and effusion. In 
every case where the full tense, slow and intermit- 
ting pulse occurs, I believe there is inflammation ; 
and as this state of the pulse occurs in most cases 
in the beginning of the disease, I suppose the in- 
flammation, in most cases, to precede the effusion 
of water. I have met with only one case in which 
the slow and tense pulse was absent ; and out of 
six dissections of patients whom I have lost by this 
disease, the brains of four of them exhibited marks 
of inflammation. 


Mr. Davis discovered signs of inflammation, 
after death from this disease, to be universal. In 
eighteen or twenty dissections, he tells us, he found 
the pia mater always distended with blood*. 
Where signs of inflammation have not occurred, 
the blood-vessels had probably relieved themselves 
by the effusion of serum, or the morbid action of 
the blood-vessels had exceeded that grade of ex- 
citement, in which only inflammation can take 
place. I have seen one case of death from this 
disease, in which there was not more than a tea- 
spoonful of water in the ventricles of the brain. 
Dr. Quin mentions a similar case. Here death 
was induced by simple excess of excitement. The 
water which is found in the ventricles of the brain 
refuses to coagulate by heat, and is always pale in 
those diseases, in which the serum of the blood, in 
every other part of the body, is of a yellow colour. 

In addition to these facts, in support of the internal 
dropsy of the brain being the effect of inflammation, 
I shall mention one more, communicated to me in 
a letter, dated July 17th, 1795, by my former pu- 
pil, Dr. Coxe, while he was prosecuting his studies 
in London. ** It so happened (says my ingenious 
correspondent), that at the time of my receiving; 


* Medical Journal, vol. VIII. 

vol. n. 2 d 


your letter, Dr. Clark was at the hospital. I read 
to him that part which relates to your success in 
the treatment of hydrocephalus interims. He was 
much pleased with it, and mentioned to me a fact 
which strongly corroborates your idea of its being 
a primary inflammation of the brain. This fact was, 
that upon opening, not long since, the head of a 
child that had died of this disease, he found be- 
tween three and four ounces of water in the ven- 
tricles of the brain ; also an inflammatory crust on 
the optic nerves, as thick as he had ever observed 
it on the intestines in a state of inflammation. The 
child lost its sight before it died. The crust ac- 
counted in a satisfactory manner for its blindness. 
Perhaps something similar may always be noticed 
in the dissections of such as die of this disease, in 
whom the eyes are much affected." 

Having adopted the theory of this disease, which 
I have delivered, I resolved upon such a change in 
my practice as should accord with it. The first 
remedy indicated by it was 

I. Blood-letting. I shall briefly mention the 
effects of this remedy in a few of the first cases in 
which I prescribed it. 



On the 15th of 'November, 1790, I was called 
to visit the daughter of William Webb, aged four 
years, who was indisposed with a cough, a pain in 
her bowels, a coma, great sensibility of her eyes to 
light, costiveness, and a suppression of urine, a 
slow and irregular, but tense pulse, dilated pupils, 
but no head-ach. I found, upon inquiry, that she 
had received a hurt on her head by a fall, about se- 
ven weeks before I saw her. From this informa- 
tion, as well as from her symptoms, I had no doubt 
of the disease being the internal dropsy of the brain. 
I advised the loss of five ounces of blood, which 
gave her some relief. The blood was sizy. The 
next day she took a dose of jalap and calomel, 
which operated twelve times. On the 18th she lost 
four ounces more of blood, which was more sizy 
than that drawn on the 15th. From this time she 
mended rapidly. Her coma left her on the 20th, 
and her appetite returned ; on the 21st she made a 
large quantity of turbid dark coloured urine. On 
the 22d her pulse became again a little tense, for 
which she took a gentle puke. On the 23d she 
had a natural stool. On the 24th her pupils ap- 
peared to be contracted to their natural size, and 
on the 30th I had the pleasure of seeing her seated 


at a tea-table in good health. Her pulse notwith- 
standing, was a little more active and tense than 


On the 24th of the same month, I was called to 
visit the son of John Cypher, in South- street, aged 
four years, who had been hurt about a month be- 
fore, by a wound on his forehead with a brick-bat, 
the mark of which still appeared. He had been 
ill for near two weeks with coma, head-ach, colic, 
vomiting, and frequent starlings in his sleep. His 
evacuations by stool and urine were suppressed ; 
he had discharged three worms, and had had two 
convulsion fits just before I saw him. The pupil 
of the right eye was larger than that of the left. 
His pulse was full, tense, and slow, and intermitted 
every fourth stroke. The symptoms plainly indi- 
cated an internal dropsy of the brain. I ordered 
him to lose four or five ounces of blood. But 
three ounces of blood were drawn, which produced 
a small change in his pulse. It rendered the inter- 
mission of a pulsation perceptible only after every 
tenth stroke. On the 25th he lost five ounces of 
blood, and took a purge of calomel and jalap. On 
the 26th he was better. On the 27th the vomiting 


was troublesome, and his pulse was still full and 
tense, but regular. I ordered him to lose four 
ounces of blood. On the 28th his puking and 
head-ach continued ; his pulse was a little tense, 
but regular ; and his right pupil less dilated. On 
the 29th his head-ach and puking ceased, and he 
played about the room. On the 4th of December 
he grew worse ; his head-ach and puking returned, 
with a hard pulse, for which I ordered him to lose 
five ounces of blood. On the 5th he was better, 
but on the 6th his head-ach and puking returned. 
On the 7th I ordered his forehead to be bathed fre- 
quently with vinegar, in which ice had been dis- 
solved. On the 8th he was much better. On the 
9th his pulse became soft, and he complained but 
little of head-ach. After appearing to be well for 
near three weeks, except that he complained of a 
little head-ach, on the 29th his pulse became again 
full and tense, for which I ordered him to lose six 
ounces of blood, which for the first time discover- 
ed a bufFy coat. After this last bleeding, he dis~ 
charged a large quantity of water. From this time 
he recovered slowly, but his pulse was a little fuller 
than natural on the 19th of January following. He 
afterwards enjoyed good health. 



In the month of March, 1792, I attended two 
children of three years of age, the one the daugh- 
ter of William King, the other the daughter of 
William Blake : each of whom had most of the 
symptoms of the inflammatory stage of the internal 
dropsy of the brain. I prescribed the loss of four 
ounces of blood, and a smart purge in both cases, 
and in the course of a few days had the pleasure of 
observing all the symptoms of the disease perfectly 
subdued in each of them. 


In the months of July and August, 1792, I at- 
tended a female slave of Mrs. Oneal, of St. Croix, 
who had an obstinate head-ach, coma, vomiting, 
and a tense, full, and slow pulse. I believed it to 
be the phrenicula, or internal dropsy of the brain, 
in its inflammatory stage. I bled her five times in 
the course of two months, and each time with ob- 
vious relief of all the symptoms of the disease. 
Finding that her head-ach, and a disposition to 
vomit, continued after the tension of her pulse was 
nearly reduced, I gave her as much calomel as ex- 


cited a gentle salivation, which in a few weeks 
completed her cure. 


The daughter of Robert Moffat, aged eight 
years, in consequence of the suppression of a ha- 
bitual discharge from sores on her head, in the 
month of April, 1793, was affected by violent 
head-ach, puking, great pains and weakness in her 
limbs, and a full, tense, and slow pulse. I believed 
these symptoms to be produced by an inflamma- 
tion of the brain. I ordered her to lose six or se- 
ven ounces of blood, and gave her two purges of 
jalap and calomel, which operated very plentifully. 
I afterwards applied a blister to her neck. In one 
week from the time of my first visit to her she ap- 
peared to be in perfect health. 


A young woman of eighteen years of age, a 
hired servant in the family of Mrs. Elizabeth 
Smith, had been subject to a head-ach every spring 
for several years. The unusually warm days which 
occurred in the beginning of April, 1793, pro- 


duced a return of this periodical pain. On the 
eighth of the month, it was so severe as to confine 
her to her bed. I was called to visit her on the 
ninth. I found her comatose, and, when awake, 
delirious. Her pupils were unusually dilated, and 
insensible to the light. She was constantly sick at 
her stomach, and vomited frequently. Her bowels 
were obstinately costive, and her pulse was full, 
tense, and so slow as seldom to exceed, for several 
days, from 56 to 60 strokes in a minute. I or- 
dered her to lose ten ounces of blood every day, 
for three days successively, and gave her, on each 
of those days, strong doses of jalap and aloes. The 
last blood which was drawn from her was sizy. 
The purges procured from three to ten discharges 
every day from her bowels. On the 12th, she 
appeared to be much better. Her pulse was less 
tense, and beat 80 strokes in a minute. On the 
14th, she had a fainting lit. On the 15th, she 
sat up, and called for food. The pupils of her 
eyes now recovered their sensibility to light, as 
well as their natural size. Her head-ach left her, 
and, on the 17th, she appeared to be in good 
health. Her pulse, however, continued to beat 
between 50 and 60 strokes in a minute, and 
retained a small portion of irregular action for se- 
veral davs after she recovered. 


I am the more disposed to pronounce the cases 
which have been described to have been internal 
dropsy of the brain, from my having never been 
deceived in a single case in which I have examined 
the brains of patients whom I have suspected to 
have died of it. 

I could add many other cases to those which have 
been related, but enough, I hope, have been men- 
tioned to establish the safety and efficacy of the re- 
medies that have been recommended. 

I believe, with Dr. Quin, that this disease is 
much more frequent than is commonly supposed. 
I can recollect many cases of anomalous fever and 
head-ach in children, which have excited the most 
distressing apprehensions of an approaching inter- 
nal dropsy of the brain, but which have yielded 
in a few days to bleeding, or to purges and blis- 
ters. I think it probable, that some, or perhaps 
most of these cases, might have terminated in an 
effusion of water in the brain, had they been left 
to themselves, or not been treated with the above 
remedies. I believe further, that it is often pre- 
vented by all those physicians who treat the first 
stage of febrile diseases in children with evacua- 
tions, just as the pulmonary consumption is pre- 
vol. it, 2 E 



vented by bleeding, and low diet, in an inflamma- 
tory catarrh. 

Where blood-letting has failed of curing this 
disease, I am disposed to ascribe it to its being used 
less copiously than the disease required. If its re- 
lation to pneumonicula be the same in its cure, that 
J have supposed it to be in its cause, then I am 
persuaded, that the same excess in blood-letting is 
indicated in it, above what is necessary in phreni- 
tis, that has been practised in pneumonicula, above 
what is necessary in the cure of an acute inflamma- 
tion of the lungs. The continuance, and, in some 
instances, the increase of die appetite in the inter- 
nal dropsy of the brain, would seem to favour this 
opinion no less in this disease, than in the inflam- 
matory state of pulmonary consumption. The ex- 
treme danger from the effusion of water into the 
ventricles of the brain, and the certainty of death 
from its confinement there, is a reason likewise why 
more blood should be drawn in this disease, than 
in diseases of the same force in other parts of the 
body, where the products of inflammation have a 
prompt, or certain outlet from the body. Where 
the internal dropsy is obviously the effect of a fall, 
or of any other cause which acts directly on the 
brain, there can be no doubt of the safety of very 
plentiful bleeding ; all practical writers upon surge- 


ry concur in advising it. The late Dr. Pennington 
favoured me with an extract from Mr. Cline's ma- 
nuscript lectures upon anatomy, delivered in Lon- 
don in the winter of 1792, which places the advan- 
tage of blood-letting, in that species of inflammation 
which follows a local injury of the brain, in a very 
strong point of light. " I know (says he) that se- 
" veral practitioners object to the use of evacua- 
" tions as remedies for concussions of the brain, 
" because of the weakness of the pulse ; but in 
" these cases the pulse is depressed. Besides, ex- 
" perience shows, that evacuations are frequently 
" attended with very great advantages. I remem- 
" ber a remarkable case of a man in this [St. Tho- 
" mas's] hospital, who was under the care of Mr. 
" Baker. He lay in a comatose state for three 
" weeks after an injury of the head. During that 
" time he was bled twenty times, that is to say, he 
" was bled once every day upon an average. He 
" was bled twice a day plentifully, but towards the 
" conclusion he was bled more sparingly, and only 
41 every other day ; but at each bleeding, there 
" were taken, upon an average, about sixteen 
" ounces of blood. In consequence of this treat- 
1 ' ment, the man perfectly recovered his health and 
, li reason.' 7 


Local bleeding by cups, leaches, scarifications, 
or arteriotomy, should be combined with venesec- 
tion, or preferred to it, where the whole arterial 
system does not sympathize with the disease in 
the brain. 

II. A second remedy to be used in the second 
stage of this disease is purges. I have constantly 
observed all the patients whose cases have been re- 
lated, to be relieved by plentiful and repeated eva- 
cuations from the bowels. I was led to the use of 
frequent purges, by having long observed their 
good effects in palsies, and other cases of conges- 
tion in the brain, where blood-letting was unsafe, 
and where it had been used without benefit. In 
the Leipsic Commentaries*, there is an account 
of a case of internal dropsy of the brain, which 
followed the measles, being cured by no other me- 
dicines than purges and diuretics. I can say no- 
thing in favour of the latter remedy, in this disease, 
from my own experience. The foxglove has been 
used in this city by several respectable practition- 
ers, but, I believe, in no instance with anv advan^ 


f Vol. xxix. p. 139* 


III. Blisters have been uniformly recommended 
by all practical writers upon this disease. I have 
applied them to the head, neck, and temples, and 
generally with obvious relief to the pain in the 
head. They should be omitted in no stage of the 
disease ; for even in its inflammatory stage, the 
discharge they occasion from the vessels of the 
head, greatly overbalances their stimulating effects 
upon the whole system. 

IV. Mercury was long considered as the only 
remedy, which gave the least chance of a recovery 
from a dropsy of the brain. Out of all the cases 
in which I gave it, before the year 1790, I suc- 
ceeded in but two : one of them was a child of 
three years old, the other was a young woman of 
twenty-six years of age. I am the more convinced 
that the latter case was internal dropsy of the brain, 
from my patient having relapsed, and died between 
two or three years afterwards, of the same disease. 
Since I have adopted the depleting remedies which 
have been mentioned, I have declined giving mer- 
cury altogether, except when combined with some 
purging medicine, and I have given it in this form 
chiefly with a view of dislodging worms. My 
reasons for not giving it as a sialagogue are the un- 
certainty of its operation, its frequent ineflicacy 
when it excites a salivation, and, above all, its dis- 


position to produce gangrene in the tender jaws of 
children. Seven instances of its inducing death 
from that cause, in children between three and 
eight years of age, and with circumstances of un- 
common distress, have occurred in Philadelphia 
since the vear 1795. 

V. Linen cloths, wetted with cold vinegar, or 
water, and applied to the forehead, contribute very- 
much to relieve the pain in the head. In the case 
of Mr. Cypher's son*, the solution of ice in the 
vinegar appeared to afford the most obvious relief 
of this distressing symptom. 

A puncture in the brain has been proposed by 
some writers to discharge the water from its ven- 
tricles. If the theory I have delivered be true, the 
operation promises nothing, even though it could 
always be performed with perfect safety. In cases 
of local injuries, or of inflammation from any cause, 
it must necessarily increase the disease ; and in 
cases of effusion only, the debilitated state of the 
whole system forbids us to hope for any relief from 
such a local remedy. 

Bark, wine, and opium promise much more sue- 

* Case II. 


cess in the last stage of the disease. I can say- 
nothing in their favour from my own experience ; 
but from the aid they affoixl to mercury in other 
diseases, I conceive they might be made to accom- 
pany it with advantage. 

Considering the nature of the indirect causes 
which induce the disease, and the case of a re- 
lapse, which has been mentioned, after an interval 
of near three ) r ears, as well as the symptoms of 
slow convalescence, manifested by the pulse, which 
occurred in the first and seventh cases, I submit it 
to the consideration of physicians, whether the use 
of moderate exercise, and the cold bath, should 
not be recommended to prevent a return of the 
disease in every case, where it has yielded to the 
power of medicine. 

I have great pleasure in adding, that the theory 
of this disease, which I have delivered, has been 
adopted by many respectable physicians in Phila- 
delphia, and in other parts of the United States, 
and that it has led to the practice that has been re- 
commended, particularly to copious blood-letting ; 
in consequence of which, death from a dropsy of 
the brain is not a more frequent occurrence, than 
from any other of the acute febrile diseases of our 




or THE 


VOL. II. 2 F 


IN treating upon the gout, I shall deliver a 
few preliminary propositions. 

1. The gout is a disease of the whole system. 
It affects the ligaments, blood-vessels, stomach, 
bowels, brain, liver, lymphatics, nerves, muscles, 
cartilages, bones, and skin. 

2. The gout is a primary disease, only of the so- 
lids. Chalk-stones, abscesses, dropsical effusions 
into cavities, and cellular membrane, and eruptions 
on the skin, are all the effects of a morbid action in 
the blood-vessels. The truth of this proposition 
has been ably proved by Dr. Cullen in his First 


3. It affects most frequently persons of a sangui- 
neous temperament ; but sometimes it affects per- 
sons of nervous and phlegmatic temperaments. 
The idle and luxurious are more subject to it, than 
the labouring and temperate part of mankind. 
Women are said to be less subject to it than men. 
I once believed, and taught this opinion, but I now 
retract it. From the peculiar delicacy of the fe- 
male constitution, and from the thin covering they 
wear on their feet and limbs, the gout is less apt 
to fall upon those parts than in men, but they ex- 
hibit all its other symptoms, perhaps more fre- 
quently than men, in other parts of the body. The 
remote causes of gout moreover to be mentioned 
presently, act with equal force upon both sexes, 
and more of them I believe upon women, than up- 
on men. 

It generally attacks in those periods of life, and 
in those countries, and seasons of the year, hi which 
inflammatory diseases are most common. It sel- 
dom affects persons before puberty, or in old age, 
and yet I have heard of its appearing with all its 
most characteristic symptoms in this city in a child 
of 6, and in a man above 80 years of age. Men of 
active minds are said to be most subject to it, but 
I think I have seen it as frequently in persons of 
slender and torpid intellects, as in persons of an 

THE GOUT. 229 

opposite character. I have heard of a case of gout 
in an Indian at Pittsburg, and I have cured a fit of 
it in an Indian in this city. They had both been 
intemperate in the use of wine and fermented li- 

4. It is in one respect a hereditary disease, de- 
pending upon the propagation of a similar tempera- 
ment from father to son. When a predisposition 
to the gout has been derived from ancestors, less 
force in exciting causes will induce it than in those 
habits where this has not been the case. This 
predisposition sometimes passes by children, and 
appears in grand- children. There are instances like- 
wise in which it has passed by the males, and ap- 
peared only in the females of a family. It even 
appears in the descendants of families who have 
been reduced to poverty, but not often where they 
have been obliged to labour for a subsistence. It 
generally passes by those children who are born be- 
fore the gout makes its appearance in a father. It 
is curious to observe how extensively the predispo- 
sition pervades some families. An English gentle- 
man, who had been afflicted with the gout, mar- 
ried a young woman in Philadelphia many years 
ago, by whom he had one daughter. His wife 
dying three weeks after the birth of this child, he 
returned to England, where he married a second 


wife, by whom he had six children, all of whom 
except one died with the gout before they attained 
to the usual age of matrimony in Great Britain. 
One of them died in her 16th year. Finally the 
father and grandfather died with the same disease. 
The daughter whom this afflicted gentleman left in 
this city, passed her life subject to the gout, and 
finally died under my care in the year 1789, in the 
68th year of her age. She left a family of chil- 
dren, two of whom had the gout. One of them, a 
lady, has suffered exquisitely from it. 

5. The gout is always induced by general pre- 
disposing debility. 

6. The remote causes of the gout which induce 
this debility, are, indolence, great bodily labour, 
long protracted bodily exercise, intemperance in 
eating, and in venery, acid aliments and drinks, 
strong tea and coffee, public and domestic vexation, 
the violent, or long continued exercise of the un- 
derstanding, imagination, and passions in study, 
business, or pleasure, and, lastly, the use of ardent, 
and fermented liquors. The last are absolutely 
necessary to produce that form of gout which ap- 
pears in the ligaments and muscles. I assert this, 
not only from my own observations, but from those 
of Dr. Cadogan, and Dr. Darwin, who say they 

THE GOUT. 231 

never saw a case of gout in the limbs in any per- 
son who had not used spirits or wine in a great- 
er or less quantity. Perhaps this may be another 
reason why women, who drink less of those liquors 
than men, are so rarely affected with this disease in 
the extreme parts of their bodies. Wines of ail 
kinds are more disposed to produce this form of 
gout than spirits. The reason of this must be re- 
solved into the less stimulus in the former, than in 
the latter liquors. Wine appears to resemble, in 
its action upon the body, the moderate stimulus of 
miasmata which produce a common remitting fe- 
ver, or intermitting fever, while spirits resemble 
that violent action induced by miasmata which pas- 
ses by the blood-vessels, ligaments, and muscles, 
and invades at once the liver, bowels, and brain. 
There is one symptom of the gout in the extremi- 
ties which seems to be produced exclusively by 
ardent spirits, and that is a burning in the palms of 
the hands, and soles of the feet. This is so uni- 
form, that I have sometimes been able to convict 
my patients of intemperance in the use of spirits, 
when no other mark of their having taken them in 
excess, appeared in the system. 

I have enumerated among the remote causes of 
the gout, the use of strong tea. I infer its predis- 
posing quality to that disease, from its frequency 


at Japan, where tea is used in large quantities, and 
from the gout being more common among that sex 
in our country who drink the most, and the strong- 
est tea. 

7. The exciting causes of the gout are frequently 
a greater degree, or a sudden application of its re- 
mote and predisposing causes. They act upon the 
accumulated excitability of the system, and by de- 
stroying its equilibrium of excitement, and regular 
order of actions, produce convulsion, or irregular 
morbid and local excitement. These exciting 
causes are either of a stimulating, or of a sedative 
nature. The former are violent exercise, of body 
or mind, night-watching, and even sitting up late 
at night, a hearty meal, a fit of drunkenness, a few- 
glasses of claret or a draught of cyder, where those 
liquors have not been habitual to the patient, a sud- 
den paroxysm of joy, anger, or terror, a dislocation 
of a bone, straining of a joint, particularly of the 
ankle, undue pressure upon the foot, or leg, from 
a tight shoe or boot, an irritated corn, and the usual 
remote causes of fever. The latter exciting causes 
are sudden inanition from bleeding, purging, vo- 
miting, fasting, cold, a sudden stoppage of mois- 
ture on the feet, fear, grief, excess in venery, and 
the debility left upon the system by the crisis of a 
fever. All these causes act more certainly when 

THE GOUT. 233 

they are aided by the additional debility induced 
upon the system in sleep. It is for this reason that 
the gout generally makes its first attack in the 
night, and in a part of the system most remote 
from the energy of the brain, and most debilitated 
by exercise, viz. in the great toe, or in some part 
of the foot. In ascribing a fit of the gout to a cause 
which is of a sedative nature, the reader will not 
suppose that I have departed from the simplicity 
and uniformity of a proposition I have elsewhere 
delivered, that disease is the effect of stimulus. 
The abstraction of a natural and habitual impres- 
sion of any kind, by increasing the force of those 
which remain, renders the production of morbid 
and excessive actions in the system as much the 
effect of preternatural or disproportioned stimulus, 
as if they were induced by causes that are exter- 
nally and evidently stimulating. It is thus in many 
other of the operations of nature, opposite causes 
produce the same effects. 

8. The gout consists simply in morbid excite- 
ment, accompanied with irregular action, or the ab- 
sence of all action from the force of stimulus. There 
is nothing specific in the morbid excitement and ac- 
tions which take place in the gout different from 
what occur in fevers. It is to be lamented that a 
kind of metastasis of error has taken place in patho- 

VOL. II. 2 G 


logy. The rejection of a specific acrimony as the 
cause of each disease, has unfortunately been fol- 
lowed by a belief in as many specific actions as 
there are different forms and grades of disease, and 
thus perpetuated the evils of our ancient systems of 
medicine. However varied morbid actions may 
be by their causes, seats, and effects, they are all 
of the same nature, and the time will probably come 
when the whole nomenclature of morbid actions 
will be absorbed in the single name of disease. 

I shall now briefly enumerate the symptoms of 
the gout, as they appear in the ligaments, the blood- 
vessels, the viscera, the nervous system, the alimen- 
tary canal, the lymphatics, the skin, and the bones 
of the human body, and here >ve shall find that 
it is an epitome of all disease. 

I. The ligaments which connect the bones are 
the seats, of what is called a legitimate or true 
gout. They are affected with pain, swelling, and 
inflammation. The pain is sometimes so acute as 
to be compared to the gnawing of a dog. We per- 
ceive here the sameness of the gout with the rheu- 
matism. Many pages, and indeed whole essays, 
have been composed by writers to distinguish them, 
but they are exactly the same disease while the mor- 
bid actions are confined to this part of the body. 

THE GOUT. 235 

They are, it is true, produced by different remote 
causes, but this constitutes no more difference in 
their nature, than is produced in a coal of fire, whe- 
ther it be inflamed by a candle, or by a spark of 
electricity. The morbid actions which are induced 
by the usual causes of rheumatism affect, though 
less frequently, the lungs, the trachea, the head, 
the bowels, and even the heart, as well as the gout. 
Those actions, moreover, are the means of a fluid 
being effused, which is changed into calcareous 
matter in the joints and other parts of the body, ex- 
actly like that which is produced by the gout. They 
likewise twist and dislocate the bones in common 
with the gout, in a manner to be described here- 
after. The only difference between what are called 
gouty, and rheumatic actions, consists in their seats, 
and in the degrees of their force. The debility 
which predisposes to the gout, being greater, and 
more extensively diffused through the body than 
the debility which precedes rheumatism, the mor- 
bid actions, in the former case, pass more readily 
from external to internal parts, and produce in both 
more acute and more dangerous effects. A simile 
derived from the difference in the degrees of action 
produced in the system by marsh miasmata, made 
use of upon a former occasion, will serve me again 
to illustrate this part of our subject. A mild re- 
mittent, and a yellow fever, are different grades of 


the same disease. The former, like the rheuma- 
tism, affects the bones chiefly with pain, while the 
latter, like the gout, affects not only the bones, 
but the stomach, bowels, brain, nerves, lymphatics, 
and all the internal parts of the body. 

II. In the arterial system the gout produces fe- 
ver. This fever appears not only in the increased 
force or frequency of the pulse, but in morbid 
affections of all the viscera. It puts on all the dif- 
ferent grades of fever, from the malignity of the 
plague, to the mildness of a common intermittent. 
It has moreover its regular exacerbations and re- 
missions once in every four and twenty hours, and 
its crisis usually on the fourteenth day, in violent 
cases. In moderate attacks, it runs on from twenty 
to forty days in common with the typhus or slow 
chronic state of fever. It is common for those per- 
sons who consider the gout as a specific disease, 
when it appears in the above forms, to say, that it 
is complicated with fever ; but this is an error, for 
there can exist but one morbid action in the blood- 
vessels at once, and the same laws are imposed 
upon the morbid actions excited in those parts of 
the body by the remote causes of the gout, as by 
the common causes of fever. I have seen two in- 
stances of this disease appearing in the form of a 
genuine hectic, and one in which it appeared to 

THE GOUT. 237 

yield to lunar influence, in the manner described by 
Dr. Balfour. In the highly inflammatory state of 
the gout, the sensibility of the blood-vessels far 
exceeds what is seen in the same state of fever from 
more common causes. I have known an instance 
in which a translation of the gouty action to the eye 
produced such an exquisite degree of sensibility, 
that the patient was unable to bear the feeble light 
which was emitted from a few coals of fire in his 
room, at a time too when the coldness of the wea- 
ther would have made a large fire agreeable to him. 
It is from the extreme sensibility which the gout 
imparts to the stomach, that the bark is so generally 
rejected by it. I knew a British officer who had 
nearly died from taking a spoonful of the infusion 
of that medicine, while his arterial system was in 
this state of morbid excitability, from a fit of the 
gout. It is remarkable that the gout is most dis- 
posed to assume a malignant character, during the 
prevalence of an inflammatory constitution of the 
atmosphere. This has been long ago remarked b}' 
Dr. Huxham. Several instances of it have occur- 
red in this city since the year 1793. 

III. The gout affects most of the viscera. In 
the brain it produces head-ach, vertigo, coma, apo- 
plexy, and palsy. In the lungs it produces pneu- 
monia vera, notha, asthma, haemoptysis, pulmonary 


consumption, and a short becking cough, first de- 
scribed by Dr. Sydenham. In the throat it pro- 
duces inflammatory angina. In the uterus it pro- 
duces hsemorrhagia uterina. It affects the kidneys 
with inflammation, strangury, diabetes, and calculi. 
The position of the body for weeks or months on 
the back, by favouring the compression of the kid- 
neys by the bowels, is the principal reason why 
those parts suffer so much in gouty people. The 
strangury appears to be produced by the same kind 
of engorgement or choking of the vessels of the 
kidneys, which takes place in the small-pox and 
yellow fever. Four cases of it are described in the 
3d volume of the Physical and Literary Essays of 
Edinburgh, by Dr. David Clerk. I have seen one 
instance of death in an old man from this cause. 
The catheter brought no water from his bladder. 
The late Mr. John Penn, formerly governor of 
Pennsylvania, I have been informed by one of his 
physicians, died from a similar affection in his kid- 
neys from gout. The catheter was as ineffectual 
in giving him relief, as it was in the case of my 
patient. The neck of the bladder sometimes be- 
comes the seat of the gout. It discovers itself by 
spasm, and a suppression of urine in some cases, 
and occasionally by a habitual discharge of mucus 
through the urethra. This disease has been called, 
by Lieutaud, " a catarrh of the bladder." Dr. 

THE GOUT. 239 

Stoll describes it, and calls it " haemorrhoids of the 
bladder." But of all the viscera, the liver suffers 
most from the gout. It produces in it inflamma- 
tion, suppuration, melena, schirrus, gall-stones, 
jaundice, and a habitual increased secretion and ex- 
cretion of bile. These affections of the liver ap- 
pear most frequently in southern countries, and in 
female habits. They are substitutes for a gout in 
the ligaments, and in the extremities of the body. 
They appear likewise in drunkards from ardent 
spirits. It would seem that certain stimuli act spe- 
cifically upon the liver, probably for the wise pur- 
pose of discharging such parts of the blood from 
the body, as are vitiated by the rapidity of its cir- 
culation. I shall, in another place*, take notice 
of the action of marsh miasmata upon the livers of 
men and beasts. It has been observed that hogs 
that live near brewhouses, and feed upon the fer- 
mented grains of barley, always discover enlarged 
or diseased livers. But a determination of the 
blood to the liver, and an increased action of its 
vessels, are produced by other causes than marsh 
miasmata, and fermented and distilled liquors. 
They appear in the fever which accompanies mad- 
ness and the malignant sore-throat, also in contu- 
sions of the brain, and in the excited state of the 

* Volume IV. 


blood-vessels which is produced by anger and ex- 
ercise. I have found an attention to these facts 
useful in prescribing for diseases of the liver, inas- 
much as they have led me from considering them 
as idiopathic affections, but as the effects only of 
morbid actions excited in other parts of the body. 

IV. The gout sometimes affects the arterial and 
nervous systems jointly, producing in the brain, 
coma, vertigo, apoplexy, palsy, loss of memory, 
and madness, and in the nerves, hysteria, hypochon- 
driasis, and syncope. It is common to say the gout 
counterfeits all these diseases. But this is an in- 
accurate mode of speaking. All those diseases 
have but one cause, and they are exactly the same, 
however different the stimulus may be, from which 
they are derived. Sometimes the gout affects the 
brain and nerves exclusively, without producing 
the least morbid action in the blood-vessels. I once 
attended a gentleman from Barbadoes who suffered, 
from this affection of his brain and nerves, the most 
intolerable depression of spirits. It yielded to large 
doses of wine, but his relief was perfect, and more 
durable, when a pain was excited by nature or art, 
in his hands or feet. 

The muscles are sometimes affected by the gout 
with spasm, with general and partial convulsions, 

THE GOUT. 241 

and lastly with great pain. Dr. Stoll describes a 
case of opisthotonos from it. The angina pectoris, 
or a sudden inability to breathe after climbing a 
hill, or a pair of stairs, and after a long walk, is 
sometimes a symptom of the gout. There is a 
pain which suddenly pervades the head, breast, and 
limbs, which resembles an electric shock. I have 
known two instances of it in gouty patients, and 
have taken the liberty of calling it the " aura arthri- 
tica." But the pain which affects the muscles is 
often of a more permanent nature. It is felt with 
most severity in the calves of the legs. Sometimes 
it affects the muscles of the head, breast, and 
limbs, exciting in them large and distressing swel- 
lings. But further ; the gout in some cases seizes 
upon the tendons, and twists them in such a man- 
ner as to dislocate bones in the hands and feet. It 
even affects the cartilages. Of this I once saw an 
instance in colonel Adams, of the state of Maryland. 
The external parts of both his ears were so much 
inflamed in a fit of the gout, that he was unable to 
lie on either of his sides. 

V. The gout affects the alimentary canal, from 
the stomach to its termination in the rectum. 
Flatulency, sickness, acidity, indigestion, pain, or 
vomiting, usually usher in a fit of the disease. The 
sick head-ach, also dyspepsia, with all its train of 

VO£. II. 2 H 


distressing evils, are frequently the effects of gout 
concentrated in the stomach. I have seen a case 
in which the gout, by retreating to this viscus, pro- 
duced the same burning sensation which is felt in 
the yellow fever. The patient who was the subject 
of this symptom died two days afterwards with a 
black vomiting. It was Mr. Patterson, formerly 
collector of the port of Philadelphia, under the Bri- 
tish government. I was not surprised at these two 
uncommon symptoms in the gout, for I had long 
been familiar with its disposition to affect the bilia- 
ry secretion, and the actions of the stomach. The 
colic and dysentery are often produced by the gout 
in the bowels. In the southern states of America, 
it sometimes produces a chronic diarrhoea, which is 
known in some places by the name of the " down- 
ward consumption." The piles are a common 
symptom of gout, and where they pour forth blood 
occasionally, render it a harmless disease. I have 
known an instance in which a gouty pain in the 
rectum produced involuntary stools in a gentleman 
in this city, and I have heard from a southern gen- 
tleman, who had been afflicted with gouty symp- 
toms, that a similar pain was excited in the same 
part to such a degree, whenever he went into a 
crowded room lighted by candles, as to oblige him 
to leave it. In considering the effects of the gout 
upon this part, I am led to take notice of a trouble- 

THE GOUT. 243 

some itching in the anus which has been described 
by Dr. Lettsom, and justly attributed by him to 
this disease*. I have known several cases of it. 
They always occurred in gouty habits. A dis- 
tressing collection of air in the rectum, which ren- 
ders frequent retirement from company necessary 
to discharge it, is likewise a symptom of gout. It 
is accompanied with frequent, and small, but hard 

Of the above morbid affections of the nerves, 
stomach, and bowels, the hysteria, the sick head- 
ach, and the colic, appear much oftener in women 
than in men. I have said that dyspepsia is a symp- 
tom of gout. Out of more than 500 persons who 
were the patients of the Liverpool infirmary and 
dispensary, in one year, Dr. Currie informs us, 
" a great majority were femalesf." 

VI. The gout affects the glands and lymphatics. 
It produced a salivation of a profuse nature in ma- 
jor Pearce Butler, which continued for two days. 
It produced a bubo in the groin in a citizen of Phi- 
ladelphia. He had never been infected with the 

* Medical Memoirs, vol. III. 

t Medical Reports on the Effects of Hot and Cold Water, 
p. 215. 


venereal disease, of course no suspicion was enter- 
tained by me of its being derived from that cause. 
I knew a lady who had periodical swellings in her 
breasts, at the same season of the year in which 
she had before been accustomed to have a regular 
fit of the gout. The scrophula and all the forms of 
dropsy are the effects in many cases of the disposi- 
tion of the gout to attack the lymphatic system. 
There is a large hard swelling without pain, of one, 
or both the legs and thighs, which has been called 
a dropsy, but is very different from the common 
disease of that name. It comes on, and goes off 
suddenly. It has lately been called in England the 
dumb gout. In the spring of 1798 I attended co- 
lonel Innes, of Virginia, in consultation with my 
Edinburgh friend and fellow- student, Dr. Walter 
Jones, of the same state. The colonel had large 
anasarcous swellings in his thighs and legs, which 
we had reason to believe were the effects of an in- 
dolent gout. We made several punctures in his 
feet and ancles, and thereby discharged a large 
quantity of water from his legs and thighs. A day 
or two afterwards his ancles exhibited in pain and 
inflammation, the usual form of gout in those parts. 
In the year 1794 I attended Mrs. Lloyd Jones, who 
had a swelling of the same kind in her foot and leg. 
Her constitution, habits, and the sober manners 
of her ancestors, gave me no reason to suspect it 

THE GOUT. 245 

to arise from the usual remote causes of gout. 
She was feverish, and her pulse was tense. 1 drew 
ten ounces of blood from her, and gave her a purge. 
The swelling subsided, but it was succeeded by an 
acute rheumatic pain in the part, which was cured 
in a few days. I mention these facts as an addi- 
tional proof of the sameness of the gout and rheu- 
matism, and to show that the vessels in a simple 
disease, as well as in malignant fevers, are often 
oppressed beyond that point in which they emit 
the sensation of pain. 

Under this head I shall include an account of 
the mucous discharge from the urethra, which 
sometimes takes place in an attack of the gout, and 
which has ignorantly been ascribed to a venereal 
gonorrhoea. There is a description of this symp- 
tom of the gout in the 3d volume of the Physical 
and Literary Essays of Edinburgh, by Dr. Clark. 
It was first taken notice of by Sauvages by the 
name of " gonorrhoea podagrica," in a work entitled 
Pathologia Methodica. I have known three in- 
stances of it in this city. In the visits which the 
gout pays to the genitals, it sometimes excites great 
pain in the testicles. Dr. Whytt mentions three 
cases of this kind. One of them was attended 
with a troublesome itching of the scrotum. I have 
seen one case in which the testicles were affected 


with great pain, and the penis with an obstinate 
priapism. They succeeded a sudden translation of 
the gout from the bowels. 

From the occasional disposition of the gout to 
produce a mucous discharge from the urethra in 
men, it is easy to conceive that it is the frequent 
cause of the fiuor albus in women, for in them, the 
gout which is restrained from the feet, by a cause 
formerly mentioned, is driven to other parts, and 
particularly to that part which, from its offices, is 
more disposed to invite disease to it, than any 
other. The fluor albus sometimes occurs in fe- 
males, apparently of the most robust habits. In 
such persons, more especially if they have been 
descended from gouty ancestors, and have led in- 
dolent and luxurious lives, there can be no doubt 
but the disease is derived from the gout, and 
should be treated with remedies which act not 
only upon the affected part, but the whole system. 
An itching similar to that I formerly mentioned in 
the anus, sometimes occurs in the vagina of wo- 
men. Dr. Lettsom has described it. In all the 
cases I have known of it, I believe it was derived 
from the usual causes of the gout. 

VII. There are many records in the annals of 
medicine of the gout affecting the skin. The ery- 

THE GOUT. 247 

sipelas, gangrene, and petechia? are its acute, and 
tetters, and running sores are its usual chronic 
forms when it appears in this part of the body. I 
attended a patient with the late Dr. Hutchinson, in 
whom the whole calf of one leg was destroyed by 
a mortification which succeeded the gout. Dr. 
Alexander, of Baltimore, informed me that petechias 
were among the last symptoms of this disease in the 
Rev. Mr. Oliver, who died in the town of Balti- 
more, about two years ago. In the disposition of 
the gout to attack external parts, it sometimes af- 
fects the eyes and ears with the most acute and 
distressing inflammation and pain. I hesitate the 
less in ascribing them both to the gout, because 
they not only occur in gouty habits, but because 
they now and then effuse a calcareous matter of the 
same nature with that which is found in the liga- 
ments of the joints. 

VIII. Even the bones are not exempted from the 
ravages of this disease. I have before mentioned 
that the bones of the hands and feet are sometimes 
dislocated by it. I have heard of an instance in 
which it dislocated the thigh bone. It probably 
produced this effect by the effusion of that part of 
the blood which constitutes chalk-stones, or by an 
excrescence of flesh in the cavity of the joint. Two 
instances have occurred in this city of its dislodg- 


ing the teeth, after having produced the most dis- 
tressing pains in the jaws. The long protracted, 
and acute pain in the face, which has been so accu- 
rately described by Dr. Fothergiil, probably arises 
wholly from the gout acting upon the bones of the 
part affected. 

I have more than once hinted at the sameness of 
some of the states of the gout, and the yellow fe- 
ver. Who can compare the symptoms and seats 
of both diseases, and not admit the unity of the 
remote and immediate causes of fever ? 

Thus have I enumerated proofs of the gout being 
a disease of the whole system. I have only to add 
under this proposition, that it affects different parts 
of the body in different people, according to the 
nature of their congenial or acquired temperaments, 
and that it often passes from one part of the body 
to another in the twinkling of an eye. 

The morbid excitement, and actions of the gout, 
when seated in the ligaments, the blood-vessels, and 
viscera, and left to themselves, produce effects dif- 
ferent in their nature, according to the parts in 
which they take place. In the viscera they pro- 
duce congestions composed of all the component 
parts of the blood. From the blood-vessels which 

THE GOUT. 249 

terminate in hollow cavities and in cellular mem- 
brane, they produce those effusions of serum which 
compose dropsies. From the same vessels proceed 
those effusions which produce on the skin erysipe- 
las, tetters, and all the different kinds of eruptions. 
In the ligaments they produce an effusion of coagu- 
lable lymph, which by stagnation is changed into 
what are called chalk-stones. In the urinary organs 
they produce an effusion of particles of coagulable 
lymph or red blood, which, under certain circum- 
stances, are changed into sand, gravel, and stone. 
All these observations are liable to some exceptions. 
There are instances in which chalk-stones have been 
found in the lungs, mouth, on the eye-lids, and in 
the passages of the ears, and a preternatural flux of 
water and blood has taken place from the kidneys. 
Pus has likewise been formed in the joints, and air 
has been found in the cavity of the belly, instead 
of water. 

Sometimes the gout is said to combine with the 
fevers which arise from cold and miasmata. We 
are not to suppose from this circumstance, that the 
system is under a twofold stimulus. By no means. 
The symptoms which are ascribed to the gout, are 
the effects of morbid excitement excited by the 
cold, or miasmata acting upon parts previously de- 
bilitated by the usual remote causes of that disease. 

VOL. II. 2 I 


A bilious diathesis in the air so often excites the 
peculiar symptoms of gout, in persons predisposed 
to it, that it has sometimes been said to be epide- 
mic. This was the case, Dr. Stoll says, in Vienna, 
in the years 1782 and 1784. The same mixture 
of gouty and bilious symptoms was observed by 
Dr. Hillary, in the fevers of Barbadoes. 

From a review of the symptoms of the gout, 
the impropriety of distinguishing it from its various 
seats, by specific names, must be obvious to the 
reader. As well might we talk of a yellow r fever 
in the brain, in the nerves, or in the groin, when 
its symptoms affect those parts, as talk of misplaced 
or retroccdent gout. The great toe, and the joints 
of the hands and feet, are no more its exclusive 
seats, than the " stomach is the throne of the yel- 
" low fever." In short, the gout may be com- 
pared to a monarch whose empire is unlimited. 
The whole body crouches before it. 

It has been said as a reflection upon our profes- 
sion, that physicians are always changing their opi- 
nions respecting chronic diseases. For a long 
while they were all classed under the heads of ner- 
vous, or bilious. These names for many years 
afforded a sanctuary for the protection of fraud and 
and error in medicine. They have happily yielded 

THE GOUT. 251 

Of late years to the name of gout. If we mean by 
this disease a primary affection of the joints, we 
have gained nothing by assuming that name • but 
if we mean by it a disease which consists simply 
of morbid excitement, invited by debility, and dis- 
posed to invade every part of the body, we con- 
form our ideas to facts, and thus simplify theory 
and practice in chronic diseases. 

I proceed now to treat of the method of cure. 

Let not the reader startle when I mention curing* 
the gout. It is not a sacred disease. There will 
be no profanity in handling it freely. It has been 
cured often, and I hope to deliver such directions 
under this head, as will reduce it as much under 
the power of medicine, as a pleurisy or an intermit- 
ting fever. Let not superstition say here, that the 
gout is the just punishment of folly, and vice, and 
that the justice of Heaven would be defeated by 
curing it. The venereal disease is more egregi- 
ously the effect of vice than the gout, and yet 
Heaven has kindly directed human reason to the 
discovery of a remedy which effectually eradicates 
it from the constitution. This opinion of the gout 
being a curable disease, is as humane as it is just: 
It is calculated to prompt to early application for 
medical aid, and to prevent that despair of relief 

■r • ... 


which has contributed so much to its duration, and 

But does not the gout prevent other diseases, and 
is it not improper upon this account to cure it ? I 
answer, that it prevents other diseases, as the daily 
use of drams prevents the intermitting fever. In 
doing this, they bring on a hundred more incura- 
ble morbid affections. The yellow fever carried 
off many chronic diseases in the year 1793, and 
yet who would wish for, or admit such a remedy 
for a similar purpose ? The practice of encourag- 
ing, and inviting what has been called a " friendly 
fit" of the gout as a cure for other diseases, resem- 
bles the practice of school boys who swallow the 
stones of cherries to assist their stomachs in digest- 
ing that delicate fruit. It is no more necessary to 
produce the gout in the feet, in order to cure it, 
than it is to wait for, or encourage abscesses or na- 
tural haemorrhages, to cure a fever. The practice 
originated at a time when morbific matter was sup- 
posed to be the cause of the gout, but it has unfor- 
tunatelv continued under the influence of theories 


which have placed the seat of the disease in the 

The remedies for the gout naturally divide them- 
selves into the following heads. 

THE GOUT. 253 

I. Such as are proper in its approaching, or 
forming state. 

II. Such as are proper in violent morbid action 
in the blood-vessels and viscera. 

III. Such as are proper in a feeble morbid action 
in the same parts of the body. 

IV. Such as are proper to relieve certain local 
symptoms which are not accompanied by general 
morbid action. And 

V. Such as are proper to prevent its recurrence, 
or, in other words, to eradicate it from the system. 

I. The symptoms of an approaching fit of the 
gout are great languor, and dulness of body and 
mind, doziness, giddiness, wakefulness, or sleep 
disturbed by vivid dreams, a dryness, and some- 
times a coldness, numbness, and prickling in the 
feet and legs, a disappearance of pimples in the 
face, occasional chills, acidity and flatulency in the 
stomach, with an increased, a weak, or a defect of 
appetite. These symptoms are not universal, but 
more or less of them usher in nearly every fit of the 
gout. The reader will see at once their sameness 
with the premonitory symptoms of fever from cold 


and miasmata, and assent from this proof, in addi- 
tion to others formerly mentioned, to the propriety 
of considering a fit of the gout, as a paroxysm of 

The system, during the existence of these symp- 
toms, is in a state of morbid depression. The 
disease is as yet unformed, and may easily be pre- 
vented by the loss of a few ounces of blood, or, if 
this remedy be objected to, by a gentle doze of 
physic, and afterwards by bathing the feet in warm 
water, by a few drops of the spirit of hartshorn in 
a little sage or camomile tea, by a draught of wine 
whey, or a common doze of liquid laudanum, and, 
according to a late Portuguese physician, by taking 
a few doses of bark. 

It is worthy of notice, that if these remedies are 
omitted, all the premonitory symptoms that have 
been mentioned disappear as soon as the arthritic 
fever is formed, just as lassitude and chilliness yield 
to a paroxysm of fever from other causes. 

II. Of the remedies that are proper in cases of 
great morbid action in the blood-vessels and vis- 

THE GOUT. 255 

I shall begin this head by repudiating the notion 
of a specific cure for the gout existing in any sin- 
gle article of the materia medica. Every attempt 
to cure it by elixirs, diet-drinks, pills, or boluses, 
which were intended to act singly on the system, 
has been as unsuccessful as the attempts to cure the 
whooping cough by spells, or tricks of legerdemain. 

The first remedy that I shall mention for redu- 
cing great morbid action in the blood-vessels and 
viscera, is blood-letting. I was first taught the 
safety of this remedy in the gout by reading the 
w T orks of Dr. Lister, above thirty years ago, and I 
have used it ever since with great advantage. It- 
has the sanction of Dr. Hoffman, Dr. Cullen, and 
many others of the first names in medicine in its 

The usual objections to bleeding as a remedy, 
have been urged with more success in the gout, 
than in any other disease. It has been forbidden, 
because the gout is said to be a disease of debility. 
This is an error. Debility is not a disease. It is 
only its predisposing cause. Disease is preterna- 
tural strength in the state of the system now under 
consideration, occasioned by the abstraction of ex- 
citement from one part, and the accumulation of it 
in another part of the body. Every argument in 


favour of bleeding in a pleurisy applies in the pre- 
sent instance, for they both depend upon the same 
kind of morbid action in the blood-vessels. Bleed- 
ing acts moreover alike in both cases by abstracting 
the excess of excitement from the blood- vessels, 
and restoring its natural and healthy equality to 
every part of the system. 

It has been further said, that bleeding disposes 
to more frequent returns of the gout. This objec- 
tion to the lancet has been urged by Dr. Syden- 
ham, who was misled in his opinion of it, by his 
theory of the disease being the offspring of -morbi- 
fic matter. The assertion is unfounded, for bleed- 
ing in a fit of the gout has no such effect, provided 
the remedies to be mentioned hereafter are used to 
prevent it. But a fit of the gout is not singular in 
its disposition to recur after being once cured. 
The rheumatism, the pleurisy, and the intermitting 
fever are ail equally disposed to return when per- 
sons are exposed to their remote and exciting 
causes, and yet we do not upon this account con- 
sider them as incurable diseases, nor do we abstain 
from the usual remedies which cure them. 

The inflammatory or violent state of the gout is 
said most commonly to affect the limbs. But this 
is far from being the case. It frequently makes 

THE GOUT. 257 

its first attack upon the head, lungs, kidneys, sto- 
mach, and bowels. The remedies for expelling it 
from the stomach and bowels are generally of a 
stimulating nature. They are as improper in full 
habits, and in the recent state of the disease, as 
cordials are to drive the small-pox from the vitals 
to the skin. Hundreds have been destroyed by 
them. Bleeding in these cases affords the same 
speedy and certain relief that it does in removing 
pain from the stomach and bowels in the first stage 
of the yellow fever. Colonel Miles owes his life 
to the loss of 60 ounces of blood in an attack of 
the gout in his bowels, in the winter of 1795, and 
major Butler derived the same benefit from the loss 
of near 30 ounces, in an attack of the gout in his 
stomach in the spring of 1798. 

I could add many more instances of the efficacy 
of the lancet in the gout when it affects the viscera, 
from my own experience, but I prefer mentioning 
one only from sir John Floyer, which is more strik- 
ing than any I have met with in its favour. He 
tells us, sir Henry Coningsby was much disposed 
to the palsy from the gout when he was 30 yeans 
old. By frequent bleedings, and the use of the 
cold bath, he recovered, and lived to be 88. Dur- 
ing his old age, he was bled every three months. 

VOL. II. 2 K 


I have said, in the history of the symptoms of the 
gout, that it sometimes appeared in the form of a 
hectic fever. I have prescribed occasional bleed- 
ings in a case of this kind accompanied with a tense 
pulse, with the happiest effects. It confined 
the disease for several years wholly to the blood- 
vessels, and it bid fair in time to eradicate it from 
the system. 

The state of the pulse, as described in another 
place*, should govern the use of the lancet in this 
disease. Bleeding is required as much in its de- 
pressed, as in its full and chorded state. Colonel 
Miles's pulse, at the time he suffered from the 
gout in his bowels, was scarcely perceptible. It 
did not rise till after a second or third bleeding. 

Some advantage may be derived from examin- 
ing the blood. I have once known it to be dis- 
solved ; but for the most part I have observed it, 
with Dr. Lister, to be covered with the buffy coat 
of common inflammation. 

The arguments made use of in favour of bleed- 
ing in the diseases of old people in a former vo- 
lume, apply with equal force to its use in the gout. 

* Defence of Blood-letting, vol. IV. 

THE GOUT. 259 

The inflammatory state of this disease frequently 
occurs in the decline of life, and bleeding is as 
much indicated in such cases as in any other in- 
flammatory fever. The late Dr. C ho vet died with 
an inflammation in his liver from gout, in the 86th 
year of his age. He was twice bled, and his blood 
each time was covered with a buffy coat. 

Where die gout affects the head with obstinate 
pain, and appears to be seated in the muscles, cup- 
ping and leeches give great relief. This mode of 
bleeding should be trusted in those cases only in 
which the morbid action is confined chiefly to the 
head, and appears in a feeble state in the rest of the 
arterial system. 

The advantages of bleeding in the gout, when 
performed under all the circumstances that have 
been mentioned, are as follow : 

1. It removes or lessens pain. 


2. It prevents those congestions and effusions 
which produce apoplexy, palsy, pneumonia notha, 
calculi in the kidneys and bladder, and chalk -stones 
in the hands and feet. The gravel and stone are 
nine times in ten, I believe, the effects of an effu- 
sion of lymph or blood from previous morbid ac- 



tion in the kidneys. If this disease were narrowly 
watched, and cured as often as it occurs, by the 
loss of blood, we should have but little gravel or 
stone among gouty people. A citizen of Philadel- 
phia died a few years ago, in the 96th year of his 
age, who had been subject to the strangury the 
greatest part of his life. His only remedy for it 
was bleeding. He lived free from the gravel and 
stone, and died, or rather appeared to fall asleep in 
death, from old age. Dr. Haller mentions a simi- 
lar case in his Bibliotheca Medicinse, in which 
bleeding had the same happy effects. 

3. It prevents the system from wearing itself 
down by fruitless pain and sickness, and thereby 
inducing a predisposition to frequent returns of the 

4. It shortens the duration of a fit of gout, by 
throwing it, not into the feet, but out of the sys- 
tem, and thus prevents a patient's lying upon his 
back for two or three months with a writhing face, 
scolding a wife and family of children, and some- 
times cursing every servant that comes near enough 
to endanger the touch of an inflamed limb. Besides 
preventing all this parade of pain and peevishness, 
it frequently, when assisted with other remedies to 
be mentioned presently, restores a man to his busi- 

THE GOUT. 261 

ness and society in two or three days : a circum- 
stance this of great importance in the public as well 
as private pursuits of men ; for who has not read 
of the most interesting affairs of nations being ne- 
glected or protracted, by the principal agents in 
them being suddenly confined to their beds, or 
chairs, for weeks or months, by a fit of the gout ? 

2. A second remedy in the state of the gout 
which has been mentioned, is purging. Sulphur 
is generally preferred for this purpose, but castor 
oil, cream of tartar, sena, jalap, rhubarb, and calo- 
mel, may all be used with equal safety and advan- 
tage. The stomach and habits of the patient should 
determine the choice of a suitable purge in every 
case. Salts are generally offensive to the stomach. 
They once brought on a fit of the gout in Dr. 

3. Vomits may be given in all those cases where 
bleeding is objected to, or where the pulse is only 
moderately active. Mr. Small, in an excellent 
paper upon the gout, in the 6th volume of the Me- 
dical Observations and Inquiries, p. 205, contain- 
ing the history of his own case, tells us that he 
always took a vomit upon the first attack of the 
gout, and that it never failed of relieving all its 
symptoms. The matter discharged by this vomit 


indicated a morbid state of the liver, for it was al- 
ways a dark greenish bile, which was insoluble in 
water. A British lieutenant, whose misfortunes 
reduced him to the necessity of accepting a bed in 
the poor-house of this city, informed the late Dr. 
Stuben, that he had once been much afflicted with 
the gout, and that he had upon many occasions 
strangled a fit of it by the early use of an emetic. 
Dr. Pye adds his testimony to those which have 
been given in favour of vomits, and says further, 
that they do most service when they discharge an 
acid humour from the stomach. They appear to 
act in part by equalizing the divided excitement of 
the system, and in part by discharging the contents 
of the gall-bladder and stomach, vitiated by the 
previous debility of those organs. Care should be 
taken not to exhibit this remedy where the gout 
attacks the stomach with symptoms of inflammation, 
or where it has a tendency to fix itself upon the 

4. Nitre may be given with advantage in cases 
of inflammatory action, where the stomach is not 

5. A fifth remedy is cool or cold air. This is 
as safe and useful in the gout as in any other in- 
flammatory state of fever. The affected limbs 

THE GOUT. 263 

should be kept out of bed, uncovered. In this way 
Mr. Small says he moderated the pains of the gout 
in his hands and feet*. I have directed the same 
practice with great comfort, as well as advantage 
to my patients. Even cold water has been applied 
with good effects to a limb inflamed by the gout. 
Mr. Blair M'Clenachan taught me the safety and 
benefit of this remedy, by using it upon himself 
without the advice of a physician. It instantly re- 
moved his pain, nor was the gout translated by it 
to any other part of his body. It was removed in 
the same manner, Dr. Heberden tells us, by the 
celebrated Dr. Harvey from his own feet. Per- 
haps it would be best in most cases to prefer cool, 
or cold air, to cold water. The safety and advan- 
tages of both these modes of applying cold to the 
affected limbs, show the impropriety of the com- 
mon practice of wrapping them in flannel. 


6. Diluting liquors , such as are prescribed in 
common inflammatory fevers, should be given in 
such quantities as to dispose to a gentle perspira- 

7. Abstinence from wine, spirits, and malt li- 
quors ' } also from such aliments as afford much nou- 


* Medical Observations and Inquiries, vol VI. p. 20 1 , 


rishment or stimulus, should be carefully enjoined. 
Sago, panada, tapioca, diluted milk with bread, 
and the pulp of apples, summer fruits, tea, coffee, 
weak chocolate, and bread soaked in chicken water 
or beef tea, should constitute the principal diet of 
patients in diis state of the gout. 

8. Blisters are an invaluable remedy in this dis- 
ease, when used at a proper time, that is, after the 
reduction of the morbid actions in the system by 
evacuations. They should be applied to the joints 
of the feet and wrists in general gout, and to the neck 
and sides, when it attacks the head or breast. A 
strangury from the gout is no objection to their 
use. So far from increasing this complaint, Dr; 
Clark and Dr. Whytt inform us, that they remove 
it*. But the principal advantage of blisters is de- 
rived from their collecting and concentrating scat- 
tered and painful sensations, and conveying them 
out of the system, and thus becoming excellent 
substitutes for a tedious fit of the gout. 

9. Fear and terror have in some instances cured 
a paroxysm of this disease. A captain of a British 
ship of war, who had been confined for several 
weeks to his cabin, by a severe fit of the gout in 

* Physical and Literary Essays, vol. III. p. 469. 

THE GOUT. 265 

his feet, was suddenly cured by hearing the cry of 
fire on board his ship. This fact was communicat- 
ed to me by a gentleman who was a witness of it. 
Many similar cases are upon record in books of 
medicine. I shall in another place insert an ac- 
count of one in which the cure effected by a fright, 
eradicated the disease from the system so com- 
pletely, as ever afterwards to prevent its return. 

Thus have I enumerated the remedies which are 
proper in the gout when it affects the blood-vessels 
and viscera with great morbid action. Most of 
those remedies are alike proper when the morbid 
actions are seated in the muscular fibres, whether 
of the bowels or limbs, and whether they produce 
local pain, or general convulsion, provided they 
are of a violent nature. 

There are some remedies under this head of a 
doubtful nature, on which I shall make a few ob- 

Sweating has been recommended in this state 
of the gout. All the objections to it in preference 
to other modes of depletion, mentioned in another 
place*, apply against its use in the inflammatory 

* Defence of Blood-letting. 
VOL. II. 2 L 


state of the gout. It is not only less safe than 
bleeding, purging, and abstinence, but it is often 
an impracticable remedy. The only sudorific me- 
dicine to be trusted in this state of the disease is 
the Seneka snake-root. It promotes all the secre- 
tions and excretions, and exerts but a feeble stimu- 
lus upon the arterial system. 

Many different preparations of opium have been 
advised in this state of the gout. They are all 
hurtful if given before the morbid action of the 
system is nearly reduced. It should then be given 
in small doses accommodated to the excitability of 
the system. 

Applications of various kinds to the affected 
limbs have been used in a fit of the gout, and some 
of them with success. The late Dr. Chalmers of 
South- Carolina used to meet the pain of the gout 
as soon as it fixed in any of his limbs, with a blis- 
ter, and generally removed it by that means in tw» 
or three days. I have imitated this practice in se- 
veral cases, and always with success, nor have I 
ever seen the gout thrown upon any of the viscera 
by means of this remedy. Caustics have sometimes 
been applied to gouty limbs with advantage. The 
moxa described and used by sir William Temple, 
which is nothing but culinary fire, has often not 

THE GOUT. 267 

only given relief to a pained limb, but carried off 
a fit of the gout in a few hours. These powerful 
applications may be used with equal advantage in 
those cases in which the gout by falling upon the 
head produces coma, or symptoms of apoplexy. 
A large caustic to the neck roused Mr. John M. 
Nesbit from a coma in which he had lain for three 
days, and thereby appeared to save his life. Blis- 
ters, and cataplasms of mustard, had been previ- 
ously used to different parts of his body, but with- 
out the least effect. In cases of moderate pain, 
where a blister has been objected to, I have seen a 
cabbage leaf afford considerable relief. It produ- 
ces a moisture upon the part affected, without ex- 
citing any pain. An old sea captain taught me to 
apply molasses to a limb inflamed or pained by the 
gout. I have frequently advised it, and generally 
with advantage. All volatile and stimulating lini- 
ments are improper, for they not only endanger a 
translation of the morbid excitement to the viscera, 
but where they have not this effect, they increase 
the pain and inflammation of the part affected. 

The sooner a patient exercises his lower limbs 
by walking, after a fit of the gout, the better. " I 
made it a constant rule (says Mr. Small) to walk 
abroad as soon as the inflammatorv state of the 
gout was past, and though by so doing, I often 


suffered great pain, I am well convinced that the 
free use I now enjoy of my limbs is chiefly owing 
to my determined perseverance in the use of that 
exercise ; nor am I less persuaded that nine in ten 
of gouty cripples owe their lameness more to in- 
dolence, and fear of pain, than to the genuine 
effects of the gout*." Sir William Temple con- 
firms the propriety of Mr. Small's opinion and 
practice, by an account of an old man who obvi- 
ated a fit of the gout as often as he felt it coming 
in his feet, by walking in the open air, and after- 
wards by going into a warm bed, and having the 
parts well rubbed where the pain began. " By 
following this course (he says) he was never laid 
up with the gout, and before his death recommend- 
ed the same course to his son if ever he should 
fall into that accident." Under a conviction of 
the safety of this practice the same author con- 
cludes the history of his own case in the following 
words : "I favoured it [viz. the swelling in my 
feet] all this while more than I needed, upon the 
common opinion, that walking too much might 
draw down the humour, which I have since had 
reason to conclude is a great mistake, and that if I 
liad walked as much as I could from the first day 

* Medical Observations and Inquiries, vol. vi. p. 220. 

THE GOUT. 269 

the pain left me, the swelling might have left me 
too in a much less time*." 

III. I come now to mention the remedies which 
are proper in that state of the gout in which a feeble 
morbid action takes place in the blood-vessels and 

I shall begin this head, by remarking, that this 
state of the gout is often created, like the typhus 
state of fever, by the neglect, or too scanty use of 
evacuations in its first stage. When the prejudices 
which now prevent the adoption of those remedies 
in their proper time, are removed, we shall hear 
but little of the low state of the arthritic fever, nor 
of the numerous diseases from obstruction which 
are produced by the blood-vessels disorganizing the 
viscera, by repeated and violent attacks of the 

To determine the character of a paroxysm of 
gout and the remedies proper to relieve it, the cli- 
mate, the season of the year, the constitution of 
the atmosphere, and the nature of the prevailing 
epidemic, should be carefully attended to by a phy- 

* Essay upon the Cure of the Gout by Moxa, vol. i. folio 
edition, p. 143 and 141. 


sician. But his principal dependence should be 
placed upon the state of the pulse. If it do not 
discover the marks which indicate bleedinsr formerly 
referred to, but is weak, quick, and soft, the reme- 
dies should be such as are calculated to produce a 
more vigorous, and equable action in the blood-ves- 
sels and viscera. They are, 

1. Opium. It should at first be given in small 
doses, and afterwards increased, as circumstances 
may require. 

2. Madeira or Sherry wine alone, or diluted with 
water, or in the form of whey, or rendered more 
cordial by having any agreeable spice infused in it. 
It may be given cold or warm, according to the 
taste of the patient, or the state of his stomach. If 
this medicine be rejected in all the above forms, 

3. Porter should be given. It is often retained 
when no other liquor will lie upon the stomach. I 
think I once saved the life of Mr. Nesbit by this 
medicine. It checked a vomiting, from the gout, 
w r hich seemed to be the last symptom of his depart- 
ing life. If porter fail of giving relief, 

4. Ardent spirits should be given, either alone, 
or in the form of grog, or toddy. Cases have ©c- 

THE GOUT, 271 

eurred in. which a pint of brandy has been taken in 
the course of an hour with advantage. Great be- 
nefit has sometimes been found from Dr. Warner's 
tincture, in this state of the gout. As these obser- 
vations may fall into the hands of persons who may 
not have access to Dr. Warner's book, I shall here 
insert the receipt for preparing it. 

Of raisins, sliced and stoned, half a pound. 
Rhubarb, one ounce. 
Sena, two drachms. 

Coriander and fennel seeds, of each one drachm. 
Cochineal, saffron, and liquorice root, each half 
a drachm. 

Infuse them for ten days in a quart of French 
brandy, then strain it, and add a pint more of bran- 
dy to the ingredients, afterwards strain it, and mix 
both tinctures together. Four table spoons full of 
this cordial are to be taken every hour, mixed with 
an equal quantity of water, until relief be obtained. 

Ten drops of laudanum may be added to each 
dose in those cases in which the cordial does not 
produce its intended effects, in two or three hours. 
If all the different forms of ardent spirits which 
have been mentioned fail of giving relief, 


5. From 30 drops to a tea spoonful of ather 
shouid be given in any agreeable vehicle. Also, 

6. Volatile alkali. From five to ten grains of 
this medicine should be given every two hours. 

7. Aromatic substances, such as alspice, ginger, 
Virginia snake-root, cloves, and mace in the form 
Of teas, have all been useful in this state of the 

All these remedies are indicated in a more espe- 
cial manner when the gout affects the stomach. 
They are likewise proper when it affects the bowels. 
The laudanum in this case should be given by 
way of glyster. After the vomiting was checked 
in Mr. Nesbit by means of porter, he was afflicted 
with a dull and distressing pain in his bowels, 
which was finally removed by two anodyne glys- 
ters injected daily for two or three weeks. 

8. Where the gout produces spasmodic or con- 
vulsive motions, the oil of amber may be given 
with advantage. I once saw it remove for a while 
a convulsive cough from the gout. 

9. In cases where the stomach will bear the bark, 
it shouid be given in large and frequent doses. It 

THE GOUT. 273 

does the same service in this state of gout, that it 
does in the slow, or low states of fever from any- 
other cause. Where the gout appears in the form 
of an intermittent, the bark affords the same relief 
that it does in the same disease from autumnal ex- 
halations. Mr. Small found great benefit from it 
after discharging the contents of his stomach and 
bowels by a dose of tartar emetic. " I do not call 
(says this gentleman) a fit of the gout a paroxysm, 
for there are several paroxysms in the fit, each of 
which is ushered in with a rigour, sickness at sto- 
mach, and subsequent heat. In this the gout bears 
a resemblance to an irregular intermittent, at least to 
a remitting fever, and hence perhaps the efficacy of 
the bark in removing the gout*." 

10. The warm bath is a powerful remedy in ex- 
citing a regular and healthy action in the sanguifer- 
ous system. Where the patient is too weak to be 
taken out of bed, and put into a bathing tub, his 
limbs and body should be wrapped in flannels dip- 
ped in warm water. In case of a failure of all the 
above remedies, 

11. A salivation should be excited as speedily 
as possible, by means of mercury. Dr. Cheyne 

* Medical Observations and Inquiries, vol. vi. p. 220. 
VOL. II. 2 M 


commends it in high terms. I have once used it 
with success. The mercury, when used in this 
way, brings into action an immense mass of latent 
excitement, and afterwards diffuses it equally 
through every part of the body. 

12. Besides these internal remedies, frictions 
with brandy, and volatile liniment, should be used 
to the stomach and bowels. Blisters should be 
applied to parts in which congestion or pain is 
seated, and stimulating cataplasms should be ap- 
plied to the lower limbs. The flour of mustard has 
been justly preferred for this purpose. It should 
be applied to the upper part of the foot. 

The reader will perceive, in the account I have 
given of the remedies proper in the feeble state of 
chronic fever, that they are the same which are 
used in the common typhus, or what is called nerv« 
ous fever. There is no reason why they should 
not be the same, for the supposed two morbid 
states of the system are but one disease. 

It is agreeable in medical researches to be under 
the direction of principles. They render unneces- 
sary, in many instances, the slow and expensive 
operations of experience, and thus multiply know- 
ledge, by lessening labour. The science of navi- 

THE GOUT. -275 

gation has rested upon this basis, since the disco* 
very of the loadstone. A mariner who has navi- 
gated a ship to one distant port, is capable of 
conducting her to every port on the globe. In like 
manner, the physician who can cure one disease 
by a knowledge of its principles, may by the same 
means cure all the diseases of the human body, for 
their causes are the same. Judgment is required, 
only in accommodating the force of remedies to the 
force of each disease. The difference in diseases 
which arises from their seats, horn age, sex, habit, 
season, and climate, may be known in a short 
time, and is within the compass of very moderate 

IV. Were I to enumerate all the local symptoms 
of gout which occur without fever, and the reme- 
dies that are proper to relieve them, I should be led 
into a tedious digression. The reader must con- 
sult practical books for an account of them. I shall 
onlv mention the remedies for a few of them. 

The theory of the gout which has been deliver- 
ed, will enable us to understand the reason why a 
disease which properly belongs to the whole sys- 
tem, should at any time be accompanied only with 
local morbid affection. The whole body is a unit, 
and hence morbid impressions which are resisted by 


sound parts are propagated to such as are weak ; 
where they excite those morbid actions we call 

The bead-ach is a distressing symptom of the 
gout. It yields to depleting or tonic remedies, ac- 
cording to the degree of morbid action which ac- 
companies it. I have heard an instance of an old 
man, who was cured of an obstinate head-ach by 
throwing aside his nightcap, and sleeping with his 
bare head exposed to the night air. The disease in 
this case was probably attended with great morbid 
action. In this state of the vessels of the brain, 
cupping, cold applications to the head, purges, a 
temperate diet, and blisters behind the ears, are all 
proper remedies, and should be used together, or 
in succession, as the nature of the disease may re- 
quire. Many persons have been cured of the same 
complaint by sleeping in woollen nightcaps. The 
morbid action in these cases is alwavs of a feeble 
nature. With this remedy, tonics, particularly the 
bark and cold bath, will be proper. I have once 
known a chronic gouty pain in the head cured by 
an issue in the arm, after pounds of bark, and ma- 
ny other tonic remedies, had been taken to no 

THE COUT. 277 

The ophthalmia from gout should be treated 
with the usual remedies for that disease when it 
arises from other causes, with the addition of such 
local applications to other and distant parts of the 
body, as may abstract the gouty action from the 

Dull but constant pains in the limbs yield to fric- 
tions, volatile liniments, muslin and woollen worn 
next to the skin, electricity, a salivation, and the 
warm and cold bath. A gentleman who was afflict- 
ed with a pain of this kind for three years and a 
half in one of his arms, informed me, that he had 
been cured by wearing a woollen stocking that had 
been boiled with sulphur in water, for two weeks 
upon the affected limb. He had previously w^orn 
flannel upon it, but without receiving any benefit 
from it. I have known wool and cotton, finely 
carded, and made into small mats, worn upon the 
hips, when affected by gout, with great advantage. 
In obstinate sciatic pains, without fever or inflam- 
mation, Dr. Pitcairn's remedy, published by Dr. 
Cheyne, has peformed many cures. It consists in 
taking from one to four tea-spoons full of the fine 
spirit of turpentine every morning, for a week or 
ten days, in three times the quantity of honey, and 
afterwards in drinking a large quantity of sack 
whey, to settle it on the stomach, and cany it into 


the blood. An anodyne should be taken eveiy 
night after taking this medicine. 

A gouty diarrhoea should be treated with the 
usual astringent medicines of the shops. Blisters 
to the wrists and ankles, also a salivation, have 
often cured it. I have heard of its being checked, 
after continuing for many years, by the patient eat- 
ing large quantities of alspice, which he carried 
loose in his pocket for that purpose. 

The angina pectoris, which I have said is a 
symptom of the gout, generally comes on with ful- 
ness and tension in the pulse. After these are re- 
duced by two or three bleedings, mineral tonics 
seldom fail of giving relief. 

Spas?ns in the stomach, and pains in the bowels, 
often seize gouty people in the midst of business or 
pleasure, or in the middle of the night. My con- 
stant prescription for these complaints is ten drops 
of laudanum every half hour, till relief be obtained. 
If this medicine be taken in the forming state of 
these pains, a single dose generally removes the dis- 
ease. It is preferable to spiced wine and spirits, 
inasmuch as it acts quicker, and leaves no disposi- 
tion to contract a love for it when it is not required 
to ease pain. 

THE GOUT. 279 

The pain in the rectum which has been describ- 
ed, yields to the common remedies for the piles. 
Cold water applied to the part, generally gives im- 
mediate relief. 

For a preternatural secretion and excretion of 
bile, gentle laxatives, and abstinence from oily 
food, full meals, and all violent exercises of the 
body and mind, are proper. 

The itching in the anus, which I have supposed 
to be a symptom of gout, has yielded in one 
instance that has come within my knowledge to 
mercurial ointment applied to the part affected. 
Dr. Lettsom recommends fomenting the part with 
a decoction of poppy heads and hemlock, and ad- 
vises lenient purges and a vegetable diet as a radi- 
cal cure for the disease*. 

For the itching in the vagina I have found a so- 
lution of the sugar of lead in water to be an excel- 
lent palliative application. Dr. Lettsom recom- 
mends as a cure for it, the use of bark in delicate 
habits, and occasional bleeding, with a light and 
moderate diet, if it occur about the time of the 
cessation of the menses. 

* Medical Memoirs, vol. III. 



Obstinate cutaneous eruptions, which are the ef- 
fects of gout, have been cured by gentle physic, a 
suitable diet, issues, and applications of the un- 
guentum citrinum to the parts affected. 

The arthritic gonorrhoea should be treated with 
the same remedies as a gonorrhoea from any other 

In the treatment of all the local symptoms that 
have been enumerated, it will be of great conse- 
quence to inquire, before we attempt to cure them, 
whether they have not succeeded general gout, and 
thereby relieved the system from its effects in parts 
essential to life. If this have been the case, the 
cure of them should be undertaken with caution, 
and the danger of a local disease being exchanged 
for a general one, should be obviated by remedies 
that are calculated to eradicate the gouty diathesis 
altogether from the system. The means for this 
purpose, agreeably to our order, come next under 
our consideration. Before I enter upon this head, 
I shall premise, that I do not admit of the seeds of 
the gout remaining in the body to be eliminated 
by art after a complete termination of one of its 
paroxysms, any more than I admit of the seeds of 
a pleurisy or intermitting fever remaining in the 
body, after they have been cured by blood-letting 

THE GOUT. 281 

6r bark. A predisposition only remains in the 
system to a return of the gout, from its usual re- 
mote and exciting causes. The contrary idea took 
its rise in those ages of medicine in which morbific 
matter was supposed to be the proximate cause of 
the gout, but it has unfortunately continued since 
the rejection of that theory. Thus in many cases 
we see wrong habits continue long after the princi- 
ples have been discarded, from which they were 

I have known several instances in which art, and 
I have heard and read of others in which acciden- 
tal suffering from abstinence, pain, and terror have 
been the happy means of overcoming a predisposi- 
tion to the gout. A gentleman from one of the 
West- India islands, who had been for many years 
afflicted with the gout, was perfectly cured of it by 
living a year or two upon the temperate diet of the 
jail in this city, into which he was thrown for debt 
by one of his creditors. A large haemorrhage from 
the foot, inflamed and swelled by the gout, acci- 
dentally produced by a penknife which fell upon 
it, effected in an Irish gentleman a lasting cure of 
the disease. Hildanus mentions the history of a 
gentleman, whom he knew intimately, who was 
radically cured of a gout with which he had been 
long afflicted, by the extreme bodily pain he suf- 

VOL. II. 2 n 


fered innocently from torture in the canton of 
Berne. He lived to be an old man, and ever after- 
wards enjoyed good health*. The following let- 
ter from my brother contains the history of a case 
in which terror suddenly eradicated the gout from 
the svstem. 

" Reading, July 21th, 1797. 


" WHEN I had the pleasure of seeing you 
last week, I mentioned an extraordinary cure of 
the gout in this town, by means of a fright. In 
compliance with your request, I now send an exact 
narration of the facts. 

" Peter Fether, the person cured, is now alive, 
a householder in Reading, seventy-three years of 
age, a native of Germany, and a very hearty man. 
The first fit of the gout he ever had, was about the 
year 1773 ; and from that time till 1785, he had a 
regular attack in the spring of every year. His 
feet, hands, and elbows were much swollen and 
inflamed ; the fits lasted long, and were excruciat- 
ing. In particular, the last fit in 1785 was so 
severe, as to induce an apprehension, that it would 

* Observat. Chirurg. Cent. I. Obs. 79. 

THE GOUT. 283 

inevitably carry him off, when he was suddenly 
relieved by the following accident. 

" As he lay in a small back room adjoining the 
yard, it happened that one of his sons, in turning 
a waggon and horses, drove the tongue of the 
waggon with such force against the window, near 
which the old man lay stretched on a bed, as to 
beat in the sash of the window, and to scatter the 
pieces of broken glass all about him. To such a 
degree was he alarmed by the noise and violence, 
that he instantly leaped out of bed, forgot that he 
had ever used crutches, and eagerly inquired what 
was the matter. His wife, hearing the uproar, ran 
into the room, where, to her astonishment, she 
found her husband on his feet, bawling against the 
author of the mischief, with the most passionate 
vehemence. From that moment, he has been 
entirely exempt from the gout, has never had the 
slightest touch of it, and now enjoys perfect health, 
has a good appetite, and says he was never heartier 
in his life. This is probably the more remarkable, 
when I add, that he has always been used to the 
"hard work of a farm, and since the year 1785 has 
frequently mowed in his own meadow, which I 
understand is low and wet. I am well informed, 
in his mode of living, he has been temperate, oc- 


casionally indulging in a glass of wine, after the 
manner of the German farmers, but not to excess. 

" To you, who have been long accustomed to 
explore diseases, I leave the task of developing the 
principles, on which this mysterious restoration 
from the lowest decrepitude and bodily wretched- 
ness, to a state of perfect health, has been accom- 
plished. I well know that tooth-achs, head-achs, 
hiccoughs, &c. are often removed by the sudden 
impression of fear, and that they return again. 
But to see a debilitated gouty frame instantly re- 
stored to vigour ; to see the whole system in a mo- 
ment, as it were, undergo a perfect and entire 
change, and the most inveterate and incurable dis- 
ease radically expelled, is surely a different thing, 
and must be acknowledged a very singular and mar- 
vellous event. If an old man, languishing under 
disease and infirmity, had died of mere fright, no- 
body would have been surprised at it ; but that he 
should be absolutely cured, and his constitution re- 
novated by it, is a most extraordinary fact, which, 
while I am compelled to believe by unexceptionable 
evidence, I am totally at a loss to account for. 

" I am your sincerely 

" affectionate brother, 

THE GOUT. 285 

These facts, and many similar ones which might 
be mentioned , afford ample encouragement to pro- 
ceed in enumerating the means which are proper 
to prevent the recurrence of the gout, or, in other 
words, to eradicate it from the system. 

V. I shall first mention the means of preventing 
the return of that state of the disease which is ac- 
companied with violent action, and afterwards take 
notice of the means of preventing the return of 
that state of it, in which a feeble morbid action 
takes place in the blood-vessels. The means for 
this purpose consist in avoiding all the remote, ex- 
citing, and predisposing causes of the gout which 
have been mentioned. I shall say a few words up- 
on the most important of them, in the order that 
has been proposed. 

I. The first remedy for obviating the violent state 
of gout is, 

1. Temperance. This should be regulated in its 
degrees by the age, habits, and constitution of the 
patient. A diet consisting wholly of milk, vege- 
tables, and simple water, has been found necessary 
to prevent the recurrence of the gout in some cases. 
But, in general, fish, eggs, the white meats and 
weak broths may be taken in small quantities once 


a day, with milk and vegetables at other times. 
A little salted meat, which affords less nourishment 
than fresh, may be eaten occasionally. It imparts 
vigour to the stomach, and prevents dyspepsia from 
a diet consisting chiefiy of vegetables. The low 
and acid wines should be avoided, but weak Ma- 
deira or sherry wine and water, or small beer, may 
be drunken at meals. The latter liquor was the 
favourite drink of Dr. Sydenham in his fits of the 
gout. Strong tea and coifee should not be tasted, 
where there is reason to believe the habitual use of 
them has contributed to bring on the disease. 

From the disposition of the gout to return in the 
spring and autumn, greater degrees of abstinence 
in eating and drinking will be necessary at those 
seasons than at any other time. With this diminu- 
tion of aliment, gentle purges should be taken, to 
obviate an attack of the gout. In persons above 
fifty years of age, an abstemious mode of living 
should be commenced with oreat caution. It has 
sometimes, when entered upon suddenly, and car- 
ried to its utmost extent, induced fits of the gout, 
and precipitated death. In such persons, the ab- 
stractions from their usual diet should be small, 
and our dependence should be placed upon other 
means to prevent a return of the disease. 

THE GOUT. 287 

£. Moderate labour and gentle exercise have 
frequently removed that debility and vibratility in 
the blood-vessels, on which a predisposition to the 
gout depends. Hundreds of persons who have 
been reduced by misfortunes to the necessity of 
working for their daily bread, have thrown off a 
gouty diathesis derived from their parents, or ac- 
quired by personal acts of folly and intemperance. 
The employments of agriculture afford the most 
wholesome labour, and walking, the most salutary 
exercise. To be useful, they should be moderate. 
The extremes of indolence and bodily activity meet 
in a point. They both induce debility, which pre- 
disposes to a recurrence of a fit of the gout. Rid- 
ing in a carriage, and on horseback, are less pro- 
per as a means of preventing the disease than walk- 
ing. Their action upon the body is partial. The 
lower limbs derive no benefit from it, and on these 
the violent state of gout generally makes its first 
attack. In England, many domestic exercises 
have been contrived for gouty people, such as 
shuttle- cock, bullets, the chamber- horse, and the 
like, but they are all trifling in their effects, com- 
pared with labour, and exercise in the open air. 
The efficacy of the former of those prophylactic 
remedies will appear in a strong point of light, 
when we consider, how much the operation of the 
remote and exciting causes of the gout which act 


more or less upon persons in the humblest ranks of 
society, are constantly counteracted in their effects, 
by the daily labour which is necessary for thek 

3. To prevent the recurrence of the gout, cold 
should be carefully avoided, more especially when 
it is combined with moisture. Flannel should be 
worn next to the skin in winter, and muslin in sum- 
mer, in order to keep up a steady and uniform per- 
spiration. Fleecy hosiery should be worn in cold 
weather upon the breast and knees, and the feet 
should be kept constantly warm and dry by means 
of socks and cork-soaled shoes. It was by wetting 
his feet, by standing two or three hours upon the 
damp ground, that colonel Miles produced the 
gout in his stomach and bowels which had nearly 
destroyed him in the year 1795. 

4. Great moderation should be used by persons 
who are subject to the gout in the exercise of their 
understandings and passions. Intense study, fear, 
terror, anger, and even joy, have often excited the 
disease into action. It has been observed, that the 
political and military passions act with more force 
upon the system, than those which are of a social 
and domestic nature ; hence generals and statesmen 
are so often afflicted with the gout, and that too, 

THE GOUT. 289 

as was hinted in another place, in moments the 
most critical and important to the welfare of a na- 
tion. The combination of the exercises of the un- 
derstanding, and the passion of avarice in gaming, 
have often produced an attack of this disease. 

These facts show the necessity of gouty people 
subjecting their minds, with all their operations, to 
the government of reason and religion. The un- 
derstanding should be exercised only upon light and 
pleasant subjects. No study should ever be pur- 
sued till it brings on fatigue ; and, above all things, 
midnight, and even late studies should be strictly 
avoided. A gouty man should always be in bed at 
an early hour. This advice has the sanction of Dr. 
Sydenham's name, and experience proves its effi- 
cacy in all chronic diseases. 

5. The venereal appetite should be indulged 
with moderation. And, 

6. Costiveness should be prevented by all per- 
sons who wish to escape a return of violent fits of 
the gout. Sulphur is an excellent remedy for this 
purpose. Dr. Cheyne commends it in high terms. 
His words are, " Sulphur is one of the best re- 
medies in the intervals of the gout. In the whole 
extent of the materia medica, I know not a more 

Vol. ir. 2 © 


safe and active medicine*." Two cases have come 
within my knowledge, in which it has kept off fits 
of the gout for several years, in persons who had 
been accustomed to have them once or twice a 
year. Rhubarb in small quantities chewed, or in 
the form of pills, may be taken to obviate costive- 
ness, by persons who object to the habitual use of 
sulphur. Dr. Cheyne, who is lavish in his praises 
of that medicine as a gentle laxative, says, he 
" knew a noble lord of great worth and much gout, 
who, by taking from the hands of a quack a drachm 
of rhubarb, tinged with cochineal to disguise it, 
every morning for six weeks, lived in health, for 
four years after, without any symptom of itf." 

I have said that abstinence should be enjoined 
with more strictness in the spring and autumn, than 
at any other time, to prevent a return of the gout. 
From the influence of the weather at those seasons 
in exciting febrile actions in the system, the loss of 
a pint of blood will be useful in some cases for the 
same purpose. It will be the more necessary if 
the gout has not paid its habitual visits to the sys- 
tem. The late Dr. Gregory had been accustomed 
to an attack of the gout every spring. Two sea- 

* Essay on the Nature and True Method of Treating the 
Gout, p. 35. 
t Page 3®. 

T.HE GOUT. 291 

sons passed away without his feeling any symptoms 
of it. He began to flatter himself with a hope 
that the predisposition to the disease had left him. 
Soon afterwards he died suddenly of an apoplexy. 
The loss of a few ounces of blood at the usual 
time in which the gout affected him, would proba- 
bly have protracted his life for many years. In the 
year 1796, in visiting a patient, I was accidentally 
introduced into a room where a gentleman from the 
Delaware state had been lying on his back for near 
six weeks with an acute fit of the gout. He gave 
me a history of his sufferings. His pulse was full 
and tense, and his whole body was covered with 
sw r eat from the intensity of his pain. He had not 
had his bowxls opened for ten days. I advised 
purging and bleeding in his case. The very names 
of those remedies startled him, for he had adopted 
the opinion of the salutary nature of a fit of the 
gout, and therefore hugged his chains. After ex- 
plaining the reason of my prescriptions, he inform- 
ed me, in support of them, that he had escaped the 
gout but two years in twenty, and that in one of 
these two years he had been bled for a fall from his 
horse, and, in the other, his body had been reduced 
by a chronic fever, previously to the time of the 
annual visit of his gout, 


As a proof of the efficacy of active, or passive 
depletion, in preventing the gout, it has been found 
that persons who sweat freely, either generally or 
partially, or who make a great deal of water, are 
rarely affected by it. 

An epitome of all that has been said upon the 
means of preventing a return of the gout, may be 
delivered in a few words. A man who has had 
one fit of it, should consider himself in the same 
state as a man who has received the seeds of a 
malignant fever into his blood. He should treat 
his body as if it were a Florence flask. By this 
means he will probably prevent, during his life, the 
re-excitement of the disease. 

Are issues proper to prevent the return of the 
violent state of gout ? I have heard of an instance 
of an issue in the leg having been effectual for this 
purpose ; but if the remedies before- mentioned be 
used in the manner that has been directed, so un- 
pleasant a remedy can seldom be necessary. 

Are bitters proper to prevent a return of this 
state of spoilt? It will be a sufficient answer to 
this question to mention, that the duke of Port- 
land's powder, which is composed of bitter ingre- 

THE GOUT. 293 

dients, excited a fatal gout in many people who 
used it for that purpose. I should as soon expect 
to see gold produced by the operations of fire upon 
copper or lead, as expect to see the gout prevented 
or cured by any medicine that acted upon the sys- 
tem, without the aid of more or less of the reme- 
dies that have been mentioned. 

II. We come now, in the last place, to mention 
the remedies which are proper to prevent a return 
of that state of gout which is attended with a feeble 
morbid action in the blood-vessels and viscera. 

This state of gout generally occurs in the evening 
of life, and in persons of delicate habits, or in such 
as have had their constitutions worn down by re- 
peated attacks of the disease. 

The remedies to prevent it are, 

1. A gently stimulating diet, consisting of animal 
food well cooked, with sound old Madeira or sherry 
wine, or weak spirit and water. Salted, and even 
smoked meat may be taken, in this state of the 
system, with advantage. It is an agreeable tonic, 
and is less disposed to create plethora than fresh 
meat. Pickles and vinegar should seldom be tasted. 
They dispose to gouty spasms in the stomach and 


bowels. Long intervals between meals should be 
carefully avoided, The stomach, when over- 
stretched or empty, is always alike predisposed to 
disease. There are cases in which the evils of in- 
anition in the stomach will be prevented, by a gouty 
patient eating in the middle of the night. 

2. The use of chalybeate medicines, • These are 
more safe when used habitually, than bitters. I 
have long been in the practice of giving the differ- 
ent preparations of iron in large doses, in chronic 
diseases, and in that state of debility which disposes 
to them. A lady of a weak constitution informed 
Dr. Cheyne, that she once asked Dr. Sydenham 
how long she might safely take steel. His answer 
was, that " she might take it for thirty years, and 
then begin again if she continued ill*." 

Water impregnated with iron, either by nature 
or art, may be taken instead of the solid forms of 
the metal. It will be more useful if it be drunken 
in a place where patients will have the benefit of 
country air. 

3. The habitual use of the volatile tincture of 
gum guiacum, and of other cordial and gently sti- 

* Essay on the Nature, and True Method of Treating 
the Gout, p. 69. 

THE GOUT. 295 

mulating medicines. A clove of garlic taken once 
or twice a day, has been found useful in debilitated 
habits predisposed to the gout. It possesses a 
wonderful power in bringing latent excitement into 
action. It moreover acts agreeably upon the nerv- 
ous system. 

Mr. Small found great benefit from breakfasting 
upon a tea made of half a drachm of ginger cut 
into small slices, in preventing occasional attacks 
of the gout in his stomach. Sir Joseph Banks was 
much relieved by a diet of milk, with ginger boiled 
in it. The root of the sassafras of our country 
might probably be used with advantage for the 
same purpose. Aurelian speaks of certain reme- 
dies for the gout which he calls " annalia*." The 
above medicines belong to this class. To be effec- 
tual, they should be persisted in, not for one year 
only, but for many years. 

4. Warmth », uniformly applied, by means of suit- 
able dresses, and sitting rooms, to every part of the 

5. The "warm bath in winter, and the temperate, 
or cold bath in summer. 

* Morborum Chronicorum. Lib. v. Cap. 2. 


6. Exercise. This may be in a carnage, or on 
horseback. The viscera being debilitated in this 
state of predisposition to the gout, are strengthened 
in a peculiar manner by the gentle motion of a 
horse. Where this or other modes of passive ex* 
ercise cannot be had, frictions to the limbs and 
body should be used every day. 

7. Cost'rceness should be avoided by taking oc- 
casionally one or two table spoons full of Dr. War- 
ner's purging tincture prepared by infusing rhubarb, 
orange peel, and caraway seeds, of each an ounce, 
for three days in a quart of Madeira, or any other 
white wine. If this medicine be ineffectual for 
opening the bowels, rhubarb may be taken in the 
manner formerly mentioned. 

8. The understanding and passions should be 
constantly employed in agreeable studies and pur- 
suits. Fatigue of mind and body should be care- 
fullv avoided. 

9. A warm climate often protracts life in persons 
subject to this state of gout. The citizens of 
Rome who had worn down their constitutions by 
intemperance, added many years to their lives, by 
migrating to Naples, and enjoying there, in a warm- 
er sun, the pure air of the Mediterranean, and sir 

THE GOUT. 297 

William Temple says the Portuguese obtain the 
same benefit by transporting themselves to the 
Brazils, after medicine and diet cease to impart 
vigour to their constitutions in their native country. 

Thus have I enumerated the principal remedies 
for curing and preventing the gout. ]VIost of them 
are to be met with in books of medicine, but they 
have been administered by physicians, or taken by 
patients with so little regard to the different states 
of the system, that they have in many instances 
done more harm than good. Solomon places all 
wisdom, in the management of human affairs, in 
finding out the proper times for performing certain 
actions. Skill in medicine, consists in an eminent 
degree in timing remedies. There is a time to 
bleed, and a time to withhold the lancet. There 
is a time to give physic, and a time to trust to the 
operations of nature. There is a time to eat meat, 
and there is a time to abstain from it. There is a 
time to give tonic medicines, and a time to refrain 
from them. In a word, the cure of the gout de- 
pends wholly upon two things, viz. proper reme- 
dies, in their proper times, and places. 

I shall take leave of this disease, by comparing 
it to a deep and dreary cave in a new country, in 
which ferocious beasts and venomous reptiles, with 

vol. ir. 2 p 


numerous ghosts and hobgoblins, are said to re- 
side. The neighbours point at the entrance of this 
cave with horror, and tell of the many ravages that 
have been committed upon their domestic animals, 
by the cruel tenants which inhabit it. At length 
a school-boy, careless of his safety, ventures to en- 
ter this subterraneous cavern, when ! to his great 
delight, he finds nothing in it but the same kind of 
stones and water he left behind him upon the sur- 
face of the earth. In like manner, I have found 
no other principles necessary to explain the cause 
of the gout, and no other remedies necessary to 
cure it, than such as are admitted in explaining the 
causes, and in prescribing for the most simple and 
common diseases. 








IN entering upon the consideration of this 
formidable disease, I feel mvself under an involun- 
tary impression, somewhat like that which was 
produced by the order the king of Syria gave to 
his captains when he was conducting them to bat- 
tle : 4 ' Fight not with small or great, save only with 
the king of Israel*." In whatever light we con- 
template the hydrophobia, it may be considered as 
pre-eminent in power and mortality, over all other 

It is now many years since the distress and hor- 
ror excited by it, both in patients and their friends, 
led me with great solicitude to investigate its na- 
ture. I have at length satisfied myself with a the- 

* II. Chron. xviii. 30. 


ery of it, which, I hope, will lead to a rational and 
successful mode of treating it. 

For a history of the symptoms of the disease, and 
many interesting facts connected with it, I beg 
leave to refer the reader to Dr. Mease's learned 
and ingenious inaugural dissertation, published in 
the year 1792. 

The remote and exciting causes of the hydropho- 
bia are as follow : 

1. The bite of a rabid animal. Wolves, foxes, 
cats, as well as dogs, impart the disease. It has 
been said that blood must be drawn in order to 
produce it, but I have heard of a case in Lancaster 
county, in Pennsylvania, in which a severe contu- 
sion, by the teeth of the rabid animal, without the 
effusion of a drop of red blood, excited the dis- 
ease. Happily for mankind, it cannot be commu- 
nicated by blood, or saliva falling upon sound parts 
of the body. In Maryland, the negroes eat with 
safety the flesh of hogs that have perished from the 
bite of mad dogs ; and I have heard of the milk of 
a cow, at Chestertown, in the same state, having 
been used without any inconvenience by a whole 
family, on the very day in which she was affected 
bv this disease, and which killed her in a few hours. 


Dr. Baumgarten confirms these facts by saying, 
that " the flesh and milk of rabid animals have 
been eaten with perfect impunity*." 

In the following observations I shall confine my- 
self chiefly to the treatment of the hydrophobia 
which arises from the bite of a rabid animal, but I 
shall add in this place a short account of all its 
©ther causes. 

2. Cold night air. Dr. Arthaud, late president 
of the society of Philadelphians in St. Domingo, 
has published several cases in which it was pro- 
duced in negroes by sleeping all night in the open 

3. A wound in a tendinous part. 

4. Putrid and impure animal food. 

5. Worms. 

6. Eating beech nuts* 

7. Great thirst. 

* Medical Commentaries, Philadelphia edition, vol. 7. p. 409. 


8. Exposure to intense heat. 

9. Drinking cold water when the body was 
very much heated. 

10. A fall. 

11. Fear. 

12. Hysteria. 

13. Epilepsy. 

14. Tetanus. 

15. Hydrocephalus. Of the presence of hydro- 
phobia in the hydrocephalic state of fever, there 
have been several instances in Philadelphia. 

16. An inflammation of the stomach. 

17. The dysentery. 

18. The typhus fever. Dr. Trotter mentions 
the hydrophobia as a symptom which frequently 
occurred in the typhus state of fever in the British 

* Medicina Nautica, p. 301. 


19. It is taken notice of likewise in a putrid fe- 
ver by Dr. Coste*; and Dr. OrifRtts observed it 
in a high degree in a young lady who died of the 
yellow fever, in 1793. 

20. The bite of an angry, but not a diseased 

21. An involuntarv association of ideas. 

Cases of spontaneous hydrophobia from all the 
above causes are to be met with in practical writ- 
ers, and of most of them in M. Audry's learned 
work, entitled, " Recherches sur la Rage." 

The dread of water, from which this disease de- 
rives its name, has five distinct grades. 1. It can- 
not be drunken. 2. It cannot be touched. 3. 
The sound of it pouring from one vessel to another, 
4. the sight of it, and 5. even the naming of it, can- 
not be borne, without exciting convulsions. Rut 
this symptom is not a universal one. Dr. Mead 
mentions three cases in which there was no dread 
of water, in persons who received the disease from 
the bite of a rabid animal. It is unfortunate for 

* Medical Commentaries, Dobson's edition, vol. II. p* 


VOL. II. 2 O^ 



this disease, as well as many others, that a single 
symptom should impose names upon them. In the 
present instance it has done great harm, by fixing 
the attention of physicians so exclusively upon the 
dread of water which occurs in it, that they have 
in a great measure overlooked every other circum- 
stance which belongs to the disease. The theory 
of the hydrophobia, which an examination of its 
causes, symptoms, and accidental cures, with all 
the industry I was capable of, has led me to adopt, 
is, that it is a malignant state of fever. My rea- 
sons for this opinion are as follow : 

1. The disease in all rabid animals is a fever. 
This is obvious in dogs who are most subject to it. 
It is induced in them by the usual causes of fever, 
such as scanty or putrid aliment*, extreme cold, 
and the sudden action of heat upon their bodies. 
Proofs of its being derived from each of the above 
causes are to be met with in most of the authors 
who have written upon it. The animal matters 
which are rendered morbid by the action of the 

* " Animal food, in a state of putridity, is amongst the 
most frequent causes of canine madness." 

" Canine madness chiefly arises from the excessive num- 
ber of ill-kept and ill-fed dogs." 

Young's Annals, vol. XVII. p. 561. 


above causes upon them, are determined to the sa- 
liva, in which a change seems to be induced, simi- 
lar to that which takes place in the perspirable 
matter of the human species from the operation of 
similar causes upon it. This matter, it is well 
known, is the remote cause of the jail fever. No 
wonder the saliva of a dog should produce a disease 
of the same kind, after being vitiated by the same 
causes, and thereby disposed to produce the same 

2. The disease called canine madness, prevails 
occasionally among dogs at those times in which 
malignant fevers are epidemic. This will not sur- 
prise those persons who have been accustomed to 
observe the prevalence of the influenza and bilious 
fevers among other domestic animals at a time 
when they are epidemic among the human species. 

3. Dogs, when they are said to be mad, exhibit 
the usual symptoms of fever, such as a want of ap- 
petite, great heat, a dull, fierce, red, or watery eye, 
indisposition to motion, sleepiness, delirium, and 
madness. The symptom of madness is far from 
being universal, and hence many dogs are diseased 
and die with this malignant fever, that are inoffen- 
sive, and instead of biting, continue to fawn upon 
their masters. Nor is the disposition of the fever 


to communicate itself by infection universal among 
dogs any more than the same fever in the human 
species, and this I suppose to be one reason why 
many people are bitten by what are called mad 
dogs, who never suffer any inconvenience from it. 

4. A dissection of a dog, by Dr. Cooper, that 
died with this fever, exhibited all the usual marks 
of inflammation and effusion which take place in 
common malignant fevers. I shall in another place 
mention a fifth argument in favour of the disease 
in dogs being a malignant fever, from the efficacy 
of one of the most powerful remedies in that state 
of fever, having cured it in two instances. 

II. The disease produced in the human species 
by the bite of a rabid animal, is a malignant fever. 
This appears first from its symptoms. These, as 
recorded by Aurelian, Mead, Fothergill, Plummer, 
Arnold, Baumgarten, and Morgagni, are chills, 
great heat, thirst, nausea, a burning sensation in the 
stomach, vomiting, costiveness ; a small, quick, 
tense, irregular, intermitting, natural, or slow pulse; 
a cool skin j great sensibility to cold air, partial cold 
and clammy sweats on the hands, or sweats accom- 
panied with a warm skin diffused all over the body, 
difficulty of breathing, sighing, restlessness, hiccup, 
giddiness, head-ach, delirium, coma, false vision. 


dilatation of the pupils, dulness of sight, blindness, 
glandular swellings, heat of urine, priapism, palpi- 
tation of the heart, and convulsions. I know that 
there are cases of hydrophobia upon record, in 
which there is said to be a total absence of fever. 
The same thing has been said of the plague. In 
both cases the supposed absence of fever is the effect 
of stimulus acting upon the blood-vessels with so 
much force as to suspend morbid action in them. 
By abstracting a part of this stimulus, a fever is 
excited, which soon discovers itself in the pulse 
and on the skin, and frequently in pains in every 
part of the body. The dread of water, and the 
great sensibility of the system to cold air, are said 
to give a specific character to the hydrophobia ; 
but the former symptom, it has been often seen, oc- 
curs in diseases from other causes, and the latter 
has been frequently observed in the yellow fever. 
It is no more extraordinary that a fever excited by 
the bite of a rabid animal should excite a dread of 
water, than that fevers from other causes should 
produce aversion from certain aliments, from light, 
and from sounds of all kinds ; nor is it any more a 
departure from the known laws of stimulants, that 
the saliva of a mad dog should affect the fauces, 
than that mercury should affect the salivary glands. 
Both stimuli appear to act in a specific manner. 


2. The hydrophobia partakes of the character of 
a malignant fever, in appearing at different intervals 
from the time in which the infection is received 
into the body. These intervals are from one day 
to five or six months. The small-pox shows it- 
self in intervals from eight to twenty days, and the 
plague and yellow fever from the moment in which 
the miasmata are inhaled, to nearly the same dis- 
tance of time. This latitude in the periods at 
which infectious and contagious matters are brought 
into action in the body, must be resolved into the 
influence which the season of the year, the habits 
of the patients, and the passion of fear have upon 

Where the interval between the time of beino- 
bitten, and the appearance of a dread of water, 
exceeds five or six months, it is probable it may 
be occasioned by a disease derived from another 
cause. Such a person is predisposed in common 
with other people to all the diseases of which the 
hydrophobia is a symptom. The recollection of 
the poisonous wound he has received, and its usual 
consequences, is seldom absent from his mind for 
months or years. A fever, or an affection of his 
nerves from their most common causes, cannot fail 
of exciting in him apprehensions of the disease 


which usually follows the accident to which he has 
been exposed. His fears are then let loose upon 
his system, and produce in a short time a dread of 
water which appears to be wholly unconnected with 
the bite of a rabid animal. Similar instances of the 
effects of fear upon the human body are to be met 
with in books of medicine. The pains produced 
by fear acting upon the imagination in supposed 
venereal infections, are as real and severe as they 
are in the worst state of that disease. 

3. Blood drawn in the hydrophobia exhibits the 
same appearances which have been remarked in 
malignant fevers. In Mr. Bellamy, the gentleman 
whose case is so minutely related by Dr. Fother- 
gill, the blood discovered with " slight traces 
of size, serum remarkably yellow." It was uncom- 
monly sizy in a boy of Mr. George Oakley whom 
I saw, and bled for the first time, on the fourth day 
of his disease, in the beginning of the year 1797. 
His pulse imparted to the fingers the same kind of 
quick and tense stroke which is common in an 
acute inflammatory fever. He died in convul- 
sions the next day. He had been bitten by a 
mad dog on one of his temples, three weeks be- 
fore he discovered any signs of indisposition. 
There are several other cases upon record, of the 
blood exhibiting, in this disease, the same appear- 


ances as in common malignant and inflammatory 

4. The hydrophobia accords exactly with malig- 
nant fevers in its duration. It generally terminates 
in death, according to its violence, and the habit of 
the patient, in the first, second, third, fourth, or 
fifth day, from the time of its attack, and with the 
same symptoms which attend the last stage of ma- 
lignant fevers. 

5. The body, after death from the hydrophobia, 
putrifies with the same rapidity that it does after 
death from a malignant fever in which no depletion 
has been used. 

6 Dissections of bodies which have died of the 
hydrophobia, exhibit the same appearances which 
are observed in the bodies of persons who have 
perished of malignant fevers. These appearances, 
according to Morgagni and Tauvry*, are marks of 
inflammation in the throat, oesophagus, trachea, 
brain, stomach, liver, and bowels. Effusions of 
water, and congestions of blood in the brain, large 
quantities of dark-coloured or black bile in the 
gall-bladder and stomach, mortifications in the 

* Bibliotheque Choisie de Medecinc, tome XV. p. 2IG. 


bowels and bladder, livid spots on the surface of 
the body, and, above all, the arteries filled with 
fluid blood, and the veins nearly empty. I am 
aware, that two cases of death from hydrophobia 
are related by Dr. Vaughan, in which no appear- 
ance of disease was discovered by dissection in any 
part of the body. Similar appearances have occa- 
sionally been met with in persons who have died of 
malignant fevers. In another place I hope to 
prove, that we err in placing disease in inflamma- 
tion, for it is one of its primary effects only, and 
hence, as was before remarked, it does not take 
place in many instances in malignant fevers, until 
the arteries are so far relaxed by two or three 
bleedings, as to be able to relieve themselves by 
effusing red blood into serous vessels, and thus to 
produce that error loci which I shall say hereafter 
is essential to inflammation*. The existence of 

* In the 6th volume of the Medical Observations and In- 
quiries, there is an account of a dissection of a person who 
had been destroyed by taking opium. " No morbid ap- 
" pearance (says Mr. Whateley, the surgeon who opened 
il the body) was found in any part of the body, except that 
u the villous coat of the stomach was very slightly inflamed." 
The stimulus of the opium in this case either produced an 
action which transcended inflammation, or destroyed action 
altogether by its immense force, by which means the more 
common morbid appearances which follow disease in a dead 
body could not take place. 

VOL. II. 2 R 


this grade of action in the arteries may always be 
known by the presence of sizy blood, and by th£ 
more obvious and common symptoms of fever. 

The remedies for hydrophobia, according to the 
principles I have endeavoured to establish, divide 
themselves naturally into two kinds. 

I. Such as are proper to prevent the disease, after 
the infection of the rabid animal is received into 
the body. 

II. Such as are proper to cure it when formed. 

The first remedy under the first general head is„ 
abstracting or destroying the virus, by cutting or 
burning out the wounded part, or by long and fre- 
quent effusions of water upon it, agreeably to the 
advice of Dr. Haygarth, in order to wash the saliva 
from it. The small-pox has been prevented, by 
cutting out the part in which the puncture was 
made in the arm with variolous matter. There is 
no reason why the same practice should not suc- 
ceed, if used in time, in the hydrophobia. Where 
it has failed of success, it has probably been used 
after the poison has contaminated the blood., The 
wound should be kept open and running for seve- 
ral months. In this way a servant girl, who was 


bitten by the same cat that bit Mr. Bellamy, is 
supposed by Dr. Fothergill to have escaped the 
disease. Dr. Weston of Jamaica believes that he 
prevented the disease by the same means, in two 
instances. Perhaps an advantage would arise from 
exciting a good deal of inflammation in the wound. 
We observe after inoculation, that the more inflam- 
ed the puncture becomes, and the greater the dis- 
charge from it, the less fever and eruption follow 
in the small-pox. 

A second preventive is a low diet, such as has 
been often used with success to mitigate the plague 
and yellow fever. The system, in this case, bends 
beneath the stimulus of the morbid saliva, and thus 
obviates or lessens its effects at a future day. 

During the use of these means to prevent the 
disease, the utmost care should be taken to keep 
up our patient's spirits, by inspiring confidence in 
the remedies prescribed for him. 

Mercury has been used in order to prevent the 
disease. There are many well- attested cases upon 
record, of persons who have been salivated after 
being bitten by mad animals, in whom the disease 
did not show itself, but there are an equal number 
©f cases to be met with, in which a salivation did 


not prevent it. From this it would seem probabie, 
that the saliva did not infect in the cases in which 
the disease was supposed to have been prevented 
by the mercury. At the time calomel was used 
to prepare the body for the small-pox, a salivation 
was often induced by it. The affection of the sali- 
vary glands in many instances lessened the number 
of pock, but I believe in no instance prevented the 
eruptive fever. 

I shall say nothing here of the many other medi- 
cines which have been used to prevent the disease. 
No one of them has, I believe, done any more 
good, than the boasted specifics which have been 
used to eradicate the gout, or to procure old age. 
They appear to have derived their credit from 
some of the following circumstances accompanying 
the bite of the animal. 

1. The animal may have been angry, but not 
diseased with a malignant fever such as I have de- 

2. He may have been diseased, but not to such 
a degree as to have rendered his saliva infectious. 

3. The saliva, when infectious, may have been 
so washed off in passing through the patient's 


clothes, as not to have entered the wound made in 
the flesh. And 

4. There may have been no predisposition in the 
patient to receive the fever. This is often observed 
in persons exposed to the plague, yellow fever, 
small-pox, and to the infection of the itch, and the 
venereal disease. 

The hydrophobia, like the small -pox, generally 
comes on with some pain, and inflammation in the 
part in which the infection was infused into the 
body, but to this remark, as in the small-pox, there 
are some exceptions. As soon as the disease 
discovers itself, whether by pain or inflammation in 
the wounded part, or by any of the symptoms for- 
merly mentioned, the first remedy indicated is blood- 
letting. All the facts which have been mentioned, 
relative to its cause, symptoms, and the appearances 
of the body after death, concur to enforce the use 
of the lancet in this disease. Its affinity to the 
plague and yellow fever in its force, is an addition- 
al argument in favour of that remedy. To be ef- 
fectual, it should be used in the most liberal man- 
ner. The loss of 100 to 200 ounces of blood will 
probably be necessary in most cases to effect a 
cure. The pulse should govern the use of the 
lancet as in other states of fever, taking care not to 


be imposed upon by the absence of frequency in it, 
in the supposed absence of fever, and of tension in 
affections of the stomach, bowels, and brain. This 
practice, in the extent I have recommended it, is 
justified not only by the theory of the disease, but 
by its having been used with success in the follow- 
ing cases. 

Dr. Nugent cured a woman by two copious 
bleedings, and afterwards by the use of sweating 
and cordial medicines. 

Mr. Wrightson w T as encouraged by Dr. Nu- 
gent's success to use the same remedies with the 
same happy issue in a boy of 15 years of age*. 

Mr. Falconer cured a young woman of the name 
of Hannah Moore, by " a copious bleeding," and 
another depleting remedy to be mentioned here- 


Mr. Poupart cured a woman by bleeding until 
she fainted, and Mr. Berger gives an account of a 
number of persons being bitten by a rabid animal, 

* Medical Transactions, vol. ii. p. 192, 
t Ditto, p. 222. 



all of whom died, except two who were saved by 

In the 40th volume of the Transactions of the 
Royal Society of London, there is an account of a 
man being cured of hydrophobia by Dr. Hartley, 
by the loss of 120 ounces of blood. 

Dr. Tilton cured this disease in a woman in the 
Delaware state by very copious bleeding. The 
remedy was suggested to the doctor by an account 
taken from a London magazine of a dreadful hy- 
drophobia being cured by an accidental and profuse 
haemorrhage from the temporal artery f. 

A case is related by Dr. InnesJ, of the loss of 
116 ounces of blood in seven days having cured 
this disease. In the patient who was the subject 
of this cure, the bleeding was used in the most de- 
pressed, and apparently weak state of the pulse. It 
rose constantly with the loss of blood. 

The cases related by Dr. Tilton and Dr. Innes 
were said to be of a spontaneous nature, but the 

* Bibliotheque Choisie de Medecine, tome xv. p. 212. 
t Medical Essays of Edinburgh, vol. i. p. 226. 
£ Medical Commentaries, vol. iii. p. 496. 


morbid actions were exactly the same in both pa- 
tients with those which are derived from the bite of 
a rabid animal. There is but one remote cause of 
disease, and that is stimulus, and it is of no conse- 
quence in the disease now under consideration, 
whether the dread of water be the effect of the saliva 
of a rabid animal acting upon the fauces, or of a 
morbid excitement determined to those parts by 
any other stimulus. The inflammation of the sto- 
mach depends upon the same kind of morbid ac- 
tion, whether it be produced by the miasmata of 
the yellow fever, or the usual remote and exciting 
causes of the gout. An apoplexy is the same dis- 
ease when it arises from a contusion by external 
violence, that it is when it arises spontaneously 
from the congestion of blood or water in the brain . 
A dropsy from obstructions in the liver induced 
by strong drink, does not differ in its proximate 
cause from the dropsy brought on by the obstruc- 
tions in the same viscus which are left by a ne- 
glected, or half cured bilious fever. These re- 
marks are of extensive application, and, if duly 
attended to, would deliver us from a mass of error 
which has been accumulating for a^es in medicine : 
I mean the nomenclature of diseases from their re- 
mote causes. It is the most offensive and injuri- 
ous part of the rubbish of our science. 


I grant that bleeding has been used in some in- 
stances in hydrophobia without effect, but in all 
such cases it was probably used out of time, or in 
too sparing a manner. The credit of this remedy 
has suffered in many other diseases from the same 
causes. I beg it may not be tried in this disease, 
by any physician who has not renounced our mo- 
dern systems of nosology, and adopted, in their ut- 
most extent, the principles and practice of Botallus 
and Sydenham in the treatment of malignant fe- 

Before I quit the subject of blood-letting in hy- 
drophobia, I have to add, that it has been used 
with success in two instances in dogs that had ex- 
hibited all the usual symptoms of what has been 
called madness. In one case, blood was drawn by 
cutting off the tail, in the other, by cutting off the 
ears of the diseased animal. I mention these facts 
with pleasure, not only because they serve to sup- 
port the theory and practice which I have endea- 
voured to establish in this disease, but because they 
will render it unnecessary to destroy the life of a 
useful and affectionate animal in order to prevent 
his spreading it. By curing it in a dog by means 
of bleeding, we moreover beget confidence in the 
same remedy in persons who have been bitten by 

VOL. II. 2 s 


him, and thus lessen the force of the disease, by 
preventing the operation of fear upon the system. 

2. Purges and glysters have been found useful 
in the hydrophobia. They discharge bile which 
is frequently vitiated, and reduce morbid action in 
the stomach and blood-vessels. Dr. Coste ascribes 
the cure of a young woman in a convent wholly to 
glysters given five or six times every day. 

3. Sweating after bleeding completed the cure 
of the boy whose case is mentioned by Mr. Wright- 
son. Dr. Baumgarten speaks highly of this mode 
of depleting, and says further, that it has never 
been cured " but by evacuations of some kind." 

4. All the advantages which attend a salivation 
in common malignant fevers, are to be expected 
from it in the hydrophobia. It aided blood-letting 
in two persons who were cured by Mr. Falconer 
and Dr. Le Compt. 

There are several cases upon record in which 
musk and opium have afforded evident relief in this 

A physician in Virginia cured it by large doses 
®f bark and wine. I have no doubt of the efficacy 


of these remedies when the disease is attended with 
a moderate or feeble morbid action in the system, 
for I take it for granted, it resembles malignant fe- 
vers from other causes in appearing in different 
grades of force. In its more violent and common 
form, stimulants of all kinds must do harm, unless 
they are of such a nature, and exhibited in such 
quantities, as to exceed in their force the stimulus 
of the disease; but this is not to be expected, more 
especially as the stomach is for the most part so 
irritable as sometimes to reject the mildest aliments 
as well as the most gentle medicines. 

After the morbid actions in the system have been 
weakened, tonic remedies would probably be use- 
ful in accelerating the cure. 

Blisters and stimulating cataplasms, applied to 
the feet, might probably be used with the same 
advantage in the declining state of the disease, that 
they have been used in the same stage of other 
malignant fevers. 

The cold bath, also long immersion in cold wa- 
ter, have been frequently used in this disease. The 
former aided the lancet, in the cure of the man 
whose case is related by Dr. Hartley. There can 
be no objection to the cold water in either of the 


above forms, provided no dread is excited by it in 
the mind of the patient. 

The reader will perceive here that I have deserted 
an opinion which I formerly held upon the cause 
and cure of the tetanus. I supposed the hydro- 
phobia to depend upon debility. This debility I 
have since been led to consider as partial, depend- 
ing upon abstraction of excitement from some, 
and a morbid accumulation of it in other parts of 
the body. The preternatural excitement predo- 
minates so far, in most cases of hydrophobia, over 
debility, that depleting remedies promise more 
speedily and safely to equalize, and render it natu- 
ral, than medicines of an opposite character. 

In the treatment of those cases of hydrophobia 
which are not derived from the bite of a rabid ani- 
mal, regard should always be had to its remote and 
exciting causes, so as to accommodate the reme- 
dies to them. 

The imperfection of the present nomenclature of 
medicine has become the subject of general com- 
plaint. The mortality of the disease from the bite 
of a rabid animal, has been increased by its name. 
The terms hydrophobia and canine madness, con- 
vey ideas of the symptoms of the disease only, 


and of such of them too as are by no means uni- 
versal. If the theory I have delivered, and the 
practice I have recommended, be just, it ought to 
be called the hydrophobic state of fever. This 
name associates it at once with all the other states 
of fever, and leads us to treat it with the remedies 
which are proper in its kindred diseases, and to 
vary them constantly with the varying state of the 

In reviewing what has been said of this disease, 
i dare not say that I have not been misled by the 
principles of fever which I have adopted ; but if 
I have, I hope the reader will not be discouraged 
by my errors from using his reason in medicine. 
By contemplating those errors, he may perhaps 
avoid the shoals upon which I have been wrecked. 
In all his researches, let him ever remember that 
there is the same difference between the knowledge 
of a physician who prescribes for diseases as limited 
by genera and species, and of one who prescribes 
under the direction of just principles, that there is 
between the knowledge we obtain of the nature 
and extent of the sky, by viewing a few feet of it 
from the bottom of a well, and viewing from the 
top of a mountain the whole canopy of heaven. 


Since the first edition of the foregoing observa- 
tions, I have seen a communication to the editors 
of the Medical Repository*, by Dr. Physick, 
which has thrown new light upon this obscure dis- 
ease, and which, I hope, will aid the remedies that 
have been proposed, in rendering them more effec- 
tual for its cure. The doctor supposes death from 
hydrophobia to be the effect of a sudden and spas- 
modic constriction of the glottis, inducing suffoca- 
tion, and that it might be prevented by creating an 
artificial passage for air into the lungs, whereby life 
might be continued long enough to admit of the 
disease being cured by other remedies. The fol- 
lowing account of a dissection is intended to show 
the probability of the doctor's proposal being at- 
tended with success. 

Oji the 13th of September, 1802, I was called, 
with Dr. Physick, to visit, in consultation with 
Dr. Griffitts, the son of William Todd, Esq. aged 
five years, who was ill with the disease called hy- 
drophobia, brought on by the bite of a mad dog, 
on the 6th of the preceding month. The wound 
was small, and on his cheek, near his mouth, two 
circumstances which are said at ail times to increase 

* Volume V. 


the danger of wounds from rabid animals. From 
the time he was bitten, he used the cold bath daily, 
and took the infusion, powder, and seeds of the 
anagallis, in succession, until the 9th of Septem- 
ber, when he was seized with a fever which at first 
resembled the remittent of the season. Bleeding, 
purging, blisters, and the warm bath were prescrib- 
ed for him, but without success. The last named 
remedy appeared to afford him some relief, which 
he manifested by paddling and playing in the water. 
At the time I saw him he was much agitated, had 
frequent twitchings, laughed often ; but, with this 
uncommon excitement in his muscles and nerves, 
his mind was unusually correct in all its operations. 

He discovered no dread of water, except in one 
instance, when he turned from it with horror. He 
swallowed occasionally about a spoon full of it at a 
time, holding the cup in his own hand, as if to pre- 
vent too great a quantity being poured at once into 
his throat. The quick manner of his swallowing, 
and the intervals between each time of doing so, 
were such as we sometimes observe in persons in the 
act of dying of acute diseases. Immediately after 
swallowing water, he looked pale, and panted for 
breath. He spoke rapidly, and with much diffi- 
culty. This was more remarkably the case when 
he attempted to pronounce the words carriage, 


water, and river. After speaking he panted for 
breath in the same manner that he did after drink- 
ing. He coughed and breathed as patients do in 
the moderate grade of the cynanche trachealis. The 
dog that had bitten him, Mr. Todd informed me, 
made a similar noise in attempting to bark, a day 
or two before he was killed. We proposed mak- 
ing an opening into his windpipe. To this his pa- 
rents readily consented ; but while we were pre- 
paring for the operation, such a change for the 
worse took place, that we concluded not to perform 
it. A cold sweat, with a feeble and quick pulse, 
came on ; and he died suddenly, at 12 o'clock at 
night, about six hours after I first saw him. He re- 
tained his reason, and a playful humour, till the last 
minute of his life. An instance of the latter ap- 
peared in his throwing his handkerchief at his fa- 
ther just before he expired. The parents consented 
to our united request to examine his body. Dr. 
Griffitts being obliged to go into the country, and 
-Dr. Physick being indisposed, I undertook this 
business the next morning ; and, in the presence 
of Dr. John Dorsey (to whom I gave the dissecting 
knife), and my pupil Mr. Murduck, I discovered 
the following appearances. All the muscles of the 
neck had a livid colour, such as we sometimes ob- 
serve, after death, in persons who have died of the 
sore throat. The muscles employed in deglutition 


and speech were suffused with blood. The epi- 
glottis was inflamed, and the glottis so thickened 
and contracted, as barely to admit a probe of the 
common size. The trachea below it was likewise 
inflamed and thickened, and contained a quantity 
of mucus in it, such as we observe, now and then, 
after death from cynanche trachealis. The oeso- 
phagus exhibited no marks of disease ; but the 
stomach had several inflamed spots upon it, and 
contained a matter of a brown appearance, and 
which emitted an offensive odour. 

From the history of this dissection, and of many 
others, in which much fewer marks appeared of 
violent disease, in parts whose actions are essential 
to life, it is highly probable death is not induced 
in the ordinary manner in which malignant fevers 
produce it, but by a sudden or gradual suffocation. 
It is the temporary closure of this aperture which 
produces the dread of swallowing liquids : hence 
the reason why they are swallowed suddenly, and 
with intervals, in the manner that has been de- 
scribed ; for, should the glottis be closed during 
the time of two swallows, in the highly diseased 
state of the system which takes place in this dis- 
ease, suffocation would be the immediate and cer- 
tain consequence. The same difficulty and danger 
attend the swallowing saliva, and hence the symp- 

vol. ir. 2 t 


torn of spitting, which has been so often taken no- 
tice of in hydrophobia. Solids are swallowed 
more easily than fluids, only because they descend 
by intervals, and because a less closure of the glot- 
tis is sufficient to favour their passage into the 
stomach. This remark is confirmed by the fre- 
quent occurrence of death in the very act of swalr 
lowing, and that too with the common symptoms 
of suffocation. To account for death from this 
cause, and in the manner that has been described, 
it will be necessary to recollect, that fresh air is 
more necessary to the action of the lungs in a fever 
than in health, and much more so in a fever of a ma- 
lignant character, such as the hydrophobia appears 
to be, than in fevers of a milder nature. An aver- 
sion from swallowing liquids is not peculiar to this 
disease. It occurs occasionally in the yellow fever. 
It occurs likewise in the disease which has pre- 
a ailed among the cats, both in Europe and Ame- 
rica, and probably, in both instances, from a dread 
of suffocation in consequence of the closure of the 
glottis, and sudden abstraction of fresh air. 

The seat of the disease, and the cause of death, 
being, I hope, thus ascertained, the means of pre- 
venting death come next under our consideration. 
Tonic remedies, in all their forms, have been ad- 
ministered to no purpose. The theory of the dis- 


ease would lead us to expect a remedy for it in 
blood-letting. But this, though now and then 
used with success, is not its cure, owing, as we 
now see, to the mortal seat of the disease being so 
far removed from the circulation, as not to be 
affected by the loss of blood in the most liberal 
quantity, As well might we expect the inflamma- 
tion and pain of a paronychia, or what is called a 
felon on the finger, to be removed by the same 
remedy. Purging and sweating, though occasion- 
ally successful, have failed in many instances ; and 
even a salivation, when excited (which is rarely the 
case), has not cured it. An artificial aperture into 
the windpipe alone bids fair to arrest its tendency 
to death, by removing the symptom which gene- 
rally induces it, and thereby giving time for other 
remedies, which have hitherto been unsuccessful, 
to produce their usual salutary effects in similar 
diseases*. In removing faintness, in drawing off 
the water in ischuria, in composing convulsions, 
and in stopping haemorrhages in malignant fever, 
we do not cure the disease, but we prevent death, 
and thereby gain time for the use of the remedies 
which are proper to cure it. Laryngotomy, ac- 

* The hoarse barking, or the total inability of mad dogs 
to bark, favours still further the idea that the mortal seat of 
the disease is in the glottis, and that the remedy which has 
been proposed is a rational one. 


cording to Fourcroy's advice, in diseases of the 
throat which obstruct respiration, should be pre- 
ferred to tracheotomy, and the incision should be 
made in the triangular space between the thyroid 
and cricoid cartilages. Should this operation be 
adopted, in order to save life, it will not offer near 
so much violence to humanity as many other ope- 
rations. We cut through a larsre mass of flesh in- 
to the bladder in extracting a stone. We cut into 
the cavity of the thorax in the operation for the 
empyema. We perforate the bones of the head 
in trepanning ; and we cut through the uterus, in 
performing the Caesarian operation, in order to save 
life. The operation of laryngotomy is much less 
painful and dangerous than any of them ; and be- 
sides permitting the patient to breathe and to swal- 
low, it is caculated to serve the inferior purpose of 
lessening the disease of the glottis by means of 
local depletion. After an aperture has been thus 
made through the larynx, the remedies should be 
such as are indicated by the state of the system, 
particularly by the state of the pulse. In hot cli- 
mates it is, I believe, generally a disease of feeble 
re-action, and rea A uires tonic remedies ; but in the 
middle and northern states of America it is more 
commonly attended with so much activity and ex- 
citement of the blood-vessels, as to require copious 
blood-letting and other depleting remedies. 


Should this new mode of attacking this furious 
disease be adopted, and become generally success- 
ful, the discovery will place the ingenious gentle- 
man who suo;o;ested it in the first rank of the medi- 


cal benefactors of mankind. 

I have only to add a fact upon this subject which 
may tend to increase confidence in a mode of pre- 
preventing the disease which has been recommend- 
ed by Dr. Hay garth, and used with success in se- 
veral instances. The same dog which bit Mr. 
Todd's son, bit, at the same time, a cow, a pig, a 
dog, and a black servant of Mr. Todd's. The 
cow and pig died ; the dog became mad, and was 
killed by his master. The black man, who was 
bitten on one of his fingers, exposed the wound fof 
some time, immediately after he received it, to a 
stream of pump water, and washed it likewise with 
soap and water. He happily escaped the disease, 
and is now in good health. That his wound was 
poisoned is highly probable, from its having been 
made eight hours after the last of the above ani- 
mals was bitten, in which time there can be but 
little doubt of such a fresh secretion of saliva hav- 
ing taken place as would have produced the hydro- 
phobia, had it not been prevented by the above 
simple remedy. I am not, however, so much en- 
couraged by its happy issue in this case as to advise 


it in preference to cutting out the wounded part. 
It should only be resorted to where the fears of a 
patient, or his distance from a surgeon render it 
impossible to use the knife. 








THE weather in December, 1788, and in 
January, 1789, was variable, but seldom very cold. 
On the first of February, 1789, at six o'clock in 
the morning, the mercury in Fahrenheit's thermo- 
meter fell 5° below 0, in the city of Philadelphia. 
At twenty miles from the city, on the Schuylkill, 
it fell 12° below 0, at the same hour. On the 19th 
and 20th of this month, there fell a quantity of 
snow, the depth of which, upon an average, was 
supposed to be about eight or ten inches. On the 
23d, 24th, 25th, and 27th, the weather was very 
cold. The mercury fluctuated during these days, 
between 4° and 10° above 0. 

In the intervals between these cold days, the 
weather frequently moderated, so that the Dela- 
ware was frozen and thawed not less than four 

VOL. ii« 2 u 


times. It was not navigable till the 8th of March, 
There were in all, during the winter and month of 
March, sixteen distinct falls of snow. 

In April and May there were a few warm days ; 
but upon the whole, it was a very cold and back- 
ward spring. The peaches failed almost univer- 
sally. There were no strawberries or cherries on 
the 24th of May, and every other vegetable pro- 
duct was equally backward. A country woman 
of 84 years of age informed me, that it was the 
coldest spring she had ever known. It was un- 
comfortable to sit without fire till the first of June. 

The measles appeared first in the Northern Li- 
berties, in December. They spread slowly in 
January, and were not universal in the city till Fe- 
bruary and March. 

This disease, like many others, had its precursor. 
It was either a gum-boil, or a sore on the tongue. 
They were both very common, but not universal. 
They occurred, in some instances, several days 
before the fever, but in general they made their 
appearance during the eruptive fever, and were a 
sure mark of the approaching eruption of the 
measles. I was first led to observe this fact ? from 
having read Dr. Quin's accurate account of the 

MEASLES IN 1789. 33$ 

measles in Jamaica. I shall now proceed to men- 
tion the symptoms of the measles as they appeared 
in the different parts of the body. 

1. In the head, they produced great pain, swel- 
ling of the eye-iids, so as to obstruct the eye- sight, 
tooth-ach, bleeding at the nose, tinnitus aurium, 
and deafness ; also coma for two days, and convul- 
sions. I saw the last symptom only in one instance. 
It was brought on by a stoppage of a running from 
t&e ear. 

2. In the throat and lungs, they produced a 
soreness and hoarseness, acute or dull pains in the 
breast and sides, and a painful or distressing cough. 
In one case* this cough continued for two hours 
without any intermission, attended by copious ex- 
pectoration. In two cases, I saw a constant invo- 
luntary discharge of phlegm and mucus from the 
mouth, without any cough. One of them ter- 
minated fatally. Spitting of blood occurred in 
several instances. The symptoms of pneumonia 
vera notha and typhoides were very common. I 
saw two fatal cases from pneumonia notha, in both 
of which the patients died with the trunk of the 
body in an erect posture. I met with two cases in 
which there was no cough till the eruption made 
its appearance on the fourth day, and one which 



was accompanied by all the usual symptoms of the 
cynanche trachealis. 

3. In the stomach the measles produced, in ma- 
ny instances, sickness and vomiting. And 

4. In the boivels, griping, diarrhoea, and, in 
some instances, bloody stools. The diarrhoea oc- 
curred in every stage of the disease, but it was 
bloody and most painful in its decline. I attended 
a black girl who discharged a great many worms, 
but without the least relief of any of her symptoms. 

There was a great variety in this disease. 1. In 
the time of the attack of the fever, from the time 
of the reception of the contagion. In general the 
interval was fourteen days, but it frequently appear- 
ed before, and sometimes later than that period. 

2. In the time of the eruption, from the begin- 
ning of the fever. It generally appeared on the 
third and fourth days. In one case, Dr. Waters 
informed me, it did not appear till the eighth day. 

3. In the abatement or continuance of the fever 
after the eruption. 

MEASLES IN 1789. 341 

4. In the colour andjigure of the eruption. In 
some it put on a pale red, in others a deep, and in 
a few a livid colour, resembling an incipient mor- 
tification. In some there appeared red blotches, 
in others an equally diffused redness, and in a few, 
eruptions like the small-pox, called by Dr. Cullen, 
rubiola varioloides. 

5. In the duration of the eruption on the skin. 
It remained in most cases only three or four days; 
but in one, which came under my care, it remained 
nine days. 

6. In the manner of its retrocession. I saw 
very few cases of its leaving the branny appearance 
so generally spoken of by authors on the skin. 

7. In not affecting many persons, and even fa- 
milies who were exposed to it. 

The symptoms which continued in many after 
the retrocession of the measles, were cough, hoarse- 
ness, or complete aphonia, which continued in two 
cases for two weeks ; also diarrhoea, opthalmy, a 
bad taste in the mouth, a defect or excess of appe- 
tite, and a fever, which in some instances was of 
the intermitting kind, but which in more assumed 
the more dangerous form of the typhus mitior. 


Two cases of internal dropsy of the brain followed 
them. One was evidently excited by a fail. They 
both ended fatally. 

During the prevalence of the disease I observed 
several persons (who had had the measles, and who 
were closely confined to the rooms of persons ill 
with them) to be affected with a slight cough, sore 
throat, and even sores in the mouth. I find a si- 
milar fact taken notice of by Dr. Quier. 

But I observed further, many children to be af- 
fected by a fever, cough, and all the other symp- 
toms of the measles which have been mentioned, ex- 
cept a general eruption, for in some there was a 
trifling efflorescence about the neck and breast. I 
observed the same thing in 1773 and 1783. In 
my note book I find the following account of the 
appearance of this disease in children in the year 
1773. " The measles appeared in March; a ca- 
" tarrh (for by that name I then called it) appear- 
" ed at the same time, and was often mistaken for 
" them, the symptoms being nearly the same in 
" both. In the catarrh there was in some instances 
" a trifling eruption. A lax often attended it, and 
" some who had it had an extremelv sore mouth, '^ 

MEASLES IN 1789. 34$ 

I was the more struck with this disease, from 
finding it was taken notice of by Dr. Sydenham. 
He calls it a morbillous fever. I likewise find an 
account of it in the 2d article of the 5th volume of 
the Edinburgh Medical Essays. The words of 
the author, who is anonymous, are as follow. 
" During this measly season, several persons, 
" who never had the measles, had all the symp- 
" toms of measles, which went off in a few clavs 
" without any eruptions. The same persons had 
" the measles months or years afterwards." Is 
this disease a common fever, marked by the reign- 
ing epidemic, and produced in the same manner, 
and by the same causes, as the variolous fever de- 
scribed by Dr. Sydenham, which he says prevailed 
at the same time with the small- pox ? I think it is 
not. My reasons for this opinion are as follow. 

1. I never saw it affect any but children, in the 
degree that has been mentioned, and such only as 
had never had the measles. 

2. It affected whole families at the same time. 
It proved fatal to one of three children whom it 
affected on the same day. 

3. It terminated in a pulmonary consumption 
in a boy of ten years old, with all the symptoms 


which attend that disease when it follows the regu- 
lar measles. 

4. It affected a child in one family, on the same 
day that two other members of the same family 
were affected by the genuine measles. 

5. It appeared on the usual days of the genuine, 
measles, from the time the persons affected by it 
were exposed to its contagion. And, 

6. It communicated the disease in one family, 
in the usual time in which the disease is taken 
from the genuine measles. 

The measles, then, appear to follow the analogy 
of the small-pox, which affects so superficially as to 
be taken a second time, and which produce on per- 
sons who have had them what are called the nurse 
pock. They follow likewise the analogy of another 
disease, viz. the scarlatina anginosa. In the ac- 
count of the epidemic for 1773, published in the 
third volume of the Edinburgh Medical Essays, 
we are told, that such patients as had previously had 
the scarlet fever without sore throats, took the sore 
throat, and had no eruption, while those who had 
previously had the sore throat had a scarlet erup- 

MEASLES IN 1789. 345 

tion, but the throat remained free from the distem- 
per. All other persons who were affected had both. 

From these facts, I have taken the liberty of 
calling it the internal measles, to distinguish it 
from those which are external, I think the dis- 
covery of this new state of this disease of some 
application to practice. 

1. It will lead us to be cautious in declaring any 
disease to be the external measles, in which there 
is not a general eruption. From my ignorance of 
this, I have been led to commit several mistakes, 
which w^ere dishonourable to the profession. I 
w r as called, during the prevalence of the measles in 
the above-named season, to visit a girl of twelve 
years old, with an eruption on the skin. I called 
it the measles. The mother told me it was im- 
possible, for that I had in 1783 attended her for 
the same disease. I suspect the anonymous author 
before -mentioned has fallen into the same error. 
He adds to the account before quoted the follow- 
ing words. " Others, who had undergone the 
" measles formerly, had at this time a fever of the 
" erysipelatous kind, with eruptions like to which 
" nettles cause, and all the previous and concomi- 
" tant symptoms of the measles, from the begin* 
<" ning to the end of the disease." 

VOL. II. 2 x 


2. If inoculation, or any other mode of lessen- 
ing the violence of the disease, should be adopted, 
it will be of consequence to know what persons are 
secure from the attacks of it, and who are still ex- 
posed to it. 

I shall now add a short account of my method 
of treating this disease. 

Many hundred families came through the dis- 
ease without the help of a physician. But in 
many cases it was attended with peculiar danger, 
and in some with death. I think it was much more 
fatal than in the years 1773 and 1783, probably 
owing to the variable weather in the winter, and 
the coldness and dampness of the succeeding spring. 
Dr. Huxham savs, he once saw the measles attend- 
ed with peculiar mortality, during a late cold and 
damp spring in England. It was much more fatal 
(ceteris paribus) to adults than to young people. 

The remedies I used were, 

1. Bleeding, in all cases where great pain and 
cough with a hard pulse attended. In some I 
found it necessary to repeat this remedy. But I 
met with many cases in which it was forbidden by 

MEASLES IN 1789. 347 

the weakness of the pulse, and by other marks of a 
feeble action in the blood-vessels. 

2. Vomits, These were very useful in remov- 
ing a nausea ; they likewise favoured the eruption 
of the measles. 

3. Demulcent and diluting drinks. These were 
barley water, bran, and flaxseed tea, dried cherry 
and raw apple water, also beverage, and cyder and 
water. The last drink I found to be the most 
agreeable to my patients of any that have been 

4. Blisters to the neck, sides, and extremities, 
according to the symptoms. They were useful in 
every stage of the disease. 

5. Opiates. These were given not only at night, 
but in small doses during the day, when a trouble- 
some cough or diarrhoea attended. 

6. Where a catarrhal fever ensued, I used bleed- 
ing and blisters. In those cases in which this fe- 
ver terminated in an intermittent, or in a mild ty- 
phus fever, I gave the bark with evident advantage. 
In that case of measles, formerly mentioned, which 
was accompanied by symptoms of cynanche tra- 


chealis, I gave calomel with the happiest effects. 
In the admission of fresh air I observed a medium 
as to its temperature, and accommodated it to the 
degrees of action in the system. In different parts 
of the country, in Pennsylvania and New- Jersey, I 
heard with great pleasure of the cold air being used 
as freely and as successfully in this disease, as in 
the inflammatory small-pox. The same people 
who were so much benefited by cool air, I was in- 
formed, drank plentifully of cold water during every 
stage of the fever. One thing in favour of this 
country practice deserves to be mentioned, and that 
is, evident advantage arose in all the cases which I 
attended, from patients leaving their beds in the fe- 
brile state of this disease. But this was practised 
only by those in whom inflammatory diathesis pre- 
vailed, for these alone had strength enough to bear 

The convalescent state of this disease required 
particular attention. 

1. A diarrhoea often continued to be trouble- 
some after other symptoms had abated. I relieved 
it by opiates and demulcent drinks. Bleeding has 
been recommended for it, but I did not find it ne- 
cessarv in a single case. 

MEASLES IN 1789. 349 

2. An opthalmia which sometimes attended, 
yielded to astringent colly ria and blisters. 

3. Where a cough or fever followed so slight as 
not to require bleeding, I advised a milk and vege- 
table diet, country air, and moderate warmth ; for 
whatever might have been the relation of the lungs 
in the beginning of the disease to cold air, they 
w r ere now evidently too much debilitated to bear it. 

4. It is a common practice to prescribe purges 
after the measles. After the asthenic state of this 
disease they certainly do harm. In all cases, the 
effects of them may be better obviated by diet, full 
or low, suitable clothing, and gentle exercise, or 
country air. I omitted them in several cases, and 
no eruption or disease of any kind followed their 

I shall only add to this account of the measles, 
that in several families, I saw evident advantages 
from preparing the body for the reception of the 
contagion, by means of a vegetable diet. 








WINTER OF 1791. 



THE latter end of the month of August, 
in the summer of 1789, was so very cool that fires 
became agreeable. The month of September was 
cool, dry, and pleasant. During the whole of this 
month, and for some days before it began, and af- 
ter it ended, there had been no rain. In the begin- 
ning of October, a number of the members of the 
first congress, that had assembled in New- York, 
under the present national government, arrived in 
Philadelphia, much indisposed with colds. They 
ascribed them to the fatigue and night air to which 
they had been exposed in travelling in the public 
stages ; but from the number of persons who were 
affected, from the uniformity of their complaints, 
and from the rapidity with which it spread through 
our city, it soon became evident that it was the 
vol. u. 2 Y 


disease so well known of late years by the name of 
the influenza. 

The symptoms which ushered in the disease 
were generally a hoarseness, a sore throat, a sense 
of weariness, chills, and a^fever. After the disease 
was formed, it affected more or less the following 
parts of the body. Many complained of acute 
pains in the bead. These pains were frequently 
fixed between the eye-balls, and, in three cases 
which came under my notice, they were terminated 
by abscesses in the frontal sinus, which discharged 
themselves through the nose. The pain, in one of 
these cases, before the rupture of the abscess, was 
so exquisite, that my patient informed me, that he 
felt as if he should lose his reason. Many com- 
plained of a great itching in the eye-lids. In some, 
the eye-lids were swelled. In others, a copious ef- 
fusion of water took place from the eyes ; and in a 
few, there was a true ophthalmia. Many com- 
plained of great pains in one ear, and some of pains 
in both ears. In some, these pains terminated in 
abscesses, which discharged for some days a bloody 
or purulent matter. In others, there was a swel- 
ling behind each ear, without a suppuration. — 
Sneezing was a universal symptom. In some, it 
occurred not less than fifty times in a day. The 
matter discharged from the nose was so acrid as t© 

in 1789, 1790, and 1791. 355 

inflame the nostrils and the upper lip, in such a 
manner as to bring on swellings, sores, and scabs 
in many people. In some, the nose discharged 
drops, and in a few, streams of blood, to the 
amount, in one case, of twenty ounces. In many 
cases, it was so much obstructed, as to render 
breathing through it difficult. In some, there was 
a total defect of tasts. In others, there was a bad 
taste in the mouth, which frequently continued 
through the whole course of the disease. In some, 
there was a want of appetite. In others, it was 
perfectly natural. Some complained of a soreness 
in their mouths, as if they had been inflamed by 
holding pepper in them. Some had swelled jaws, 
and many complained of the tooth-ach. I saw only 
©ne case in which the disease produced a coma. 

Many were affected with pains in the breast and 
sides. A difficulty of breathing attended in some, 
and a cough was universal. Sometimes this cough 
alternated with a pain in the head. Sometimes it 
preceded this pain, and sometimes it followed it. 
It was at all times distressing. In some instances, 
it resembled the chin- cough. One person expired 
in a fit of 'coughing, and many persons spat blood 
in consequence of its violence. I saw several pa- 
tients in whom the disease affected the trachea 
chiefly, producing great difficulty of breathing, 


and, in one case, a suppression of the voice, and 
I heard of another in which the disease, by falling 
on the trachea, produced a cynanche trachealis. 
In most of the cases which terminated fatally, the 
patients died of pneumonia notha. 

The stomach was sometimes affected by nau- 
sea and vomiting ; but this was far from being a 
universal symptom. 

I met with four cases in which the whole force 
of the disease fell upon the bowels y and went off in 
a diarrhoea ; but in general the bowels were regu- 
lar or costive. 

The limbs were affected with such acute pains 
as to be mistaken for the rheumatism, or for the 
break- bone-fever of 1780. The pains were most 
acute in the back and thighs. 

Profuse sweats appeared in many over the whole 
body in the beginning, but without affording any 
relief. It was in some instances accompanied by 
erysipelatous, and in four cases which came to my 
knowledge, it was followed by miliary eruptions. 

The pulse was sometimes tense and quick, but 
seldom full. In a great majority of those whom I 
visited it was quick, weak, and soft. 

in 1789, 1790, and 1791. 357 

There was no appearance in the urine different 
from what is common in all fevers. 

The disease had evident remissions, and the fe- 
ver seldom continued above three or four days; 
but the cough, and some other troublesome symp- 
toms, sometimes continued two or three weeks. 

In a few persons, the fever terminated in a tedi- 
ous and dangerous typhus. 

In several pregnant women it produced uterine 
haemorrhages and abortions. 

It affected adults of both sexes alike. A few 
old people escaped it. It passed by children un- 
der eight years old with a few exceptions. Out 
of five and thirty maniacs in the Pennsylvania hos- 
pital, but three were affected by it. No profes- 
sion or occupation escaped it. The smell of tar 
and tobacco did not preserve the persons who 
worked in them from the disease, nor did the use 
of tobacco, in snuff, smoking, or chewing, afford 
a security against it.* 

* Mr. Howard informs us that the use of tobacco is not 
a preservative against the plague, as has formerly been sup- 
posed ; of course that apology for the use of an offensive 
weed should not be admitted. 


Even previous and existing diseases did not pro- 
tect patients from it. It insinuated into sick cham- 
bers, and blended itself with every species of chro- 
nic complaint. 

It was remarkable that persons who worked in 
the open air, such as sailors, and 'long-shore-men, 
(to use a mercantile epithet) had it much worse 
than tradesmen who worked within doors. A 
body of surveyors, in the eastern woods of Penn- 
sylvania, suffered extremely from it. Even the 
vigour of constitution which is imparted by the sa- 
vage life did not mitigate its violence. Mr. An- 
drew Ellicott, the geographer of the United States, 
informed me that he was a witness of its affecting 
the Indians in the neighbourhood of Niagara with 
peculiar force. The cough which attended this 
disease was so new and so irritating a complaint 
among them, that they ascribed it to witchcraft. 

It proved most fatal on the sea- shore of the 
United States. 

Many people who had recovered, were affected 
a second time with all the symptoms of the disease. 
I met with a woman, who, after recovering from it 
in Philadelphia, took it a second time in New- York, 
and a third time upon her return to Philadelphia. 

in 1789, 1790, and 1791. 359 

Many thousand people had the disease who were 
not confined to their houses, but transacted busi- 
ness as usual out of doors. A perpetual coughing 
was heard in every street of the city. Buying and 
selling were rendered tedious by the coughing of 
the farmer and the citizen who met in market 
places. It even rendered divine service scarcely 
intelligible in the churches. 

A few persons who were exposed to the disease 
escaped it, and some had it so lightly as scarcely to 
be sensible of it. Of the persons who were con- 
fined to their houses, not a fourth part of them kept 
their beds. 

It proved fatal (with few exceptions) only to old 
people, and to persons who had been previously 
debilitated by consumptive complaints. It likewise 
carried of several hard drinkers. It terminated in 
asthma in three persons whose cases came under 
my notice, and in pulmonary consumption, in many 
more. I met with an instance in a lady, who was 
much relieved of a chronic complaint in her liver ; 
and I heard of another instance of a clergyman 
whose general health was much improved by a se- 
vere attack of this disease. 


It was not wholly confined to the human species. 
It affected two cats, two house-dogs, and one horse, 
within the sphere of my observations. One of the 
dogs disturbed his mistress so much by coughing 
at night, that she gave him ten drops of laudanum 
for several nights, which perfectly composed him. 
One of the cats had a vomiting with her cough. 
The horse breathed as if he had been affected by 
the cynanche trachealis. 

The scarlatina anginosa, which prevailed during 
the summer, disappeared after the first of October; 
but appeared again after the influenza left the city. 
Nor was the remitting fever seen during the pre- 
valence of the reigning epidemic. 

I inoculated about twenty children for the small- 
pox during this prevalence of the influenza, and ne- 
ver saw that disease exhibit a more favourable ap- 

In the treatment of the influenza I was governed 
by the state of the system. Where inflammatory 
diathesis discovered itself by a full or tense pulse, 
or where great difficulty of breathing occurred, 
and the pulse was low and weak in the beginning 
of the disease, I ordered moderate bleeding. In a 

in 1789, 1790, and 1791. 361 

few cases in which the symptoms of pneumony 
attended, I bled a second time with advantage. In 
all these instances of inflammatory affection, I gave 
the usual antiphlogistic medicines. I found that 
vomits did not terminate the disease, as they often 
do a common catarrh, in the course of a day, or of 
a few hours. 

In cases where no inflammatory action appeared 
in the system, I prescribed cordial drinks and diet, 
and forbad every kind of evacuation. I saw seve- 
ral instances of persons who had languished for a 
week or two with the disease, who were suddenly 
cured by eating a hearty meal, or by drinking half 
a pint of wine, or a pint of warm punch. In all 
these cases of weak action in the blood-vessels, 
liquid laudanum gave great relief, not only by sus- 
pending the cough, but by easing the pains in the 

I met with a case of an old lady who was sud- 
denly and perfectly cured of her cough by a fright. 

The duration of this epidemic in our city was 
about six weeks. It spread from New- York and 
Philadelphia in all directions, and in the course of 
a few months pervaded every state in the union. 
It was carried from the United States to several of 

vol. ii. 2 z 


the West- India islands. It prevailed in the island 
of Grenada in the month of November, 1789, and 
it was heard of in the course of the ensuing winter 
in the Spanish settlements in South- America. 

The following winter was unusually mild, inso- 
much that the navigation of the Delaware was not 
interrupted during the whole season, only from 
the 7th to the 24th of February. The weather on 
the 3d and 4th days of March was very cold, and 
on the 8th and 9th days of the same month, the 
mercury in Fahrenheit's thermometer stood at 4° 
at 7 o'clock in the morning. On the 10th and 
11th, there fell a deep snow. The weather during 
the remaing part of the month was cold, rainy, and 
variable. It continued to be variable during the 
month of April. About the middle of the month 
there fell an unusual quantity of rain. The showers 
which fell on the night of the 1 7th will long be connect- 
ed in the memories of the citizens of Philadelphia 
with the time of the death of the celebrated Dr. 
Franklin. Several pleurisies appeared during this 
month ; also a few cases of measles. In the last 
week of the month the influenza made its appear- 
ance. It was brought to the city from New- Eng- 
land, and affected, in its course, all the intermediate 
states. Its symptoms were nearly the same as they 
were in the preceding autumn, but in many people 

in 1789, 1790, and 1791. 363 

it put on some new appearances. Several persons 
who were affected by it had symptoms of madness, 
one of whom destroyed himself by jumping out of 
a window. Some had no cou°;h, but verv acute 
pains in the back and head. It was remarked that 
those who had the disease chiefly in the breast the 
last year, complained now chiefly of their heads, 
while those wiiose heads were affected formerly, 
now complained chiefly of their breasts. In many 
it put on the type of an intermitting fever. Seve- 
ral complained of constant chills, or constant 
sweats ; and some were much alarmed by an un- 
common blue and dark colour in their hands. I 
saw one case of ischuria, another of an acute pain 
in the rectum, a third of anasarca, and a fourth of a 
palsy in the tongue and arms ; all of which appear- 
ed to be anomalous symptoms of the influenza. 
Sneezing, and pains in the ears and frontal sinus, 
were less common now than they were in the fall ; 
but a pain in the eye- balls was a universal symptom. 
Some had a pain in the one eye only, and a few 
had sore eyes, and swellings in the face. Many 
women who had it, were affected by an irregular 
appearance of the catamenia. In two persons 
whom I saw, the cough was incessant for three 
days, nor could it be composed by any other re- 
medy than plentiful bleeding. A patient of Dr. 
Samuel Duineld informed me, after his recovery, 


that he had had no other symptom of the disease 
than an efflorescence on his skin, and a large swel- 
ling in his groin, which terminated in a tedious ab- 


The prisoners in the jail who had it in the au- 
tumn, escaped it this spring. 


During the prevalence of this disease, I saw no 
sign of any other epidemic. 

It declined sensibly about the first week in June, 
and after the 12th day of this month I was not 
called to a single patient in it. 

The remedies for it were the same as were used 
in the fall. 

I used bleeding in several cases on the second, 
third, and fourth days of the disease, where it had 
appeared to be improper in its first stage. The 
cases which required bleeding were far from being 
general. I saw two instances of syncope of an 
alarming nature, after the loss of ten ounces of 
blood ; and I heard of one instance of a boy who 
died in half an hour after this evacuation. 

in 1789, 1790, and 1791. 365 

I remarked that purges of all kinds worked 
more violently than usual in this disease. 

The convalescence from it was very slow, and a 
general languor appeared to pervade the citizens 
for several weeks after it left the city. 

The month of December, 1790, was extremely 
and uniformly cold. In the beginning of the 
month of January, 1791, the weather moderated, 
and continued to be pleasant till the 17th, on which 
day the navigation of the Delaware, which had 
been completely obstructed by the ice, was opened 
so as to admit of the arrival of several vessels. 
During the month of December many people com- 
plained of colds; but they were ascribed wholly to 
the weather. In January four or five persons in a 
family were affected by colds at the same time ; 
which created a suspicion of a return of the influ- 
enza. This suspicion was soon confirmed by ac- 
counts of its prevailing in the neighbouring coun- 
ties of Chester and Montgomery, in Pennsylvania, 
and in the distant states of Virginia and Rhode- 
Island. It did not affect near so generally as in 
the two former times of appearance. There was 
no difference in the method of treating it. While 
the common inflammatory diseases of the winter 
bore the lancet as usual, it was remarked that pa- 


tients who were attacked by the influenza, did 
not bear bleeding in a greater proportion, or in a 
larger quantity, than in the two former times of its 
appearance in the city. 

I shall conclude this account of the influenza by 
the following observations : 

1. It exists independently of the sensible quali- 
ties of the air, and in all kinds of weather. Dr. 
Patrick Russel has proved the plague to be equally 
independent of the influence of the sensible qualities 
of the atmosphere, to a certain degree. 

2. The influenza passes with the utmost rapidity 
through a country, and affects the greatest number 
of people, in a given time, of any disease in the 

3. It appears from the histories of it which are 
upon record, that neither climate, nor the different 
states of society, have produced any material 
change in the disease. This will appear from com- 
paring the account I have given, with the histories 
of it which have lately been given by Dr. Grey, 
Dr. Hamilton, Dr. A. Fothergill, Mr. Chisholm, 
and other modern physicians. It appears further, 
that even time itself has not been able materially to 

in 1789, 1790, and 1791. 367 

change the type of this disease. This is evident, 
from comparing modern accounts of it with those 
which have been handed down to us by ancient 

I have hinted in a former essay at the diminutives 
of certain diseases. There is a state of influenza, 
which is less violent and more local, than that which 
has been described. It generally prevails in the 
winter season. It seems to originate from a mor- 
bid matter, generated in crowded and heated 
churches, and other assemblies of the people. I 
have seen a cold, or influenza, frequently universal 
in Philadelphia, which I have distinctly traced to 
this source. It would seem as if the same species 
of diseases resembled pictures, and that while some 
of them partook of the deep and vivid nature of 
mosaic work, others appeared like the feeble and 
transient impressions of water colours. 






VOL. II. 3 A 




MY business in this chair is to teach the 
institutes of medicine. They have been divided 
into physiology, pathoiogy, and therapeutics. The 
objects of the first are, the laws of the human body 
in its healthy state. The second includes the his- 
tory of the causes and seats of diseases. The sub- 
jects of the third are the remedies for those diseases. 
In entering upon the first part of our course, I am 
met by a remark delivered by Dr. Hunter in his 
introductory lectures to his course of anatomy. 
* £ In our branch (says the doctor) those teachers 
who study to captivate young minds with ingeni- 
ous speculations, will not leave a reputation be- 
hind them that will outlive them half a century. 


When they cease from their labours, their labours 
will be buried along with them. There never 
was a man more followed and admired in physio- 
logy, than Dr. Boerhaave. I remember the ve- 
neration in which he was held. And now, in the 

space of forty years, his physiology is it 

shocks me to think in what a light it appears*." 
Painful as this premonition may be to the teachers 
of physiology, it should not deter them from spe- 
culating upon physiological subjects. Simple ana- 
tomy is a mass of dead matter. It is physiology 
which infuses life into it. A knowledge of the 
structure of the human body occupies only the me- 
mory. Physiology introduces it to the higher and 
more noble faculties of the mind. The compo- 
nent parts of the body may be compared to the 
materials of a house ; lying without order in a yard. 
It is physiology, like a skilful architect, which con- 
nects them together, so as to form from them an 
elegant and useful building. The writers against 
physiology resemble, in one particular, the writers 
against luxury. They forget that the functions 
they know and describe belong to the science of 
physiology ; just as the declaimers against luxury 
forget that all the conveniencies which they enjoy 
beyond what are possessed in the most simple 
stage of society, belong to the luxuries of life. 

* Lect. xi. p. 198, 


The anatomist who describes the circulation of the 
blood, acts the part of a physiologist, as much 
as he does, who attempts to explain the functions 
of the brain. In this respect Dr. Hunter did ho- 
nour to our science ; for few men ever explained 
that subject, and many others equally physiologi- 
cal, with more perspicuity and eloquence, than that 
illustrious anatomist. Upon ail new and difficult 
subjects there must be pioneers. It has been my 
lot to be called to this office of hazard and druoVe- 
ry ; and if in discharging its duties I should meet 
the fate of my predecessors, in this branch of me- 
dicine, I shall not perish in vain. My errors, like 
the bodies of those who fall in forcing a breach, 
will serve to compose a bridge for those who shall 
eome after me, in our present difficult enterprise. 
This consideration, aided by just views of the na- 
ture and extent of moral obligation, will overba- 
lance the evils anticipated by Dr. Hunter, from 
the loss of posthumous flime. Had a prophetic 
voice whispered in the ear of Dr. Boerhaave in the 
evening of his life, that in the short period of forty 
years, the memory of his physiological works would 
perish from the earth, I am satisfied, from the 
knowledge we have of his elevated genius and 
piety, he w T ould have treated the prediction with 
the same indifference that he would have done, had 
he been told, that in the same time, his name 


should be erased from a pane of glass, in a noisy 
and vulgar country tavern. 

The subjects of the lectures I am about to deli- 
ver, you will find in a syllabus which I have pre- 
pared and published, for die purpose of giving you 
a succinct view of the extent and connection of 
our course. Some of these subjects will be new 
in lectures upon the institutes of medicine, parti- 
cularly those which relate to morals, metaphysics, 
and theology. However thorny these questions 
may appear, we must approach and handle them ; 
for they are intimately connected with the history 
of the faculties and operations of the human mind ; 
and these form an essential part of the animal eco- 
nomy. Perhaps it is because physicians have hi- 
therto been restrained from investigating, and de- 
ciding upon these subjects, by an erroneous belief 
that they belong exclusively to another profession, 
that physiology has so long been an obscure and 
conjectural science. 

In beholding the human body, the first thing 
that strikes us, is its life. This, of course, should 
be the first object of our inquiries. It is a most im- 
portant subject ; for the end of all the studies of a 
physician is to preserve life ; and this cannot be 
perfectly done, until we know in what it consists. 


I include in animal life, as applied to the human 
bod}-, motion, sensation, and thought. These three, 
when united, compose perfect life. It may exist 
without thought, or sensation ; but neither sensa- 
tion, nor thought, can exist without motion. The 
lowest grade of life, probably exists in the absence 
of even motion, as I shall mention hereafter. I have 
preferred the term motion to those of oscillation and 
vibration, which have been employed by Dr. Hart- 
ley in explaining the laws of animal matter ; because 
I conceived it to be more simple, and better adapted 
to common apprehension. 

In treating upon this subject, I shall first consider 
animal life as it appears in the waking and sleeping- 
states in a healthy adult, and shall afterwards in- 
quire into the modification of its causes in the foe- 
tal, infant, youthful, and middle states of life, in 
certain diseases, in different states of society, in 
different climates, and in different animals. 

I shall begin by delivering three general proposi- 

I. Every part of the human body (the nails and 
hair excepted) is endowed with sensibility, or ex- 
citability, or with both of them. By sensibility is 
meant the power of having sensation excited by the 

376 ustqjjiry into the 

action of impressions. Excitability denotes that 
property in the human body, by which motion is 
excited by means of impressions. This property 
has been called by several other names, such as irri- 
tability, contractility, mobility, and stimulability. 

I shall make use of the term excitability, for the 
most part, in preference to any of them. I mean 
by it, a capacity of imperceptible, as well as obvi- 
ous motion. It is of no consequence to our pre- 
sent inquiries, whether this excitability be a quality 
of animal matter, or a substance. The latter opi- 
nion has been maintained by Dr. Girtanner, and 
has some probability in its favour. 

II. The whole human body is so formed and 
connected, that impressions made in the healthy 
state upon one part, excite motion, or sensation, or 
both, in every other part of the body. From this 
view, it appears to be a unit, or a simple and in- 
divisible quality, or substance. Its capacity for re- 
ceiving motion, and sensation, is variously modified 
by means of what are called the senses. It is ex- 
ternal, and internal. The impressions which act 
upon it shall be ennumerated in order. 

III. Life is the effect of certain stimuli acting 
upon the sensibility and excitability which are ex- 
tended, in different degrees, over every externa! 


and internal part of the body. These stimuli are 
as necessary to its existence, as air is to flame. 
Animal life is truly (to use the words of Dr. Brown) 
V a forced state.' ' I have said the words of Dr. 
Brown ; for the opinion was delivered by Dr. Cul- 
len in the university of Edinburgh, in the year 
1766, and was detailed by me in this school, many 
years before the name of Dr. Brown was known as 
a teacher of medicine. It is true, Dr. Cullen af- 
terwards deserted it ; but it is equally true, I 
never did ; and the belief of it has been the foun- 
dation of many of the principles and modes of 
practice in medicine which I have since adopted. 
In a lecture which I delivered in the year 1771, I 
find the following words, which are taken from a 
manuscript copy of lectures given by Dr. Cullen 
upon the institutes of medicine. " The human 
body is not an automaton, or self- moving machine; 
but is kept alive and in motion, by the constant 
action of stimuli upon it." In thus ascribing the 
discovery of the cause of life which I shall endea- 
vour to establish, to Dr. Cullen, let it not be sup- 
posed I mean to detract from the genius and merit 
of Dr. Brown. To his intrepidity in reviving and 
propagating it, as well as for the many other truths 
contained in his system of medicine, posterity, I 
have no doubt, will do him ample justice, after the 
errors that are blended with them have been 
vol. ii« 3 B 


corrected, by their unsuccessful application to tha 
cure of diseases. 

Agreeably to our last proposition, I proceed to 
remark, that the action of the brain, the diastole 
and systole of the heart, the pulsation of the arte- 
ries, the contraction of the muscles, the peristaltic 
motion of the bowels, the absorbing power of the 
lymphatics, secretion, excretion, hearing, seeing, 
smelling, taste, and the sense of touch, nay more, 
thought itself, are all the effects of stimuli acting 
upon the organs of sense and motion. These sti- 
muli have been divided into external and internal. 
The external are light, sound, odours, air, heat, 
exercise, and the pleasures of the senses. The in- 
-ternal stimuli are food, drinks, chyle, the blood, a 
certain tension of the glands, which contain secret- 
ed liquors, and the exercises of the faculties of the 
mind ; each of which I shall treat in the order in 
which they have been mentioned. 

I. Of external stimuli. The first of these is 
light. It is remarkable that the progenitor of the 
human race was not brought into existence until all 
the luminaries of heaven were created. Light acts 
chiefly through the medium of the organs of vision. 
Its influence upon animal life is feeble, compared 
with some other stimuli to be mentioned hereafter,; 


but it has its proportion of force. Sleep has been 
said to be a tendency to death ; now the absence of 
light we know invites to sleep, and the return of it 
excites the waking state. The late Mr. Ritten- 
house informed me, that for many years he had 
constantly awoke with the first dawn of the morn- 
ing light, both in summer and winter. Its influ- 
ence upon the animal spirits strongly demonstrates 
its connection with animal life, and hence we find 
a cheerful and a depressed state of mind in many 
people, and more especially in invalids, to be inti- 
mately connected with the presence or absence of 
the rays of the sun. The well-known pedestrian 
traveller, Mr. Stewart, in one of his visits to this 
city, informed me, that he had spent a summer in 
Lapland, in the latitude of 69°, during the greatest 
part of which time the sun was seldom out of sight. 
He enjoyed, he said, during this period, uncom- 
mon health and spirits, both of which he ascribed 
to the long duration, and invigorating influence of 
light. These facts will surprise us less when we 
attend to the effects of light upon vegetables. Some 
of them lose their colour by being deprived of it ; 
many of them discover a partiality to it in the di- 
rection of their flowers ; and all of them discharge 
their pure air only while they are exposed to it*. 

* " Organization, sensation, spontaneous motion, and life, 
sxist only at the surface of the earth, and in places exposed 



2. Sound has an extensive influence upon hu- 
man life. Its numerous artificial and natural sour- 
ces need not be mentioned. I shall only take no- 
tice, that the currents of winds, the passage of 
insects through the air, and even the growth of 
vegetables, are all attended with an emission of 
sound ; and although they become imperceptible 
from habit, yet there is reason to believe they all 
act upon the body, through the medium of the 
ears. The existence of these sounds is established 
by the reports of persons who have ascended two 
or three miles from the earth in a balloon. They 
tell us that the silence which prevails in those re- 
gions of the air is so new and complete, as to pro- 
duce an awful solemnity in their minds. It is not 
-necessary that these sounds should excite sensation 
or perception, in order to their exerting a degree of 
stimulus upon the body. There are a hundred 
impressions daily made upon it, which from habit 
are not followed by sensation. The stimulus of 
aliment upon the stomach, and of blood upon the 
heart and arteries, probably cease to be felt, only 

to light, We might affirm the flame of Prometheus's torch 
was the expression of a philosophical truth that did not es- 
cape the ancients. Without light, nature was lifeless, ina- 
nimate, and dead. A benevolent God, by producing life, has 
spread organization, sensation, and thought over the surface 
of the earth." — Lavoisier. 


from the influence of habit. The exercise of walk- 
ing, which was originally the result of a deliberate 
act of the will, is performed from habit without the 
least degree of consciousness. It is unfortunate for 
this, and many other parts of physiology, that we 
forget what passed in our minds the first two or 
three years of our lives. Could we recollect the 
manner in which we acquired our first ideas, and 
the progress of our knowledge with the evolution 
of our senses and faculties, it would relieve us 
from many difficulties and controversies upon this 
subject. Perhaps this forgetfulness by children, 
of the origin and progress of their knowledge, 
might be remedied by our attending more closely 
to the first effects of impressions, sensation, and 
perception upon them, as discovered by their little 
actions ; all of which probably have a meaning, as 
determined as any of the actions of men or women. 

The influence of sounds of a certain kind in pro- 
ducing excitement, and thereby increasing life, 
cannot be denied. Fear produces debility, which 
is a tendency to death. Sound obviates this debi- 
lity, and thus restores the system to the natural and 
healthy grade of life. The school-boy and the 
clown invigorate their feeble and trembling limbs 
by whistling or singing as they pass by a country 
church-yard, and the soldier feels his departing life 


recalled in the onset of a battle by the noise of the 
fife, and of the poet's " spirit stirring drum." In* 
tox'ication is frequently attended with a higher de- 
gree of life than is natural. Now sound we know 
will produce this with a very moderate portion of 
fermented liquor ; hence we find men are more 
easily and highly excited by it at public entertain- 
ments where there is music, loud talking, and hal- 
looing, than in private companies where there is no 
auxiliary stimulus added to that of the wine. I 
wish these effects of sound upon animal life to be 
remembered ; for I shall mention it hereafter as a 
remedy for the weak state of life in many diseases, 
and shall relate an instance in which a scream sud- 
denly extorted by grief, proved the means of re- 
suscitating a person who was supposed to be dead, 
and who had exhibited the usual recent marks of 
the extinction of life. 

I shall conclude this head by remarking, that 
persons who are destitute of hearing and seeing 
possess life in a more languid state than other peo- 
ple ; and hence arise the dulness and want of spi- 
rits which they discover in their intercourse with 
the world. 

3. Odours have a sensible effect in promoting 
animal life. The greater healthiness of the conn- 


try, than cities, is derived in part from the effluvia 
of odoriferous plants, which float in the atmosphere 
in the spring and summer months, acting upon 
the system, through the medium of the sense of 
smelling. The effects of odours upon animal life 
appear still more obvious in the sudden revival of 
it, which they produce in cases of fainting. Here 
the smell of a few drops of hartshorn, or even of 
a burnt feather, has frequently in a few minutes 
restored the system, from a state of weakness bor- 
dering upon death, to an equable and regular de- 
gree of excitement. 


4. Air acts as a powerful stimulus upon the sys- 
tem, through the medium of the lungs. The com- 
ponent parts of this fluid, and its decomposition in 
the lungs, will be considered in another place*. I 
shall only remark here, that the circulation of the 

* It is probable, the first impulse of life was imparted to 
the body of Adam by the decomposition of air in his lungs. 
I infer this from the account given by Moses of his creation, 
in Genesis, chap. ii. v. 7. " And the Lord God formed man 
of the dust of the ground, and breathed into his nostrils the 
breath of life," in consequence of which, the verse adds, he 
became " a living soul." This explanation of the origin of 
life in the father of the human race, appears to accord more 
with reason, as well as the order of the words which de- 
scribe it, than the common opinion of his having been anr- 
znated by the infusion of a living soul into his body. 


blood has been ascribed, by Dr. Goodwin, exclu- 
sively to the action of air upon the lungs and heart. 
Does the external air act upon any other part of 
the body besides those which have been mentioned? 
It is probable it does, and that we lose our sensa- 
tion and consciousness of it by habit. It is certain 
children cry, for the most part, as soon as they 
come into the world. May not this be the effect 
of the sudden impression of air upon the tender 
surface of their bodies ? And may not the red co- 
lour of their skins be occasioned by an irritation 
excited on them by the stimulus of the air ? It is 
certain it acts powerfully upon denudated animal 
fibres ; for who has not observed a sore, and even 
the skin when deprived of its cuticle, to be affected, 
when long exposed to the air, with pain and inflam- 
mation? The stimulus of air, in promoting the 
natural actions of the alimentary canal, cannot be 
doubted. A certain portion of it seems to be ne- 
cessarily present in the bowels in a healthy state. 

5. Heat is a uniform and active stimulus in pro- 
moting life. It is derived, in certain seasons and 
countries, in part from the sun ; but its principal 
source is from the lungs, in which it appears to be 
generated by the decomposition of pure air, and 
from whence it is conveyed, by means of the circu- 
lation, to every part of the body. The extensive 


influence of heat upon animal life, is evident from 
its decay and suspension during the winter in cer- 
tain animals, and from its revival upon the approach 
and action of the vernal sun. It is true, life is di- 
minished much less in man, from the distance and 
absence of the sun, than in other animals ; but this 
must be ascribed to his possessing reason in so high 
a degree, as to enable him to supply the abstraction 
of heat, by the action of other stimuli upon his 

6. Exercise acts as a stimulus upon the body in 
various ways. Its first impression is upon the mus- 
cles. These act upon the blood-vessels, and they 
upon the nerves and brain. The necessity of ex- 
ercise to animal life is indicated, by its being kindly 
imposed upon man in paradise. The change which 
the human body underwent by the fall, rendered 
the same salutary stimulus necessary to its life, in 
the more active form of labour. But we are not to 
suppose, that motion is excited in the body by ex- 
ercise or labour alone. It is constantly stimulated 
by the positions of standing, sitting, and lying upon 
the sides ; all of which act more or less upon mus- 
cular fibres, and by their means, upon every part 
of the system. 

VOL. II. 3 c 



7. The pleasures we derive from our senses have 
a powerful and extensive influence upon human 
life. The number of these pleasures, and their 
proximate cause, will form an agreeable subject for 
two or three future lectures. 

We proceed next to consider the internal stimuli 
which produce animal life. These are 

I. Food. This acts in the following ways. 1. 
Upon the tongue. Such are the sensibility and 
excitability of this organ, and so intimate is its con- 
nection with every other part of the body, that the 
whole system is invigorated by aliment, as soon as 
it comes in contact with it. 2. By mastication. 
This moves a number of muscles and blood-ves- 
sels situated near the brain and heart, and of course 
imparts impressions to them. 3. By deglutition, 
which acts upon similar parts, and with the same 
eflect. 4. By its presence in the stomach, in 
which it acts by its quantity and quality. Food, 
by distending the stomach, stimulates the contigu- 
ous parts of the body. A moderate degree of dis- 
tention of the stomach and bowels is essential to a 
heal thy excitement of the system. Vegetable ali- 
ment and drinks, which contain less nourishment 
than animal food, serve this purpose in the human 
body. Hay acts in the same manner in a horse. 


Sixteen pounds of this light food in a day are ne- 
cessary to keep up such a degree of distension in 
the stomach and bowels of this animal, as to impart 
to him his natural grade of strength and life. The 
quality of food, when of a stimulating nature, sup- 
plies the place of its distension from its quantity. 
A single onion will support a lounging highlander 
•on the hills of Scotland for four and twenty hours. 
A moderate quantity of salted meat, or a few ounces 
of sugar, have supplied the place of pounds of less 
stimulating food. Even indigestible substances, 
which remain for days, or perhaps weeks in the 
stomach, exert a stimulus there which has an in- 
fluence upon animal life. It is in this way the tops 
of briars, and the twigs of trees, devoid not only 
of nourishing matter, but of juices, support the 
camel in his journies through the deserts of the 
eastern countries. Chips of cedar posts moistened 
with water have supported horses for two or three 
weeks, during a long voyage from Boston to Suri- 
nam ; and the indigestible cover of an old Bible pre- 
served the life of a dog, accidentally confined in a 
room at Newcastle upon Tyne, for twenty days. 
5. Food stimulates the whole body by means oi the 
process of digestion which goes forward in the sto- 
mach. This animal function is carried on by a 
process, in which there is probably an extrication of 


heat and air. Now both these, it has been re- 
marked, exert a stimulus in promoting animal life. 

Drinks, when they consist of fermented or dis- 
tilled liquors, stimulate from their quality ; but 
when they consist of water, either in its simple 
state, or impregnated with any sapid substance, 
they act principally by distention. 

II. The chyle acts upon the lacteals, mesenteric 
glands, and thoracic duct, in its passage through 
them ; and it is highly probable, its first mixture 
with the blood in the subclavian vein, and its first 
action on the heart, are attended with considerable 
stimulating effects. 

III. The blood is a very important internal sti- 
mulus. It has been disputed whether it acts by 
its quality, or only by distending the blood-vessels. 
It appears to act in both ways. I believe with Dr. 
Whytt, that the blood stimulates the heart and ar- 
teries by a specific action. But if this be not ad- 
mitted, its influence in extending the blood-vessels 
in every part of the body, and thereby imparting 
extensive and uniform impressions to every animal 
fibre, cannot be denied. In support of this asser- 
tion it has been remarked, that in those persons 


who die of hunger, there is no diminution of the 
quantity of blood in the large blood-vessels. 

IV. A certain tension of the glands, and of other 
parts of the body, contributes to support animal 
life. This is evident in the vigour which is im- 
parted to the system, by the fulness of the seminal 
vesicles and gall bladder, and by the distension of 
the uterus in pregnancy. This distension is so 
great, in some instances, as to prevent sleep for 
many days and even weeks before delivery. It 
serves the valuable purpose of rendering the female 
system less liable to death during its continuance, 
than at any other time. By increasing the quantity 
of life in the body, it often suspends the fatal issue 
of pulmonary consumption, and ensures a tempo- 
rary victory over the plague and other malignant 
fevers ; for death, from those diseases, seldom 
takes place, until the stimulus, from the distension 
of the uterus, is removed by parturition. 

V. The exercises of the faculties of the mind 
have a wonderful influence in increasing the quaiir 
tity of human life. They all act by reflection only, 
after having been previously excited into action 
by impressions made upon the body. This view 
of the re- action of the mind upon the body accords 
with the simplicity of other operations in the ani- 


mal economy. It is thus the brain repays the 
heart for the blood it conveys to it, by reacting 
upon its muscular fibres. The influence of the 
different faculties of the mind is felt in the pulse, 
in the stomach, and in the liver, and is seen in the 
face, and other external parts of the body. Those 
which act most unequivocally in promoting life are 
the understanding, the imagination, and the passions. 
Thinking belongs to the understanding, and is at- 
tended with an obvious influence upon the degree 
and duration of life. Intense study has often ren- 
dered the body insensible to the debilitating effects 
of cold and hunger. Men of great and active un- 
derstandings, who blend with their studies tempe- 
rance and exercise, are generally long lived. In 
support of this assertion, a hundred names might 
be added to those of Newton and Franklin. Its 
truth will be more fully established by attending 
to the state of human life in persons of an opposite 
intellectual character. The cretins, a race of idiots 
in Valais, in Switzerland, travellers tell us, are all 
short lived. Common language justifies the opi- 
nion of the stimulus of the understanding upon the 
brain : hence it is common to say of dull men, that 
they have scarcely ideas enough to keep themselves 


The imagination acts with great force upon the 
body, whether its numerous associations produce 
pleasure or pain. But the passions pour a constant 
stream upon the wheels of life. They have been 
subdivided into emotions and passions properly so 
called. The former have for their objects present, 
the latter, future good and evil. All the objects 
of the passions are accompanied with desire or 
aversion. To the former belong chiefly, hope, 
love, ambition, and avarice ; to the latter, fear, ha- 
tred, malice, envy, and the like. Joy, anger, and 
terror, belong to the class of emotions. The pas- 
sions and emotions have been further divided into 
stimulating and sedative. Our business at present 
is to consider their first effect only upon the body. 
In the original constitution of human nature, we 
were made to be stimulated by such passions and 
emotions only as have moral good for their objects; 
Man was designed to be always under the influence 
of hope, love, and joy. By the loss of his inno- 
cence, he has subjected himself to the dominion of 
passions and emotions of a malignant nature ; but 
they possess, in common with such as are good, a 
stimulus which renders them subservient to the 
purpose of promoting animal life. It is true, they 
are like the stimulus of a dislocated bone in their 
operation upon the body, compared with the action 
of antagonist muscles stretched over bones, which 


gently move in their natural sockets. The effects 
of the good passions and emotions, in promoting 
health and longevity, have been taken notice of by 
many writers. They produce a flame, gentle and 
pleasant, like oil perfumed with frankincense in the 
lamp of life. There are instances likewise of per- 
sons who have derived strength and long life from 
the influence of the evil passions and emotions that 
have been mentioned. Dr. Darwin relates the 
history of a man, who used to overcome the fa- 
tigue induced by travelling, by thinking of a per- 
son whom he hated. The debility induced by 
disease is often removed by a sudden change in 
the temper. This is so common, that even nurses 
predict a recovery in persons as soon as they be- 
come peevish and ill-natured, after having been 
patient during the worst stage of their sickness. 
This peevishness acts as a gentle stimulus upon 
the system in its languid state, and thus turns the 
scale in favour of life and health. The famous 
Benjamin Lay, of this state, who lived to be eighty 
years of age, w r as of a very irascible temper. Old 
Elwes was a prodigy of avarice, and every court in 
Europe furnishes instances of men who have at- 
tained to extreme old age, who have lived constantly 
under the dominion of ambition. In the course of 
a long inquiry which I instituted some years ago 
into the state of the body and mind in old people, 


I did not find a single person above eighty, who 
had not possessed an active understanding, or active 
passions. Those different and opposite faculties of 
the mind, when in excess, happily supply the place 
of each other. Where they unite their forces, they 
extinguish the flame of life, before the oil which 
feeds it is consumed. 

In another place I shall resume the influence of 
the faculties of the mind upon human life, as they 
discover themselves in the different pursuits of men. 

I have only to add here, that I see no occasion 
to admit, with the followers of Dr. Brown, that 
the mind is active in sleep, in preserving the mo- 
tions of life. I hope to establish hereafter the 
opinion of Mr. Locke, that the mind is always pas- 
sive in sound sleep. It is true it acts in dreams ; 
but these depend upon a morbid state of the brain, 
and therefore do not belong to the present stage of 
our subject, for I am now considering animal life 
only in the healthy state of the body. I shall say 
presently, that dreams are intended to supply the 
absence of some natural stimulus, and hence we 
find they occur in those persons most commonly, 
in whom there is a want of healthy action in the 
system, induced by the excess or deficiency of cus- 
tomary stimuli. 

VOL. II. 3 D 


Life is in a languid state in the morning. It ac- 
quires vigour by the gradual and successive appli- 
cation of stimuli in the forenoon. It is in its most 
perfect state about mid-day, and remains stationary 
for some hours. From the diminution of the sen- 
sibility and contractility of the system to the action 
of impressions, it lessens in the evening, and be- 
comes again languid at bed-time. These facts will 
admit of an extensive application hereafter in 
lectures upon the practice of physic. 




THE stimuli which have been enumerated^ 
when they act collectively, and within certain 
bounds, produce a healthy waking state. But they 
do not always act collectively, nor in the determin- 
ed and regular manner that has been described. 
There is, in many states of the system, a deficiency 
of some stimuli, and, in some of its states, an ap- 
parent absence of them all. To account for the 
continuance of animal life under such circumstan- 
ces, two things must be premised, before w r e pro- 
ceed to take notice of the diminution or absence of 
the stimuli which support it. 

1. The healthy actions of the body in the wak- 
ing state consist in a proper degree of what has 
been called excitability and excitement. The for- 
mer is the medium on which stimuli act in pro- 
ducing the latter. In an exact proportion, and a 
due relation of both, diffused uniformly throughout 
every part of the body, consists good health. Dis- 


ease is the reverse of this. It depends in part up- 
on a disproportion between excitement and excita- 
bility, and in a partial distribution of each of them. 
In thus distinguishing the different states of excite- 
ment and excitability in health and sickness, you 
see I dissent from Dr. Brown, who supposes them 
to be (though disproportioned to each other) equa- 
bly diffused in the morbid, as well as the healthy 
state of the bod}^. 

2. It is a law of the system, that the absence of 
one natural stimulus is generally supplied by the 
increased action of others This is more certainly 
the case where a natural stimulus is abstracted sud- 
denly; for the excitability is thereby so instantly 
formed and accumulated, as to furnish a highly sen- 
sible and moveable surface for the remaining sti- 
muli to act upon. Many proofs might be adduced 
in support of this proposition. The reduction of 
the excitement of the blood-vessels, by means of 
cold, prepares the way for a full meal, or a warm 
bed, to excite in them the morbid actions which 
take place in a pleurisy or a rheumatism. A horse 
in a cold stable eats more than in a warm one, and 
thus counteracts the debility which would other- 
wise be induced upon his system, by the abstrac- 
tion of the stimulus of warm air. 


These two propositions being admitted, I pro- 
ceed next to inquire into the different degrees and 
states of animal life. The first departure from 
its ordinary and perfect state which strikes us, is 

I. Sleep. This is either natural or artificial. 
Natural sleep is induced by a diminution of the ex- 
citement and excitability of the system, by the con- 
tinued application of the stimuli which act upon the 
body in its waking state. When these stimuli act 
in a determined degree, that is, when the same 
number of stimuli act with the same force, and for 
the same time, upon the system, sleep will be 
brought on at the same hour every night. But 
when they act with uncommon force, or for an un- 
usual time, it is brought on at an earlier hour. 
Thus a long walk or ride, by persons accustomed 
to a sedentary life, unusual exercise of the under- 
standing, the action of strong passions or emo- 
tions, and the continual application of unusual 
sounds seldom fail of inducing premature sleep. 
It is recorded of pope Ganganelli, that he slept 
more soundly, and longer than usual, the night 
after he was raised to the papal chair. The effects 
of unusual sounds in bringing on premature sleep, 
is further demonstrated by that constant inclination 
to retire to bed at an early hour, which countrr 


people discover the first and second days they 
spend in a city, exposed from morning till night 
to the noise of hammers, files, and looms, or of 
drays, carts, waggons, and coaches, rattling over 
pavements of stone. Sleep is further hastened by 
the absence of light, the cessation of sounds and 
labour, and the recumbent posture of the body on 
a soft bed. 

Artificial sleep may be induced at any time by 
certain stimulating substances, particularly by opi- 
um. They act by carrying the system beyond the 
healthy grade of excitement, to a degree of indi- 
rect debility, which Dr. Brown has happily called 
the sleeping point. The same point may be in- 
duced in the system at any time by the artificial 
abstraction of the usual stimuli of life. For exam- 
ple, let a person shut himself up at mid-day in a 
dark room, remote from noise of all kinds, let him 
lie down upon his back upon a soft bed in a tempe* 
rate state of the atmosphere, and let him cease to 
think upon interesting subjects, or let him think 
only upon one subject, and he will soon fall asleep. 
Dr. Boerhaave relates an instance of a Dutch phy- 
sician, who, having persuaded himself that waking 
was a violent state, and sleep the only natural one 
of the system, contrived, by abstracting every kind 
of stimulus in the manner that has been mentioned.. 


to sleep away whole days and nights, until at 
length he impaired his understanding, and finally 
perished in a public hospital in a state of idiotism. 

In thus anticipating a view of the cause of sleep, 
I have said nothing of the effects of diseases of the 
brain in inducing it. These belong to another 
part of our course. The short explanation I have 
given of its cause was necessary in order to ren- 
der the history of animal life, in that state of the 
system, more intelligible. 

At the usual hour of sleep there is an abstraction 
of the stimuli of light, sound, and muscular motion. 
The stimuli which remain, and act with an increas- 
ed force upon the body in sleep, are 

1. The heat which is discharged from the body, 
and confined by means of bed-clothes. It is most 
perceptible when exhaled from a bed- fellow. Heat 
obtained in this way has some Limes been employed 
to restore declining life to the bodies of old people. 
Witness the damsel who lay for this purpose in the 
bosom of the king of Israel. The advantage of 
this external heat will appear further, when we con- 
sider how impracticable or imperfect sleep is, when 
we He under too light covering in cold weather. 


2. The air which is applied to the lungs during 
sleep probably acts with more force than in the 
waking state. I am disposed to believe that more 
air is phlogisticated in sleep than at any other time, 
for the smell of a close room in which a person has 
slept one night, we know, is much more disagree- 
able than that of a room, under equal circumstances, 
in which half a dozen people have sat for the same 
number of hours in the day time. The action of 
decomposed air on the lungs and heart was spoken 
of in a former lecture. An increase in its quantity 
must necessarily have a powerful influence upon 
animal life during the sleeping state. 

Respiration is performed with a greater ex- 
tension and contraction of the muscles of the breast 
in sleep than in the waking state ; and this cannot 
fail of increasing the impetus of the blood in its 
passage through the heart and blood-vessels. The 
increase of the fulness and force of the pulse in 
sleep, is probably owing in pail to the action of 
respiration upon it. In another place I hope to 
elevate the rank of the blood-vessels in the animal 
economy, by showing that they are the fountains 
of power in the body. They derive this pre-emi- 
nence from the protection and support they afford 
to every part of the system. They are the perpe- 


tual centinels of health and life ; for they never 
partake in the repose which is enjoyed by the mus- 
cles and nerves. During sleep, their sensibility 
seems to be converted into contractility, by which 
means their muscular fibres are more easily moved 
by the blood than in the waking state. The dimi- 
nution of sensibility in sleep is proved by many 
facts to be mentioned hereafter ; and the change of 
sensibility into contractility will appear, when we 
come to consider the state of animal life in infancy 
and old a^e. 

4. Aliment in the stomach acts more powerfully 
in sleep than in the waking state. This is evident 
from digestion going on more rapidly when we are 
awake than when we sleep. The more slow the 
digestion, the greater is the stimulus of the aliment 
in the stomach. Of this we have many proofs 
in daily life. Labourers object to milk as a 
breakfast, because it digests too soon ; and often 
call for food in a morning, which they can feel all 
day in their stomachs. Sausages, fat pork, and 
onions are generally preferred by them for this 
purpose. A moderate supper is favourable to easy 
and sound sleep ; and the want of it, in persons who 
are accustomed to that meal, is often followed by 
a restless night. The absence of its stimulus is 
probably supplied by a full gall-bladder (which al- 

VOL. II. 3 E 


ways attends an empty stomach) in persons wh© 
are not in the habit of eating suppers. 

5. The stimulus of the urine, accumulated in the 
bladder during sleep, has a perceptible influence 
upon animal life. It is often so considerable as to 
interrupt sleep ; and it is one of the causes of our 
waking at a regular hour in the morning. It is 
moreover a frequent cause of the activity of the un- 
derstanding and passions in dreams ; and hence we 
dream more in our morning slumbers, when the 
bladder is full, than we do in the begining or mid- 
dle of the night. 

6. The fasces exert a constant stimulus upon the 
bowels in sleep. This is so considerable as to ren- 
der it less profound when they have been accumu- 
lated for two or three days, or when they have been 
deposited in the extremity of the alimentary canal. 

7. The partial and irregular exercises of the un- 
derstanding and passions in dreams have an occa- 
sional influence in promoting life. They occur only 
where there is a deficiency of other stimuli. Such 
is the force with which the mind acts upon the body 
in dreams, that Dr. Brambilla, physician to the 
emperor of Germany, informs us, that he has seen 
instances of wounds in soldiers being inflamed, and 


putting on a gangrenous appearance in consequence 
of the commotions excited in their bodies by irri- 
tating dreams*. The stimulating passions act 
through the medium of the will ; and the exercises 
of this faculty of the mind sometimes extend so far 
as to produce actions in the muscles of the limbs, 
and occasionally in the whole body, as we see in 
persons who walk in their sleep. The stimulus of 
lust often awakens us with pleasure or pain, accord- 
ing as we are disposed to respect or disobey the 
precepts of our Maker. The angry and revengeful 
passions often deliver us, in like manner, from the 
imaginary guilt of murder. Even the debilitating 
passions of grief and fear produce an indirect ope- 
ration upon the system that is favourable to life in 
sleep, for they excite that distressing disease called 
the night mare, which prompts us to speak, or hal- 
loo, and by thus invigorating respiration, overcomes 
the languid circulation of the blood in the heart and 
brain. Do not complain then, gentlemen, when 
you are bestrode by this midnight hag. She is 

* A fever was excited in Cinna the poet, in consequence 
of his dreaming that he saw Ceesar, the night after he was 
assassinated, a;;d was invited to accompany him to a dreary- 
place, to which he pointed, in order to sup with him. Con- 
vulsions and other diseases, I believe, are often excited in 
the night, by terrifying or distressing dreams. 

Plutarch's Life of M, Brutus, 


kindly sent to prevent your sudden death. Per- 
sons who go to bed in good health, and are found 
dead the succeeding morning, are said most com- 
monly to die of this disease. 

I proceed now to inquire into the state of animal 
life in its different stages. I pass over for the pre- 
sent its history in generation. It will be sufficient 
only to remark in this place, that its first motion is 
produced by the stimulus of the male seed upon the 
- female ovum. This opinion is not originally mine. 
You will find it in Dr. Haller*. The pungent taste 
which Mr. John Hunter discovered in the male 
seed renders it peculiarly fit for this purpose. No 
sooner is the female ovum thus set in motion, and 
the foetus formed, than its capacity of life is sup- 

1. By the stimulus of the heat which it derives 
from its connection with its mother in the womb. 

2. By the stimulus of its own circulating blood. 

3. Bv its constant motion in the womb after the 
third month of pregnancy. The absence of this 

* " Novum foe turn a seminis masculi slimulo vitam conce- 
pisse." — Elancnia Physiologic., vol. viii. p. 177. 


motion for a few days is always a sign of the indis- 
position or death of a foetus. Considering how 
early a child is accustomed to it, it is strange that 
a cradle should ever have been denied to it after it 
comes into the world. 

II. In infants there is an absence of manv of the 
Stimuli which support life. Their excretions are 
in a great measure deficient in acrimony, and their 
mental faculties are too weak to exert much influ- 
ence upon their bodies. But the absence of stimu- 
lus from those causes is amply supplied 

1. By the very great excitability of their sys- 
tems to those of light, sound, heat, and air. So 
powerfully do light and sound act upon them, that 
the Author of nature has kindly defended their eyes 
and ears from an excess of their impressions by 
imperfect vision and hearing, for several weeks af- 
ter birth. The capacity of infants to be acted up- 
on by moderate degrees of heat is evident from their 
suffering less from cold than grown people. This 
is so much the case, that we read, in Mr. Umfre- 
ville's account of Hudson's Bay, of a child that 
was found alive upon the back of its mother after 
she was frozen to death. I before hinted at the 
action of the air upon the bodies of new-born in- 
fants in producing the red colour of their skins. It 


is highly probable (from a fact formerly mentioned) 
that the first impression of the atmosphere which 
produces this redness is accompanied with pain, 
and this we know is a stimulus of a very active na- 
ture. By a kind law of sensation, impressions, 
that were originally painful, become pleasurable by 
repetition or duration. This is remarkably evident 
in the impression now under consideration, and 
hence we find infants at a certain age discover signs 
of an increase of life by their delightful gestures, 
when they are carried into the open air. Recollect 
further, gentlemen, what was said formerly of ex- 
citability predominating over sensibility in infants. 
We see it daily, not only in their patience of cold, 
but in the short time in which they cease to com- 
plain of the injuries they meet with from falls, cuts, 
and even severe surgical operations. 

2. Animal life is supported in infants by their 
sucking, or feeding, nearly every hour in the day 
and night when they are awake. I explained for- 
merly the manner in which food stimulated the sys- 
tem. The action of sucking supplies, by the 
muscles employed in it, the stimulus of mastication. 

3. Laughing and crying, which are universal in 
infancy, have a considerable influence in promoting 
animal life, by their action upon respiration, and 


the circulation of the blood. Laughing exists un- 
der all circumstances, independently of education 
or imitation. The child of the negro slave, born 
only to inherit the toils and misery of its parents, 
receives its master with a smile every time he en- 
ters his kitchen or a negro- quarter. But laughing 
exists in infancy under circumstances still more 
unfavourable to it ; an instance of which is related 
by Mr. Bruce. After a journey of several hundred 
miles across the sands of Nubia, he came to a 
spring of water shaded by a few scrubby trees. 
Here he intended to have rested during the night, 
but he had not slept long before he was awakened 
by a noise which he perceived was made by a soli- 
tary Arab, equally fatigued and half famished with 
himself, who was preparing to murder and plunder 
him. Mr. Bruce rushed upon him, and made him 
his prisoner. The next morning he was joined by 
a half- starved female companion, with an infant of 
six months old in her arms. In passing by this 
child, Mr. Bruce says, it laughed and crowed in 
his face, and attempted to leap upon him. From 
this fact it would seem as if laughing was not only 
characteristic of our species, but that it was early 
and intimately connected with human life. The 
child of these Arabs had probably never seen a 
smile upon the faces of its ferocious parents, and 


perhaps had never (before the sight of Mr. Bruce) 
beheld any other human creature. 

Crying has a considerable influence upon health 
and life in children. I have seen so many instances 
of its salutary effects, that I have satisfied myself 
it is as possible for a child to " cry and be fat," as 
it is to " laugh and be fat." 

4. As children advance in life, the constancy of 
their appetites for food, and their disposition to 
laugh and cry, lessen, but the diminution of these 
stimuli is supplied by exercise. The limbs* and 
tongues of children are always in motion. They 
continue likewise to eat oftener than adults. A 
crust of bread is commonly the last thing they ask 
for at night, and the first thing they call for in the 
morning. It is now they begin to feel the energy 
of their mental faculties. This stimulus is assisted 
in its force by the disposition to prattle, which is 
so universal among children. This habit of con- 
verting their ideas into words as fast as they rise, 
follows them to their beds, where we often hear 

* Niebuhr, in his Travels, says the children in Arabia are 
taught to keep themselves constantly in motion by a kind of 
vibratory exercise of their bodies. This motion counteracts 
the diminution of life produced by the heat of the climate of 


them talk themselves to sleep in a whisper, or to 
use less correct, but more striking terms, by think- 
ing alond. 

5. Dreams act at an early period upon the bodies 
of children. Their smiles, startings, and occasional 
screams in their sleep appeal* to arise from them. 
After the third or fourth year of their lives, they 
sometimes confound them with things that are real. 
From observing the effects of this mistake upon 
the memory, a sensible woman whom I once knew, 
forbad her children to tell their dreams, lest thev 
should contract habits of lying, by confounding 
imaginary with real events. 

6. New objects, whether natural or artificial, 
are never seen bv children without emotions of 


pleasure which act upon their capacity of life. 
The effects of novelty upon the tender bodies of 
children may easily be conceived, by its friendly 
influence upon the health of invalids who visit 
foreign countries, and who pass months or years 
in a constant succession of new and agreeable im- 

III. From the combination of all the stimuli that 
have been enumerated, human life is generally in 
excess from fifteen to thirty- five. It is during this 

vol. iio 3 r 


period the passions blow a perpetual storm. The 
most predominating of them is the love of pleasure. 
No sooner does the system become insensible to 
this stimulus, than ambition succeeds it in, 

IV. The middle stage of life. Here we behold 
man in his most perfect physical state. The sti- 
muli which now act upon him are so far regulated 
by prudence, that they are seldom excessive in their 
force. The habits of order the system acquires in 
this period, continue to produce good health for 
many years afterwards ; and hence bills of mor- 
tality prove that fewer persons die between forty 
and fifty- seven, than in any other seventeen years 
of human life. 

V. In old age, the senses of seeing, hearing, and 
touch are impaired. The venereal appetite is 
weakened, or entirely extinguished. The pulse 
becomes slow, and subject to frequent intermis- 
sions, from a decay in the force of the blood-ves- 
sels. Exercise becomes impracticable, or irksome, 
and the operations of the understanding are per- 
formed with languor and difficulty. In this shat- 
tered and declining state of the system, the absence 
and diminution of all the stimuli which have been 
mentioned are supplied, 


1. By an increase in the quantity, and by the 
peculiar quality of the food which is taken by old 
people. They generally eat twice as much as per- 
sons in middle life, and they bear with pain the 
usual intervals between meals. They moreover 
prefer that kind of food which is savoury and sti- 
mulating. The stomach of the celebrated Parr, 
who died in the one hundred and fiftieth year of 
his age, was found full of strong, nourishing ali- 

2. Bv the stimulus of the fseces, which are fre- 
quently retained for five or six days in the bowels 
of old people. 

3. By the stimulus of fluids rendered preterna- 
turally acrid by age. The urine, sweat, and even 
the tears of old people, possess a peculiar acrimo- 
ny. Their blood likewise loses part of the mild- 
ness which is natural to that fluid ; and hence the 
difficulty with which sores heal in old people ; and 
hence too the reason why cancers are more com- 
mon in the decline, than in any other period of hu- 
man life. 

4. By the uncommon activity of certain passions. 
These are either good or evil. To the former be- 
long an increased vigour in the operations of those 


passions which have for their objects the Divine 
Being, or the whole family of mankind, or their 
own offspring, particularly their grand- children. 
To the latter passions belong malice, a hatred of the 
manners and fashions of the rising generation, and, 
above all, avarice, This passion knows no holi- 
days. Its stimulus is constant, though varied daily 
by the numerous means which it has discovered of 
increasing, securing, and perpetuating property. It 
has been observed that weak mental impressions 
produce much greater effects in old people than in 
persons in middle life. A trifling indisposition in 
a. grand- child, an inadvertent act of unkindness from 
a friend, or the fear of losing a few shillings, have, 
in many instances, produced in them a degree of 
wakefulness that has continued for two or three 
nights. It is to this highly excitable state of the 
system that Solomon probably alludes, when he 
describes the grasshopper as burdensome to old 

5. By the passion for talking, which is so com- 
mon, as to be one of the characteristics of old age. 
I mentioned formerly the influence of this stimulus 
upon animal life. Perhaps it is more necessary in 
the female constitution than in the male ; for it has 
long ago been remarked, that women who are very 
taciturn, are generally unhealthy. 


6. By their wearing warmer clothes, and prefer- 
ring warmer rooms, than in the former periods of 
their lives. This practice is so uniform, that it 
would not be difficult, in many cases, to tell a man's 
age by his dress, or by finding out at what degree 
of heat he found himself comfortable in a close 

7. By dreams. These are universal among old 
people. They arise from their short and imperfect 

8. It has been often said, that " We are once 
men, and twice children." In speaking of the state 
of animal life in infancy, I remarked that the con- 
tractility of the animal fibres predominated over 
their sensibility in that stage of life. The same 
thing takes place in old people, and it is in conse- 
quence of the return of this infantile state of the 
system, that all the stimuli which have been men- 
tioned act upon them with much more force than in 
middle life. This sameness, in the predominance 
of excitability over sensibility in children and old 
people, will account for the similarity of their habits 
with respect to eating, sleep, exercise, and the use 
of fermented and distilled liquors. It is from the 
increase of excitability in old people, that so small 
a quantity of strong drink intoxicates them ; and it 


is from an ignorance of this change in their consti. 
tutions, that many of them become drunkards, after 
passing .the early and middle stages of life with 
sober characters. 

Life is continued in a less imperfect state in old 
age in women than in men. The former sew, 
and knit, and spin, after they lose the use of their 
ears and eyes ; whereas the latter, after losing the 
use of those senses, frequently pass the evening of 
their lives in a torpid state in a chimney corner. 
It is from the influence of moderate and gently sti- 
mulating employments, upon the female constitu- 
tion, that more women iive to be old than men, 
and that they rarely survive their usefulness in do- 
mestic life. 

Hitherto the principles I am endeavouring to 
establish have been applied to explain the cause of 
life in its more common forms. Let us next in- 
quire, how far they will enable us to explain its 
continuance in certain morbid states of the body, in 
which there is a diminution of some, and an appa- 
rent abstraction of all the stimuli, which have been 
supposed to produce animal life. 

I. We observe some people to be blind, or deaf 
and dumb from their birth. The same defects 


of sight, hearing, and speech, are sometimes 
brought on by diseases. Here animal life is de- 
prived of all those numerous stimuli, which arise 
from light, colours, sounds, and speech. But the 
absence of these stimuli is supplied, 

1. By increased sensibility and excitability in 
their rem tilling senses. The ears, the nose, and 
the fingers, afford a surface for impressions in 
blind people, which frequently overbalances the 
loss of their eye- sight. There are two blind young 
men, brothers, in this city, of the name of Button, 
who can tell when they approach a post in walking 
across a street, by a peculiar sound which the 
ground under their feet emits in the neighbourhood 
of the post. Their sense of hearing is still more 
exquisite to sounds of another kind. They can 
tell the names of a number of tame pigeons, with 
which they amuse themselves in a little garden, by 
only hearing them fly over their heads. The cele- 
brated blind philosopher, Dr. Moyse, can distinguish 
a black dress on his friends, by its smell ; and we 
read of many instances of blind persons who have 
been able to perceive colours by rubbing their fin- 
gers upon them. One of these persons, mentioned 
by Mr. Boyle, has left upon record an account of 
the specific quality of each colour as it affected his 
sense of touch. He says black imparted the most, 


and blue the least perceptible sense of asperity t@ 
his fingers. 

2. By an increase of vigour in the exercises of 
the mental faculties. The poems of Homer, Mil- 
ton, and Blacklock, and the attainments of Sander- 
son in mathematical knowledge, all discover how 
much the energy of the mind is increased by the 
absence of impressions upon the organs of vision. 

II. We sometimes behold life in idiots, in whom 
there is not only an absence of the stimuli of the 
understanding and passions, but frequently, from 
the weakness of their bodies, a deficiency of the 
loco-motive powers. Here an inordinate appetite 
for food, or venereal pleasures, or a constant habit 
of laughing, or talking, or playing with their hands 
and feet, supply the place of the stimulating opera- 
tions of the mind, and of general bodily exercise. 
Of the inordinate force of the venereal appetite in 
idiots we have many proofs. The cretins are much 
addicted to venery ; and Dr. Michaelis tells us that 
the idiot whom he saw at the Passaic falls in New- 
Jersey, who had passed six and twenty years in a 
cradle, acknowledged that he had venereal desires, 
and wished to be married, for, the doctor adds, he 
had a sense of religion upon his fragment of mind, 


and of course did not wish to gratify that appetite 
in an unlawful manner. 


III. How is animal life supported in persons who 
pass many days, and even weeks without food, and 
in some instances without drinks? Long fasting- 
is usually the effect of disease, of necessity, or of 
a principle of religion. When it arises from the 
first cause, the actions of life are kept up by the 
stimulus of disease*. The absence of food when 
accidental, or submitted to as a means of producing 
moral happiness, is supplied, 

1. By the stimulus of a full gall bladder. This 
state of the receptacle of bile has generally been 
bile found to accompany an empty stomach. The 
is sometimes absorbed, and imparts a yellow colour 
to the skin of persons who suffer or die of famine. 

* The stimulus of a disease sometimes supplies the p'ice 

of food in prolonging life. Mr. C. S , a gentleman well 

known in Virginia, who was afflicted with a palsy, which 
had resisted the skill of several physicians, determined to 
destroy himself, by abstaining from food and drinks. He 
lived sixty days without eating any thing, and the greatest 
part of that time without tasting even a drop of water. His 
disease probably protracted his life thus long beyond the 
usual time in which death is induced by fasting. See a 
particular account of this case, in the first number of the 
second volume of Dr. Coxe's Medical Museum. 

VOL. II. 3 G 


2. By increased acrimony in all the secretion* 
and excretions of the body. The saliva becomes 
so acrid by long fasting, as to excoriate the gums, 
and the breath acquires not only a fcetor, but a 
pungency so active, as to draw tears from the eyes 
of persons who are exposed to it. 

3. By increased sensibility and excitability in, 
the sense of touch. T1a blind man mentioned by 
Mr. Boyle, who could distinguish colours by his 
fingers, possessed this talent only after fasting. 
Even a draught of any kind of liquor deprived him 
of it. I have taken notice, in my account of the 
yellow fever in Philadelphia, in the year 1793, of 
the effects of a diet bordering upon fasting for six 
weeks, in producing a quickness and correctness 
in my perceptions oi the state of the pulse, which 
I had never experienced before. 

4. By an increase of activity in the understand- 
ing and passions. Gamesters often improve the 
exercises of their minds, when they are about to 
play for a large sum of money, by living for a day 
or two upon roasted apples and cold water. Where 
the passions are excited into preternatural action, 
the absence of the stimulus of food is scarcely felt* 
I shall hereafter mention the influence of the desire 


©f life upon its preservation, under all circum- 
stances. It acts with peculiar force when fasting 
is accidental. But when it is submitted to as a 
religious duty, it is accompanied by sentiments and 
feelings which more than balance the abstraction 
of aliment. The body of Moses was sustained, 
probably without a miracle, during an abstinence 
of forty days and forty nights, by the pleasure he 
derived from conversing with his Maker u face to 
face, as a man speaking with his friend*." 

I remarked formerly, that the veins discover no 
deficiency of blood in persons who die of famine. 
Death from this cause seems to be less the effect 
of the want of food, than of the combined and ex- 
cessive operation of the stimuli, which supply its 
place in the system. 

IV. We come now to a difficult inquiry, and 
that is, how is life supported during the total ab- 
straction of external and internal stimuli which takes 
place in asphyxia, or in apparent death, from all its 
numerous causes ? 

I took notice, in a former lecture, that ordinary 
life consisted in the excitement and excitability of 

* Exodus xxxiii, 11. xxxiv, 28. 


the different parts of the body, and that they were 
occasionally changed into each other. In apparent 
death from violent emotions of the mind, from the 
sudden impression of miasmata, or from drowning, 
there is a loss of excitement ; but the excitability 
of the system remains for minutes, and, in some 
instances, for hours afterwards unimpaired, pro- 
vided the accident which produced the loss of ex- 
citement has not been attended with such exertions 
as are calculated to waste it. If, for example, a 
person should fall suddenly into the water, without 
bruising his body, and sink before his fears or ex- 
ertions had time to dissipate his excitability ; his 
recovery from apparent death might be effected by 
the gentle action of heat or frictions upon his body, 
so as to convert his accumulated excitability era- 
dually into excitement. The same condition of 
the system takes place when apparent death occurs 
from freezing, and a recovery is accomplished by 
the same gentle application of stimuli, provided the 
organization of the body be not injured, or its ex- 
citability wasted, by violent exertions previously 
to its freezing. This excitability is the vehicle of 
motion, and motion, when continued long enough, 
produces sensation, which is soon followed bv 
thought ; and in these, I said formerly, consists 
perfect life in the human body. 


For this explanation of the manner in which life 
is suspended and revived, in persons apparently- 
dead from cold, I am indebted to Mr. John Hun- 
ter, who supposes, if it were possible for the body 
to be suddenly frozen, by an instantaneous abstrac- 
tion of its heat, life might be continued for many 
years in a suspended state, and revived at pleasure, 
provided the body were preserved constantly in a 
temperature barely sufficient to prevent re-anima- 
tion, and never so great as to endanger the de- 
struction of any organic part. The resuscitation 
of insects, that have been in a torpid state for 
months, and perhaps years, in substances that 
have preserved their organization, should at least 
defend this bold proposition from being treated as 
chimerical. The effusions even of the imagination 
of such men as Mr. Hunter, are entitled to respect. 
They often become the germs of future discoveries. 

In that state of suspended animation which oc- 
curs in acute diseases, and which has sometimes 
been denominated a trance ', the system is nearly in 
the same excitable state that it is in apparent death 
from drowning and freezing. Resuscitation, in 
these cases, is not the effect, as in those which have 
been mentioned, of artificial applications made to 
the body for that purpose. It appears to be spon- 
taneous ; but it is produced by impressions made 


upon the ears, and by the operations of the mind 
in dreams. Of the actions of these stimuli upon 
the body in its apparently lifeless state, I have sa- 
tisfied myself by many facts. I once attended a 
citizen of Philadelphia, who died of a pulmonary 
disease, in the 80th year of his age. A few days 
before his death, he begged that he might not be in- 
terred until one week after the usual signs of life 
had left his body, and gave as a reason for this re- 
quest, that he had, when a young man, died to all 
appearance of the yellow fever, in one of the West- 
India islands. In this situation he distinctly heard 
the persons who attended him, fix upon the time 
and place of burying him. The horror of being 
put under ground alive, produced such distressing 
emotions in his mind, as to diffuse motion through- 
out his body, and finally excited in him all the usur 
al functions of life. In Dr. C reighton's essay upon 
mental derangement, there is a history of a case 
nearly of a similar nature. " A young lady (says 

the doctor), an attendant on the princess of , 

after having been confined to her bed for a great 
length of time, with a violent nervous disorder, was 
at last, to all appearance, deprived of life. Her 
lips were quite pale, her face resembled the coun- 
tenance of a dead person, and her body grew cold. 
She was removed from the room in which she died, 
was laid in a coffin, and the day for her funeral was 


fixed on. The day arrived, and according to the 
custom of the country, funeral songs and hymns 
were sung before the door. Just as the people were 
about to nail on the lid of the coffin, a kind of per- 
spiration was observed on the surface of her body. 
She recovered. The following is the account she 
gave of her sensations : she said, " It seemed to 
her as if in a dream, that she was really dead ; yet 
she was perfectly conscious of all that happened 
around her. She distinctly heard her friends speak- 
ing and lamenting her death at the side of her cof- 
fin. She felt them pull on the dead clothes, and 
lay her in it. This feeling produced a mental 
anxiety which she could not describe. She tried 
to cry out, but her mind was without power, 
and could not act on her body. She had the 
contradictory feeling as if she were in her own 
bodv, and not in it, at the same time. It was 
equally impossible for her to stretch out her arm 
or open her eyes, as to cry, although she continu- 
ally endeavoured to do so. The internal anguish 
of her mind was at its utmost height when the fu- 
neral hymns began to be sung, and when the lid of 
the coffin was about to be nailed on. The thought 
that she was to be buried alive was the first which 
gave activity to her mind, and enabled it to ope- 
rate on her corporeal frame. 


Where the ears lose their capacity of being act- 
ed upon by stimuli, the mind, by its operations in 
dreams, becomes a source of impressions which 
again sets the wheels of life in motion. There is 
an account published by Dr. Arnold, in his obser- 
vations upon insanity*, of a certain John Engel- 
breght, a German, who was believed to be dead, 
and who was evidently resuscitated by the exer- 
cises of his mind upon subjects which were of a 
delightful or stimulating nature. This history shall 
be taken from Mr. Engelbreght's words. " It 
was on Thursday noon (says he), about twelve 
o'clock, when I perceived that death was making 
his approaches upon me from the lower parts up- 
wards, insomuch that my whole body became stiff*. 
I had no feeling left in my hands and feet, neither 
in any other part of my whole body, nor was I at last 
able to speak or see, for my mouth now becoming 
very stiff, I was no longer able to open it, nor did 
I feel it any longer. My eyes also broke in my 
head iri such a manner that I distinctly felt it. For 
all that, I understood what they said, when they 
were praying by me, and I distinctly heard them 
say, feel his legs, how stiff and cold they have be- 
come. This I heard distinctly, but I had no per- 
ception of their touch. I heard the watchman cry 

* Vol. ii. p. 298. 


11 o'clock, but at 12 o'clock my hearing left me." 
After relating his passage from the body to heaven 
with the velocity of an arrow shot from a cross 
bow, he proceeds, and says, that as he was twelve 
hours in dying, so he was twelve hours in returning 
to life. " As I died (says he) from beneath up- 
wards, so I revived again the contrary way, from 
above to beneath, or from top to toe. Being con- 
veyed back from the heavenly glory, I began to hear 
something of what they were praying for me, in the 
same room with me. Thus was my hearing the 
first sense I recovered. After this I began to have 
a perception of my eyes, so that, by little and little, 
my whole body became strong and sprightly, and 
no sooner did I get a feeling of my legs and feet, 
than I arose and stood firm upon them with a firm- 
ness I had never enjoyed before. The heavenly 
joy I had experienced, invigorated me to such a 
degree, that people were astonished at my rapid, 
and almost instantaneous recovery." 

The explanation I have given of the cause of re- 
suscitation in this man will serve to refute a belief 
in a supposed migration of the soul from the body, 
in cases of apparent death. The imagination, it is 
true, usually conducts the whole mind to the abodes 
of happy or miserable spirits, but it acts here in the 
same way that it does when it transports it, in com- 

VOL. He 3 H 


mon dreams, to numerous and distant parts of the 

There is nothing supernatural in Mr. Engel- 
breght being invigorated by his supposed flight to 
heaven. Pieasant dreams always stimulate and 
strengthen the body, while dreams which are ac- 
companied with distress or labour debilitate and 
fatigue it. 




LET us next take a view of the state of 
animal life in the different inhabitants of our globe, 
as varied by the circumstances of civilization, diet, 
situation, and climate. 

I. In the Indians of the northern latitudes of 
America there is often a defect of the stimulus of 
aliment, and of the understanding and passions. 
Their vacant countenances, and their long and dis- 
gusting taciturnity, are the effects of the want of 
action in their brains from a deficiency of ideas ; 
and their tranquillity under all the common cir- 
cumstances of irritation, pleasure, or grief, are the 
result of an absence of passion ; for they hold it to 
be disgraceful to show any outward signs of anger, 
joy, or even of domestic affection. This account 
of the Indian character, I know, is contrary to that 
^which is given of it by Rousseau, and several other 
writers, who have attempted to prove that man may 
become perfect and happy without the aids of civi- 
lization and religion. This opinion is contradicted 


by the experience of all ages, and is rendered ridi- 
culous by the facts which are well ascertained in 
the history of the customs and habits of our Ame- 
rican savages. In a cold climate they are the most 
miserable beings upon the face of the earth. The 
greatest part of their time is spent in sleep, or un- 
der the alternate influence of hunger and gluttony. 
They moreover indulge in vices which are alike 
contrary to moral and physical happiness. It is in 
consequence of these habits that they discover so 
early the marks of old age, and that so few of them 
are long-lived. The absence and diminution of 
many of the stimuli of life in these people is sup- 
plied in part by the violent exertions with which 
they hunt and carry on war, and by the extravagant 
manner with which they afterwards celebrate their 
exploits, in their savage dances and songs. 

II. In the inhabitants of the torrid regions of 
Africa there is a deficiency of labour ; for the earth 
produces spontaneously nearly all the sustenance 
they require. Their understandings and passions 
are moreover in a torpid state. But the absence 
of bodily and mental stimuli in these people is am- 
ply supplied by the constant heat of the sun, by the 
profuse use of spices in their diet, and by the pas- 
sion for musical sounds which so universally cha- 
racterises the African nations. 



HI. In Greenland the body is exposed during 
a long winter to such a degree of cold as to reduce 
the pulse to 40 or 50 strokes in a minute. But 
the effects of this cold in lessening the quantity of 
life are obviated in part by the heat of close stove 
rooms, by warm clothing, and by the peculiar na- 
ture of the aliment of the Greenlanders, which con- 
sists chiefly of animal food, of dried fish, and of 
whale oil. They prefer the last of those articles in 
so rancid a state, that it imparts a fee tor to their 
perspiration, which, Mr. Crantz says, renders even 
their churches offensive to strangers. I need hardly 
add, that a diet possessed of such diffusible quali- 
ties cannot fail of being highly stimulating. It is 
remarkable that the food of all the northern nations 
of Europe is composed of stimulating animal or 
vegetable matters, and that the use of spiritous li- 
quors is universal among them. 

IV. Let us next turn our eyes to the miserable 
inhabitants of those eastern countries which com- 
pose the Turkish empire. Here we behold life in 
its most feeble state, not only from the absence of 
physical, but of other stimuli which operate upon 
the inhabitants of other parts of the world. Among 
the poor people of Turkey there is a general defi- 
ciency of aliment. Mr. Volney in his Travels tells 
us, " That the diet of the Bedouins seldom exceeds 


six ounces a day, and that it consists of six or seven 
dates soaked in butter-milk, and afterwards mixed 
with a little sweet milk, or curds." There is like- 
wise a general deficiency among them of stimulus 
from the operations of the mental faculties; for 
such is the despotism of the government in Tur- 
key, that it weakens not only the understanding, 
but it annihilates all that immense source of stimuli 
which arises from the exercise of the domestic and 
public affections. A Turk lives wholly to himself. 
In point of time he occupies only the moment in 
which he exists; for his futurity, as to life and 
property, belongs altogether to his master. Fear 
is the reigning principle of his actions, and hope 
and joy seldom add a single pulsation to his heart. 
Tyranny even imposes a restraint upon the stimu- 
lus which arises from conversation, for " They 
speak (says Mr. Volney) with a slow feeble voice, 
as if the lungs wanted strength to propel air enough 
through the glottis to form distinct articulate 
sounds." The same traveller adds, that " Thev 
are slow in all their motions, that their bodies are 
small, that they have small evacuations, and that 
their blood is so destitute of serosity, that nothing 
but the greatest heat can preserve its fluidity." 
The deficiency of aliment, and the absence of men- 
tal stimuli in these people is supplied, 


1. By the heat of their climate. 

2. By their passion for musical sounds and fine 
clothes. And 

3. By their general use of coffee, garlic*, and 

The more debilitated the body is, the more 
forcibly these stimuli act upon it. Hence, accord- 
ing to Mr. Volney, the Bedouins, whose slender 
diet has been mentioned, enjoy good health ; for 
this consists not in strengrii, but in an exact propor- 
tion being kept up between the excitability of the 
body, and the number and force of the stimuli 
which act upon it. 

V. Many of the observations which have been 
made upon the inhabitants of Africa, and of the 
Turkish dominions, apply to the inhabitants of 
China and the East- Indies. They want, in mam- 
instances, the stimulus of animal food. Their 
minds are, moreover, in a state too languid to act 
with much force upon their bodies. The absence 
and deficiency of these stimuli are supplied by, 

* Niebuhr's Travels. 


1. The heat of the climate in the southern parts 
of those countries. 

2. By a vegetable diet abounding in nourish- 
ment, particularly rice and beans. 

3. By the use of tea in China, and by a stimu- 
lating coffee made of the dried and toasted seeds of 
the datura stramonium, in the neighbourhood of 
the Indian coast. Some of these nations likewise 
chew stimulating substances, as too many of our 
citizens do tobacco. 

Among the poor and depressed subjects of the 
governments of the middle and southern parts of 
Europe, the deficiency of the stimulus of whole- 
some food, of clothing, of fuel, and of liberty, 
is supplied, in some countries, by the invigorating 
influence of the christian religion upon animal life, 
and in others by the general use of tea, coffee, 
garlic, onions, opium, tobacco, malt liquors, and 
ardent spirits. The use of each of these stimuli 
seems to be regulated by the circumstances of cli- 
mate. In cold countries, where the earth yields its 
increase with reluctance, and where vegetable ali- 
ment is scarce, the want of the stimulus of disten- 
sion which that species of food is principally calcu- 
lated to produce is sought for in that of ardent 


spirits. To the southward of 40% a substitute for 
the distension from mild vegetable food is sought 
for in onions, garlic, and tobacco. But further, a 
uniform climate calls for more of these artificial sti- 
muli than a climate that is exposed to the alternate 
action of heat and cold, winds and calms, and of wet 
and dry weather. Savages and ignorant people 
likewise require more of them than persons of 
civilized manners, and cultivated understandings. 
It would seem from these facts that man cannot ex- 
ist without sensation of some kind, and that when 
it is not derived from natural means, it will always 
be sought for in such as are artificial. 

In no part of the human species, is animal life in 
a more perfect state than in the inhabitants of 
Great Britain*, and the United States of America. 
With all the natural stimuli that have been men- 
tioned, they are constantly under the invigorat- 
ing influence of liberty. There is an indissoluble 
union between moral, political, and physical happi- 
ness ; and if it be true, that elective and represen- 
tative governments are most favourable to indivi- 
dual, as well as national prosperity, it follows of 
course, that they are most favourable to animal 
life. But this opinion does not rest upon an indtic- 

* Haller's Elementa Physiologic, vol. viii. p. 2. p. 107. 
VOL. II. 3 I 


tion derived from the relation, which truths up- 
on all subjects bear to each other. Many facts 
prove animal life to exist in a larger quantity and 
for a longer time, in the enlightened and happy 
state of Connecticut, in which republican liberty 
has existed above one hundred and fifty years, than 
in any other country upon the surface of the globe. 

It remains now to mention certain mental stimuli 
which act nearly alike in the production of animal 
life, upon the individuals of all the nations in the 
world. They are, 

1. The desire of life. This principle, so deeply 
and universally implanted in human nature, acts 
very powerfully in supporting our existence. It 
has been observed to prolong life. Sickly tra- 
vellers by sea and land, often live under circum- 
stances of the greatest weakness, till they reach 
their native country, and then expire in the bo- 
som of their friends. This desire of life often turns 
the scale in favour of a recovery in acute diseases. 
Its influence will appear, from the difference in the 
periods in which death was induced in two per- 
sons, who were actuated by opposite passions with 
respect to, life. Atticus, we are told, died of volun- 
tary abstinence from food in five days. In sir Wil- 
liam Hamilton's account of the earthquake at Cala- 


bria, we read of a girl who lived eleven days with- 
out food before she expired. In the former case, 
life was shortened by an aversion from it ; in the 
latter, it was protracted by the desire of it. The 
late Mr. Brissot, in his visit to this city, informed 
me, that the application of animal magnetism (in 
which he was a believer) had in no instance cured 
a disease in a West-India slave. Perhaps it was 
rendered inert by its not being accompanied by a 
strong desire of life ; for this principle exists in a 
more feeble state in slaves than in freemen. It is 
possible likewise the wills and imaginations of these 
degraded people may have become so paralytic by 
slavery, as to be incapable of being excited by the 
impression of this fanciful remedy. 

2. The love of money sets the whole animal 
machine in motion. Hearts which are insensible 
to the stimuli of religion, patriotism, love, and even 
of the domestic affections, are excited into action 
by this passion. The city of Philadelphia, between 
the 10th and 15th of August, 1791, will long be 
remembered by contemplative men, for having fur- 
nished the most extraordinary proofs of the stimu- 
lus of the love of money upon the human body. A 
new scene of speculation was produced at that 
time by the scrip of the bank of the United States. 


It excited febrile diseases in three persons who be- 
came my patients. In one of them, the acquisition 
of tweive thousand dollars in a few minutes by a 
lucky sale, brought on madness which terminated 
in death in a few days*. The whole city felt the 
impulse of this paroxysm of avarice. The slow 
and ordinary means of earning money were desert- 
ed, and men of every profession and trade were 
seen in all our streets hastening to the cofFee-house, 
where the agitation of countenance, and the desul- 
tory manners, of all the persons who were interest- 
ed in this species of gaming, exhibited a truer pic* 
ture of a bedlam, than of a place appropriated to 
the transaction of mercantile business. But fur- 
ther, the love of money discovers its stimulus up- 
on the body in a peculiar manner in the games of 
cards and dice. I have lieard of a gentleman in 
Virginia who passed two whole days and nights in 
succession at a card table, and it is related in the 
life of a noted gamester in Ireland, that when he 
was so ill as to be unable to rise from his chair, he 
would suddenly revive when brought to the hazard 
table, by hearing the rattling of the dice. 

* Dr. Mead relates, upon the authority of Dr. Hales, thai 
more of the successful speculators in the South-Sea scheme 
of 1720 became insane, than of those who had been ruined 
bv it. 


3. Public amusements of all kinds, such as a 
horse race, a cockpit, a chase, the theatre, the cir- 
cus, masquerades, public dinners, and tea parties, 
all exert an artificial stimulus upon the system, and 
thus supply the defect of the rational exercises of 
the mind. 

4. The love of dress is not confined in its sti- 
mulating operation to persons in health. It acts 
perceptibly in some cases upon invalids. I have 
heard of a gentleman in South-Carolina, who al- 
ways relieved himself of a fit of low spirits by chang- 
ing his dress ; and I believe there are few people 
who do not feel themselves enlivened, by putting 
on a new T suit of clothes. 

5. Novelty is an immense source of agreeable 
stimuli. Companions, studies, pleasures, modes 
of business, prospects, and situations, with respect 
to town and country, or to different countries, that 
are nemo, all exert an invigorating influence upon 
health and life. 

6. The love of fame acts in various ways ; but 
its stimulus is most sensible and durable in military 
life. It counteracts in many instances the debilitat- 
ing effects of hunger, cold, and labour. It has some- 
times done more, by removing the weakness which 


is connected with many diseases. In several in- 
stances it has assisted the hardships of a camp life, 
in curing pulmonary consumption. 

7. The love of country is a deep seated principle 
of action in the human breast. Its stimulus is some- 
times so excessive, as to induce disease in persons 
who recently migrate, and settle in foreign coun- 
tries. It appears in various forms ; but exists most 
frequently in the solicitude, labours, attachments, 
and hatred of party spirit. All these act forcibly 
in supporting animal life. It is because newspa- 
pers are supposed to contain the measure of the 
happiness or misery of our country, that they are 
so interesting to all classes of people. Those vehi- 
cles of intelligence, and of public pleasure or pain, 
are frequently desired with the impatience of a 
meal, and they often produce the same stimulating 
effects upon the body*. 

8. The different religions of the world, by the 
activity they excite in the mind, have a sensible in- 
fluence upon human life. Atheism is the worst of 
sedatives to the understanding and passions. It is 
the abstraction of thought from the most sublime, 

* They have been very happily called by Mr. Green, in 
his poem entitled Spleen, " the manna of the day." 


and of love from the most perfect of all possible 
objects. Man is as naturally a religious, as he is 
a social and domestic animal ; and the same vio- 
lence is done to his mental faculties, by robbing 
him of a belief in a God, that is done by dooming 
him to live in a cell, deprived of the objects and 
pleasures of social and domestic life. The neces- 
sary and immutable connection between the texture 
of the human mind, and the worship of an object 
of some kind, has lately been demonstrated by the 
atheists of Europe, who, after rejecting the true 
God, have instituted the worship of nature, of for- 
tune, and of human reason ; and, in some instances, 
with ceremonies of the most expensive and splen- 
did kind. Religions are friendly to animal life, in 
proportion as they elevate the understanding, and 
act upon the passions of hope and love. It will 
readily occur to you, that Christianity, when believ- 
ed and obeyed, according to its original consis- 
tency with itself, and with the divine attributes, is 
more calculated to produce those effects than any- 
other religion in the world. Such is the salutary 
operation of its doctrines and precepts upon health 
and life, that if its divine authority rested upon no 
other argument, this alone w T ould be sufficient to 
recommend it to our belief. How long mankind 
may continue to prefer substituted pursuits and 
pleasures to this invigorating stimulus, is uncer- 


tain ; but the time, we are assured, will come, 
when the understanding shall be elevated from its 
present inferior objects, and the luxated passions 
be reduced to their original order. This change 
in the mind of man, I believe, will be effected only 
by the influence of the christian religion, after all 
the efforts of human reason to produce it, by means 
of civilization, philosophy, liberty, and govern- 
ment, have been exhausted to no purpose. 

Thus far, gentlemen, we have considered animal 
life as it respects the human species ; but the prin- 
ciples I am endeavouring to establish require that 
we should take a view of it in animals of every 
species, in all of which we shall find it depends up- 
on the same causes as in the human body. x 

And here I shall begin by remarking, that if 
we should discover the stimuli which support life 
in certain animals to be fewer in number, or weaker 
in force than those which support it in our species, 
we must resolve it into that attribute of the Deity 
which seems to have delighted in variety in all his 

The following observations apply more or less to 
di the animals upon our globe. 


1. They all possess either hearts, lungs, brains, 
nerves, or muscular fibres It is as yet a contro- 
versy among naturalists whether animal life can ex- 
ist without a brain ; but no one has denied muscu- 
lar fibres, and of course contractility, or excitabi- 
lity, to belong to animal life in all its shapes. 

2. They all require more or less air for their 
existence. Even the snail inhales it for seven 
months under ground, through a pellicle which it 
weaves out of slime, as a covering for its body. 
If this pellicle at any time become too thick to 
admit the air, the snail opens a passage in it for 
that purpose. Now air we know acts powerfully 
in supporting animal life. 

3. Many of them possess heat equal to that of 
the human body. Birds possess several degrees 
beyond it. Now heat, it was said formerly, acts 
with great force in the production of animal life. 

4. They all feed upon substances more or less 
stimulating to their bodies. Even water itself, che- 
mistry has taught us, affords an aliment, not only 
stimulating, but nourishing to many animals. 

5. Many of them possess senses, more acute and 
excitable, than the same organs in the human 

VOL. II. 3 K 


species. These expose surfaces for the action of 
external impressions, that supply the absence or de- 
ficiency of mental faculties. 

6. Such of them as are devoid of sensibility, pos- 
sess an uncommon portion of contractility, or sim- 
ple excitability. This is most evident in the poly- 
pus. When cut to pieces, it appears to feel little 
or no pain. 

7. They all possess loco- motive powers in a 
greater or less degree, and of course are acted up- 
on by the stimulus of muscular motion. 

8. Most of them appear to feel a stimulus, from 
the gratification of their appetites for food, and for 
venereal pleasures, far more powerful than that 
which is felt by our species from the same causes. 
I shall hereafter mention some facts from Spalan- 
zani upon the subject of generation, that will prove 
the stimulus, from venery, to be strongest in those 
animals, in which other stimuli act with the least 
force. Thus the male frog during its long connec- 
tion with its female, suffers its limbs to be ampu- 
tated, without discovering the least mark of pain, 
and without relaxing its hold of the object of its 


9. In many animals we behold evident marks of 
understanding and passion. The elephant, the fox, 
and the ant exhibit strong proofs of thought ; and 
where is the school boy that cannot bear testimony 
to the anger of the bee and the wasp ? 

10. But what shall we say of those animals, 
which pass long winters in a state in which there 
is an apparent absence of the stimuli of heat, exer- 
cise, and the motion of the blood. Life in these 
animals is probably supported, 

1. By such an accumulation of excitability, as 
to yield to impressions, which to us are impercep- 

2. By the stimulus of aliment in a state of di- 
gestion in the stomach, or by the stimulus of ali- 
ment restrained from digestion by means of cold ; 
for Mr. John Hunter has proved by an experiment 
on a frog, that cold below a certain degree, checks 
that animal process. 

3. By the constant action of air upon their bo- 

It is possible life may exist in these animals, du- 
ring their hybernation, in the total absence of im- 


pression and motion of every kind. This may be 
the case where the torpor from cold has been sud- 
denly brought upon their bodies. Excitability here 
is in an accumulated, but quiescent state. 

11. It remains only under this head to inquire, 
in what manner is life supported in those animals 
which live in a cold element, and whose blood is 
sometimes but a little above the freezing point? 
It will be a sufficient answer to this question to re- 
mark, that heat and cold are relative terms, and that 
different animals, according to their organization, 
require very different degrees of heat for their ex- 
istence. Thirty-two degrees of it are probably as 
stimulating to some of these cold blooded animals 
(as they are called), as 70° or 80° are to the hu- 
man body. 

It might afford additional support to the doctrine 
of animal life, which I have delivered, to point out 
the manner in which life and growth are produced 
in vegetables of all kinds. But this subject belongs 
to the professor of botany and natural history*, 
who is amply qualified to do it justice. I shall 
only remark, that vegetable life is as much the off- 
spring of stimuli as animal, and that skill in agri- 

* Dr. Barton. 


culture consists chiefly in the proper application of 
them. The seed of a plant, like an animal body, 
has no principle of life within itself. If preserved 
for many years in a drawer, or in earth below the 
stimulating influence of heat, air, and water, it dis- 
covers no sign of vegetation. It grows, like an 
animal, only in consequence of stimuli acting upon 
its capacity of life. 

From a review of what has been said of animal 
life in all its numerous forms and modifications, we 
see that it as much an effect of impressions upon a 
peculiar species of matter, as sound is of the stroke 
of a hammer upon a bell, or music of the motion 
of the bow upon the strings of a violin. I exclude 
therefore the intelligent principle of Whytt, the 
medical mind of Stahl, the healing powers of Cul- 
len, and the vital principal of John Hunter, as much 
from the body, as I do an intelligent principle from 
air, fire, and water. 

It is no uncommon thing for the simplicity of 
causes to be lost in the magnitude of their effects. 
By contemplating the wonderful functions of life 
we have strangely overlooked the numerous and 
obscure circumstances which produce it. Thus 
the humble but true origin of power in the people 
is often forgotten in the splendour and pride of go- 


vernments. It is not necessary to be acquainted 
with the precise nature of that form of matter, 
which is capable of producing life from impressions 
made upon it. It is sufficient for our purpose to 
know the fact. It is immaterial, moreover, whe- 
ther this matter derives its power of being acted 
upon wholly from the brain, or whether it be in 
part inherent in animal fibres. The inferences arc 
the same in favour of life being the effect of stimuli, 
and of its being as truly mechanical as the move- 
ments of a clock from the pressure of its weights, 
or the passage of a ship in the water from the im- 
pulse of winds and tide. 

The infinity of effects from similar causes, has 
often been taken notice of in the works of the 
Creator. It would seem as if they had all been 
made after one pattern. The late discovery of the 
cause of combustion has thrown great light upon 
our subject. Wood and coal are no longer belie v» 
ed to contain a principle of fire. The heat and 
flame they emit are derived from an agent altoge- 
ther external to them. They are produced by a 
matter which is absorbed from the air, by means 
of its decomposition. This matter acts upon the 
predisposition of the fuel to receive it, in the same 
way that stimuli act upon the human body. The 
two agents differ only in their effects. The former 



produces the destruction of the bodies upon which 
it acts, while the latter excite the more gentle and 
durable motions of life. Common language in ex- 
pressing these effects is correct, as far as it relates 
to their cause. We speak of a coal of fire being 
alhe, and of the flame of life. 

The causes of life which I have delivered will 
receive considerable support by contrasting them 
with the causes of death. This catastrophe of the 
body consists in such a change induced on it by 
disease or old age, as to prevent its exhibiting the 
phenomena of life. It is brought on, 

1. By the abstraction of all the stimuli which 
support life. Death from this cause is produced 
by the same mechanical means that the emission of 
sound from a violin is prevented by the abstraction 
of the bow from its strings. 

2. By the excessive force of stimuli of all kinds. 
No more occurs here than happens from too much 
pressure upon the strings of a violin preventing its 
emitting musical tones. 

3. By too much relaxation, or too weak a tex- 
ture of the matter which composes the human body. 
No more occurs here than is observed in the ex- 


tinction of sound by the total relaxation, or slender 
combination of the strings of a violin. 

4. By an error in the place of certain fluid or so- 
lid parts of the body. No more occurs here than 
would happen from fixing the strings of a violin 
upon its body, instead of elevating them upon its 

5. By the action of poisonous exhalations, or of 
certain fluids vitiated in the body, upon parts which 
emit most forcibly the motions of life. No more 
happens here than occurs from enveloping the 
strings of a violin in a piece of wax. 

6. By the solution of continuity by means of 
wounds in solid parts of the body. No more oc^ 
curs in death from this cause than takes place 
when the emission of sound from a violin is pre- 
vented by a rupture of its strings. 

7. Death is produced by a preternatural rigidity, 
and in some instances by an ossification of the solid 
parts of the body in old age, in consequence of 
which they are incapable of receiving and emitting 
the motions of life. No more occurs here, than 
would happen if a stick or pipe- stem were placed 
in the room of catgut, upon the bridges of the 



violin. But death may take place in old age with- 
out a change in the texture of animal matter, from 
the stimuli of life losing their effect by repetition, 
just as opium, from the same cause, ceases to pro- 
duce its usual effects upon the body. 

Should it be asked, what is that peculiar organi- 
zation of matter, which enables it to emit life, when 
acted upon by stimuli, I answer, I do not know. 
The great Creator has kindly established a witness 
of his unsearchable wisdom in every part of his 
works, in order to prevent our forgetting him, in 
the successful exercises of our reason. Mohammed 
once said, " that he should believe himself to be a 
God, if he could bring down rain from the clouds, 
or give life to an animal." It belongs exclusively 
to the true God to endow matter with those singu- 
lar properties, which enable it, under certain circum- 
stances, to exhibit the appearances of life. 

I cannot conclude this subject, without taking 
notice of its extensive application to medicine, me- 
taphysics, theology, and morals. 

The doctrine of animal life which has been 
taught, exhibits in the 

vol. n. 3 L 


First place, a new view of the nervous system, 
by discovering its origin in the extremities of the 
nerves, on which impressions are made, and its ter- 
mination in the brain. This idea is extended in an 
ingenious manner by Mr. Valli, in his treatise upon 
animal electricity. 

2. It discovers to us the true means of promot- 
ing health and longevity, by proportioning the num- 
ber and force of stimuli to the age, climate, situa- 
tion, habits, and temperament of the human body. 

3. It leads us to a knowledge of the causes of all 
diseases. These consist in excessive or preterna- 
tural excitement in the whole, or a part of the hu- 
man body, accompanied generally with irregular- 
motions, and induced by natural or artificial stimuli. 
The latter have been called, very properly, by Mr. 
Hunter, irritants. The occasional absence of mo- 
tion in acute diseases is the effect only of the ex- 
cess of impetus in their remote causes. 

4. It discovers to us that the cure of all diseases 
depends simply upon the abstraction of stimuli from 
the whole, or from a part of the body, when the 
motions excited by them are in excess ; and in the 
increase of their number and force, when motions 
are of a moderate nature. For the former pur- 


pose, we employ a class of medicines known by 
the name of sedatives. For the latter, we make 
use of stimulants. Under these two extensive 
heads, are included all the numerous articles of the 
materia medica. 

5. It enables us to reject the doctrine of innate 
ideas, and to ascribe all our knowledge of sensible 
objects to impressions acting upon an innate capa- 
city to receive ideas. Were it possible for a child 
to grow up to manhood without the use of any of 
its senses, it would not possess a single idea of a 
material object ; and as all human knowledge is 
compounded of simple ideas, this person would be 
as destitute of knowledge of every kind, as the 
grossest portion of vegetable or fossil matter. 

6. The account which has been given of animal 
life, furnishes a striking illustration of the origin of 
human actions, by the impression of motives upon 
the will. As well might we admit an inherent 
principle of life in animal matter, as a self-deter- 
mining power in this faculty of the mind. Mo- 
tives are necessary, not only to constitute its free- 
dom, but its essence; for, without them, there could 
be no more a will, than there cou!d be vision with- 
out light, or hearing without sound. It is true, 
they are often so obscure as not to be perceived. 


and they sometimes become insensible from habit; 
but the same things have been remarked in the 
operation of stimuli, and yet we do not upon this 
account deny their agency in producing animal life. 
In thus deciding in favour of the necessity of mo- 
tives, to produce actions, I cannot help bearing a 
testimony against the gloomy misapplication of this 
doctrine by some modern writers. When proper- 
ly understood, it is calculated to produce the most 
comfortable views of the divine government, and 
the most beneficial effects upon morals and human 

7. There are errors of an impious nature, which 
sometimes obtain a currency, from being disguised 
by innocent names. The doctrine of animal life 
that has been delivered is directly opposed to an 
error of this kind, which has had the most bane- 
ful influence upon morals and religion. To sup- 
pose a principle to reside necessarily and constant- 
ly in the human body, which acted independently 
of external circumstances, is to ascribe to it an at- 
tribute, which I shall not connect, even in language, 
with the creature man. Self-existence belongs 
only to God. 

The best criterion of the truth of a philosophical 
©pinion, is its tendency to produce exalted ideas of 


die Divine Being, and humble views of ourselves. 
The doctrine of animal life which has been deli- 
vered is calculated to produce these effects in an 
eminent degree, for 

8. It does homage to the Supreme Being, as the 
governor of the universe, and establishes the cer- 
tainty of his universal and particular providence. 
Admit a principle of life in the human body, and 
we open a door for the restoration of the old Epi- 
curean or atheistical philosophy, which supposed 
the world to be governed by a principle called na- 
ture, and which was believed to be inherent in 
every kind of matter. The doctrine I have taught, 
cuts the sinews of this error ; for by rendering the 
continuance of animal life, no less than its com- 
mencement, the effect of the constant operation of 
divine power and goodness, it leads us to believe 
that the whole creation is supported in the same 

9. The view that has been given of the depen- 
dent state of man for the blessing of life, leads us 
to contemplate, with very opposite and inexpressi- 
ble feelings, the sublime idea which is given of the 
Deity in the scriptures, as possessing life " within 
himself." This divine prerogative has never been 
imparted but to one being, and that is the Son of 


God. This appears from the following declara- 
tion. " For as die Father hath life in himself, so 
hath he given to the Son to have life wit bin him- 
self."* To this plenitude of independent life, we 
are to ascribe his being called the " life of the 
world," " the prince of life," and " life" itself, in 
the New Testament. These divine epithets which 
are very properly founded upon the manner of our 
Saviour's existence, exalt him infinitely above sim- 
ple humanity, and establish his divine nature upon 
the basis of reason, as well as revelation. 

10. We have heard that some of the stimuli 
which produce animal life, are derived from the 
moral and physical evils of our world. From be- 
holding these instruments of death thus converted 
by divine skill into the means of life, we are led to 
believe goodness to be the supreme attribute of the 
Deity, and that it will appear finally to predominate 
in all his works. 

11. The doctrine which has been delivered, is 
calculated to humble the pride of man by teach- 
ing him his constant dependence upon his Maker 
for his existence, and that he has no pre-eminence 
in his tenure of it, over the meanest insect that flut- 

* John v. verse 26. 


ters in the air, or the humblest plant that grows 
upon the earth. What an inspired writer says of 
the innumerable animals which inhabit the ocean, 
may with equal propriety be said of the whole hu- 
man race. " Thou sendest forth thy spirit, and 
they are created. Thou takest away their breath 
- — they die, and return to their dust." 

12. Melancholy indeed would have been the is- 
sue of all our inquiries, did we take a final leave of 
the human body in its state of decomposition in the 
grave. Revelation furnishes us with an elevating, 
and comfortable assurance that this will not be the 
case. The precise manner of its re-organization, 
and the new means of its future existence, are un- 
known to us. It is sufficient to believe, the event 
will take place, and that after it, the soul and body 
of man will be exalted in one respect, to an equality 
with their Creator. They will be immortal. 

Here, gentlemen, we close the history of animal 
life. I feel as if I had waded across a rapid and 
dangerous stream. Whether I have gained the op- 
posite shore with my head clean, or covered with 
mud and weeds, I leave wholly to your determi-