Chapter IV: Preface (4)

If the vomit failed of opening the bowels, I gave gentle doses of salts and cream of tartar[37], or of the butter-nut pill[38], so as to procure two or three plentiful stools. The matter discharged from the bowels was of a highly bilious nature. It was sometimes so acrid as to excoriate the rectum, and so offensive, as to occasion, in some cases, sickness and faintness both in the patients and in their attendants. In every instance, the patients found relief by these evacuations, especially from the pains in the head and limbs.

[37] I have found that cream of tartar renders the purging neutral
salts less disagreeable to the taste and stomach; but accident
has lately taught me, that the juice of two limes or of one
lemon, with about half an ounce of loaf sugar, added to six
drachms of Glauber or Epsom salt, in half a pint of boiling
water, form a mixture that is nearly as pleasant as strong
beverage.

[38] This pill is made from an extract of a strong decoction of the
bark of the white walnut-tree.

In those cases, where the prejudices of the patients against an emetic, or where an advanced state of pregnancy, or a habitual predisposition to a vomiting of blood occurred, I discharged the bile entirely by means of the lenient purges that have been mentioned. In this practice I had the example of Doctor Cleghorn, who prescribed purges with great success in a fever of the same kind in Minorca, with that which has been described[39]. Doctor Lining prescribed purges with equal success in an autumnal pleurisy in South Carolina, which I take to have been a form of a bilious remittent, accompanied by an inflammatory affection of the breast.

[39] The tertiana interposita remissione tantum of Dr. Cullen.

After evacuating the contents of the stomach and bowels, I gave small doses of tartar emetic, mixed with Glauber's salt. This medicine excited a general perspiration. It likewise kept the bowels gently open, by which means the bile was discharged as fast as it was accumulated.

I constantly recommended to my patients, in this stage of the disorder, to _lie in bed_. This favoured the eruption of the rash, and the solution of the disease by perspiration. Persons who struggled against the fever by _sitting up_, or who attempted to shake it off by labour or exercise, either sunk under it, or had a slow recovery.

A clergyman of a respectable character from the country, who was attacked by the disease in the city, returned home, from a desire of being attended by his own family, and died in a few days afterwards. This is only one, of many cases, in which I have observed travelling, even in the easiest carriages, to prove fatal in fevers after they were formed, or after the first symptoms had shown themselves. The quickest and most effectual way of conquering a fever, in most cases, is, by an early submission to it.

The drinks I recommended to my patients were sage and balm teas, weak punch, lemonade, wine whey, tamarind and apple water.

The apple water should be made by pouring boiling water upon slices of raw apples. It is more lively than that which is made by pouring the water on roasted apples.

I found obvious advantages, in many cases, from the use of pediluvia, every night.

In every case, I found the patients refreshed and relieved by frequent changes of their linen.

On the third or fourth day, in the forenoon, the pains in the head and back generally abated, with a sweat which was diffused over the whole body. The pulse at this time remained quick and weak. This was, however, no objection to the use of the bark, a few doses of which immediately abated its quickness, and prevented a return of the fever.

If the fever continued beyond the third or fourth day without an intermission, I always had recourse to blisters. Those which were applied to the neck, and behind the ears, produced the most immediate good effects. They seldom failed of producing an intermission in the fever, the day after they were applied. Where delirium or coma attended, I applied the blister to the neck on the _first_ day of the disease. A worthy family in this city will always ascribe the life of a promising boy, of ten years old, to the early application of a blister to the neck, in this fever.

Where the fever did not yield to blisters, and assumed malignant, or typhus symptoms, I gave the medicines usually exhibited in both those states of fever.

I took notice, in the history of this fever, that it was sometimes accompanied with symptoms of a dysentery. Where this disease appeared, I prescribed lenient purges and opiates. Where these failed of success, I gave the bark in the intermissions of the pain in the bowels, and applied blisters to the wrists. The good effects of these remedies led me to conclude, that the dysentery was the febris introversa of Dr. Sydenham.

I am happy in having an opportunity, in this place, of bearing a testimony in favour of the usefulness of OPIUM in this disease, after the necessary evacuations had been made. I yielded, in prescribing it at first, to the earnest solicitations of my patients for something to give them relief from their insupportable pains, particularly when they were seated in the eyeballs and head. Its salutary effects in procuring sweat, and a remission of the fever, led me to prescribe it afterwards in almost every case, and always with the happiest effects. Those physicians enjoy but little pleasure in practising physic, who know not how much of the pain and anguish of fevers, of a certain kind, may be lessened by the judicious use of opium.

In treating of the remedies used in this disease, I have taken no notice of blood-letting. Out of several hundred patients whom I visited in this fever, I did not meet with a single case, before the 27th of September, in which the state of the pulse indicated this evacuation. It is true, the pulse was _full_, but never _hard_. I acknowledge that I was called to several patients who had been bled without the advice of a physician, who recovered afterwards on the usual days of the solution of the fever. This only can be ascribed to that disposition which Doctor Cleghorn attributes to fevers, to preserve their types under every variety of treatment, as well as constitution. But I am bound to declare further, that I heard of several cases in which bleeding was followed by a fatal termination of the disease.

In this fever relapses were very frequent, from exposure to the rain, sun, or night air, and from an excess in eating or drinking.

The convalescence from this disease was marked by a number of extraordinary symptoms, which rendered patients the subjects of medical attention for many days after the pulse became perfectly regular, and after the crisis of the disease.

A bitter taste in the mouth, accompanied by a yellow colour on the tongue, continued for near a week.

Most of those who recovered complained of nausea, and a total want of appetite. A faintness, especially upon sitting up in bed, or in a chair, followed this fever. A weakness in the knees was universal. I met with two patients, who were most sensible of this weakness in the right knee. An inflammation in one eye, and in some instances in both eyes, occurred in several patients after their recovery.

But the most remarkable symptom of the convalescence from this fever, was an uncommon dejection of the spirits. I attended two young ladies, who shed tears while they vented their complaints of their sickness and weakness. One of them very aptly proposed to me to change the name of the disease, and to call it, in its present stage, instead of the break-bone, the _break-heart fever_.

To remove these symptoms, I gave the tincture of bark and elixir of vitriol in frequent doses. I likewise recommended the plentiful use of ripe fruits; but I saw the best effects from temperate meals of oysters, and a liberal use of porter. To these was added, gentle exercise in the open air, which gradually completed the cure.

AN ACCOUNT

OF THE

_SCARLATINA ANGINOSA_,

AS IT

APPEARED IN PHILADELPHIA,

IN THE YEARS 1783 AND 1784.

The beginning of the month of July was unusually cool; insomuch that the mercury in Fahrenheit's thermometer stood at 61° in the day time, and fires were very comfortable, especially in the evening. In the last week but one of this month, the weather suddenly became so warm, that the mercury rose to 94-1/2°, at which it remained for three days. As this heat was accompanied by no breeze from any quarter, the sense of it was extremely distressing to many people. Upwards of twenty persons died in the course of those three days, from the excess of the heat, and from drinking cold water. Three old people died suddenly within this space of time. This extreme heat was succeeded by cool weather, the mercury having fallen to 60°, and the month closed with producing a few intermitting and remitting fevers, together with several cases of inflammatory angina.

The weather in the month of August was extremely variable. The mercury, after standing for several days at 92°, suddenly fell so low, as not only to render fires necessary, but in many places to produce frost.

Every form of fever made its appearance in this month. The synocha was so acute, in several cases, as to require from three to four bleedings. The remitting fever was accompanied by an uncommon degree of nausea and faintness. Several people died, after a few days' illness, of the malignant bilious fever, or typhus gravior, of Dr. Cullen. The intermittents had nothing peculiar in them, in their symptoms or method of cure.

Towards the close of the month, the scarlatina anginosa made its appearance, chiefly among children.

The month of September was cool and dry, and the scarlatina anginosa became epidemic among adults as well as young people. In most of the patients who were affected by it, it came on with a chilliness and a sickness at the stomach, or a vomiting; which last was so invariably present, that it was with me a pathognomonic sign of the disease. The matter discharged from the stomach was always bile. The swelling of the throat was in some instances so great, as to produce a difficulty of speaking, swallowing, and breathing. In a few instances, the speech was accompanied by a squeaking voice, resembling that which attends the cynanche trachealis. The ulcers on the tonsils were deep, and covered with white, and, in some instances, with black sloughs. In several cases, there was a discharge of a thick mucus from the nose, from the beginning, but it oftener occurred in the decline of the disease, which most frequently happened on the fifth day. Sometimes the subsiding of the swelling of the throat was followed by a swelling behind the ears.

An eruption on the skin generally attended the symptoms which have been described. But this symptom appeared with considerable variety. In some people it preceded, and in others it followed the ulcers and swelling of the throat. In some, it appeared only on the outside of the throat, and on the breast; in others, it appeared chiefly on the limbs. In a few it appeared on the second or third day of the disease, and never returned afterwards. I saw two cases of eruption without a single symptom of sore throat. The face of one of those patients was swelled, as in the erisypelas. In the other, a young girl of seven years old, there was only a slight redness on the skin. She was seized with a vomiting, and died delirious in fifty-four hours. Soon after her death, a livid colour appeared on the outside of her throat.

The bowels, in this degree of the disease, were in general regular. I can recollect but few cases which were attended by a diarrh[oe]a.

The fever which accompanied the disease was generally the typhus mitior of Doctor Cullen. In a few cases it assumed symptoms of great malignity.

The disease frequently went off with a swelling of the hands and feet. I saw one instance in a gentlewoman, in whom this swelling was absent, who complained of very acute pains in her limbs, resembling those of the rheumatism.

In two cases which terminated fatally, there were large abscesses; the one on the outside, and the other on the inside of the throat. The first of these cases was accompanied by troublesome sores on the ends of the fingers. One of these patients lived twenty-eight, and the other above thirty days, and both appeared to die from the discharge which followed the opening of their abscesses.

Between the degrees of the disease which I have described, there were many intermediate degrees of indisposition which belonged to this disease.

I saw in several cases a discharge from behind the ears, and from the nose, with a slight eruption, and no sore throat. All these patients were able to sit up, and walk about.

I saw one instance of a discharge from the inside of one of the ears in a child, who had ulcers in his throat, and the squeaking voice.

In some, a pain in the jaw, with swellings behind the ears, and a slight fever, constituted the whole of the disease.

In one case, the disease came on with a coma, and in several patients it went off with this symptom.

A few instances occurred of adults, who walked about, and even transacted business, until a few hours before they died.

The intermitting fever, which made its appearance in August, was not lost during the month of September. It continued to prevail, but with several peculiar symptoms. In many persons it was accompanied by an eruption on the skin, and a swelling of the hands and feet. In some, it was attended by a sore throat and pains behind the ears. Indeed, such was the predominance of the scarlatina anginosa, that many hundred people complained of sore throats, without any other symptom of indisposition. The slightest occasional or exciting cause, and particularly cold, seldom failed of producing the disease.

The month of October was much cooler than September, and the disease continued, but with less alarming symptoms. In several adults, who were seized with it, the hardness of the pulse indicated blood-letting. The blood, in one case, was covered with a buffy coat, but beneath its surface it was dissolved.

In the month of November, the disease assumed several inflammatory symptoms, and was attended with much less danger than formerly. I visited one patient whose symptoms were so inflammatory as to require two bleedings. During the decline of the disease, many people complained of troublesome sores on the ends of their fingers. A number of children likewise had sore throats and fevers, with eruptions on their skins, which resembled the chicken-pox. I am disposed to suspect that this eruption was the effect of a spice of the scarlatina anginosa, as several instances occurred of patients who had all the symptoms of this disease, in whom an eruption of white blisters succeeded their recovery. This form of the disease has been called by Sauvage, the scarlatina variolosa.

I saw one case of sore throat, which was succeeded not only by swellings in the abdomen and limbs, but by a catarrh, which brought on a fatal consumption.

A considerable shock of an earthquake was felt on the 29th of this month, at ten o'clock at night, in the city of Philadelphia; but no change was perceived in the disease, in consequence of it.

In December, January, and February, the weather was intensely cold. There was a thaw for a few days in January, which broke the ice of the Delaware, but it was followed by cold so excessive, as to close the river till the beginning of March. The mercury, on the 28th and 29th of February, stood below 0 in Fahrenheit's thermometer.

For a few weeks in the beginning of December, the disease disappeared in the circle of my patients, but it broke out with great violence the latter end of that month, and in the January following. Some of the worst cases that I met with (three of which proved fatal) were in those two months.

The disease disappeared in the spring, but it spread afterwards through the neighbouring states of New-Jersey, Delaware, and Maryland.

I shall now add an account of the remedies which I administered in this disease.

In every case that I was called to, I began the cure by giving a vomit joined with calomel. The vomit was either tartar emetic or ipecacuanha, according to the prejudices, habits, or constitutions of my patients. A quantity of bile was generally discharged by this medicine. Besides evacuating the contents of the stomach, it cleansed the throat in its passage downwards. To ensure this effect from the calomel, I always directed it to be given mixed with syrup or sugar and water, so as to diffuse it generally over every part of the throat. The calomel seldom failed to produce two or three stools. In several cases I was obliged, by the continuance of nausea, to repeat the emetics, and always with immediate and obvious advantage. I gave the calomel in moderate doses in every stage of the disease. To restrain its purgative effects, when necessary, I added to it a small quantity of opium.

During the whole course of the disease, where the calomel failed of opening the bowels, I gave lenient purges, when a disposition to costiveness required them.

The throat was kept clean by detergent gargles. In several instances I saw evident advantages from adding a few grains of calomel to them. In cases of great difficulty of swallowing or breathing, the patients found relief from receiving the steams of warm water mixed with a little vinegar, through a funnel into the throat.

A perspiration kept up by gentle doses of antimonials, and diluting drinks, impregnated with wine, always gave relief.

In every case which did not yield to the above remedies on the third day, I applied a blister behind each ear, or one to the neck, and, I think, always with good effects.

I met with no cases in which the bark appeared to be indicated, except the three in which the disease proved fatal. Where the sore throat was blended with the intermitting fever, the bark was given with advantage. But in common cases it was unnecessary. Subsequent observations have led me to believe, with Doctor Withering, that it is sometimes hurtful in this disease.

It proved fatal in many parts of the country, upon its first appearance; but wherever the mode of treatment here delivered was adopted, its mortality was soon checked. The calomel was used very generally in New-Jersey and New-York. In the Delaware state, a physician of character made it a practice not only to give calomel, but to anoint the outside of the throat with mercurial ointment.

ADDITIONAL OBSERVATIONS

UPON THE

_Scarlatina Anginosa_.

This disease has prevailed in Philadelphia, at different seasons, ever since the year 1783. It has blended itself occasionally with all our epidemics. Many cases have come under my notice since its first appearance, in which dropsical swellings have succeeded the fever. In some instances there appeared to be effusions of water not only in the limbs and abdomen, but in the thorax. They yielded, in every case that I attended, to purges of calomel and jalap. Where these swellings were neglected, they sometimes proved fatal.

In the winter of 1786-7, the scarlatina anginosa was blended with the cynanche parotidea, and in one instance with a typhus mitior. The last was in a young girl of nine years of age. She was seized with a vomiting of bile and an efflorescence on her breast, but discovered no other symptoms of the scarlatina anginosa till the sixteenth day of her fever, when a swelling appeared on the outside of her throat, and after her recovery, a pain and swelling in one of her knees.

In the month of July, 1787, a number of people were affected by sudden swellings of their lips and eyelids. These swellings generally came on in the night, were attended with little or no pain, and went off in two or three days. I met with only one case in which there was a different issue to these symptoms. It was in a patient in the Pennsylvania hospital, in whom a swelling in the lips ended in a suppuration, which, notwithstanding the liberal use of bark and wine, proved fatal in the course of twelve days.

In the months of June and July, 1788, a number of people were affected by sudden swellings, not only of the lips, but of the cheeks and throat. At the same time many persons were affected by an inflammation of the eyes. The swellings were attended with more pain than they were the year before, and some of them required one or two purges to remove them; but in general they went without medicine, in two or three days.

Is it proper to refer these complaints to the same cause which produces the scarlatina anginosa?

The prevalence of the scarlatina anginosa at the _same time_ in this city; its disposition to produce swellings in different parts of the body; and the analogy of the intermitting fever, which often conceals itself under symptoms that are foreign to its usual type; all seem to render this conjecture probable. In one of the cases of an inflammation of the eye, which came under my notice, the patient was affected by a vomiting a few hours before the inflammation appeared, and complained of a sickness at his stomach for two or three days afterwards. Now a vomiting and nausea appear to be very generally symptoms of the scarlatina anginosa.

In the autumn of 1788, the scarlatina anginosa appeared with different degrees of violence in many parts of the city. In two instances it appeared with an obstinate diarrh[oe]a; but it was in young subjects, and not in adults, as described by Doctor Withering. In both cases, the disease proved fatal; the one on the third, the other on the fifth day.

In the month of December of the same year, I saw one case in which a running from one of the ears, and a deafness came on, on the fifth day, immediately after the discharge of mucus from the nose had ceased. This case terminated favourably on the ninth day, but was succeeded, for several days afterwards, by a troublesome cough.

I shall conclude this essay by the following remarks:

1. Camphor has often been suspended in a bag from the neck, as a preservative against this disease. Repeated observations have taught me, that it possesses little or no efficacy for this purpose. I have had reason to entertain a more favourable opinion of the benefit of washing the hands and face with vinegar, and of rinsing the mouth and throat with vinegar and water every morning, as means of preventing this disease.

2. Whenever I have been called to a patient where the scarlatina appeared to be in a _forming_ state, a vomit of ipecacuanha or tartar emetic, mixed with a few grains of calomel, has never failed of completely checking the disease, or of so far mitigating its violence, as to dispose it to a favourable issue in a few days; and if these observations should serve no other purpose than to awaken the early attention of patients and physicians to this speedy and effectual remedy, they will not have been recorded in vain.

3. When the matter which produces this disease has been received into the body, a purge has prevented its being excited into action, or rendered it mild, throughout a whole family. For this practice I am indebted to some observations on the scarlatina, published by Dr. Sims in the first volume of the Medical Memoirs.

4. During the prevalence of the inflammatory constitution of the atmosphere, between the years 1793 and 1800, this disease occurred occasionally in Philadelphia, and yielded, like the other epidemics of those years, to copious blood-letting, and other depleting remedies.

AN INQUIRY

INTO

THE CAUSE AND CURE

OF

_THE CHOLERA INFANTUM_.

By this name I mean to designate a disease, called, in Philadelphia, the "vomiting and purging of children." From the regularity of its appearance in the summer months, it is likewise known by the name of "the disease of the season." It prevails in most of the large towns of the United States. It is distinguished in Charleston, in South Carolina, by the name of "the April and May disease," from making its first appearance in those two months. It seldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency and danger are always in proportion to the heat of the weather. It affects children from the first or second week after their birth, till they are two years old. It sometimes begins with a diarrh[oe]a, which continues for several days without any other symptom of indisposition; but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter discharged from the stomach and bowels is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children, in this stage of the disease, appear to suffer a good deal of pain. They draw up their feet, and are never easy in one posture. The pulse is quick and weak. The head is unusually warm, while the extremities retain their natural heat, or incline to be cold. The fever is of the remitting kind, and discovers evident exacerbations, especially in the evenings. The disease affects the head so much, as in some instances to produce symptoms not only of delirium, but of mania, insomuch that the children throw their heads backwards and forwards, and sometimes make attempts to scratch, and to bite their parents, nurses, and even themselves. A swelling frequently occurs in the abdomen, and in the face and limbs. An intense thirst attends every stage of the disease. The eyes appear languid and hollow, and the children generally sleep with them half closed. Such is the insensibility of the system in some instances in this disease, that flies have been seen to alight upon the eyes when open, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally the purging continues without the vomiting, through the whole course of the disease. The stools are frequently large, and extremely f[oe]tid, but in some instances they are without smell, and resemble drinks and aliment which have been taken into the body. The disease is sometimes fatal in a few days. I once saw it carry off a child in four and twenty hours. Its duration is varied by the season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence, and disposes it to a favourable termination. It often continues, with occasional variations in its appearance, for six weeks or two months. Where the disease has been of long continuance, the approach of death is gradual, and attended by a number of distressing symptoms. An emaciation of the body to such a degree, as that the bones come through the skin, livid spots, a singultus, convulsions, a strongly marked hippocratic countenance, and a sore mouth, generally precede the fatal termination of this disease. Few children ever recover, after the last symptoms which have been mentioned make their appearance.

This disease has been ascribed to several causes; of each of which I shall take notice in order.

I. It has been attributed to dentition. To refute this opinion, it will be necessary to observe, that it appears only in one season of the year. Dentition, I acknowledge, sometimes aggravates it; hence we find it is most severe in that period of life, when the greatest number of teeth make their appearance, which is generally about the 10th month. I think I have observed more children to die of this disease at that age, than at any other.

II. Worms have likewise been suspected of being the cause of this disease. To this opinion, I object the uncertainty of worms ever producing an idiopathic fever, and the improbability of their combining in such a manner as to produce an annual epidemic disease of any kind. But further, we often see the disease in all its force, before that age, in which worms usually produce diseases; we likewise often see it resist the most powerful anthelmintic medicines; and, lastly, it appears from dissection, where the disease has proved fatal, that not a single worm has been discovered in the bowels. It is true, worms are in some instances discharged in this disease, but they are frequently discharged in greater numbers in the hydrocephalus internus, and in the small-pox, and yet who will assert either of those diseases to be produced by worms.

III. The summer fruits have been accused of producing this disease. To this opinion I object, that the disease is but little known in country places, where children eat much more fruit than in cities. As far as I have observed, I am disposed to believe, that the moderate use of ripe fruits, rather tends to prevent, than to induce the disease.

From the discharge of bile which generally introduces the disease, from the remissions and exacerbations of the fever which accompanies it, and from its occurring nearly in the same season with the cholera and remitting fever in adults, I am disposed to consider it as a modification of the same diseases. Its appearance earlier in the season than the cholera and remitting fever in adults, must be ascribed to the constitutions of children being more predisposed from weakness to be acted upon, by the remote causes which produce those diseases.

I shall now mention the remedies which are proper and useful in this disease.

I. The first indication of cure is to evacuate the bile from the stomach and bowels. This should be done by gentle doses of ipecacuanha, or tartar emetic. The vomits should be repeated occasionally, if indicated, in every stage of the disease. The bowels should be opened by means of calomel, manna, castor oil, or magnesia. I have generally found rhubarb improper for this purpose, while the stomach was in a very irritable state. In those cases, where there is reason to believe that the offending contents of the primæ viæ have been discharged by nature (which is often the case), the emetics and purges should by no means be given; but, instead of them, recourse must be had to

II. Opiates. A few drops of liquid laudanum, combined in a testaceous julep, with peppermint or cinnamon-water, seldom fail of composing the stomach and bowels. In some instances, this medicine alone subdues the disease in two or three days; but where it does not prove so successful, it produces a remission of pain, and of other distressing symptoms, in every stage of the disease.

III. Demulcent and diluting drinks have an agreeable effect in this disease. Mint and mallow teas, or a tea made of blackberry roots infused in cold water, together with a decoction of the shavings of hartshorn and gum arabic with cinnamon, should all be given in their turns for this purpose.

IV. Glysters made of flaxseed tea, or of mutton broth, or of starch dissolved in water, with a few drops of liquid laudanum in them, give ease, and produce other useful effects.

V. Plasters of Venice treacle applied to the region of the stomach, and flannels dipped in infusions of bitter and aromatic herbs in warm spirits, or Madeira wine, and applied to the region of the abdomen, often afford considerable relief.

VI. As soon as the more violent symptoms of the disease are composed, tonic and cordial medicines should be given. The bark in decoction, or in substance (where it can be retained in that form), mixed with a little nutmeg, often produces the most salutary effects. Port wine or claret mixed with water are likewise proper in this stage of the disease. After the disease has continued for some time, we often see an appetite suddenly awakened for articles of diet of a stimulating nature. I have seen many children recover from being gratified in an inclination to eat salted fish, and the different kinds of salted meat. In some instances they discover an appetite for butter, and the richest gravies of roasted meats, and eat them with obvious relief to all their symptoms. I once saw a child of sixteen months old, perfectly restored, from the lowest stage of this disease, by eating large quantities of rancid English cheese, and drinking two or three glasses of port wine every day. She would in no instance eat bread with the cheese, nor taste the wine, if it was mixed with water.

We sometimes see relief given by the use of the warm bath, in cases of obstinate pain. The bath is more effectual, if warm wine is used, instead of water.

I have had but few opportunities of trying the effects of cold water applied to the body in this disease; but from the benefit which attended its use in the cases in which it was prescribed, I am disposed to believe that it would do great service, could we overcome the prejudices which subsist in the minds of parents against it.

After all that has been said in favour of the remedies that have been mentioned, I am sorry to add, that I have very often seen them all administered without effect. My principal dependence, therefore, for many years, has been placed upon

VII. Country air. Out of many hundred children whom I have sent into the country, in every stage of this disease, I have lost but three; two of whom were sent, contrary to my advice, into that unhealthy part of the neighbourhood of Philadelphia called the _Neck_, which lies between the city and the conflux of the rivers Delaware and Schuylkill. I have seen one cure performed by this remedy, after convulsions had taken place. To derive the utmost benefit from the country air, children should be carried out on horseback, or in a carriage, every day; and they should be exposed to the open air as much as possible in fair weather, in the day time. Where the convenience of the constant benefit of country air cannot be obtained, I have seen evident advantages from taking children out of the city once or twice a day. It is extremely agreeable to see the little sufferers revive as soon as they escape from the city air, and inspire the pure air of the country.

I shall conclude this inquiry, by recommending the following methods of preventing this disease, all of which have been found by experience to be useful.

1. The daily use of the cold bath.

2. A faithful and attentive accommodation of the dresses of children, to the state and changes of the air.

3. A moderate quantity of salted meat taken occasionally in those months in which this disease usually prevails. It is perhaps in part from the daily use of salted meat in diet, that the children of country people escape this disease.

4. The use of sound old wine in the summer months. From a tea-spoon-full, to half a wine glass full, according to the age of the child, may be given every day. It is remarkable, that the children of persons in easy circumstances, who sip occasionally with their parents the remains of a glass of wine after dinner, are much less subject to this disease, than the children of poor people, who are without the benefit of that article of diet.

5. Cleanliness, both with respect to the skin and clothing of children. Perhaps the neglect of this direction may be another reason why the children of the poor, are most subject to this disease.

6. The removal of children into the country before the approach of warm weather. This advice is peculiarly necessary during the whole period of dentition. I have never known but one instance of a child being affected by this disease, who had been carried into the country in order to avoid it.

I have only to add to the above observations, that since the prevalence of the yellow fever in Philadelphia after the year 1793, the cholera infantum has assumed symptoms of such malignity, as to require bleeding to cure it. In some cases, two and three bleedings were necessary for that purpose.

OBSERVATIONS

ON THE

_CYNANCHE TRACHEALIS_.

The vulgar name of this disease in Pennsylvania is HIVES. It is a corruption of the word _heaves_, which took its rise from the manner in which the lungs heave in breathing. The worst degree of the disease is called the BOWEL HIVES, from the great motion of the abdominal muscles in respiration.

It has been called suffocatio stridula by Dr. Home, and cynanche trachealis by Dr. Cullen. Professor Frank calls it trachitis, and Dr. Darwin considers it as a pleurisy of the windpipe. By the two latter names, the authors mean to convey the correct idea, that the disease is the same in its nature with the common diseases of other internal parts of the body.

It is brought on by the same causes which induce fever, particularly by cold. I have seen it accompany, as well as succeed, the small-pox, measles, scarlet-fever, and apthous sore throat. In the late Dr. Foulke it succeeded acute rheumatism. The late Dr. Sayre informed me, he had seen it occur in a case of yellow fever, in the year 1798.

It sometimes comes on suddenly, but it more frequently creeps on in the form of a common cold. Its symptoms are sometimes constant, but they more generally remit, particularly during the day. It attacks children of all ages, from three months to five years old. But it occasionally attacks adults. It generally runs its course in three or four days, but we now and then see it protracted in a chronic and feeble form, for eight and ten days.

Dissections show the following appearances in the trachea. 1. A slight degree of inflammation. 2. A thick matter resembling mucus. 3. A membrane similar to that which succeeds inflammation in the pleura and bowels, formed from the coagulating lymph of the blood. 4. In some cases the trachea exhibits no marks of disease of any kind. These cases are generally violent, and terminate suddenly. The morbid excitement here transcends inflammation. Similar instances of the absence of the common signs of disease after death, occur in other parts of the body. Where the cynanche trachealis has appeared in the high grade which has been last mentioned, it has been called spasmodic. Where the serous vessels of the trachea have been tinged with red blood, it has been considered as inflammatory. Where a liquid matter has been found in the trachea, it has been called humoral; and where a membrane has been seen adhering to the trachea, it has received from Dr. Michaelis the name of angina polyposa. But all these different issues of the cynanche trachealis are the effects of a difference only in its force, or in its duration: they all depend upon one remote, and one proximate cause.

In the _forming_ state of this disease, which may be easily known by a hoarseness, and a slight degree of stertorous cough, a puke of antimonial wine, tartar emetic, ipecacuanha, or oxymel of squills, is for the most part an immediate cure. To be effectual, it should operate four or five times. Happily children are seldom injured by a little excess in the operation of this class of medicines. I have prevented the formation of this disease many hundred times, and frequently in my own family, by means of this remedy.

After the disease is completely formed, and appears with the usual symptoms described by authors, the remedies should be

1. Blood-letting. The late Dr. Bailie of New-York used to bleed until fainting was induced. His practice has been followed by Dr. Dick of Alexandria, and with great success. I have generally preferred small, but frequent, to copious bleedings. I once drew twelve ounces of blood, at four bleedings, in one day, from a son of Mr. John Carrol, then in the fourth year of his age. Dr. Physick bled a child, of but three months old, three times in one day. Life was saved in both these cases. Powerful as the lancet is, in this disease, its violence and danger require that it should be aided by

2. Vomits. These should be given every day, or oftener, during the continuance of the disease. Their good effects are much more obvious and certain in a disease of the trachea, than of the lungs, and hence their greater utility, as I shall say hereafter, in a consumption from a catarrh, than from any other of its causes.

3. Purges. These should consist of calomel and jalap, or rhubarb, and should always follow the use of emetics, if they fail of opening the bowels.

4. Calomel should likewise be given in large doses. Dr. Physick gave half a drachm of this medicine, in one day, to the infant whose case has been mentioned. I have never known it excite a salivation when given to children whose ages rendered them subjects of it, probably because it has been given in such large quantities as to pass rapidly through the bowels. Its good effects seem to depend upon its exciting a counter-action in the whole intestinal canal, and thereby lessening the disposition of the tracheal blood-vessels to discharge the mucus, or form the membrane, which have been described.

5. Blisters should be applied to the throat, breast, neck, and even to the limbs.

6. Dr. Archer of Maryland commends, in high terms, the use of polygola, or Seneka snake-root, in this disease. I can say nothing in favour of its exclusive use, from my own experience, having never given it, but as an auxiliary to other remedies.

7. I have seen great relief given by the use of the warm bath, especially when it has been followed by a gentle perspiration.

8. Towards the close of the disease, after the symptoms of great morbid action begin to decline, a few drops of liquid laudanum, by quieting the cough which generally succeeds it, often produce the most salutary effects. They should be given in flaxseed, or bran, or onion tea, of which drinks the patient should drink freely in every stage of the disease.

The cynanche trachealis is attended with most danger, when the patient labours under a _constant_ and audible stertorous breathing. The danger is less, when a dry stertorous cough attends, with _easy_ respiration in its intervals. The danger is nearly over, when the cough, though stertorous, is _loose_, and accompanied with a _discharge_ of mucus from the trachea.

An eruption of little red blotches, which frequently appears and disappears two or three times in the course of this disease, is always a favourable symptom.

I once attended a man from Virginia, of the name of Bampfield, who, after an attack of this disease, was much distressed with the stertorous breathing and cough which belong to it. I suspected both to arise from a membrane formed by inflammation in his trachea. This membrane I supposed to be in part detached from the trachea, from the rattling noise which attended his breathing. He had used many remedies for it to no purpose. I advised a salivation, which in less than three weeks perfectly cured him.

Since the general adoption of the remedies which have been enumerated, for the cynanche trachealis, instances of its mortality have become very uncommon in the city of Philadelphia.

AN ACCOUNT

OF THE EFFICACY OF

BLISTERS AND BLEEDING,

IN THE CURE OF OBSTINATE

_Intermitting Fevers_.

The efficacy of these remedies will probably be disputed by every regular-bred physician, who has not been a witness of their utility in the above disease; but it becomes such physicians, before they decide upon this subject, to remember, that many things are true in medicine, as well as in other branches of philosophy, which are very improbable.

In all those cases of _autumnal_ intermittents, whether quotidian, tertian, or quartan, in which the bark did not succeed after three or four days trial, I have seldom found it fail after the application of blisters to the wrists.

But in those cases where blisters had been neglected, or applied without effect, and where the disease had been protracted into the _winter_ months, I have generally cured it by means of one or two moderate bleedings.

The pulse in those cases is generally full, and sometimes a little hard, and the blood when drawn for the most part appears sizy.

The bark is seldom necessary to prevent the return of the disease. It is always ineffectual, where blood-letting is indicated. I have known several instances where pounds of that medicine have been taken without effect, in which the loss of ten or twelve ounces of blood has immediately cured the disease.

I once intended to have added to this account of the efficacy of blisters and bleeding in curing obstinate intermittents, testimonies from a number of medical gentlemen, of the success with which they have used them; but these vouchers have become so numerous, that they would swell this essay far beyond the limits I wish to prescribe to it.

AN ACCOUNT

OF

THE DISEASE OCCASIONED

BY

_DRINKING COLD WATER_

IN WARM WEATHER,

AND THE METHOD OF CURING IT.

Few summers elapse in Philadelphia, in which there are not instances of many persons being diseased by drinking cold water. In some seasons, four or five persons have died suddenly from this cause, in one day. This mortality falls chiefly upon the labouring part of the community, who seek to allay their thirst by drinking the water from the pumps in the streets, and who are too impatient, or too ignorant, to use the necessary precautions for preventing its morbid or deadly effects upon them. These accidents seldom happen, except when the mercury rises above 85° in Fahrenheit's thermometer.

Three circumstances generally concur to produce disease or death, from drinking cold water. 1. The patient is extremely warm. 2. The water is extremely cold. And 3. A large quantity of it is suddenly taken into the body. The danger from drinking the cold water is always in proportion to the degrees of combination which occur in the three circumstances that have been mentioned.

The following symptoms generally follow, where cold water has been taken, under the above circumstances, into the body:

In a few minutes after the patient has swallowed the water, he is affected by a dimness of sight; he staggers in attempting to walk, and, unless supported, falls to the ground; he breathes with difficulty; a rattling is heard in his throat; his nostrils and cheeks expand and contract in every act of respiration; his face appears suffused with blood, and of a livid colour; his extremities become cold, and his pulse imperceptible; and, unless relief be speedily obtained, the disease terminates in death, in four or five minutes.

This description includes only the less common cases of the effects of drinking a _large_ quantity of _cold_ water, when the body is _preternaturally_ heated. More frequently, patients are seized with acute spasms in the breast and stomach. These spasms are so painful as to produce syncope, and even asphyxia. They are sometimes of the tonic, but more frequently of the clonic kind. In the intervals of the spasms, the patient appears to be perfectly well. The intervals between each spasm become longer or shorter, according as the disease tends to life or death.

It may not be improper to take notice, that punch, beer, and even toddy, when drunken under the same circumstances as cold water, have all been known to produce the same morbid and fatal effects.

I know of but one certain remedy for this disease, and that is LIQUID LAUDANUM. The doses of it, as in other cases of spasm, should be proportioned to the violence of the disease. From a tea-spoonful to near a table-spoonful have been given in some instances, before relief has been obtained. Where the powers of life appear to be suddenly suspended, the same remedies should be used, which have been so successfully employed in recovering persons supposed to be dead from drowning.

Care should be taken in every case of disease, or apparent death, from drinking cold water, to prevent the patient's suffering from being surrounded, or even attended by too many people.

Persons who have been recovered from the immediate danger which attends this disease, are sometimes affected after it, by inflammations and obstructions in the breast or liver. These generally yield to the usual remedies which are administered in those complaints, when they arise from other causes.

If neither the voice of reason, nor the fatal examples of those who have perished from this cause, are sufficient to produce restraint in drinking a _large_ quantity of _cold_ liquors, when the body is _preternaturally_ heated, then let me advise to

1. Grasp the vessel out of which you are about to drink for a minute or longer, with both your hands. This will abstract a portion of heat from the body, and impart it at the same time to the cold liquor, provided the vessel be made of metal, glass, or earth; for heat follows the same laws, in many instances, in passing through bodies, with regard to its relative velocity, which we observe to take place in electricity.

2. If you are not furnished with a cup, and are obliged to drink by bringing your mouth in contact with the stream which issues from a pump, or a spring, always wash your hands and face, previously to your drinking, with a little of the cold water. By receiving the shock of the water first upon those parts of the body, a portion of its heat is conveyed away, and the vital parts are thereby defended from the action of the cold.

By the use of these preventives, inculcated by advertisements pasted upon pumps by the Humane Society, death from drinking cold water has become a rare occurrence for many years past in Philadelphia.

AN ACCOUNT

OF THE

_EFFICACY OF COMMON SALT_,

IN THE CURE OF

HÆMOPTYSIS.

From the present established opinions and practice respecting the cause and cure of hæmoptysis, the last medicine that would occur to a regular-bred physician for the cure of it, is COMMON SALT; and yet I have seen and heard of a great number of cases, in which it has been administered with success.

The mode of giving it is to pour down from a tea to a table-spoonful of clean fine salt, as soon as possible after the hæmorrhage begins from the lungs. This quantity generally stops it; but the dose must be repeated daily for three or four days, to prevent a return of the disease. If the bleeding continue, the salt must be continued till it is checked, but in larger doses. I have heard of several instances in which two table spoons-full were taken at one time for several days.

It sometimes excites a sickness at the stomach, and never fails to produce a burning sensation in the throat, in its passage into the stomach, and considerable thirst afterwards.

I have found this remedy to succeed equally well in hæmorrhages, whether they occurred in young or in old people, or with a weak or active pulse.

I had prescribed it for several years before I could satisfy myself with a theory, to account for its extraordinary action upon the human body. My inquiries led me to attend more particularly to the following facts:

1. Those persons who have been early instructed in vocal music, and who use their vocal organs moderately through life, are seldom affected by a hæmorrhage from the lungs.

2. Lawyers, players, public cryers, and city watchmen, all of whom exercise their lungs either by long or loud speaking, are less affected by this disease, than persons of other occupations.

I acknowledge I cannot extend this observation to the public teachers of religion. I have known several instances of their being affected by hæmoptysis; but never but one in which the disease came on in the pulpit, and that was in a person who had been recently cured of it. The cases which I have seen, have generally been brought on by catarrhs.

To this disease, the practice of some of our American preachers disposes them in a peculiar manner; for it is very common with this class of them, to expose themselves to the cold or evening air, immediately after taking what a celebrated and eloquent preacher used to call a _pulpit sweat_.

3. This hæmorrhage chiefly occurs in debilitated habits, or in persons afflicted by such a predisposition to consumption, as indicates a weak and relaxed state of the lungs.