Chapter IX: Front Matter (9)

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].

[68] The late Mr. Andrew Spence was the first regular bred dentist that
settled in Philadelphia. There are now several well educated
gentlemen in the city of that profession.

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!

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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.
----, 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