Medical Inquiries and Observations, Vol. 4 / The Second Edition, Revised and Enlarged by the Author

The combined influence of great heat and intemperance in drinking, acting upon passions unusually excited by public objects, on the 4th of July, every year.

The general and inordinate use of segars.

The want of sufficient force in the water which falls into the common sewers to convey their contents into the Delaware, renders each of their apertures a source of sickly exhalations to the neighbouring streets and squares.

The compact manner in which the gutters are now formed, by preventing the descent of water into the earth, has contributed very much to retain the filth of the city, in those seasons in which they are not washed by rain, nor by the waste water of the pumps and hydrants.

The timbers of many of the wharves of the city have gone to decay. The docks have not been cleaned since the year 1774, and many of them expose large surfaces to the action of the sun at low water. The buildings have increased in Water-street, and with them there has been a great increase of that kind of filth which is generated in all houses; the stores in this street often contain matters which putrify; from all which there is, in warm weather, a constant emission of such a fœtid odour, as to render a walk through that street, by a person who does not reside there, extremely disagreeable, and sometimes to produce sickness and vomiting.

In many parts of the vicinity of the city are to be seen pools of stagnating water, from which there are exhaled large quantities of unhealthy vapours, during the summer and autumnal months.

The privies have become so numerous, and are often so full, as to become offensive in most of the compact parts of the city, more especially in damp weather.

The pump water is impregnated with many saline and aërial matters of an offensive nature.

While these causes exert an unfriendly influence upon the bodies of the citizens of Philadelphia, the extreme elevation or depression of their passions, by the different issues of their political contests (now far surpassing, in their magnitude, the contests of former years), together with their many new and fortuitous modes of suddenly acquiring and losing property, predispose them to many diseases of the mind.

The present diseases of Philadelphia come next under our consideration.

Fevers have assumed several new forms since the year 1766. The mild bilious fever has gradually spread over every part of the city. It followed the filth which was left by the British army in the year 1778. In the year 1780, it prevailed, as an epidemic, in Southwark, and in Water and Front-streets, below Market-street[67]. In the years 1791 and 1792, it assumed an inflammatory appearance, and was accompanied, in many cases, with hepatic affections. The connection of our subject requires that I should barely repeat, that it appeared in 1793 as an epidemic, in the form of what is called yellow fever, in which form it has appeared, in sporadic cases, or as an epidemic, every year since. During the reign of this high grade of bilious fever, mild intermittents and remittents, and the chronic or nervous forms of the summer and autumnal fever, have nearly disappeared.

Inflammations and obstructions of the liver have been more frequent than in former years, and even the pneumonies, catarrhs, intercurrent, and other fevers of the winter and spring months, have all partaken more or less of the inflammatory and malignant nature of the yellow fever.

The pulmonary consumption continues to be a common disease among both sexes.

The cynanche trachealis, the scarlatina anginosa, the hydrocephalus internus, and cholera infantum, are likewise common diseases in Philadelphia.

Madness, and several other diseases of the mind, have increased since the year 1766, from causes which have been mentioned.

Several of the different forms of gout are still common among both sexes.

Apoplexy and palsy have considerably diminished in our city. It is true, the bills of mortality still record a number of deaths from the former, every year; but this statement is incorrect, if it mean a disease of the brain only, for sudden deaths from all their causes are returned exclusively under the name of apoplexy. The less frequent occurrence of this disease, also of palsy, is probably occasioned by the less consumption of animal food, and of distilled and fermented liquors, by that class of citizens who are most subject to them, than in former years. Perhaps the round hat, and the general use of umbrellas, may have contributed to lessen those diseases of the brain.

The dropsy is now a rare disease, and seldom seen even in our hospital.

The colica pictonum, or dry gripes, is scarcely known in Philadelphia. I have ascribed this to the use of flannel next to the skin as a part of dress, and to the general disuse of punch as a common drink.

The natural small-pox is nearly extirpated, and the puerperile fever is rarely met with in Philadelphia. The scrophula is much less frequent than in former years. It is confined chiefly to persons in humble life.

I proceed, in the order that was proposed, to take notice of the present medical opinions which prevail among the physicians of Philadelphia. The system of Dr. Boerhaave long ago ceased to regulate the practice of physic. It was succeeded by the system of Dr. Cullen. In the year 1790, Dr. Brown's system of medicine was introduced and taught by Dr. Gibbon. It captivated a few young men for a while, but it soon fell into disrepute. Perhaps the high-toned diseases of our city exposed the fallacy and danger of the remedies inculcated by it, and afforded it a shorter life than it has had in many other countries. In the year 1790, the author of this inquiry promulgated some new principles in medicine, suggested by the peculiar phænomena of the diseases of the United States. These principles have been so much enlarged and improved by the successive observations and reasonings of many gentlemen in all the states, as to form an American system of medicine. This system rejects the nosological arrangement of diseases, and places all their numerous forms in morbid excitement, induced by irritants acting upon previous debility. It rejects, likewise, all prescriptions for the names of diseases, and, by directing their applications wholly to the forming and fluctuating states of diseases, and the system, derives from a few active medicines all the advantages which have been in vain expected from the numerous articles which compose European treatises upon the materia medica. This system has been adopted by a part of the physicians of Philadelphia, but a respectable number of them are still attached to the system of Dr. Cullen.

A great change has taken place in the remedies which are now in common use in Philadelphia. I shall briefly mention such of them as are new, and then take notice of the new and different modes of exhibiting such as were in use between the years 1760 and 1766.

Vaccination has been generally adopted in our city, in preference to inoculation with variolous matter.

Digitalis, lead, zinc, and arsenic are now common remedies in the hands of most of our practitioners.

Cold air, cold water, and ice are among the new remedies of modern practice in Philadelphia.

Blood-letting is now used in nearly all diseases of violent excitement, not only in the blood-vessels, but in other parts of the body. Its use is not, as in former times, limited to ounces in specific diseases, but regulated by their force, and the importance of the parts affected to health and life; nor is it forbidden, as formerly, in infancy, in extreme old age, in the summer months, nor in the period of menstruation, where symptoms of a violent, or of a suffocated disease, manifested by an active or a feeble pulse, indicate it to be necessary.

Leeches are now in general use in diseases which are removed, by their seat or local nature, beyond the influence of the lancet. For the introduction of this excellent remedy into our city we are indebted to Mr. John Cunitz.

Opium and bark, which were formerly given in disguise, or with a trembling hand, are now, not only prescribed by physicians, but often purchased, and taken without their advice, by many of the citizens of Philadelphia. They even occupy a shelf in the closets of many families.

The use of mercury has been revived, and a salivation has been extended; with great improvements and success, to nearly all violent and obstinate diseases. Nor has the influence of reason over ignorance and prejudice, with respect to that noble medicine, stopped here. Cold water, once supposed to be incompatible with its use, is now applied to the body, in malignant fevers, in order to insure and accelerate its operation upon the salivary glands.

Wine is given in large quantities, when indicated, without the least fear of producing intoxication.

The warm and cold baths, which were formerly confined chiefly to patients in the Pennsylvania hospital, are now common prescriptions in private practice.

Exercise, country air, and the sea shore, are now universally recommended in chronic diseases, and in the debility which precedes and follows them.

Great pains are now taken to regulate the quantity and quality of aliments and drinks, by the peculiar state of the system.

Let us now inquire into the influence of the new opinions in medicine, and the new remedies which have been mentioned, upon human life.

The small-pox, once the most fatal and universal of all diseases, has nearly ceased to occupy a place in our bills of mortality, by the introduction of vaccination in our city. For the prompt adoption of this great discovery, the citizens of Philadelphia owe a large debt of gratitude to Dr. Coxe, and Mr. John Vaughan.

Fevers, from all their causes, and in all their forms, with the exception of the bilious yellow fever, now yield to medicine. Even that most malignant form of febrile diseases is treated with more success in Philadelphia than in other countries. It would probably seldom prove mortal, did a belief in its being derived from an impure atmosphere, and of its exclusive influence upon the body, while it prevailed as an epidemic, obtain universally among the physicians and citizens of Philadelphia.

The pulmonary consumption has been prevented, in many hundred instances, by meeting its premonitory signs, in weakness and feeble morbid excitement in the whole system, by country air, gentle exercise, and gently stimulating remedies. Even when formed, and tending rapidly to its last stage, it has been cured by small and frequent bleedings, digitalis, and a mercurial salivation.

The hydrocephalus internus, the cynanche trachealis, and cholera infantum, once so fatal to the children of our city, now yield to medicine in their early stages. The two former are cured by copious bleeding, aided by remedies formerly employed in them without success. The last is cured by moderate bleeding, calomel, laudanum, and country air.

The gout has been torn from its ancient sanctuary in error and prejudice, and its acute paroxysms now yield with as much certainty to the lancet, as the most simple inflammatory diseases.

The dropsy is cured by renouncing the unfortunate association of specific remedies with its name, and accommodating them to the degrees of excitement in the blood-vessels.

The tetanus from wounds is now prevented, in most cases, by inflaming the injured parts, and thereby compelling them to defend the whole system, by a local disease. Where this preventing remedy has been neglected, and where tetanus arises from other causes than wounds, it has often been cured by adding to the diffusible stimulus of opium, the durable stimuli of bark and wine.

Death from drinking cold water, in the heated state of the body, is now obviated by previously wetting the hands or feet with the water; and when this precaution is neglected, the disease induced by it is generally cured by large doses of liquid laudanum.

Madness, which formerly doomed its miserable subjects to cells or chains for life, has yielded to bleeding, low diet, mercury, the warm and cold baths, fresh air, gentle exercise, and mild treatment, since its seat has been discovered to be in the blood-vessels of the brain.

The last achievement of our science in Philadelphia, that I shall mention, consists in the discovery and observation of the premonitory signs of violent and mortal diseases, and in subduing them by simple remedies, in their forming state. By this means, death has been despoiled of his prey, in many hundred instances.

In this successful conflict of medicine with disease and death, midwifery and surgery have borne a distinguished part. They derive their claims to the gratitude of the citizens of Philadelphia from the practice of each of them being more confined, than formerly, to a few members of our profession. It is in consequence of the former being exercised only by physicians of regular and extensive educations, that death from pregnancy and parturition is a rare occurrence in Philadelphia.

I should greatly exceed the limits prescribed to this inquiry, should I mention how much pain and misery have been relieved, and how often death has been baffled in his attempts upon human life, by several late improvements in old, and the discovery of new remedies in surgery. I shall briefly name a few of them.

In cases of blindness, from a partial opacity of the cornea, or from a closure of the natural pupil, a new pupil has been made; and where the cornea has been partially opaque, the opening through the iris has been formed, opposite to any part of it, which retained its transparency.

The cure of fractures has been accelerated by blood-letting, and, where the union of a broken bone has not taken place from a defect of bony matter, it has been produced by passing a seton between the fractured ends of the bone, and effecting a union thereby between them. Luxations, which have long resisted both force and art, have been reduced in a few minutes, and without pain, by bleeding at deliquium animi.

Old sores have been speedily healed, by destroying their surfaces, and thereby placing them in the condition of recent accidents.

The fruitless application of the trepan, in concussions of the brain, has been prevented by copious bleeding, and a salivation.

A suppression of urine has been cured, by the addition of a piece of a bougie to a flexible catheter.

Strictures in the urethra have been removed by means of a caustic, also, in a more expeditious way, by dividing them with a lancet.

Hydrocele has been cured by a small puncture, and afterwards exciting inflammation and adhesion by an injection of wine into the tunica vaginalis testis.

The popliteal aneurism and varicose veins have both been removed by operations that were unknown a few years ago.

For the introduction of several of those new surgical remedies, and for the discovery and improvement of others, the citizens of Philadelphia are indebted to Dr. Physick. They are likewise indebted to him and Dr. Griffitts for many of the new and successful modes of practice, in the diseases that have been mentioned. Even the few remedies that have been suggested by the author of these inquiries, owe their adoption and usefulness chiefly to the influence of those two respectable and popular physicians.

Before I dismiss this part of our subject, I have only to add, that since the cure and extraction of the teeth have become a distinct branch of the profession of medicine, several diseases which have arisen from them, when decayed, have been detected and cured[68].

We have thus taken a comparative view of the medical theories and remedies of former and modern times, and of their different influence upon human life. To exhibit the advantages of the latter over the former, I shall mention the difference in the number of deaths in three successive years, at a time when the population of the city and suburbs was supposed to amount to 30,000 souls, and in three years, after the population exceeded double that number.

Between the 25th of December, 1771, and the 25th of December, 1772, there died 1291 persons.

Between the same days of the same months, in 1772 and 1773, there died 1344 persons.

Within the same period of time, between 1773 and 1774, the deaths amounted to 1021, making in all 3,656. I regret that I have not been able to procure the returns of deaths in years prior to those which have been mentioned. During the three years that have been selected, no unusually mortal diseases prevailed in the city. The measles were epidemic in 1771, but were not more fatal than in common years.

Between the 25th of December, 1799, and the 25th of December, 1800, there died 1525 persons.

Between the same days of the same months, in the years 1801 and 1802, there died 1362 persons.

Within the same period of time, between 1802 and 1803, the deaths amounted to 1796, making in all 4,883.

Upon these returns it will be proper to remark, that several hundreds of the deaths, in 1802 and 1803, were from the yellow fever, and that many of them were of strangers. Of 68 persons, who were interred in the Swedes' church-yard alone, one half were of that description of people. Deducting 500 from both those causes of extra-mortality in the three years, between 1799 and 1803, the increase of deaths above what they were in the years 1771 and 1774 is but 727. Had diseases continued to be as mortal as they were thirty years ago, considering the present state of our population, the number of deaths would have been more than 7,312.

To render the circumstances of the statement of deaths that has been given perfectly equal, it will be necessary to add, that the measles prevailed in the city, in the year 1802, as generally as they did in 1771.

From the history that has been given, of the effects of the late improvements and discoveries in medicine upon human life, in Philadelphia, we are led to appreciate its importance and usefulness. It has been said, by its enemies, to move; but its motions have been asserted to be only in a circle. The facts that have been stated clearly prove, that it has moved, and rapidly too, within the last thirty years, in a straight line.

To encourage and regulate application and enterprize in medicine hereafter, let us inquire to what causes we are indebted for the late discoveries and improvements in our science, and for their happy effects in reducing the number of deaths so far below their former proportion to the inhabitants of Philadelphia.

The first cause I shall mention is the great physical changes which have taken place in the manners of our citizens in favour of health and life.

A second cause, is the assistance which has been afforded to the practice of physic, by the numerous and important discoveries that have lately been made in anatomy, natural history, and chemistry, all of which have been conveyed, from time to time, to the physicians of the city, by means of the Philadelphia and hospital libraries, and by the lectures upon those branches of science which are annually delivered in the university of Pennsylvania.

3. The application of reasoning to our science has contributed greatly to extend its success in the cure of diseases. Simply to observe and to remember, are the humblest operations of the human mind. Brutes do both. But to theorize, that is, to think, or, in other language, to compare facts, to reject counterfeits, to dissolve the seeming affinity of such as are not true, to combine those that are related, though found in remote situations from each other, and, finally, to deduce practical and useful inferences from them, are the high prerogatives and interest of man, in all his intellectual pursuits, and in none more, than in the profession of medicine.

4. The accommodation of remedies to the changes which are induced in diseases by the late revolutions in our climate, seasons, and manners, has had a sensible influence in improving the practice of medicine in our city. The same diseases, like the descendants of the same families, lose their resemblance to each other by the lapse of time; and the almanacks of 1803 might as well be consulted to inform us of the monthly phases of the moon of the present year, as the experience of former years, or the books of foreign countries, be relied upon to regulate the practice of physic at the present time, in any of the cities of the United States.

5. From the diffusion of medical knowledge among all classes of our citizens, by means of medical publications, and controversies, many people have been taught so much of the principles and practice of physic, as to be able to prescribe for themselves in the forming state of acute diseases, and thereby to prevent their fatal termination. It is to this self-acquired knowledge among the citizens of Philadelphia, that physicians are in part indebted for not being called out of their beds so frequently as in former years. There are few people who do not venture to administer laudanum in bowel complaints, and there are some persons in the city, who have cured the cynanche trachealis when it has occurred in the night, by vomits and bleeding, without the advice of a physician. The disuse of suppers is another cause why physicians enjoy more rest at night than formerly, for many of their midnight calls, were to relieve diseases brought on by that superfluous meal.

6. The dispensary instituted in our city, in the year 1786, for the medical relief of the poor, has assisted very much in promoting the empire of medicine over disease and death. Some lives have likewise been saved by the exertions of the humane society, by means of their printed directions to prevent sudden death; also, by the medical services which have lately been extended to out-patients, by order of the managers of the Pennsylvania hospital.

7thly and lastly. A change, favourable to successful practice in Philadelphia, has taken place in the conduct of physicians to their patients. A sick room has ceased to be the theatre of imposture in dress and manners, and prescriptions are no longer delivered with the pomp and authority of edicts. On the contrary, sick people are now instructed in the nature of their diseases, and informed of the names and design of their medicines, by which means faith and reason are made to co-operate in adding efficacy to them. Nor are patients left, as formerly, by their physicians, under the usual appearances of dissolution, without the aid of medicine. By thus disputing every inch of ground with death, many persons have been rescued from the grave, and lived, years afterwards, monuments of the power of the healing art.

From a review of what has been effected within the last nine and thirty years, in lessening the mortality of many diseases, we are led to look forward with confidence and pleasure to the future achievements of our science.

Could we lift the curtain of time which separates the year 1843 from our view, we should see cancers, pulmonary consumptions, apoplexies, palsies, epilepsy, and hydrophobia struck out of the list of mortal diseases, and many others which still retain an occasional power over life, rendered perfectly harmless, provided the same number of discoveries and improvements shall be made in medicine in the intermediate years, that have been made since the year 1766.

But in vain will the avenues of death from those diseases be closed, while the more deadly yellow fever is permitted to supply their place, and to spread terror, distress, and poverty through the city, by destroying the lives of her citizens by hundreds or thousands every year. Dear cradle of liberty of conscience in the western world! nurse of industry and arts! and patron of pious and benevolent institutions! may this cease to be thy melancholy destiny! May Heaven dispel the errors and prejudices of thy citizens upon the cause and means of preventing their pestilential calamities! and may thy prosperity and happiness be revived, extended, and perpetuated for ages yet to come!

INDEX.

• A.
• Anthelmintics, i. 228
• Arsenic, a remedy for cancerous sores, i. 240
• Army of the United States, diseases of, i. 269
• ——, causes of, i. 272
• ——, remedies for, i. ibid.
• Agriculture, the practice of, recommended to country physicians, i. 388
• Age, old, observations on the state of the body and mind in, i. 427
• ——, its diseases, i. 446
• ——, ——, their remedies, i. 449
• Air, cool, its good effects in the yellow fever of 1793, iii. 279
• Association of ideas, its effects upon morals, ii. 45
• B.
• Barometer, its mean elevation in Philadelphia, i. 96
• Blisters, their efficacy in obstinate intermittents, i. 179
• ——, —— in the bilious fever of 1780, i. 128
• ——, —— in the yellow fever of 1803, when applied in its early stage, iv. 141
• Bed, lying in, useful in the bilious fever of 1780, i. 128
• Bleeding, its efficacy in the cure of obstinate intermittents, i. 179
• ——, —— in the yellow fever of 1793, iii. 253
• ——, reasons for the practice, iii. 254
• ——, circumstances which regulated it, iii. 261
• ——, objections to it answered, iii. 269
• ——, gradual manner of abstracting blood recommended, iii. 273
• Blood-letting, defence of it as a remedy for certain diseases, iv. 275
• ——, indicated in fevers, iv. ibid.
• ——, its good effects in fevers, iv. 277
• ——, objections to it answered, iv. 284
• ——, its comparative advantages, iv. 313
• ——, circumstances which should regulate its use, iv. 316
• ——, appearances of the blood, iv. 326
• ——, when forbidden, or to be used cautiously, iv. 344
• ——, its advantages in pregnancy, iv. 349
• ——, in parturition, iv. 353
• ——, during the cessation of the menses, iv. 356
• ——, in curing the disease induced by a large dose of opium, iv. 357
• ——, in curing the disease induced by poison, iv. ibid.
• ——, in diabetes, iv. ibid.
• Blood-letting, in dislocated bones, iv. 358
• Blood, quantity drawn from several persons in 1797, iv. 37
• ——, appearances of it in 1793, iii. 256
• ——, —— in 1794, iii. 404
• C.
• Civilization, diseases derived from it, i. 32
• ——, —— not necessarily connected with it, i. 60
• Climate of Pennsylvania, account of, i. 71
• ——, its changes, i. 76
• ——, its temperature, i. 78
• ——, its effects upon health and life, i. 108
• Calomel, useful joined with emetics in scarlatina anginosa, i. 144
• ——, its effects as a purge, when combined with jalap, in the yellow fever, iii. 241
• ——, objections to it answered, iii. 243
• Contagious, the yellow fever not so, iv. 223
• Cholera infantum described, i. 157
• ——, a form of bilious fever, i. 158
• ——, its remedies, i. 160
• ——, means of preventing it, i. 164
• Cynanche trachealis, its different names, i. 169
• ——, appearances in the trachea after death, i. 170
• ——, its different grades, i. 171
• ——, its remedies in its forming state, i. ibid.
• ——, its remedies after it is formed, i. 172
• ——, favourable and unfavourable signs of its issue, i. 174
• Consumption, pulmonary, thoughts on, i. 199
• Consumption, pulmonary, Indians, and persons who lead laborious lives, not subject to it, i. 200
• ——, radical remedies for it in exercise, labour, and the hardships of a camp and naval life, i. 204
• ——, its causes, ii. 62
• ——, not contagious, ii. 79
• ——, tracheal, described, ii. 84
• ——, its remedies, ii. 87
• ——, premonitory signs, ii. ibid.
• ——, of the remedies for its inflammatory state, ii. 89
• ——, of blood-letting, ii. ibid.
• ——, of a vegetable diet, ii. 104
• ——, of the remedies for its hectic state, ii. 107
• ——, for its typhus state, ii. 108
• ——, of its radical remedies, ii. 128
• ——, of exercise, ii. ibid.
• ——, of travelling, ii. 137
• ——, signs of its long or short duration, and of its issue in life and death, ii. 144
• ——, its different ways of terminating in death, ii. 147
• College of physicians, their letter to the citizens of Philadelphia, declaring the existence of the yellow fever in the city, &c. in 1793, iii. 82
• ——, their letter to the governor of the state, on the origin of the yellow fever in 1793, iii. 197
• ——, their opinion of the origin of the fever in 1799, iv. 100
• D.
• Diseases of the Indians, i. 16
• ——, from civilization, i. 30
• Diseases produced by ardent spirits, i. 343
• ——, of the military hospitals, during the revolutionary war between Great-Britain and the United States, i. 269
• ——, of old age, i. 446
• Drunkenness, a fit of it described, i. 338
• ——, remedies for it, i. 374
• Disease, summer and autumnal, its sources, iv. 163
• ——, means of preventing it in its malignant forms, iv. 173
• ——, in its mild forms, iv. 198
• ——, in its intestinal forms, iv. 200
• ——, of preserving cities and communities from them, iv. 202
• ——, of exterminating them, iv. 210
• ——, from drinking cold water, i. 186
• ——, ——, how prevented, i. ibid.
• ——, ——, its cure, i. 185
• Dropsies, their causes, ii. 151
• ——, divided into inflammatory, and of weak morbid action in the blood-vessels, ii. 157
• ——, remedies for the inflammatory state of, ii. 160
• ——, ——, with weak morbid action in the blood-vessels, ii. 176
• Dropsy of the brain, internal, ii. 191
• ——, its history, ii. 195
• ——, its causes, ii. 203
• ——, its cure, ii. 210
• Distress, familiarity with it, its moral effects, ii. 46
• Death, its proximate cause, ii. 447
• E.
• Emetics, useful in the bilious fever of 1780, i. 186
• ——, in the scarlatina anginosa of 1783 and 1784, i. 144
• ——, in the yellow fever of 1798, iv. 79
• ——, in the yellow fever of 1799, iv. 97
• ——, hurtful in the yellow fever of 1797, iv. 44
• Exhalations, putrid, their sources and effects in producing the summer and autumnal disease, iv. 163
• F.
• Faculty, moral, inquiry into the influence of physical causes on, ii. 3
• Fruits, summer, useful in destroying worms, i. 229
• Fever, bilious, history of it in 1780, i. 117
• ——, outlines of a theory of, iii. 3
• ——, its unity asserted, iii. 17
• ——, unity of its exciting causes, iii. 16
• ——, objections to a nosological arrangement of its different forms, iii. 33
• ——, effects of, iii. 39
• ——, different states of, enumerated, iii. 41
• ——, objections to putrefaction in, iii. 43
• ——, bilious yellow, history of, in 1793, iii. 69
• ——, ——, its exciting causes, iii. 88
• ——, ——, its premonitory signs, iii. 93
• ——, ——, its first symptoms, iii. 95
• ——, ——, symptoms of it in the blood-vessels, iii. 97
• ——, ——, ——, in the liver, lungs, and brain, iii. 104
• ——, ——, ——, in the stomach and bowels, iii. 108
• ——, ——, ——, in the secretions and excretions, iii. 110
• Fever, bilious yellow, symptoms of it, in the nervous system, iii. 116
• ——, ——, ——, in the senses and appetites, iii. 122
• ——, ——, ——, in the lymphatic and glandular system, iii. 124
• ——, ——, ——, on the skin, iii. 125
• ——, ——, ——, in the blood, iii. 128
• ——, ——, nature of the black vomit, iii. 111
• ——, ——, types of the, iii. 135
• ——, ——, the empire of, over all other diseases, iii. 139
• ——, ——, who most subject to it, iii. 148
• ——, ——, negroes affected by it in common with white people, iii. 151
• ——, ——, state of the atmosphere during the prevalence of, iii. 158
• ——, ——, signs of the presence of miasmata in the body, universal, iii. 157
• ——, ——, cases of re-infection, iii. 164
• ——, ——, external appearances of the body after death in, iii. 165
• ——, ——, appearances of the body by dissection, iii. 167
• ——, ——, account of the distress of the city, iii. 175
• ——, ——, its moral effects upon the inhabitants, iii. 179
• ——, ——, number of deaths from it, iii. 181
• ——, ——, is checked and destroyed by rain, iii. 184
• ——, ——, inquiry into its origin by the governor of the state, iii. 196
• ——, ——, said to be imported by the college of physicians, iii. 197
• ——, ——, objections to their opinion, and proofs of its domestic origin, iii. 198
• ——, the sameness of its origin with the plague, iii. 211
• ——, state of the weather in 1793, iii. 215
• ——, method of cure, iii. 223
• ——, dissentions of the physicians, iii. 235
• ——, of purging, iii. 239
• ——, its salutary effects, iii. 241
• ——, objections to it answered, iii. 243
• ——, blood-letting, its utility, iii. 253
• ——, salivation, its utility, iii. 284
• ——, convalescence, iii. 289
• ——, remarks on the use of stimulating remedies in this fever, iii. 292
• ——, comparative view of the success of all the modes of practice employed in the fever, iii. 298
• Fever, yellow, of 1794, history of, iii. 357
• ——, its exciting causes, iii. 367
• ——, symptoms in the different systems of the body, iii. 369
• ——, in the blood-vessels, iii. ibid.
• ——, in the viscera, iii. 371
• ——, in the alimentary canal, iii. 373
• ——, in the secretions and excretions, iii. 375
• ——, in the nervous system, iii. 379
• ——, in the senses and appetites, iii. 383
• ——, in the lymphatic system, iii. ibid.
• ——, in the blood, iii. 387
• ——, different forms of the fever, iii. 388
• ——, its origin, iii. 397
• ——, method of cure, iii. 401
• ——, bleeding, iii. 402
• ——, good effects of cool air and cold water in, iii. 409
• ——, of a salivation, iii. 411
• ——, of blisters, iii. 413
• ——, of tonic remedies, iii. 415
• ——, of the inefficacy of bark, iii. ibid.
• ——, of the effects of wine, iii. 418
• ——, ——, of opium, iii. 419
• ——, ——, of nitre, iii. 421
• ——, ——, of antimonials, iii. ibid.
• Fever, yellow, sporadic cases of, in the years 1795 and 1796, iii. 437
• Fever, yellow, of 1797, iv. 3
• ——, symptoms of, iv. 13
• ——, type of, iv. 20
• ——, different forms of, iv. 21
• ——, influence of the moon upon it, iv. 27
• ——, number of deaths, particularly of physicians, iv. 30
• ——, origin of it, iv. 33
• ——, its remedies, iv. ibid.
• ——, of bleeding, iv. ibid.
• ——, of purging medicines, iv. 37
• ——, of a salivation, iv. 39
• ——, different ways in which mercury acted upon the mouth and throat, iv. 40
• ——, of emetics, iv. 44
• ——, of diet and drinks, iv. 45
• ——, of tonic remedies, iv. 49
• ——, of blisters, iv. 49
• ——, of sweet oil, iv. 51
• ——, relative success of different modes of practice, iv. 53
• ——, signs of a favourable and unfavourable issue of the fever, iv. 55
• Fever, yellow, of 1798, account of, iv. 67
• ——, symptoms of, iv. 68
• ——, in the blood-vessels, iv. ibid.
• ——, alimentary canal, iv. ibid.
• ——, on the tongue, iv. 69
• ——, in the nervous system, iv. ibid.
• ——, in the eyes, lymphatics, and blood, iv. 71
• ——, different modes in which it terminated in death, iv. 74
• ——, state of the weather in 1798, iv. 77
• ——, origin of the fever, iv. 78
• ——, remedies for it, iv. ibid.
• ——, bleeding, iv. ibid.
• ——, emetics, iv. 79
• ——, purges, iv. 81
• ——, of a salivation, iv. ibid.
• ——, of sweats, iv. 82
• ——, of bark, iv. 83
• ——, of blisters, iv. ibid.
• ——, symptoms which indicated a favourable and unfavourable issue of the disease, iv. 84
• ——, different modes of practice in this fever, and their different success, iv. 85
• Fever, bilious, of 1799, iv. 91
• ——, sickliness among certain animals, iv. 94
• ——, its symptoms, iv. 95
• ——, its remedies, iv. 97
• Fever, yellow, of 1799, signs of a favourable and unfavourable issue of it, iv. 99
• ——, its origin, iv. 100
• Fever, yellow, sporadic cases of, in 1800, iv. 103
• ——, ——, in 1801, iv. 111
• Fever, yellow, of 1802, account of, iv. 123
• ——, its origin, iv. 123
• ——, its types, iv. 127
• Fever, yellow, as it appeared in 1803, iv. 133
• ——, symptoms of, iv. 136
• ——, remedies for, iv. 139
• Fever, yellow, sporadic cases in 1804, iv. 147
• Fever, yellow, as it appeared in 1805, iv. 153
• ——, its origin, iv. 155
• ——, its remedies, iv. 156
• ——, not contagious, iv. 223
• G.
• Gout, peculiarities belonging to it, ii. 227
• ——, its remote causes, ii. 230
• ——, women most subject to it, ii. 232
• ——, its exciting causes, ii. ibid.
• ——, its symptoms, ii. 234
• ——, method of cure, ii. 251
• ——, remedies in its forming state, ii. 253
• ——, in a paroxysm, when attended with great morbid or inflammatory action in the blood-vessels, ii. 252
• ——, when attended with weak morbid action in the blood-vessels, ii. 269
• ——, remedies for its symptoms, ii. 275
• ——, means for preventing the return of inflammatory, ii. 285
• ——, with weak morbid action, ii. 293
• H.
• Hospitals, their origin, i. 55
• ——, military, their evils, i. 276
• ——, constructed with ground floors, to be preferred in fevers, i. 275
• Heat, greatest in Philadelphia, i. 87
• Habit, its effects upon morals, ii. 43
• Hæmoptysis, observations on, i. 191
• Hydrophobia, observations on, ii. 301
• ——, its causes, ii. 302
• ——, its symptoms in rabid animals, ii. 306
• ——, ——, in the human species, ii. 308
• ——, supposed to be a malignant fever, ii. ibid.
• ——, remedies to prevent it, ii. 315
• ——, ——, to cure it in its malignant or inflammatory state, ii. 317
• ——, ——, to cure it when attended with weak morbid action in the blood-vessels, ii. 323
• ——, death from it, supposed to be from suffocation, ii. 326
• ——, laryngotomy suggested to prevent it, ii. 332
• I.
• Indians, oration on their diseases and remedies, i. 3
• ——, peculiar customs of their women, i. 9
• ——, ——, of their men, i. 11
• ——, ——, of both sexes, i. 12
• Indians, their diseases, i. 16
• ——, their remedies, i. 20
• ——, comparative view of their diseases and remedies with those of civilized nations, i. 39
• Iron, its preparations useful in destroying worms, i. 232
• Imitation, its effects upon morals, ii. 42
• Influenza, account of it, as it appeared in Philadelphia in 1789, 1790, and 1791, ii. 353
• ——, history of its symptoms, ii. 354
• ——, mode of treatment, ii. 360
• Jaw-fall, or trismus, in infants, i. 254
• L.
• Laudanum, its efficacy in the disease brought on by drinking cold water in hot weather, i. 185
• Legs, sore, observations on, i. 411
• ——, classes of people most subject to them, i. 412
• ——, their remedies, i. 416
• Longevity, circumstances which favour it, i. 428
• Life, animal, inquiry into its causes, ii. 371
• ——, a forced state, or the effects of impressions, ii. 377
• ——, enumeration of those impressions, ii. 378
• ——, how supported in sleep, ii. 397
• ——, in the fœtus in utero, ii. 404
• ——, in infancy, ii. 405
• ——, in youth, ii. 409
• ——, in middle life, ii. 410
• ——, in old age, ii. ibid.
• ——, in persons blind, or deaf and dumb from their birth, ii. 414
• Life, in idiots, ii. 416
• ——, after long abstinence, ii. 417
• ——, in asphyxia, ii. 419
• ——, in the Indians of North-America, ii. 427
• ——, in the Africans, ii. 428
• ——, in the Turkish empire, ii. 429
• ——, in China and the East-Indies, ii. 431
• ——, in the poor inhabitants of Europe, ii. 432
• ——, stimuli which act alike in promoting it upon all nations, ii. 434
• ——, how supported in sundry animals, ii. 441
• ——, its extinction in death, how effected, ii. 447
• M.
• Midwifery, the practice of it more successful by men than by women, i. 53
• Manufactures, sedentary, unfriendly to the health of men, i. 65
• Measles, history of, in 1789, ii. 338
• ——, their symptoms, ii. 339
• ——, a spurious, or external form of them described, ii. 342
• ——, remedies used in them, ii. 346
• ——, history of them, as they appeared in 1801, iv. 117
• Medicine, an inquiry into its comparative state, in Philadelphia, between 1760 and 1766, and 1805, iv. 365
• Diet of the inhabitants between 1760 and 1766, iv. 366
• Dresses, iv. 368
• Customs which had an influence on health, iv. 369
• Diseases, iv. 370
• N.
• Nature, meaning of the term, i. 35
• ——, the extent of her powers in curing diseases, i. 20
• Nosology, objections to it, iii. 33
• Negroes subject to the yellow fever in common with the white people, iii. 366
• O.
• Opium, useful in the bilious fever of 1780, i. 130
• ——, the disease induced by it cured by blood-letting, iv. 357
• Onion juice, useful in destroying worms, i. 231
• P.
• Philadelphia, its situation, i. 74
• ——, population, i. 76
• ——, diseases between 1760 and 1766, and 1805, iv. 365
• Purges, useful in the bilious fever of 1780, i. 127
• ——, ——, in the yellow fever of 1793, iii. 231
• ——, objections to them answered, iii. 243
• Pulse, state of, in old people, i. 439
• ——, in the yellow fever of 1793, in persons not confined with it, iii. 157
• ——, in fevers, when it indicates blood-letting, iv. 316
• Putrefaction, does not take place in the blood, iii. 43
• Pregnancy, a morbid state of the system, iv. 349
• ——, effects of blood-letting in relieving its diseases, iv. ibid.
• Parturition, a disease, iv. 353
• ——, effects of blood-letting in lessening its pains, iv. ibid.
• Q.
• Quarantine laws, their inefficacy to prevent a yellow fever, iv. 218
• ——, their evils, iv. ibid.
• R.
• Rain, usual quantity in Pennsylvania, i. 72
• Revolution, American, its influence upon the human body and mind, i. 279
• S.
• Snow, common depth in Pennsylvania, i. 91
• Sweating described among the Indians of North-America, i. 22
• Scarlatina anginosa of 1783 and 1784 described, i. 138
• ——, additional observations on, i. 147
• ——, prevented by gentle purges, i. 151
• ——, cured by emetics in its forming state, i. 150
• Salt, common, useful in the hæmoptysis, i. 192
• ——, in destroying worms, i. 230
• Sugar, useful in destroying worms, i. ibid.
• Spirits, ardent, their effects upon the human body and mind, i. 337
• ——, diseases produced by them, i. 343
• ——, their effects on property, i. 347
• ——, substitutes for them, i. 353
• ——, persons predisposed to their use, i. 360
• ——, their influence upon the population of the United States, i. 364
• Sweats, useful in the yellow fever of 1803, iv. 140
• Salivation, its usefulness in the yellow fever of 1793, iii. 284
• ——, ——, of 1794, iii. 411
• ——, ——, of 1797, iv. 49
• ——, ——, of 1798, iv. 81
• Small-pox, new mode of inoculating for, i. 311
• T.
• Tetanus, its causes, i. 248
• ——, its remedies when from wounds, i. 256
• ——, ——, when from other causes, i. 259
• W.
• Winters, cold, in Pennsylvania, i. 76, 77, 79
• Winds, common, in Pennsylvania, i. 90
• Water, cold, disease from drinking it when the body is preternaturally heated, i. 184
• Worms, natural to young children, and to young animals, i. 218
• ——, intended, probably, to prevent disease, i. 219
• ——, destroyed by medicines that act mechanically and chemically upon them, i. 128
• Wounds, gun-shot, in joints, followed by death, i. 274