--- Page 1 --- --- Page 2 --- i Wabit Carter roion Liltary Bmunt lluttersitt --- Page 3 --- --- Page 4 --- A29a --- Page 5 --- --- Page 6 --- --- Page 7 --- A N E NQU 1e I R Y INTO THE. NATURE, AND CAUSES OF THE GREAT MORTALITY AMONG THE TROOPS AT S 1 T. DOMINGO: WITH PRACTICAL REMAI R K S a ON-THE F E V'E R OF THAT ISLAND; AND DIRECTIONS FOR THE CONDUCT OF EUROPEANS ON THEIR FIRST ARRIVAL IN WARM CLIMATES. B Y HECTOR MLEA N, M. D. ASSISTANT INSPECTOR OF HOSPITALS FOR ST. DOMINGO. Cazfa latet, vis ef notifima. L 0 N DO N: Printed for T. CADELL, Jun. and W. DAVIES (Succeffors to MrCADELL) in the Strand, M.DCC.XCVII, --- Page 8 --- --- Page 9 --- TO HIS ROYAL HIGHNESS FREDERICK AUGUSTUS DUKE OF YOR K, - FIELD MARSHAL, AND COMMANDER IN CHIEF OF ALL HIS MAJESTY's FORCES, &c. &c. &c. &c. THIS ATTE M P T, TO CONTRIBUTE, TOWARDS THE PRESERVATION OF THE HEALTH OF THE ERITISH ARMY, (Ofwhich, in critical Times, HE has been chofen the Guardian; and in the Conduet of which, HE has difplayed, not only, the Hereditary Valour of the HoUsE of BRUNSWICK, but fuch confummate Prudence, and exaEt Propriety 3 as at once, to merit the Applaufe of the PUBLIC, by His Vigilance, and to command the Affection of the SOLDIER, by His Attention and Kindnefs) I S, BY HIS ROYAL HIGHNESS's PERMISSION HUMBLY INSCRIBED, AS A MARK OF THE MOST PROFOUND RESPECT, AND SINCERE GRATITUDEB Y HIS ROYAL HIGHNESS's MOST OBLIGED AND DEVOTED SERVANT, THE AUTHOR, St. James's Place, 26th June 1797. --- Page 10 --- --- Page 11 --- PR E 2 FAC E. FTER the publications, which have already appeared on the Yellow Fever; it may require fome apology, for offering the prefent Work to the Public. The Feverdeferibed byDr.RusH, which raged with fo much violence at Philadelphia, differs very widely from the difeafe, which caufed the aftonifhing mortality of St. Domingo. Nor does the peftilence of Boullam, as defcribed by Dr. CHISHOLM, bear any ftriking refemblance to the Endemic Remittent, which made fuch havock amongour troops. a 3 They require fome apology, for offering the prefent Work to the Public. The Feverdeferibed byDr.RusH, which raged with fo much violence at Philadelphia, differs very widely from the difeafe, which caufed the aftonifhing mortality of St. Domingo. Nor does the peftilence of Boullam, as defcribed by Dr. CHISHOLM, bear any ftriking refemblance to the Endemic Remittent, which made fuch havock amongour troops. a 3 They --- Page 12 --- vi PREFACE They defcribe a fever highly. peftilential, and contagious; whereas the fevèr of St. Domingo, never manifefted any fuch difpofition. Having had the beft opportunitics, during a refidence of nearly of three years at Port-au-Prince ; obferving the progrefs, and treatment of the St. Domingo Remittent; I thought it my duty to communicate the refult of my experience, and the obfervations I made the and of the fei on genius type It be the fate of a ver. may. again, Britifh army, to vifit this inhofpitable ifland, and to fuffer from its difeafes ; 3 it is therefore of importance to colleét every information, which enable us, to € avoid may them with more 6 them, or to combat fuccefs, --- Page 13 --- PREFACE vii fuccefs, when they occur. Every praétitioner ought to come forward, with his ftock of faéts, and,obfervations ; for the benefit of the Public. : The mortality at St. Domingo; has filled the minds of with terror and every one aftonifhment; and though men of diftinguifhed abilities in their profeflion, affiduoufly attended the fick ; their fuccefs was by no means, proportioned to their exertions or talents. When many minds, however, are occupied in one refearch, the fubjedt is viewi ed in various lights 3 and, difcoveries lof importance may at length be made. Impreffed with thefe fentiments, I havel thrown ther, the remarks and obfervations, toge: a 4 which --- Page 14 --- viii PREFACE which arofe from an extenfive experience ; during a painful attendon the General Hofpital at ance, To thefe: I have Port-au-Prince. added, whatever appeared to me conneéted with the welfare of an deftined to act in a warm army, 3 31 OO0 climate. The conftant occupation, my furnilhed me, did not profeflion permit me, to: take down fo many hiftories of the difeafe, as Iwifhed; Iwas obliged to make my notés fhort; to retain only, leading and circumflances. The important I have chiefly laboured to points imeftablifh, are of confiderable Ihave endeavoured to portance.. that what has been termed prove, the Yellow Fever of St. Domingo, 1S :4 --- Page 15 --- PREFACE ix is not an infeéious difeafe; that it is not a néw or peculiar diftemper; but the common Remittent Endemic of that country, applied to the Englith conftitution, and nied occafionally with accompayeliownefs, as an accidental fymptom. The dread of its being infcétious, has injured the recruiting fervice, by terrifying young men from eulifting in any Weft India regiment ; and many have been kept in a ftate of continual alarm and terror, when the fervice required them. to have the leaft communication with the fick. It is pleafing to refleét, that the general teflimony of all the phyficians.at St. Domingo, declares that the Remittent of that ifland is not contagious. One fource of fear, is thus removed.; a fource,which has unne- fervice, by terrifying young men from eulifting in any Weft India regiment ; and many have been kept in a ftate of continual alarm and terror, when the fervice required them. to have the leaft communication with the fick. It is pleafing to refleét, that the general teflimony of all the phyficians.at St. Domingo, declares that the Remittent of that ifland is not contagious. One fource of fear, is thus removed.; a fource,which has unne- --- Page 16 --- X PREFACE unneceflarily, alarmed and terrified all thofe, who embarked for this elimate. I have endeavoured to fhow the caufes, which render the Weftern climate peculiarly dangerous to our youth; and I have recommended a fcheme of recruiting men, for this fervice, at a more advanced period of life. The chance ofliving,in a warm climate increafes, as we advance from thirty-five to fifty years of age. Men at thefe periods, may enjoy health at St. Domingo, and perform aétive duties. I have founded my plan of Prevention, on the theory I adopted refpedting the caufes, which rendered the Remittent fo deftruétive. The --- Page 17 --- PREFACE xi The rules for diet and exercife the refult.of experience, and are vation, and I truft will,be obferreal found of utility ; as they: apply to allwarm climates. 03 23 dort Ei +1 The method of TOtaaL Inofe Cure, which I purfued, after many Auétuations of opinion and practice, may be too bold, by thofe who have thought feen the not eafe. mapicdprogrefisof the difT It ed; in howewerhappily fucceed. many inftancess 5 and I have candidly fated thes which it was founded, grounds on rious' fuccefs. and its vabafiles In, a difeafe, which ordiniary means, the cian muft feck, phylifources, and éndeayour) extriordinary reto: vigour, what would fmubdueby sommon not yield to expedients. et It --- Page 18 --- sii, PREFACE that in the courfe It is probable, of the work, I have made obfervawhich have been formerly tions, made by others on fimilar fubjects.- to avoid this, in meIt is not eafy it if it occurs, dical reafoning; of the arifes from my ignorance of authors, for I had not the power books during my reperufing any It was a fidence in St. Domingo. with duty, I owed to the Army for their which I ferved; to publith whatever might enable benefit, or fecure. them to avoid danger, their health. To that Army, Iowe which I thall almany obligations, and remember, ways acknowledge, If this work conwith gratitude. Or to intributes to fave one life, troduce a better mode of treating difeafe; I fhall feel this formidable myfelf --- Page 19 --- PREFACE xili myfelf more than rewarded, for labour. my Itis : a pity, that Officers in mand, do not read fuch commedical parts of works, as treat oft the health of foldiers. This kind of knowledge, in warm and unhealthy climates, would prove highly ufeful. The General of an army, be well ought to informed, in whatever regards, the Encampment, Exercife of his foldiers.. Diet, or in the It is not power of medical men, to purfue extenfive plans, without the fupport of the Commanding Officer; they can only recommend, but cannot execute, Their fchemes of health, are more readily complied with, when the officer underfands fally, the principles on which they are in warm and unhealthy climates, would prove highly ufeful. The General of an army, be well ought to informed, in whatever regards, the Encampment, Exercife of his foldiers.. Diet, or in the It is not power of medical men, to purfue extenfive plans, without the fupport of the Commanding Officer; they can only recommend, but cannot execute, Their fchemes of health, are more readily complied with, when the officer underfands fally, the principles on which they are --- Page 20 --- xiv PREFACE. The works of are recommended. PRINGLE, and MONRO, JACKSON, on this contain valuableinformation fubjeét. Whilft I venture thus before the Public, I muft claim their indulI am fully aware of the imgence; perfeéion of my effay. It was written in the buftle of a few weeks leave of abfence, from the duties of ftation ; to which I am again my The fpeedily to' return. language muft often offend the ear ; and the arrangement is not fo correét as might be wifhed. I have endeavoured to ftate, in the cleareft manwhatever I thought ner I could, interefting Or ufeful. I have blended the matter of faét, and my reafoning, too much together; but my time --- Page 21 --- PREFACE, Xv time would not this permit me to alter arrangement, which would oblige me:to new-model the work. Thefe, and other fuggeftions, made by a friend, celebrated were talents and for his learning; who condefcended to perufe the work, and whofe remarks, would better infure it a reception, if I could avail myfelf of his plan, Itruft this form fome will apology, for the gencral incorreénefs of the performance, I fhall conclude, that by obferving, many praétitioners have their patients, by loft finite fearching for deindications, in the St. Domingo. fever of in Time has been loft, combating the leffer effcéts, fymptoms of the difeafe, or, ject has My obbeen, to alter, if poflible, by fudden --- Page 22 --- - xvi PREFACE fudden and powerful means, all the circumflances of the habit, and by this change, to give rife to a new train of movements. It ought to that when we be ever remembered, in the overcome any morbid aétion, human body, or fufpend its power; is immediately difthat the fyftem ufual laws. pofed, to return to its the aétion, ofa So that to fufpend in the body, is to morbid power, from afford the fyftem a ceffation hoftilities; ifI mdy fo fpeak, and to enable it to recover its ancient conftitution. Upon the whole, I have endeayeured to make this Enquiry as ufeto the Army, for ful as poflible whom alone it was written. --- Page 23 --- CONTENTS. Page INTRODUCTION I CHAPTER I. SECT. I. Cbaraèter of ST. DOMINGO Situation of its Towns Caufès of Ill Healtb State of tbe Britifh in Port-au-Prince a 12 Diference between tbe French and Englith Conftitutions a 14 French Medical Practice examined m 18 SECT. II. Furtber Confderations 01 tbe Cayfes efIll Health Miafmata confidered, and tbe Efe8ls of Moilure a 24 b Tbe SECT. I. Cbaraèter of ST. DOMINGO Situation of its Towns Caufès of Ill Healtb State of tbe Britifh in Port-au-Prince a 12 Diference between tbe French and Englith Conftitutions a 14 French Medical Practice examined m 18 SECT. II. Furtber Confderations 01 tbe Cayfes efIll Health Miafmata confidered, and tbe Efe8ls of Moilure a 24 b Tbe --- Page 24 --- xviii CONTEN T S. Page The Efeltsof Debility on tbe Vafcular Syfuem-Determinatins arife from Debility Chemifiry tbe great Source of Improvement in Medicine Tellownefs, not akvays caufed by Bile SECT. III. Pletboric Habit, dangerous in thbe Remittent 36 Young Men more expofed to danger than otbers-Women and old. Men efcape the Fever a 37 Praôtical inferences, from thefe Fatts - 38 Scheme of recruiting Men at a certain Period of Life SECT. IV. Caufes wbich retard Medical Improvement 41 Surgery and Medicine compared Of Proximate Caufès in Difeale Our Ignorance of tbefe prevents Improvement a CHAP- --- Page 25 --- CONTENTS xix CHAPTER II. SECT. I. Page Tbe Dificulties of preferibing by Indication Abfird Reafoning on fuppofed Proximate Caufès Morbid aétion confitutes Dijafe SECT. II, Opinion of tbe Tellow Fever-It appears to be tbe common Remittent lt is not the Fever of Philadelphia or Boulam Tbe Tellow Fever not contagious Groundsfor tbis Reafoning SECT. III. Caufes of tbe Frequency of tbe Remittent 8I Similar Caufès produce Remittents and Intermittents b 2 State --- Page 26 --- XX CONTENTS Page State ef the Organs in tbe Remittent - 86 Pbenomena in tbe Remittent - 9I Critical Days Caufès wbich excite tbe Fever Diagnofic dificult Prognofic SECT. IV. Two Cafès of tbe Remittent-Frzncb Treatment ef tbem I04 Difpute in Jamaica on the Nature ef tbe Fever III Praclice oftbe Gentlemen at St. Domingo IIS Various Remedies examined - 119 Calomel; Blood-letting 3 B3c. I2I Cafes detailed be Autbor's Treatment of tbe Remittent after confiderable Experione-Comparative Succe/s oftbis Metbod - Praétical Remarks CHAP- --- Page 27 --- CONTENTS. xxi CHAPTER III. SECT. I. Page Means ef Presentin-Changer in the Syfem from Haat-Preparatiue Courfe for a Hot Climate SECT. II. Metbod of treating Troops after landingSituations to be cbofèn for tbeir Refidence Manner of Exercife recommended - Diferent Pofts examined SECT. III. Confderations on General and Regimental Ho/pitals Hofpital Corps, mnftfor tbeir Occupation 235 A Medical Board, recommended witb large Armics a - 241 Tbe Qyalifcatimns of Phyfcians examined 243 + SECT. --- Page 28 --- xxii CONTENTS, SECT. IV. Page Con/iderations 012 Diet adapted to tbe Climate Clarct and Madeira compared 252, Diet recommended by the Autbor Smoking confidered-Its Efeets Flannel examined Cotion Sbirts recommended Bilious Complaints Caufes of Bile a - Cure Of tbe Prickly Heat-Its Caufes, and Nature It is not dangerous, or critical Batbing not dangerous, wben it is out APPENDIX. --- Page 28 --- xxii CONTENTS, SECT. IV. Page Con/iderations 012 Diet adapted to tbe Climate Clarct and Madeira compared 252, Diet recommended by the Autbor Smoking confidered-Its Efeets Flannel examined Cotion Sbirts recommended Bilious Complaints Caufes of Bile a - Cure Of tbe Prickly Heat-Its Caufes, and Nature It is not dangerous, or critical Batbing not dangerous, wben it is out APPENDIX. --- Page 29 --- CONTENTS xxiii APPENDIX Page Reafoning oftbe Autbor confirmed by Practice In Intermittents Fevers Ulcers Lues Venerea Small-Pox a - 341 NOTES --- Page 30 --- E R R A T A. Pp. 310 to 318. the top lines, for The Author's Pradice in Intermittents, &c. read Appendix. --- Page 31 --- I ] INTRODUCTION. THE prefent Enquiry propofes to inveftigate the nature and caufes of the aftonifhing mortality among the troops in St. Domingo; ; a mortality almoft unequalled in the annals of war, and which has néarly annihilated our army in that quarter, or rendered them incapable of energy and exertion. In this view, it is an enquiry of the utmoft importance, as the prefervation of fo many valuable fubjects is involved in it. The I opportunities I have had of obfervation have been numerous and extenfive: a refidence of nearly three years at Port-au-Prince, which might be confidered rather as a general hofpital than a garrifon, enabled me to mark the progrefs of that formidable difeafe, which in this country has obtained, without dif tinction, the name of Yellow Fever. At a very early period, I could not help remarking the unequal warfare carried on, in that quarter, between an and European army a people inured to the climate. The European foldier, languid and relaxed, from the B exceflive --- Page 32 --- INTRODUCTION exceffive heat, had to contend with my, inferior indeed in the art of an encformidable from a frame of war, but body which was adapted to the climate, and. derived and activity from that influence of the vigour by which foreign fun, troops were enervated and exhaufted. In a warm climate, the European foldier requires many comforts; but the naked Brigand climbs the tree for his daily food, and fleeps in perfect fecurity under the broad canopy of the fky. A conteft with fuch a people muft be ever tedious, and uncertain. We cannot uncqual, their faftneffes. purfue them to The neighbouring mountain affords them the fame protedtion and means of exiftence with the one from which they have been juft driven, and an extenfive fertile country affords them perpetual Such a people can only be brought into change. fubjection by a treaty, or overcome by an of negroes, poffeffed of the fame habits army themfelves, but more expert in arms, and led as on by fuch a proportion of as might animate and European troops armies of India encourage them. The are organized on"this principle ; and I am convinced the armies of the Weft would become more victorious by fimilar management. I believe been juft driven, and an extenfive fertile country affords them perpetual Such a people can only be brought into change. fubjection by a treaty, or overcome by an of negroes, poffeffed of the fame habits army themfelves, but more expert in arms, and led as on by fuch a proportion of as might animate and European troops armies of India encourage them. The are organized on"this principle ; and I am convinced the armies of the Weft would become more victorious by fimilar management. I believe --- Page 33 --- INTRODUCTION I believe Sir ADAM WILLIAMSON had in contemplation the commencement, and tually begun this fcheme of acreturn to England war, which his pleating. Under prevented him from coman officer fo pular, and to whom the natives defervedly poftrongly attached, fuch a plan were fo produced the moft beneficial would have lives of thoufands, who have effects 5 the fword of the enemy, but fallen, not by the have been by the climate, would ifland (pared; and the conqueft of the would become more certain and rapid. The temporary more blifhment would expence of the eftahave they no doubt be increafed 3 but diminifhed under an Do we not incur an oppofite plan? the hire of enormous expence in tranfports, and the fhips of war to convoy them ? and attendance of fuffer ftill a greater lofs in the do we not fo many of our valuable deftruétion of troops ? So much I have thought it the general plan ofour my duty to fay on ropeans we muft have operations. Some Euthere, but their ought to be diminithed, and number formed from the they thould be veteran remains ments who have already ferved of the regicome the terrors of the there, and overan additional climate. To fuch men pay: might be granted; no reward B: 2 can --- Page 34 --- INTRODUCTION çan equal the hazard of the fervice. I doubtful whether it would be found am to accept the fubmiffion of the policy they all inclined to fubmit Brigands, were at the prefent moment; they are too numcrous to be and fhould they once more bend under trufted; the lafh of the planter, their habits of indolence and depredation would foon return, and they would again figh for licentious idlenefs. Among new negroes they would be fo many apoftles of fedition, and they would fcatter amongft them the creed of the tional convention; a creed which would make narevolt and murder duty, and which would dignify every aét of horror with the facred name of an enthufiafmn for freedom, The only fcheme of fubduing them to. be, the enlifting appears to me great numbers of them into our army, and forming them into regiments commanded by Britifh officers, or French loyalifts ofa approved fidelity. Military difcipline, without extreme rigour, would habits of fubordination and attachment beget officers 3 and marks of to their diflinétion, beftowed amongft them, would judicioufly litary pride, and an ardour generate miconneét and very neceffary to fupport fuch bodies. The whom we could not employ in this reft, muft be protcéted in fome manner, diftriét, as free men, under French loyalifts ofa approved fidelity. Military difcipline, without extreme rigour, would habits of fubordination and attachment beget officers 3 and marks of to their diflinétion, beftowed amongft them, would judicioufly litary pride, and an ardour generate miconneét and very neceffary to fupport fuch bodies. The whom we could not employ in this reft, muft be protcéted in fome manner, diftriét, as free men, under --- Page 35 --- INTRODUCTION under the aufpices of our $ guardianfhip of government and the fent to fome our laws, Or they muft be other country, or divided watched among the feveral eftates and, re-peopled 1: to exterminate now to be! is perhaps impoffible, and them entirely would not, I truft, be were it. poffible, Britain, who would recommended by Great which ftain the not renew" the fcenes: Spanifh annals ; fcenes which deluged the peaceful plains of the blood ofthat meek Hifpaniola with were its natural and patient race, who poffeffors. DYE Thefe obfervations, dical, are by no means thoughi not frictly meMy objeét is to diminifh foreign to my purpofe. Britifh foldiers in St. the mortality of plan would Domingo; and fuch a more effectually anfwer the pofe, than all the medical exertions purmoft experienced and fkilful of the errors committed in the choice phyficians, The for the of fituations army, on our firft St. Domingo, have been taking poffeffion at fince. Mifled feverely felt ever advice, by erroneous and interefted they were conducted to the moft unhealthy fpot in the Port-au-Prince, they languifhed and dwindled ifland, where any fervice to the caufe away without they were meant to B 3 fupport. --- Page 36 --- INTRODUCTION fupport. Even the advantages gained by the enterprize of the gallant MARKHAM hardly any compenfation for his own individual were lofs, and the many others who porting his exertions, A few perifhed in fapin the Bite of frigates cruifing Lugan would have more advantages than any force gained ftation at Port-au-Prince, we could the grave of our which has proved Army, and which muft have ultimately fallen into our poffeffion. I fhall now proceed to the immediate nefs of this work ; to enquire into the buliof the mortality that has diftreffedour caufes forces, --- Page 37 --- CHAPTER I. SECT. I. Cbaratter of Sr. Dostrnco-Saruatisr ef its Touns-Canfes of Ill Healtb-State of tbe Britith in hurt-acbris-Dfres ben tween the French and Englifh Conftitutions -French Medical Praélice examined. ST-DOMINGO, from the earlieft accounts of its fettlement to the prefent period, has been an ifland remarkably unhealthy. The Spanifh recordsbear the moft unequivocal teftimony yofthe rapid and deftruétive progrefs ofits difeafes, which unpeopled their rifing villages, and difappointed their precipitate rapacity in the purfuit of many of its favourite objeéts. Since the French have had a fhare of this valuable ifland, they have alfo experienced the fatal effeêts of its climate. It was their policy to conceal the ravages of difeafe, and to induce as many as poffible to colonize and B 4 fettle bear the moft unequivocal teftimony yofthe rapid and deftruétive progrefs ofits difeafes, which unpeopled their rifing villages, and difappointed their precipitate rapacity in the purfuit of many of its favourite objeéts. Since the French have had a fhare of this valuable ifland, they have alfo experienced the fatal effeêts of its climate. It was their policy to conceal the ravages of difeafe, and to induce as many as poffible to colonize and B 4 fettle --- Page 38 --- C CHARACTER OF [Chap. I. fettle in this moft luxuriant and fertile try. They fucceeded; and counmany daring adventurers took up their abode in this fruitful region, from which they feldom entertained any with to return to the mother Even noble families obtained country. and fent their grants of lands, fpurious defcendants to occupy them, who, in this new habitation, enjoyed every luxury, and the mimic fplendor of the nobleffe themfelves. Thefe adventurers wifhed to return ; and they never accordingly cultivated and adorned their plantations, refidence of their youth and as the ed to the fertility of the age. This, joincountry, is one reafon why the ifland of St. highly cultivated Domingo was more than any of ours. The planters and colonifts of our Englimh iflands feldom pais their lives abroad, and look with fond expedtation to. the day again to revifit their native they are their foil; hence plantations are not fo highly finifhed in the culture, nor their cftablifhments fo fplendid or permanent as thofe of the French. The Englifh pianter confults prefent advantage ; the French, looks further forward. The towns of St. Domingo,, Port - elpecially au-Prince, are admirably calculated for --- Page 39 --- Sed, I] ST. DOMINGO. for the purpofes of commerce, Confiderations of health gave way to the fchemcs.of avarice and. the convenience of riches. It muft be confeffed, that the attaining French made the utmoft ofjevery fituation pied, and improved them they Occuas far as they were capable of improvement; ; their ftreets were wide, extenfive, and-open, a chain ofvirandas, or piazzas, fheltered from. the fun, conneéted all the houfes, under which the walk free from paffenger could every inconvenience : a row of trees on either fide of the ftreet refrefhed the eye, and gave a rural appearance to the whole, whilft fireams of water, flowing along, çarried off any impurities, which, in fpite of care, might accumulate. The French every have taken great care to fupply all their towns ply with water 5 a great confideration in am- hot countries, but which we neglect in our colonies in a remarkable manner. But notwithftanding thefe endeavours. on the part of the French, they: occupied fituations, which could not be rendered healthy by employed. any means they Itis Port-au-Prince is one of thofe.. placed at the bottom of an immenfe which pufhes itfelf into the heart of St. bite, Domingo, The fcite of, the lower part of the town is, in fact, on a marfh * gained from the, fea, countries, but which we neglect in our colonies in a remarkable manner. But notwithftanding thefe endeavours. on the part of the French, they: occupied fituations, which could not be rendered healthy by employed. any means they Itis Port-au-Prince is one of thofe.. placed at the bottom of an immenfe which pufhes itfelf into the heart of St. bite, Domingo, The fcite of, the lower part of the town is, in fact, on a marfh * gained from the, fea, --- Page 40 --- JO CHARACTER'OF fea, the fkirts of which [Chap. I weeds or mangroves, are covered with where mal and vegetable decompofed animatters are thrown; on thefe the fun promifenoufly and the breeze exerts its power, with conveys the noxious a new activity to the lungs and particles of the inhabitants, But this bofoms fea breeze, which in is not all: the other fituations as the genial fource of refrefhment is hailed is here and health, interrupted ; the ifland of fo placed in the mouth of the Gonave is a great meafure, to harbour, as, in intercept this and, before it arrives at falutary gale; lofes its ufunalcoolnefs, Port-au-Prince, it lands, and by paffing over heated gathering in its courfe pours. This neceffarily refults from noxious-va- the fituation of the town. Befides inland caufes of ill health, thefe manifeft to the action of others. Port-au-Prince is expofed It is level, on the verge ofthe placed on a' by very lofty bite, and furrounded which mountains, from the bottom of a horizontal plain ftretches the town. Torrents of towards rain, rufh water, in times of through this plain, and retain their impetuofity till they reach the fea. The land is Gnfa ren ceafes the moiftened, but after the torwater - ftagnates; fmall ftreams, attaining --- Page 41 --- ST. DOMINGO. i1 Sea, 1.] level, lofe the impetus attaining a horizontal they linger in the in their defcent; acquired with the foil form a plain, and by mingling fun acts marfh: On this marth a vigorous its noxious particles, daily, and evaporates to. the lungs of every which are conveyed to their ikins, one that breathes, and applied with and probably in this manner communicate caufe of the blood. This is a never cealing conftantly rearing mortal difeafe, a nurfery we draw vinto our poifon. In every infpiration, in bofom a column of air thus impregnated, of thefe every ftep we walk, a frefhapplication it is no wonparticles is made to our bodies; Britith der then, that on this fatal fpot the caught fever in each treacherous breeze. troops that the French, when they excluIt is true, did not perith in the fively poffeffed this town, The caufes of this fame proportion with us. French difference are not difficult to trace; the free country, and could at poffeffed a open atpleafure retire to breathe the more pure mofphere of their diftant plantations. Every in fhort, every inhamerchant, every planter, into the bitant, poffeffed the power of retiring country and changing their fituation. In that the French, when they excluIt is true, did not perith in the fively poffeffed this town, The caufes of this fame proportion with us. French difference are not difficult to trace; the free country, and could at poffeffed a open atpleafure retire to breathe the more pure mofphere of their diftant plantations. Every in fhort, every inhamerchant, every planter, into the bitant, poffeffed the power of retiring country and changing their fituation. In --- Page 42 --- CHARACTER In this manner OF [Chap. I. which would they obviated the fatal effeêts otherwife refult from the uniform andennfiantaplitatione They. were befides sef@heeshaledmif@maine vegetables, and amply fapplied with. frefh to pleafure every. luxury that or health. Very different contributed fituation of the Britifh; was the fide by the enemy, furrounded on every within the walls they. were imprifoned of.a : town half daily expofed to the fources of demolithed, without a fupply of good difeafe, and food.. Inftead of the vegetable or animal fpirits, which the view of cheerful clevation of naturally produces, the Britifh profperity and peace by every thing that could fink were depreffed flate of the mind to a forts that defpondency. In want of the comand can render war or exile expofed to an unfriendly tolerable, the daily fun, they became fpectators of death. The vages of fever amongft them confant ragloom, and weakened the fpread a general ment of debility is favourable vital powers; a moand the to the invafion conquefts of difeafe, and thonfands perifhed; befides, the accordingly the numbers who daily Britifh, from cned, that a large expired, were fo weakOn thofe who portion of duty. was thrown LI were wcll, or cven convalefcent. Thus --- Page 43 --- Seat. I.] ST. DOMINGO. Thus difeafe, by debilitating and expofing the- few who had efcaped direét attacks, neceffarily perpetuated and increafed itfelf. The Frénch inhabitants were chiefly compofed of people born in St. Domingo, and fupported by that gradual adaptation to the climate, which habit confers on the natives of the moft unhealthy regions. All the Englith inhabitants were chiefly ftrangers from northern' climates, and little habituated to any warm region. A ftate of war too expofes. all claffes, in a befieged or blockaded town, to numerous difadvantages, but chiefly the foldier, who muft brave every viciflitude of climate, the frequent changes of each varying night, without the benefit often of refrefhing reft or reftorative diet. In peace it is otherwife ; there is no caufe for the fame vigilance and perfeverance; the foldier carries on his duty with all the comforts of civil life. Port-au-Prince had all the difadvantages of a blockaded town; the foldiers or inhabitants could not change their fituation, or fly to the hills from the ravages of difeafe. Danger furrounded them in every quarter, and they were obliged tacitly to fubmit to their fate. The French poffeffed other advantagés. Their ftorative diet. In peace it is otherwife ; there is no caufe for the fame vigilance and perfeverance; the foldier carries on his duty with all the comforts of civil life. Port-au-Prince had all the difadvantages of a blockaded town; the foldiers or inhabitants could not change their fituation, or fly to the hills from the ravages of difeafe. Danger furrounded them in every quarter, and they were obliged tacitly to fubmit to their fate. The French poffeffed other advantagés. Their --- Page 44 --- CHARACTER OF Their confitutions feem [Chap. I. better warm climates than calculated for life in old France, ours. The manner of calculated to form or its colonies, was not that irritable, plethoric habit, in which the effeêts fanguine, mation are particularly felt, and ofinflamthey procced with in which nation. The rapidity to a fatal termicolonies, French, ere they vifited either for a tranfient thefe refidence, were in a ftate of or permanent ration ; they took feveral falutary prepalated to diminifh the medicines calcucontinued, on their arrival, plethoric ftate 3 they rate, cautious, and fober to purfue a modetity of animal food plan ofl flife; the quanthey they ufed was very indulged not in fmall; whilft the wine, or ardent fpirits, body was kept and they were gradually moderately open, the fun ; the accuftomed to bear to cleanfe the tepid bath too was ufed fkin from impurities, preferve it open, for the and ration, fo effential to health. purpofes of perfpion the contrary, who The Englith, in every refpect the embarked for war, were Their diet, reverfe of the French, animal food, compofed and of large portions of mented liquors, amply diluted with ferritable. In this rendered them full and irftate they embarked; in this ftate --- Page 45 --- Scâ.I I.] ST. DOMINGO. IS ftate they landed; fuperadding the effects of falt provifions at fea. Inftead of the preparative and fober regimen of the French, we are inclined to prolong our convivial enjoyments, and facrifice confiderations of health to gaiety and friendfhip. Some are impreffed with fear, and imagine that debauches of wine banith not only their fears but their danger. This is an opinion fatal to many. They land, and, friend meeting friend, ruih to the feaft, where, to ufe the words of ADDISON, the 46 death and difeafe lie in ambufcade among dithes." On the carly arrival of the Britith too, after the long confinement of a paffage,. they run about the ftreets, carelefs whither, and expofe themfelves at once to the fun's moft powerful influence. Ere habit has imparted its defenfive powers, they are ordered to duties which require activity, and which increafe the irritability of the conftitution, and, in this fituation, as it were betrayed into debility, they are feized with fever, which finds them an unrefifting prey. In this manner that aftonifhing havock, which has terrified and alarmed abroad, and excited juft fears at home, was created, and continued, IfI-miftake not, it will be found, on at once to the fun's moft powerful influence. Ere habit has imparted its defenfive powers, they are ordered to duties which require activity, and which increafe the irritability of the conftitution, and, in this fituation, as it were betrayed into debility, they are feized with fever, which finds them an unrefifting prey. In this manner that aftonifhing havock, which has terrified and alarmed abroad, and excited juft fears at home, was created, and continued, IfI-miftake not, it will be found, on --- Page 46 --- - CHARACTER OF on a ftrict examination, [Chap. I. inflammatory habit that a tendency to an the Remittent forms the bafis on which of St. Domingo eftablithes devaftation. The fudden its to the vital determinations made organs depend entirely on energy and irritability of the the In the French vafcular fyftem. ments do not conftitution, fuch derangethere is not in the readily take place, becaufe fame vafcular fyftem either the energy- or irritability as in the The re-aétion, as it is Englifh. and feeble in the termed, is weak former; in the ftrong and powerful; hence latter, is French perith than of fewer of the aétually attacked the Englith, when ference in by fever. But this difno degree depends on the riority of their medical fupearrogantly affume. practice, which - It is with they, obliged to mention, that I have pain I am one French not met with the leaft practitioner, on whofe reliance could be placed. veracity by vanity, and that fpirit of Impelled narrative, which of late fills all gafconade in ings, they exaggerate their writlate, and, with deliberate every thing they rebute to themfelves the impudence, attrilents. Such a moft extraordinary tacharge againft a fet of men, profefling at leaft a liberal purfuit, ought to be --- Page 47 --- Seôt. I.] ST. DOMINGO. be very Érmly and well fupported. I appcal, without hefitation, to every medical gentleman who has practifed with them in the Weft Indies, and I do not fear the leaft contradiction. Equally cconomic of medicines and truth, they committed their patients to a nurie, and left the ifiue to nature, If theré is any thing in the powers of medicine, or in vigorcus treatment and preicription, it is wholly wanting in the French practice, Ptifans and frequent injedions form the prominent features of their treatment. The German dieta aquaa, and large quantities of lemonade, are alfo prefcribed. Camphor, opium, muik, and ather, are very rarely given; ; except in the hopelefs ftages of fever, and then not in quantities to produce any great effect. Ido not deny that the French phyficians merit praife for their attention to a very effential part of medical treatment. Nurfing is often of as great importance as medicine, and they have improved it; but they poffefs no higher merit. Their plan forms a very excellent part of a fyftem of praéticc, but cannot be furely trufted wholly. Jet the French and Englith modes oftreatment be blended and mixed ; the vigour of our practice, with the benefit of French nuring, and the patient will have every chance the C prefent that the French phyficians merit praife for their attention to a very effential part of medical treatment. Nurfing is often of as great importance as medicine, and they have improved it; but they poffefs no higher merit. Their plan forms a very excellent part of a fyftem of praéticc, but cannot be furely trufted wholly. Jet the French and Englith modes oftreatment be blended and mixed ; the vigour of our practice, with the benefit of French nuring, and the patient will have every chance the C prefent --- Page 48 --- - - - CHARACTER.OF fChap. I. prefent flate of medical him. knowledge can afford On my firft arrival at French phyfician of fome Port-au-Prince, a lities, almoft induced learning and abia mede of me to believe; that he had treating the Endemic of that country, which generally fucceeded. his converfation, and Trufting to took him to vifit confiding in his fkill, I one ofmyaffiftants then under fever; Irequefted he would prefcribe; he the took management into his hands, and the youth perifhed. This would be a folitary inftance ofno great weight, as it might the ableft happen with phyfician, were it not followed a number of others by the equally notorious. But phylicians always had fome filly fubterfuge, fuch as not being called in obftinacy of the time, the patient, and a variety of other trifing evafions. But I Thall not reft the proof of what I have afferted Dr. on this alone. JacKsox, whofe abilities and are univerfally known, and whofe learning and eandour have been liberality thofe who have experienced by all fional ever met him in his profefFrench chaméter; configned to the care of a phyfician, a certain number ofthe man and Dutch Gerconfident troops. From his pompous and afertions, much was expected; it was --- Page 49 --- Sea.I] ST. DOMINGO. was a fair experiment, and a liberal tg fon between French and Englifh compariWhat was the refult? On 2 treatment. returns from that comparifon of the deaths hofpital, the number of milar confiderably exceeded our lofs with finumbers. This was an unequivocal and amply refuted all their trial, truth was fairly ftated, and exaggeration. made them The filent. I would not be thus examining the particular in proceedings of the French phyficians, had not they, in the moft illiberal and fhameful manner, founded propagated unreports relative to Englith praétice. They boldlyafferted, thatthe Englifhp and furgeons, killed their phyficians ignorant of their patients, and were induftrioufly profeflion. Such a report, diminifhed circulated, had bad effedts; it the confidence of the the medical ftaff; and troops in utmoft confidence is of the confequence, as it fupports the and elevates it with hope. mind, contented with They were not feattering thefe St. Domingo, but they alfo rumours at addrefed wrote home, and an anonymous letter to the medical board, and even put paragraphs in our all tending to leffen the confidence papers, of Britifh in the medical officers the them. who attended Itruft I Thall be excufed for entering C2 into in utmoft confidence is of the confequence, as it fupports the and elevates it with hope. mind, contented with They were not feattering thefe St. Domingo, but they alfo rumours at addrefed wrote home, and an anonymous letter to the medical board, and even put paragraphs in our all tending to leffen the confidence papers, of Britifh in the medical officers the them. who attended Itruft I Thall be excufed for entering C2 into --- Page 50 --- - CHARACTER OF [Chap.I. into this detail, and fating the queftion Every one will allow that there is fairly. to be learned in the difeafes of fomething by being on the fpot, which every country tion Or neither deferipreading can fupply ; nor can it be fuppofed, where human lives are at that any one would for a moment fake, 'adopt tthe plan of others, where hefitate to it any hope of fuccefs.- The promifed pride, man who from prejudice, or illiberal rejeét rivalfhip; would improvement, Or defpife ought to be expélled knowledge, who would fociety as a monfter, facrifice the human race to his unfecling vanity; but in no place was improvement more likely. to be adopted, than St. Domingo, where, plans of treatment bad unfortunately, all our but little fuccefs. The medical faff of that ifland pofed of men of was comwhofe liberal - education, and to attention the army will bear it was not likeiy that fuch teftimony; men would fàcrifice, to an illiberal prejudice, the lives of their countrymen, endearcd to them quaintance, and by common by achardfhips. It might be fuppofed, and in fact it given out, that St. was rival Domingo, before our arthere, was by no means unhealthy; and I that --- Page 51 --- Scôt, I.J ST. DOMINGO. that their garrifons fuffered this declaration very little. In the French phyficians exulted; but they attributed the difference tircly to their own fkill and faperior enment. We have already feen how managecreditzis due to their much affertions; and in as well as in moft inftances, this, found falfe. they will be Every body knows, that St. Domingo was always unhealthy. The moft falubrious and beft climates have their of difeafe, there is no periods that can boafe country yet known of an exemption from thefe laws nature. It has been already ftated, that the French fuffered lefs than we have done but the fame fever, which has troops, raged alfo in the fwept off our French and made great havock. There garrifons, ftronger proof given of the cannot be a French mortality of the troops, during the old than their being obliged, government, every three oOr four years, to renew the garrifons with What became of thefe 10,000 men. troops i few of them ever returned to France. They became victims to the fever of the ifland. When the lution begun its horrors, it was revopower of that convulfed not in the ufual nation to fend the fapply to St. Domingo; the former garrifons were confequently greatly diminifhed; C3 and, during the old than their being obliged, government, every three oOr four years, to renew the garrifons with What became of thefe 10,000 men. troops i few of them ever returned to France. They became victims to the fever of the ifland. When the lution begun its horrors, it was revopower of that convulfed not in the ufual nation to fend the fapply to St. Domingo; the former garrifons were confequently greatly diminifhed; C3 and, --- Page 52 --- CHARACTER OF and, in fact, we,found [Chap. I. very few ofthe veteran troops of Old France to cr progrefs. Ihave cppofe our views been thus full and explicit, on the former ftate of this ifland, difprove the falfe affertions of the to phyficians, and refute infinuations French unfounded and illiberal; but which, equaliy ing defpondence and fears, and by creatfidence, might produce the worft leffening coneffects, Hifpaniola has always been, and I fear a certain degree will always in healthy; but our further continue, unprogrefs into the country, by enabling us to change our fituation, by varying the fcene, by amufing and delighting the fenfes, and being enabled to procure a more wholefome diet, pel our fears, and may yet difSuch infpire more confidence. a change would gratify the feclings of humanity, and be particularly thofe who have witnefied pleafing to the fcenes of our carly diftrefling I fhall operations in that ifland, proceed in the next feétion to examine more particularly the mode in which the fever is produced, and the manner ofits tion Qn the human body, operaa --- Page 53 --- Sedt. II.] ST. DOMINGO. SECT. II. Further Confiderations on the Caufès ofIll Heath -Miafmata confidered, and tbe Efe8s ef Moilure-The Efedts ofDebility 0n tbe Vafcular SpRom-Daturminations arife from Debility-Cbemitry the great Source ef Improvement in Mediciae-Tilisunf not always caufed by Bile. IN enumerating the general caufes whichproduce, or rather difpofe, to ill health, at St. Domingo, I omitted to mention the Land Winds, which prevail more particularly inJune and July, but are more or lefs felt throughout the year, Thefe breezes blow in the morning, and have a pleafing coolnefs at an early hour 5 but they fometimes continue for days, and eyen weeks, and 'as the day advances become hot, drying, and unplcafànt, refembling the Siroc of Naples. Thefe winds fuddenly check perfpiration, the great fource of cool-. nels and health; the fkin becomes parched and dry, and there is ufually a fenfe ofo oppreflion - - 4 in lefs felt throughout the year, Thefe breezes blow in the morning, and have a pleafing coolnefs at an early hour 5 but they fometimes continue for days, and eyen weeks, and 'as the day advances become hot, drying, and unplcafànt, refembling the Siroc of Naples. Thefe winds fuddenly check perfpiration, the great fource of cool-. nels and health; the fkin becomes parched and dry, and there is ufually a fenfe ofo oppreflion - - 4 in --- Page 54 --- DISEASES OF [Chap. I., in breathing, and a tendency to figh. Thefe winds very generally excite fever, and bring on paroxylims anew, in convalefcents. The French Chut their doors and windows againft them, and go out as little as poffible whilft they prevail; but their effeéts are fenfibly feit. Let us now examine the caufes, which more remotely feem to produce the fatal fever.in queftion. It would feem that it arifcs from elaftic fluids, miafmata, or vapours, applied to the human body, either thrcugh the medium of the lungs or fkin, or perhaps fwallowed with the faliva. This opinion is rendered probable, by obferving that the fever arifes more frequently, and proceeds with more feverity, in fituations where a brifk evaporation from ftagnant marfhes Îs going forward. It would feem that rain, fimply as fuch, or dew, do not produce any derangenient in the human fyftem, except what may arife from fimple obftruéticn and the effeéts of cold. : I have. myfelf been expofed to the dews, without the means of thifting, for two nights and upwards, when a prifoner with the Brigands, without feeling any inconvenience. DoctoreJACKSON and --- Page 55 --- Sest. II.] ST. DOMINGO. and MASTER were fimilarly Otuated, without any bad confequence ; and in coming from Jamaica to St. Domingo I have flept feveral nights on deck, with a very light covering; Ineyer found any illnefs refult, though I have been wet for feveral hours. The longer, water has been incorporated with the foil, without freth rain, the more virulent and dangerous the miafmata become, Thus, the feafons in which rains prevail are found more healthy than- when dry weather has continued for any time: in the firft cafe, the rain is again evaporated before the foil has imparted its pernicious qualities, but in dry weather it has remained, fo as to acquire the fatal activity it exerts on the fyftem. In what manner the aétion of the fun, and the admixture of a certain foil, produces this.activity, can perhaps, fcarçe be explained in the prefent ftate of chemical knowledge. It muft be admitted too, that fatal miafmata arife where there are no very certain appearances of a marfhy foil. The Mole and St. Mark's, do not appear furrounded with marihes, yet the fever reigns in both thefe places, with greatactivity. Miafmata may certainly be wafted with the land breezes in fome activity to a confiderable diftance; they are of a certain foil, produces this.activity, can perhaps, fcarçe be explained in the prefent ftate of chemical knowledge. It muft be admitted too, that fatal miafmata arife where there are no very certain appearances of a marfhy foil. The Mole and St. Mark's, do not appear furrounded with marihes, yet the fever reigns in both thefe places, with greatactivity. Miafmata may certainly be wafted with the land breezes in fome activity to a confiderable diftance; they are --- Page 56 --- M 4 - 1 26, DISEASES OF [Chap. I, are undoubtedly more powerful the nearer they are to their fource, and in time become changed by admixture with the atmofphere and diftance from their origin. Thus fhips, lying in harbour ata certain diftance from the fhore, are liable to the fever of St. Domingo, but if they go to fea, or cruize at a greater diftance from the land, the crew become more healthy, and lefs obnoxious to difeafe. It is nat to be doubted but the fan aéing on moifture, almoft in any foil, will produce difeafe, The grand defeCt in our knowledge, arifes from our being ignorant of the particular nature, of the elaftic fluid or miafina $ which arifes from marth. If this point was once afcertained, we could reafon on the varieties produced difference in the foil, and the lefs by a adtion of the fan; foas or greater perhaps to throw fome light on varieties in difeafe, which feem to arife : from thefe caufes. How thefe miafmata or vapours produce their effects on the body is not diftinatly known. Let us attend to the phanomena which they produce, and.try to-account for them on principles already afcertained, or rendered highly probable, from the phenomena themfelves, The --- Page 57 --- Sest. IL.] ST. DOMINGO. The firft evident effeêts are, debility and languor in many of the important funétions oflife. The vafcular fyftem, in fome ofits fubordinate divifions, appears greatly weakened; for although there feems a degree of excitement and action, yet irregular determinations of blood take place to various organs, fuch as the head, ftomach, important liver, and lungs-Deteminatons of blood cannot happen to any particular organ without debility in fome part of the vafcular fyftem, which deftroys the balance eftablifhed for a juft circulation between the propelling power of the heart and the refiftance of the arteries. ordinary cafes, where the In of the heart is not altered, propelling if power weaknefs in a particular fet of there is any mination veffels, a deterhappens; :. ; but in cafes offever, whilft the veffels feem to lofe greatly their power, the energy of the heart is refifting increafed. From this caufe the remarkably determinations danger of during fever is greatly mented. In what direét augmanner all this is produced eludcs at prefentourkeeneft It would feem, at times, that the refearch. attacked at once the miafmata from the very principle of life 3 beginning, in fuch cafes, all 1s fubdued, and the fufferer energy gradually perifhes under greatly their power, the energy of the heart is refifting increafed. From this caufe the remarkably determinations danger of during fever is greatly mented. In what direét augmanner all this is produced eludcs at prefentourkeeneft It would feem, at times, that the refearch. attacked at once the miafmata from the very principle of life 3 beginning, in fuch cafes, all 1s fubdued, and the fufferer energy gradually perifhes under --- Page 58 --- DISEASES OF under a fenfe of [Chap.I. diminution of animal oppreffion only, and a flow powers. Many inftances of this kind which at firtt flattered the occurred, fpectator, but which ftruck the unexperienced ferver with attentive obimpreflions of the Where there is a fenfe of pain and greateft danger. the ftock of a re-action, fenfibility and vital is entire, and may be aéted on with energy, yet but wherc thefe are fome hope; dued, the caufe of the greatly impaired or fubwill in difeafe is powerful, and general be victorious. In to the utility and proportion the neceffity, of any organ to maintenance of life, will be the a determination to danger of lungs, and the it; thus the brain, the ftomach, as being neceffary to fupport the living highly moft dangerous feats for phanomena, are the In the brain, either its thefe derangements. ftroyed by fubtile direét funétions are depreffure from caufes, Or by more evident tion' of its cffufion on it, or by the deftructhel lungsis organization. The ftruéture of progrefs frequently deftroyed by the fudden ing their ofinflammatien, which, by diminifhu capacity, and the eafe with their effential funétions which direét are performed, has a tendency to deftroy life, which we feem --- Page 59 --- Seat. II.] ST. DOMINGO, feem to renovate and frengthen wonderful from this organ. But befides the direét influence the lungs have on the vital any impediment in their funétions principle, new determinations in the blood, and creates guithes life by the flow extindifeafe. progrefs of partial The ftomach, the moft important of all our functions, becomes, in the fever fupport St. Domingo, a principal feat of of tion. Very carly in the difeafe, determinaan immenfe quantity of blood fills its veffels, inflames its inner coats, and begets in it a fenfibility and irritability almoft incredible. In vain it is attempted to throw in any medicine, in the the moit foothing or lenient forms ; the moft grateful cordials, and the moft infipid are thrown up with a celerity liquids explofion. The effort equal to an fore to reject is made beany thing almoft touches the ftomach. Thefe efforts to reach are continued often death. From the till blood, and the great determination of violence of the action in the veffels, immenfe fecretions are made in the ftomach, from which,acquiring there a dark colour the admixture of other fluids, and haps portions of the coats of the perftomach, is called up with a celerity liquids explofion. The effort equal to an fore to reject is made beany thing almoft touches the ftomach. Thefe efforts to reach are continued often death. From the till blood, and the great determination of violence of the action in the veffels, immenfe fecretions are made in the ftomach, from which,acquiring there a dark colour the admixture of other fluids, and haps portions of the coats of the perftomach, is called --- Page 60 --- DISEASES OF called the Black [Chap.I. fatal prefage ofthe Vomiting, generally a very themfelves event ; at length the coats are feparated and detached, and a mortification, affording a temporary from agony, clofes the cruel fcene. fufpenfe During this progrefs there is little remif. fion; but in general a flight abatement fymptoms. occurs towards of the cerbation foon follows. noon, and an exathe animal What fecret law of mines thefe cconomy infuences and deterperiods and fluétuations of are not at fever known. prefent, nor perhaps ever will be In fome inftances, where roxyln has finifhed the difeafe one patime, the whole would for a given chemical appear to refemble a procefs, where a certain time was required to complete it; but the renewals, and the fimilarity of the fubfequent exacerbation, fucceeding obliges us to abandon tive opinion, and confefs fpeculaviolent and our ignorance. In rapid cafes, where a fudden recovery has happened, it has fometimes. preceded by a tormenting intolerable been fome particular pain in finger or toe; ; at laft, a livid fpot, with an extended rofy bafe, makes its appearance, and the difeafe is certain chemical gone ; as if a combination had happened, and --- Page 61 --- Seêt. II.] S T. DOMINGO, and the refult had efcaped by a filent but vigorous effort, like the electric fluid. On the difcovery of the real nature of the marth miafma, of the various circumftances which affect its condition, on which its ftrength and noxious founded the future powers depend, is tricate improvement of this inpart of medicine. That new chemical combinations are formed, deftruétive the principle of life, no one will to has ferioully deny, who thought on the fubject; in other way can the fudden no derangements be in any manner accounted for. The mechanic effects of miafmnata would, from their nature, be imperceptible, very are utterly and, though we ignorant of the direét chemical changes or proceffes, yet it may be with more inferred, probability than any other pofition, that they really exift. fupis. now Chemiftry of the unfolding more intimately the nature animal fibre; and if human aided by fcience, promife abilities, jects which any light on fubnature has involved in we may entertain fome darknefs, hope --But chemiftry ofimprovement. mourns the death of LAYOISIER,Ofhim, whofe labours made it a new feience; and promifed to fcatter light over the , probability than any other pofition, that they really exift. fupis. now Chemiftry of the unfolding more intimately the nature animal fibre; and if human aided by fcience, promife abilities, jects which any light on fubnature has involved in we may entertain fome darknefs, hope --But chemiftry ofimprovement. mourns the death of LAYOISIER,Ofhim, whofe labours made it a new feience; and promifed to fcatter light over the --- Page 62 --- - DISEASES O.F [Chap.I. the darkeft inveftigations. The lois of a man, who devoted his time and fortune to the moft enlightened purfuits, with fo much happy fuccefs, and perfeverance, will be felt by future generations, and will defcend to pofterity as one of the great ftains of the revolution. Many appearances induce us to believé, that very confiderable changes go on in the fluids. The fudden-appearance of livid fpots, the oozing of blood from all the mouth, and its rupture from the nofe, cannot be accounted for from the folids only; both are ufually affected, and muft be fo from their very intimate connection, and Atanding in the relation of affecting each other, as caufes and effeets of many phanomena. The yellownefs, which is certainly no fas vourable appearance, and gives a peculiar name to the fever, does not always feem to depend on the mixture of bile with the blood. It is not eafy to fupport the opinion I am about to offer, becaufe the facts which would render it cléar are not cafily obtained. The fame opinion was formed by my fricnd, Dr. MASTER, before we had ever converfed on --- Page 63 --- Sed. Il.] ST. DOMINGO. on the fubjeét, and on the fame The yellownefs appeared to us, to arife grounds. from a change effected in the colour of the dependent, on a peculiar aétion in the veffels ferum, becaufe jaundice, or a mixture of bile with ; the blood, is not in itfelf a difeafe fatal, or even very fuddenly formidable ; and becaufe, jaundice comes on frequently towards the clofe of the fever, without producing danger; 5 nay, it is rather a favourable any and in cafes where recoveries crifis 5 in the yellow have happened, fever, as it is termed, the in the fkin has continued for tinge without any other of the a long time ufually charaéterize, fymptoms which tend, or more immediately atjaundice. Diffections have not in fatal cafes, fhown, any great derangement in the biliary fyftem 5 no calculi and little natural diftenfion or obltruction; preteryellownefs befides, the its fulleft comes on very fuddenly, and to extent.-There is indeed a dation as to the places where it grabefore it fpreads begins, univerfally; the of it, however, is different from progrefs The veffels of the jaundice. firft alarm of that eye, give generally the the difeafe ; and the onyx of nails, becomes very foon affected; but in the yellownefs accompanying the Remit- : D tent preteryellownefs befides, the its fulleft comes on very fuddenly, and to extent.-There is indeed a dation as to the places where it grabefore it fpreads begins, univerfally; the of it, however, is different from progrefs The veffels of the jaundice. firft alarm of that eye, give generally the the difeafe ; and the onyx of nails, becomes very foon affected; but in the yellownefs accompanying the Remit- : D tent --- Page 64 --- DISEASES OF tent ofSt. [Chap. I. Dominge, a different progrefs is ob. fervèd; the neck, in the courfe of the the cheeks, in an angle from the nofe, jugu'ars, ftreaks, give the firitintimation; forming pafs along the breaft and back yeilow tinges and the feet are often deeply irregularly, the reft of the body is coloured before materialiy Where the veffels ofthe affe@ted.- eye have been much furcharged, fo as to refemble the ment of real jaundice, with other commenceproper to that difeafe, the event has fymptoms in general, more happy. Ihave proved, that the fhade of yellow which thought too, Remittent of St. attends the that which Domingo is different from accompanies this is a fanciful difference; jaundice; perhaps ftated would feem but what I have to indicate fome ftate of the blood, peculiar admixture: independent of bilious future obfervation throw more light on the fubjeét. may Upon the whole then, it would miafimnata, or particles of elaftic appear that from the earth, in the condition vapours, rifing and acted on by a called marfh, remote caufes of very vigorous fun, are the the Remittent of St. Domingo; and that they enter the human fyftem, either by the veflels of the fkin or the lungs, or mixed with the by faliva; that there --- Page 65 --- Sed. II.] S7 T. DOMINGO. there they produce feveral morbid or derangements, probably by phanomena combinations with the fubtile forming new fluids and clements of the folids, and thus become and deftruétive, by noxious ganization deranging the peculiar ortion. which produces the living condiWe muft lament our the particular mode of ignorance as to obfèrve certain operation, but we may circumftances which influence the iffue of the difeafe ftrongly ment. To mark thefe or derangeis to make fome grefs. It is true, that I have heard protioners chatter about difeafes with the practifacility they fpoke of any common fame they had a caufe at hand to incident ; fymptom, and a remedy, with a explain every tain effeéts to refult from ftring of cerit ; to ufe the expreffion ofan cloquent 6c to have been in writer, they feemed but from fuch nature's cabinet council :" area men little can be we all, iti is true, in the twilight of hoped; we fee to a certain diftance, knowledge; all objeéts beyond which Iv would appear confufed, and blended, and not readily believe him who would affert he faw diftinétly beyond the limits of vifion. In the next fection common continue to take a further view of the we fhall and its phanomena, fever D2 , they feemed but from fuch nature's cabinet council :" area men little can be we all, iti is true, in the twilight of hoped; we fee to a certain diftance, knowledge; all objeéts beyond which Iv would appear confufed, and blended, and not readily believe him who would affert he faw diftinétly beyond the limits of vifion. In the next fection common continue to take a further view of the we fhall and its phanomena, fever D2 --- Page 66 --- DISEASES OF [Chap.K. SECT. III. Pletboric Habit dangerous in tbe RemittentYoung Men more expofed to danger than otbers-Women and Old Men efcope the Bewr-Pradical Inftrencesfrom thefi Fatis -Scbeme of recruiting Men at an advanced PeriadefLge. ITwasremarked in the fecond a habit full, irritable, and feétion, that the Remittent of St. plethoric, afforded nity of Domingo an opportufhall manifefling its utmoft violence : I now profecute this opinion, and the reafons which led me to entertain deliver have already obferved, that it. I nations, founded irregular determion a diminifhed in veffels of fome part of the energy the firft effects of the fyftem, were the to the human application of the miafmnata body; the confequent ments in the organs, to which thefe derangenations are made, form the determilence of re-action in habits danger; the vio-- mation is difpofed to inflamalways dangerous, either the general fate of difeafe, by aiding the direét or by producing confequences of inflammation, or rupturing fmall veffels. I have --- Page 67 --- Sedt. III.] ST. DOMINGO, Ihave feen Weft many corpulent people in the Indies, who have endured the climate well, but had not all the charaéteriftics habit I have been of the deferibing, as Remittent rendering the dangerous. I have founded opinion, of fach conftitutions my larly unfavourable, being particuon the following tions :-Firft, by obferving confiderathe fever invaded always, that when rapid, fuch habits, that it was fevere, and violent: fecondly, marking that by refifteen to young men, from the age of and twenty-five or thirty, the irritable plethoric period, were more feéted than.thofe feverely afthirdly, more advanced in life: and by obferving that old men, to cighty years, of from fixty renew life, and age, feem as it were to better enjoy health in warm than in any other fituation climates, they happen to be attacked ; and when proceeds with little with fever, it nation. Women violence, toa happy termiviolence too are exempted from the offever, except in particular where intoxication has inftances, and plethoric ftate. produced the irritable Ferales then, and men, who are in a condition of old the reverfe of the body directly : plethoric and not by any means run the fame irritable, do attacked by this fatal rifque when remittent, It is fair D3 then when proceeds with little with fever, it nation. Women violence, toa happy termiviolence too are exempted from the offever, except in particular where intoxication has inftances, and plethoric ftate. produced the irritable Ferales then, and men, who are in a condition of old the reverfe of the body directly : plethoric and not by any means run the fame irritable, do attacked by this fatal rifque when remittent, It is fair D3 then --- Page 68 --- - DISEASES'OF [Chap. I, then to conclude, as it is moft deftruétive the young and plethoric, that in flate conduces fomething in that which to this fatality. The eafe with determinations are made in thefe habits to particular organs, and the violence of action, feem to me to be the chief fources redanger, In old men the fibre is of a new condition relaxed, and flate of brought on, refembling the youth ; and, in fact, they become warm climates, and more cheerful; fatin energy is infufed in, their a new life conftitutions, and prolonged beyond its expeéted Thefe changes would feem period. the to be produced by relaxing powers of heat, and fome fecret vital energy connedted with it. Relaxation and irritability, to a certain degree, are the liar charadteriftics of the juvenile fibre. pecuHow habit, Or nativity in particular climates, fo as to prevent difeafes, cannot be operate on any certain principles explained 3 we can only acknowledge our ignorance, by that ture calculates the faying, nafpecies for the regions inhabit, or that we gradually they ftitutions fuitéd to the climate in acquire conmay be placed. which we The doctrine I have been be of little ufe, unlefs fome difeuffing would practical inferenccs could --- Page 69 --- Seêt. III:] ST. DOMINGO, could be made for the benefit of our troops. If I at right in remarking, that a habit difpofed to inflammation, from its peculiar circumftances, is in a dangerous condition, when attacked by the fever of St. Domingo; it wiil follow, that the troops who are to ferve in that country, ought to be made up of men, at a particular period of life: fuch men toc, have the advantage of being well difciplined; their morals are eftablifhed, and their paffions calmed; and they are in every way fitted, for that kind of fervice; whilft the younger troops, are left at home to be formed and regulated. Men from the age of thirty-fve, to fifty years, are in a condition to act in St. Domingo; whilft our youth would be fpared and fent to garrifons, where they would be gradually inured to heat, and enabled at a future period to undergo the fatigue of the warmeft region. This plan would be of the utmoft importance; the elder part of each corps might be thus drafted, and proceed with fome confidence to their fation. Men, who in colder climates begin to lofe their aétivity and ftrength, would in St. Domingo be in forne degree renovated and rendered again ferviceable. By this means the inactive period of life would be rendered ufeful, and the young and vigorous kept at D 4 home, to heat, and enabled at a future period to undergo the fatigue of the warmeft region. This plan would be of the utmoft importance; the elder part of each corps might be thus drafted, and proceed with fome confidence to their fation. Men, who in colder climates begin to lofe their aétivity and ftrength, would in St. Domingo be in forne degree renovated and rendered again ferviceable. By this means the inactive period of life would be rendered ufeful, and the young and vigorous kept at D 4 home, --- Page 70 --- DISEASES OF home, where their [Chap, I. happily exerted. ftrength could be moft I tfuft this fcheme will challenge the attention of our it will prevent Government; fervice in many untimcly deaths; the every view will derive will have men on whom benefit; it be placed, when fome reliance can and our youth will duty requires them to act, certain be faved from the almoft deftruétion of the climate, When regiments are thus formed view to the Weft India with a be ftill more fervice, they would improved and proteéted ing in warm, but more by refidfore they embark for the healthy regions, bewould afford them Weft. Gibraltar a mild veffels would become feafoning; their habituated expanfion, and the fkin would be gradually to and open for rendered lax thus be perfpiration. A period put to the devaftation ofthat might and fcenes, the recollection climate, humanity, would in of which, fhocks a great meafire ceafe, Before I quit this fubject I Chall mark, that men at the age of juft reto' me very well able to fuftain forty years, feem vice in *St. ten years ferDomingo; and as all are relieved in a lefs period, oar garrifons they would poffefs fuflicient --- Page 71 --- Sea, IV.] S T: DOMINGO. 4x fufficient vigour ofhabit to go through every toil, In regiments thus organized it might be proper to reward the fervices of men, who had adted with reputation as ferjeants in a warm climate, and give them promotion. The men of charaéter would thus have fomething to hope for, and their good conduct would meet encouragement in their profeflion 3 above all, the Weft India fervice would be carried on with fuccefs : at prefent, neither military talents nor numbers are of ufe; our hofpitals contain our garrifons, and the few who carry on duty are languid and convalefcent 3 they are not fit for enterprize or hazard; and nominal armies will never atchieve conquefts. SECT. IV. Caufès, wbich tetard Medical ImprovementSurgery and Medicine canpard-O/prasisaute Caufès in Difaf-Our Ignorance of tbefe prevents Improvement. Is SHALL now proceed more direétly to examine the Fever, and endeavour to afcertain its clafs; but before its particular hiftory is unfolded, and the praétice is defcribed, it will be neceffary to take a view of the ftate of or hazard; and nominal armies will never atchieve conquefts. SECT. IV. Caufès, wbich tetard Medical ImprovementSurgery and Medicine canpard-O/prasisaute Caufès in Difaf-Our Ignorance of tbefe prevents Improvement. Is SHALL now proceed more direétly to examine the Fever, and endeavour to afcertain its clafs; but before its particular hiftory is unfolded, and the praétice is defcribed, it will be neceffary to take a view of the ftate of --- Page 72 --- DISEASESIOF of Medical [Chap. I. Knowledge. I have my praétice on our ignorance of founded Caufes and the pofitive Proximate it will be nature offever; ; and that neceffiary to fhow the real ftate of queftion, before the principles guided me are underftood. which In all medical refearches, counter thofe we have to enobftacles, which render inveftigation fo difficult, in a fcience, of the principles have not been hitherto which certained. The indolent have afpurfuit fo arduous, and abandoned a ing fyftems of the adopted the reignthe learned and day. The ficcels of been ingenious has by no means equal to what might be expected their talents or induftry. from days of Medicine, from the varied HIPPOCRATES, has been a fyftem of conjeéture, which has in almoft changed its afpect every age; each century to the fudent novel doctrines, wbich prefented turn made way for others. in their Thefe were influenced frequently changes of natural by the progrefs philofophy, efpecially by chemif. try, but more commonly by the or caprice of medical ingenuity nate, that amidf thefe profeffors. It is fortufluctuations and theory, practice was not much ofopinion held an even courfe difturbed;it nearly, and though difS ferent --- Page 73 --- - - Sedt. IV.] ST. DOMINGO. ferent views were entertained as to the mode in which medicines produced their effects, yet the fame prefcriptions and mode of treatment obtained amongit phyficians whofe theoretical tenets were very different; ; on other occafions a péculiar praétice was purfued by individuals, from what might be expeéted very oppofite from the theory they maintained. This was particularly the cafe of SYDENHAM, as Dr. JACKSON clearly points out. There can be no doubt, however, that a more philofophical and rational manner of inveftigation has been purfued by the moderns. Facts have been more accurately obferved, and experiments made with more precifion 5 the laws of the living body have been more attentively examincd, and the principles of philofophy are applied with more caution to animated matter 5 theory too is made to refult from a çareful obfervation of facts; it is what it fhould be, an induétion, and not a pre-conçeived dodtrine, The circulation of the blood, as afcertained by the immortal HARVEY, throws light on many of the fymptoms which occur in difeafes, and of which the ancients muft have entertained abfurd notions. The progrefs of time and accident have put us in poffefion of many y are applied with more caution to animated matter 5 theory too is made to refult from a çareful obfervation of facts; it is what it fhould be, an induétion, and not a pre-conçeived dodtrine, The circulation of the blood, as afcertained by the immortal HARVEY, throws light on many of the fymptoms which occur in difeafes, and of which the ancients muft have entertained abfurd notions. The progrefs of time and accident have put us in poffefion of many --- Page 74 --- a DISEASES OF [Chap. I, many valuable remedies totally unknown to the earlier phyficians; and the wonderfulaid ofchemiftry 1S likely to unravel the myfterious laws of thé animal ceconomy, and throw light on obfcure phanomena both ofhealth and difeafe. many The chemifts too have put us in poffeffion of many active powers, with which the human fyftem may be affeéted, fo as to produce changes; and the analyfis of various fubftances, has wonderfully extended our knowledge and increafed our power. The numerous difcoveries in anatomy have improved phifiology and furgery ; we have more accurate notions of the feats of difeafes, and we can explain more fully the operation of morbid caufes. The intercourfe between various countries, and the cheapnefs of printing, have increafed in a remarkable manner our ftock of faéts. The experience ofd celebrated men, and their obfervations on the difeafes, climate, and habits of particular countries, thus become a general property in medicine, and may be perufed by every one who has induftry or curiofity. In this manner we are furnifhed with valuable materials, which may be examined and compared, and from which we may draw tant and ufeful conclufions. The imporgeneral progrefs of icience has no doubt contributed to the --- Page 75 --- Sed.IV.] ST. DOMINGO, the improvement of medicine; but, above all, the inftitution of focietics and has contributed to correét and holpitals dical enlarge meknowledge over Europe. In tbe powers of the mind are called into fociety, action, doctrines are minutely examined, the ambition and induftry of individuals reftrained the are not by terror or authority of teachers 5 opinions are compared, latent facts are brought forward, and the refult is publifhed for general public The records of celebrated infpection. bear ample univerfitics will teftimony to the benefit of medical affociations; hofpitals too are great fchools of practice, where numerous cafes enable the phyfician to generalize, and from a multitude of facts to draw ufeful 1 conclufions; it is in fuch inftitutions that medicine may receive real improvement; the fician, free from the fetters which phypractice generally impofes, and which private the moft celebrated cannot fhake off without prejudice to their reputation, proceeds with more boldnefs to experiment and innovation, which, under judicious management, may be purfued without alarming the feelings of humanity. It is to the prejudices of kind and the fears of manpractitioners we attribute generalize, and from a multitude of facts to draw ufeful 1 conclufions; it is in fuch inftitutions that medicine may receive real improvement; the fician, free from the fetters which phypractice generally impofes, and which private the moft celebrated cannot fhake off without prejudice to their reputation, proceeds with more boldnefs to experiment and innovation, which, under judicious management, may be purfued without alarming the feelings of humanity. It is to the prejudices of kind and the fears of manpractitioners we attribute --- Page 76 --- - DISEASES OF tribute the ineffeétual [Chap.I. who, routine of fearing the lofs of emolument phyficians, ployment, dare not venture out of their or emmels. To this caufe alone tramin a great may be afcribed, meafure, the flow progrefs of practical knowledge. Upon the whole, however, Medicine been flowly improving from the has POCRATES, days of Hiption though by no means in to other fciences. It proporconfider the may be ufeful to peculiar caufes which progrefs; for we find, both retarded.its cients and moderns, that among the anand induftry men of great talents applied themfelves to there muft therefore exift medicine; ; able obftacles fome infurmountin the fcience itfelf. riment is the fource from Expefciences, true which, in other tained. Or definite knowledge is obIn order to attain this it is abfolutely knowledge, neceffary that the which the philofopher fubjedt on a given or known operates, remains in tions and ftate, Or that its modificachanges be afcertained by a infallible rule. certain Secondly, in experience from a few generalifing our fo as to objects of any clafs, it develope the nature of the is neceflary that the few whole, we have examined, --- Page 77 --- Sed.IV.] ST. DOMINGO, mined, comprehend the laws and all that tribe of nature of objeêts. - If this is not cafe, no juft inference can be made the the few to the from be ufeful many, nor will or extenfive; but when experience the ofa whole clafs of nature objects can be afcertained, by precifely ofthat experiments on a few fubjects clais, then, the his philofopher can extend conclufions : to the whole clafs, he may not have individually which Becaufe, experiments, examined. repeated and on a few fubjects, have afcertained confirmed of a whole clafs, whofe the laws fo far as regarded his effential properties, fixed and immutable. conclufions, remained immortal It was thus that the NEWTON proceeded, and from the fimple laws of gravitation afcertained complicated motions of the celeftial the in this manner other fciences bodies ; or lefs rapidly, but with advance more approaching a degree of certainty demonftration. In medicine, however, have although phyficians appealed to experiment, and made clufions, yet it will that contions can never be fo appear their induc in other fcienccs. precife and decifive as influence of When we examine the experience on praétice, we find it general, certained complicated motions of the celeftial the in this manner other fciences bodies ; or lefs rapidly, but with advance more approaching a degree of certainty demonftration. In medicine, however, have although phyficians appealed to experiment, and made clufions, yet it will that contions can never be fo appear their induc in other fcienccs. precife and decifive as influence of When we examine the experience on praétice, we find it general, --- Page 78 --- DISEASES OF [Chap. 1 general; though the principles which late that influence are loofely and regu afcertained. After all the inaccurately pains a phyfician take, in comparing, may examining, and in what conftitutions difcerning be liable ftill agree or differ, he will to error from the dubious outlines which difcriminate different the indefinite laws which habits, and duals. This belong to indivireafoning applies to medicine as a fcience,. Surgery IS Whilf it very different. preferibes rules for operations, and difcuffes the beft plan for reducing a or curing a fracture, it is a refpeétable luxation, ufeful art, becaufe fuch and reafoning is founded on- the almoft unvaried ftruéture of human bodies ; but when it deviates into medical reafoning, not founded on thefe fimple principles,idegenerates, and becomes lefs able, becaufe more refpeêBut to return: vilionary and uncertain. If the nature of the bodies on which the philofopher operates, be either abfolutely different each from each, or conflantly ing, and if one Or more bodies do not changtain the collective conqualities of the whole, experiments made on a few will by no be conclufive. In fuch cafes human means know- + ledge --- Page 79 --- Seét IV.] ST. DOMINGO. ledge will be always imperfeét. But thus it isin medicine: No number of human bodies poffefs in all refpects the fame affemblage of properties ; thefe are diverfified by endlefs modifications. The delicate nature of the human fyftem, the difficulty and danger of making experiments, the impoffibility of af certaining their precife cffeéts, the rious phanomena of life, the aétion of myfte- animated matter, its relations and form fuch a chaos as confound dependencics, and refearch; experiments, which in other obftruét fuits may be extended and purhere limited 5 and inductions, multiplied, made are certain reftrictions and under conditions, cannot be wholly trufted. The human frame, though regulated by fome general laws, which belong to the fpecies at large, is alfo fubject to the influence of peculiar ones, which affect the individual only, and which are not' the fame, perhaps, in any two of the hence an experiment, made fpecies; ; on a few individuals, and applied generally, muft lead into error. If animal bodies neceffarily and regulated by general laws were guided affected by the only, and never the peculiarities which belong to individual, then fimilar powers, to fuch body, would always applied produce fimilar E effects, , is alfo fubject to the influence of peculiar ones, which affect the individual only, and which are not' the fame, perhaps, in any two of the hence an experiment, made fpecies; ; on a few individuals, and applied generally, muft lead into error. If animal bodies neceffarily and regulated by general laws were guided affected by the only, and never the peculiarities which belong to individual, then fimilar powers, to fuch body, would always applied produce fimilar E effects, --- Page 80 --- DISEASES OF [Chap. I. effects, and a juft induction could be made from a few to a great number, indeed any extent; but human bodies are to each by its oWI laws, termed governed its conftitution. The by phyficians mark and fhades, however, which diferiminate variety, are fo obfcure as to elude the moft frequently ver. From this acute obferdificulty much confufion arifes in praétice. Facts remain as fuch with refpect to individuals, but are not folid foundations of reafoning in other cafes, to which they do not fully apply, from fome fubtile unknown difference in the conftitution of each, and yet thie circumftances been extremely fimilar. Some may have difeafes, effentially different in their nature and caufes, exhibit phanomena fo fimilar, that the moft fagacious obferver is apt to be mifled, and thus the efforts of the phyfician become nicious or ufelefs, perSimilar caufes too produce great in the effeéts, as applied to different variety. bodies, according to the peculiar difpofition of each. Hence difeafes efentially different in themfelves, and produced by different apt to be confounded and caufes, are ; difeafes effentially the famc, or produced by the fame caufes, --- Page 81 --- Sect. IV.] S T. DOMINGO. caufes, are judged to be different. Of the firft clafs, continued fevers afford numerous proofs, and remittents and intermittents are examples of the fecond. The treatment accordingly muft be often improper, from the difficulty of diferiminating. Our beft medical records do not afford complete hiftories of morbid phanomena, ; becaufe the circum-, ftances in which the difference of difeafesoften confifts are very minute, and do not readily admit of defcription. Language has not cpithets fufficiently accurate or' delicate to: imprefs fubtile fhades, which the eye of the immediate fpectator can hardly catch. I have known phylicians prediét very exaétly the ifue of a difeafe from the general afpect of a patient, and many minute appearanccs, which they could not pofibly defcribe in words; fo as to make another fully comprehend the foundation of their opinion. The phyfician cannot follow the plan of the natural philofopher; the latter can multiply his experiments on matter, to make extenfive and general conclufions; but the former is oppofed in his career by the moral and civil inftitutions of fociety. If he defcends to the brute. creation, and feizing a chain of analogy, transfers his induction from the one to the E 2 other, minute appearanccs, which they could not pofibly defcribe in words; fo as to make another fully comprehend the foundation of their opinion. The phyfician cannot follow the plan of the natural philofopher; the latter can multiply his experiments on matter, to make extenfive and general conclufions; but the former is oppofed in his career by the moral and civil inftitutions of fociety. If he defcends to the brute. creation, and feizing a chain of analogy, transfers his induction from the one to the E 2 other, --- Page 82 --- DISEASES OF other, he will be liable [Chap. I. fitution and habits to error : the conof the are fo different from inferior animals clufion ours, that no ftriét concan be made from tirely confined to them; experiments enthey cannot be interrogated as to the effeéts of the the phylician and powers of their employs, our judgment apparent feclings muft be erroneous. We apply frequently whofe effential powers to affect a body, underftood. propertics are not by any means. fibre, The nature of the animal except a few of its tally unknown to us that phanomena, is toftitution, which ; elementary congives it fingular and ful properties, has hitherto, and wonderfor ever elude refearch; and may probably of applying when we ipeak powers, which are to its peculiar ftate, we talk a change lolophy language which phiought to reject. From our ignorance of the cfential ofanimated nature matter, we neceffarilyreafon regarding the direét changes failely either by morbid caufes produced in. it, mote caufes of difeafe or medicincs. Reof the fenfes; but often. elude the power when they are vifible, and fubject to examination, as in the matter the of finall-pox, we know very liitle of their mode --- Page 83 --- Sect. IV.J ST. DOMINGO. mode ofading; we remark, indeed, a number of unaccountable phanomena follow their plication to the living fyftem, but that is all. apSuch are the boundaries which it has pleafed the Author of Nature to affix to our refearches. The effects of medicines then muft be in fome degree vague and uncertain but meaicines are the power by which. the phyfi- 5 cian hopes to produce changes, or alter the morbid condition. If, however, the ftate of the animal fibre is unknown, it will be impoflible to modify with precifion the which is to change that ftate. It is power not fiurprifing then that medicine fhould fo be a conjedtural fcience. The long unmarked of conftitutions contributes variety rais greatly to embarour purfuits. If we poffeffed a fcale, which, graduated like a thermometer, would the varieties of exprefs conftitutions, then might a regulated and ufeful experience be but, upon the whole, when we. confider expedted; the numberlefs obftacles fully. it is peculiar to medicine; aftonifhing what progrefs we have made. It is unreafonable and ufelefs to medicine the fame fixeda and expect in which invariable.principles refult from experiment in other fciences, Whoever direêts his attention to E 3 the a thermometer, would the varieties of exprefs conftitutions, then might a regulated and ufeful experience be but, upon the whole, when we. confider expedted; the numberlefs obftacles fully. it is peculiar to medicine; aftonifhing what progrefs we have made. It is unreafonable and ufelefs to medicine the fame fixeda and expect in which invariable.principles refult from experiment in other fciences, Whoever direêts his attention to E 3 the --- Page 84 --- DISEASES OF the healing [Chap. I. art, muft content himfelf with probability; if he expects to certain and immutable develope or meet refearches or extend his principles to guide his be conclufions, he will : difappointed. Let us take medicine is, nor look for what in the as it cannot be nature of things attained: it has no fixed as a fcience, nor any pretenfion principles tive evidence. The to demonftra.. may ftill be rendered experience of medicine art be placed ufeful, and the healing the human among the purfuits beneficial to race. It has been queftioned, whole, the pradtice of whether, on the the fum of human phyfic has diminifhed I, who am fufferings, or prolonged life. rank, believe willing to give to medicine its full it may have contributed but if, on a flriet to both; 3 examination, it fhould appear to have merely alleviated only diftrefs, even then, it has pain and the attention a ftrong claim to ofmankind. It is thatian art, which profeffes the aftonifhing of pain and difeafe, fhould diminution reccived fo little have, in all agcs, ment. In the encouragement from governarifen, gifted with prefent century men have who have acutenefs and judgment, greatly diftinguihed themfelves ; they --- Page 85 --- Seét.IV.] S T. DOMINGO. they have opened the road to truth, and prefented to the phyfiologift views the- moft interefting and extenfive ; they have purfued plans ofi inveftigation, which promife fuccefs, and may ultimately develope the myftic laws and conftitution of life. In.this walk, DARWIN and BEDDOES, hold the firft rank ; the talents of the latter. have been generoully exerted, to banifh the terrors of the young and beautiful, in the defeat of a tremendous difeafe. Let us hope that fome fortunate genius may yet arife to difpel the remaining darknefs which furrounds us, whofe bold and decifive talents will bear down all oppofition and difficulty, and in the midft of prejudiçe rear the durable monument oft truth. Having now pointed out the chief obftacles. to medical improvement, I hall proceed to examine our knowledge of Proximate Caufes, E 4 --- Page 86 --- DISEASES OF [Chap. II, CHAPTER II, SECT. I. Tbe Difcultics ef preferibing by Alfurd IndicatianReafoning on2 Juppojed Proximate Caufs-Morbid A8ion corfitutes Difafe. IN obferving practice, Ihave remarked, ef pecially. in fevers, the vague and views of prefeription, founded fanciful It appeared to me, that without on indications, ledge of the Proximate fome knowCaufe, and its mode of operating, we only loft, time in effects; the fource of which combating known to us. This rendered was wholly uninert. The phyfician became praétice very fpectator, or interfered in either an idle mifed little fuccefs, a manner that proceeded in its courfe whilft the difeafe proThe with little hiftory of fevers, from interruption, the HIPFOCRATES, exhibits days of account of idle theories only a humiliating and ufelefs fyftems. The its mode of operating, we only loft, time in effects; the fource of which combating known to us. This rendered was wholly uninert. The phyfician became praétice very fpectator, or interfered in either an idle mifed little fuccefs, a manner that proceeded in its courfe whilft the difeafe proThe with little hiftory of fevers, from interruption, the HIPFOCRATES, exhibits days of account of idle theories only a humiliating and ufelefs fyftems. The --- Page 87 --- Sedt, Lj. ST.DOMINGO, The ancients blended with their doétrines obfcure" notions from the reigning nor have the moderns been much philofophy, in their more happy invefligations. Fettered by a blind veneration for antiquity, as ifage could fanction error, they copied the abfurd notions of their predeceffers. Few of the moderns have any claim to originality ; the features of their fyftems may be traced in the pages of GALEN, and in the writings of ARITEUS and AVICENNA.. The late Dr. BROWN, though by no means a popular charaéter, exhibited to the public the firft philofophical attempt of any confequence in his fate, and that of his labours, pathology. have $ juftly and pathetically defcribed been by Dr. BEDDOES; but although his fyftem is by no means free from errors, it is the moft five and enlightened that has comprehenyet appeared. Fevers, however, are ftill a barrier in medicine, which neither been able diligence or talents have to furmount. Diffatisfied with the prefent mode of practice, founded on direét indication, let us examine our knowledge of proximate caufes; ifit appears that we know very, little of thefe, it will aifo that indications are often ill founded appear and our nugatory. The --- Page 88 --- R DISEASES OF The [Chap. II, theory of medicine, though improved by a better mode of confiderably ed by the moderns, is ftill reafoning adoptit be dedsced from very deficient. If rately obferved, a number of faéts accuif it confifts of the principles unfolded by experiment, and into a general law, then it will embodied to the explanation of jufly apply happens too often, that phanomena; but it theory isa out attention to fact or affumed withthe bafis of a experiment, and forms fyftem, to which fitted and cemented, till every thing is ed, which the a fimfy fabric is rearbreath of ground, a truth blows to the The theory of the proximate caufe has varied in fevers confiderably in modern BoERHAAVE thought it confifted in times': : the fluids, which itfelf a ftate of was entirely affumed; réquired proof, and the folids HOFFMAN imagined who only were concerned; and CULLEN, copied entircly from him, the attributed all phanomena to fpali. Aftér all thefe inveftigations, we are yet to learn in what it really confifts. It would be ufelefsat this riod to enter on the refutation of thefe petrines 3 I believe even docwhich was certainly the moft CULLEN's fyftem, ingenious, has now was entirely affumed; réquired proof, and the folids HOFFMAN imagined who only were concerned; and CULLEN, copied entircly from him, the attributed all phanomena to fpali. Aftér all thefe inveftigations, we are yet to learn in what it really confifts. It would be ufelefsat this riod to enter on the refutation of thefe petrines 3 I believe even docwhich was certainly the moft CULLEN's fyftem, ingenious, has now --- Page 89 --- Seét. II.] ST. DOMINGO, 59. now few advocates. It may be remarked, in refpeét to them all, that effects were feized which were in themto explain phaenomena, felves links in the chain ofa appearances which the remote caufes produced. The abfurdity of fixing on any intermediate link, to account for all the phanomena, is very evident. We fhould pay little attention to an artift, who, in explaining the movements of a watch, would pitch on any of the intermediate machinery as the fource of the whole. CULLEN's theory had gained confiderable, credit over Europe, when BROWN's fyftem appeared, which, among other benefits, produced not only a more vigorous fpirit of enquiry, but an ufeful fcepticifm in fyftem. Before this period, the theory, and praétice were influenced wholly by the Cullenian fchool; fpafm and its cure were in the mouth of every one, and the pupils of Edinburgh retired from college devoted to this orthodox fyftem. V It is not, however, entirely without ufe thus to form theories; opinions new,and fingular awake genius to examine, confirm, or rejeét them ; the faculties of the mind are exercifed by refearch, and its powers increafed; --- Page 90 --- DISEASES OF ed; truth [Chap. Il. may be deteéted. When eftablifhed, or falfehood in one refearch, there many minds are employed for is at leafta better chance difcovery 5 the different views in objedts are prefented render which more eafy, and the accefs to invetigation fimple. To be convinced knowledge more rant is a great that we are ignoand to difcover ftep towards improvement, ftimulates the infufficiency of a a farther theory lifion, a light enquiry. In fuch a colduct may at length fparkle to us through the obicure conhave hitherto concealed receffes which though truth ; falfe theories, dangerous as to their influence practice, have fometimes been on ling into action the ufeful, by calTo the talents of eminent fyftem of Dr. CULLEN men. bably the work of BROWN, we owe proeflay of MILLMAN, and certainly the banith theory. Let us not entirely Even when we cannot many doubts, we may thus clear tain way, and the proceed a cerfinilhed journey may be by a more fortunate traveller. happily prejudice be banifhed from Let tenable pofts be refearch, let uncandidly us retain ancient doétrines furrendered, nor let veneration for from an improper antiquity. Proximate men. bably the work of BROWN, we owe proeflay of MILLMAN, and certainly the banith theory. Let us not entirely Even when we cannot many doubts, we may thus clear tain way, and the proceed a cerfinilhed journey may be by a more fortunate traveller. happily prejudice be banifhed from Let tenable pofts be refearch, let uncandidly us retain ancient doétrines furrendered, nor let veneration for from an improper antiquity. Proximate --- Page 91 --- Seét, a I] ST. DOMINGO. 6t Proximate caufes have been fought with great cagernefs in all phyfical enquiries 5 but the magic conneétion which fubfifts between a preceding and confequent effcét, has and will cluded, probably for a ever elude, our keeneft purfait. Philofophy marks.a chain, or uniform manner, in which effects.a appear to be connected, and calls by the name. of caufe, effect which it cannot trace higher, for which an it has no. antecedent; and which is followed by a train of other cffedts, which in theit turn become caufes, and, perhaps, have other connection with the no higheft links than being merely in. fucceflion. When we obferve a chain of phanomena uniformly and: confantly fucceed one another in a certain invariable way, it is to place theni in the relation of cuftomary caufe effect, though by this mode of and lofe fight of the higheft link reafoning we and attribute all the we can trace, termediate appearances to an inone, from which we deduce whatever follows. To illuftrate fhali, for my meaning, I example, take CULLEN's on the proximate caufe of fever. reafoning brated profoffor laid hold of This celefor all the fubfequent fpafn to account fymptoms. Now fpafm is --- Page 92 --- DISEASES OF. is itfelf an individual [Chap. If. effect in the train of phanomena which the morbid caufe duced; for it has been proved proby minute and accurate very clearly evident obfervers, that other time with derangements are prefent at the fame (pafm, and are fometimes to precede and fometimes known Naufea, an to accompany it.. inexpreflible anxiety and fenfation about the ftomach, uneafy Janguor, and debility, are perceptible before any marks of pafm have appeared. Thefe are which the morbid caufe modes in derangements in the ufual operates; they are, a great meafure conftitute functions, and in. it would be the difeafe ; but juft as fair and as good reafoning to fay, that languor and icty, was the debility, or anxproximate caufe, and all the other produced be, that fymptoms. The truth feems to fpafin is a fymptom of fever, in common with many others, but not means the proximate by any. caufe, as Dr. CULLEN imagined. Feyer exifts and proceeds no fpafm can be traced, nay, when there when pofitive evidence that it is not is there are clear teftimonies prefent; for traction of the that fpafim, or conwithout extreme veffels, has taken placc and there producing one fymptom of fever ; are cafes of fever, where a moifture has ptom of fever, in common with many others, but not means the proximate by any. caufe, as Dr. CULLEN imagined. Feyer exifts and proceeds no fpafm can be traced, nay, when there when pofitive evidence that it is not is there are clear teftimonies prefent; for traction of the that fpafim, or conwithout extreme veffels, has taken placc and there producing one fymptom of fever ; are cafes of fever, where a moifture has --- Page 93 --- Sedt.1.] ST. DOMINGO, has continued on the fkin whole courfe of the difeafc, throughout and the has had that foft relaxed. feel where it that a free exit to the perfpirable indicates matter. Ifthe production of (pafm was at all times followed by fever, which it ought to be if it is the proximate caufe, every immerfion in cold ter would create a fever ; but the waeffects of cold bathing, and the little falutary from accidental danger plunging, are ftrong againft this conclufion. I have arguments thefe enumerated objections to fhew the little ufe and fallacy of feizing, for a Proximate individual effeét of the morbid caufe, an has no other conneétion- with power, which the. phanomena than an accidental fubfequent precedence. Let us now examine what we proximate caufes, and what mean by of them. A we really know proximate caufe is that tion which exhibits the morbid condiand without which phanomena, ment exift it they could not for a mo- ; is the final operation of mnote caufes concentrated fo redifeafe and as to produce cine is fo obfcurc derangement. No part of mediin as this ; we are our plans of cure' founded daily baffled becaufe we reafon on indications, falfely, and proceed to prac3 tice --- Page 94 --- 64: DISEASES OF [Chap. Il: tice on principles not eftablifhed, and gether unknown. I am not altoone inftance in which acquainted with the nature of the we diftinétly afcertain proximate caufe; Iallude more efpecially to fevers; we remark, its mode of operation, and the indeed, produces, but the peculiar ftate phanomena it give it vigour, and conftitute its neceffary to tally unknown to us. When cflence, is towe fpeak then of proximate caufes, we fpeak of unknown ers producing effeéts which we obferve, powoperating in an unknown' and being able to afcertain the manner, without which exhibits them. precife condition dently Thefe caufes are evimodified, but we are ignorant of the precife and definite modifications. ing the cafc, the practice of This bedefinite indication muft be preferibing by ble; for if we do not know erroneous or feea in what the proximate caufe itfelf confifts, how are we to prefcribe means for its removal? and if not removed, we do it be of nothing on this icheme management. An indication is that thod which the operation of the mecaufe points out for its own removal. proximate cations of cure are always Indifounded on a fuppofed to be knowlerige of the proximate caufe; they are the obviating fchemes which we for if we do not know erroneous or feea in what the proximate caufe itfelf confifts, how are we to prefcribe means for its removal? and if not removed, we do it be of nothing on this icheme management. An indication is that thod which the operation of the mecaufe points out for its own removal. proximate cations of cure are always Indifounded on a fuppofed to be knowlerige of the proximate caufe; they are the obviating fchemes which we --- Page 95 --- Sect. I.] ST. DOMINGO we adopt - to fruftrate the noxious power ; but if our movements chief of a' is directed to a partial effect, the attention permitted to exert its full difeafe is gain fuch ftrength, and to vigour as not to be come, by any means we can afterwards readily overploy.-Whilt CULLEN's ems tice in fevers, the chief theory, guided praccome fpafmn; and object was to overfor this purpofe, medicines were employed than which had no other effeet gradually to debilitate, and render courfe of the difeafe the more infupportable; adding naufea to the catalogue of by Itis true, that we are fometimes fymptoms, fuccelsful in practifing by a feppofed indication indication itfelf is at leaft ; when the tainly the manner in which doubtful, and cerfils it. Thus, the medicine fulwhen a fharp inftrument rugged thorn, bas or penetrated the gans, a locked jaw is fometimes fofter orquence, after the the confeOn the fuppofition offending body is removed. that this arifes treme irritability, from exfometimes opium is preferibed, which happily removes the the precife manner in which danger, though is produced, the locked cannot be afcertained, jaw operation by which opium nor the. precife ftate then, which rémoves it. The neceffarily produces F and --- Page 96 --- a a DISEASES OF and exhibits the [Chap. II. morbid phanomena, unknown, it is impoffible to form being indications, founded in judicious phyfician's. fact, on a fiction of the Till the laws of animal are more minutely unfolded, nature late; and try to we muft fpecuenlarge our views in -We have feen that the praétice. fevers, though influenced practice, efpecially in bas not, for a by various theories, period of two thonfand materially improved, Here then the years, left open to field is innovation $ nor hag as Dr. BEDDOES bappily experience, tenfions to fet expreffes it, any preup to overawe Where, however, an fpeculation. uniform, and experience is broad, which extenfive, it may form a may be followed with lirtle guide, but where danger; : decided experienice leads to no ufeful or plan, and where indications formed to amufe the are only fair and practitioner, it is then juft to take fome other ground, till a pofition is difcovered from which faccefsfully we may play our artillery on the difeafe. Inftead then of looking to fpecial which the modes,in direct proximate caufe operates, let our attention to its general us' we really knew, in effects. If rect any one inftance, the dis precife circumftances; which conftituted. the indications formed to amufe the are only fair and practitioner, it is then juft to take fome other ground, till a pofition is difcovered from which faccefsfully we may play our artillery on the difeafe. Inftead then of looking to fpecial which the modes,in direct proximate caufe operates, let our attention to its general us' we really knew, in effects. If rect any one inftance, the dis precife circumftances; which conftituted. the --- Page 97 --- Sea.1.] ST. DOMINGO. the proximate caufe, I am perfuaded the Materia Medica would furnith us with means to vanquith it. 'It is abfurd to fay, that we know the proximate caufe in fevers, whilft thefe fevers baffle our fkill; becaufe, in moft inftances, where we form opinions approaching truth, on the.caufes ofdifeafe, we inftantly fucceed in the cure. The living body, in the ftate called health, performs its functions with eafe and harmony; of . every part the fyftem acts in unifon, and agreeable to its na- % ture ; producing pleafurable fenfations, and performing every operation neceffary to ferve the whole in perfect order. This E mony of animal action conftitutes good health; it confifts in a peculiar mode of action inherent, or proper, to the feveral organs which compofe the body; but there are caufes, which feduce thefe powers, or organs from their obedience to the propér animal laws, and oblige them to deviate into other modés of action, which create derangements, pain, and uneafinefs, and which ultimately deftroy the fyftem entirely. Thefe aberrations, from the ufual movements of the animal termed difeafes, and the caufes which frame are them are morbid produce powers. The new manner of adting introduced by the caufes of difeafe F 2 has --- Page 98 --- DISEASES OF has been termed morbid [Chap.If. was firft ufed by the late celebrated adtion.-This term HUNTER, whofe original and mafculine Mr.JoHN of thinking, introduced turn hints into medical many new and ufeful and furgical reafoning. Morbid aétion is the ufual functions, derangement in the produced by the caufe.-As we do not comprehend what proximate ftitutes the nature and effence of that conlet us try to modify and change the ftate power, ofthe body; fo as to render the operation of the proximate caufe lefs deftruétive. If we fucceed in changing the given fate of the we affuredly change all the nature of body, morbid action, fo as the new feries perhaps to give rife to a the ofphanomena lefs dangerous than former.-It has been remarked, that before morbid powers can produce their on the body, there muft exift between cffeéts what them Dr.JACKSON callsa anaptitude. nionis countenanced, by Thisopiobferving, that men may be expofed to morbid though it often requires a long time before caufes, yet produced; that is, before the difeafe is takes place, which peculiaraptitude to morbid influence. difpofes the fyftem to yield In our to change the ftate of the attempts then, fyftem at once 3 at it exift between cffeéts what them Dr.JACKSON callsa anaptitude. nionis countenanced, by Thisopiobferving, that men may be expofed to morbid though it often requires a long time before caufes, yet produced; that is, before the difeafe is takes place, which peculiaraptitude to morbid influence. difpofes the fyftem to yield In our to change the ftate of the attempts then, fyftem at once 3 at it --- Page 99 --- Seat. I] ST. DOMINGO. 6g it is poffible the aptitude itfelf may be deftroyed, and the-very principle ofthe difeafe banifhed. The influence of babit is moft powerfully felt in all the actions of the living fyftem; hence, perhaps, the ftate ofhealth is fo long continued, and is more natural to the conftitution. Whilft the movements of the body are harmonioufly performed, and poffefs vigour, it will be more difficult to imprefs changes; hence a ftate of vigour is at all times a kind of proteétion from contagious' difeafes; but when the actions of the living fyftem are performed with languora from whatever caufe, morbid anddebility, changes are" more readily. impreffed and adopted; the feeble rivulet may be diverted into any channel, but the vigorous. torrent purfues its courfe, infenfible to fmall obftacles; hence! a ftate of debility renders the fyftem more obnoxious to contagion, or the influence of difeafe. Iam' inclined to believe that morbid caufes fail in producingdifcafe; not from the wantofaptitude, but of vigour in the contagion, or itfelf. Many men, for inftance, refift the power influence of ardent fpirits in certain quantities, while others are eafily intoxicated; but man can be overpowered by a fufficient every tity. Thofe men, commonly called quanrobuft, are F 3 not --- Page 100 --- DISEASES OF not always [Chap. II. poffeffed of the greateft vigour; fo that this animal dicted by fecing what reafoning is not contradily overcome we call ftout men reafucceeds by contagion, If the in changing the condition phyfician the whole operation of the ofthe body, wil! be alfo changed. proximate caufe called a random This, perhaps, may be fo than that founded practice; but it is not more rying our means, on indications; ; and in Vacoveries, accident may give rife to difanalogies will be ence confulted, whilft the feized, and experieniarged. In views in praétice are to (how, that an Appendix I fhall endeavour this doctrine has enced the practice of fecretly influbeing phyficians, without of acknowledged, ahd that, in fact, the ulcers, as pointed out by Mr. cure TER, was diredly founded JoHN HUNwell as the mode of on this dodrine,as other fevers. treating intermittents and ife to difanalogies will be ence confulted, whilft the feized, and experieniarged. In views in praétice are to (how, that an Appendix I fhall endeavour this doctrine has enced the practice of fecretly influbeing phyficians, without of acknowledged, ahd that, in fact, the ulcers, as pointed out by Mr. cure TER, was diredly founded JoHN HUNwell as the mode of on this dodrine,as other fevers. treating intermittents and --- Page 101 --- Sedt. II.] STN DOMINGO. SECT. II." ox nati Opinion of tbe Tellow Peverali appears to be tbe common Remittent-It is not tbe Féver ef Philadelphia or Boulam-The Tellois Fever not amutagiu-Grandhfor tbis Reafoning. ISHALL now proceed more immediately to the object of this work, the Fever of St. Domingo. a After all the inftances ofthis Fever which I have witneffed, and all the attention I could pay to it, I. am of.opinion, that it is > the common remittent of that country, rendered formidable, by being applied to the Englith conftitution 5 that the variety, which appeared in its progrefs, depended entirely on the variety in the feveral conftitutions which it attacked; and that the yellownefs, which gives it a peculiar name, only marks its worft ftages, and is rather accidental than peculiarly characteriftic. F 4 Dr. --- Page 102 --- O.N THE FEVER [Chap. II. Dr.JACKSON, in his treatife, which contains many valuable remarks, has, with uncommon fidelity and accuracy, noted various fpecies of the Jamaica remittent, which feems to me. to have been of the fame kind with -what raged at St. Domingo, violence. differing only in Perhaps the immenfe mortality which has happened in the Weft Indies within thefe four.years, 7153 is to be attributed numbers who have I been fent to the greater for the purpofes of to that quarter war; for, befides failors and foldiers, war creates room for a great number of fpeculators; who follow the from views of commerce. It muft be army admitted, perhaps, that the climate itfelf has changed, and has been more injurious to the European conftitution, within this period, than at any former time, What the fecret caufes of this change be; we do not but it has been MSLAO in the Welt know; that during thele feafons there has Indies, greater heat, and alefs fall of rain at its prevailed period 5 and I have before remarked, proper that this circumftance always renders the miafmata more vigorous and adive; befides, the climate of the moft J healthy regions a undergoes frequent injurious to the European conftitution, within this period, than at any former time, What the fecret caufes of this change be; we do not but it has been MSLAO in the Welt know; that during thele feafons there has Indies, greater heat, and alefs fall of rain at its prevailed period 5 and I have before remarked, proper that this circumftance always renders the miafmata more vigorous and adive; befides, the climate of the moft J healthy regions a undergoes frequent --- Page 103 --- Sea.II.] OF STIDOMINGO, frequent changes, for which we means equal to account; are by no their many difeafes make appearance faddenly in fuch without our being able to explain, places, fatisfactory manner, the means by in any are produced, and they which they any evident again retire without change in the climate in which they arofe, fo minute are the which influence the origin of difeafes. circumftances The fever ofPhiladelphiz, which has defcribed with his ufual Dr. RusH never appeared at St. accuracy, certainly period of my refidence Domingo, during the many fimilar features 5 though there are St. in the remittent of Domingo, both in the fymptoms and treatment, One important and ference takes place between ftriking difof them; the fever Philadelphia was remarkably whilft that of St. contagious, manifefted that Domingo in no one inftance tendency. It is true, troops have been difembarked that and at other at the Mole, places, with a contagious fever amongft them, which carried off its type and fymptoms varied numbers ; but the remittent. This latter confiderably from many of the fever appeared in with them from tranfports, the who had carried it encampment formed in Ireland --- Page 104 --- ON THE FEVER [Chap. II. Ireland previous to their embarkation. the change and From ircitability created inall man bodies by the action huform of fevers ofheat, the type and muft be changed in warm climnates. There are few cafes of fever, where the pulfe is increafed, but the hepatic fers fome degree of fyftem fuf repletion, and confequently its fecreting hence powers are increafed; a degree of jaundice is generally plicated with every febrile comWeft Indies; but this complaint in the tranfitory differs very widely, in my opinion, yellownefs from the inflantaneous one which takes place in the remittent of St. Domingo. It is true, that numbers fuffered from a contagion ried afhore with them from the they carthe 96th regiment tranfports ; were almoft annihilated e by a fever of this defcription ; and other regiments fuffered alfo from the fame caufe; but contagions muft very foon ceafe and difappear in a hot climate. The principle of contagion muft confift in diftinét elaftic ticles, or be affociated with moifture, partach itfelf to wood, walls, or atfrom which the action of heat cloathing, Scc. detaches it fo as to be applied to the human in body an active almoft annihilated e by a fever of this defcription ; and other regiments fuffered alfo from the fame caufe; but contagions muft very foon ceafe and difappear in a hot climate. The principle of contagion muft confift in diftinét elaftic ticles, or be affociated with moifture, partach itfelf to wood, walls, or atfrom which the action of heat cloathing, Scc. detaches it fo as to be applied to the human in body an active --- Page 105 --- Sca.IL] OF ST. DOMINGO. active flate ; it muft be evident prima facie, warm climates then, that, to the fpreading of are unfavourable tion of heat contagions ; for the acexpands, and rarefies, and tilifes all matter capable of volathus blending them with the evaporation, and by alters their qualities atmofphere, either lefs noxious, entirely or renders them Perfons, to receive muft in general be very near the fource infection, of fo as to be impreffed whilf it poffeffés it, otherwife it fails of effect. We remark vigour, further, that all the means we employ to chambers, purify hofpitals, or thips, and banith infection, are nothing more than tificial warm climate to creating an arfphere. From this arifes. the rarefy the atmogations, which, beneft of fumiperhaps, are only ufefulin portion to the volume of fmoke which profrom them. No one, I prefume, iffies tend to point out any new combinations, will prewhich the principle of contagion is by lized or rendered inert. Of other neutraprevénting infection I Thall means of afterwards. - fpeak more fully The Remittent of St. Domingo bears analogy to the fever defcribed by Dr. no HOLME, and which he CHISfuppofes was carried from --- Page 106 --- ON THE FEVER from Boulam, in [Chap. II. Africa,by. a Guinea RusH very clearly proves, in his thip. Dr. that the own perfon, Philadelphia fever was contagious, and he merits the remarkably for his fearlefs higheft praife induftry amidit fo many dan. gers. Contagious difeafes are marked ftriking and rapid by a point, in which progrefs, from a 'certain they have commenced, from which they extend, without and tion, toallaround them; when any diftincadmiflion into théy have found a particular diftriét, or they lay them wafte; and thofe who family, forward to perform the offices of are moft are tinhappily the firft to fuffer. The humanity ànd attendants ofthe fick become friends perith; the phylician infedted, and from habit, is at length himfelf, more dauntlefs and flies the dreadful fcared from his office, fcene. This mifery Philadelphia, in common with Aleppo, has experienced; but no circumftance ing an infectious fever occurred attendmittent of St. in the reDomingo. When a was feized in the barracks, it foldier to fpread in that was hot obferved times particular quarter,and fomeonly one was attacked; nor could we remark, when they came into the that in one cafe whatever the hofpitals, evident. The medical contagion was gentlemen could not have fcene. This mifery Philadelphia, in common with Aleppo, has experienced; but no circumftance ing an infectious fever occurred attendmittent of St. in the reDomingo. When a was feized in the barracks, it foldier to fpread in that was hot obferved times particular quarter,and fomeonly one was attacked; nor could we remark, when they came into the that in one cafe whatever the hofpitals, evident. The medical contagion was gentlemen could not have --- Page 107 --- Se&.IL.] - OF ST. DOMINGO. have poflibly cfcaped if there had been 77 infection; for though they might for fome any time refift its influence, it IS not probable that they would always efcape, ftreams of expofed to the contagion which muft have iffued from fuch a number of bodies in its moft vigorous ftate of action ; but the moft expofed to this gentlemen danger never as to fufped that their difeafe fuffered,fo infection. Dr. Scor, Mr. arofe from BUCKLE, and WARREN, Mr. many other gentlemen, who gave the fick the moft affiduous caped this fever, attention, efdom vifited lefs although each ofthem felthree than feventy or eighty times a day. Itis true, Dr. ST. patients and Mr. PoWRIE died; but CLAIR for a long time they had been expofed to the caufes of the remittent before they were attacked. Sr. CLAIR was full and plethoric, Dr. and means a good fubjedt for any febrile by no and Mr. PoWRIE had been diforder; fiderable fatigue. Nor expofed to conany inftance, that the could we remark, in immediate the fick fuffered attendants of diers, who more than others. The folperformed the office of in general very healthy, and nurfes, were of contagion. At without any fear firft, in the ward to my care, I feparated the feverifh configned from the others, --- Page 108 --- ON THE FEVER [Chap. II, others, as much as my limits permitted; on other occafions I was but them with the obliged to blend convalefcent; but I néver obferved, that in this fituation any of their immediate neighbours fuffered, or that the fevér fpread. I was led to confider the difeafe tagious, by reading the conRusH ; whofe publication of Dr. authority muft have great weight in all medical opinions ; but the fever he fo ably deicribes, differs of St. greatly from that Domingo. This difference may arife from the climate of Philadelphia, and the riety produced in the conftitution; vabut our knowledge is too limited to explain the operation of thefe caufes. precifely There is no point on which I am more decided, than the abfence of contagion in the remittent of St. Domingo. The of medical reafoning, and the loofe uncertainty principles on which it is founded, has given rife to variety of medical opinions on almoft a fibject ; but on this every queftion we were all agreed; no difference of riety of opinion fentiment, no vaappeared amongft us. Dr. WRIGH r, who was my colleague, and whofe accuracy of obfervation and ftrength of ment entitle him to attention, was of the judg- fame way . Domingo. The of medical reafoning, and the loofe uncertainty principles on which it is founded, has given rife to variety of medical opinions on almoft a fibject ; but on this every queftion we were all agreed; no difference of riety of opinion fentiment, no vaappeared amongft us. Dr. WRIGH r, who was my colleague, and whofe accuracy of obfervation and ftrength of ment entitle him to attention, was of the judg- fame way --- Page 109 --- Scet. IL.] OF ST. DOMINGO. way of thinking ; he had made his at Cape Nicholas Mole, before I had conclufions the faction of meeting him; fo that fatishave biaffed each other. we could not Dr. GORDON whohad likewife, lestenfiveoportunitier and was anxious to afcertain this ofobfervation, tirely coincided in the fame queftion, enrecolleét, it was alfo the opinion ; and if I ScoT; in decifive opinion of Dr. fhort, I never converfed with dical géntleman at St. any meform the fame Domingo, who did not judgment. Ihad not an nityofo converfing with theJamaica opportuon this fubject; but I have been practitioners on feveral occafions fevers informed, that thips fpread for a little time brought there in rity. This one feature with great feveguifhes this fever from then greatly diftinthat which raged at Philadelphin, or the difeafe defcribed CHISHOLME. by Dr. This is a queftion of the utmoft to afcertain. If it importance proof could really was proved, and the not be difficult, that a there exifted e contagion, our practice and be different. If there precautions muft would be ufelefs is an infection, it and inhuman ever to fend any European to that climate. groundlefs fears, terrified Already have and fubdued our countrymen $ --- Page 110 --- OF THE FEVER [Chap. II, countrymen 3 and rendered them more to fever, and more eafily liable name ofSt. conquered. The Domingo is execrated, and ed by all defcriptions. The dreadoflicer and bound for this fervice look foldier as doomed to certain deftruétion. upon themfelves lofe the benefit of their The foldiers the officer is comrades attention 5 approached with fear friends or fervants ; all the by his fo pleafing in the fick bed, foothing attentions, are banifhed ror. The fervice fuffers by terwhich by thefe falfe are exaggerated in alarms, conveyed in the every narrative; ; and language fear always The climate is, no doubt, fufficiently fupplies. the young and vigorous terrible to and will ; many have perifhed, always perifh, at that period of If the plan, however, of life. the age of forty-five, fending men from to fifty years, is ever adopted by government; this mortality from climate will in a great meafure ceafe, and the fervice will be carried on with more fuccefs ; at any rate it will be vigour and know, from the united pleafing to phyficians and teftimony of all the furgeons who ferved at St. Domingo; that the Remittent of that called thbe Yellow ifland, Fever, IS NOT INFECTIOUS, life. the age of forty-five, fending men from to fifty years, is ever adopted by government; this mortality from climate will in a great meafure ceafe, and the fervice will be carried on with more fuccefs ; at any rate it will be vigour and know, from the united pleafing to phyficians and teftimony of all the furgeons who ferved at St. Domingo; that the Remittent of that called thbe Yellow ifland, Fever, IS NOT INFECTIOUS, --- Page 111 --- Sea.III.] OF ST, DOMINGO, SECT. III. Caufes oftbe Frequency oftbe Remittent-Sinilar Caufès produce Remittents and Intermittenti-State of tbe Organs in tbe Remit. vent-Phanmena in tbe Remitont-Critical Days-Comfe wbicb excite the Fever-Di agmfic difcult-Prognalic-. IT will now be afked, how came fever to be fo frequent, and this, not contagious, and what deftructive; ifit is it really is P defeription of fever It became deftructive, by of ftrangers prefented having a number dition, to its poifon; in a concondition unfavourable to their fafety. This has been already explained, in a mer part of this work. The caufe formotely produces this fever is which refloating in the atmofphere, and breathed by or otherwife every one alike, applied to their bodies. Hence great numbers are feized at the fame becaufe great numbers are expofed, to the time, petual action of a very powerful pergives the fever agent. This when it is an appearance of infedtion, only the operation of a caufe generally --- Page 112 --- REMITTENT FEVÉR [Chap. IK, rally acting. Every man is probably charged with the' expofed, and 1 we do not know miafmata, though fully the circumftances abfolutely required to make them active. ingenious, and ufeful remarks Many Dr. RUSH on this are made by entirely with important fiubject. Iagrec him, that the caufe of fever may lurk for a long time inoffenfive, till the abftraction of ftimuli, or the addition or accumulated ofthem, energy and action. excitability, give them an As great numbers are expofed then, many muft be fo as really to become feverilh impregnated, dition in which ; and-as the conthey are attacked is unfavourable, the iffue is frequently fatal. I have already faid, that I think the St. Domingo fever, commonly called the Tellow Fever, merely the remittent endemic of the ifland,applied to the Englith conftitution in a. certain condition $ and further, that the yellownefs, for reafons already always bilious, but alledged, is not an accidental variety, marking only its worft ftage, and on a change in the ferum.-I fhall depending fully give iny reafons now more for this opinion 0 3 if are groundlefs, I thall think they an mylelf happy in opportunity of changing, them, for the more of the ifland,applied to the Englith conftitution in a. certain condition $ and further, that the yellownefs, for reafons already always bilious, but alledged, is not an accidental variety, marking only its worft ftage, and on a change in the ferum.-I fhall depending fully give iny reafons now more for this opinion 0 3 if are groundlefs, I thall think they an mylelf happy in opportunity of changing, them, for the more --- Page 113 --- Sea. III.] OF ST. DOMINGO, more enlarged and correét views of others, who may be more fortunate in their inveftigations. Ihave obferved this Fever, with all the attention in my power : and I have feen it ceed to its fatal termination, in pronumerous inftances, without the leaft yellownefs whatever. Whilft, on other occafions, it made an early appearance, and excited juft alarms for the patient; but when it went on without the yellownefs, the fame fymptoms and movements took place, as when the yellownefs prefent, except the abfence of that formida- was ble fymptom. The yellownefs, if it marked a peculiar difeafe, would have really with it peculiar fymptoms, which would along charaéter to it, and regularly attend its give grefs ; but no fuch pro: fymptoms ever appear. Theinceffant vomiting is a fymptom common to the remittent in both ftages, with, and without yellownefs. The mode of attack is precifely the fame in both forms, and when we fucceed in either, the form of practice is the fame, There is no feparate and diftinét type to charaéterife a new fever, different from the prevailing endemic; The yellownefs, appears to. me, to mark only an G 2 aggra- --- Page 114 --- R EN MITTENT FEVER [Chap. IF. aggravated cafe of the Remittent; to be a fage of it more replete with merely danger. The power of the caufes produces more manifeft changes or derangements; and in whatever manner. they are effeéted, they cannot exift without the greateft danger to the There does not exift then a fyftem. meriting the name : of Yellow peculiar fever; Fever, in St. Domingo; it is only a variety, marking danger, and, in fact, nothing more than great the common Remittent: The fever of St. Domingo I have termed a Remittent, becaufe its' type refemblés that form moré than any other. The remiffions, in moft. inflances, are very obfcure; and in many not altogether difcernible ; Ihave, howa ever, marked them very diftinctly in a few cafes. They occur, in and' 2 géneral, towards noon, are of more or leis duration, to the feverity of the attack; according fometimes, however, they are protracted, and happen in the afternoon'; but in géneral fome llight alleviation of the fymptoms, fome relief to the oppreffion, fome diminution in the heat, or in the violence of reaction, are perceptible, in the forenoon, and thercfore the fever may be called remittent. I have cafes. They occur, in and' 2 géneral, towards noon, are of more or leis duration, to the feverity of the attack; according fometimes, however, they are protracted, and happen in the afternoon'; but in géneral fome llight alleviation of the fymptoms, fome relief to the oppreffion, fome diminution in the heat, or in the violence of reaction, are perceptible, in the forenoon, and thercfore the fever may be called remittent. I have --- Page 115 --- Sedt. III.] OF ST, DOMINGO. - I hàve for a long time thought, that Intermittents and Remittents arofe, precifely from the fame caufes, and only differed in the caufès were form, as applied to different çonftitutions, or as different degrees of the fame dif. eafe. There is hardly a country in which Intermittents prevail, but where allo the Remittent makes its mild and confluent appearance. The fmall-pox every lows to arife from the fame fource; body.al5 yet the appearancés are fo different in different ftitutions, that they would almoft feem conent difeafes. The Intermittent differme only the milder form of appears to in itfelfis the Remittent, which aggravated ftage, as the confluent is, of the inild fimall-pox. When caufe is not very powerful, Or the conftitution applied to a not difpofed to adopt morbid movements of any duration, an Intermittent is produced; but when it poffeffes energy and ftrength, or is applied to a conftitution to revolt from the laws of health, and ready new movements, then the remittent adopt completed. In the milder type is fhape of the Remittent, the fame remedies effeét a cure; and the more the Intermittent approaches, by having no difinctintervals, to the more difficult and Remittent, the dangerous the cafe becomes, G 3 The --- Page 116 --- REMITTENT FEVER The [Chap. II, Intermittents and Remittents are nerally inhabitants of the fame geeither prevail at the fame country, and one time, as forms of difeafe, or appear to fucceed one from minute changes in the climate another, tution. I have or conftifrequently feen the Intermittent commence the attack, and repeat its form for one or more paroxyfms, and the caufe gained afterwards, as mittent ftrength, affume the refhape, and prove fatal. On other OCcafions Ihave obferved the once begin the difeafe, but Remitting type at mitigating in its progrefs, either from fome change in the atmofphere or conflitution, affume the Intermitting fhape, and the. patient has efcaped, They have thus appeared in the fame and have affumed their places, varjeties of refpective forms, as one difeafe, fo as to induce me to çonfider them as only forms of one fever. The Remittent of Saint Domingo, attacks at all feafons ; but with more violence and deftruction, during the months in which a vigorous exhalation is going forward; and when the falls of rain are lefs frequent. From the beginning of May, till the middle of November, the Remittent continues its ravages with uncealing violence; but when the rains fall plentifully, their places, varjeties of refpective forms, as one difeafe, fo as to induce me to çonfider them as only forms of one fever. The Remittent of Saint Domingo, attacks at all feafons ; but with more violence and deftruction, during the months in which a vigorous exhalation is going forward; and when the falls of rain are lefs frequent. From the beginning of May, till the middle of November, the Remittent continues its ravages with uncealing violence; but when the rains fall plentifully, --- Page 117 --- Sed. III.] OF ST. DOMINGO. plentifully, and the heat is fomewhat diminilhed, the Intermittent form begins its reign. They generally commence their attack, either în a ftate of indireét debility, or where there is confiderable excitement. The Remittent ufually. attacks by laffitude, and wearinefs, or by chilly fits, and flight pains in the bones, with great inclination to flecp, and an unaccountable liftleffnefs to every thing around. At other times it is ufhered in by a regular paroxyfm of ague, which, going through its common courfe, leaves the patient languid and weak; in this flate the Remittent affumes its proper form. The pulfe, at times, is little altered, and no great change in the heat of the body 5 but the eye has an eXpreffion ofanguifh, fometimes of ferocity, and a certain grimnefs takes place in the countenance, as Dr, JACKSON has remarked in the fever of Jamaica. In fome inftances, the is oppreffed and contracted, and the pulfe is under the influence of very low patient inclined to figh; in others, the fpirits, and is hard and full; the face pulfe at onçe flulhed, and the patient complains of intenfe head-ach. Thefe feveral modes of attack are not uncommon. The patient continues in this flate the night, and at times during enjoys a calm fleep, G 4 at --- Page 118 --- REMITTENT FEVER at times fuddenly [Chap. II. ftarts; and he is, fees himfelf affailed forgetting where by dreadful toms, and wilhes to rofh into the phanjump through his windows, ftreet, or leétion returns, he When recollen on his bed; ufually falls lilefs, or fial- ; and, fighing, flecps During this time all the again. fiderably fecretions are condifturbed; the urine is in fmall quantities, high coloured, and turbid; fpiration is irregular, perfmnall interrupted, and in proportion; the faliva becomes and the to:gue is covered vifcid, of various colours; the over with a cruft unufual $ bile is fecreted in quantities, and thrown into the mach, from which it is again ftoed; the fkin becomes fpeedily ejectand feels like a board; ablolutely impervious, be made on it by no impreffion can by any ftimulants any plan of relaxation, or çond, often we yet know, On the feon the third day, the determinations to the vital dangerous ftomach is afailed, and its organs begin; the infammation : the veflels çoats affeéted with diftended with an unufual of them become which throws them into quantity of blood, and gives them all the an inordinate action, mation ; the whole irritability of inflamftomach innér furface of the may in this flate be confidered as one inflamed çond, often we yet know, On the feon the third day, the determinations to the vital dangerous ftomach is afailed, and its organs begin; the infammation : the veflels çoats affeéted with diftended with an unufual of them become which throws them into quantity of blood, and gives them all the an inordinate action, mation ; the whole irritability of inflamftomach innér furface of the may in this flate be confidered as one inflamed --- Page 119 --- Sedt. III.] : OF ST. DOMINGO. inflamed furface, to which nothing is with impunity ; the veffels, thus diftended applied and active, fecrete more copioufly, and their fecretion is poured into the ftomach, which acts with violence to return it; and thus ports a conftant determination to itfelf. fuplength the veffels, overcome At action, lofe their by perpetual tone, and pour out of blood, which, mixing in the ftomach portions the former fecretion, and an addition of with create what is termed the black bile, a moft dangerous vomiting, fymptom; becaufe the ftate neceflary to produce it, is a ftate of the greateft derangement. There are of this proofs progrefs; 3 the pain and irritability of the flomach, and the great fecretions in its vity, argue, in the moft decided Çathat the blood veffels are manner, a ftate refembling furcharged, and in infammation : that . is really the cafe, appears from this which fhow the inner coats of the diffections, peeled off, and ftomach feparated, This could not happen without organic lafion 5 and fuch fions are commonly the refult of lainfammation, and increafed action. previous In manner is the inceffant this vomiting accounted for, on pretty certain principles. That is really the cafe, may be further this argued from $ the --- Page 120 --- REMITTENT FEVER, the ftate oft the fkin, it [Chap. II. being found locked, and fhut up, completely moft effential and refufing a paflage to its urine, in cuftomary difcharge. The common cafes of difeafe, is increafed when the perfpiration is diminithed, and balance is fupported between a does not happen in the them; but this the Remittent; for though perfpiration is almoft entirely the urine feldom fuffers fuppreffed, mafs of an increafe. The blood, in thefe be circumftances, muft augmented by the retention of different fecretions 3 the confequence muft be, the weaker or more lax veffels will be that charged, and fuffer all the furinflammation. The confequencés of liver, the ftomach, and the brain, poffeffing a large fyftem of in a foft medium, become veffels, to thefe determinations particularly liable find, that in thefe ; and accordingly we organs they really take place. In fome inftances the the very firft moment, feels patient, from only a kind of infenfibility ; and languifhes away his life without any pain, The powers of life, attacked in their very principle, yicld dually to the irrefiftible gramorbid oppreffion, of the caufe; whilft the fyftem, unable from the beginning to make any proportionate refiftance, furrenders itfelf to diffolution without a ftruggle. During organs they really take place. In fome inftances the the very firft moment, feels patient, from only a kind of infenfibility ; and languifhes away his life without any pain, The powers of life, attacked in their very principle, yicld dually to the irrefiftible gramorbid oppreffion, of the caufe; whilft the fyftem, unable from the beginning to make any proportionate refiftance, furrenders itfelf to diffolution without a ftruggle. During --- Page 121 --- Sedt, III.] OF S T. DOMINGO, During this progrefs, changes feem produced in the great mafs of the blood itfelf: what ooZes from the gums exhales the moft faetid odour, and the many fpots, which, under the title of vibices, or macula, are difperfed over the body ; argue fome confiderable change in the folids and fluids. From the fator of the breath, and the horrid fmell of matter iffuing from the fick, I think it every will be difficult to queftion the exiftence of a putrid ftate, - We fee that in the fmall-pox, a matter often deftruétive to life is introduced with impunity in numerous inftances ; and I çan fee no reafon why the putrefactive ftate may not exift, in a certain degree, whilft the living phanomena are going forward. If it be not, a putrefaétion in the fluids; we are yet to learn, what it is that produces that fcetid fmell; whilft the blood, by iffuing from the gums, nofe, and anus, feems really in a more fluid ftate. A laxity of the folids alone will not explain the haemorrhage, without a change in the blood itfelf; and fhould we admit, that laxity fometimes accounts for the fow of blood, we fhall be ftill in the dark as to the foetor. It may be proper to remark, I have frequently feen the dying in a that fituation --- Page 122 --- REMITTENT FEVER fituation I could not [Chap, II. very putrid fmell of approach their them, from the bodies 5 and that, immediately on their death, they were able, and tainted the air to a infuffertance. Thea confiderable dif appetite is entircly in any degree prefent, gone,but when becomes whimfical and capricious. The defire extremely is often remarkable ; but fmall for drink can be fwallowed at a time; and portions only thefe, unfortunately, are again thrown up' with violent exertion. The Remittent is at times in with convulfons, ufhered which I have feen repeated at the periods of exacerbation. the third day, fometimes on the About the fecond, Cr evening of the perhaps as late as the fifth, yellownefs begins to make its fatal pearance in ftreaks along the cheek, apangles with the aleof the noftrils; forming fue the courfe of-the they puralfo jugulars; the back is tinged in the fame irregular firftfreaks extend,and manner; 3 the the veffels of the become more apparent; and in a few hours eye the are evidently affected, whole body affumes a golden hue ; the black and becomes vomiting increafes, darker; the patient feels at once relieved, from the pain in his ftomach; talks of his happy fenfations, which, alas ! are only delufive fue the courfe of-the they puralfo jugulars; the back is tinged in the fame irregular firftfreaks extend,and manner; 3 the the veffels of the become more apparent; and in a few hours eye the are evidently affected, whole body affumes a golden hue ; the black and becomes vomiting increafes, darker; the patient feels at once relieved, from the pain in his ftomach; talks of his happy fenfations, which, alas ! are only delufive --- Page 123 --- Sea. III.] OF ST. DOMINGO. delufive preludes of his death. The futters, and becomes feeble; cold fweats pulfe break out on the face; the extremities become cold; the cye, inexpreflive, and half clofed, finks in the focket; the pulfe entirely ceafes, breathing becomes laborious, and the rattle in the throat, announces the near approach of diffolution, which a convulfion generally clofes. s Ihave feen cafes where a total has continued for feveral infenfibility days, whilft the pulfe fapported confiderable ftrength, attended with aétive hamorrhage from the noftrils, without affording relief; and yet the has recovered. One cafe of this kind patient I tended with my friend, Dr. WRIGHT, where atthefe fymptoms proceedied for feveral in the manner above defcribed; but days happily efcaped. our patient It was impoffible at times to mark any ticular critical days, as deaths and recoveries parhappened irregularly, without anye evident election for particular periods. The fifth however, the feventh, and the eleventh, day, peared in fome degree critical, apthough not any means in a certain invariable order. by I have --- Page 124 --- RÉMITTENT FEVER" have feen [Chap. Il. the fever proceed, without great violence, to the twentieth any after all, prove fatal at day, and yet, a time when were entertained df a full hopes inflances, either the recovery. In fuch gradual and flow patient was cut off by the diminution of animal ers, or a fudden exacerbation has powtinguifhed life. In flow at once exthe human cafes, the powers of fyftem are infenfibly when any exciting caufe is wafted, and vigour left to combat the applied, there is no of debility in difeafe. In a ftate warm climates, there is left to renovate the diffipated nothing caufes of relaxation ftrength: the are continually whilft the body is weakened in all its applied, tions; hence very few funcfrom a ftate of great complete recoveries, Weft Indies debility, ever occur, in the 5 but in moft cafes, where veries have happened, obftruétions recoin are formed many important organs of the human body; the liver, the mefenteric the veffels of the glands, and fkin, are fo their ufual funétions obftruéted, that rupted; are confiderably internor are they reftored to their common offices, before a colder climate has general vigour to the conftitution. imparted Remittent of St. Thus, the dable in Domingo is not only formiitfelf, but alfo lays the foundation of many are formed many important organs of the human body; the liver, the mefenteric the veffels of the glands, and fkin, are fo their ufual funétions obftruéted, that rupted; are confiderably internor are they reftored to their common offices, before a colder climate has general vigour to the conftitution. imparted Remittent of St. Thus, the dable in Domingo is not only formiitfelf, but alfo lays the foundation of many --- Page 125 --- Seât, III.] OFSTI DOMINGO many other difeafes, in the end equally fatal. It may be worthy of remark, that before the Remittent affumed the Intermittent dyfentery fometimes type,. a intervened, but the Intermittent form generally returned, and after going through fome paroxyfins, ended in obftinate dyfenteries. With refpect to crifis, in this fever, it Was feldom very evident ; fometimes a profufe fpiration, fometimes the return of perfleep, an hamorrhage at the nofe, or fudden diarrhcea, put: an end to the difeafe; on other occafions, it terminated in jaundice, which came on by flow degrees, and feemed to remove all the febrile fymptoms. I remarked before, that in fome inftances the patient was relieved at the appearance of an once, by particular inflammatory fpot on a finger or toe, as if the caufe of fever had efcaped by an explofion. This mark was firft made by Dr. rehave feen feveral JACKSON, and I could inflances to - confirm it. I never obferve any remarkable lunar fluence over the periods of acceffion. in- : With refpect to Prognofis, it forms, the moft difficult of perhaps, part our difcuffion. The eye, the moft interefting fions, which feems organ on thefe Occaas it were to predict cvery event, --- Page 126 --- REMITTENT FEVER [Chap, II. event, is a difficult ftudy ; the minute and variations which it changes imprefs the phyfician, undergoess which fcribe them, though he cannot deare great difficulties in noflic; language has not words progthefe minute thades; to defcribe: the beholder. they can only be felt by Thefe ditliculties will be dily acknowledged, by thofe who reaw, the language of the paffions, fo underfand ftood, but fo difficult to cafily underFrom the convey in words. eyc, conjoined with fome other circumftances, I generally drew and I was, unfortunately, my prognoftic, my opinions of feldom deceived in danger, It muft be acknowledged, that I have met with a few which I had formed cafes, of afterwards a favourable idea, which proved fatal; but they were few number, and occurred in in ance with the difeafe. my firft acquaintBut the Diagnoftic of the Remittent equally dificult; nor do I now know is edly any clear and precife mark decidby which its or fymptom variably afcertained. commencement could be inand the decilive The anxiety of friends, fteps a to oppofc danger, render phyfician would take noftic of the fcience of confiderable progimportance ; I fhall briefly were few number, and occurred in in ance with the difeafe. my firft acquaintBut the Diagnoftic of the Remittent equally dificult; nor do I now know is edly any clear and precife mark decidby which its or fymptom variably afcertained. commencement could be inand the decilive The anxiety of friends, fteps a to oppofc danger, render phyfician would take noftic of the fcience of confiderable progimportance ; I fhall briefly --- Page 127 --- Sedt. III.] OF ST.DOMINGO. briefly ftate the circumftances on which I ufally formed my judgment, as to the iffue ofa cafe. The youth of the patient, and a plethoric ftate, were invariably circumftances of The ftate of body, in which the danger. the moment the difeafe patient was at' invaded him, influenced my opinion of his fafety. If it came on, after the indireét debility ofa debauch in wine, and fitting up late, there was always very confiderable danger ; nor do I recolleét almoft an inftance of a favourable termination, where the fever thus commenced. remember I being once prefent at the-flank mefs, on the HillatPort-an-Prine, when confiderable quantities ofwine were drank, and the fat up very late; my duty required me to leave party them at a feafonable hour; but three of the party, were next morning feized with fever, and two of them perifhed on the fourth I think it neceffary to be thus day. fubject that fo nearly explicit on a interefts us all, When the fever made its attack, after expofed to great fatigue, and the action of being the fun, it Was always attended with danger. If the perfon attacked. was habitually fubjedt to H appre- --- Page 128 --- REMITTENT FEVER [Chap. It. apprehenfions of danger, and low iffue of the cafe was rendered fpirits, the Ifit made its very doubtful, appearance in habits not cirçumfanced as I have deferibed, the danger, risparibus, was confiderably diminifhed. catebining then thefe confiderations Comtual morbid with the acformed phanomena in the individual, I my opinion, which, in moft was correct. inftances The morbid phanomena, which great danger, were the indicated opprefiion ofall the funétions following.: fuch an impeded theiraction; at once, as greatly the pulfe and the being enfeebled, ftrength at onceremarkably diminifhed.. Suppreffed animal careleffnefs movements, and a general vourable as to the event, indicated no faiffue ; in fact, where the tion made no conftiturefiftance, and feemed as it were, vanquifhed and at once, more danger than fubdued, there was Becaufe even in a violent re-action. it argued the complete vigour of the morbid caufe. energy and changed his natural When the patient affumed mannero oflying in bed, and any whimfical or unufual was no favourable polition, it eated fymptom. Sighing indidanger; it did not feem to arife from meditation on the difeafe, but involuntarily, from it were, vanquifhed and at once, more danger than fubdued, there was Becaufe even in a violent re-action. it argued the complete vigour of the morbid caufe. energy and changed his natural When the patient affumed mannero oflying in bed, and any whimfical or unufual was no favourable polition, it eated fymptom. Sighing indidanger; it did not feem to arife from meditation on the difeafe, but involuntarily, from --- Page 129 --- Seat. III.] OF STDOMINGO, from congeftion about the veffels of the heart and lungs. The feces and breath being remarkably foetid was a fatal fymptom frequently ; nor were hamorrhages from the nofe,ift they were repeated, figns of fafety. The tongue afforded alfo fome figns to aflift the judgment: ifit trembled thruft remarkably on being out, it was unfavourable, or if it was covered over with a leaden coloured cruft, whilft the edges wore a brilliant red ance; a brown or bilious cruft is not appear-, fo formidable, elpecially if it appears loofe, and cafily feparates when touched. The violence of the general fymptoms is commonly attended with danger : vomiting, head-ach, ftration of ftrength, when great prolong continued, are lymptoms of great derangement, and intenfe difeafe. The nervous argue an fymptom affords many-alarming figns of danger. Tremor ofthe body when moved, with a tendency to faint flight exertion, juftly alarm the obferver on fierce delirium, which ; the propofes heroic and raves of battle, is lefs to be dreaded action, the low, muttering, grim, than is loft in meditating melancholy, which wrath, without an attempt to move. But above all, the affords the beft means ofjudging, in eye the feveral fymptoms conjunction with already mentioned: a H 2 certain --- Page 130 --- IOO REMITTENT certain FEVER [Chap: Il. penfive fadnefs in its glances, preffion of anguith an exits unfpeakable, a languor in objects, movement, an inclination to fhut out all are figns of the greateft cially when combined danger, clpecumftances above with - many of the cirwill make the ftated. But no defcription what has been phyfician fully comprehend watched faid of the eye, unlefs he has it at the patient's bed-fide, feen a phyfician fo inattentive I have ftances of to the circumthat prognoftic, that he has a gentleman was given out, better, who was recovering, and much the ftory. expiring as he was This is attended with bad relating quences, and brings ridicule and confefidence on the profeffion. want ofconobferver will The moft attentive fpeak with will often approach, diffidence, but he his conclufions. truth, and be fortunate in Succefsful confidence in the prognoftic begets fician, and opinion and fkill of the proves to the world that he is phyinattentive to the phanomena not have omitted to before him. I general, mention, that the features in termed the conftituting with the eyes what is exprefion of the of the greateft iervice in countenance, arenance little altered in prognofis. A countedoes not indicate the general exprefion danger, but where the fea2 tures ful confidence in the prognoftic begets fician, and opinion and fkill of the proves to the world that he is phyinattentive to the phanomena not have omitted to before him. I general, mention, that the features in termed the conftituting with the eyes what is exprefion of the of the greateft iervice in countenance, arenance little altered in prognofis. A countedoes not indicate the general exprefion danger, but where the fea2 tures --- Page 131 --- Sect. III.] OF ST. DOMINGO, IOI tures lofe their peculiar caft and and have no expreflion at all, character, confiderable orappear vacant, tained. apprehenfions are to be enterWhen the features exprefs anguifh, grimnefs, or diftrefs, of which the patient himfelf does not openly complain, though they feem printed on his face, there is confiderable danger, efpecially if fighing is added to the catalogue: There is little to be learned from the pulfe; I have feen an intermitting one precede a happy crifis ; in neral, it is more favourable when gethan even when full, flow, ftrong, when the pulfe is not much or equable : when that is changed, and change to feeblenefs, the heart is fubdued, and its powers and action diminifhed. I have now given the circumftances from which, in general, unfavourable be formed, opinions may though they are not in every cafe pofitive or decifive; yet from the combination or prefençe of a great number of them, a probable judgment may be given. very Having fpoken of the fymptoms and pearances, on which unfavourable apof the patient's fate are opinions grounded, it will be proper to ftate the circumftances which afford H 3 fome --- Page 132 --- REMITTENT FEVER fome hope of [Chap. - II. fymptoms recovery. The abfencé of the fpect ofa favourable already detailed, affords fome proattacks iffue. When the difeafe a perfon, not particularly weakened by fatigue, plethoric, or bauchery, and where or enervated by. deaction, and the fenfes there is a moderate dition to make entire, he is in a cona fucceféful refiftance. Ifthe remiffions are diftinét, and the fecretions remarkably changed or impeded; if the not appears inclined to the Intermiting fever fleep refrefhes; if the mind form; if gour, whilft there is a fupports its vithe circumftances fenfibility to danger, A deafnefs are ftill more, favourable, difeafe is occurring in the progrefs of the not an unfavourable fymptom. gradual return of perfpiration The efpecially towards over the body, morning, is alfo favourable, Eruptions about the mouth and face, with confiderable pain and ith thick cruft infammation; a brownfrom on the tongue, the edges, but leaving them difappearing of natural colour, are no their ances. Moderate thirft, unpromifing and appearwithout that intente, moderate heat, tients complain of, burning feel, many paare promifing fymptoms. The natural difcharge ofthe faeces and without extreme offenfive urine, finell, and of a natural morning, is alfo favourable, Eruptions about the mouth and face, with confiderable pain and ith thick cruft infammation; a brownfrom on the tongue, the edges, but leaving them difappearing of natural colour, are no their ances. Moderate thirft, unpromifing and appearwithout that intente, moderate heat, tients complain of, burning feel, many paare promifing fymptoms. The natural difcharge ofthe faeces and without extreme offenfive urine, finell, and of a natural --- Page 133 --- Sect. III.] OF ST. DOMINGO. tural confiftence and colour, leads to a favourThe coming on of jaundice, able prognoftic. towards the clofe of the fever, in a gradual manner, is by no means an unpromifing fympThe return of moderate appetite, and a tom. for in the courfe of the difeafe, I defire acids, of have often found very pleafing prefages recovery. The eye, and the countenance, preunclouded afpeêt, animated ferving a fteady by hope, and undepreffed by terror or apprchended danger, afford the molt certain affurance of a happy termination. I am aware, that all I have ftated forms a hiftory of the favourable and very imperfeét unfavourable circumftances, which may influence the judgment of phyficians. Obfervations, and an opportunity of recording them, and multiplying them, can alone increafe our ftock of knowledge in this moft ufeful-branch of medicine.. It certainly admits of great improvement, and forms, perhaps, the moft ufeful and interefting part of phyfiognomy. By this improvement, we might hope to forefee, at an early period, the force of the difeafe, and be enabled to apply fuitable means, before it attained that ftrength, which we could foretell in its infancy. This certainly would be a H 4 great --- Page 134 --- TREATMENT OF THE [Chap. II. great advantage; though, I fear, we thall never attain that perfection in it, which LAVATER fondly thinks attainable. We fhould indeed be perfect, if we could trace in the features, the finall-pox lurking in the habit; or the Remittent, before it produced its peculiar toms ; but a knowledge of prognoftic, fymp- far more limited, will be very ufeful to the phyfician, X SECT. IV. 1wo Cafes oftbe Romitent-Erench Treatment of them-Dipute in Jamaica 072 the Nature of tbe Fever-Pradtice of the Gentlemen at St. Domingo--Parisur Remedies examined Calomel; Blood letting; 8c--Cafes detailed -Tbe Practice purfied by tbe Autbor after long Esporisit-Campuratis Succefs oftbis Motbod-Pradical Remarks. IT is now time to come to the treatment of this fatal difeafe, which made fo many cruel ravages among our troops, and carried on a deftruétion almoft equal to the plagues of Aleppo. On of tbe Fever-Pradtice of the Gentlemen at St. Domingo--Parisur Remedies examined Calomel; Blood letting; 8c--Cafes detailed -Tbe Practice purfied by tbe Autbor after long Esporisit-Campuratis Succefs oftbis Motbod-Pradical Remarks. IT is now time to come to the treatment of this fatal difeafe, which made fo many cruel ravages among our troops, and carried on a deftruétion almoft equal to the plagues of Aleppo. On --- Page 135 --- Seat.I IV.] FEVER OF. ST. DOMINGO, ro5 On my firft arrival at Port-au-Prince, I had few opportunitics of fecing the fever; but very foon, a young gentleman, in whom I was extremely interefted, had a ferious attack; he complained of a pain in his bones, and a very fevere head-ach, with an inclination to vomit; and before I had feen him, though I might probably have recommended it at that period, he had taken an emetic, which operated well, but unfortunately cited an irritability in the ftomach, which exIw could never afterwards fubdue. thefe fymptoms continued As on the third with a full, hard pulfc, and he had day, landed from Europe, I direéted him juft bled, and accordingly he loft twelve to be which afforded him fenfible relief. He ounces, about twenty-one years of age, rather was thoric, and fomewhat timid, from the ries he had AReE previoufly heard. Anxious to do every thing in my power for this amiable young man, and not choofing to truft in the treatment of a new difeafe, I myfelf Monfieur PERE, formerly king's begged under the French government in that phyfician to payhim a vifit; ifland, dered him heaccordingly came, andorlarge quantities of lemonade, injections in the courfe of the three - day, a warm bath, --- Page 136 --- TREATMENT OF THE bath, and another [Chap. II, which he blood-letting in the foot, in placed confiderable faith in ing a revulfion from the head. makto the long As I trufted experience of Monfieur this difeafe, I did not PERE, in his treatment. On the interrupt any part of he ordered him night of the fourth, fmall a bolus of camphor with a vilited addition of opium. Ony the fifth he was again, when I found a confiderable degree of coma prefent, and a low, muttering voice. The circulation rapid, nilhing, and vibices made was dimitheir on the neck and back, intermixed appearance with perfectly black. In this fituation, after fpots tepid bath, I direéted four blifters the plied to his ancles, and the infide to be apând of the thigh, finapifms to the feet, whilft he fwallowed occafionally a little ether and cinnamon ter; but all was in vain, for the cafe wanated fatally on the fame termicafe there evening. In this was no yellownefs the whole courfe of the during remifion, difeafe, nor any diftiné except the abatement which followed the blood-letting. Another young man was taken ill, on board fhip, a few days before, but lightly not judge it of any confequence, did S attributing his feet, whilft he fwallowed occafionally a little ether and cinnamon ter; but all was in vain, for the cafe wanated fatally on the fame termicafe there evening. In this was no yellownefs the whole courfe of the during remifion, difeafe, nor any diftiné except the abatement which followed the blood-letting. Another young man was taken ill, on board fhip, a few days before, but lightly not judge it of any confequence, did S attributing his --- Page 137 --- Sea.IV.] FEVER OF ST, DOMINGO. I07 his head-ach and laffitude to a long walk he had taken, expofed to the fun. He was about twenty-onc years ofage, very robuft, vigorous, and plethoric. He had been three days complaining, when I faw him. I ordered him on fhore; he feemed better for the agitation of the carriage in bringing him to a lodging. He was bathed in the evening, and I ordered him twenty grains of James's powder, and eight of calomel, This medicine operated well, producing a perfpiration and feveral loofe foetid ftools. During the 4th, he was tolerably cafy, and drank very freely oflemonade. On the sth, there was a tendency to coma : and the vomiting became at the fame time very diftreffing and inceffant. In this fituation, though I had formed no plan cfgeneral treatment, I applied a large blifter over the region of the ftomach, ordered him at the fame time an injection, and took cight ounces of blood from his arm. The irritation ftill continued in the ftomach; but as the blifter produced its cffect, the vomiting gradually abated, and at length entirely ceafed; the coma was diminifhed, and the pulfe acquired more vigour and regularity. During this procefs, there was no remarkable heat, and the fkin had not that locked feel, fo evident in --- Page 138 --- ro8 TREATMENT OF THE. (Chap. II. in many cafes of this difeafe. He paffed the night of the sth with more comfort than any previous night fince he had the attack, On the morning of the fixth, the vomiting again made a flight appearance, and he complained, that whenever thirft obliged him to drink, it gave him great pain, as he felt his fomach beginning to contraét, how foon the liquid touched it. This day I prefcribed him fmall draughts of cinnamon water, extremely weakened by dilution - ; to which were added a few drops oflaudanum. Thefe remained on bis ftomach, and gave him fome relief. I begged of him to avoid motion, and to drink as little as he could, for fear of bringing on again the irritability of the ftomach. The tepid bath was repeated ; but now the fkin became impervious, and felt dry and hufky I remarked too, the veffels of the eye becoming tinged with yellow. On the morning of the feventh, the yellownefs had become more evident, and had tinged the fkin and nails. He felt very much relieved from pain, his recollection was clear and unclouded, and his mind had all its wonted energy ; but his pulfe was low, Auttering, and quick ; he complained of fharp pains. in his bowels, and fome difliculty in making water. Iordered his belly to be well fomented, I remarked too, the veffels of the eye becoming tinged with yellow. On the morning of the feventh, the yellownefs had become more evident, and had tinged the fkin and nails. He felt very much relieved from pain, his recollection was clear and unclouded, and his mind had all its wonted energy ; but his pulfe was low, Auttering, and quick ; he complained of fharp pains. in his bowels, and fome difliculty in making water. Iordered his belly to be well fomented, --- Page 139 --- Se&t.IV.] FEVER OF ST, DOMINGO, fomented, and direéted him to get an with fifty drops ftrong infufion of injection Throughout the day, he was very much opium. lieved, but, towards reevening, a violent came on, the' fury of which purging reftrain ; he was nothing could every moment up, difcharging finall, fcetid, liquid ever he tafted ftools; whenany thing, it feemed to through the inteftines with pafs pidity, I tried inconceivable raevery means I could devife to ftop this purging, poflibly circulation by direding the to the furface, by irritable ftate of the inteftinal diminifhing the aftringents, after the fibre, and by I could manner of Dr. MosELY. not unlock the fkin, which the Warm bath, and the aétion of refifted internal diaphorctics ; Icould not diminifh the irritability of the inteftines ; nor did prove of the leaft afringents utility. Whilf the was thus holding its difeafe became, in a remarkable victorious career, he wine, and intreated degree, attached to neft to be me, in a manner too earrefufed,. to let him have fome. had heard of cures I from this delufive performed fometimes of call, as if it were the voice nature, preferibing to herfelf; and Iaccordingly indulged him with fuch as I conceived he portions, might bear without exhaufting --- Page 140 --- IIO TREATMENT OF THE [Chap. Il. haufting him ; he feized the wine with avidity, pouring on me many benediétions for what he termed the only gratification he could enjoy. The difeafe, however, continued to increafe, his fenfes gradually decayed, he paffed his faeces in bed without any fenfibility, and, altogether, became the moft diftrefling fpeétacle I. had ever witneffed. On the twenty-firft day from the commencement of the difeafe he expired, whilft, in a fit of delirium, he was attempting to get out at the window. Thus perifhed two young men of great promife 5 they were the firtt Iever attended in the Remittent of St. Domingo. The yellownefs in this inftance continued to the laft. What furprifed me moft was, the obftinacy of the diarrhoea, which, in violence, exceeded any thing I had ever witneffed. Since that period I have feen cafes of the fame kind, which lingered many much longer period, but on toa fatal. In the houfe of Mr. generally proved DALTON, a refpectable Englith merchant at Port-au-Prince, many of his clerks and affiftants foon after they landed; perifhed very indeed, as he affured me, furprifed me moft was, the obftinacy of the diarrhoea, which, in violence, exceeded any thing I had ever witneffed. Since that period I have feen cafes of the fame kind, which lingered many much longer period, but on toa fatal. In the houfe of Mr. generally proved DALTON, a refpectable Englith merchant at Port-au-Prince, many of his clerks and affiftants foon after they landed; perifhed very indeed, as he affured me, --- Page 141 --- Sect.I IV.] FEVER OF ST. DOMINGO, I7r me, hardly any efcaped, who were attacked. Thefe gentlemen had all been attended a French phyfician. From the by had feen-of French fpecimen I practice, I was not much inclined to purfue it further ; nor did their fuccefs in any part of the town one in following them. I fàw before juftify any a very vigorous, powerful, and fatal me which performed its operations difeafe, feemed to require the moft fuddenly, and to oppofe it. Vigour of difeafe powerful means always vigour of treatment. I fàw in the requires French practice no power to change the ftate of the body ; I could obferve nothing but a rifing fyftem of nurfing, and the difeafe tempomitted entirely to its own courfe. I commyfelf to fuch books as were within applied reach, but they feemed to converfe my other forms of fever; than thofe before about me. About this time, a moft illiberal controverfy was carried on by the practitioners of Jamaica, relative to the beft mode of in the Remittent. The practice objeét of this did not feem to be the difeovery of difpute it became the means of truth; expreffing perfonal refentments, and, rival enmities. Such difputes, conducted on thefe principles, always dilgrace --- Page 142 --- I12 TREATMENT OF THE [Chep.H. dilgrace a profeffion, and bring the into fome degree of combatants fidence is loft in contempt, Public conmen, who are againft each other, and declaiming fupporting fyftems of treatment in the fame oppofite The advocates of each difeafe. and active to enlift fyftem were keen banner, and, in the partifans under their eagernefs of was warped and perverted. party, truth in the Jamaica The difputants of refentment controverfy, in the warmth againft each other, general truth, that the leaft forgot one have taught reflection might difeafe, which them; they forgot, that in a attacked fo many various conftitutions, in a great variety of no one, uniform, invariable mode circumftances, ment could poflibly take of treatchance of fuccefs, There place with any plainer maxim, cannot furely be a. than, that as and conftitutions circumftances vary, that the muft vary alfo; but the treatment maica univerfally praéitioners of Jaranged two the themfelves under banners; one maintained the ticular efficacy of mercury in all cafes; parother, with equal ardour, the fusperior eflicacy of maintained the antiphlogiftic blood-letting, and other remedies. I had the good fortune, before I quitted the Weft Indies, to meet conftitutions circumftances vary, that the muft vary alfo; but the treatment maica univerfally praéitioners of Jaranged two the themfelves under banners; one maintained the ticular efficacy of mercury in all cafes; parother, with equal ardour, the fusperior eflicacy of maintained the antiphlogiftic blood-letting, and other remedies. I had the good fortune, before I quitted the Weft Indies, to meet --- Page 143 --- a Seat. IV.J FEVER OF ST. DOMINGO, meet feveral reputable and could not praétitioners in Jamaica; talents had help regretting, that their not been better than a virulent difpute, which employed, in our ftock could not add to of.knowledge. It was difficult to draw any the facts exhibited in this conclufion, from party, as might be naturally difeuffion; each duced inftances of expedted, promodes of treatment, recovery, under oppofite which each the benefit of their attributed to That men recover under peculiar management. cumftances will not be very oppofite cirwho has feen queftioned, by any one the any praétice ; becaufe, general outlines of a difeafe may be though lar, there exift minute fhades, fimia different treatment. The which juftify two patients, under the fame conftitution' of mhay be widely different, and form offever, variety will be produced in the confequently effeêts. a fides, oppofite modes of Bethe cafes, to be thefame, treatment, fuppofing mode may cure, becaufeeach operates a total change in the condition of the body, and thus banithes given morbid the fyfkems phanomena; ; fo that neither of the purfued in Jamaica, derive fipport, from this cafual fuccels. any great lect right, the fucceffes IfI recolofeach feemed nearly I 1o balanced, --- Page 144 --- TREATMENT OF THE [Chap. II, balanced, if we may rely on the accounts publifhed at Kingfton, news-paper Puzzled, and diflatisfied with thefe counts, I betook myfelf to the acdifeafe itfelf; till the ftudy of the phanomena fhould me fomething of their teach mode of nature, fo as to form a treatment. Scon afterwards, I occafion to vifit fome failors had DALTON's on board Mr. thips in the road; had ill for fome days, before I faw they been the manner of them, as it is feamen, to conceal their dif eafes, till they can no longer be I found feveral affected with kept fecret. pulfe quick and a fmart fever, the tenfe, the countenance attended with a fufhed, one or cedienterkpeshaud.ahi two indeed were in a different fituation; their countenance fighed, inftead of expreffed anguith, they low and feeble. refpiring, and the pulfe was had In one of them, the hiccup juft begun. The firft I diredted to be bled pretty freely; and to take fifteen grains of James's powder at bed time, to which emollient an injection was added. confiderably relieved; fome They were fpiration had been degree of perach produced; and the headWas diminifhed; but tremely weak, and in they were eXone of them fome lownefs appeared. To the other two I yelferibed a large blifter preeach, over the region of cup juft begun. The firft I diredted to be bled pretty freely; and to take fifteen grains of James's powder at bed time, to which emollient an injection was added. confiderably relieved; fome They were fpiration had been degree of perach produced; and the headWas diminifhed; but tremely weak, and in they were eXone of them fome lownefs appeared. To the other two I yelferibed a large blifter preeach, over the region of --- Page 145 --- Seét. IV.] FEVER OF ST. DOMINGO, of the fomach, with a camphire IIS fmall portion of bolus, and a opium. When I returned next day, I found one oft the latter had pired towards morning; and the others exconfiderably relieved. They, were vered after a long convalefcence, however, recoIt was a. practice followed at Port-auPrince by the medical gentlemen, when I arrived. there, and I purfued it firft ment any one was alfo, the mofeized, to order him bath, to cleanfe, purify, and relax the a.tepid that there might be fkin, fo exit of no obftacle to the free perfpiration. After the put to bed, the Patient was belly was opened by a lenient injection; and cight or ten grains of with a portion of James's calomel form of powder, in the pills, were generally taken immediately. prefcribed, to be Thefe the difcharge of large ufually procured by ftool or quantitics of bile, either vomiting, Ifhowever this tity had no effect, which fometimes quanthe injection was happened, of calomel, repeated, and a larger dofe joined to fome again given. If they had ftill purgative, was dofes were Alill no effeét, the amazing increafed, till fometimes an quantity of calomel was without the fmalleft fwallowed apparent effect. At I 2 times --- Page 146 --- X16 TREATMENT OF THE [Chap. II. times a fudden falivat'on made its which, in general, put an end to the appearance, fever; but which itfelf became a moft formidable which nothing could reftrain. Itis difeafe, many have recovered after true, that a falivation was excited, but they are ufually thrown into a moft dangerous ftate of which they feldom attain debility; from cafe occurred in any ftrength. One my own ward in the where the patient got entirely hofpital, well, of the fever, but the falivation refifted every means I ufed, to reftrain it. Mild poffible local purges, applications near the mouth, to divert the circulation, ftrong aftringents, all employed in vain; it proceeded without were abatement till the éxhaufted patient funk under it. Dr. Scor' vifited this perfon with me, but all our treatment was in vain. Ifafter thefe preferiptions, the fever did not abate, tepid baths were repeated, and retics adminiftered; with mild diluent diaphoand fuch form of drinks, nourifhment, as was eafily digefted without giving uneafinefs in the ftomach. Such was rice water, boiled to a certain confiftence, in which the foluble farina, bicnded with the water into a cream. This cream was mixed with a fmall portion of Madeira but all our treatment was in vain. Ifafter thefe preferiptions, the fever did not abate, tepid baths were repeated, and retics adminiftered; with mild diluent diaphoand fuch form of drinks, nourifhment, as was eafily digefted without giving uneafinefs in the ftomach. Such was rice water, boiled to a certain confiftence, in which the foluble farina, bicnded with the water into a cream. This cream was mixed with a fmall portion of Madeira --- Page 147 --- Seét. IV.] FEVER OF ST. DOMINGO, I17 Madeira and fingar, and the patient direéted to take fmall portions of it, as the ftomach would bear. If any diftinét remiflion on, which was rarely the cafe, the cold came infufion of bark, with cinnamon water, or other cordialaddition, was preferibed; at other times the decoction. Though I can fay little for the efficacy of the bark, except in the Intermitting form. I certainly obferved no inflance in the Remittent in which I could mark, that it produced reany confiderable effect at all. Other fymptoms were combated arofe. When the as they vomiting was fevere, blif ters were applied over the region of the ftomach 5 injections were preferibed to remove any fourçe of irritation in the bowels, and fuch drinks were ordered, in fmall as quantities, were ofa nature to produce the leaft poffible irritation. Of this fort, were beef tea, toaft and water, rice water, with a little cinnamon boiled in it; and when the ftrength and feemed to decay, and refift all thefe pulfe wine was ordered, and the warmer means; to fupport if poflible the living ftimulants, phanomena. Camphorated boluffes, and blifters to the extremities, were alfo added to the plan oftreatment. Such were the outlines ofour general I 3 practice, --- Page 148 --- I18 TREATMENT OF THE [Chap. II, practice, on my firft acquaintance with difeafe. the It is to be remarked, that letting Was occafionally though bloodbecome an performed, it did not indifpenfible part ofour plan ; for manyinflances of fever occurred, where bloodletting did not feem ing prévioufly necefary; the perfon bein the weakened, by a Jong refidence climate, and not in a fituation to dergo any confiderable lofs of blood. unthis mode of treatment, moft of Under perithed ; very few, in our patients lives to our my opinion, owed their praétice 5 and yet we beftowed every poffible attention. It is not conceive the fituation of eafy to a medical placed in fuch ' a dilemma, officer, hundreds of his furrounded by of mifery, countrymen, in every ftage looking up to him for when he cannot refcue them from afiflance, danger, whilft every fcheme of impending exertion of practice, every thought Or induftry, ment fail of fuccels. It is then evéry experito confider every circumftance, humanity, fibly afford a chance it that can pofinto ; is then, fair to new paths of treatment, which deviate lefs ficceféful, than what we cannot be I have witneffed have already tried. fcenes of mifery, I can never forget; them from afiflance, danger, whilft every fcheme of impending exertion of practice, every thought Or induftry, ment fail of fuccels. It is then evéry experito confider every circumftance, humanity, fibly afford a chance it that can pofinto ; is then, fair to new paths of treatment, which deviate lefs ficceféful, than what we cannot be I have witneffed have already tried. fcenes of mifery, I can never forget; --- Page 149 --- = Sedt. IV.] FEVER OF ST. DOMINGO, I19 forget; they impreffed me too powerfully to be erafed from my memory. It is proper in a queftion fo important, the treatment of this formidable as be difeafe, to very explicit on every method that has been tried; and to reafon on them calmly and fully, before any plan is relinquifhed that might afford the leaft chance of fuccels; and alfo to weigh carefully the grounds on which new opinions are admitted as foundations any for practice : I thall therefore take a view of the fuccefs attending the various plans of practice in our hofpitals, and, fo far as Icould collect information, in Jamaica. I muft confefs, that the plan I (hall recommend had fo great a trial, as I might with; in order not eftablith it. The opinions and faêts to I ground it, did not occur to on which me in their full light, until a fhort period before I left Saint Domingo; fo that I had not many nities of applying the opportuprinciples to actual practice 5 which alone is the true teft. Let us firft attend to the plan of lomel. The uncertainty ofits giving cain my mind a very ftrong operation forms objection againft it $ many patients have fwallowed fome hundred I 4 grains --- Page 150 --- - TREATMENT : OF THE grains without [Chap. II, Now the rapid producing any effeét at all. progrefs of the difeafe, fomething on which we can requires which will produce its effects pofitively rely, which in all cafes will caufe quickly, and change. If, therefore, fome evident tain in its a medicinc is uncerit operation, and does not act certainly does not fpeedily, promife to be an ufeful remedy in a difeafe fo rapid, and of fo much vigour. The inteftines, by fome means other, are rendered veryinfenfiblein or nor are they readily affected this fever, whether it is that by any medicine, 2 large fecretion of they are covered over with inner mucus, which guards their furface, or that their general is impaired, cannot be eafily fenfibility it is a certain fact, that whilft afcertained, but agonifed and convulfed the ftomach is the inteftines by extreme fenfibility, maintain the moft obdurate inactivity. Aware of this, Dr. THEODORE DON, if I miftake not, ufed unétion, Gorin this manner to and tried fyftem; but the convey mercury into the abforbents feemed infenfible, as in the inteftines 5 and when equally lomel really affected the caby any means fyftem, we could not regulate the effect or know what quantity to produced, it would act. prefcribe, or when Whilf we were thus amufed, looking inactivity. Aware of this, Dr. THEODORE DON, if I miftake not, ufed unétion, Gorin this manner to and tried fyftem; but the convey mercury into the abforbents feemed infenfible, as in the inteftines 5 and when equally lomel really affected the caby any means fyftem, we could not regulate the effect or know what quantity to produced, it would act. prefcribe, or when Whilf we were thus amufed, looking --- Page 151 --- Sect. IV.] FEVER OF ST. DOMINGO, T2T looking out fur the effeéts calomel was to produce, we were often difappointed, whilf the difeafe continued its courfe without interruption; and when it did prcduce faliva-' tion, the index of its having entered the tem, that very falivation became a fyf ferious difeafe, and left the very patient in a ftate of dangerous debility. But it feldom that it produced this effect with happened it much oftener remained any certainty, i dormant in the body, without producing any evident A medicine then, of this uncertain change. tion, of which three grains will defcripfometimes bring on changes; 5. when at others, five hundred are taken without effeét, cannot be lied on, in a difeafe, where reule, ought to create fome every means we ifting circumftances. alteration in the exfhewn But calomel has never any fpecific power in this difeafe; its great ufe has been as a purgative, and an alterative of the given flate of the perhaps In this view it was ufed, I think, frftem, in the fever of by RUSH, Philadelphia. Nor is it out great ufe. It clears the withthe feces which inteftines from would otherwife and prove very injurious; it affifts in remain, and expelling worms, which killing blefome are often -trou. ; it unloads the veffels, which determinations --- Page 152 --- TREATMENT OF THE minations [Chap. II. may have furcharged; and it contribute to effeêt an may in the exifting imperceptible change circumftances of fever, to render it more eafy of fo as I have feen, it cure; ; but, fo far as cannot be relied on as a cipal agent in the cure of the prinRemittent. It is true, that in our hofpital, maica, fome recoveries and in Jahappened where quantities of calomel had been large had produced no vifible taken; but it ftances of the change in the circumdifeafe. The Remittent through its ufual revolutions, went ruption, and ceafed without without interThe an evident crifis. movements of health ever ready to return, and more natural, from hand, to commence their habit, are at morbid aétion is action ; when the not vigoroufly the morbid caufe. This is fupported by a fair, candid count of calomel, fo far as I have obferved aceffects, or gathered them from the its of others. remarks Let us next examine which has been Bark, as a fpecific, preferibed frequently in the Remittent, and from which pected confiderable fuccefs, practitioners exinteftines bad been Whenever the previonlly evacuated; and the at morbid aétion is action ; when the not vigoroufly the morbid caufe. This is fupported by a fair, candid count of calomel, fo far as I have obferved aceffects, or gathered them from the its of others. remarks Let us next examine which has been Bark, as a fpecific, preferibed frequently in the Remittent, and from which pected confiderable fuccefs, practitioners exinteftines bad been Whenever the previonlly evacuated; and the --- Page 153 --- Scet. IV.] FEVER OF ST. DOMINGO, the Remittent had Chewn the leaft abatement in the feverity of the fo the fymptoms, as to merit name of remiffion, I conftantly the bark, at firft in fubftance, in dofes prefcribed of fcruple, repeated as often as the ftomach a would bear it. But even thefe fmall were often rejected, and left fuch dofes, ficknefs behind a degree of them, that I was under the necefiity of abandoning the bark in The cold infufion, and the decoction, fubltance. inftead of the powder, in as were ufed large the ftomach would bear, but quantities as rejected. Imuft even this was fay that I never faw any inftance, in which the bark decidedly riod to the return of the fever; put a pewhere there was an evident except in cafes diftinét remiflion, tendency to very previous to its ufe. In fuch inftances the Remittent is inclined to Intermittent type, and adopt the a form lefs confequently to affume powerful, and more readily fubdued by the bark, which in that of eale,e thape the difenjoys a fpecific fuperiority, over medicine. It happens any other Remittent has ceafed for frequently, when the fome days, thatit will again return, with increafed often on fuch occafions violence, and is fo proves fatal. Nothing powerful in preventing fuch returns as the ufe of the bark; which ought to be begun, the moment --- Page 154 --- TREATMENT OF THE moment the remiffion is [Chap. II, where the ftomach diftinét, In inflances, the infufion could not retain the bark or decoction, 11 have direéted $ be given by injedtion; fometimes it, to the amount of half in powder, to mixed in three an ounce thrice a ounces of water, and with day; drops of Jaudanum. At other fifty fcribed the times I predecoction, or the infufion, ing the injection oftener. This repeatprefcription, I found mode of The ftomach very ufeful and fuccefsful. patient was not irritated, nor did the complain of that naufea and fo diftreffing to his feelings. anxiety that the bark Every effect, obtained, in commonly produces, was thus an eafy, agreeable form, without giving difguft, which too often arifes from the repetition gf this medicine. All çould fee, in the ufe ofthebark, then, that I the fever, fhowed wâs, that where a difpofition towards remiffion, or aétually remitted, it. many occafions, the prevented, on return or renewal of paroxifmns, If found it moft fucceféful in form of injcétion, becaufe in this the could carry the ufe of it much further manner I any other way. I had no good than in afcertaining, whether the red opportunity of moft powerful; in the few or pale bark was attempted this inflances, where I. experiment, Icould nct obferve any , or aétually remitted, it. many occafions, the prevented, on return or renewal of paroxifmns, If found it moft fucceféful in form of injcétion, becaufe in this the could carry the ufe of it much further manner I any other way. I had no good than in afcertaining, whether the red opportunity of moft powerful; in the few or pale bark was attempted this inflances, where I. experiment, Icould nct obferve any --- Page 155 --- - Seat. IV.J FEVER OF ST. DOMINGO, any fuperiority in the red bark ; it did not pear to operate in leffer apeffects quantities; nor were its more fpeedily produced. But it would require a more enlarged comparifon, between them, to afcertain the fact, and a more fedulous attention to circumfances, than Ihad the power of paying. Let us next examine the effects of in the Remittent. This molt ufeful Opium medicine, the kind foother of agony and quires to be ufed in this fever with pain, remoft caution, Ihave the utfound the remarks of RUsH on this fubject, in the treatment of the Philadelphia fever, nearly coincide with the obfervations I made in my notes on the Remittent of St. Domingo. In the beginning, I always found it injurious, where reftlefs nights, and anxicty fcribe it in large dofes. tempted me to pretled It procured no fetreft; for a time the delirium was increafed, to which a ftupor rather than fucceeded ; and the Dext day languor, fcep bility, and weaknefs irritaprevailed; in fhort, laudanum did not feem by any means to amend the ftate of the patient. It is, very difficult however, a point to fettle, how much of a new ftimulus muf be given, to do away the acion 2 --- Page 156 --- C TREATMENT OF THE action of one [Chap. 1l. already operating in the Perhaps we fail in ohr hopes of body. this very opium from difficulty 5 and frequently from ing it in fmall dofes; ; but the givcoma, and the irritability tendency to hindered produced by' it, me, from carrying the ufe of it further, than what the agonies of the extorted from humanity. patient, is puthed fo Opium, unlefs it great a length, as to banith aétion of other the it is ftimuli, can be of no fervices temporizing with the fever; and the difeafe afleep, lulling vigour. I have perhaps to recruit its fometimes found it ufeful, given by injedtion, in lence of moderating the viovomiting 5 on fuch occafions, I have prefcribed two hundred drops, in a fmall quantity of warm water. I have alfo to antimonials and joined it much with a view to camphire, not fo in the produce a general effect fyftem, as to fecure the retention the other medicines in the ftomach. of view I found it fometimes In this feen the Remittent ufeful. I have in many inftances in by convulfions, which ufhered the periods of were repeated at exacerbation 0e ; in thefe cafes large dofes, by the mouth and by produced happy effects, and feemed injection, the fever in a more to leave manageable form. In cafes in the produce a general effect fyftem, as to fecure the retention the other medicines in the ftomach. of view I found it fometimes In this feen the Remittent ufeful. I have in many inftances in by convulfions, which ufhered the periods of were repeated at exacerbation 0e ; in thefe cafes large dofes, by the mouth and by produced happy effects, and feemed injection, the fever in a more to leave manageable form. In cafes --- Page 157 --- Sect. IV.] FEVER OF ST. DOMINGO. cafes too, where remiffions had commenced, and where a return was apprehended, I fcribed opium prevery frecly ; and, as I conceive, with. good effects. Towards the termination of the Remittent, when the happy tient was fatigued by reftlefs nights, I found paopium of very. confiderable ufe; but it was frecly prefcribed; and other ftimulants given, when it was withdrawn from the were tient. Upon the whole, opium paour prefent ftate of knowledge be cannot ufed in with advantage, in the beginning of the Remittent; but it is of fignal fervice in : many occurrences during the difeafe. Antimonials,tnder which we rangeJAMEs's powders, did not appear to me of fervice ; fometimes they any great produced tion, which afforded peripirathe temporary relief from fymptoms ; but they again returned, and continued their courfe, In tice, indeed till a fhort my early pracperiod before my departure, I was in the habit of continuing pretty large dofes of James's powders with calomel; and though in joined produced fome flight abatement general in the they toms, yet they could by no means be fymp- relied on as decilivé means of cutting fhort, the courfe of the fever. In --- Page 158 --- 128 TREATMENT OF THE In one infance, [Chap. If. where I had an tunity of feeing the firft evident opporthe Remittent, in a effeéts of 2 few days landed; gentleman, who had been five I prefcribed him grains of James's powder, and twentycalomel, after a warm bath: ten of fweat was raifed, and he had an aftonifhing and bilious ftools feveral copious, ; there was a miffion next complete remorning ; when he was a fcruple of bark ordered tinued for fome every hour, which he condays without of a return, and he recovered any fymptoms further repetition of the difeafe. without any bable, that in It is prothus fuccefsful, many inftances, we might be if we had an being called in fo opportunity of quently carly; but it more frehappens, that the difeafe has courfe of three days before run a its obliges the patient to call for affiftance. aggravation firft approaches, in The fact, are infidious, nor any one aware of is danger; a pleafing languor induces fleep, and a defire to nor is it, till head-ach and recine, bones aroufe pains in the himfelf attention, that a perfon thinks unwell. At leaft thefe were the fenfations I felt in an attack of this fever, foon difappeared. It is which to fce the early ftage of the particularly difficult, Remittent among foldiers, firft approaches, in The fact, are infidious, nor any one aware of is danger; a pleafing languor induces fleep, and a defire to nor is it, till head-ach and recine, bones aroufe pains in the himfelf attention, that a perfon thinks unwell. At leaft thefe were the fenfations I felt in an attack of this fever, foon difappeared. It is which to fce the early ftage of the particularly difficult, Remittent among foldiers, --- Page 159 --- - Sect. IV.] FEVER OF ST. DOMINGO, foldiers. They never complain in the beginning, and have fuch an averfion to into an hofpital, that they conceal their fitua-: go tion till: the difeafe has confirmed itfelf in their conftitutions. It is not. furprifing that foldiers diflike genéral hofpitals ; they fee few return, who once enter their very gates.: C Having confidered the chief means ufed to.combat the Remittent; I fball now exa-. mine the effects of Blood-letting fo far as I had-an opportunity of obferving them. Having been for : fome years .in ' the habit of feeing the inhabitants of warm climates, . was imprefled with. one general I lative to opinion re-, blood-letting, which was, that the inhabirants of warm climates, after a refidence ofany length,.could not afford to blood, from the purpofes of the animal fpare nomy. To this opinion I was led, CeCoferving, in general the lax ftate of the by obof thofe who refided in warm fibres, diminution, climates; the or rather the abfence of the: rofeate European bloom ; and the of the fluids by great wafte perfpiration. Befides thefe confiderations; ; I remarked, that though the inhabitants of warm- climates, poffefs aftivity 3 and are more fprightly and great lively, K than --- Page 160 --- TREATMENT OF THE than the [Chap. IL.: the fame Europeans ; they, by no means-p poffefs of the ftrength. Whether a certain ftate blood, that we call denfe, red, and: healthy, be the caufe or effect of in 3 the fibres, may be difficult ftrength: afcertain ; but precifely to: this, we afcertain that it. is intimately diflinatly, ftate of the conneéted with fucha ai and body. The ftate of ftrength, rofy. colour, are always conneéted denfe ftate of the blood. But with a habit never the pale relaxed produces, denfe and red blood. Phyficians have drawn fome . thefe phanomena. conclufions from! clafs bear They infer that the firfti blood-letting, without any matérial injury, and often with advantage; whilft fecond, cannot béar evacuation, the to the conftitution. without injury trine, I held Imprefied with this doc-: to be in blood-letting in a warm climate general improper; without ing, that although this refleétto thofe, who had for reafoning might apply it could not any time refided there, apply to new not been exhaufted comers, who had by heat. by perfpiration Or relaxed who Befides, even in the feeble clafs, may. have refided for fome time in a hot climate, if they are feized with eafes, I can fee no acute dif letting; becaufe this impropriety in bloodevacuation, by remova ing ing, that although this refleétto thofe, who had for reafoning might apply it could not any time refided there, apply to new not been exhaufted comers, who had by heat. by perfpiration Or relaxed who Befides, even in the feeble clafs, may. have refided for fome time in a hot climate, if they are feized with eafes, I can fee no acute dif letting; becaufe this impropriety in bloodevacuation, by remova ing --- Page 161 --- Sect. IV.]- FEVER OF ST.DOMINGO. ing a ftate which would 13F deftroy the muft be lefs injurious, than fyftem, bility. I fhould not therefore a temporary deftates of infammation, hefitate in fome to bleed even warm climates. freely, in evacuation Though I would not puth the to the fame extent as in newly Janded. e I am doubtful, Europeans, cafes of hepatitis, whether in all the inflammation, blood-letting be proper 5 as may be of the and mercury feems to fucceed paffive kind; ; its ftimulant in the cure, by power chiefly. From this view of the conftitution in climates, I was warm improperly led to confider blood-letting as always injurious, and fequently abftained from it. I found conthat the gentlemen, who had befides, rience than. a longer expemyfeif at Port-au-Prince, had not adopted it as a means of cure. The French indeed had bled the difeafe, but very freely, at every ftage of they carried it beyond the proper bounds, and I faw an inftance or where their patients funk under this two, tion. The, fate of Lieutenant evacua18th light dragoons, S9 of the this was certainly treatment. If haftened'by blood-Ietting good effects, which I believe it does produces inftances, it muft be in mott "performed very"e early' in K 2 the --- Page 162 --- TREATMENT OF THE the difeafe, and be [Chap. II. I fhall have performed with boldnefs. occafion to explain this more fully hereafter. P When I began confider the difeafe, and the maturely to attacked ; when I obferved fubjects which it and fymptoms with its phanomena judged that in moft accurate attention, I then inftances an early bloodletting might be ufeful. After I had formed this opinion, the firft occurred of it opportunity which trying was on my worthy friend Captain Sof the Royal ufeful and active officer. Artillery, an return from another fick officer Ihappened on my by chance, and to call on him found him with a very fmart fever; his pulfe quick and ftrong with intenfe heat, an inclination to vomit, and his face very highly flufhed. Captain Sof a florid complexion, was plethoric, and rous. He breathed with vigowith difficulty, and infpired a figh. There was fome flight delirium, and want of recollection. forgot my lancets, I fent a fcrvant for Having and waited by his bedfide, till them, Leaft he fhould be alarmed fcr they arrived. a for it himfelfat fuch meafure; was a late hour, I it to him, without propofed urging it, as abfolutely, neceffary; he agreed without hefitation ; and Laccordingly took about fixteen ounces from his a figh. There was fome flight delirium, and want of recollection. forgot my lancets, I fent a fcrvant for Having and waited by his bedfide, till them, Leaft he fhould be alarmed fcr they arrived. a for it himfelfat fuch meafure; was a late hour, I it to him, without propofed urging it, as abfolutely, neceffary; he agreed without hefitation ; and Laccordingly took about fixteen ounces from his --- Page 163 --- Sedt. IV.] FEVER OF ST. DOMINGO. his arm. He was fenfible of inftant relief; the head-ach abated; the fluth in his countenance fubfided, his breathing became eafy, and his recollection complete, He turned round in his bed, and fell into an cafy, found fleep. I vifited him next prowhen I found him much more cafy morning; than the preceding day 5 though the fever had not wholly left him. He had enjoyed a comfortable night, and felt no diftreffing fymptom, except a fenfe of laffitude and wearinefs, infeparable from fevér. His tongue however had a bilious afpect, and was covered over with a yellow cruft. I preferibed him fix grains of calomel, with ten grains of James's powder; which operated in the courfe of the day; and procured the difcharge of much bilious matter. The fever became more moderate, though there was for feveral days a want of recollection, and fome degree ofdelirium prefent. When the remifions mitted me to ufe the bark, it was given, per- and the cold bath completed the cure. S- - was thirty years of Captain dificulty in the Weft Indies, age.-The great was. to procure ftrength after the fever ceafed; this was of ten unattainable without change of climate. K 3 The --- Page 164 --- TREATMENT OF THE: [Chap. II. The next cafe in which I tried the effects of blood-letting was in my friend Capt. Cof the 41ft, whofe exértions at Bizoton, and wherever the fervice required him, at length brought on an attack of the Remittent. It has been rightly remarked by RUSH, that the caufe of fever often lurks in the body without being called into aétion for many days; and I have no doubt, but it may again pafs out of the body, without producing any morbid change ; unlefs it be aflifted by the addition or abftraétion of other ftimuli. Of the truth of Rusn's remarks, I have feen numerous proofs. Both Captain C-- and Captain Swere attacked, after having undergone confiderable fatigue on fervice. They were much expofed to laborious exertion. When I vifited C- 1 I found him affected with a confiderable degrce of fever; he complained of great pain in his back and loins; and an inability to maintain an ereét pofition. There was confiderable heat, and fome degree ofhead-ach. Having a lancet in my pocket, I inftantly bled him pretty frecly, to the amount of twelve ounces. Lordered his feet to. be bathed in warm water, and prefcribed one fcruple of James's powder, with tên grains of calomel. Thefe produced nearly the fame effeêts with a confiderable degrce of fever; he complained of great pain in his back and loins; and an inability to maintain an ereét pofition. There was confiderable heat, and fome degree ofhead-ach. Having a lancet in my pocket, I inftantly bled him pretty frecly, to the amount of twelve ounces. Lordered his feet to. be bathed in warm water, and prefcribed one fcruple of James's powder, with tên grains of calomel. Thefe produced nearly the fame effeêts --- Page 165 --- Seét. IV.] FEVER OF ST. DOMINGO: effects as in Captain SS cafe, and he found himielf fo well in the morning ; that he was imprudent enough to venture out, and ride. The fubfequent ufe of the bark vented any return. In feveral cafes prethe foldiers, I performed the fàme among and prefcribed the fame medicines, operation, when I had an opporturity of fecing them in the early ftager If the blood-letting is not formed on the fecond, or at furtheft on. per- the third day, I do not imagine it will have fuccefs. But in the cafes where I had an tunity of adting on the firft or fecond day, oppor- the event was in general fortunate; ; though fome perifhed ; nor is it likely that any method will ever be difcovered, which Thall invariably mife fuccefs. But we do a great deal, if pro- we leffen the mortality. In another inftance, in Captain L--, of the 82d regiment, a very ftout, plethoric man, whom I faw the morning aftér the fever had made, its manifeft appearance, Idirected a large blood-letting to the amount of fixteen very ounces. The blood, as Mr. BELL, furgeon of the.artillery, informed me, was fizy. Capt. L- felt very confiderable relief from the cvacuâtion; the head-ach abated and his reK 4 collection --- Page 166 --- - TREATMENT OF THE [Chap. II, colleétion became more clear; he was even cheerful; and though naturally a timid man under illnefs, fpoke with confidence of his re covery. After the blood-letting he had feveral injections, and took one fcruple of James's powder, without calomel, as the injections had operated very frecly. The der had produced fome powperfpiration, and he was in the evening much better. Next day, however, the head-ach again returned, with fome degree of delirium; and the pulfe became rapid, and ftrong. I direéted Mr. BELL, to take away eight ounces more blood; and repeat the powder and injeétions. After this, Dr. ScoT and myfelf vifited him late at night, and found him fo free from fever, that we concluded, he had every chance to do well. I never faw him afterwards, having been taken very ill myfelf that night, and rendered inçapable of returning to him any more. I underftood however, that next day, he had an exacerbation, and vehemently demanded fome porter or wine, which being delayed or refufed, he was agitated by a moft furious paffion, after which he funk into an irrecoverable debility, and expired with fpafins and convulfions. This is not the only inftance in which violent excitement has proved fuddenly fatal, I never faw him afterwards, having been taken very ill myfelf that night, and rendered inçapable of returning to him any more. I underftood however, that next day, he had an exacerbation, and vehemently demanded fome porter or wine, which being delayed or refufed, he was agitated by a moft furious paffion, after which he funk into an irrecoverable debility, and expired with fpafins and convulfions. This is not the only inftance in which violent excitement has proved fuddenly fatal, --- Page 167 --- Seôt. IV.] FEVER OF ST. DOMINGO. fatal. Iconfefs, that his death appears to me, to have been brought about by anger only. To thefe cures, too few to form any decifive opinion, I Ohall add, that Dr. JACKSON, whofe fagacity and attention. are cqually confpicuous, was much more fuccefsful, after he made more free with the lancet. The 56th regiment had been fuffering from the Remittent very feverely' at the Mole, both before and after they were landed'; they had loft a number of men, but when Dr.JACKSON took the management of the fick, and, bled freely; the mortality diminithed more And though the fever defcribed confiderably. differs by RUsH, materially in being highly contagious, yet there are circumftances of great fimilitude in the fymptoms; and I look on Dr. Rusn's practice as a confirmation of the benefits of blood-letting. Let us next attend to the effects of in the Remittent. As the inteftines, from Purging the beginning, are affeéted with inactivity, it is neceffary that they fhould be roufed by ftimuli, to difcharge their contents. It has been obferved befides, that bile is very amply fecreted, and at times paffes to the inteftines, where it --- Page 168 --- - TREATMENTOF THE [Chap. EI, it would beçome putrid and ftimulant; and would of itfelf be a fource of fever. : It is proper then to employ purging to clear the inteftinal canal from faces, which, if retained, would prove an unpleafant fimulus, to the whole fyftem, In fuch cafes of intef-. tinal inactivity and retehtion of faces, it is probable that fome particles of a putrid nature pafs through the lacteals into the blood, where they cannot produce any falutary effect; but contribute to the general irritation then prefent. But purging is a mearis of diminifhing re-action, and leffening the velocity of the pulfe. The increafed fecretion from the veffels of the inteftines, diminifhes the abfolute quantity of the circulating mafs, relieves the veffels from tenfion, and renders the danger of determinations infinitely lefs, Purging too, I conceive in many inftances may remove miafmata -from the inteftines, which might add to the feverity, of the difeafe. It is a mild fpecics of evacuation, which patients inclined to pafs into a low ftate, bear better than any other. Iqueftion, however, whether it be very proper except in the early ftage; as it may be the means ofincrcafing the irritable ftate of the ftomach. And befides, as we wifh if poflible to avoid determinations, , Purging too, I conceive in many inftances may remove miafmata -from the inteftines, which might add to the feverity, of the difeafe. It is a mild fpecics of evacuation, which patients inclined to pafs into a low ftate, bear better than any other. Iqueftion, however, whether it be very proper except in the early ftage; as it may be the means ofincrcafing the irritable ftate of the ftomach. And befides, as we wifh if poflible to avoid determinations, --- Page 169 --- Seét.IV.J FEVER OF SF. DOMINGO, tions, to the inward organs, it is doubtful, whether purging may not increafe this tendency. In this view, it is better, perhaps to employ it carly ; and in the further progrefs of the difeafe, to truft to injections. Thefe clear, not only the rectum, the natural - of the fieces; but a ftimulus is depot commonly plied to the upper inteftines, which folicits apthem to propel their contents. Ihave, in fome cafes, placed much reliance on this eyacuation; where the patient has been full, but of that habit, which inclines to melancholy, or nervous, and which would not bear the lancet. But I çannot fay I have reafon to boaft of its fuccels. On the evening of the i7th June, Iv was called to vifit my friend Capt. I- 1795, of the 6gth regiment. I found him in bed, complaining ofa dull heavy pain in his head; with a very. flight naufea, and a fenfe of obftruétion in the noftrils, as if he had cold. He faid, the firft fymptom he had caught marked was drowfinefs, and an inclination re- to recline. The pulfe was frequent, but not hard, and the tongue flightly furred over, with a leaden coloured cruft. The fkin was with very littlé increafe ofheat, open, Capt. I- - was --- Page 170 --- TREATMENTOF THE [Chap: II. was about thirty years ofa age; full but not florid; and of a bilious afpect. I direéted his feet to be bathed; and gave him four calomel pills, containing in all ten grains. On the 18th, I called in the morning ; the general fymptoms, much as on thei7th; the head-ach increafed; he had vomited the pills, foon after he took them, paffed the night rather reftlefs, and with the pills, had brought up a large quantity of deep coloured bile, but had no ftools. Iordered him the calomel again, but in fmaller quantities, to be repeated, till fome effect was produced. During this he had twelve day evacuations; which, as he faid, fcalded him in the paffage; but the head-ach and drowfinefs abated; though there was a kind of fupor ftill remaining. I wifhed now to apply a blifter to the neck, but he pofitively objedted; and faid he only wanted fomething to procure reft; after the fatigue of the preceding night. In the evening the tepid bath was ordered, and he took at bedtime B. Aq: ammon. acet. 3i. Cinnamon. 311. Tinét. op: gtts. XXX, Sumend. h. f On -ach and drowfinefs abated; though there was a kind of fupor ftill remaining. I wifhed now to apply a blifter to the neck, but he pofitively objedted; and faid he only wanted fomething to procure reft; after the fatigue of the preceding night. In the evening the tepid bath was ordered, and he took at bedtime B. Aq: ammon. acet. 3i. Cinnamon. 311. Tinét. op: gtts. XXX, Sumend. h. f On --- Page 171 --- Sea.IV.] FEVER OF ST. DOMINGO.- On the I9th, found him : much refrefhed, after a found fleep, and a, glowing general perfpiration ; the tongue continued loaded; and there appeared Atill, a great determination towards the head. There was a' kind of infenfibility to common occurrence, and a careleffnefs as to the event, which I have often feen, a prefage of danger. I ordered him again the calomel pills. 2oth, he paffed the night without any Acep, but felt no pain; the pills operated towards morning, and duced feven complete evacuations: The R was nearly natural, the tongue covered with the leaden coloured cruft, but clearing from the edges and tip inwards, leaving them of a bright red colour. The head-ach was gone, the pulfe 88 in'a minute, rather contracted, little thirft, the countenance duiky and very grim, with a ftrong propenfity to fleep. B. Infuf. cort. Peruv. 3viii. Tinét. colomb. 3ii. Aq. ammon. acet. 3if. M. Of this he took a fpoonful every half hour. During the day, the bark fat cafy on his ftomach, and he paffed a good deal of bilious matter in his ftools; but the pulfe became creeping and fmall, and the kin continued relaxed, --- Page 172 --- - TREATMENT OF THE [Chap. II. relaxed, without moifture. In the evening I direéted him, to be wafhed with cold water and to have fome buckets of it. dathed him ; after which he took at bedtime, over K. Aq. ammon. acet. 3f. Pulv. Jacob. gr. xii. Tinét. op. gtts. XV. M. He was ordered wine and water for drink, in the proportion of one third of wine. 21ft. I vifited him very early in the mornings and found him very comatofe, and the pulfe juft perceptible. I immediately rode off to the hofpital, and returned with three blifters and a camphorated mixture. But I found the agitation of death upon him, and he expired placillyandeaimlyar twelveat noon on the fifth day, from the time he had firft complained; which happened one day before I had vifited him. It is a curious coincidence, that Lieut. B- of the fame regiment, who was taken ill at nearly the fame hour, died alfo this within half an hour of'Capt. Iday, Here was a cafe without any remarkable fymptoms of determination, except towards the head, and I am of opinion, it muft have been of the ferous kind, as the face never appeared expired placillyandeaimlyar twelveat noon on the fifth day, from the time he had firft complained; which happened one day before I had vifited him. It is a curious coincidence, that Lieut. B- of the fame regiment, who was taken ill at nearly the fame hour, died alfo this within half an hour of'Capt. Iday, Here was a cafe without any remarkable fymptoms of determination, except towards the head, and I am of opinion, it muft have been of the ferous kind, as the face never appeared --- Page 173 --- Seat. IV.]. FEVER OF ST. DOMINGO, . 143 peared Aufhed or red; which would have bably happened, if the! veffels: of the head pro-: were furcharged with blood.r I therefore judged purging the mofti proper evacuation though Ir regretted afterwards, that I had not 5 bledihim, and that I had: N1 not infifted: on! plying. blifters I early! But we always apwhere; we 3 are S unfuccefsful. Another regret of my planiwas to excite perfpiration, part) and alter, if poffiblegthe. given ftate of the when thefe views failed, I had bodyy only to port the conftitution and vital fapio fuch-means as. are commonly ufed powers by: occafions. In cafes: like the on fimilar the vital prefent, where powers are gradually finking into a hopelefs inactivity; where the pulfe is hardly, felt; where the patient does not complain perhaps of any pain; 5 I have fometimes ufedi the warmeft and moft ftimulant with fome effect. This hint I took from powders, the practice of my learned colleague SON, Ihave prefcribed brandy with Dr.JACKpepper, and Jamaica given pills made. up : of Cayenne pepper, camphor; and opium: What will noti one try, that can afford" the fmalleft in fuch a. miferable dilemma, when he chance,. fees thei common efforts feeble and ufelefs? By. thefe means, I-was oncé. fucceisful, in <he-cafe of a foldier --- Page 174 --- 144 e TREATMENT OF THE a foldier in the 18th [Chap. II. I had light dragoons, of whom abfolutely defpaired 5 the pulfe was' nearly gone, convulfive twitches, where felt; his extremities were every he exhibited were cold, and He took in the every appearance of diffolution. of courfe of fix hours, 20 grains Cayenne pepper, fix of of opium. The camphor, and two; pulfe gained ftrength, extremities became the: which had warm, and the features, of fhrunk, and affumed the death, began to fill out and have alpect fion; the anguith in the exprefthe evening he was able eye vanifhed, and in was a kind of refurreétion to articulate, This inftance of this fort from death. One juftifies occafional bold innovation, and, practice. His name is FITZGERALD; and I believe he is now alive his regiment. When with and common practice common expedients ; it is a fails, to vary our means, and mode facred duty otherwife we become the idle, of treatment; tators of death. It is inhuman fpec-: that where we have no argument, to fay, no leading and principle to guide us, there muft be precife and we muft practife in the dark. danger, moft decilive practice, there In our we do not is a great deal only to accurately know, and were we act.where we have thefe precife principles, ; it is a fails, to vary our means, and mode facred duty otherwife we become the idle, of treatment; tators of death. It is inhuman fpec-: that where we have no argument, to fay, no leading and principle to guide us, there muft be precife and we muft practife in the dark. danger, moft decilive practice, there In our we do not is a great deal only to accurately know, and were we act.where we have thefe precife principles, --- Page 175 --- Sea-IV.] FEVER.OF ST., DOMINGO. ciples, the cafe emin general would be mitted to nature, f we affume the comof phyfician, let us merit the name and give afliftance. We muft eitherad appellation, tor do nothing. Practice in boldly hitherto been too tame and feeble my opinion, has has been facrificed ; too much ration to prejudice ; and a venefor opinion. We neither think or act for ourfelves in tedicine.-Fear has us 5 and we have furrendered deprefled our reafon to fyftem and doétrine: Unfuccefsful cafes, pérhaps more inftruction, than the fuccefsful. carry -Weare never. to defpair; itis a common, but -a good medical maxim, to guide the that while there is life, there: is phyfician, hope 5 we ought never to ceafe to act, whilf the be aéted on. While the vital body can the frame, fpark animates though it may be dim and feeble, it may be rekindled, and ftrengthened; fibre may again produce the animal the menarin theircommon order; and the phanoenjoy the unequalled happinefs,of phyfician a fellow being to exiftence. But récalling we are more particularly called on for exertion, in a fever like the Remittent of St: Domingo, which has hitherto baffled every attempt, and committed unheard of deftruétion ; we will be in every expedient, and juftified humanity itfelf will L apologife --- Page 176 --- TREATMENT OF THE [Chap. II. apologife for boldnefs and innovation. I not without hope, that we thall am this formidable difeafe. yet cure We now come to confider the effects of Warm and Cold Bathing in the Remittent. Warm baths have been ufedin medicine a very early period ; they were recommended from by the Greck and Roman cure of phyficians in the many difeafes. Among the Greek phyficians, there is reafon to believe cold bathing was practifed with that nefs; though great boldthey are deficient in detail. warm climates, tepid baths have In ed among the luxuries of the always rankvoluptuous. But great and independent of the fenfations créated by them, they become pleafing ticularly effential from other reafons. parmatter of perfpiration incrufts The the fkin, fo as to form and refts on fome degree block obftructions, and in up the The tepid bath, by exhaling veffels. purities, and wafhing away thefe imthem ftimulating the veffels, enable to carry on their functions with and advantage. It is eafe larity and pleafant inconceivable, the hibath fecling, which the warm produces. The fpirits are and a chcerfulnefs enfues enlivened; ; as ifa burden was removed; fome degree block obftructions, and in up the The tepid bath, by exhaling veffels. purities, and wafhing away thefe imthem ftimulating the veffels, enable to carry on their functions with and advantage. It is eafe larity and pleafant inconceivable, the hibath fecling, which the warm produces. The fpirits are and a chcerfulnefs enfues enlivened; ; as ifa burden was removed; --- Page 177 --- Beé.IV:] FEVER OF st. DOMINGO, removed ; as it is often expreffed. But befides thefe evident ufes, of tepid baths, in relaxing, cleanfing, and ftimulating the cutaneous veffels; there is another purpofe of great The warm bath, always increafes utility. and leaves the in fenfibility, body a fituation to be acted on. Senfibility is the great charaéteriftic of animated matter, it is what chiefly dif tinguifhes it; and forms the great balis on which changes are produced. Without fenfibility, we in vain attempt to act on the human fyftem. In this view Ihave often ufed the warm bath, and have found it highly beneficial, Cold bathing alfo has numerous advantages in warm climates and their difcafes; it renovates the ftrength of the animal fibre; 3 and by the fudden fhock the vafcular agitates all fyftem, producing in it, a very quick change. But its chief effects are, to impart tone and ftrength to the veffels, to invigorate the general fyftem, and by the agitation, remove obftructions in the more minute ramifications, of arteries and In this view, I have found cold veins. ufeful. Cold bathing very bathing has been of late years introduced into the treatment of fever. The Indians of America, followed this fuccefsfully, and in plar very a a very curious manner. L 2 They --- Page 178 --- a TREATMENT OF THE [Chap. II. ftrialy purfued the plan of'effecting a change in the fyftem. Their manner was, to fhut the fick up, in what is termed a wigwam Ot hut. They took a large ftone, and heated it in the fire till it became red; it was then taken Oût and a bucket of water poured over it; the fmnoke or warm vapour could rot-efeape ; for that the patient was not only breathing'this warm and humid atmofphere, but was, as it were immerfed in it. By this treatment, a, perfpiration was ufaally brought forth, in the very height of which, thei; patient was carried out and plunged into coid water. TFhis practicé, which we flhould confider very hazardous, is faid to fucceed wonderfully amongft them, and to banifh fever in moft inftances. We-do not exaétly know the fpecies of fever which reigns amongft them, but from what I could learn, it appears to be of the Remittent form. At any rate, the fact of theirs effecting cures, in this "manner, in the early part of the difeafe, is, perfedtly"a afcertained. It is a daring, bold practice, but if fuccefs crowns it, why not adoptit. TE I remember when in the Eaft Indies; on board the-Airly Caftle Indiaman, fome-cafes L of of fever which reigns amongft them, but from what I could learn, it appears to be of the Remittent form. At any rate, the fact of theirs effecting cures, in this "manner, in the early part of the difeafe, is, perfedtly"a afcertained. It is a daring, bold practice, but if fuccefs crowns it, why not adoptit. TE I remember when in the Eaft Indies; on board the-Airly Caftle Indiaman, fome-cafes L of --- Page 179 --- Sea.IV:] FEVER OF ST. DOMINGO. of Remittent occurred at. Diamond Harbour, where. the. company's fhips anchor. Several perithed in fpite of eyery attention; one of them however in a fit of delirium jumped. lout at onevof. the ports. Hejwas immediately picked up, rubbed dry, and put to bed., His fenfes returned inftantly, his pulfe became more I regular; he fell intoa: profound fleep; and next morning there was a complete remillion. Herecovered afterwards I recolleét another inftance very fpeedily. perfectly fimilar, oni board the Princefs Amelia Eaft Indiaman, in the fame place. The Remittent had carrie d off more than halfthe fhip's company; though every affiftance, every comfort the fick could have; was procured by Capt. Millet, the humane commander of the fhip. A feaman of the nameofDavies, a very ftout athletic man, in'whom the Remittent had at times alternated with epilepfy, jumped overboard; at the moment he didi this, an alligator was along fide the thip. He feemed to become. at onçe fenfible of his danger, and fwaim with gréat visgour till hé was ailifted. I faw: him the moment he came: on: "deck; his countenance, which before was grim and anpromifing, affumed a more mild andt temperate alpect ; his pulfe, which had been extremely quick and L 3 feebie, --- Page 180 --- i5o TREATMENT OF THÉ [Chap. II. feeble, was now flower and fuller collection, which had ; and his rediftinét, been confufed and inbecame clear and accurate. I rected him to be waihed diand over with put to bed; he fell into a brandy, which terminated in profound fleep, an univerfal warm, and profufe. The perfpiration, very diftinét remiffion, and confequence was. a a fpeedy recovery, Thefe cafes made a ftrong my mind, and I was determined impreffion on opportunity of to take an accident imitating a practice, which had pointed out. I had not then feen the book of my friend Dr. An JACKSON. opportunity was foon furnifhed, of it further; upwards of trying thirty men were in my ward, at the Diamond Harbour and I commenced holpital, dafhing buckets of over them from fome water height; but whether the water was not fufficiently cool, or the patients beingin expectation did not feel the that the circumftances fhock, Qr do not were really different; I know, but I was not by any means fo fuccefsful, as I had hoped from the two I have juft related. From the time cafes, Dr. JACKSON's I perufed book, I became more fully perfuaded that cold bathing, or rather the dafhing of cold water might he made very ufeful ; but whether the water was not fufficiently cool, or the patients beingin expectation did not feel the that the circumftances fhock, Qr do not were really different; I know, but I was not by any means fo fuccefsful, as I had hoped from the two I have juft related. From the time cafes, Dr. JACKSON's I perufed book, I became more fully perfuaded that cold bathing, or rather the dafhing of cold water might he made very ufeful --- Page 181 --- Sedt. IV.] FEVER OF ST. DOMINGO. ufeful in the treatment of fever. And accordingly, I feduloufly applied myfelf to obferve its effeéts. The beneficial confequences from cold water, feem to me to arife entirely from it in the given ftate of a revolution produces the body; by which the whole morbid phanomena are changed. In the very early ftage of fever, before it has eftablifhed its peculiar mode ofaction ; before the re-action begins, I think the praétice of dafhing cold water on be very ufeful. But after the the patient, may fever has eftablifhed its peculiar morbid action, after the circulation and veffels re-adt, after determinations to particular organshavebegun, I hold this practice lefs certain. Becaufe it is not likely to banifh the mode of acting then fixed; and the fudden energy of the veffels from fo powerfal a ftimulus, may aflift determinations, and promote an inflammatory difpofition. Previous evacuation may perhaps againft thefe mifchiefs. In cafes, where guard is much impaired, where the recolfenfibility where the fyftem is as it lection is confufed, I were oppreffed, and wants energy to remove the oppreflion, where the pulfe is feeble and frequent, in fuch cafes, I hold the dathing of cold water, to be one of the beft and moft powerful remedies. The general effeêtsIobL 4 ferved --- Page 182 --- 152 : TREATMENT OF THET [Chap. II. ferved to refult from this praétice, where itr e was happily applied, were, an improved fecolleétion, more cheerfulnefs of afpect; a diei minution of heat and anxiety, the pulfe ren dered more full and equable; a tendency to: fleep and perfpiration, and fometimes 'al diftinét. remiflion. I have faidithat thefe were the general effects, where: dafhing of cold water on the patient Was happily applieda It muft not be concealed, that I have ufed it often without fuccefs, in cafes, where I promifed myfelf much from its ufe. I have not at times been ableito obferve, that it produced any great effect. We have yet much to learn from experience, on this fubject. The dura tion ofapplying water; the repetition ofit,and the peculiar circumftances in which it is moft ufeful, are not as yet accurately afcertained. I 1 am of opinion with-RUSH, that it will be moft ufefully employed, in cafes, where there ismuch A dimination ofunervous energy.h eIn order to: imitate the:Indian@i@cheme, aslir ncarly as Ic could; Eoften: premifed the warmabathi, andi whilfe the patientrwas aitting rrin its Thad leito-lor-thrcal buckets-oficold water: faddenly 2dafhedi omi him. Iemployed the warmbath fin fuel cafee, merely torcreate a greater degree -ôf fenGbility, thatet thie coldi - - - I wateriniight-be more ervous energy.h eIn order to: imitate the:Indian@i@cheme, aslir ncarly as Ic could; Eoften: premifed the warmabathi, andi whilfe the patientrwas aitting rrin its Thad leito-lor-thrcal buckets-oficold water: faddenly 2dafhedi omi him. Iemployed the warmbath fin fuel cafee, merely torcreate a greater degree -ôf fenGbility, thatet thie coldi - - - I wateriniight-be more --- Page 183 --- Sea.IV.] FEVER OF ST: DOMINGOT morel acutely felt, àndproduce its change Or, action, with more certainty. Surprife adds greatly to the power, of thefe remedies; we. may often fail, becaufe the patients have fummoned refolation to ibear the fhock, It is. often. impoffible to : take them by furprife; when once your practice is; known, they. expeét the, cold water, whenever the warmbath is ordered. Befides, it isy doubtful whether dafhing cold water on the body produces,the full effect ofl la iplunge, by which every; point in, 2 thel fyftem is at once affected; and in, the two cafes Ihave related, the cold was! longer applied, than it ever is in dalhing. : Thefe - are points, forexperience to.determine.) aoid : In one cafe, net5v where I DIH I perfevered, and repeated. 3 the application of cold water, I was. fo fortunate as to fucceed; and to preferve to his king and country a very valuable officer, in moft perilous circumftances. I allude. to Col. H of the twenty-ninth light dragoons. / His dangerous fituation is well known to many officers at Port-au-Prince. Col. H- is of a thin, fpare habit, but active, and rather vigorous. Soon after he arrived at Port-au-Prince, he was feized by the Remittent, ZEY From. the very beginning the vital energies, --- Page 184 --- TREATMENT OF THE [Chap. II. energies, were remarkably delirium commenced with the overpowered; a. was feeble and fever; the pulfe locked, and very quick, the fkin dry and the countenance anguith and expreffive of fituation, danger. I removed him to a where I could daily vifit often as his cafe required. him as emptied, and I direéted His bowels were fome buckets his fervant to expofe of water to a ftream of a fituation, where the fun could air, in fo as to have it as cold have no accefs, him as pofflible; I then had brought out into the viranda, and on a chair, at a time he was fo feated trembled all feeble, that he over, and manifefted a to faint. When feated difpofition on the chair, I over him a bucket of the poured elevation ofanother water, from the chair placed behind He was then rubbed dry and him. put to bed; the confequence was, that his pulfe became fuller and ftronger, his recolleétion his fkin relaxed, more clear, and with a gentle over it. This flate continued perfpiration till towards evening, when fymptoms of a frefh bation appeared. He exacergallery, and was again taken to the made another application of cold water as before, with the fame effects. next day, the water was The on the third fome applied three times; fymptoms of determination to confequence was, that his pulfe became fuller and ftronger, his recolleétion his fkin relaxed, more clear, and with a gentle over it. This flate continued perfpiration till towards evening, when fymptoms of a frefh bation appeared. He exacergallery, and was again taken to the made another application of cold water as before, with the fame effects. next day, the water was The on the third fome applied three times; fymptoms of determination to --- Page 185 --- FEVER OF ST DOMINGO. I5S. Sect. IV.] and fome degree of to the ftomach came on, its appearthe yellownes too begun coma; the became Auttering, quick, ance, and pulfe blifter was placed over and feeble. A large each ancle; the cold the ftomach, and one on three times; and at water was again repcated inftead ofonc, were each time two buckets ofit, overhim; the effeéts were remarkable; thrown more regular, the the pulfe became inftantly recollection became and wis wvitae wasincreafed, blifters rofe well, the vomiting diftinét. The feemed to be averted ceafed, and the danger of the from the ftomach. The application the in the fame manner, water was repeated became deep, but fourth day; the yellownefs on the fifth; remifiion took place a complete adminiftered to prevent when the bark was This was one of any renewal of the paroxyfm. of the Remittent, in the-moft dangerous cafes Iadwhich I ever faw a recovery happen. from vifed Col.H-, to proceed to Jamaica, for afterwards to go which he was obliged with dyfenteric Europe. He was affeéted his ftrength. complaints, and did not regain I add, that he is now kt is with great pleaiure This was the recovered. in England perfectly ofthe effects ofcold water moft decifive cafe attribute to it, I ever met with. I certainly the --- Page 186 --- TREATMENT OF THE the whole of the fuccefs. [Chapril, effects fo inflantincoufly Becaufel good cation foliowed the ; and I am convinced the appli. obtained folely from this remiffion was praétice, In the cafe too of mya amiable and - friend, Major C-, of the regretted tained, by the fame soth, I had obfion; $ though means, a complete remif Dr.JACKSON, from the ning augured danger. The fever begins abfent for two days before had becn maica. The inhabitants we arrived in. Jato receive of Kingiton, who ufed lodgers, weréi imprefled with of the Yellow Fever's laridea would being infeétious, and not-admit any fick from St. I went from houfe tohoufe Demingo, modations for to procuré accomhim, and at. in the evening, I length, very late culty: fucoceded; afterimuch diffiDuring the day he-fuffered the eft anxiety, from an eagernefs greatveffel,. and to iquiti the get on fhore; we landed about eight in the evening, and he was in a gentleman's curricle, conveyed At this time he had to his chambers. fuflicient walk, and was fomewhat ftrength to his feet bathed and cheerful. Heil ihad the night went to bed. He paffed uneafy and reftleis, hei fighed wfrequently, and I forefaw, thatr the Parixicty he had fuffered agitationand coming on fhore, would recal ; we landed about eight in the evening, and he was in a gentleman's curricle, conveyed At this time he had to his chambers. fuflicient walk, and was fomewhat ftrength to his feet bathed and cheerful. Heil ihad the night went to bed. He paffed uneafy and reftleis, hei fighed wfrequently, and I forefaw, thatr the Parixicty he had fuffered agitationand coming on fhore, would recal --- Page 187 --- Seet.IV.] FEVER OF ST. DOMINGO. recal a frefh paroxyfin of the Remittent. I called to my afliftance Dr.GRANT,an eminent phyfician of Kingfton,and an opening medicine About eleven however,in the was preferibed. forforenoon,the paroxyfm made a diftinét,and midableappcarance; the vital powers, were oppreffediand funk at once ; feveral blifters were and cordial medicines; ; but all was in applied, vain, the difeale baffled every. attempt, and this truly valuable man, perithed about ten o'clock at night; whilft I was fupportinghim in bed. This'cafe proves the danger of anxiety and fatigue in recalling the fever to new action ; fuch returns are always dangerous, as they find-t the patient in a ftate of great debility. In another cafe, Major C-k's, 69th regiment, whom I faw very early in the difeafe, fo as to give the warm and cold bath every fair chance, I proved ultimately unfuccefsful; for though at different times remiffions were procured, and the ftrength and fpirits feemed to improve, yet the fever Aill returned. But from the beginning, the deep fighing was prefent, a fymptom I have ever feen formidable; he had at times fuch diftinét remiffions, that Dr.JACKSON, whofe fagacity is feldom --- Page 188 --- 158 TREATMENT OF THE feldom [Chap: Il, chance difappointed, of thought he had a fair recovery. In this cafe peared fome fymptoms of there apwards the liver, and Dr. determination tomended mercurial JACKSON recomtile liniment, ând unétion, joined with volaaccordingly a confiderable quantity was thrown in, but without Calomel too had been effeét. ed, a combination of all very liberaily employed, and the the plans was adopthad a fair, dafhing of water in all its forms diftinét trial. The had its fatal termination fever, however, Major C-k had been on the ninth day. fervice, he loft his much exhaufted by otherwife much arm in Corfica, and was with hurt, and had then recovered in the difficulty. Weft His habit, was what we call lived Indies bilious, and he had always freely. I cannot help what I have often witneffed remarking here, of this difeafe in the fatal cafès ; an uncommon calm which perfectly forefceing fortitude, with the moft heroic death, talked of it mind was ferene, indifisrence; whilft the have met acute, and firm. This I equally among the priyates and officers; and though in the courfe of the eafe, they have expreffed difevent, and feemed fome fear of the proached the anxious, yet when it apclofe, they became at once dauntlefs afe in the fatal cafès ; an uncommon calm which perfectly forefceing fortitude, with the moft heroic death, talked of it mind was ferene, indifisrence; whilft the have met acute, and firm. This I equally among the priyates and officers; and though in the courfe of the eafe, they have expreffed difevent, and feemed fome fear of the proached the anxious, yet when it apclofe, they became at once dauntlefs --- Page 189 --- Sed. IV.J FEVER OF ST. DOMINGO, dauntlefs and indifferent. I have feen men. calmly fettling their affairs, after the circulation had. ceafed for hours, to be perceptible. From what this ferenity of mind, fo general in this dicafe, has its origin, it is impoffible to determine.. A few hours before Major C-k expired, I came into his room, he looked at me ftedfaftly; and his hand, in which no ftretching out pulfe was he faid, my time is at laft come perceptible, tell me I muft die in a very fhort 5 time. my feclings Iam obliged to you for your exertions ; he called his fervant, and afked if a little wine would injure him ; I told him not ; he defired him to fill out two glaffes, of which he to take one, and holding the other begged me he obferved, that we had paffed himfelf, hours together, and that he many happy for the laft time, now addreffed me He drank a little of the wine, gave directions about his burial, fhook me cordially by the hand, and turned round in his bed, wheré he very foon afterwards expired. Iattended another cafe, with my friend Dr. FRASER, of the 18th light dragoons, whofe profefional abilities are very well known. This was a cafe of an officer of great promife, in --- Page 190 --- TREATMENT OF THE [Chap. II. in whom all the army felt particular intereft, In this inftance, affiftance was given from the very beginning, and Dr. FRASER judicioufly combined every mode of treatment, that had the leaft, chance of fuccefs: The dafhing of water hot and cold was tried fedu- -loufly. Calomelhad been given combined with purgatives; blood-letting had been frecly ufed; and towards the clofe, blifters and cordials, and yet after all the vigilance, and care employed,the patient perifbed. The fituation in which this officer caught the difeafe, muft have given the higheit aétivity to miafmnata. The regiment was ftationed at a ruined plantation, furrounded on all fides by a circle of marthes, from which the caufes of the Remittent muft have been conftantly iffuing in. their utmoft vigour. The confequence was, that numbers fell down, and Dr. FRASER affured me little impreflion could be made on them, by any means,. he couid fuggeft. Some of them cameinto the general hofpital ; they for the moft part perifhed; ; and we could boaft of very little fuccefs. But though this proves, that in eertain circumftances of difeafe, we are not aiways faccefsful, it docs not forbid the hope, that we mnay yet become more fortunate, from further.experience. I am Aill perI fuaded Dr. FRASER affured me little impreflion could be made on them, by any means,. he couid fuggeft. Some of them cameinto the general hofpital ; they for the moft part perifhed; ; and we could boaft of very little fuccefs. But though this proves, that in eertain circumftances of difeafe, we are not aiways faccefsful, it docs not forbid the hope, that we mnay yet become more fortunate, from further.experience. I am Aill perI fuaded --- Page 191 --- Sedt. IV.J FEVER OF ST. DOMINGO, 16r fuaded, that proper management great deal, and a happy may do a combination of treatment, effect many recoveries. In the of dafhing cold water, I hold eflicacy confidence, in very confiderable changing and altering the ftate ofthe body, and given revolution. In introducing a falutary my own cafe, when threatened with the Remittent, and when in fact, roxylin had begun, I found the a panefit from vigorous greateft beached treatment. My head feverely, the pain in my loins and back were intenfe, and I felt an almoft infurmountable inclination, to recline and flumber. An inftantaneous determination made to the ftomach, and had been the vomiting had begun: in this fituation, I diredted fervant to prepare the warm bath, into which my immediately I plunged ; when I had remained there, about five minutes, I ordered him have in readinefs, three buckets of cold to drawn from a well water, fàt up in the adjoining the houfe, I then bathing tub, and in that the three were pofition fiderable poured over me. I felt a confhock, and my headach increafed to great violence; Ia arofe and was rubbed down witha rough towel, and inftantly When Ilaid put to bed. down, I took a fcruple of powder. The Jamcs's vomiting had ceafed on my M getting --- Page 192 --- TREATMENT OF THE [Chap. II. getting into the bath. My headach after laying down, but abated fpoke my fervant faid that I incoherently. I fell fhortly into a found fleep, and a general proout all over perfpiration broke found my body; when I awaked, I myfelf perfeétly relieved from all unpleafant feclings, and complained fenfe of wearinefs, only of a Some inclination mit ftill remained, but it to VOed; and in the courfe gradually difappearenabled of the day I was to begin the infufion of took two pills bark, and given me by Dr. ScoT, containing fix grains of calomel. I had turns, and in two no retake'o days was enabled again to charge of my ward in the General Hofpital. From all the that it fymptoms, Iam fatisfied, was a real attack ofthe Remittent, and that the change brought on by the bath, cured a happy termination oft the proparoxyfin. Ihave now finilhed the remarks I had make on the various means ufed to the Remittent of St. to combat Domingo ; it would pear on the whole, that apcarly part of the blood-letting in the - difeafe, is onc of the means we have yet adopted; beft paring the body for the action whether by preof other remedies, atisfied, was a real attack ofthe Remittent, and that the change brought on by the bath, cured a happy termination oft the proparoxyfin. Ihave now finilhed the remarks I had make on the various means ufed to the Remittent of St. to combat Domingo ; it would pear on the whole, that apcarly part of the blood-letting in the - difeafe, is onc of the means we have yet adopted; beft paring the body for the action whether by preof other remedies, --- Page 193 --- FEVER OF ST. DOMINGO. Seôt. IV.] dies, or in its own nature preventing dangerous confequences. I fhall add. a. few words more on the ufe which in-a variety of modes has of opium, in the cure of the Remittent. been employed I have feen the ufe ofit, atIn Intermittents, adminiftered in 3 tended with the beft effedts, LIND. the cold ftage, in the manner of Dr. brought on the hot ftage, and It certainly termination, with conduéted it to a happy And I comfort to the patient's feelings. great twice feen, the return of the pahave once or by taking a large roxyfm, entirely prevented But I muft, in the amdofe of laudanum. to that of pleft manner, join my teftimony the ufe of it Rush's, in faying, that I found in the early ftage of the Remittent, attended even, when the pain with bad confequences, called on humaand reftlefinels of the patient headach nity for any means of relief. The increafed, the fyftem in general was always the fkin more dry rendered more irritable, followed and parched, and an evident debility clofe of the But towards the. its operation. of remiflion, fever, where there are fymptoms bad freedom may be ufed, without any more And it is a means of acceleconfequence. rating M 2 --- Page 194 --- TREATMENT OF THE [Chap. II. rating recovery, by procuring fleep, and refrething and invigorating the fyftem. I fhall now proceed to ftate the treatment I purfued in the Remittent, before I left St. Domingo, and the grounds on which I planned my practice. The Autbor's Treatment oftbe Remittent, after confiderable Experience. WHENEVER I was called to vifit a pérfon attacked by the Remittent in the manner already defcribed, if there was any inflammatory difpofition, Or that the patient was a ftranger lately arrived, Ii inftantly bled him in proportion to his frength and the urgency of the cafe; the quantity can only be afcertained by the circumfances then prefent, and cannot be regulated but at the patient's bed-fide.- No direétions can be given in words, that wouldapply to any number of cafes; as minute occurrences. - often guide the phyfician, Iam however of opinion, that much depends on the evacuation being liberal at firft ; if the fymptoms do not change, and the pulfe retains its vigour Of increafes in ftrength, the evacuation may be repeated next day, but not fo freely as Onl the firft. After the blood-letting the patient Was ordered into the warm bath, and the patient's bed-fide.- No direétions can be given in words, that wouldapply to any number of cafes; as minute occurrences. - often guide the phyfician, Iam however of opinion, that much depends on the evacuation being liberal at firft ; if the fymptoms do not change, and the pulfe retains its vigour Of increafes in ftrength, the evacuation may be repeated next day, but not fo freely as Onl the firft. After the blood-letting the patient Was ordered into the warm bath, and --- Page 195 --- Sedt. IV.] FEVER OF ST. DOMINGO. and whilf fitting there, half elevated out of the tub, three buckcts of cold water were dathed over him ; he was then taken out, and well rubbed with a rough dry cloth, and put to bed well covered; ; the room was chofen airy and open, and the bed placed in- fuch a manner, that no diredt draught of air played upon it. As foon as he was put in bed, an injedtion was adminiftered, and eight or ten grains of calomel joined with a feruple of James's powder, were formed into pills, and one ordered every half hour till their effcets were produced ; the patient was permitted to drink frecly of lemonade, beef tea, rice or barley water, tamarind water, orangeade, or any light drink that was pleafant to the tafte.: If the fever did not give way to this treatment the bath'and cold water, were repeated again and again, till fome impreflion was made in changing the given circumftances of the body. The pills too were continued, till the bowels were evacuated, and a difpofition to loofenefs was brought on; ; and the fkin releafed from that hard crufly feel, fo unpleafaht to the touch. In general, where I could employ the baths, I direéted them three times a day, and uniformly found that good effects refulted. When cafual fymptoms occurred, immeM 3 diate --- Page 196 --- TREATMENT OF THE diate attention [Chap. II: was paid to them. Of all means ufed to fupprefs the exceflive the ing and remove the vomitblifters irritation, I think large early applied are the beft; butI gine we are in general too late in imathem, and permit the determinations applying formed before we to be when attempt to counteract them, they are too powerful to be and havealready removed, I think in produced their fatal tendency, every cafe, where the flighteft irritability appears, nay, where there is a blifter fhould bc none, that fo as to applied over the ftomach, prevent the determination to that important organ ; for what is the pain or venience of a. blifter, incon-. rity that the compared with the fecuapplication may afford. recommend then, and Iwould blifter to the Iactually preferibed a region of the ftomach on fecond day ; this does not the of the treatment. When interrupt any part the onçe vomiting has commenced, the patient fhould be reéted to fwallow as little didrink whatever, but to moiften R8, poffible of any mouth the fauces and often, to remove that drynefs which conduces fo much to the fenfation of It is in vain to prefcribe the thirft, mildeft liquids, Mhatninsnghifremginabine ,whatever the inner ftomach is fure to be rtouches rejeéted with violence; çe vomiting has commenced, the patient fhould be reéted to fwallow as little didrink whatever, but to moiften R8, poffible of any mouth the fauces and often, to remove that drynefs which conduces fo much to the fenfation of It is in vain to prefcribe the thirft, mildeft liquids, Mhatninsnghifremginabine ,whatever the inner ftomach is fure to be rtouches rejeéted with violence; --- Page 197 --- Sect. IV.J FEVER OF ST. DOMINGO, violence ; and every time the ftomach is thrown into thefe convulfive motions, the difeafe is frengthened, and. the danger increafed. Whenever the naufea and pain fomentations fhould be applied, and continued appear, frequently, after the blifters are even or rifen ; very foft flannel may be placed, for this employed purpofe, wrung out of hot water, or decoétion of chamomile, of which fome tertain a high opinion. All medicincs enbe laid alide, during the height of the fhould tion; neither cordials or fedatives will irritathe, purpofe; I have never met with anfwér medicine that would for any time remain any in the ftomach. Buta above all, we are to refrain from the ufe of purgatives Or antimonials, medicines which produce their effeêts erting their firft action on the fibres by of ex- the ftomach itfelf, cfpecially calomel We are in this flage to truft andjallap.- - intirely to tions, and to repeat them often. injecother Broth, and nourifhing liquids may be thrown into the body in this manner, and the faeces be removed, by adding irritation to the may mon emollient injection. If the blifters com- heal quickly, freth ones muft be applied, and the difcharge fupported by iffue ointment. From this manner of ufing blifters, I have feen the moft beneficial cffects refult, nor have I ufed. M 4 any --- Page 198 --- TREATMENT OF THE [Chap. II. any remedy with more fatisfaction and fuccefs in.1 removing dangerous (ymptoms.-Ido not remember a cafe, where blifters failed in removing this moft dangerous irritability of the ftomach, where they were early employed and perfifted in. I have alfo feen blifters fingularly ufeful in the latter ftages of the Remittent, when the - fpirits flagged, when there was a difpofition to coma, and the pulfe was low and fluttering, with that infentibility fo ofter prefent with fuch fymptoms. In thefe cafes I have fuccefsfully applied blifters to the neck and fhoulders, to the ancles and infide of the thighs, they were not large but made very ftrong fo as to act; and I 1 have feen cafes where I could attribute recovery to themalone. One medicine I muft mention, which I have ufed with good effeét after the irritability of the ftomach had fomewhat abated; it was a folution of white vitriol in ; mint water, with the aadition of a few pepper- drops of laudanum; I ufed the proportion of two feruples of the vitriolito, fix ounces of water and thirty drops of laudanum. Of this mixture I prefcribed a table-fpoonful every halfhour, tillthe fymptomedifappeared. Dr.JAcksoNufed at times portions of burnt alum with good effect. Thefe muft act by their aftringent power, which is applied in a fmall bulk without was a folution of white vitriol in ; mint water, with the aadition of a few pepper- drops of laudanum; I ufed the proportion of two feruples of the vitriolito, fix ounces of water and thirty drops of laudanum. Of this mixture I prefcribed a table-fpoonful every halfhour, tillthe fymptomedifappeared. Dr.JAcksoNufed at times portions of burnt alum with good effect. Thefe muft act by their aftringent power, which is applied in a fmall bulk without --- Page 199 --- Sea.IV.] FEVER OF ST. DOMINGO. without diftending the ftomach. The veffels in the inner coats, previoufly furcharged and dilated, are thus contracted and the diftention which made them ftrengthened, fo irritable is diminifhed, and they acquire fome portion of their former tone and feeling. It is in this manner only, I can account for the - good effects ofaftringents in this ftate of the ftomach. In the progrefs of the Remittent, when remarkable cfpecially debility occurred, I ftill fifted in the ufe of the cold water, and perrally found that the geneftrength was repaired, the pulfe rendered more equable, and the recollection more diftinét and more decifive. During the recurrence of this debility, Iufed camphor joined with nitre, and fometimes James's powder, as I judge with good cffect, in opening the fkin ; and where there was tendency to fubfultus, any opium was added in confiderable dofes. Ifin fpite of thefe means the pulfe ftill continued to fink, and the vital energies to diminifh, I had recourfe to the warmeft ftimulants, fuch as ather, brandy, cayenne pepper, brandy baths, &cc. It is then, of importance to maintain and the living fupport phanomena, to roufe the dying arteries, and to diffufe ftimulus, from the grand centre --- Page 200 --- TREATMENT OF THE [Chap. II, centre the ftomach. However theory may criticife fuch practice, experience will juftify it, as fometimes fuccefsful, and fuccefs is the beft comment on any mode of treatment. When remitlions were obtained, and the difeafe fhowed a difpofition to yield, the infufion of the bark and vitriolic acid were prefcribed, and continued during the tedious flage of convalcfcence, when the patient was apt to fall into a number of difeafes, arifing from the previous derangement and debility oft the fyftem. It was in this general manner then I conduéted the treatment of the Yellow Fever as it has been termed 5 varying my means, in many particulars as occafion required. I might have perhaps furnifhed a number of cafes in detail; but my conftant occupation did not permit me to take down thefe medical hiftories at full length. I noted the general outlines, and progrefs, the remarkable occurrences, the general effeets of various treatment; ; but this was all I could do, Occupied from morning to bight in the hofpital, or vifiting fick officers, difperfed over a large town, it was impoflible to be very minute. Belore Iprocecd to difcuis the vicws on which Iefta- number of cafes in detail; but my conftant occupation did not permit me to take down thefe medical hiftories at full length. I noted the general outlines, and progrefs, the remarkable occurrences, the general effeets of various treatment; ; but this was all I could do, Occupied from morning to bight in the hofpital, or vifiting fick officers, difperfed over a large town, it was impoflible to be very minute. Belore Iprocecd to difcuis the vicws on which Iefta- --- Page 201 --- FEVER OF ST. DOMINGO. Sest. IV.] I thall mention one I eftablithed my practice, blifters which may precaution in the ufe of the I much inconvenience to patient; vent the feat of them with the mean the guarding from the fies. The moutmoft vigilance they croud upon it, ment the fkin is removed, which become in this and depofit their eggs, and often form danneft a race of maggots, out myriads and deep ulcers, pouring gerous animals. The patient of thefe difgufing from their mooften feeis excruciating pain the animal tion,.and their efforts to feed on without cannot be banifhed fibre. They form finufes, into much torture. They and elude the forceps or. which they retire, fpirits, and the probe. They refift mercury, fublimate, in all ftrong folution of corrofive of their lives, which I have tried the duration for which in thefe elements they fupported is The fuccefsful and decifive remedy hours. which never fails to kill the oil of turpentine, accefs to and banifh them, when it has proper This remedy was firft retheir habitations. friend Dr. WRIGHT commended to me by my intenfe of St. Domingo. It frequently gives fits.; and almoft throws the patient into pain, to be in the befo that care ought employed on ginning to prevent the flies from alighting the fore. I thall --- Page 202 --- TREATMENT OF THE [Chap. II. I fhall now ftate the grounds on which my praétice was founded.--In the firft place I adopted no one particular remedy to which in all cafes I invariably applied, without the affiftance of others. Itis evident, that as circumftances of difeafe vary in almoft every individual, fo muft our means be varied alfo, if we wilh to meet the difeafe and fairly combat it. On this principle the fupporters of bloodletting, and the prefcribers of calomel are equally wrong. No invariable mode of treat-) ment can be adopted with fuccefs in any. one difeafe. I accordingly adopted and blended all the fyftems of management which have been offered in the Remittent. I was certainly more fuccefsful, after Iadopted bloodletting than before, and in many cafes among the officers 5 where I was called early, had no reafon to be diffatisfied with my Jabour. In the General Hofpital, I could not by any means boaft the fame fuccefs 5 the cafes which came under our infpection there, were of the worft defcription in themfelves, and we feldom faw them in the early ftage. The furgeons of regiments feldom ordered their patients to the General Hofpital, until the cafe became very dangerous ; in fuch circumftances many recoveries could not be expected, and accordingly the mortality was very great. reafon to be diffatisfied with my Jabour. In the General Hofpital, I could not by any means boaft the fame fuccefs 5 the cafes which came under our infpection there, were of the worft defcription in themfelves, and we feldom faw them in the early ftage. The furgeons of regiments feldom ordered their patients to the General Hofpital, until the cafe became very dangerous ; in fuch circumftances many recoveries could not be expected, and accordingly the mortality was very great. --- Page 203 --- Sea.IV.] FEVER OF ST. DOMINGO. great,--But to return; ; I before fated, in the beginningof this work, that the firft-effedts of the caufes of the Remittent, were to form determinations of blood to various parts of the body, but more efpecially the internal organs : That thefe determinations confifted in a larger portion of the blood being direéted to particular veffels, diftending and ftretching them, producing an increafed morbid fenfibility, and all the fymptoms ofacute inflammation. That the caufe of thefe phanomena, was a diminution of ftrength, in fome parts of the vafcular fyftem, by which the balance of circulation was deftroyed ; and that the danger of the difeafe,, confifted chiefy in the ftrength of of the - fuch determination, and the importance to which it was direéted. That thefe deorgan terminations actually happen may be inferred from the phanomena oft the difeafe itfelf. The irritability of the fomach, the aftonifhing impatience it manifefts in rejedting folids or fluids, the convulfive agonies into which it is thrown, the pain to the touch, are ftrong proofs of this fact. But diffections prove beyond all contradiction, that effects very fimilar to thofe ofi inflammation, aclually take place; the inner coats ofthe ftomach are often found feparated from --- Page 204 --- TREATMENT OF THE from the reft, and [Chap. IL, cretions of that floating loofe with the feorgan. The tity ofa a ropy clear fluid often aftonifhing thrown quanthe patient has had no drink, up, when an increafed fecretion in the proves clearly could not happen, without ftomach, which in the veffels, and an increafed action than the ufual a larger quantity of blood proportion to that organ. That determination happens to the head, is indireétly proved, by the coma often the Aufhing in the face, and the prefent S by of the arteries about the vifible action and direétly by neck and temples ; diffection, which fhows actual derangement, and marks of fulnefs in veffels, But what is more to the the cafes, where the indireét point, in proofs have great fuffufions ofa clear fluid have been occurred; found in the brain. This clearly adtion of thefe argues an increafed in veffels, and an unufual fulnefs confequence. I know, it is difficult draw precife and juft conclufions to ftate of the brain after death; from the ; becaufe in the ftruggles of dying, and the peculiar circumflances of refpiration, almoft during thefe agonies, every onc dies in a ftate And hence, the veffels ofthe brain ofapoplexy.- diftended on diffection, appear overthough this diftention might not exift till a few minutes before + death; but unufual fulnefs confequence. I know, it is difficult draw precife and juft conclufions to ftate of the brain after death; from the ; becaufe in the ftruggles of dying, and the peculiar circumflances of refpiration, almoft during thefe agonies, every onc dies in a ftate And hence, the veffels ofthe brain ofapoplexy.- diftended on diffection, appear overthough this diftention might not exift till a few minutes before + death; but --- Page 205 --- See.IV.] FEVER OF ST.DOMINGO, but where the fymptoms already ftated have appeared in the head, and where intenfe has been prefent; and diffection pain afterwards confirms, I think the conclufion may be fairly made, that there was a determination to the veffels of the brain. The liver too is frequently attacked by determination. In very almoft every diffection, that I have either feen or heard of; the liver has been found fomewhat enlarged and tumid, and the gall bladder commonly diftended and full. In one inftance which occurred, when I was at Cape Nicholas Mole, in a perfon under the care of my friend Dr. FELLOWS; the liver contained an amazing.impofthume full of pus. It had hollowed out, nearly half the hepatic fubftance; and the reft of it was uncommonly and mid. I had feen this large, tuman a few days before he died, he complained of fome pain in that hypochondrium, and I fufpected that the liver was affeéted. . Dr. FELLOWS, with a laudable induftry opened and examined diffection a in warm climate, is not the him; moft agrceable manner of inquiry. It appears then, from unqueftionable facts that determinations happen, and that the greateft really from them. The danger arifes danger of determination, would feem intimately conneéted with a certain --- Page 206 --- TREATMENT OF THE [Chap. II: tain tone ofthe veffels, or what à has been called an inflammatory diathefis, and this again to depend on the abfolute quantity and momentum of the circulating mafs. If this view be correct, and it is the only one in which circumftances lead me, to fee the difeafe, the propriety of an early and liberal blood-letting is at once efablithed. Thefe are decided modes in which the proximate caufe operates, and blood-letting appears to me the beft and moft likely means to avert danger 5 but when the bias towards determination is completely formed, it is then matter of great difficulty, to prevent its going on. When the morbid action is once begun in confequence of determination, it is not eafy by any mcans to refirain it; but to diminifh the bulk, and confequently the momentum of the circulating mais, is the beft means we can employ to prevent it's fatal confequences. The veffels muft act vigoroufly and be in a ftate of diftention to produce the effects we obferve in the fto-. mach itfelf; the inner coats cannot be rated fepa-. without confiderable violence, nor the organization of the veffeis and coats could not undergo fuch complete derangement, without mcans to refirain it; but to diminifh the bulk, and confequently the momentum of the circulating mais, is the beft means we can employ to prevent it's fatal confequences. The veffels muft act vigoroufly and be in a ftate of diftention to produce the effects we obferve in the fto-. mach itfelf; the inner coats cannot be rated fepa-. without confiderable violence, nor the organization of the veffeis and coats could not undergo fuch complete derangement, without --- Page 207 --- Sest. IV.] FEVER OF ST. DOMINGO, without great morbid aétion. Buc blood. letting diminifhes diftenfon, tone, and the veffels; and therefore feems beft vigour 01 to prevent danger. And it is of the calculated utmoft importance, that the morbid adtion in the ftomach, head, or liver, fhould not at -all commence; ast then, ,our blood-letting and other means may be too late. The effect ofa fti- & mulus, or rather the action it produces, and does in certain circumftances, may, after the ftimulus itfelfis removed. continue, is of Hence it importance, to prevent the ment of morbid action. commenceA fact occurs, in the adminiftration purgatives, which illuftrates this of it often happens in the exhibiton reafonings that of falts, they are inftantly, rejected frum the ftomach; but the purgative effects are notwithftanding. That tis ; the fimulusi prodnced ed by the falts to the fibres ofthe partftomach, had begun a certain action there, which had forward and continued after the falts gone felves had been thrown up. It is the fane themdeterminations, ifonce they have been forined, in, and that a peculiar action has been in the veffels 5 though the momentum produced and bulk,ofthe circulating mals, may beafterwards N diminifhed; --- Page 208 --- 1,8 TREATMENT OF THE [Chap. II. diminifhed, and the danger of the determination perhaps leffened, yet fome of its peculiar effeets will go forward; and be at times hazardous. So that prevention, would feem a more fecure ground of practice 5 and bloodletting appears to me, to be the chief and beft means of effecting it. I truft it has appeared from the above reafoning, that it is effential to perform blood-letting very early ; and as liberally as the circumftances of the patient will admit. It will appear alfo, that if the action of the veffels is not dimini(hed, after the firft blood-letting, that it will be neceffary'to repeat it; till that effect is really produced. Much of the future events of the difeafe muft depend lon an carlyblod-leting.- It is to be obferved, that this doctrine, more efpecially applies to the cafe of ftrangers, newly arrived; and poffefling like the Englifh, the full, irritable, plethoric habit, on which the Remittent eftablifhes its conquefts. It is in fuch habits, that determinations, are apt to be produced. But they may occur in people, who have refided for a long time in the climate, whofe vigour. and ftrength have been diminifhed by perfpiration, and the relaxation, heat always induces. In thefe cafes, + blood- to the cafe of ftrangers, newly arrived; and poffefling like the Englifh, the full, irritable, plethoric habit, on which the Remittent eftablifhes its conquefts. It is in fuch habits, that determinations, are apt to be produced. But they may occur in people, who have refided for a long time in the climate, whofe vigour. and ftrength have been diminifhed by perfpiration, and the relaxation, heat always induces. In thefe cafes, + blood- --- Page 209 --- FEVER OF ST. DOMINGO. Seet. IV.] with the blood-letting cannot be employed fame freedom. Iomitted in my plan of tréatment to mention the fkin.-V Whenever we are able to Friction on the fupply of blood induce aétion in the veffels, to that to them is increafed, or a determination In this fet of veffels takes place. particular which by view Friétion was recommended, action the having a chance of exciting into force of veffels of the fkin, would divert the circulation to the furface of the body. the that the determiFor it has been obferved, towards the internal nations are apt to happen divert the Friction therefore may organs. the fpa(m, which circulation to the farface, thus removed, commonly takes place, may be to important organs and the determinations powder was preprevented. The James's often feen. fcribed alfo in this view, as I have calomel on the fkin; whilit the it operate and removed feculent matcleared the bowels prejudicial to ter, which might prove highly the fyftem. and powders are - Both the calomel James's conduce to alteratives, and may powerful ftate of the body; though change the given I am N 2 --- Page 210 --- TREATMENT OF THE [Chap.II. Iam not clear, that fimnaller dofes of calomel, would not fucceed better, than large ones, as thefe become purgative. And purgatives certainly muit in fome degree favour detérminations.. The action of the veffels in the inteftines once excited, folicits a greater flow. of blood towards them; and purgatives rate by producing this action. Whether ope- they compenfate for this by removing, what would prove highly ftimulant and dangerous, in the inteftines, may be doubtful, as frequent injections might effect this end. Purgatives appear to me a dubious remedy; they certainly irritate, although they produce evacuation, yet in this way, they may contribute to diminith the bulk and momentun of the circulating mafs. : In Dr. Rusa's practice confiderable ftrefs is laid on their carrying the calomel brifkly through, and he feems to think that it contributed to the good effects of it, to be thus hurried through the inteltines. To his authority, I pay great deference; but I cannot clearly conceive how this method could contribute to the good effects of calomel. I have already, pretty frecly expreffed my opinion of its ufe, as an alterative. Icomes contribute to diminith the bulk and momentun of the circulating mafs. : In Dr. Rusa's practice confiderable ftrefs is laid on their carrying the calomel brifkly through, and he feems to think that it contributed to the good effects of it, to be thus hurried through the inteltines. To his authority, I pay great deference; but I cannot clearly conceive how this method could contribute to the good effects of calomel. I have already, pretty frecly expreffed my opinion of its ufe, as an alterative. Icomes --- Page 211 --- Scct. IV.] FEVER OF ST. DOMINGO. I ccme now to fpeak of.the warm and cold bath, which I fo freely employed here I muft recur ; and fhortly to the doctrine of proximate caufes, and our general knowledge of fever. It has been we do not know, already faid, that precifely and definitely, the nature of proximate caufes, and therefore, that practice by indication; is often mere amufement, a fiction, by which we deceive ourfelves and our patient. Our of fever, in its intimate and knowledge of exifting; is not much neceffary mode Theories have rifen after more extenfive.- theories, and funk into oblivion 5 they are perufed by again the curious, as monuments of the diflicuity of the fubject; and the defeét of thefe knowledge. In circumftances, the phyfician, untutored by any rational inftructor, muft fearch out principles for himfelf; and try fome new path, by which he may prove more fuccefsful in his refearches. On thefe as I could not prefcribe by definite grounds, indica-, tion, in the Remittent, when the various means already enumerated, failed of fuccefs; I attempted to change at once the whole or exifting circumftances of the given, fo as to change the morbid fyftem; by thus phanomena ; and introducing a new order of things, N 3 have --- Page 212 --- TREATMENT OF THE [Chap. II. have a better chance of curing the difeafe. It is evident if the whole ftate of the body, undergoes a revolution ; that the morbid caufe, cannot in a new condition of the body, produce the fame phanomena as before. But it may be afked, whether I can afcertain, that the new order of circumftances will be lefs dangerons, than the former which have been banifhed by my praétice P To this I reply, that no new circumftances or change, can be more dangerous, than the ftate, we attempt to alter; and that the revolution in the fyftem affords fome chance, and therefore, that there is a preference due to it.- In cafes, where few efcape, and where certain fymptoms form prefages of death $ it is furely the duty of the phyfician to vary. his means, and not obftinately perfift in any one method, which has not been fuccefsful. Inflead of adhering to blood-letting or calomel, to bark, injections, diluents, or any one method, I took advantage of them all, and combined or feparated them, as occafion might require. From an attentive view of the difeafe and its fymptoms, I drew fome general conclufions, which had an influence on my pradice 3 but I was often placed in a fituafion, to abandon thefe conclufions, and attempt ift in any one method, which has not been fuccefsful. Inflead of adhering to blood-letting or calomel, to bark, injections, diluents, or any one method, I took advantage of them all, and combined or feparated them, as occafion might require. From an attentive view of the difeafe and its fymptoms, I drew fome general conclufions, which had an influence on my pradice 3 but I was often placed in a fituafion, to abandon thefe conclufions, and attempt --- Page 213 --- Seat. IV.] FEVER OF ST. DOMINGO. innovation. As the moft powerful tempt of a change in the given cirmeans effeéting cumftances, I ufed the cold bath. And I premifed the warm, in order to create a high degree of fenfibility, becaufe, without fenfibility, we have no bafis to act on ; nor can any change be actually produced. I had the fatisfaction to fee many cafes, in which I had reafon to congratulate myfelf on adopting and purfuing thefe opinions, and if even our fuccefs is confined to a few inftances, there will be good grounds ftill, for innovation. view I have now pretty fully explained my of the difeafe, and the grounds of my practice; and I am not without hope, if it ever is my lot to be again placcd, where it rages, that I fhould be more fuccefsful, than heretofore. It réquires a long experience to form accurate conclufions. I have now only to obferve, that, Iconfined the ufe of the bark to the convalefcent period, when it feemed to prevent acceflions, and to increafe the ftrength and appetite. A long 1 train of difeafes often followed the Remittent, all intimately blended with debility. Obftinate incurable diarrhoeas frequently appeared, which refifted any thing I could ever N 4 try. --- Page 214 --- 184 PRACTICAL REMARKS on the- [Chap. II. try. Malignant eruptions, ending often in foul ulcers, were fometimes the confequence of the fever ; aedematous fwellings, lofs of appetite, great languor and debility, often remained for a long time, in fpite of remedy." It was always my opinion, every that ftrength could not be recruited, in' fituations, produdtive of miafmata; and therefore, I uniformly recomiended, as ioon as the patient could bear it, a change of fituation and climate. The ftate of our garrifons, did not fonetin.csadn.it oft the abfence ofofficers, who ought to have had the benefits ofa Many change. languifhed away life, in this unfortunate im priicnment. It has been remarked, by many practitioners, that ulcers in the Weft Indies are much mnore obitinate than in Europe ; and I believe there has been ground for the obfervation. But I muft confels, that I have been furprifed, by the fuccefs I have feen, both in wounds and ulcers at St. Domingo. rations have been performed with more Ope- than European fucceis, by Meffrs. WARREN; MONTAGUF, and BUCKLE; and I have feen ulcers of the moft malignant afpeét cured, under the direétion of the fame tlemen. genHaving than in Europe ; and I believe there has been ground for the obfervation. But I muft confels, that I have been furprifed, by the fuccefs I have feen, both in wounds and ulcers at St. Domingo. rations have been performed with more Ope- than European fucceis, by Meffrs. WARREN; MONTAGUF, and BUCKLE; and I have feen ulcers of the moft malignant afpeét cured, under the direétion of the fame tlemen. genHaving --- Page 215 --- Sedt. IV.] FEVER OF ST. DOMINGO. 18; Having now finifhed, what I had to on the Remittent, and its fay, offera few words treatment, I fhall more, on the clafs to which I have réferred it. Dr. JACKSON, whom it is not fafe to differ, and for with authority I have the greateft whofe ders the Yellow Fever refpect, confias a diftinét difeafe, entirely different, from the Endemic Remittent $ and for this apinion he offers the following reafons: <6 In our enquiries into the hiftory of the Yellow Fever JACKSON) fome circumftances (fays Dr. feives to our obfervation, which prefent themlittle curious. It has are not a never been that a negroe, immediately from the obferved, coaft Africa, has been attacked with this of neither have Creoles, who have lived difeafc; ftantly in their native conknown to fuffer from country, ever been it; yet Creoles or Africans, who have travelled to higher latitudes of Europe, or the America, are not by means exempted from it; when any to the iflands of the Weft Indies. they return males particularly, fuffer from it, Europcans, foon after their arrival in tropical climates; the natives of Europe, have yet after year or two in thofe hot remained for a after they have climates, elpecially experienced the ordinary endemic --- Page 216 --- PRACTICAL REMARKS on the [Chap. II. demic of the Yellow country ; the appearance of the Fever, is obferved to be occurrence.; but befides, only a rare feldom difcovers that this difeafe who have lived itfelf, among thofe people, pical any length of time in a' trocountry ; it has likewife been known to attack the fame fcarcely ever unlefs accidentally after his perfon twice, colder region. The return from a contrary, does not ceafe Remitting Fever on the have refided, the to attack fuch as in thofe greateft part of their life, climates, or who have the moft regular and lived, after fact, which feems abftemious manner ; a to prove, that there actually exifts fome effential difference, the two difeafes, or which fhows between the revolution of at leaft that the a feafon or two deftroys in European conftitution, a certain or difpofition for the one difeafe, aptitude ftill retains for the which it which other."-The above facts, are ftrictly true, do not by weaken my any means, difference conclufions, or conftitute any real in the difeafe; on the they feem to ftrengthen contrary, cans and Creoles, live my doctrine. Afrithey do not poffefs that chiefly on vegetables; on which conftitution or habit Iallege the Remittent its conquefts. eftablifhes They have not the inflammatory , aptitude ftill retains for the which it which other."-The above facts, are ftrictly true, do not by weaken my any means, difference conclufions, or conftitute any real in the difeafe; on the they feem to ftrengthen contrary, cans and Creoles, live my doctrine. Afrithey do not poffefs that chiefly on vegetables; on which conftitution or habit Iallege the Remittent its conquefts. eftablifhes They have not the inflammatory --- Page 217 --- FEVER OF ST. DOMINGO: Seêt. IV.] which the feplethoric fulnefs on matory acceffion of the fever feem to deverity and travel to Europe, or pend; but when they they do acthe higher latitudes of America, in the this conftitution, by a change quire doing what Eumanner of their living; by. livand Americans do; in fhort, by ropeans in the fame manner. They are then, on ing liable to the fever; their return from Europe, form. But Atill and fometimes to its worft the difeafe is lefs violent in general, among and Creoles, than among Euthe Negroes Becaufe in their haropeans or Americans. diathefis, does not bits, the inflammatory After the natives exift in the fame dégree. have remained, as Dr. JACKSON of Europe in thofe hot climates; ftates, one or two years, the ufual endeefpecially after undergoing is obferved to be a mic; the Yellow Fever the conftirare occurrence. That is, after a refidence of one or two years, tution, by mild difeafe, lofes the and by undergoing a fucceedinflammatory difpofition 5 then, any attack does not proceed fo far, as to ining which I have noted, as duce the yellownefs, and the worft marking a dangerous gradation, of the Remittent. All the fecurity, ftage which --- Page 218 --- 288 PRACTICAL REMARKS on the which [Chap. I, people derive from a long a tropical country, arifes from refidence in diminution of the the gradual inflammatory habit, which chiefly fcems to produce the worft fymptoms of the Remittent. ftages and fame reafons, feldom The fever, for the is returns twice; but this only a very general obfervation, for ever the plethoric ftate is produced wherewho have refided for in thofe, years in thefe, tries; the fever is apt to return with counviolence. Of this I have feen fatal ftances. Captain many inL, of the 82d ment, died of the fecond attack regitance of twelve months at the diffrom the which he had happily firft, from recovered. R- died after he had Captain at St. Domingo, Refidence refidedtwenty months the chance of. exiftence only improves by diminifhing the infammatory diathefis. 66 The on the contrary, (fays Remitting fever ceafe to attack thofe Dr.JACKSON) who does not years in the climate, and have reiided for abftemious lived in the moft manner; ; and hence, there be a difference between the muft Yellow Fever.", Now Endemic and all this amounts fimply to this, that reafoning mittent attacks thofe, who though the Reinay have refided for hing the infammatory diathefis. 66 The on the contrary, (fays Remitting fever ceafe to attack thofe Dr.JACKSON) who does not years in the climate, and have reiided for abftemious lived in the moft manner; ; and hence, there be a difference between the muft Yellow Fever.", Now Endemic and all this amounts fimply to this, that reafoning mittent attacks thofe, who though the Reinay have refided for --- Page 219 --- Scô. IV.j FEVER OF ST. DOMINGO. for fome time in a tropical does not commonly country; yet it proceed to that violent ultimate ftage of danger, the yellownefe. Bea caufe the inflammatory diathefis has been deftroyed by the relaxing powers of heat, and perfpiration. But theyare not wholly exempt ed, they are only fubjedted to a milder form of difeafe, from the antecedent of the conftitution. circumftances, Dr-JACKSON has ftated the facts with his ufual we differ in our conclufions corrednels; but 5 to his candour, I moft willingly fubmit my inferences. With refpect to the variety of forms into which the Remittent is divided, Icannot better than ufe the words of Dr. do He has defcribed in the JACKSON. following all I have ever feen, viz. 66 A quotation cc difeafe, in which figns of fpecies of 66 evident at a putrefaction, are very early ftage; which 66 nerally rapid in its courfe, and which is gesc ally terminates in black ufuS6 lownefs feldom vomiting. Yelor never fails to make its appearance, in the prefent sc perhaps it is only this inftance; and form, which €6 ftricly fpeaking can be called the Yellow Fever. I 66 Secondly, --- Page 220 --- Igo PRACTICAL REMARKS 01 the [Chap.II, Secondly, into a form which either has no remiflions, or remiflions which 66 perceptible; in which are fearcely figns of 66 fections are more obvious, than nervous af6c putrefcency, and in which fymptoms of 66 black yellownefs and vomiting are rare occurrences. 66 another form in which Into e and remiflions regular paroxyfms cannot be 66 which there traced; but in are marks of C6 and violent irritation, appearances, of 66 in the earlier inflammatory diathefis ftage, which C6 a fhort continuance give way after to <6 figns of debility and putrefcency; which 66 frequently fucceeds, or even yellownefs 6c. fo much dreaded fometimes the vomiting of matter 66 dark colour. The difeafe of a which I have / divided in the above manner, in three €6 ftinét forms, difappears to be in ce and the fame. The difference of reality one ce toms the fympprobably arifes, from very trivial or very accidental caufes; it is a ce matter of great dificulty to difcriminate thofe <6 which are effential and figns, neceffary to its exiftence. It is in fome €e degree. peculiar to ftrangers from colder regions, foon 66 their arrival in the Weft after E6 Indies, and may generally be diftinguithed from the remit66 ting reality one ce toms the fympprobably arifes, from very trivial or very accidental caufes; it is a ce matter of great dificulty to difcriminate thofe <6 which are effential and figns, neceffary to its exiftence. It is in fome €e degree. peculiar to ftrangers from colder regions, foon 66 their arrival in the Weft after E6 Indies, and may generally be diftinguithed from the remit66 ting --- Page 221 --- Sedt. IV.] FEVER OF ST. DOMINGO, 66 ting endemic of the county, not only by the 66 obicurenefs, or total want of paroxylms and 66 remiflions, but likewife by a certain expref66 fion of the cye and countenance, with fome66 tbing unufually difagreeable, in the feelings 66 of which words convey only an imperfect 46 idea." --- Page 222 --- $92 REMITTENTOF ST.DOMINGO: [Chap.III. CHAPTER III. SECT. I. REMITTENT OF ST. DOMINGO. Means of Presentin-Changes in the Sytem from Hat-Praparatiue Courfe for a Hot Climate. HAVING finithed, all I had to fay, on the Remittent of St. Domingo, I proceed to a very important fubject, the means of prevention. This will neceffarily include fome preparation for the climate, previous to landing; with the moft likely means of avoiding difeafe, after the troops difembark; to which fome Obfervations will be added on Diet, Situation, and Exercife. Numerous directions have already been given in various books for the conduét of troops --- Page 223 --- Seét. I.] MEANS OF PREVENTION. troops on board thip; the beft and moft concife, that I have met with are contained in pamphlet written by Mr. STUART, a in the Eaft India Company's furgeon drèffed to the Court of fervice, and adtherefore Direétors. I fhall 1 not enter into any minute details on this fubject; but obferve, that if my remark be correct, that the inflaminatory diathefis,in conftitution, creates any danger, our at fea, muft be direéted to diminifh preparation this dency. The great benefits of tengood air, and drynefs, are known to cleanlinefs, who has paffed any time on board evéry one effeêts of thip. The paffing from a cold climate into a warm one, are fometimes very fuddenly felt. Head-ach, naufea, an increafe in the and ftrength of the celerity lious pulfe, a difcharge of bimatter ; argue fome in ftate of the folids and derangement the fluids. The effeats of heat are produced in the general body. The folids and fluids fuffer human but not apparently in the fame expanfion, the fluids fcem to be expanded proportion; before rigid fibres of the folids the this may be inferred from fufficiently yield; which often the hainorrhage, happens from the nofe, from the feverifhnefs and tenfion of the pulfe, from the fcanty perfpiration, which occurs on our O entry inte angement the fluids. The effeats of heat are produced in the general body. The folids and fluids fuffer human but not apparently in the fame expanfion, the fluids fcem to be expanded proportion; before rigid fibres of the folids the this may be inferred from fufficiently yield; which often the hainorrhage, happens from the nofe, from the feverifhnefs and tenfion of the pulfe, from the fcanty perfpiration, which occurs on our O entry inte --- Page 224 --- 194 REMITTENT OF ST.DOMINGO: [Chap. .III, into warm climates. Thefe would feem to argue, that the fluids fuffering a fudden expanfion, burft the barrict of the blood-veffels, before they had time to accommodate themfclves, to the new bulk of their contents. Heat too, renders all the veffels more irritable, and appears to communicate a fimulus to the whole fyftem. Hence the fecretions in general are increafed, except fuch as mutually the place of each other; as the perfpiration, fupply and difcharge of urine are known to do. Perfpiration relieves the fyftem in two ways, firft by diminihing the abfolute bulk of the mafs of fluids, and thus accommodating them to the folids; and fecondly, by conduéting off the exceis of pofitive heat, in the procefs of evaporation. Thefe objects are of the utmoft confequence in the animal ceconomy. Our great aim then muft be to put the body in a condition, on our approach to a warm climate, not to fuffer from the unavoidable expanfion and change that muft go forward. This is to be effected by diminifhing the fluids, and lefening the irritability of the fyftem. On $ our getting into the warm latitudes, before the heat becomes intenfe ; we muft begin our preventive means. All thofe who are vigorous, plethoric, or irritable in their confitu- % tions, --- Page 225 --- Sech.I.] MEANS OF PREVENTION. tions, ought to be bled, in proportion to their frength; it is impoffible to lay down rules. For this purpofe, the precife of war, ought to lay to; that tranfports, the motion or fhips ofthe thip might not create prefent or future inconvenience to thofe who are bled. After this general blood-letting, a dofe of falts be adminiftered to all thofe, in whom ought the to ration was performed. They fhould be after- opewards, every other day made to plunge in the falt water, for which purpofe, large tubs might be placed on the forecaftle. This would cleanfe the fkin, and preferve the per tone of the veffels from profudden a relaxation. The undergoing too time troops at the fame ought to be put on a lowér diet. The quantity of falt provifion muft be leffened, and if they have been hitherto, accuftomed ardent fpirits, they ought now to leave them to entirely off; and to fubftitute the lefs cious beverage of fpruce beer, perniand water. But thefe porter, or wine the firft drinks ought to be of board quality, and approved of, by a mixed of military and medical officers. Unfortunately the liberal fupplies of ment to the army, fall too governcommiffaries and frequently a prey to ficers and contractors ; whilft the offoldiers, are robbed of their juftalD 2 lowances. them to entirely off; and to fubftitute the lefs cious beverage of fpruce beer, perniand water. But thefe porter, or wine the firft drinks ought to be of board quality, and approved of, by a mixed of military and medical officers. Unfortunately the liberal fupplies of ment to the army, fall too governcommiffaries and frequently a prey to ficers and contractors ; whilft the offoldiers, are robbed of their juftalD 2 lowances. --- Page 226 --- 196 REMITTENT OF ST.DOMINGO:TCHP III, lowances. Thofe who can live on a more liberal fcale, and can command vegetables freth animal food, and ought to diminifh tbe quantity of the Jatter, as well as their former quantity of wine. For though the wafte perfpiration requires, that the by mafs be recruited, yet it is not circulating the whole of this neceffary, that fapply fhould be in wine. The great bafis of all our drinks fhould be water, blended with fuch portions of other nourifhing fluids, as will not permit it to weaken too much, which perhaps it were it not for this addition. might do, Before the troops are landed the fame means already recommended ought again to be repeated; fo that the inflammatory diathefis would in a great meafure be fubdued. Ardent fpirits though they create a ftrength and excitement, temporary ftrength yet difipate the more than any other means. The languor and debility of a debauch laft much longer than the joyous moments which duced them. In this manner by profrequent titions, the animal repepowers are deftroyed beyond recovery; and many men, formed to delight fociety, become humiliating monuments of debauchery. The ftimuli of ardent fpirits, wine, --- Page 227 --- MEANS OF PREVENTION. Sea. I.] and animal food, exhauft the fyftem wine, others, and wafte its excitamore than any Men capable of great bility more completely. always, been fober abexertions have almoft STEWART, feldom ftemious men. Walking in wine, yet he tafted animal food, or indulged of country, walked over an aftonithing extent and with without hurting his conftitution; found. than is commonly more perfeverance who follows the fame plan, Dr. JACKSON, abftemious life, gives; and has always led an proofs of vigour, in his own perfon, remarkable now paft under this regimen; and though and more of age, is more active, forty years fatigue, than moft of capable of undergoing At Port-aumen of twenty. our young feldom mounted a horfe, and yet Prince he barrack, every regimental he vifited every ward in the general hofhofpital, and every And he did fometimes twice a day. pital, in the evening. Indepennot feem fatigued inftances of the benedent of thefe direêt life, we remark fits of a moderate abftemious climates in general, that the natives of warm adopt this unleis corrupted by Europeans, moft of the plan of abftinence. Among oflife is enforced Eaftern nations, this fobriety Their wife by the principles of their religion. legiflators, O 3 hofpital, and every And he did fometimes twice a day. pital, in the evening. Indepennot feem fatigued inftances of the benedent of thefe direêt life, we remark fits of a moderate abftemious climates in general, that the natives of warm adopt this unleis corrupted by Europeans, moft of the plan of abftinence. Among oflife is enforced Eaftern nations, this fobriety Their wife by the principles of their religion. legiflators, O 3 --- Page 228 --- 198 REMITTENT OF ST.DOMINGO:[ [Chap.III. legiflators, enfured their obedience by facred ties; by which they performed duties effential to their exiftence and happinefs; with more pleafure and fecurity. The Mahometans, though they do not abfolutely decline the pleafures of wine, referve the full enjoyment of it to their celeftial manfions. The Gentoos, find a fuflicient reward on earth, and praétife. moderation without a bribe. Temperance, like other virtues, is its own reward. But whilft I recommend temperance and moderation, I do not mean to infinuate, that we fhould wholly abftain from wine or animal food; on this fubject I thall be more explicit in its place. It requires prudence and care to. relinquith habits to which we have been long enured. It muft be done by flow and cautious degrecs, or we run a great rifque in the attempt to improve. It would be rafh to reduce a man, accuftomed to drink a bottle of wine after dinner, to two glaffes; fuch a reduétion might be really dangerous. Nature, and the example of the natives of warm climates, would feem to point out, that the fame diet which is neceflary in cold countries, is not fuitable to tropical climates, Nature --- Page 229 --- MEANS OF PREVENTION. Sca.I.] in the tropical climate, the Nature exhibits, and debilitated, and human fyftem, relaxed which without the fame powers and vigour The mark the robuft inhabitant of Europe. this of the natives, founded on example teaches a mode of living prodifference, of their animal to the vigour portioned this the rule of our diet, powers. Making to alter our it would be certainly proper into the warmer manner of living, on getting effeét of heat to expand latitudes. Ifit be the and by fuch change to debilitate and relax, it muft affect every part of the animal fibre; diminich the vigour of every the fyftem, and the living body. Aorgan, which compofes the ftomach muft fecl mong the other organs, and in fact we find its this general influence; for animal diminifhed; the appetite powers and when the ftomach hapfood is languid, thing that requires to be full of any pens fubdue it, there is,a remarkable energy to and other fymptoms of oppreffion induced; of the food muft be dyfpeplia. The nature of the ftomach. proportioned to the vigour muft conclude, that If this is a true axiom, we weakened and relaxed, as the ftomach becomes of the body; in common with other organs with fuch nourithwe ought to fupply it only ment O 4 omach hapfood is languid, thing that requires to be full of any pens fubdue it, there is,a remarkable energy to and other fymptoms of oppreffion induced; of the food muft be dyfpeplia. The nature of the ftomach. proportioned to the vigour muft conclude, that If this is a true axiom, we weakened and relaxed, as the ftomach becomes of the body; in common with other organs with fuch nourithwe ought to fupply it only ment O 4 --- Page 230 --- 200 REMITTENT OF ST.DOMINGO:CHN III. ment as it can readily manage and fubdue. Animal food in any large proportion, requires confiderable vigour in the ftomach to digeft and fubdue it. The proportion ofit which enters diet in Europe, fhould therefore be diminifhed in a tropical climate; and a ference given to vegetables. Light foups to me Em well calculated for the powers the ftomach retains; they do not require any great vigour to fubdue them, and appear with little change to be fit for immediate affimilation. TheFrench have adopted this mode of and are more healthy than we are. living, remarkable for their light They are foups and wines, and the large portions ofbread, and vegetables. which compofe their diet; all their plans and methods oflife are diredtly calculated to diminifh the inflammatory conftitution on which the Remittent makes its moft tack. dangerous atBut, independent of the eafe with which digeftion is performed, and the tion eftablifhed by this method, between propor- the powers of the ftomach and the refiftance of the food; it poffeffes another that it gradually lowers the habit greatadvantage; to a fecure and lefs hazardous ftandard. For fhould the Remittent make its attack, it finds the habit in a fituation to make a proper refiftance. Thefe --- Page 231 --- Scat. L] MEANS OF PREVENTION. Thefe remarks apply to the Weft Indies in general, but more efpecially where Remittents prevail: It belongs to this fection to remark, that much depends on the period of arrival in the Weft Indies ; but this is difficult to range, with any certainty, the attempt arbe made, but the elements controul may our arrangements. When however Government attend to a certain feafon, the troops for Weft can India fervice thould be embarked in ber. They will then, in all Septemin November when the probability arrive healthy period commences,andrhey have before them four months of a milder temperature, during which can be feafoned without they danger. This is the only part of the year for aétivity or exertion it is the only time in which ; European foldiers can be ufeful. They may be exercifed with fafety and trained to fatigue; It would therefore in every view be a defireable embarking Wett India period for. troops. This was made in 1795 from-this attempt event proved highly difaftrous country, but the and However fuch a boifterous feafon dangerous. common is not a occurrence, and we ftill for better fuccefs. may hope aétivity or exertion it is the only time in which ; European foldiers can be ufeful. They may be exercifed with fafety and trained to fatigue; It would therefore in every view be a defireable embarking Wett India period for. troops. This was made in 1795 from-this attempt event proved highly difaftrous country, but the and However fuch a boifterous feafon dangerous. common is not a occurrence, and we ftill for better fuccefs. may hope --- Page 232 --- 202 REMITTENT OF ST.DOMINGO: [Chap.11f, SECT. II. - Metbod of treating Troups after landingSituations to be cbofèn for tbeir Refidence Manner ef Exercjfe rsmmemidl-Dgirs Pofs examined. HAVING made thefe general remarks on Diet, which, fo far as the rules can be complicd with, are applicable at fea; ; I1 fhall now' fappofe the troops difembarked. The marks which will be offered rewill on this fubject, apply in general to the Weft Indies I fhall afterwards ; point out more what applies to the ifland of St. particularly, Domingo. When troops are landed, the firft of the officers attention, fhould be to fècure object for them dry and comfortable quarters ; and to prevent as much as poflible, with extraordinary Aridtnefs, their having intercourfe with the troops already in garrifon. The effeêts this intercourfe are, commonly, riot, of ance, and drunkennefs. Inftead of intemperthem to run about the freets, and allowing themfelves with novelty fatigue reftrained 5 they ought to be' from any unneceffary exercife, with the --- Page 233 --- TREATMENT OF TROOPS. Sea.II-] caution. The moft pofitive the moft vigilant muft be iffued, and, ftrict orders on this head, of confineand enforced. During this period which ought to laft two or three days, ment, fhould all have a dofe of cooling phylic, they foluble tartar and fuch as falts and manna 5 jalap; with 1 a variety of other preparations to be fuitable to-t the purpofe. They ought food. with very little animal fed on foups, forbidden. All ardent fpirits to be abfolutely this preparatory regimen, After undergoing taken out to. exercife in the they may be The troops then, morning, with fome fafety. be to the following day ought to marched, on fituation, well Theltered a known healthy winds, lofty, and dry. This from unfriendly for it is removal never fhould be neglected; that the miproved, by accurate obfervation, afmata, which produce the Remittent, generequire ten or fifteen days to produce rally more accurately fpeaking retheir effeét '; or of that duration, quire an expofure to them, and yields to before the body is faturated their influencé. This points out an abfolute the fituation of the neceffity for changing and troops, as foon as pofible, after landing, or themfelves. For all the places refrefhing in the Weft Indies, where troops are towns commonly which produce the Remittent, generequire ten or fifteen days to produce rally more accurately fpeaking retheir effeét '; or of that duration, quire an expofure to them, and yields to before the body is faturated their influencé. This points out an abfolute the fituation of the neceffity for changing and troops, as foon as pofible, after landing, or themfelves. For all the places refrefhing in the Weft Indies, where troops are towns commonly --- Page 234 --- 204 REMITTENT OF ST. DOMINGO: commonly landed, have been [Chap.In, built > purpofes of commerce, with for the deration of their very little confihealthfulnefs. general on low grounds, They are in being fituated at the foot of and thefe grounds are fomewhat high mountains, fituations for marfhy, and therefore not fit Jamaica forms troops. To this Port Royal in dry foil, and an exception, being a fandy reckoned in that ifland healthy 5 though not in the fame very. Stoney Hill barracks, degree as tered, and an clevated, well theldry fituation. When the probable, that troops are thus removed, it is they will not fuffer, in great degree, from the Endemic of any try. For allowing, that the the counthem, the moment miafmata act upon probable, they land, it is not imas they require a certain length of expofure, to produce their effeét, that the troops may efcape after three days delay. But granting that a certain portion of them is admitted; the change into another with a purer air, may prevent the ill climate, effeéts which might otherwife refult. The mata do not feem to miaf pox; and from operate like the fmallthe fmalleft conceivable ticle, produce their pareffcôts, as decidedly, as if a great --- Page 235 --- Sedt. II.] TREATMENT OF TROOPS. a great quantity was employed. For the violence of Remittents, which we fuppofe, arife from miafmata; feems to the quantity of thém, depend, On applied to the body, where the attack takes place. Thus, at Port-au-Princc.whers, there are large marfhes, the fever attacks ftrangers much fooner, and procéeds with more violence, than at where there is not the fame nurfery for Jeremie; ; miafmata as at Port-au-Prince. And at Bizoton, which rifes from the middle of a marfh, the Remittent attacks after a fhorter than at Port-au-Prince; refidence, becaufe, there are larger portions of miafinata produced and plied to the fyftem. It is therefore apthat a certain quantity of miafmata is probable necef. fary to produce the Remittent, and a certain length of expofure requifite to faturate the body. Thefe are fufficient reafons, for moving new-landed retroops, to well known healthy fituations. When they are their diet fhould be as much as removed; up with wholefome poflible made vegetables; and great care taken, that no excefs be committed with fruits and acids, which bring on troublefome arrhcea and dangerous cholic, dinot to be allowed; but Spirits ought is fpruce beer, or what perhaps preferable, good porter may be given the body. Thefe are fufficient reafons, for moving new-landed retroops, to well known healthy fituations. When they are their diet fhould be as much as removed; up with wholefome poflible made vegetables; and great care taken, that no excefs be committed with fruits and acids, which bring on troublefome arrhcea and dangerous cholic, dinot to be allowed; but Spirits ought is fpruce beer, or what perhaps preferable, good porter may be given --- Page 236 --- 206 REMITTENT OF ST.DOMINGO: [Chap.IIf. given without hazard. Each foldier might confume three pints a day; with advantage. If fpirits are ever granted, water fhould be added, to dilute them ; perhaps half a wine glafs of good brandy undiluted, might be allowed after dinner. Soldiers cannot believe their exiftence fecure without ardent fpirits. And the officer may find it neceffary fometimes to concede fomething cven to their caprice. I now fuppofe the troops in healthy, well fituated cantonments, where they are to be trained for the fervice of a hot climate, with all the fecurity againft the invafion of the Remittent, that they can well poffefs. If they are in the neighbourhood of running water, or any convenient fituation for bathing, I would ftrongly recommend the cold bath, every morning, or every other morning. Unlefs the firgeon of the dorps, points out unfit fubjects for this healthy exercife, they fhould be all ordered to bathe. An officer and the fargeon ought to fuperintend this operation, that no riot or play may take place, which might keep them too long naked, or in the water. When they have plunged and wafhed themfelves, they are to be rubbed dry with a coarfe towel, with which each of them ought --- Page 237 --- Sea, II.] TREATMENT OF TROOPS. ought to be furnifhed; and then retiré to their barracks with a brifk pace. They will fecl themfelves light, invigorated, and cheerful. They refift in this manner, the relaxing effeéts of heat, they acquire ftrength without the inflammatory habit, and they become fit for fervice, without fearing difeafe.- This, as THOMPSON has expreffed it, is the pureft exercife of health; the kind refrefher of the fummer heats. And the fame adds, € that the Roman arms, which fubdued poet the world, firft learned to fubdue the wave.' At the mefs of foldiers an officer ways to be prefent, to regulate their ought aland feesthat noimproprietyis conduét, is committed. This particularly neceffary in the Weft Indies, where all the caution and vigilance is hardly fufficient, to the employed prevent men from getting a poifonous kind of rum, which deftroys numbers. I faw at St. ftriking example of the benefit of Domingo this a tion, in the royal, or firft regiment. Colonel attenGreen, with the moft laudable and indefatigable zeal, was never abfent from the mefs of his foldiers ; he regulated, ordered, and Conduéted every thing. The cffects of thismanagement were aftonifhing; the royal were the moft orderly, the neateft, and beft looking men getting a poifonous kind of rum, which deftroys numbers. I faw at St. ftriking example of the benefit of Domingo this a tion, in the royal, or firft regiment. Colonel attenGreen, with the moft laudable and indefatigable zeal, was never abfent from the mefs of his foldiers ; he regulated, ordered, and Conduéted every thing. The cffects of thismanagement were aftonifhing; the royal were the moft orderly, the neateft, and beft looking men --- Page 238 --- 208 REMITTENT OF ST.DOMINGO: [Chap.III, men in the garrifon; their deportment and appearance diftinguifhed them at a and other regiments looked diftance; up to them as objeéts of imitation. This fort of attention in officers, greatly improves the military ardour of foldiers, they feel their own importance, they are fenfible of the kindnefs thewn them by their fuperiors; and they will not difgrace their friendfhip. At all events this vigilance muft prevent riot and drinking, or the finuggling of rum into the mefs; for which the moft ingenious ftratagems are contrived. After regulating fituation and diet, the next thing of importance, is military exercife; which is to complete the foldier for the pofes of his profeffion. It has been a genéral purpractice among officers, and from the beft motives, to prevent the men as much as poffible, from running about in the fun, or being evén expofed to it for any time. This reftriétion is certainly very proper for the firft few days after their arrival, but no longer. The foldiers who arrive in the Weft Indies are deftined tô ferve in a hot country. They muft,as fervice may require it, be expofed to the action of the fun for many hours ; and often for a whole day; --- Page 239 --- Sedt. II.] TREATMENT OF TROOPS, day; is it not abfurd then, not to initiate thefe men into a gradual tolerance of what at foine period they muft undergo ? Itis not from a dark chamber, we would bring a perfon, to fit him, to bear the fplendour of light, without hurting his eye. Nor would we train, in a heated apartment, a foldier for the cold of Nova Zembla. region Equally improper, is the method of chafing troops to their barracks, whenever they appear in the fun. The confequence is, that troops thus educated; in the cool fhade of their unfit for barracks, are rendered any fervice; in this retreat they languifh and fleep their time away, they acquire indolent habits, they become relaxed; and for want ofbetter amufement get drunk. When the fervice requires them to quit the fhade, and march into the field; they are of fatigue, the firft beam of the fun incapable them; like tender plants they thrink injures from the breeze, ficken and die. Nor is this furprifing; it is to them, a fudden change, plunge at once into fevere they being exertion; without gradually inured or trained to it; and they fuffer accordingly. It is that this prejudice fhould aftonifhing prévail, and be evén encouraged by medical men, as I have frequently feen. Ifindeed foldiers could fight, P with beam of the fun incapable them; like tender plants they thrink injures from the breeze, ficken and die. Nor is this furprifing; it is to them, a fudden change, plunge at once into fevere they being exertion; without gradually inured or trained to it; and they fuffer accordingly. It is that this prejudice fhould aftonifhing prévail, and be evén encouraged by medical men, as I have frequently feen. Ifindeed foldiers could fight, P with --- Page 240 --- 210 REMITTENT OF ST.DOMINGO:[ with umbrellas [Chap. III.E eclipfe, whilft over them, or: command an they were in the field, the: prefent method of training them, would be proper and. ufeful. But as not yet cffeminacy has corrupted, or miracles affifted our ar-t mies, we muft recur. to methods founded common fenfe, and common réafon. in! it, that gives the What is. fuperiority to black over ours in a warm climate ? Is it troops capability of not the without enduring the heat of the fun danger P-and ought it not to aim gradually to be our level P bring our own troops to their Nothing will do this but a gradual habit, which at laft fteels education ; ftitution, and fits it for the confeen at any exigency. I have Port-au-Prince, many men on fhort excurfions, affected drop down they had been by the heat/ If gradually inured, this not happen. I brought would fun's utmoft heat myfelf to bear the fenfation. without any difagreeable fhould be able My profeffion réquired, that I to go out at every time day in which I might be called ofthe ufed an umbrella, and I rode on; I never my afliftance all day, wherever was required without any inconvenience.. But, t-Iacquired this habit dually. Dr. JACKSONgrahabits, and acquired the fame walked: à daily in the fun, without fuffering --- Page 241 --- Sea.II.] TREATMENT OF TROOPS. 21I fuffering any injury.-With refpect to it is neceffary to form this habit of troops, the fun very gradually. Let them enduring exercife at five o'clock in the begin to continue this morning; and practice for two or three then come on, to half after five, to fix, days, or eight o'clock, prolonging their feven, field each day flay in the ; and making the hour progreffive, After a habit of performing their ercife at cight o'clock, let them be exgradually brought on to twelve in the forenoon, the warmeft period of the day; and at firft detained for fhort intervals, which wards be increafed to may afterthus any time. Troops will become highly ufeful; and in time be equally fit with the natives of the undergo any fatigue or fervice. I country to common appeal to fenfe, on this queftion, to the rience ofe every one who has attentively expeviewed troops on any expedition in a warm climate. It muft be évident, that it is them by proper to train degrees, to form and eftablifh a habit of bearing heat, to which the the fervice, muft nature of unavoidably expofe fome time or other. them, When at Madrafs, in India, I had an portunity of obferving, that the troops in that opP 2 country on this queftion, to the rience ofe every one who has attentively expeviewed troops on any expedition in a warm climate. It muft be évident, that it is them by proper to train degrees, to form and eftablifh a habit of bearing heat, to which the the fervice, muft nature of unavoidably expofe fome time or other. them, When at Madrafs, in India, I had an portunity of obferving, that the troops in that opP 2 country --- Page 242 --- 212 REMITTENT OF ST.DOMINGO:[ [Chap. III. country were generally exercifed, at an hour in the morning without early and that any variation; théy were fent back to their barracks with a fedulous care, to guard them from the fun. I underftood at the fame time, from number of officers; that on fervice, a thefe troops fuffered from the fun. many of had an opportunity of Having mentioning this fubject to the late Sir ARCHIBALD then governor ofthat CAMPEELL, with fettlement; he was ftruck fome obfervations which arofe in our converfation; and that excellent officer the plan of progreffive exercife, from adopted to a more advanced hour of the an carly day. At firft, troops will not bear a long period in the heat of the fun, but by degrees, they may be fo as to undergo long marches, without inured, convenience. This is any ina fubject of great importance 3 as a very different fyftem is at prefent carried on in the Weft Indies tem which unfits the foldier ; a fyffor and expofes him to new perils excrtion, which we might eafily 3 againft tention. guard, by a little at- - Iam fo convinced,on the proprictyofbringing up foldiers, to a gradual endurance of heat, that I am aftonifhed, it fhould nôt have been long fince --- Page 243 --- TREATMENT OF TROOPS. Scét. II.] but prejudices do not eafily give fince adopted; has from immemorial time way ; and the fun the European been reckoned unfriendly to conftitution. The reftriction is highly proper Itisa curious fact, proved almoft by at firft. thofe who arrive from Enigevery. one, that from the latter in land in a warm climate, or for endure the heat Or cold better, England ; than during any fubfequent the firft feafon, in one. This is a dangerous prepoffeffion, either cafe. It is difficult to explain, how the arifes. It would feem to me, to defenfation chicfly; that we conpend on this principle Weft ceive the heat of the Eaft or Indies, its real fandard. And the greatly beyond the cliinhabitants of warm regions imagine of to be much colder than they mates Europe, arrive under this really are. When people not find. impreffion in thefe climates, they.do cold with the degrees, the heat or correfpond brave had fixed,and therefore they imagination until the fervour of fancy has all caution, feel the heat or cold as abated, when they they really are. After the troops have been ftationed for a few weeks in healthy fituations, they might for a few days at a time to do be permitted duty P 3 be much colder than they mates Europe, arrive under this really are. When people not find. impreffion in thefe climates, they.do cold with the degrees, the heat or correfpond brave had fixed,and therefore they imagination until the fervour of fancy has all caution, feel the heat or cold as abated, when they they really are. After the troops have been ftationed for a few weeks in healthy fituations, they might for a few days at a time to do be permitted duty P 3 --- Page 244 --- 214 REMITTENT OF ST.DOMINGO: duty in lefs falubrious [Chap. III, again to their former places, and then, return thus become ftations. They would length refift the gradually habituated, and at The influence of the mialinata. want of fuch fituations at St. proved highly Domingo the injurious to our troops. When troops from Ireland arrived at the they were obliged to live for weeks Mole, the tranfports, where on board and made an infectious fever raged; great havoc amongft them. This would not have happened if they had landed and encamped, been on the ing hills, Or if there, had been neighbourto receive them ; the proper barracks numbers perifhed confequence was, that ; and that little army, which originally confifted of five thoufand very thoftly reduced to fifteen. hundred. men, was were no places prepared for tbe fick, There neceffaries. or their Military and medical ftores were landed.in: hafte, and ftrewed the ihores, like fragments of-a wreck. The exertions of the medical gentlemen. at this poft were extraordinary. 1 Mr. WEIR, - the of hofpitals, took infpector-general providing in the beft every poffibie means, of took the manner for the fick. He duty of phyfician, and fatigued himfelf in cvery department that prefence. Dr. JACKSON required his exerted his ufual u humanity: --- Page 245 --- TREATMENT OF TROOPS. Sea.IL.h and Drse MASTER, CLEGHORN; humanitys had their ample fhare of emand FELLOWS; Yet from y not feeking a more ployment.; fituation, the treops perifhed rapidly: healthy from Ireland an infecIn_fact, they imported fever, which, for a: fhort period, raged; tious of the endeniic of the ifland, independent a execution. In fuch circumftances, and didigreat of medical men proved of no the exertions wide amongft us, and.inevail; 3 terror fpread of death. Of fuch imcreafed the conquefts fituations. portance is it to chufe healthy CNL oeri 0t of the healthy pofts It.is now time to fpeak : which unforturately: are few at St. Domingo, deferibed. a It in number, and therefore eafily in the courfe may be the'lot of Britifh troops unfortunate of war, to land, again, in this Ifthis misfortune Ahould ever happen, ifland. as the nature ofthe let us take fuch precauitions will admit. J country; in its prefent fituation, is it to chufe healthy CNL oeri 0t of the healthy pofts It.is now time to fpeak : which unforturately: are few at St. Domingo, deferibed. a It in number, and therefore eafily in the courfe may be the'lot of Britifh troops unfortunate of war, to land, again, in this Ifthis misfortune Ahould ever happen, ifland. as the nature ofthe let us take fuch precauitions will admit. J country; in its prefent fituation, aot sprt 3 from its commodious harbour, is ct TheN Mole, where troops are firft generally the place ought to be made. in brought, but no- delay fituation. Such troops as are really nethis the defence of; the poft; muft be ceffary for the preparatory landed, and after undergoing P 4 regimen --- Page 246 --- a - 216 REMITTENT OF ST. DOMINGO: [Chap. III. regimen already mentioned, they are to encamp on the brows of the hills, beyond the town, in the manner which general WHYTE very judicioufly adopted. They are there lefs expofed to danger, and form a cordon of defence round the garrifon. It has been clearly proved, that lofty fituations very are not byanyr means the moft healthy in mar/hy countries; becaufe they are more expofed to ftreams ofmiafmata, from the veryeircumfanceof their elevation. We are therefore to chufe dry and well-fheltered fituations, efpecially againft the land winds. We are to take câre, that no marfhes of any extent are to windward of us 5 and that we have, if poffible, ftreams of running water in our neighbourhood. After landing at the Mole, what may be abfolutely neceffary for its defence-the reft ofthe troops, fhould proceed for Jeremie, a diftrict of the Grand Anfe; by far the moft healthy fituation in St. Domingo. It was to this place, that the convalefcent French, ufed to fly as to Montpelier, for health ; and generally fucceeded. The inhabitants and troops of this quarter, wear an European afpect, when compared with the fallow complexion of their neighbours. The country is dry and lofty, ftreams of --- Page 247 --- TREATMENT OF TROOPS. Seôt. II.] and rufh down from the mountains, of water and refrefhes theair. Here the fea breeze, cools to land then is the fituation, where we ought fervice of St. the bulk of our troops for the in' this After they have been Domingo. fituation for fome weeks, they may healthy or the Mole, and laft of be fent to St. Marc's, their refiBut during all to Port-au-Prince. ought not to be condence at Jéremie; they be fcattered over the fined to the town ; but for this which purmoft. healthy plantations, ufeful barracks. pofe, may be converted into object, cannot To this the French proprietors defence and federive from the troops as they. barracks at Jeremie were judicurity. The Colonel MURRAY's incioufly ereêted under to fend If it becomes neceffary fpeétion. Port-au-Prince;' they troops, to that fatal fpot, in town, ought not for any time to remain of mialmata. They which in fact is a nurfery of the ought to be encamped on the brows, in a which furround that town, mountains to Bifoton. This curve line from Tourgeot out by Dr. ofincampment, was pointed plan who travelled over the ground 3 but JACKSON, from fome frivolous obit was not adopted that the inhabitants jection. It was alleged, trufted or that of the town, could not be ; they , ought not for any time to remain of mialmata. They which in fact is a nurfery of the ought to be encamped on the brows, in a which furround that town, mountains to Bifoton. This curve line from Tourgeot out by Dr. ofincampment, was pointed plan who travelled over the ground 3 but JACKSON, from fome frivolous obit was not adopted that the inhabitants jection. It was alleged, trufted or that of the town, could not be ; they --- Page 248 --- 218 REMITTENT OF ST. DOMINGO: [Chap.III. they would lofe confidence and fly the town, This could not well have taken place, when Fort Royal, formed one point of the Semecircle and Biffoton the other, whilft the connedting line was a chain of pofts-however, the plan was not adopted. The greateft attention ought to. be paid, that troops are not placed, in fituations known to be unhealthy. The fpirits fink, and the operation of fear renders the accefs of difeafe more eafy and certain. To places remarkably unhealthy, as Port-au-Prince, the beft fcafoned troops ought to be fent; and placed in Fort Royal, which commands the town. fo very completely, that in cafe of commotion, its artillery might very foon reduce it to afhes. The duty in the town might be performed by our beft colonial troops, under. the. command of.honourable and well-tried officers, fuch as the baron Montalembert or Defource. The duty of Biffoton muft fall to them alfo, being the moft unhezlthy of all our pofts. The colonial troops would exift there, though it be certain death to ours. The Britith in this arrangement, are to occupy the brows and declivities of the mountains e ; dry and well fheltered pofts. They form a grand outline, and defend the town, at leaft much more effectually, --- Page 249 --- TREATMENT OF TROOPS. 219 Se&t. II.] included in its effeatually, than if they were would be thus removed, hofpitals. They of.difeafe, the miaffrom the great fource a country mata ; and they would occupy where they would find a purer atmofphere, profpeêts, and more healthy more chearful amufement.. Croix de Bouquet is found tolerably The French inhabitants, but it healthy, by the the few Britith who rehas proved fatal to fided there. a fpread over the plain of the The plantations barracks, Cul de Sac, form the worft pofible and fertile becaufe the whole of that wonderful where a conftant exhalafpot, is itfelf a marfh, forward; and the accommodations tionis going and foldiers are of the. worft for the officers from the devaftation oftheunhappy f defcription; to erafe every mo- / negroes, who.are willing and every trace of nument of human induftry, former labours. It is indeed melancholy, their thefe wide-extended ruins. to ride' among clegance, and Every where, marks of opulence, all now, levelled with the ground, commerce, the hands which affifted to rear by many of and proteét them. Our tionis going and foldiers are of the. worft for the officers from the devaftation oftheunhappy f defcription; to erafe every mo- / negroes, who.are willing and every trace of nument of human induftry, former labours. It is indeed melancholy, their thefe wide-extended ruins. to ride' among clegance, and Every where, marks of opulence, all now, levelled with the ground, commerce, the hands which affifted to rear by many of and proteét them. Our --- Page 250 --- A 220 REMITTENT OF ST. DOMINGO: [Chap. III. Our troops have alfo fuffered very much at L'Arcahaye, which formerly was reckoned a very healthy fituation. Whether it was, that LE POINT the French commandant, did not chufe any interference, from Englith officers, or that he really had no good fituation for. them or their troops ; it is certain that all the officers fent to that quarter made complaints of their treatment. This poft therefore fhould be chiefly occupied by colonials. St.Marc's, formerly prettyhealthy, has ed very fatal to our troops. Part of the ninety- provfixth regiment landed there, and were foon. exterminated to a man. But I believe an infeétious jail fever, had raged amongft them 5 ere they left the tranfports, and carried off great numbers after they landed. On a view of St. Marc's, it would appear to be advantageoufly fituated for health. It is fheltered on the land fide from the peftilential land winds, by very lofty mountains ; the foil on which the town is placed appears dry and fandy, the fkirts ofit are wafhed by the fea, which carries off many impurities, and the fea breeze, blows with little interruption. Yet after all, this place has been very unhealthy to the Britith troops. I think the opening of a ditch round the --- Page 251 --- TREATMENT OF TROOPS. Seat. II.] expofed a great furface for the town, which contributed to this unexhalation has greatly inhabitants themIndeed the healthfulnefs. remark, and feemed to date felves made this and fever, from of ficknefs, the commencement this period. when LEOGANE was alfo very unhealthy, fituated in a had of it ; it is we poffeffion Nor. were we much more formarthy plain. where it was hoped we tunate in Mirebalais, much better health. fhould. have enjoyed vifited this poft, he When Dr. JACKSON that the Briti(h troops ftrongly recommended, the they then fhould be moved from ground and in occupied, to a more healthy pofition, them ; but fact an order was given to move found means to the French commandant them till they all evade it, and detained in fome perifhed. He was engaged nearly of fupply; and the Britifh lucrative contraêts The 82d regiment cuftomers. were good Iever faw, was ftationed one of the fineft, which they were fent, as a in this quarter, to devaftation of Port-aurefuge from the of them had already Prince, where numbers that théy perifhed ; it is melancholy to relate, returned in a and here found no fanétuary, few in fome perifhed. He was engaged nearly of fupply; and the Britifh lucrative contraêts The 82d regiment cuftomers. were good Iever faw, was ftationed one of the fineft, which they were fent, as a in this quarter, to devaftation of Port-aurefuge from the of them had already Prince, where numbers that théy perifhed ; it is melancholy to relate, returned in a and here found no fanétuary, few --- Page 252 --- - 222 REMITTENT OF ST. DOMINGO: few months not [Chap.IIL. tember twenty men ftrong. In Sep1795, this regiment was Sir ADAM reviewed by WILLIAMSON, complete in all its officers,andmen; nine hundredand in September 1796, fiftyi itrong; for they had not fifty men fit duty, and in November, arrived au-Prince from at PortMirebalais, with hardly their complement of non-commiffioned This beautiful corps, in the (pace of lefs officers. a year, loft upwards of eight hundred than and twenty officers. Such is the men, devaftation of this climate. melancholy All our troops then, ought, if be landed at Jeremie, and poffible, to after there, a feafoning of fome weeks, undergoing diftributed in rotation they may. be firft to other pofts ; to the leaft deftructive, and going change, till they are able to do continuing a au-Prince. The duty at Portnature of fervice may OCcafionally oppofe thefe muft be guided arrangements, as we by cireumftances, and the pofition of our enemy. But where thefe rules can be obferved, I am convinced are of importance, and might be they and obferved without regulated benefit to the expence, and with real fervice. I omitted --- Page 253 --- OF TROOPS. 223 Sect. II.] : TREATMENT that the Grand Bois, 2 I omitted to mention, is recknot very diftant from Port-au-Prince, with oned by the inhabitants equally healthy Jeremie itfelf. To this place, troops newly be ordered. I confefs there are arrived difficulties might in the way of thefe arrangefome uncertain poffeffion of the ments from our ifland, and the neceffity of avoiding expence, which has already drained the in' 'a country well as the Britifh treafury 5 as proved e gravé of the Britith army. of this work, A Tremarked in a former part chief difficulty arofe in reftoring that a from the continual apEuropeans to health, of miafmata, and the relaxing powers plication heat itfelf. Once the patient is weak, we of fucceed in him ftrength. Lanfeldom giving in fpite of every guor and debility prevail, The cold bath, and the means we employ. maintain the patient ufe of bark, though they fclin ftatu quo, without,any progrefs, yet are dom fucceed completely ; becaufe they not conftantly applied, or uniformly powers whereas the powers of heat are conadting; and acting; ftantly and uniformly applied their effects then cannot be countérbalanced, by the aétion of temporary powers, which are fucceed in him ftrength. Lanfeldom giving in fpite of every guor and debility prevail, The cold bath, and the means we employ. maintain the patient ufe of bark, though they fclin ftatu quo, without,any progrefs, yet are dom fucceed completely ; becaufe they not conftantly applied, or uniformly powers whereas the powers of heat are conadting; and acting; ftantly and uniformly applied their effects then cannot be countérbalanced, by the aétion of temporary powers, which are --- Page 254 --- 224 REMITTENT OF ST. DOMINGO: are [Chap.IL, only prefent for a fhort period, and effeét changes of very fhort duration. The of climate, on the human action. the action of medicines, body is perpetual 3 The effeds of climate temporary and fhort. then, muft prevail, over the'aétion of medicines. always vinced of the truth of this Conexperience; I was doctrine, by fatal well-chofen always of opinion, that a fituation at Jeremie, for a convalefcent poft, would be of the lity. Here the emaciated greateft utiofficer and placed in a different climate, and foldier, by new fcenes, would be furrounded recovered. The invigorated and bute voyage itfelf would contrito this defirable end; the anxiety and novelty, would divert movement; from the mind brooding over misfortune, and thought a new and more give to The coolnefs of pleafing direétion. Jeremie, which an European climate, would approaches markably to contribute rerecovery. We are pleafed in finding ourfelves in fituations fimilar native to our country; our habits are foothed, and our conftitutions acknowledge a kindred pathy ; whilft our progrefs in fym. day delights us. From the firft ftrength every ever faw Jeremie, I was of moment I was a fituation opinion, that it highly calculated for a convalefcent --- Page 255 --- Seat. II.] TREATMENT OF TROOPS. valefcent hcfpital, and poft ; and that it 225, not only be itfelf guarded by might but alfo fend back to the other convalefcents, foned men, who having pofts feademic, and recovered, undergone the en-. fidence and would feel more confecurity. In this idea, I was joined by my friend Dr. WRIGHT, with whom I have often coincided in opinions; and we jointly gave in a medical SirADAM WILLIAMSON, paper to meafure. He was however recommending this turn to Europe, and did not preparing to rechufe to enter upon a plan, which might be more tive of expence, than he could forefee producperiod. The at that doned. plan was accordingly abanMr. WEIR has fince adopted the fame opinion, and partly converted into a convalefcent ftation. Dr. Jeremie who vifited this JACKSON, fent there all the quarter, intended to have convalefcents uf Port-auPrince; but though he recommended it ly, the fcheme was never warmThere were numerous fully adopted. veffels employed by government, at a vaft expence, which often lay for a confiderable time idie, that have thus been moft might ufefully, and employed, for the benefit of the beneficially Jeremie was a central troops. point, to which the Q convalefcents' who vifited this JACKSON, fent there all the quarter, intended to have convalefcents uf Port-auPrince; but though he recommended it ly, the fcheme was never warmThere were numerous fully adopted. veffels employed by government, at a vaft expence, which often lay for a confiderable time idie, that have thus been moft might ufefully, and employed, for the benefit of the beneficially Jeremie was a central troops. point, to which the Q convalefcents' --- Page 256 --- 226 REMITTENT OF ST.DOMINGO: [Chap.III. convalefcents of the Mole, St. Marc's, Larcahaye, and Port-au-Prince, might have bcen eafily fent, and from which they could again be returned with perfect facility. One of the government veffels, might have been fitted up as an hofpital thip, with an affiftant furgeon on board, and proper remedies, to convcy the convalefcents from the other pofts to Jeremic. This thip, when not actuaily On fervice, might occaiionally run to fea, with fick officers, and afford them a chance of, recovery, which they could not have on fhore. And if well armed, the might proteét trade, and be a terror to gun boats and privateers. Such a fcheme, though extremcly fimple, and necefiary, was not adopted, after all the recommendation it received. Medical officers can never enforce fchemes ofhealth; they may recommend, but cannot execute. Perhaps on thefe points, their authority is too limited; though an extenfion of it might interfere with that abfolute power, commanders muft pofiefs to enfure general'obedience. The expence could not be great, when we confider the price of every foidicr to government, before he is landed in that country. Many. might havec recovered at this poft, who languifhed --- Page 257 --- / TREATMENT OF TROOPS. : 227 Sed. II.] and conlanguithed life away; in the general where, valefcent hofpitals of Port-au-Prince; 5 and though they had good médical affiftance, much attendance as the nature of circumas at length to thefafances permitted : yielded climate. tal land perpetual action of the L a build104 Itis trué we had Vat Port-au-Prince, placed ing we called a Convalefcent Hofpital, part of confpicuoully, in the moft unhealthy Elevated beyond all fhelter, it ftood the town. land breeze that blew, and expofed to every miafmata, as they were arrefted the floating it blended with the air. In 11 this hofpital, could not be expeéted, that many recoveries would happen; ; but as the foldiers fent there, over the danger of the firft had in general got and. attack, they lingered for a longer period; the either died there, or returned again to The proportion of ufeful general hofpital. flender.. Indced, the gerecoveries, was very itfelf ftood in no promifing neral 1 hofpital and on the borders of a fituation, it was low, better (heltered marfh. But on the whole, a fituation than the convalefcent hofpital. on his arrival at Port-auDr. JACKSON the ftate ofthe hofPrince, furveyed minutely pitals, Q_2 , or returned again to The proportion of ufeful general hofpital. flender.. Indced, the gerecoveries, was very itfelf ftood in no promifing neral 1 hofpital and on the borders of a fituation, it was low, better (heltered marfh. But on the whole, a fituation than the convalefcent hofpital. on his arrival at Port-auDr. JACKSON the ftate ofthe hofPrince, furveyed minutely pitals, Q_2 --- Page 258 --- 228 REMITTENT OF ST. DOMINGO: : [Chap. III. pitals, and was fenfible of their naked fituation. He accordingly expofed thin curtains to be recommended loofe fufpended before all the galleries, and to contain within their the whole ward, in which the fick fhade, placed. This was of great ufe ; it were the bounds of each ward, enlarged by adding the lery, which before, the fick could not galfor the fun. It afforded them occupy change of place, and a cool retreat an agrecable ward, which the breath of fo from the rendered many fick, had hot, and which was made ftill more diftreffing from the groans and complaints of the dying. But it had another advantage, by poffefing a loofe texture, it-admitted the air pretty freely; and when the land winds blew. and were hot, they were rendered cool, by throwing water on the curtains. The hot winds are thus tempered in the Eaft and rendered pleafant and Indies, they would be otherwife refrefhing 5 when infufferable and dangerous. But befides thefe purpofes, the curtains might anfwer another ufe: They might very. important probably purify the atmo-. fphere, by arrefting the mialmata in their grefs, and thus anfwer the purpofe of natural profhelter. --- Page 259 --- HOSPITALS Sect. III.] SECT. III. 012 General and Reginental He/- Confderations Corps, unfit for their Occupiah-Hopital Medical Board recommended wvitb pationQyalifications ef Phyfilarge Armies-Tbe cians examined. IN this Seétion, I (hall confider fome which could not enter fo procircumftances, the difcuflion of the fubjects we perly into but which are intimately have been treating; them. And firft, with refpect conneéted with to General and Regimental Hofpitals. have been reprobated by General hofpitals without a number of officers, and phyficians, The eftablifhbeing able to abolith them. is always an expenment of a general hofpital, When there are a five cumbrous inftitution. who are able to number of wards, the foldiers, into fomove, vifit one another, and mingle habits are cieties and clubs, where military too, loft, in riot or. idlenefs. The attendants muft fimilar intercourfe, and as they have a of the wine and liquors, prehave charge fcribed Q_3 ficians, The eftablifhbeing able to abolith them. is always an expenment of a general hofpital, When there are a five cumbrous inftitution. who are able to number of wards, the foldiers, into fomove, vifit one another, and mingle habits are cieties and clubs, where military too, loft, in riot or. idlenefs. The attendants muft fimilar intercourfe, and as they have a of the wine and liquors, prehave charge fcribed Q_3 --- Page 260 --- 239. DISEASES OF ST, DOMINGO: [Chap. III. fcribed for the fick; they are enabled to enliven their meetings, by a confiderable thare of gaiety. In this manner, the fick are often totally neglected, in fpite of every vigilance on the part of thofe who attend them. - Squabbles, noife, and riot, are the refult of thefe affociations. It has, I believe, been remarked, that though a foldier may enter a general bofpital with all his military ardour thick upon him, that he will never return with it.-And I have feen enough to convince me, of the truth of the obfervation. Though the foldiers are in general very unwilling to enter, they are equally unwilling to come out; and linger their time in paffive languor, or in the more deftruétive fcenes of debauchery, The inftitution of general hofpitals, throws on the medical ftaff, the whole duty of regimental furgeons; who are thus rendered idle and ufelefs. It was thus at Port-auPrince, pievious tothe arrival ofDr.JACKSON, who reguiated the regimental hofpitals on a better footing. There was indeed onc bclong-. ing to the twenty-third regiment, which was very well managed; and with little expence to government, under the diredtion cf Mr. BorLAND, furgeon of that corps. Mr. WEIR at the Mole, arranged the regimental holpitals --- Page 261 --- Sest. III-] H-O SPITAL S. in fuch a manner, that they had very few indeed, in their general hofpital. At Port-auPrince, we feldom had-lefs than two hundred, and often more. The reafon was, that there were not, well endowed regimental hofpitals, and that the furgeons, the moment a patient to them, ordered him to the gewas reported the neral hofpital. The confequence was, general hofpital was crowded, and became the receptacle of all the army. Many arguments of in preference to are in favour regimental, hofpitals. The inftitution itfelf is general conduéted with little expence to the public ; whereas a general hofpital creates an enormous demand, and adds greatly to the expenditure of an army. In moft regiments, there. for this purpofe; which is a fund appropriated if properly managed would prove in general cqual to the. expence. But if it fhould not, it would be much better for government to afford them a regulated fupply under the infpection of a proper officer, than to inftitute A.regimental furgeon a general hofpital. muft derive great affiftance, from knowing the charaéter and difpofition of his patient; which in a general hofpital cannot be fo well known or afcertained. The patient is attended by his çomrades, from whom he will receive more Q_4 tendernefs expence. But if it fhould not, it would be much better for government to afford them a regulated fupply under the infpection of a proper officer, than to inftitute A.regimental furgeon a general hofpital. muft derive great affiftance, from knowing the charaéter and difpofition of his patient; which in a general hofpital cannot be fo well known or afcertained. The patient is attended by his çomrades, from whom he will receive more Q_4 tendernefs --- Page 262 --- 232 DISEASES OF ST. DOMINGO: [Chap. III, tendernefs of attention, than can be hoped for in. the indifcriminate attendance of hired nurfes. Nor has the patient the fame chance of departing from his military habits and becoming'corrupted. The circle in which he is placed is narrower, and his opportunities to err fewer. He is placed more immediately under the eye of his officers, who, by frequent vifits, maintain good order in the ward. To, thefe officers, they know they are to return when their health is reeftablifhed, and they are confcious their behaviour will be noticed and recollected. In a place like St. Domingo, where numbers are at once taken ill, it may not be convenient to obtain houfes independent of public inftitu. tions to contain all the fick of a regiment. When this is the cafe, the general hofpital, may be divided into departments for each regiment, and their furgcons in that fituation, ought to attend them. If they require medicines or fapplies, which the regimental cheft, or regimental fund cannot fuflain, let them be fapplied from the ftores provided by government for the army at large, It may be aiked, how the medical ftaff are to be employed in this arrangement, as the patients in the ge3 neral --- Page 263 --- HOSPIT ALS. Seat. III-] from the feveral neral hofpital are recruited ? The ftaff may be regiments in the garrifon thefe in fuperintending moft ufefully employed mode of in hofpitals, in fecing the praétice, abufes ; and in affifting, where their correêting This will afford fervices may be moft requifite. fufficient employment ; with the OCthe ftaff the fick officers in their cupation ofa attending quarters. In this manner, an arefpedtive will be faved to government, mazing expence habits of the foldiers will be and the military will have the benefit preferved ; whilft they and of better attention, both from the furgeon their comrades. The furgeons themfelves, will have an opportunity of acquiring knowand experience 5 and will be employed ledge in the proper line of their. duty. To correêt abufes in the French departdestientionefdeiafpedos ments,willoccupy' with the greateft advantage in St. Domingo; with what to the country. It is aftonifhing eagernefs and acutenefs they purfued depredation, and what a variety ofingenious pretexts formed, to attain their purpofe. Nor is they their leaders from fome it eafy to exculpate thefe frauds. fufpicion of countenancing The duty. To correêt abufes in the French departdestientionefdeiafpedos ments,willoccupy' with the greateft advantage in St. Domingo; with what to the country. It is aftonifhing eagernefs and acutenefs they purfued depredation, and what a variety ofingenious pretexts formed, to attain their purpofe. Nor is they their leaders from fome it eafy to exculpate thefe frauds. fufpicion of countenancing The --- Page 264 --- - - 234 DISEASES OF ST. DOMINGO: [Chap. III, The difficulties, with which any improvement was introduced, which propofed reform, or the diminution of expence; lead to a belief, that they have an intereft in fupporting the impofition. Dr. JACKSON, found unexpedted obftacles thrown in his way, by commanding officers. And it was after much trouble and difficulty that his plans were partially executed. Yet his fcheme made a faving to this country of K.50,000 a year; no fmall retrenchment in one department. In this charge, I do not, without difcrimination, involve the French officers of rank; this would be illiberal and unjuft; there are amongft them, men for whom Icntertain the higheft refpect, and who deferve well of this country 5 but there are alfo men, to whom thefe charges will fully apply, and who have enriched themfelves by the fpoil cf this ifland.-- --- Page 265 --- HOSPITAL CORPS. Sca.IIL.] CORPS. HOSPITAL againft general, and in ANOTHER argument arifes from the favour of regimental hofpitals, fick. It was immode of attendance on the female to procure poflible at Port-au-Prince, hofpital. It became nurfes for the general foldiers, who therefore neceffary, to employ had efcaped the endemic, or recovered, having than. others. But although more confidence in attend their own comrades, foldiers readily they do not fo willingly the fame regiment, Befides, the regiments to wait upon others. fuch foldiers belong, do not eafily agrec which continue in the general hofpital. to'let them Thefe difficulties, which were reprefented, from gave rife to the levy of an HofpitalCorps; All which.all fuch men were to be taken. men Or nurfes, were to be fupplied the orderly and the military comfrom this regiment; behaved' in a mandant was to fee, that they regular, and proper manner. He was decent, made to him by to attend to the complaints and to direét his the phyficians and furgeons, for the benefit men, in the moft ufeful manner it is of the fick. To perform thefe duties, evident the levy of an HofpitalCorps; All which.all fuch men were to be taken. men Or nurfes, were to be fupplied the orderly and the military comfrom this regiment; behaved' in a mandant was to fee, that they regular, and proper manner. He was decent, made to him by to attend to the complaints and to direét his the phyficians and furgeons, for the benefit men, in the moft ufeful manner it is of the fick. To perform thefe duties, evident --- Page 266 --- DISEASES OF ST. DOMINGO: evident that the men who [Chap.1f1 corps, fhould be regular, compofèd this No duties fober, and humane, are more facred, than the fick; no duties attentions to require more ftridtnefs of manner, or greatér decency ând firmnefs of deportment. Such a corps, ought to be compofed oft the beft men of the this occupation army, to whom from might be given as a relcafe feverer duty, and a reward for conduct; as the payis better than in the good and the fervice to be ranks, fo laborious as in the field, performed, not quite forming this But inftead of body on thefe were made up of outcafts from principles, all they either ofr men, whom difeafe had regiments ; for any duty; Or of thofe who had incapacitated themfelves to drinking and abandoned confituted, debauchery. Thus they were much fitter for Bay, or the hofpital of invalids, than Botany ployment which required any emBut to thefe men humanity or.action. the we were obliged to conlign nocturnal charge of the fick ; on thefe, they depended for drink, and every other affiflance during the night. Many have. happened from fuch negleéts mult this corps been attendants. Had behaved and properly made up of well fteady men, it might be of great fervice; --- Page 267 --- HOSPITAL CORPS. Seat.11.] but in the manner it was conftituted, fervice; could not be of any ufe. occurred to the - Another great dificulty, of wards. who had charge medical gentlemen number ofaffiftThere were not a fufficient or pay to make up the prefcriptions, ants, attention in fecing them taken. the neceffary cighty occalions, a ward containing On many the attendance of one mepatients, had only to be apowho was obliged dical gentleman, and It - attendant, furgeon, phylician. thecary, fome careful men to is true, we trained up but they affift in making up preparations, their care. could not be wholly trufted to the labours that medical gentleSuch were in this deftruétive climate. men had to undergo reft from their labours, Others had fome lof eafe; no ceffation they enjoyed no interval at home from their toils. The government of affiftnot to blame for this fcarcity were had. fent out numbers, on the ants. They 3 but the ftaff, and attached to regiments who climate had fwept them away. One man be feafoned in that country, and can is once to a hoft of ftrangers, depended on, is equal and fall who themfelves require affiftance, victims, had fome lof eafe; no ceffation they enjoyed no interval at home from their toils. The government of affiftnot to blame for this fcarcity were had. fent out numbers, on the ants. They 3 but the ftaff, and attached to regiments who climate had fwept them away. One man be feafoned in that country, and can is once to a hoft of ftrangers, depended on, is equal and fall who themfelves require affiftance, victims, --- Page 268 --- 238 DISEASES OF ST. DOMINGO: [Chap.i1f, victims, when their exertions quired. Seafoned are moft rémen, ought to have everg encouragement, and fhould be fought witli diligence 5 on them only can the rely for affiftance. Ere fick, to the climate they are feafoned they muft and thefe two t acquire experience; fervice qualities are invaluable. If a does not reward merit, it will have men of talents ; they will defert never employ themfelves, where it; and How they are rewarded. many regiments and fhips of war, havé I feen in St, Domingo, without mate, from the plan of a furgeon or émploying young and inexperienced men.-They fell victims themfelves, when their aid was moft But fuppofing, they had lived, what afliftance requifite. çould they have given to the fcene was prefented before fick; a new of deftruétion. them, and unheard The rapid progrefs of an aflonifhing fever, amazed their faculties, European praétice was tame and feeble, formcr experience only tended to confound them; they were idle fpeétators, till they themfelves, perifhed. It is true, that we muft all to acquire experience, in a ftate of begin comparative ignorance 3 but thofe wlio command armies, ought to chufe their medical affiftance from warm climates; which, though they may not prefent fcenes like St. Domingo, --- Page 269 --- Seêt. III.] MILITARY PHYSICIANS. Domingo, will at leaft prepare the more than the fchools of Europe. phyfician, I thall not be contradiéted, when Iam fure it is abfurd to fend out I affert, that phyficians from don, to combat the difeafes of St. LonThe requifite knowledge for this Domingo.- only be acquired on the purpofe cân painful, and accurate fpot, after a long, attention. Out of feven phyficians, all highly qualified in their feffion, who were deflined for the St. promingo eftablifhment; Doonly two were duty when Ileft that ifland. Dr. doing fell a victim to the fever at the CLEGHORN, Mole. FELLOWS, after ftruggling Dr. his long, to perform duty, was obliged to retire, in an hopelefs ftate. : Dr. CAVE, has been almoft to' return alfo; Dr. MASTER, who in obliged of illnefs, nobly continued his a flate went much ficknefs; he and labours, underDr. SON only remain of the feven HENDERwere meant for the ifland. phyficians who Inftead of fending medical men from land to thofe iflands, where Engchance they have littie of of-exercifing their profeffion, or even, preferving their lives ; phylicians of raéter ought to.Be chaBarbadocs, and other encouragtd, from Jamaica, hot climates, where fimilar nobly continued his a flate went much ficknefs; he and labours, underDr. SON only remain of the feven HENDERwere meant for the ifland. phyficians who Inftead of fending medical men from land to thofe iflands, where Engchance they have littie of of-exercifing their profeffion, or even, preferving their lives ; phylicians of raéter ought to.Be chaBarbadocs, and other encouragtd, from Jamaica, hot climates, where fimilar --- Page 270 --- DISEASES OF ST.DOMINGO: [Chap. III. fimilar difeafes reign, and where they have been already feafoned. Thofe who have followed the army and acquired experience, are ineftimable, and fhould receive every encouragement. To 2 knowledge of the climate, and its difeafes, they add another valuable acquifition, the knowledge of the habits and manners of foldiers ; the moft neceffàry knowledge to a military phyfician or fargeon. Let the moft celebrated phyficians of Edinburgh or London, be fent out with an army to a warm climate, like St. Domingo; without being previoufly feafoned, and acquainted with military habits ; and I believe they would feel, and acknowledge, the truth of thefe remarks. It is aftonifhing that any other mode of recruiting this eftablifhment, fhould ever be thought of. The army itfelf, generally fupplies a great number of men of good abilities, who have braved the climate, and feen a great deal of practice. To thefe, in proportion to their abilities, a juft preference fhould be given; when they are not to be found, it is then fair and proper to look out for others, who may be competent to fill the ftation. But,in the Weft Indies, or in fuch iflands of them, as have a large army, there --- Page 271 --- Seêt, III.] MEDICAL BOARD, there ought to be a Medical mine fuch candidates Board; to exaas may offer themfelves on the fpot, and may be requifite to nominate. It is there only, in actual practice, and aétual duty 5 that a judgment can be formed doing . of the abilities or induftry of any one. Such a board might be compofed of two two phyficians, and two furgeons who infpectors, ; would regulate and fill up vacancies, and recommend the proper people for advancement. - The recommendation of fuch a board, to the commander in chief at home; ought to infure the candidate, whatever they recommended. In this manner, the fervice would never be in want of proper affiftance 5 and the diligent, induftrious and able candidate, would be warded. Men will not chufe to revice, and forfake other enter a feruncertain purfuits, on vague and grounds 5. nor is it fair to it, without fome affurance of expect on the prefent benefit. But footing, nothing can be mifed, till an anfwer is obtained from home. proIn the mean time, the fervice fuffers, the want of affiftance, which by if the might be procured ; infpeétors on the fpot, and who alone can be judges, enjoyed fuflicient could adduce powér. I many proofs of inconvenience and lofs to the fervice, from this management. R Boards it, without fome affurance of expect on the prefent benefit. But footing, nothing can be mifed, till an anfwer is obtained from home. proIn the mean time, the fervice fuffers, the want of affiftance, which by if the might be procured ; infpeétors on the fpot, and who alone can be judges, enjoyed fuflicient could adduce powér. I many proofs of inconvenience and lofs to the fervice, from this management. R Boards --- Page 272 --- 242 DISEASES OF ST. DOMINGO: [Chap. III. Boards are a council, for the commander in chief, to advife him on points, in which he cannot be fuppofed himfelf perfectly converfant. Ofthis kind are medicalappoinuments, ; of which medical men, ought undoubtedly to have fome direétion. They are to take care, that no improper perfon, Ohall fill any medical fituation in the army 5 they are anfwerable to the commander in chief for their recommendations, and are in fact to advife him on the medical department. Thus far their powers extend, and thus far they are proper. Ifit be right to grant thefe powers to a board at home, it would be ftill more proper, to grant them to one abroad. The board of England is competent to regulate all the bufinefs of the three kingdoms, becaufe the difeafes of thefe countries are nearly fimilar; and the courie of education purfued in our medical fchools, qualifies their pupils for this fervice. Abroad, it is otherwife. No courfe of leétures, no reading, can qualify for that fervice. A long experience, and accurate obfervation, can alone entitle the prachitioner to any confidence. The difeafes are too rapid for delay, too dangerous for doubts. The phyfician muft at once decide, or the patient is loft for ever. A very --- Page 273 --- Sect, III.] MEDICAL PROMOTIONS, A very proper caution, and a refpect to an ufeful form, have been very proper adhered to, in the conduét ofMedical too rigidly tions. In the origin of degrees, promoOr medical graduation, the chief point of was, that by holding out a certain importance, number of profefional examinations, through which the candidate muft pafs, he would be poffefs a liberal education, and obliged to tention to his purfuits. When he pay ftriet atthefe trials, he came forth fanctioned had paffed public, by the approval of a learned to the fuppofed, impartial judges of his merit. body, The public became thus guarded. againft ric pretenders, againft empirate improper and illitepractitioners. No liberal man will thefe ufeful and neceflary forms, his deny, approbation. It muft be confeffed, that warmeft univerfities, departing from the dignity of many this form, have proftituted their perfon, who could fanction, to any purchafe their feal and nature. It is therefore figcolleges, neceffary, that fome maintaining the purity and of the original form, fhould intention didates a preference, gain, to their CanThe benefits of this general againft empirics, were very properly protedtion, extended R 2 to . It muft be confeffed, that warmeft univerfities, departing from the dignity of many this form, have proftituted their perfon, who could fanction, to any purchafe their feal and nature. It is therefore figcolleges, neceffary, that fome maintaining the purity and of the original form, fhould intention didates a preference, gain, to their CanThe benefits of this general againft empirics, were very properly protedtion, extended R 2 to --- Page 274 --- 244 DISEASES OF ST. DOMINGO: to the army of late [Chap.IIf, has been adhered years only. But the rule to, with more than ordinary rigidity. The line of phyfician to the army has been confined to the bachelors of the Englifh graduates or fome univerfities only; exceptions have been made in favour Dublin. I have faid, that the form of highly proper, but I fhall itfelfis that on a fair liberal go farther, and fay, too ftricly adhered conftruétion it cannot be to. But making allowance for the celebrity of other every fities; I believe it will univerthat hardly be queftioned, EDINBURGH, is at this moment the FirsT MEDICAL SCHOOL IN EUROPE. this is true, as I believe will be If upon what principle are the graduates acknowledged, ofthat college excluded from being army? uslefs phyficians to the they are alfo licentiates of the London college. It cannot be fairly that Edinburgh, anxious for the fame fuppofed, of fchool, is lefs ftrict than the London its in its examination of candidates. college univerfities Ifthe other are lefs ferupulous, it is no reafon for claffing Edinburgh with good der a gencral prohibition. An them, unLondon, will hardly infpire examination at fudden any candidate with knowledge. And I imngine, it will not --- Page 275 --- Scét. III.] MEDICAL PROMOTIONS, not be denied, that a fludent from the Edinburgh School, is as likely to underftand the theory of Medicine, as a pupil of Oxford, Cambridge, or Dublin. Fortunately, fcience is not confined to any one univerfity, but be acquired in all, by genius or induftry. may But ifa a reftriction is necefary, and Iam of opinion it is ; let the great feminaries be privileged to offer candidates, viz. The Two ENGLISH UNIVERSITIES, DUBLIN, and EDINBURGH, let their graduates, without further examination, be cligible, for the office any of phyficians to the Forces. But it is not farely neceffary to oblige thefe graduates to at London, The urgency of fervice, and pafs the neceffities of war, fometimes require that the moft pofitive rules, which guide, in time of peace, be laid afide for the benefit of the fervice. What will do in time of will anfwer in time ofwar, peace, not Thefe remarks apply to every department of the army. Promotions muft be made for the purpofes of war, which in time of would very juftly be reprobated as peace, as an infringement on the general rules improper; of the R 3 army. neceffities of war, fometimes require that the moft pofitive rules, which guide, in time of peace, be laid afide for the benefit of the fervice. What will do in time of will anfwer in time ofwar, peace, not Thefe remarks apply to every department of the army. Promotions muft be made for the purpofes of war, which in time of would very juftly be reprobated as peace, as an infringement on the general rules improper; of the R 3 army. --- Page 276 --- - 246 DISEASES OF ST. DOMINGO: [Chap.III. army. But thefe cafes ofneceffity ceafe, when the urgency which gave rife to them no longer exifts. The EAST INDIA Company, the moft extenfive and opulent commercial body in Europe, have laid down very juft and proper laws to regulate their fervice in time of peace; but in time of war thefe laws give way to cafual urgency and unforefeen necefity. Ifit becomes neceffary then on fervice, and in time of war, to break through eftablithed rules, in the great body of the army itfelf; is it not to be expeéted that in every leffer department of it, urgencies and neceflities may arife, which juftify an infringement on general rules, that have not provided for thefe cafualties. Let us fuppofe, that an army, well appointed in the medical department, fets out for St. Domingo; but foon after its arrival there, is deprived of its phyficians and furgeons, who perifh in the fever; let uS further fuppofe, that this army continues fickly, and every day, more and more requires affiftance, Jamaica is in the neighbourhood, with many experienced practitioners; but alas! they have not undergone an cffential form, they have graduated at Edinburgh or Dublin, and therefore --- Page 277 --- MEDICAL PROMOTIONS. 247. Seêt. IIL] Would this reafoning fore are not eligible. would he the commander in chief; guide becaufe no licenpermit his men to perifh, be called to their ailifttiate of London could ance?- of this difficulty, another But independent his procuring ferious objettion would oppofe St. A practitioner in Jamaica or affiftance. unconneêted with the army, and Domingo, would not readily engaged in other purfuits, thefe, and engag: in a be induced to foriake fome inducefervice, for a temporary benefit; ment muft be held out, fome permanency in offered; but this neither the commander chief or the direétor of hofpitals can pofitively which are not do. In thefe circumftances, which I have féen unlikely to happen, and without nearly yerified; the army may perich From this fatement, it would dapafliftance. it is jufl, that in certain circumftances, pear, and proper, to break through rules, expedient for urgency and which have made no provifion and calamities necefity; for the great cafualties in time of of war. The, rule may be proper but does not apply to war. peacc, R 4 But . In thefe circumftances, which I have féen unlikely to happen, and without nearly yerified; the army may perich From this fatement, it would dapafliftance. it is jufl, that in certain circumftances, pear, and proper, to break through rules, expedient for urgency and which have made no provifion and calamities necefity; for the great cafualties in time of of war. The, rule may be proper but does not apply to war. peacc, R 4 But --- Page 278 --- 248 DISEASES OF ST. DOMINGO: [Chap.I III. But independent of the diplomas of univerfities, which certainly prove, that a man has walked through the formalities ofhiseducation, as barrifters eat their commons 5 public tef-, timonies of another kind might be fometimes admitted in favour of a phyfician to the army. Of this kind, are the publications of medical men, their profeflional character and fuccefs. I fhould have conceived, that Dr.JAcksoN's book on the Fevers of the Weft Indies, would have entitled him to be a phyfician to the army; if he had no other teftimony, and had never feen London, Edinburgh, or Dublin. I think upon the whole, that the rule of making licenciates only, phyficians tothearmy, is too rigidly adhered to, and that the power of the direétor ofhofpitals is too limited; and that both may be produétive of bad confequences to the army. Iam not fure, whether it would not be for the benefit of the army, to make ita ftep, to the furgeons, after a long and approved fervice, and thus make it a military graduation. This would hold out fomething to men of experience, to continue in the fervice, fomething to reward their toils and labour; at prefent, it muft be confeffed, that there --- Page 279 --- Seat. III.] MEDICAL PROMOTIONS. there is no encouragement, to bind a man of talents to the army. I believe, that this was once a plan in the fervice ; and if ftrialy but fairly regulated, would prove very beneficial. Having now gone through this mifcellaneous fection, I Thall proceed to fay a few words, on Wines, and fome further remarks on Diet, in which fome obfervations will be pffered on fmoaking; and bilious complaints. --- Page 280 --- DIESASES OF ST.DOMINGO: [Chap, III. SECT. IV. Confiderations 012 Diet, adapted to the ClimateClaret and Madeira compared-Dit recommendedby tbe Autber-Smoaking con/ideredIts efad--Flanlesosined-Catier Sbirts recommendedBilios Complaintt-Gayfes of Bile-Cure--Of the Prickly Heat-lts Caufès and Nature-It is not dangerous or critical-Batbing iiot dangercus avben it is out. IN the general remarks offered on Diet, I did not enter fo particularly into the fubjedt as might be requifite, I thall here obferve,' that I think fome changes might be introduced with real advantage in the diet of our foldiers in the Weft; particularlyin theirdrinks. Rum, in the manner they get it, mult poffefs pernicious qualities ; it is of the very worft kind, ftrong and ardent. Moderation is not the moft confpicuous virtue among foldiers. Ithink good porter might be fubftituted with great advantage inftead of rum :-It ought to be of the beft quality and bottled in that country:-Of this it would not perhaps be too I much, might be introduced with real advantage in the diet of our foldiers in the Weft; particularlyin theirdrinks. Rum, in the manner they get it, mult poffefs pernicious qualities ; it is of the very worft kind, ftrong and ardent. Moderation is not the moft confpicuous virtue among foldiers. Ithink good porter might be fubftituted with great advantage inftead of rum :-It ought to be of the beft quality and bottled in that country:-Of this it would not perhaps be too I much, --- Page 281 --- DIE T, 8c. 25E Sed. IV.] each foldier three pints per much, to grant and lefs perday. Porter is more nourifhing, it has not that nicious than rum or brandy 5 which by repetition foon ex2étive ftimulus, to haufts the excitability, or gives vigour caufes. This might be occafionally morbid beer, or a pint of found varied with fpruce fuch as, when Madeira. On fome occafions, centinel is expofed to a cold, or rainy night, a full of good brandy may, I think a wine glafs one as he enters on be given with advantage 5 before he and another when relieved, duty ; that this would lays down. I do notimagine, circumftances. be injurious, in thefe particular aétion, It would tend to fupport the vafcular dimithe of cold is apt to which application diminution of aétion. feems nifh; ; and this of difeafe. The exfavorable to the invafion would not be citement. of a glafs of brandy on any formidable collapfe. fo great as to bring that no more The porter fhould be fo divided, be taken ata time 5 in larger quanthan a pint and favours the tities, it brings on drowfinefs, be diftriproduction of bile. One pint might in the forenoon, mixed with water $ buted and a third at bed-time. another at dinner-time, for the fupply of This would be fufficient moifture --- Page 282 --- DISEASES OF ST. DOMINGO: [Chap. III. moifture and nourifhment, and would in no degrec, produce intoxication. Thus much, regarding the foldiers; $ I thall now confider the diet and drink of officers, who live in a manner fomewhat different. And firft as to wines :-The chief of thefe ufed in the Weft Indies, are Madeira and Claret 5 port being referved only for the fick, Good, found, old madeira, is no doubt an excellent wine in that climate; in this conditica the volatile, ardent and fpirituous part has in a great meafure fled, and the body, confifling of 2 great bafis of water and the juice of the grape remains. But few officers drink this quality of madeira, becaufe it cannot be procured 5 they are obliged much oftener to ufe a fecondary kind, into which a gcod deal ofbrandy has been thrown. This fort of madeira, is nothing more than a mixture of brandy and the drinking of it muft be very pernicious, and afford many opportunities, for the attacks of fever. Claret is lefs fubject to adulteration, and when found, and of a good body, appears to me the fitteft winc for the Eaft or Weft Indies. It poffefles more of the nutrient grapc, and lefs of the fpirituous fe a fecondary kind, into which a gcod deal ofbrandy has been thrown. This fort of madeira, is nothing more than a mixture of brandy and the drinking of it muft be very pernicious, and afford many opportunities, for the attacks of fever. Claret is lefs fubject to adulteration, and when found, and of a good body, appears to me the fitteft winc for the Eaft or Weft Indies. It poffefles more of the nutrient grapc, and lefs of the fpirituous --- Page 283 --- DIET, &c. Se&t. IV.] and it is not fpirituous part than madeira ; means fo apt to intoxicate; it poffeffes by any ufeful laxative quality. Suppofing befides an and claret, to be of equal good then madeira their kind, I fhould give the prequalities in I believe it lefs injurious ference to claret. fimulant and heatlefs to the conftitution; and nourithing. ing; and more temperate guide manFaihion and accident frequently kind in the choice of the moft important wonder that they fhould rule their things; no their In the luxuries, which are offspring. Eaft Indies, univerfally, a preference Îs given in the Weft, madeira bears the palm. to claret; under the name of The claret ufed in India, claret; or claret for the London marEnglih to me the beft kind ket, has always appeared and is fomewhat of it; it has a full body, themthan what the French more powerful, it will be generally felves ufed. I believe, that claret neither intoxicates nor allowed, fo foon as madeira. Thefe heats the body a good are in my. opinion two circumftances, to claret: but many ground for a preference from an idea are deterred from drinking claret, that it has not ftimulus enough for a relaxed ftomach or that it is, what they call too cold. I 5 believe this objection to be partly fanciful; --- Page 284 --- 254 DISEASES OF ST. DOMINGO: [Chap. III. fanciful; but to prevent this danger, a fewi glaffes of madeira may precede the claret, fo as to heat and warm the ftomach; Or what would anfwer equally well, a half wine glafsful of brandy; with this foundation, the claret may. be taken without any danger to the ilomach. There are many who believe that pretty hard drinking contributes to their fafety in a warm climate. Iam by no means of this opinion, for I think in its confequences, it fubjedts them more readily to the invafion of fever; but moderate living with a due proportion of folid, and liquid nourifhment, contributes to the maintenance of health, and preferves the conftitution from difeafe. It is very difficult to draw the line accurately; but I fhould think it a good general rule, to eat fmall portions of animal food ; to cat foup or broth, and to let vegetables have a place in our repaft. As to drinking, we may perhaps do well nct to exceed what promotes cheerfulnefs and a focial fpirit, without intoxication. The quantity which in different conftitutions produces this difpolition, is as various as the conftitutions themfelves. But I fhould imagine, that a bottle of claret after dinner, when a perfon fits two hours, cannot prove injurious to the conftitution I ; for in this portions of animal food ; to cat foup or broth, and to let vegetables have a place in our repaft. As to drinking, we may perhaps do well nct to exceed what promotes cheerfulnefs and a focial fpirit, without intoxication. The quantity which in different conftitutions produces this difpolition, is as various as the conftitutions themfelves. But I fhould imagine, that a bottle of claret after dinner, when a perfon fits two hours, cannot prove injurious to the conftitution I ; for in this --- Page 285 --- Seat. IV.] DIET, &c. this climate there is a. conftant going forward, which exhaufts the perfpiration diminifhes the fluids, unlefs body, and is a conftant faupply fupported: and as the proportion. of animal food ought to be diminifhed, from which the chief nourifhment is extracted, this mode of deriving it from fluids, becomes fary and ufeful. more necefPerhaps a life of abfoluté fobricty, would not conduce to health in the Weft Indies; the fyftem would "become 1 weak and languid; and obftruétions too happen; fo that fobriety itfelf might error 5 but to this error few oflicers might be an to fall a facrifice. are likely But it muft not be fuppofed, that I am couraging enI debauchery, or drunkennefs, when recommend a rather generous manner of life. There is a great difference, between living well, and living freely, between moderation and excefs ; but we obferve, in climates, that the natives, who live warm on vegetables, and to whom entirely wine and animal religion forbids, food, are weak, timid, and incapable of.exertion. They do not attain the ftrength or activity of their who indulge in thefe articles of food. neighbours, Gentoos, or Hindoos, are not fo athletic The as the --- Page 286 --- 256 DISEASES OF ST.DOMINGO: the Mahometans [Chap. III, ftriéted or Perfians, who are not reby the fame laws of Hence, it is fair to conclude, that abftinence. portions of wine conduce to moderate maintenance of healeh. vigour and the It is a cuftom in the Weft Indies, on fenfation, to drink founded and the day, fome during the forenoon, diluent, this is done in obedience refrelhing drinks; perative fenfe. to thirft, a very immade Weak fangoree, or a drink up of found madeira, water, acid, and fugar; lemonade, tamarind water, and fuch compofitions, are cooling and pleafant 5 and may contribute to health by fupporting fpiration. Perfpiration greatly conduces per-, health: it preferves, by the to ceis, a great coolnefs in the evaporating prothe veffels from the body ; it relieves and diftention of the fluids, without permits the expanfion by heat to go on pain or detriment. It diminifhes faline and ftimulant part oft the the may throw out of the blood; and it themfelves, body the miafmata which excite and caufe The obftruétion of this moft ufeful fever. muft be produétive ofthe worft difcharge, but it can only be fupported, confequences; regular fupply of fuids, by kceping up a * which thefe mild diluents without permits the expanfion by heat to go on pain or detriment. It diminifhes faline and ftimulant part oft the the may throw out of the blood; and it themfelves, body the miafmata which excite and caufe The obftruétion of this moft ufeful fever. muft be produétive ofthe worft difcharge, but it can only be fupported, confequences; regular fupply of fuids, by kceping up a * which thefe mild diluents --- Page 287 --- Sea. IV.j DIET, &c. diluents very amply do. It is fometimes aftonifhing, how quickly it is produced after drink of this kind; it burfts forth almoft a immediately. Whenever I found the perfpiration diminih, and my fkin becoming parched dry, I ufed to re-eftablifh it or a draught of fangoree, or lemonade, immediately, * by A free perfpiration, is the fureft health in a hot climate. prefervative of In" carrying on duty at St. Domingo, I was good deal of riding, expofed to a being generally fix or eight hours on horfeback every and day; confequently I perfpired very freely.-I wore flannel, but made ufe of cotton never, It was not unufual with me to thift five fhirts. a day ; fometimes oftener, each times drenched in fhirt being perfpiration. To this of it, I attribute profufion my fafety, amidft fo much exhalation of miafmata, for fo long a time. drank frecly of lemonade, I fangoree, tamarind water, weak wine and water, and other diluent compofitions ; and when night came, I was always prépared to enjoy my repofe. The tea breakfaft, ufed Indies, by us in the Weft appears to me leis fuited to the than the breakfaft of the climate, think, French; 2 though I they rather incline to excefs, What S is --- Page 288 --- 258 DISEASES OF ST. DOMINGO: [Chap. IIT, is called a fecond breakfaft in our not feem to me calculated iflands, does But I do not to fupport health. object fo much to tea on the ground of its being, what is itfelf, nervous, as to- the called quantity of water we drink with it; which is warm relaxing, and which tea is not calculated certainly corredt. Now it is of the utmoft to to preferve the powers ofthe confequence, tire as poffible; for the ftomach, as envigour of the body increafes, or diminifhes in proportion to the powers ofthis moft effential organ; from which as from a center, ftrength and nourifhment are propagated to the reft of the But warm wateris not calculated fyftem, the ftomach, or add to its to ftrengthen energy; on the contrary, its long continued ufe muft relax, weaken, and impair its powers ; nor is the reft of the breakfaft calculated to infpire The butter is feldom vigour. good, nor are oils eafily digefted. The breakfaft which I ufed, and found light and in the nourifhing, was made up following manner. With bread, ufed frefh I eggs, or a fimall portion of tender beef fteaks, or broiled flice of beef; and inftead pigeons, or a of tea and hot water, I drank cold water with a fourth part claret. This breakfaft I always found light, is feldom vigour. good, nor are oils eafily digefted. The breakfaft which I ufed, and found light and in the nourifhing, was made up following manner. With bread, ufed frefh I eggs, or a fimall portion of tender beef fteaks, or broiled flice of beef; and inftead pigeons, or a of tea and hot water, I drank cold water with a fourth part claret. This breakfaft I always found light, --- Page 289 --- Seat: iv.] DIET, &ec. 25g light, and eafy of digeftion. The firft of it, afforded fufficient nourifhment, part out creating bulk; and the cold withclaret braced the fibres of the water and ftomach, and gave. them ftrength. I placed great on the water's being reliance, very cool; to effect I had it in a jar ofa loofe clay which, which the water texture, through perfpired, in the day and in the night it was time; air; fo that expofed to a ftream of in the morning, it was cool and pleafant. After this breakfaft, I found felfi light and vigorous, and myof the day. I muft equal to the duties confefs, I think it more falutary, than tea, hot water, and rancid butter. I never indulged in fappers, which think are too heavy meals, for a hot I The ftomach muft be affifted climate. perform its by exercife to functions; it is not fo in Europe ; and as it has not the powerful as of exercife to affift it after advantages may be laid afide with fupper, that meal advantage. Some caution is neceffary in the. ufe of fruits, in which ftrangers are apt to indulge immoderately at firft. I think the ufe of is more falutary at breakfaft, than them after dinner. They are applied more clofely to the the ftomach; there is coats of more exercife to digeft S 2 them; --- Page 290 --- 260 DISEASES OF ST. DOMINGO: [Chap. III, them; and the tafte itfelfis more a better guide than after pure, and is dinner. melons, pine apples, plantains in Oranges, moderate quantities, aré good and fafe fruits; there another which is not inaptly called IS marrow, from its refemblance vegetable to that animal fubftance, which may be ufed with great -I have feen a preparation of it, with fafety. juice and fugar, which refembles in tafte: lime berries and cream. It will not bela ftrawto reftrain the appetite for fome badrule ufe of thefe fruits, time, in the gradually allowing more indulgence, till they can be ufed with perfect fafety. That the ftomach may not giver too much to a new ftimulus, it will be way proper rule to take a little brandy after a truits ; and in this manner, I think uling be taken with they may fafety and advantage. Nature, in every climate, feems to have produced, what is more immediately ufeful and grateful to its inhabitants.-In moft countries we not only find the neceffaries oflife; but that kind of them moft fuitable to the nature,of the climate. Nothing can be fo gratefal to the thirfty palate, as the mild acids of the orange and tamarind; nothing more luxuriant, than the delicate flavour ef the. pine apple or + the , I think uling be taken with they may fafety and advantage. Nature, in every climate, feems to have produced, what is more immediately ufeful and grateful to its inhabitants.-In moft countries we not only find the neceffaries oflife; but that kind of them moft fuitable to the nature,of the climate. Nothing can be fo gratefal to the thirfty palate, as the mild acids of the orange and tamarind; nothing more luxuriant, than the delicate flavour ef the. pine apple or + the --- Page 291 --- DIET, &c. Seét. IV.] abound, where the mangoe. Thefe happily Every they are moft requifite and grateful. and climate abounds in them ; the poor warm at nature's luxuriant the rich may banquet table. in the army, Ihave feen a practice purfued Iallude to the which I think very improper. to their giving the men ardent fpirits previous fatigue. Nothing can be more undertaking inftead ofenthan this praétice; prepoflerous bear it wholly unfits abling men to fatigue, theu for it. Ifitis meant to create a tempofrenzy,ina defperate attack,itmay perhaps rary but unlefs the enterprize anfwer the purpofe; will be is effected in a moment, we difapthe languor foon follows the excitepointed ; them paffive; and it has ment, and renders walkers, and been already fhewn that great the fatigue, are men who undergo greateft the thofe who live moderately, and during of thofe exértions ufe water performance chiefly. of animal food exhauft the Great like portions the ufe of ardent fpirits ; the fyftem, and an inclination to excitability is wafted, induced. Previous to the undertaking fleep of S 3 --- Page 292 --- 262 DISEASES OF ST.DOMINGO: of any ferious [Chap. IHI, fervice, where. expected, the canteen of fatigue is parade, fhould be every foldier on lemonade examined, and filled with or water. No fpirits or mixture of fpirits fhould be permitted, till the fervice is performed, when greater indulgence granted. In the ftate produced may be diers either become rafh and by fpirits, folfinate and difobedient, or ob-. cowardly. In a ftate of the influence of habit and fobriety them foliow their officers difcipline, will make and obey orders. Icome now to fpeak of another nected with health, which Juxury condiers ufe in the Weft officers and folTOBACCO, Indies, Viz. SMOKING This is an artificial few men naturally take to finoking luxury, caufe it is at firft highly tobaçco; betafte for it can only refult from unpleafant, and a and habit. perfeverance Smoking in India is a real luxury 5 the hookah contains, the moft odours of the Eaftern grateful felfis ofa fpices; the tobacco itvolved particular delicate kind, and is foi inamong other ingredients, that its liar fmell or flavour are not pecuhave feen European perceptible. I where ladies, fit in the rooms, gentlemen fmoked, to enjoy without trouble, the fragrant finell, the hookah diffufed; a and habit. perfeverance Smoking in India is a real luxury 5 the hookah contains, the moft odours of the Eaftern grateful felfis ofa fpices; the tobacco itvolved particular delicate kind, and is foi inamong other ingredients, that its liar fmell or flavour are not pecuhave feen European perceptible. I where ladies, fit in the rooms, gentlemen fmoked, to enjoy without trouble, the fragrant finell, the hookah diffufed; --- Page 293 --- CSMOK IN G, &c. E 263 Sea.IV.J that I ever faw fufed; nor do I recolleéty The fmoking of it unpleafant to.any ftranger. this character; it is tobacco has no claim to firft trial; almoft univerfally difagrecable on no. fmall effort to perfevere, and it requires and. render: it pleafant. what firft led to Itis not eafy to afcertain, this praétice. the origiri and comitencemehtof virtues, in Perhaps am opinion iof its medical from duced fome, whilft others: commenced and the idlenefs. The languor of heat, mere have equally produced inactivity of cold, effect is nearly equal, fmokers, becaufe the luxuriant methods In Afia, the more clegant and excite, the which amufc are employed, inhabitants of thefe fertile gay and volatile delight, in the plealant régions. The Turks whilft the fancies, and delirium of opium; inhabitants and leis irritable more phlegmatic, Holland; ufe the more of Kamfchatka, and which alone powerful : ftimulus of tobacco, habits. roufe their torpid and lethargic çan Weft Indies, the only improvement on In the is the ufe of the fegarthe Dutch method, kind of tobacco than the which is: a milder partiVirginian. In fome places it undergoes the fun, cular management; ; it is expofed to. after S 4 --- Page 294 --- 264 DISEASES OF ST. DOMINGO: [Chap. III, after being repeatedly wafhed in water 5 fo that the ftrong effential oil is: diffipated and evaporated, and the leaves rendered milder. After this preparation, they are rolled up into tubes for ufe. The Spaniards are famous for their fegars, which by connoiffeurs are fuppofed to excel all others. : There cannot be a doubt, that the ufe of . fnoking has been purfued for years, by men who have not materially fnffered from it 3 juft as men purfue a courfe of drinking, without fecming to receive injury. But this is a negative and very doubtful proof of its healthfulnefs. When we attend to the effeéts of fnoking, we find, that after proving a very confiderable fimulus, great languor is induced. For tobacco produces nearly the fame effeêts as ardent fpirits or opium. It exhauits excitability, and expofes the conftitution to the action of morbid powers. The worft effeet of finoking tobacco, is the lois of faliva or fpittle, which it produces. This not only weakens the fyftem, hy creating an unneceffary evacuation, but proves alfo highly deftructive to the digeftive powers of the ftomach. For there is no doubt.. that the faliva, which forms a large portion of the juices ardent fpirits or opium. It exhauits excitability, and expofes the conftitution to the action of morbid powers. The worft effeet of finoking tobacco, is the lois of faliva or fpittle, which it produces. This not only weakens the fyftem, hy creating an unneceffary evacuation, but proves alfo highly deftructive to the digeftive powers of the ftomach. For there is no doubt.. that the faliva, which forms a large portion of the juices --- Page 295 --- KI N G, &c. Beêt. IV.] - SM'O of which blend and fubdue the ingefta juices poffelfes great powér, in the the ftomach'; It has been proved in procefs of digeftion. and in thofe of Dr. BLACK's experiments, of the. IRWIN, that the mufcular powers than ftomach have lefs influence on digeftion, imagined. The liquors which was generally feem: to act as menftrua to the food,-appear little with to carry on the digeftive procefs, ftruéture of the reliance on the mufeular where it.is carried on. The expulfion organ; of. the mixed mais, feems and propelling fibres of wholly to depend on the mufcular and fomething muft be. granted the ftomach ; itfelf. to their aétion in the digeftive procels is feldom well performed, where For digeftion relaxation in the we have reafon to fufpect that we Abres of the ftomach; and we find, and when we improve the appetite digeftion, ftate. But fucceed in removing the relaxed whether this lax ftate of fibre, affects digeftion from the mere effect on the mufcular fibre, the nature ofthe gaftric juices, or by changing cannot be éafily fo as to weaken their powers ; afcertained. At any rate, if it be admitted, the faliva, is neceffary of ufeful in dithat the waite of it by fmoking, muft geftion, injurious to that procefe. And in prove highly fact, --- Page 296 --- 866 DISEASES OF ST. DOMINGO: fact, I have. feen it fo [Chap.dll, eminent fmokers, repeatedly; ; few. of-the are able next enjoy their breakfaft, morping to figure at dinner. I had- and - make no great an, my own houfe at St. opportunity in Domingo, of particularly the effects of fmoking. remarking amiable young anan, lived with 14 very weeks $ who was me for fome fegar. He began uncoenmenly.atached as foon to A his bed, and continued as he was. out of intermifion, it all day, with little until bed time. The: confes quence was, he loft his appetite almoft tirely, he could not digeft any folid enlived on foup, and other food, he was thin naturally, but Jight articles ; she from the became more emaciated, marafimnus continuance of fmoking. This I or wafting, and the lofs of attribute entirely to the appetites of faliva by fmoking. great expenditure 51 sU a I have feen. in many. people of difpofition, that the ftimulus a coftive communicated from the mouth of fmoking, and inteftinal to the fomach them, and canal; has produçed action in procured a ftool; fmoked for this purpofe many people fmoked for only. The foldiers effects of paftime, and 21 to obviate the rain, It raifes the pulfe, and maintains fmoking. great expenditure 51 sU a I have feen. in many. people of difpofition, that the ftimulus a coftive communicated from the mouth of fmoking, and inteftinal to the fomach them, and canal; has produçed action in procured a ftool; fmoked for this purpofe many people fmoked for only. The foldiers effects of paftime, and 21 to obviate the rain, It raifes the pulfe, and maintains --- Page 297 --- G, &c, 267. SeS:1V.)- >S MOKIN excitement in the, maintains a confiderable it aÉts in the fame manner, fyftem; ; in this way 3 and may, in with ardent fpirits or brandy Like other ftimoderation be. really ufeful. muft be inmuli, the quantity and duration lofes its. effedt; fmoking creafed $ otherwife habit, and it becomes a neceffary at length enllaves the conftitution, the whole then, it feems to have Upon from laffitude and idlenefs, and had its origin, in climates, where to have been perpetuated created from extreme thefe difpofitions are feem on the whole heat or cold. It would the faliva, to be inimical to health, by wafting weakening to digeftion, and thus fo neceffary But that in and diminifhing the appetite. fimulus of it may particular fituations, the moderately ufed with advantage, to promote be of the feces, and to refift the the expulfion vafcular exinfluence of cold, by fupporting it is ufed too citement. But in general, extent, and freely in,t the Weft Indies, to an leaves that brings on - debilitys and duration, to the attack of difeafe. the fyftem expoled introduced in the hours It is unfortunately the tafte is vitiated, and of drinking, when and it is not unpur fenfations lefs perfeét, common --- Page 298 --- 268 DISEASES OF ST. DOMINGO: : [Chap. III. common in thefe circumftances to fee it continued for five or fix hours. The confequences may be eafily imnagined ; languor and debility are experienced throughout next day.; the appetite is deftroyed and all vital energy diminifhed, No fituation can be imagined; more inviting to the invafion of Fever. And I have feen many inftances of an attack the enfuing day, after exceffive fmoking; to which no doubt exceflive drinking bad been conjoined, Before I clofe this fection, I thall add a few obfervations on Flannel, as ufed now very generally by our troops in the Weft Indies. The great ufe of flannel next the fkin, has appeared to me, to be the maintenance of an artificial, but uniform climate, which prevented flight viciflitudes of weather from affeéting the foldier; when neceffarily expofed to it. Another ufe, which may be almoft reduced to the former, is the abforption of perfpiration, which in a linen fhirt, would be applied cold to the body, and check the energy of the vafcular fyftem. That" flaninel, may in fome degree produce thefe effects I believe, but I imagine it has contributed much , to be the maintenance of an artificial, but uniform climate, which prevented flight viciflitudes of weather from affeéting the foldier; when neceffarily expofed to it. Another ufe, which may be almoft reduced to the former, is the abforption of perfpiration, which in a linen fhirt, would be applied cold to the body, and check the energy of the vafcular fyftem. That" flaninel, may in fome degree produce thefe effects I believe, but I imagine it has contributed much --- Page 299 --- &c. Sea.IV.] 1 FLANNEL the health of foldiers in the much lefs to imagined. Weft Indies, than may be generally exciting to me, to debilitate, by It appears and keeping it inceftoo much perfpiration, the foldier lefs fit fantly up 5 and to render by creating a for the cafualties of fervice, confiartificial fenfibility, alive to any great Befides, the foldier feels derable change. in his exertions. incumbered, hot, and uneafy is to refult ftill, apt But a worfe confequence the nurfery of diffromit; it may become exhalations from the eafe, by retaining the with them again applied body, and having It is well known, the chance of abforption the foldiers that no attention can prevent wheri it befrom wearing it too long; They comes a foul nurfery of uncleannefs. number with them a fufficient cannot carry as often as they of thefe Chirts to, change in fact, to be clean or comfortable, ought 5 climate to - fhift every they ought in a warm day. of the Aannel jackets or fhirts, Inftead hot, and uneafy; Iwould which are heavy, think would anfwer the recommend, what I of the dif-. purpofe much better, without any half mentioned; I mean cotton advantages fhirts --- Page 300 --- 270 DISEASES OF ST. DOMINGO: [Chap. Ill. fhirts without fleeves, in the manner worn in India under the denomination of banian fhirts. Thefe would be eafer carried about, the foldier could pack up a good number of them, as they do not fill up much room, by which means he could fhift oftener, and keep himfelf more clean. Thefe would abforb the per(piration,and create lefs heat;' they would preferve the foldier from the danger of viciffitude, and diflipate his vigour lefs, than the flannel. He might always have a fufficient number for the neceflàry change. During all my labours at St. Domingo, I never wore flannel; cotton fhirts were my only protection, and I found them fufficiently comfortable amidft every viciffitude. I 1 have now difcuffed almoft every thing I judged of any importance to touch, relative to the health and prefervation of troops in the Weft Indies ; a fubject of great importance, were my abilities equal to the weight of the difcuffion. Ihave fairly ftated what I faw, and the conclufions I drew on the fpot after much experience. I think itis the duty ofe every practitioner to come thus forward, and contribute to our ftock of facts, and the mais of opinions. Subjedts-appear in different lights to different phyficians, --- Page 301 --- COMPEAINTSIT 291 Sea.IV.] BILIOUS and in the variety of pofitions, we. phyficians, the moft diftinét view of may at length gain Before' I.come to the which they are capable. that the reawhich is only in proof, Appendix, has obtained tacitly foning I have 4 employed few remarks on in medicine, I-fhall fubjoin a what is called BILIoUS COMPLAINTS; and the PRICKLY HEAT; both very troublefome difeafes. BILIOUS COMPLA) I N T S. OF variety of pofitions, we. phyficians, the moft diftinét view of may at length gain Before' I.come to the which they are capable. that the reawhich is only in proof, Appendix, has obtained tacitly foning I have 4 employed few remarks on in medicine, I-fhall fubjoin a what is called BILIoUS COMPLAINTS; and the PRICKLY HEAT; both very troublefome difeafes. BILIOUS COMPLA) I N T S. OF men, or NO fubject on which, profefional or loofely, patients, fpeak more inaccurately or prothan on what relates to the fecretion, has duétion of Bile. Bile in warm climâtes, that in afcribed to it, the fame general agency belongs alone to the nervous lyecolder regions which is any how tem. Every complaint is bilious. Diet complex or inexplicablé, and not biis divided into what is bilious, in the converted lious; as if it was inftantly be ftomach itfelf, into this Auid. It may prothen to take a fhort view of this fubject, It per on it with more accuracy. fo as to fpeak that the bile is hardly neceffary to premife, is --- Page 302 --- 272 DISEASES OF ST. DOMINGO: [Chap. IIF, is not ai liquor produced or generated in the ftomach itfelf; at any time, or in any circumftances ; that diet of any kind, can only produce a larger quantity ofthis fluid, byacting on the liver and its veffels; its through confent or vicinity to the ftomach. That its excefs only. can be a difeafe, as a certain tity of it, is effential to the purpofes of quari- digeftion. The liver is the feat of this fecretion alone. It does not exift at all in the ftomach, but is wholly derived from this gland. But from the neighbourhood of the ftomach to this organ, whatever affeéts it will in fome degree affect the liver alfo. Bilious affections, or an increafed ffow of bile, occur either fingly and diftinét, or combined with other difeatés; I fhall confine felf chiefly to thofe accumulations of my- this fecretion, which arife more efpecially in confequence of heat. The circulation of the blood in the;liver, ts-carried on in a particular manner, a vein is made to perform a double oftice ; and the movement of the blood is more flow, than perhaps in any other organ of the body. The general effect of heat, muft be felt here, as in every other part cf the fyftem, and as the circulation is ufually quickened, eatés; I fhall confine felf chiefly to thofe accumulations of my- this fecretion, which arife more efpecially in confequence of heat. The circulation of the blood in the;liver, ts-carried on in a particular manner, a vein is made to perform a double oftice ; and the movement of the blood is more flow, than perhaps in any other organ of the body. The general effect of heat, muft be felt here, as in every other part cf the fyftem, and as the circulation is ufually quickened, --- Page 303 --- Sech. IV.] BILIOUS COMPLAINTS 273 - of blood will pafs ened, larger quantities veffels in a given time. through the hepatic ftimulate the glandular Heat befides, may. itlelf; sit certainly ime ftructure of the liver. Orfenfibility and irritability to. every parts There is reafon to believe that moft of gan. the fecretions, are, increafed by heat. The femen is more copious in warm climates, of than in cold ones, this, and the irritability the whole fyftem form one caufe of the 66, ÇuVeneris," fo remarkable in tropical rOs pido led that heat its gions. We are to,conclude, felf, independent of other caufes, operates powerfully in caufing large, fecretions of bile. Becaufe fuch fecretions, are feldom obferved when they; do in cold climates, and-becaufe, caufes, which occur they feem to: arife from rather operate in a fimilar manner, to heat, or heat. itfelf. Thus the immoderate produce debauches of wine, : and ufe of ardent (pirits, violent exercife, are known to produce great fecretions of bile. Whatever, remains for a long time in the. ftomach, and refiits the pFor to bring on a large cefs of digeftion, 19 apt Of this kind are fecretion of this Auid. pickles, veal, lamb, eggs, falt. meats, cheefe, oils, and fat meatsa Large fecretion quantitiss of of porter, likewife increafe the bile, T --- Page 304 --- 274 DISEASES OF ST. DOMINGO: bile. Smoaking [Chap. III, lates the tobacco, or whatever ftimuthe general fyftem, or more elpecially ftomach; contributes to this fecretion. Thefe, by making the fibres of the act, either with unufual ftomach unufual time ; by ftretching vigour, or for an ing bulk, and them, or by creatpreffing on the liver; in all thefe ways, perhaps, contribute to an increafed cretion. feUnufual fecretions of the biliary fluid, emphaticallycalled, ee The Bile,"a and conftitute are often, a very troublefome difeafe, doétrines, and abfurd Many ideal on this fubject; notions, are entertained people imagine, that théy eat or fwallow is converted what fuid in the ftomach. This into this arife from want of anatomical opinion can only has been thewn, that heat of knowledge. itfelf It in fact does produce, is apt, and cretions of bile, in a tondency to large feproduces this warm climates. If heat Tar cffect,b by ftimulating the vafcufyitem, and expanding it, how inore powerfully muft it' act, when much othier caufes, which increafe aided by Teblibility ; and which add to the iritability and mais, that muft pafs through the circulating folicit'in that organ liver'; or 2o uenoia itfelf, a more vigorous acoud tion, ions of bile, in a tondency to large feproduces this warm climates. If heat Tar cffect,b by ftimulating the vafcufyitem, and expanding it, how inore powerfully muft it' act, when much othier caufes, which increafe aided by Teblibility ; and which add to the iritability and mais, that muft pafs through the circulating folicit'in that organ liver'; or 2o uenoia itfelf, a more vigorous acoud tion, --- Page 305 --- BILIOUS COMPLAINTS. 275 Sea.IV.] and contiguity of the tion, by the fympathy thefe caufes, proftomach. Heat aflifted by fecretions of and morbid duces enormous, caufes, may be bile. To the co-operating agents added naufea, one of the moft powerfil which in the increafe of bile. The caufes liver, increafe the fecretion. of bile from the may be reduced to the following H E A T, in whatever manner Naufea or vomiting, excited; ufe of ardent fpirits or The immoderate wine, after meals, Violent exercife, efpecially S3 Vifcid food, whether folid, or gelatinous the ftomach. Heavy meals, over, diftending Fat or greafy food, oils, and acidsn: affections of the mind. ods Deprefling morbid fenfibility in the liver itfelf; A Obftruction in its veffels. other of thefe caufes, may be reTo one or I have ever feen. ferred all the bilious.cafes, and In fome, feveral of thefe caufes combinc, render the difeafe very obftinate. T 2 Having --- Page 306 --- 276 DISEASES OF ST. DOMINGO: [Chap. IH. Having now enumerated the caufes, which produce large fecretions, let us attend to the fymptoms, which they commonly in the fyftem. - - The firft is, bring on ral fenfe of wearinefs, with ufually, a genethe bones ; and a defire a flight aching in conflant inclination to recline, with a is to' . fleep. The impaired, Or becomes fuddenly appetite but a preference is voracious; 5 large given to hot difhes, wich When quantities of fpicery; fuch as currie.- the patient has eat heartily, the toms for a time difappear; and lead fympbelieve that he is well, The fkin him to dry, and a peculiar uneafy-heat, is felt becomes palms of the hands and foles in the The of the - feet, eyes are moved with uneafinefs and a general languor pain, prevails over the body. Perfpiration in general is much the face alone diminifhed, a fudden. burf appears moift; IlOW and then hot and the hands. The difagreeable affects deep yellow tongue is covered with a veffels of the tinge, a head-ach comes on, the colour, admata, wear a flight yellowith lefs; fometimes deep; the paticnt is reftanxious and uncafy; fléep is turbulent, interrupted by irregular recolleétion and flight delirium; and the head-ach itfelf more particularly the encompaffes a eyes and fockets. The naufea. and then hot and the hands. The difagreeable affects deep yellow tongue is covered with a veffels of the tinge, a head-ach comes on, the colour, admata, wear a flight yellowith lefs; fometimes deep; the paticnt is reftanxious and uncafy; fléep is turbulent, interrupted by irregular recolleétion and flight delirium; and the head-ach itfelf more particularly the encompaffes a eyes and fockets. The naufea. --- Page 307 --- BILIOUS COMPLAINTS. 277 Se&. IV.] in the mornnaufea is efpecially diftrefling the thé firft attempt to get up ; ing, on frequént and the heat pulife becomes very bound, intenfe. The belly is moft frequently occurs, though now . and then a diarrhcea fool. fcalding fenfation at with a particular for three or four Thefe fymptoms .continuc. carried off; they are more days, till the bile is lels violent in different conftitutions, acor and circumftances of cording to the nature the abfolute or pofitive each; 5 and perhaps, ftomach. Bile even in quantity of bile in the natural ftate, and quantity, proves its moft excites the action of the inftimulant, and ftill more teftines and ftomach; it muft prove and fo when applied in large quantities, the ftomach and inteftines are in a more when too, that thefe fecreirritable ftate. Perhaps of blood, and tions made from larger fupplies are ftate of'acute fenfibility in the organs, in a ftimulant and aétive.. in their own-nature more circumftances of the We know, that certain the fecretions much more vigororgans,render them entire new ous and ftimulant, giving The faliva of the dog; is perfedtly qualities. in the healthy ftate of that animal ; harmlefs but when the fecreting organs have undergone in the madnefs of this faithful ata change, tendant, T3 --- Page 308 --- 278 DISEASES OF ST. DOMINGO. tendant, this [Chap.III, moft very faliva becomes one of the vigorous and formidable the ftate of the poifons. Again, effcét organs, being changed, the ofany fluid on them, it tered, will be very different. fuppofing unaltent, the irritable In the Remitftomach and mild juices rejeêts its natural ; the femen paffes flaccid penis, without through the it is full ofl blood, and any fenfation; but when in a ftate of inflammation, the fàme fluid temporary five motions, and creates convulbile then fhould pleafing fenfations. If the but not be altered in its increafed in qualities, ftomach in quantity, and applied to the a certain condition, it will morbid effeéts. But there is produce perfuaded, that no fecretion reafon to be or diminifhed, is ever increafed qualities, becaufe without being changed in its the condition of the fecreting organ is changed ; and therefore it is improbable that fomething unufual not in the nature of the bile, is produced ed in large when it is fecretquantities. All our apt to be thrown into aétion organs are ftimulus, though by any unufual if the condition of apparently very mild. But ritable, and the ftomach be more irbile is the quantity or quality of the altered, are we not to expedt a vigorous action of that organ 3 and in very fact, we find and therefore it is improbable that fomething unufual not in the nature of the bile, is produced ed in large when it is fecretquantities. All our apt to be thrown into aétion organs are ftimulus, though by any unufual if the condition of apparently very mild. But ritable, and the ftomach be more irbile is the quantity or quality of the altered, are we not to expedt a vigorous action of that organ 3 and in very fact, we find --- Page 309 --- CAUSES OF THE BILE. Seét. IV.] this very aétion too, find it fo-unfortunately relieve itfelf, by its vicinity of the ftomach to affects this organ, and confent with the liver, Natural voand induces larger fecretions. relief; miting however, affords a temporaty into the ftobut as the bile is again flowing return; and the mach, the head-ach and naufea times before fame procefs is repeated feveral We feldom relief is obtained. any permanent until the bowels are opened, attain repolc, which is not uncomeither by the bile itfelf, This progefs mon, or by means of medicines. is termed in the of bilious fecretion, is what Weft Indies, a < Fit of the bile," Eaft and the general hiftory of its Ihave now given fo violent in moft fymptoms; they are not though I have cafes, as Ihave defcribed them, occur in feen all the tranfitions mentioned, in myfelf. cafes ; and not unfrequently many drowfinefs, heat in the hands, The languor, warn the paand lofs of appetite, generally difeafe; and if means tient of the approaching that no ferious were early ufed, it is probable, accumulation would ever happen. morbid fecretions of bile, the : To prevent be avoided. All food accafional caufes muft or T4 --- Page 310 --- 280 DISEASES OF ST DOMINGO: [Chap, III. OER or drink, which from their nature are apt ta.. remsin lng in the ftomach, fhould be very iparingly,or notatalluted. The ftomach thould néver be over diftended either with folids or fluids--for this very diftention unqueitionably creates bile. Suppers, fmoaking, and ardent fpirits, by throwing the ftomach into action, favour the production of this fluid; ; and Chould. be carefully avoided. Very young gelatinous meat, refifts in a remarkable mannertheactionof the ftomach, and therefore favours the increafe of bile. Pork, veal, butter, cheefe, fmoaked beef, falt meats, refiit the powers of digeftion in hot cuuntries, and thould be avoided by thofe, who are fabjedt to biliary diforders.- The diet fhould be light and eafy, compofed of fully ripened fruits ;. and large portions of vegetables, with a fmali quantity of animal ford; fuch as roaft murron or beef, or fowls. White wines, efpecially found madeira, from a long experience, I can venture to reccmmend 'in preference to the red ; of thefe claret appears the ieatt hurtful. Beer and porter muft be fparingly ufed, as they feem in fuch cafes to be very prejudiciai. I have indeed féen cafes, where porter created a diarrhcea; in thefe peculiar circumftances, it was an ufeful remedy. Riding, and cold bathing, ford; fuch as roaft murron or beef, or fowls. White wines, efpecially found madeira, from a long experience, I can venture to reccmmend 'in preference to the red ; of thefe claret appears the ieatt hurtful. Beer and porter muft be fparingly ufed, as they feem in fuch cafes to be very prejudiciai. I have indeed féen cafes, where porter created a diarrhcea; in thefe peculiar circumftances, it was an ufeful remedy. Riding, and cold bathing, --- Page 311 --- Seôt. IV.] CURE OF THE BILE. are likely means to prevent accumulaing, bilé. attentions of this kind, the tions of By difeafe will feldom come on. Let us now fee, what we are to hope from medicine, when there is an increafed fecretion of this Auid. Two plans offer themfelves, for the expulfion of bile ; viz. to employ cathartics, and remove it by ftool; or emetics, When bile has and remove it by vomiting. ftomach, accumalated in the been largely reaching, it is fometimes neand produced emetic means. ceffary to affift the procefs by But unlefs in This is for immediate relief. héadthefe circumnftances, or preffed by fevere vomiting an improper plan, achs, Iimagine obfervations extend, I have So far as my and naufea, uniformly found, that vomiting whatever manner excited or conduéted, in increafe, and in fact to feemed always to claffed thefe produce bile. I have, therefore, as exciting caufes. * In fea ficknefs, and in vomitingcaufed by mequantity ofbile is often brought dicines;a great fiuppofed, the caufe of up, which is commonly though itis much oftner the previous ficknefs, One the effeét of the naufca and reaching. reafon --- Page 312 --- 282 DISEASES OF ST. DOMINGO: reafon would however induce [Chap.III, me in cafes, to cmploy full particular conceive how fuch vomiting. I cannot could affail the an immenfe flow ofbile tion of the ftomach, confidering the fituaobftruétion common biliary duét, unlefs an either by fpafm, Or fome other means, exifted in the duodenum; below éntry of the duét. By this the of the bile is prevented, and means the entry into the flomach. it is regurgitated Tor remove and fpafm, thisobftruction and I think vomiting I may be fometimes tried, have feen cafes where it to be ufeful in this feemed think the beft way. But after all, I mulations plan of treatment, when accuhave happened, is by laxatives and purgatives. Salts I have found to the bilious fecretion evacuate leave the patient more copioufly, and to more free from all its toms, than any other medicine. fympThe objection to their ufe, arifes from the only they produce; this may in a naufea obviated by great meafure be diffolving the falts in namon water, which I have often fimple cinpractifed. Laxatives, which fuccefsfully the ftomach and teaze and irritate lated to bowels, do not feem calcuevacuate the bile, for in fact, their long continued by dirritation-more is produced. Perfpiration other medicine. fympThe objection to their ufe, arifes from the only they produce; this may in a naufea obviated by great meafure be diffolving the falts in namon water, which I have often fimple cinpractifed. Laxatives, which fuccefsfully the ftomach and teaze and irritate lated to bowels, do not feem calcuevacuate the bile, for in fact, their long continued by dirritation-more is produced. Perfpiration --- Page 313 --- CURE OF THE BILE. Seat. IV.] and urine, are means of-carPerfpiration Ihave feen inftances, rying the bile away. where the urine tinged linen ofa pretty deep exifted; and the yellow, where no jaundice the fame apperfpiration has often produced In order to pearance in a flighter degree. perfpiration, I have fometimes prepromote few of James's powiders, fcribed, a grains which being given over joined to a laxative; produced the double effeét of increaling night, by the fkin, and emptying the the difcharge If the firft dofe of falts does not enbowels. free the patient from all bilious fymptirely fecond dofe muft be preferibed; and toms, a of falts diminifhed, fo as to ob-, the quantity which I have ciaffed as an viate the naufea, exciting caufe. has been efteemed in India a moft Calomel, fuccefsful remedy, in all bilious complints. derived ftrength, from I believe this opinion diforders. of it in hepatic the great utility dofe fufficient to purge, Calomel, if given in a this cflice without griping, feldom performs and naufea ; and if given in fmaller quantities, it does not anfwer the purpofe, and is very apt its peculiar effects on the conftito produce But the fact is, that calomel is feldom tution. prefcribed --- Page 314 --- 284 DISEASES OF ST. DOMINGO: [Chap. III. preferibed fingly, it is commonly joined to Cathartic extraét Of aloe, and aided by falts. It does not appear to me, to poffefs the amazing virtue afcribed to it in India; though I do not deny, that Ihave fometimes founditconvenient and ufeful. The eafe with which it canbe taken in pills, has no doubt added to the charaéter ofthis medicine, as the naufea which is fometimes the caufe, and fometimes the effect of bile, renders it difficult to adminifter any bulky or difagrecable compofition. Calomel pills,are certainly lefs naufeous and more commodious than falts; ; and the quantity be fo managed, as not to caufe any great may turbation; but I am ofopinion it never clears. perthe ftomach or inteftines fo effectually as falts, Many pradticioners of India are of the fame opinion. Their common method is to order a calomel pill at night, and a fmall dofe of falts in the morning, and I believe this to be good praétice. The calomel pill produces in the ftomach and inteftines, the purgative commotion; after which a very fmall dofe of falts will procure a very free evacuation, Such evacuations muft be repeated, till the patient is relieved from the fymptoms we havealready mentioned; till the languor and drowfinefs are vanifhed. But calomel can only operate as a purgative, , and a fmall dofe of falts in the morning, and I believe this to be good praétice. The calomel pill produces in the ftomach and inteftines, the purgative commotion; after which a very fmall dofe of falts will procure a very free evacuation, Such evacuations muft be repeated, till the patient is relieved from the fymptoms we havealready mentioned; till the languor and drowfinefs are vanifhed. But calomel can only operate as a purgative, --- Page 315 --- CURE OF THE BILE. Seét. IV.] with the difadvantage of having a purgative, and of producing at times a rough operation, accident in warm clifalivation, a dangerous mates. be from attention to Much may expeéted, and exciting caufes in preventthe occafional ing a fit of the bile. General temperance, moderate exercife, will greatly contribute and end. When the fimalleft tendency, or to this the leaft fymptom appears, the patient onght little caftor oil; an excelient and into take a - laxative, or 1 a fmall dofe of falts; and nocent adopt a lower diet, and lefs exfor fome days habitual tendency to the ercife. If there is an effeét of heat production of bile, from the minute attention to diet, and alone, it requires enumeratd, which. évery circumftance alrcady conduces to excite the dileafe. Gentle riding cold I have found in fuch cirand bathing, cumftances to. be highly ufeful. The bilious habit is very difficult to cure, it has eftablifhed itfelf. I have reafon once mercurial courfe would to believe, thata flight to in the tendenéy - be very ufeful diminithing In feveral cafes, large fecretions in the liver. in the Eaft and Weft Indies, where the bilious habit - DE --- Page 316 --- 286 DISEASES OF ST. DOMINGO: habit [Chap. III. prevailed, I have had occafion mercury, for other difeafes, and to ufe foon the remarked how that fyftem was fairly loaded or the bilious affected ; fymptoms abated and peared. This may be perhaps difapother circumftances, fuch attributed to mode of living; but thefe as changes in the as to produce this were not fo fudden Future revolution in the habit. experience muft decide, and to determine it fully. Bile enable us lefs combined, with all the appears more or: and with the fevers ofthe fevers of India, believe with the fevers Weft Indics 5 and I it is of all warm an attendant on our own autumnal climates ; and in various fhapes fevers, of the ftomach and gives rife to diforders bowels. Savages, and rude meafure nations, are in a great exempted from this difeafe, larly thofe, whofe religious inftitutions particuwine and animal food; from this forbid ceffarily led to conclude, that we are neand luxury of our refinement diet, are the caufes of our being fo much troubled with this difeafe. renders all the fevers in which it It makes its appearance, more complex; but from the enumeration of its own particular many appearances may be explained, fymptoms, which render rude meafure nations, are in a great exempted from this difeafe, larly thofe, whofe religious inftitutions particuwine and animal food; from this forbid ceffarily led to conclude, that we are neand luxury of our refinement diet, are the caufes of our being fo much troubled with this difeafe. renders all the fevers in which it It makes its appearance, more complex; but from the enumeration of its own particular many appearances may be explained, fymptoms, which render --- Page 317 --- Sea.IV.] - CURE. OF THE BILE. render the type of thefe difeafes No difeafe is fo often mentioned complicated. to the titioner of a hot climate, as the bile; the prac- inactivity and languor, which it produces, the lofs of and U appetite, diflike to all exertion, are no doubt very ferious grounds of But unlefs the patient poffeffes complaint, dinary fortitude and more than orabftinence and perfeverance, in a plan of reftriction, there can be little done, without the afliftance of an European climate; that is, without getting from the influence of a caufe perpetually body. For medicines acting on the can afford temporelief only, if the fecretion is caufed fo the heat of the climate. Medicines are témporary powers, which cannot be ufed often without danger; and very they are oppofed tothe action of a power, which never ceafes to operate, and always acts, with more or lefs vigour. In cafes of this kind, where attention to diet, and the other means fail, and where the difeafc feems to refult from the influence heat alone, the patient ought to feek colder of regions, as his only refource. Here he in all probability will tions have recover, unlefs great obftructaken place. It may be a good general rule, to ufe purgative mineral and to take a' good deal of exerçife waters, on horfes back --- Page 318 --- 288 DISEASES OF ST. DOMINGO: [Chap. IIL back or an open carriage; but if thefe recourfe muft be had to fail, influence of mercury. When the a cold climate itfelf, and the of mineral waters, do not fucceed ufe after the patient's arrival, there is very foon . fufpect obftructions. In reafon to change of climate alone is ordinary cafes, the fufficient to every thing that IS neceflary. produce Lns E A great varicty of ridiculous methods ufed in warm : cliunates, to are prevent, or what they term, to cut the bile, in which confiderable confidence is placed; but which, of themfelves, have never appeared to me to any power, I have known much confidence poffels placed in fwallowing a raw egg, beat fhell and all, in a mortar, and taken very up, carly. This preparation might operate as a laxative, and certainly promote the evacuation of bile ; but in any other mode, I cannot conceive it would have any effect whatever. If it remained the ftomach for any time, from the vifcid in ture of the white part, I fhould be inclined nafuppofe, that inftead of to by prèventing, it would, fupporting an irritation in the caufe a larger fecretion of bile, At ftomach, I cannot perceive any rate, could be any manner, in which it remarkably antibilious. The fhell has promote the evacuation of bile ; but in any other mode, I cannot conceive it would have any effect whatever. If it remained the ftomach for any time, from the vifcid in ture of the white part, I fhould be inclined nafuppofe, that inftead of to by prèventing, it would, fupporting an irritation in the caufe a larger fecretion of bile, At ftomach, I cannot perceive any rate, could be any manner, in which it remarkably antibilious. The fhell has --- Page 319 --- Seaiv.j - CURE OF THE BILE. thas too little calcarious fubfance to be of great ufe, as an abforbent, and the contents any -it, poffefs no chemical of activity, to form new combinations Of neutralize the bile. It is however a popular medicine, and as it does not do any perceivable harm, and flatters the hopes ofthe patient, I never forbade it. Many fuppofe, that popular remedies of this kind have their origin, in a difcovery of real virtue in them: this may be fometimes cafe, as accident the unqueftionably has put us in pofefion of valuable-r rémedies; but in ral, popular remedies are the offspring of gene- fuperftitions or the cunning of quacks: Tt is however dangerous for the interfère with phyfician to them, as his oppofition is nerally afcribed to ungenerous motives. geAnother preventative of fome reputation, the fwallowing of an orange, is getting out of bed; this is a immediately on extolled. remedy much I'confefs, I hold the fame of its powers, with the opinion lieved, that its preceding 5 it is beway, it operation-is laxative, and in this may have a good effect. But of all the remedies Ss cut the bile,' >> which are ufed to fpruce beer has been held in U the --- Page 320 --- 290 DISEASES OF ST.DOMINGO: [Chap. II. the higheft eftimation, and I have heard many great drinkers of it declare, that it was impoffible to be bilious, if only a fufficient quantity of it was taken. I have tried this medicine myfelf, and taken a bottle of it, the moment I got out of bed ; after which I rode, and I certainly found it, a very pleafant and brifk laxative. With refpeét to the orange, I never eat one, when I had rcafon to fufpect the prefence of bile in my ftomach, without feeling myfelfinftantly fick, andinclined. to vomit ; I do not know, whether others have experienced fimilar effects. Water creffes, and lime water, have had their fhare of reputation, as preventatives of bile; I cannot fpeak of either, having never tried them. Water creffes muft however be a feeble mcans, and can only act, as a part of a fyftem of diet. Oflime water, I fhould be inclined to think more favourably. It may ftrengthen the fibres, of the ftomach, and diminith morbid irritability, and thus contribute to diminifh the fecretions from the liver, by leffening all irritation in its neighbourhood. No queftions are more frequently put to phyficians, and none more embarraffing; than whether this or that dith is bilious ? Thefe queftions mcans, and can only act, as a part of a fyftem of diet. Oflime water, I fhould be inclined to think more favourably. It may ftrengthen the fibres, of the ftomach, and diminith morbid irritability, and thus contribute to diminifh the fecretions from the liver, by leffening all irritation in its neighbourhood. No queftions are more frequently put to phyficians, and none more embarraffing; than whether this or that dith is bilious ? Thefe queftions --- Page 321 --- Sca.IV.] CURE OFTHE BILE. 1 29t queftions are ufually afked at table, there is not much room for difcuffion. where anfwer muft be given, and this anfwer An abroad as a.medical goes that they do not aphorifin. It is a pity, hurtful and recolleét, that what may prove bilious, in one ftomach, have any bad effeét whatever in may not that it is excefs in another; and general, which article of diet hurtful. But renders any certain fubftances they believe, that in the ftomach, diffolve themfelves into bile as ices melt into their It is right to inform them, that elements. kind nothing oft this happens, and that bile comes from liver alone, without the mach; from being formed in the ftoin which howeverit may be derived larger quantities, by diftending the ftomach with improper or indigeftible food. I cannot take my leave dies, without ofPopular Remementioning that fpruce acquired at one period beer, great fame in St. mingo as a fovereign medicine in the DoFever. From the Yellow to the idle beginning, I gave no credit reports circulated in its could not reconcile to myfelf, favour. I which had no that fpruce beer, but as a perceptible action on the fyftem, courfe offo laxative, could poffibly change the powerfula difeafe as the Remittent U 2 of --- Page 322 --- 292 DISEASES OF ST. DOMINGO: of St. Domingo. [Chap. III. reported inflances Overpowered however by fation of of fuccefs, and the converevery body; it became to give it a trial. Ia accordingly requifite fick failors, in various permitted fome ftages of the to ufe this new remedy Remittenit, it produced very freely. In fome, vomiting and ficknefs; but in neral, had its common effect geBut in no one inflance as a laxative. in the leaft whatever, did itappear degree to affect the courfe oft the fever., Indeed our foldiers, could not have perifhed, if fortunately it had virtues, for they very freely poffefed any pleafant indulged in this beverage. Mr. WEIR made trials It at the Mole, with the fame liberal of that always attends him. I had fpirit, nity of hearing the refult. no opportuThe perfon who firft tues of promulgated the virfpruce beer, was one SMITH, the mafter ofan American veffel. He maintained that by its ufe only, he had preferved his company : and communicated his thip's and knowledge doctrines, to the mafters of fome Englith tranfports, who immediately became and Praétitioners. The Pupils and pleafant, and fyftem was fimple palate of failors, peculiarly adapted to the It accordingly fpread with great tues of promulgated the virfpruce beer, was one SMITH, the mafter ofan American veffel. He maintained that by its ufe only, he had preferved his company : and communicated his thip's and knowledge doctrines, to the mafters of fome Englith tranfports, who immediately became and Praétitioners. The Pupils and pleafant, and fyftem was fimple palate of failors, peculiarly adapted to the It accordingly fpread with great --- Page 323 --- PRICKLY HEAT. Sect: IV.] the thipping, who congreat rapidity among focial intercourfe. But verted difeafe, into a either from unfortunately numbers perithed, much or too little of the prefeription. too however, who in the eagernels offyfSMITH loft of his intereft, accomtem had not fight his views in pradtice. pliched pretty fully for infpired Befides a confiderable reputation, the founder ofa new knowledge, and being he enjoyed the f.tisfaction fect of phyficians, of effence of felling a confiderable cargo which. his new pupils greedily purof fpruce; This impofture was chafed at his own price. of being lefs ingenious, and has the advantage the than many other impofitions on prejudicial, Public. a few words on what is I thall now fpeak termed, THE PRICKLY HEAT. PRICKLY HEAT has been fo termed The fenfation which attends this eruption, from a as if the fkin was pricked In the feveral.points which it occupies. The prickly heat begins make its appearance how foon the perfpi-. to U 3 ration --- Page 324 --- 294 DISEASES OF ST. DOMINGO: [Chap. UII. - ration has become general and conftant, and fpreads itfelfall over the body,beginingwhere the perfpiration is, moft profufe. From the pricking fenfation, which attends it, and an uneafy itching, it becomes at' times highly troublefome, and a real difeafe.- There is a kind of fenfibility fpread over the whole fkin,. fo that it will hardly bear the touch ofthe fofteft fhirt, and renders every movement of the body painful and tormenting; but efpecially fo, before the commencement of a free perfpiration; juft as the body attains full warmth. This eruption, by the inhabitants of the Eaft and Weft Indies, is reckoned the beft indication of a high and fecure ftate ofhealth. They believe, that fomething very injurious to the habit and conftitution is now thrown on the furface, which had previoufly lurked, În the inmoft fyftem, and was inimical to the principles oflife. They confider no one in a ftate of any fecurity, until this cruption has made its full appearance ; when they are perfuaded, he cannot fuffer from any effect, the climatc can produce. The Prickly Heat, is undoubtedly a promifing and falutary appearance,asitistheeffed of omething very injurious to the habit and conftitution is now thrown on the furface, which had previoufly lurked, În the inmoft fyftem, and was inimical to the principles oflife. They confider no one in a ftate of any fecurity, until this cruption has made its full appearance ; when they are perfuaded, he cannot fuffer from any effect, the climatc can produce. The Prickly Heat, is undoubtedly a promifing and falutary appearance,asitistheeffed of --- Page 325 --- HEAT. Sest. 1V.] 1 PRICKLY eftablifhed and powerful perfpiration, of.an of the higheft which is certainly a difcharge climate. It is indced importance in a warm ftate ofillnefs, that any onc, falls into a feldom, where the perfpior yields to the Remittent, and eitablithed. ration has been frec, copious, in a due ftate mafs of Auids, is.kept The great force of the blood is direéted of coolnefs, the of great towards the furface, and a proportion the bulk between is eftablifhed importance, of the Auids, and their conand expanfion It will be ealily conceived, taining veffels. locked,and impervious, thatifthefkin becomes that a the admiffion of. morbid particles, on is barred againft them; chief-fource of efcape, fituations they. might through which in other have paffed innoxious. Heat then, as a fign of free and The Prickly falutary and is a very. copious perfpiration, But it is not critical, or important eruption. matter thrown does it confift of any injurious For, we firft the furface of the body. on that it arifes with the commencement obferve, and is increafed or diminifhed of perfpiration, which increafe or diminifh with the caufes, one muft have itfelf. Every the perfpication climate; that during remarked in a warm coolnefs U 4 --- Page 326 --- 296 DISEASES OF ST. DOMINGO: [Chap, III, coolnefs of the morning, there is very little of this eruption vifible, nor is the fkin painful or unéafy ; but when exercife, or the natural progrefs of the day, have direéted the circulation more powerfuily to the furface; a pricking painful fenfation immediately commençes, the eruption begins as it were to emerge from the fkin, and becomes efflorefcent; until the aétual commencement of perfpiration gives it, its full and complete pearance. It is obfervable too, that during apthe land winds, which lock the fkin very completely, and render the body hot and uncaly, the prickly heat is hardly apparent. It is not unufual on thefe occafions, to drink warm diluents, to reftore perfpiration - ; the moment it begins ta make its appearance, the prickly heat begins alfo, and gives the firft warning of its approach. From this conneétion, and fubfequent appearance, uniformly prefent, between the perfpiration and prickly heat, the one always preceding the other, I think they may be claffed in the re-) lation of caufe and effect. The prickly heat never made its appearance in any perfon, not fubject to very copious perfpiration, and COpious perfpiration never continued for any time, without producing the prickly heat. The make its appearance, the prickly heat begins alfo, and gives the firft warning of its approach. From this conneétion, and fubfequent appearance, uniformly prefent, between the perfpiration and prickly heat, the one always preceding the other, I think they may be claffed in the re-) lation of caufe and effect. The prickly heat never made its appearance in any perfon, not fubject to very copious perfpiration, and COpious perfpiration never continued for any time, without producing the prickly heat. The --- Page 327 --- Sedt. IV.] PRICKLY HEAT. The caufes which increafe or diminifh fpiration, likewife increafe or diminith perprickly heat. But. befides thefe the which mark them as caufe and relations, Shall be able to account for the effeat, we on this reafoning better than phanomenon, any other. It will be difficult to fhow, that ter injurious to the conftitution any matin the fyftem, previous really exifted to the the prickly heat. When fuch appearance of how matter. is, introduced, it is feldom thrown any furface, without the on the ftage, and intervention. of a febrile: after a certain fcales I .off, leaving the progrefs, retires or body But nothing of this kind is obfervable perfeétly free, produétion or in the appearance of prickly comes on avowedly in a ftate of health, heat; it nected with a phanomenon the moft conthat.can happen ; and without the falutary or. affiftance of any febrile. prefence has no fated or precife commotion. It and does not retire period, of exiftence, time or fcale off at ; but maintains its any given as the perfpiration is free appearance, and as long as the caufes which uniform; as long. thefe produce itoperate, ceafe, or are. diminifhed, the When difappears, or is confiderably prickly heat leffened, I Let --- Page 328 --- 298 DISEASES OF ST. DOMINGO: [Chap. IIL Let us attend to the manner, in which it would feem to be produced by the action of perfpiration in the veffels of the fkin. It is produced in the fame manner, with eruptions which appear on the furface, in confequence ofapplying plaifters, fuch as Burgundy pitch, or the emplaftrum roborans, that 1S, by exciting great and unufual action in the veffels, and fupporting a continual perfpiration. It: is not improbable, that the perfpiration in a. warm climate is fomewhat more acrid than ini colder countries ; it wili bc therefore more apt to irritate the mouths of the exhaling vef-. fels on the furface, and at length to erode them, fo as to produce the prickly heat. This eruption would feem to be produced then, in. the following manner. The exhaling veffels on the furface, by the general direétion of the circulation towards them, are made more irritable, which IS Aill more increafed by their perpetual action in pouring out the perfpira-. tion, which is itfelf an acrid faline matter, by which their orifices are eroded. Thefe erofions pour out a lymphatic fuid, which incrufting Onl the fkin, forms the ermption, The pricking fenfation previous to the actual commencement.of perfpiration, would feem owing to the irritability of the vefiels onthe furface, by the circulation towards them, are made more irritable, which IS Aill more increafed by their perpetual action in pouring out the perfpira-. tion, which is itfelf an acrid faline matter, by which their orifices are eroded. Thefe erofions pour out a lymphatic fuid, which incrufting Onl the fkin, forms the ermption, The pricking fenfation previous to the actual commencement.of perfpiration, would feem owing to the irritability of the vefiels onthe furface, by --- Page 329 --- Sedt. IV.] PRICKLY HEAT. by which they are thrown into tion on the firft approach of unufual acquantity of blood towards them. an uncommon From this account of the Prickly which I believe to be juft, from all I Heat, ever obferve, it is evident, that there could thing critical or is nodangerous' in it; thatit is matter thrown out on the furface, to not the body ; and that it is in no' other relieve lutary, than as it way faindicates, a free and copious perfpiration. From this account, it be evident, that therc will alfo the can be no danger from retropulfion, or rather the retiring of prickly heat, except what may arife caufe that checked from the furd notions have been perfpiration. Many'abfubject, which have entertained on this really proved to health. It has been prejudicial pofed, that the matter of very generally faphighly injurious, and prickly heat wastiring of it intothe therefore, that the rebody was extremely gerous. It was remarked, that whén dandenly retired or vanifhed from it fud-: the body, that difeafc the furface of danger of it was afcribed ufually enfited, and the prickly heat to the matter of The again entering the circulation. people who thus reafon do not recolleét, that --- Page 330 --- 300. DISEASES OF ST. DOMINGO: [Chap. III.: that whatever obftruéts perfpiration, ît entirely, whether cold, or ftops fever, muftalfo or the effeéts of put an end to the prickly which is only an effeé of heat, perfpiration. The danger then, does not arife from the fion of prickly heat, but from what retropulthe obftruction of caufed, perfpiration, and from the obftruction itfeif. From falfe perhaps foning on this fubject, reamany men are made, extremely unhappy, who believe, that the leait. diminution of the prickly heat is and attribute to this eruption dangerous, or unpleafant fenfation. Their every difeafe, tious life, is a cauregimen, and their feelings, are alive to, every change, I.have known many fall into a dangerous ftate of relaxation, perfons, caufe they would not continue the cold bath; befor fear of beating in the prickly heat. Theories of this kind are dangerous, when they impedé or deftroy falutary habits, Before I had an opportunity of to the prickly heat, I was biaffed attending by the general prejudice, and avoided every that I thought tended to repel it. I thing, afraid of the cold bath, and avoided it. was On my arrival however in India, I became convinced, that the opinions entertained relative ta a dangerous ftate of relaxation, perfons, caufe they would not continue the cold bath; befor fear of beating in the prickly heat. Theories of this kind are dangerous, when they impedé or deftroy falutary habits, Before I had an opportunity of to the prickly heat, I was biaffed attending by the general prejudice, and avoided every that I thought tended to repel it. I thing, afraid of the cold bath, and avoided it. was On my arrival however in India, I became convinced, that the opinions entertained relative ta --- Page 331 --- PRICKLY HEAT. Sea.IV.1 falle and abfurd. I to prickly heat were ori détermined to try an experiment was and whilft my body was thickly myfelf, with the prickly heat; I refolved to encrufted Tank of. water in bathe. There was a large and of Diamond Harbour, the neighbourhood more cool and I chofe the morning, as being without heating pleafant. - I walked to it, of inyfelf, and in the prefence of a number who thought I was committing a gentlemen, action, plunged into the water, very defperate for twenty minutes. where I amufed myfelf from this praétice, I found no inconvenience fomeand répeated it every other morning, often times, in. the middle of the day, and The prickly heat was diin the evéning. received minifhed, becaufe the perfpiration of check, but with the return a temporary alfo. But neither that difcharge it returned the time the fufpenfion of perfpiration, during abfence of of bathing, nor the confequent heat, which loft its efflorefcence, the prickly created the leaft degree and feemed to retire, I found the of ill health ; on the contrary, effects of cold bath. attended with its ufual the vigour and hilarity of the fyfincreafing time tem. I could not for a long prevail of the officers to follow my example, on any from --- Page 332 --- 302 DISEASES OF ST. DOMINGO: [Chap. III. from the dreadofbad confequences. At length the feamen began to foilow me, and ventured in. When they found it was not attended with any bad confequence; for all of them were covered over with prickly heat; they plunged in without referve, and often, when in'a a ftate of perfpiration, without ever feeling the leaft inconvenience. Such was the effeét of prejudice, that if I had not in my own perfon, tried the experiment ; I fhould probably continue to believe, that the prickly heat was a critical difcharge. The effect of fuch prejudices is often dangerous ; we are deprived of a very. falutary praétice, and our views of difeafe are perverted : Thus a perfon, who believes, that the ftriking in, as itis termed, of the prickly heat, is attended with bad confequences, nay with imminent danger, lives in a ftate of perpetual anxiety ; and in a warm climate, would avoid bathing; the moft falutary of all exercife. And when in a ftate of illnefs, if the prickly heat retires, inftead of attending to more important fymptoms, the chief attention would be direéted to reftore this eruption, which has no connection with the difeafe, and is fuppreffed only in confequence of the diminution of peripiration, , is attended with bad confequences, nay with imminent danger, lives in a ftate of perpetual anxiety ; and in a warm climate, would avoid bathing; the moft falutary of all exercife. And when in a ftate of illnefs, if the prickly heat retires, inftead of attending to more important fymptoms, the chief attention would be direéted to reftore this eruption, which has no connection with the difeafe, and is fuppreffed only in confequence of the diminution of peripiration, --- Page 333 --- LYTBE A.T. Sect. IV-] CPRICK other way adds to, or perpiration, but: in no forms the diforder ofthe patient. in affirming that the prickly IfI am right and heat is mercly. an effect of a very copious ; and depends entirely continued perfpiration it will follow, that the precauon that ftate, its retiring tions ufually taken to guard againft does retire, the and that when it are ufclefs; arife from that circumflance, danger does not catife diminifhing but from the aétion of a perfpiration. heat however, at times, rifes The prickly conftitutes difeafe. The to a height which irritation, is made patient, from the extreme is uneafy, and fome, degrée of feverifhnefs induced: in this fituation, the phylician is fometimes called for, and immediate relief It will be evident, that no immeexpeéted. bediate relief can be realenably expeéted; caufe the cure muft depend on diminifhing furand averting from the the perfpiration, and force of the circulation. face the direétion I 5 fome relief This cannot be done fuddenly diminithing the cloathings may be given by cotton by laying afide fannel, and fubftituting fhirts; by avoiding diluent drinks, violent exercife, --- Page 334 --- 304 DISEASES OF ST. DOMINGO: [Chap. III. ercife, fmoking, and heated But where the rooms, or meffes. patient is very uneafy, and efpecially if he is full and plethoric means already ; to the recommended, a ought to be added, and afterwards blood-letting dofes cf lenient phyfic. The feveral live on a lower diet, and take little patient Chould he ought to drink lefs, and avoid exercife; ation, where he may be every SituAfter expofed to heat. premifing thefe means, he fhould be direéted to the cold bath, which will fo derate it as to become mois not entirely banifhed. very tolerable ;. if it it forms But no degree of any objection, to cold the troops 5 it is not attended bathing among fmalleft danger, and is a means of with the the health and fpirits of the foldiers. increafing feen this prejudice, Ihave from preverit a number of men bathing, in fituations, where have enjoyed this they might falutary and delightfsl luxury. It may be ufeful too, to minds of imprefs on the praétitioners and patients, this neral truthsthat no difeafe ofany geever had its origin from the importance; retiring of the ftriking in - or prickly heat. But that in cafes, where difeafe has occurred, and where the feen this prejudice, Ihave from preverit a number of men bathing, in fituations, where have enjoyed this they might falutary and delightfsl luxury. It may be ufeful too, to minds of imprefs on the praétitioners and patients, this neral truthsthat no difeafe ofany geever had its origin from the importance; retiring of the ftriking in - or prickly heat. But that in cafes, where difeafe has occurred, and where the --- Page 335 --- Bed, IV.] PRICKLY HEAT. tite prickly heat retired; this has in confequence ofa caufe, which happened the fyftem in general, and diminifhed deranged ration. We are perfpitherefore, not to look to the retiring of the prickly heat in any light; it is oné of the fymptoms, important a caufe of difeafe; and but not time, in we are not to lofe direéting our efforts to reftore this éruption, which will of itfelf return perfpiration. We are to atténd to with portant more imcircumftances, and to direét our to the general effeéts of the morbid views, inftead of caufè, this combating one individual effeét. In manner danger may be the difeafe prevented, and brought to a But whilft we happy termination. were perfuaded, that the prickly heat poffeffed fome noxious deftractive of life; our efforts quality, throw it were direéted to again on the furface. For this purpofe, heating means were the original difeafe was either employed, until a more dangerous exafperated into itfelf in the form, or fully eltablifhed fyftem. I have remarked, that it was a occurrence among the French, very rare are very different from whofe habits ours. It is never fcen, among the feldom or negroes, Qr the natives X of --- Page 336 --- 306. DISEASES OF ST.DOMINGO: [Chap. III. of the Eaft Indics. Our heated, from our mode of life, fyftems are more ration more faline and acrid, than and'our that perfpiFrench. of the They hardly know the whilf few of us efcape it. It is prickly heat, however of confequence, to view itin its proper not to fuffer ourfelves to be mifled light, and by an improper prejudice. One circumftance has contributed, to erroncous opinion relative chiefly the prickly heat.-It was obferved, to application of. cold to the on the body, that the prickly heat difappeared, and that fome pleafant fymptoms occurred; which unattributed to the departure of this were It was further remarked, that cruption. which ufually warm bathing, brought back the eruption, af. forded great relief, and rémoved the fant fenfation of the patient. The whole unpleathe difeafe was of courfe attributed of tiring of the prickly to the reheat, and the its reftoration. Now, the faét is, that recovery to impeding cold, by perfpiration, and thutting up the fkin, had produced the degree of illnefs which exifted, and that this exhalation for time being a the caufe was urmatasganaets of the departure ofr prickly heat, and the warm bath, by relaxing the contraction the furface, and reftoring on perfpiration, reftored $ alfo ly to the reheat, and the its reftoration. Now, the faét is, that recovery to impeding cold, by perfpiration, and thutting up the fkin, had produced the degree of illnefs which exifted, and that this exhalation for time being a the caufe was urmatasganaets of the departure ofr prickly heat, and the warm bath, by relaxing the contraction the furface, and reftoring on perfpiration, reftored $ alfo --- Page 337 --- - - Sedt. IV.] PRICKLY HEAT.. alfo the eruption, and removed the difeafe. 307 the whole of the difeafe confifted in But obftruétion of the a fimple fkin, and a diminution of perfpiration, the departure of the heat, being merely an accident, which prickly no fhare-in producing had fymptoms, an effeét of circumftances, being itfelf vioully occurred.. which had preHaving now finifhed, all the I had to offer, on Difeafes in obfervations Indies, I Chall the Weft endeavour procced to the APPENDIX, and to fhow, that the reafoning I have employed on the treatment of Fever, has influenced phyficians tacitly in the cure of moft difeafes.- X 2 --- Page 338 --- --- Page 339 --- - 309 ) APPE N DIX. Regfning oftbe. Autbor cofrmedéy Pradtice, In TNTERMITRENTS, FEVERS; ULCERS; LUES VENEREA; SMALL-Pox, IN the beginning of this book, Iremarked that the practice, by definite tion, in Fevers, was not to be trufted, indicagreater light was thrown on the until Caufe : that our attempts muft be Proximate to. effect fpeedy and powerful direéted, alter the whole condition of the changes, to introduce new body, to on the movements, and to imprefs fyftem another mode of Let us examine with candour action. ment of difeafes, and fee the treatpradtice, how far this though not acknowledged in X 3 terms, --- Page 340 --- THE AUTHOR'S PRACTICE, terms, has prevailed.-And firft let us proceed to INTERMITTENTS, It will probably for ever remain a fecret, how thefe affume their peculiar and diftinguifhing types. We cannot form any theory relative to : this point, that can afford the leaft fatisfaction to a juft thinker. Leaving this inveitigation, to fome fortunate genius $ I fhall attend to the different methods of cure, which have occafionally proved fuccefsful. When we attempt to prefcribe in Inter-. mittents, from a knowledge of their proximate caute, we find ourfelves very foon in obfcurity. The remote caufes, are indeed, pretty well afcertained, and the fituations in which Intermittents ufually arife, are likewife well-known. But of the precife condition; whichconftitutes the proximate caufe, we are entirely ignorant. From a difference in the condition of the fyftem, or the modification in the remote caufes, marth miafmata fometimes create Intermittents, fometimes Remittents or Dyfentery. We remark, that an ourfelves very foon in obfcurity. The remote caufes, are indeed, pretty well afcertained, and the fituations in which Intermittents ufually arife, are likewife well-known. But of the precife condition; whichconftitutes the proximate caufe, we are entirely ignorant. From a difference in the condition of the fyftem, or the modification in the remote caufes, marth miafmata fometimes create Intermittents, fometimes Remittents or Dyfentery. We remark, that an --- Page 341 --- IN INTERMITTENTS an expofure to thefe miafmata, after a tain period, produces a peculiar mode ofact- cering in the fyftem, which brings on cold thivering, heat and fweating; and difpofes thefe phanomena to difappear. and return, in a certain periodical manner. Itis acknowledged, that the proximate caufe is unknown, but we know, that its mode of acling muft be changed, Or itfelf banifhed, before any thing can be done for the effectual relicf of the patient. When we obferve one caufe, various effects in different producing that the caufe bodies, it follows, dies itfelfis. modified; or the boto which it is applied; determine its aétion in a particular manner, Itis remark-. able, that a contagion, evidently the fame, when applied to different bodies, effects- fo very various in each. produces It is therefore improbable, that the types of Re- not mittents and Intermittents, refult from the habit; 9 and not from any fpecific the morbific miafmnata. It variety in be wifhed, that were much to we cquld afcertain the cife ftate, which determines the prethis I fear is not to be attained. type; but Our feriptions in preIntormittents, are founded X 4 chiefly --- Page 342 --- THE AUTHOR'S PRACTICE, chiefy on experience, gained from cafual obfervation, or accident ; for we not found indications, canthe on a knowledge of proximate caufe, It is true, that ficians have fuppofed it to confift phyin an atonic ftate of the chiefly, and have afcribed the extreme veffels, to its tonic good effeêts of bark powers. But it is not any means evident, that this atonic by exifts in all cafes, nor is. it at all ftate the bark effects clear, that a cure, by tone. If bark communicating other tonics operated in this manner, would produce equal effects, in good but this does proportion to their powers 5 not happen. will prefently Befides, it effect appear, that other means cures in in faét Intermittents, which do not poffels any tonic truth feems to be, that powers. The produced in the a fecret change is laft morbid action, which at ceafes, and the ufual reftored to the movements are views to fyftem. We direét our create a change, in the action of the fyftem, fo general, peculiar modes of the as to difpoffefs the morbid action. a change, Peruvian barkis known Such to effect, and experience frequently But other fupports its ufe. means have been alfo employed with The produced in the a fecret change is laft morbid action, which at ceafes, and the ufual reftored to the movements are views to fyftem. We direét our create a change, in the action of the fyftem, fo general, peculiar modes of the as to difpoffefs the morbid action. a change, Peruvian barkis known Such to effect, and experience frequently But other fupports its ufe. means have been alfo employed with --- Page 343 --- IN INTERMITTENTS with faccefs, in changing the morbid achealth to the fyftem. tion, and reftoring only the return of Some of thefe prevent whilft others are attended one paroxyfm, benefit. An emetic with more permanent is given at the time a paroxyfmn approach- and the fometimes entirely prevents it; ing, LIND, has fhortened the duration ingenious the ufe of opium. Now thefe of a fit, by yexamined, are in themfelves means.féparstelye different effeêts. They different; and produce however calculated to effect a change, are banifhes the morbid action.- which Ifit be faid, that bark cures Intermittents that the by giving tone ; we may remark, has of emetics is not tonic, nor operation ftriking power of this kind. laudanum, any animals, When fpiders, or other difgufting the practice is are given to aguifh patients, of changing ftriély founded on the plan morbid aétion without definite indication. Horror is excited, and the fyftem is under the infuence of a powerfal change, which the agency of the morbid caufe. fuperfedes in any other manner, account for I cannot which have fometimes the good effects, fuch animals. To arifen from fwallowing the benefit the fame account may be placed of --- Page 344 --- THE AUTHOR'S PRACTICE, of dafhing water fuddenly on the patien: 3 which has often fhertened the duration, and meliorated the whole ofa paroxylm. Exercife, and the effects ofi interefting intelligence, fall into the fame clafs. We cannot account for their effects in any other manner. Steel,is on many occafionsa powerful and ufeful tonic; but it poffeffes little virtue, in curing Intermittents. The kind of change it produces, does not feem calculated to ovércome the morbid aétion ; an argument, that fomething more than want of tone conftitutes the proximate caufe. Ihave in numerous inftances cured Intermittents, in India, and at fca, by the ufe of calomel, after bark had entirely failed. Now mercury, has never been fuppofed to give or to produce tone ; on the contrary, its action is commonly attended with debility ; unlefs in cafes, where it removes a more powerful enemy to the conftitution than itfelf.- Thus, it reftores vigour, to conftitutions worn out by lues venerea, or weakened by the violence of hepatitis. It acts however in the cure of Intermittents, not by any and at fca, by the ufe of calomel, after bark had entirely failed. Now mercury, has never been fuppofed to give or to produce tone ; on the contrary, its action is commonly attended with debility ; unlefs in cafes, where it removes a more powerful enemy to the conftitution than itfelf.- Thus, it reftores vigour, to conftitutions worn out by lues venerea, or weakened by the violence of hepatitis. It acts however in the cure of Intermittents, not by any --- Page 345 --- IN INTERMITTENTS direéted to any indiviany fpecific power, caufe; but dual effeêt of the proximate by caufing a change, in the general movements of the habit, the morbid aétion is at length banifhed. A folution of arfenic, has been employed fuccefsfully in the treatment of Intervery and feems to produce its effeêts mittents ; in a fimilar manner. And it would appear, that bark itfelf, as Dr. JACKSON remarks, produces its cffedts, not by any fpecific by which it would in all cafes act power, gradually fuccelsfully, but by introducing into the habit counter movéments. Methods the moft various, have fometimes the moft happy effects, fo that we produced that thefe arofc, merely from muft conclude, inducing changes,. In the remarks now offered on the manner' of treating Intermittents, it has been obferved, that various plans fréquently fucceed in the prevention of paroxyfins, which do not appear to be direétly calculated, to obviate the proximate caufe. The indications are not formed on any definite knowledge of this fubject, We merely effet a cure --- Page 346 --- 316, THE AUTHOR'S PRACTICE, cure by producing a change. Bark, which frequently fucceeds, is by no means a remedy always to be relied on. I have met with many agues of the tertian and quotidian periods, which refifted the ufe of bark in the largeft dofes, and after a long continued ufe. The Intermittents of Bengal, particularly furnifhed thefe inftances S thofe of China, yielded to the common treatment. In cafes of this kind, even where great debility prevailed, I ufed mercury, and was never difappointed in my views. Soon after the patient commenced this courfe, the paroxylis became more mild, continued for a fhorter time, and in all refpeêts changed their violent procedure, That iS, there was fomething in the aétion of the proximate caufe, which the feeble effeéts of the bark could not banifh, but which gave way to the more potent operation of mercury. The native practitioners in India, from a kind ofinftinétive knowledge, for they are very illiterate, purfue the fcheme ofintroducing changes in the fyftem. When at Calcutta, I happened to converfe with one of them, on their method of curing the Intermittent, which not unfrequently attacked the , there was fomething in the aétion of the proximate caufe, which the feeble effeéts of the bark could not banifh, but which gave way to the more potent operation of mercury. The native practitioners in India, from a kind ofinftinétive knowledge, for they are very illiterate, purfue the fcheme ofintroducing changes in the fyftem. When at Calcutta, I happened to converfe with one of them, on their method of curing the Intermittent, which not unfrequently attacked the --- Page 347 --- - IN INTERMITTENTS inhabitants. He informed me, that the offchemes; that they they purfued a variety buckets of cold water,. on fometimes poured the cold fit, and afterthe patient, during coverings wards wrapped him up in warm the this means he alleged, that in bed; by and the hot brought cold fit was (hortened, fweat flowed more' on. He faid that the and thaton the whole, the paroxy.fms freely, fhorter and milder from this pradtice. were which had He fhowed me fome powders, which he an. aromatic fmell like caffia, but he had prepared from dried herbs; the herbs themfelves, would not produce them. nor inform me, where to procure fhort He faid, they effeéted cures in a very but that time, among their own people; hot and the biood ofEuropeans, being more required more powerful meinflammatory, indeed a nut, of an dicines. He produced flexible olive colour, covered with an elaftic, about the fize of an almond, it conhufk, bitter tafted kernel, with a fmall tained a flavour. The method degree of aromatic this medicine, according to him, of ufing bruife the kernel with a few grains : was to and forming the mais of common pepper, tili into pills, to adminifter them frequently the, or --- Page 348 --- - THE AUTHOR'S PRACTICE, the paroxyfms, at length gave way. He called the nut; kut ka léeja, or lota kâ pil. I fapplied myfelf with large quantities of the nut, and tried it, in many cafes, with excellent effect, but could not truft the curè entirely to their ufe. It was a powerful and good bitter, it warmed the patient; and cre4 ated a grateful and pleafing fenfation in the ftomach. a From what has been faid on the variety of methods, in which Intermittents may be cured, it is evident, we do not practife on any definiteindication; weeithertry changes, which experience has already fanctioned, or feize an analogy; and exhibit fuch remedies, as in other cafes are known to produce powerful effects. The treatment of continued fevers, is founded on the fame principles. Of CONTINUED FEVERS, CONTINUED FEVERS have been an opprobrium to phyficians in all the ages of medicine. The Ancients have thrown little light on the fubject, nor have the Moderns been much more fuccefsful, Ingenious fyftems practife on any definiteindication; weeithertry changes, which experience has already fanctioned, or feize an analogy; and exhibit fuch remedies, as in other cafes are known to produce powerful effects. The treatment of continued fevers, is founded on the fame principles. Of CONTINUED FEVERS, CONTINUED FEVERS have been an opprobrium to phyficians in all the ages of medicine. The Ancients have thrown little light on the fubject, nor have the Moderns been much more fuccefsful, Ingenious fyftems --- Page 349 --- - FEVERS. 319 IN CONTINUED fyftems have been offered, and rejedted.- often Theory, which though fpeculative, infuences the phyfician, feldom had vigour becaufe it was enough to change praétice, commonly rather an effufion of ingenuity, induétion from juft reafoning. On than an theory and practice have many occafions, and in there was been at variance ; general and little union, between fpeculation experience. Cures occurred underthe moft opmodes of treatment,, and the confipofite which this cafual fuccefs infpired dence, rémedies. gave currency to particular The Ancients, in their cure of Fevers, continued the frenuous for a long period, without afimitators of their predeceffors, to truth of novelty. The remote piring fevers, are undoubtedly caufes ofcontinued caufe, oblcure; but above all, the proximate exhibits the moror what more immediately refearch. bid phenomena, has eluded every It is ufelefs to repeat the various conjectures which at diferent periods occupied is fufficient to remark, the medicatwerldsiti of them have ever led to a decithat none five, or certain plan ofcure. Fevers, --- Page 350 --- THE AUTHOR'S PRACTICE, Fevers, of the continued form, at times, the type of affume, there Intermittents; that is, appears a certain degree of in the abatement fymptoms, at ftated times; but again refume their wonted they courfe, in periods correfponding with the returns of tertian paroxyfims. This is the moft at leaft. But whether this frequent type fomething in the conftitution, dépends, on mines the return ofthe which deterration of fever, or on the powerful caufes, is not opeBut there are continued known. percéptible fevers, in which no abatement is evident, and run through their whole they fuffering courfe, without any vifible or apparent the feverity of the change in tion of the fymptoms. The operaproximate caufe, in continued fevers, is fteady and powerful; and feems yet, to have bid defiance, to all the as tions of theory, or the dreams of fuggefOn a furvey of the praétice, credulity. tained in continued which has obfevers, all aras of medicine; I through the mind, it has been confefs, that in my The praétice ofthe uniformly too feeble. Indians in America, pcars to me to poffefs more apbe more likely to do vigour, and to tems as good, than all the fyfyet promulgated by the fchools of" phyfic all the as tions of theory, or the dreams of fuggefOn a furvey of the praétice, credulity. tained in continued which has obfevers, all aras of medicine; I through the mind, it has been confefs, that in my The praétice ofthe uniformly too feeble. Indians in America, pcars to me to poffefs more apbe more likely to do vigour, and to tems as good, than all the fyfyet promulgated by the fchools of" phyfic --- Page 351 --- A P P E N D I X. Whatever the proximate caufe phyûic. the morbid aétion, may be, which produces of fever, it and exhibits the phanomena be and to keep poffeffeems to tenacious, Such a fion with wonderful perfeverance. which caufe is not eafily moved; powers to flight changes are not likely produce bold and decifive praétice muft be affect it; can do thing; and as adopted before we weak any for the on the part, we cannot pitch let the whole fyftem play of our engines, and the difeafc banifhed be ftormed at once, From the want of by a powerful invafion. and the influence of this energy in pra@tice, of fever, has idle theories, the treatment Nor has it ever beén feebly conduéted. although affirmed by been clearly proved; that the credulous or difhoneft practitioners, hort was really cut by courfe of a fever, It is at leaft probathefe tame operations. caufes of difeafe are ble, that the proximate the introduétion of only to be removed, which by effect a general counter movements, the action of the whole fyftem, difference, in that the practice or its parts. Now we fee, thoufand years, in fever for a period of two introducèd changes fufficiently ypowhad not with certainty the operaerful, to remove Y tions --- Page 352 --- A P P E N D I X. tions of the proximate caufe, The morbid aétion, we muft conclude, is very powerful, it does not feem on any occafion to give way, to feeble oppofition. Slight attempts avail nothing; in fuch cafes, there is room for innovation. If we are perfuaded, that fudden changes, or revolutions, are proper, let them poffefs energy to effect their purpofe. The prejudices of mankind, and the fears of practitioners, oppofe this general fcheme of treatment, but I have no doubt, but the bold phyfician, will be crowned with frequent, and unexpected fuccefs. I have often feen remarkable effcêts from fudden changes, applied in fuch a manner, as to alter the whole circumftances of the habit. When we fee a fever obftinately refifting ordinary means, and fweeping without diftinction, the toiling race of man; is it not then incumbent on us to varyour means, and increafe the chance of fuccefs by multiplied efforts ? In fuch difafters any new plan, can hardly be lefs fuccefsful than the old one ; and experiment may at length put us in poffeflion ofa better method.. All our prefent knowledge muft have at firft arifen from chance trials. It is from experience alone, that principles can be deduced, or enlarged, that fweeping without diftinction, the toiling race of man; is it not then incumbent on us to varyour means, and increafe the chance of fuccefs by multiplied efforts ? In fuch difafters any new plan, can hardly be lefs fuccefsful than the old one ; and experiment may at length put us in poffeflion ofa better method.. All our prefent knowledge muft have at firft arifen from chance trials. It is from experience alone, that principles can be deduced, or enlarged, that --- Page 353 --- - te A P P E N D I X. that hints can be extracted, which by further enquiry, profecuted fyftems. may become the bafis of Inveftigation, is flow and we generalize and extend from fimnall laborious, nings ; but the philofopher is rewarded beginthe difcovery of truth, by by mankind durable benefits. conferring on From the great mais of cafual a felection is made, which experiencé enlighten pofterity. The may ferve to tice, by method of pracinducing a revolution or the habit and change in conftitution, and thus banilhing morbid action, extends and gives a fcope to the our views, he could not otherwife phyfician, which trine attain. The doc. applies to a number of difeafes, gives a new foundation to and indication praétice, when wholly fails. I fhall fhow few inftances, its direét in a diforders, where the application to other could have no practice by indication place; as the was wholly unknown. proximate caufe In the remarkable hiftory related BOERHAAVE, of the by KA and powers of irritation fympathy; we fce a wonderful of the force of terror in inftance changing a morbid Y 2 action, --- Page 354 --- 324. A P P E N D I. X, aétion, that had eftablithed itfelf fully in the fyftem. The ftriking figureof BOERI MAAVE, his folemn, awful deportment, his determined manner, impreffed fear, and excited movements in the fyftem, which banifhed. and conquered the influence of the morbid caufe. This memorable hiftory confirms. very ftrongly the reafoning on morbid ac-: tion, and the manner of changingit, by fudden and powerful means 3 for in no other way could the mere appearance of BoERHAAVE produce any effcét. The farprife however, and impreffions of fcar, by altering the movements of the fyftem, banifhed the morbid, and reftored the healthy move- - ments of the conftitution. There are numerous cafes on record, where fudden and powerful revolutions, have wonderfully affeéted the body. In Lord ANSON's voyage, it is related, that on one occafion great numbers were proftrated by the fcurvy. A fhip however câme fuddenly in fight, fuppofed to be an enemy 5 the men were roufed, and became anxious and eager for battle. The appearances of difeafe greatly abated, and, they fcemed, as it were, to have at once reco2 vered. ftitution. There are numerous cafes on record, where fudden and powerful revolutions, have wonderfully affeéted the body. In Lord ANSON's voyage, it is related, that on one occafion great numbers were proftrated by the fcurvy. A fhip however câme fuddenly in fight, fuppofed to be an enemy 5 the men were roufed, and became anxious and eager for battle. The appearances of difeafe greatly abated, and, they fcemed, as it were, to have at once reco2 vered. --- Page 355 --- A P P E N D I X. foon afterwards relapfed. The vered. They banith an effects of furprife and novelty, obftinate hiccup. Now there is nothing in thefe cafes, pardireéted againft any individual efticularly caufe; the whole aétion fect of the morbid and in of the fyftem is fuddenly changed, this manner the morbid aétion is banifhed. It has been remarked by almoft every one, who has ever followed an army, that men languith and become fickly in eafy quarters, when their powbut recover very rapidly of danby the approach ers are-awakened, or the expeétation of an enemy. ger, record an inftance of the I Thall now changes, or aftonifhing effects of fudden movements in the fyftem. When powerful to Bombay, in the MidI was proceeding fever: dlefex Eaft Indiaman, a continued which attacked great broke out on board, few died. We numbers; though very for retouched at the Cape of Good Hope frefhments, and proceeded on our paffage. The fever ftill continued to affect the icaunder it for weeks. men, and they lingered S. When we came however to lat. 36* 19 Y3 eight --- Page 356 --- A P P'E N D I X. eight or ten of the people had very unfavourable fymptoms. Next day a violent gale arofe, with a tremendous, tumultuous fea, agitating our fhip with rapid and uncommon motion. It exceeded in violence, all the ftorms and tempefts, the oldeft men amongft us could remember. It was wholly out cf my power, for two days, to vifit the fick, or give them any affiftance. When I ventured amongft them, on the third day, Ic expeéted to have found feveral dead, and the others much worfe. They had hardly received any nourithment, and little attention of any kind, during the continuance of the gale. But how great was my aftonifhment to find, when I vifited them, that they were all free of fever, and complained only of debility. The courfe of the fever had been entirely ftopped. No one will here argue, that there was any prefcription, founded on direét precife indication; the morbid action, which previoufly exifted, was changed by very powerful movements in the fyftem. The dreadful agitation of the thip, appears the chicfagent, which by a continuance of three days could not fail to bring on important changes. Fear, hope, and a variety of frong emotions, muft have alternately free of fever, and complained only of debility. The courfe of the fever had been entirely ftopped. No one will here argue, that there was any prefcription, founded on direét precife indication; the morbid action, which previoufly exifted, was changed by very powerful movements in the fyftem. The dreadful agitation of the thip, appears the chicfagent, which by a continuance of three days could not fail to bring on important changes. Fear, hope, and a variety of frong emotions, muft have alternately --- Page 357 --- A P P E N D I X. prevailed. Sudden changes then, alternately inftances produced cures, by have in many whole circumaltering at once, the given and by and condition of the body, ftances, fet of movements totally difintroducing a adopts its ferent, until the fyftem at length This is in no ufual and falutary aétion. indication, or any way founded, on partial. morbid I individual effeét of the power. in with any indication am not acquainted that would lead me, to continued fever, confident of fuccefs. We be in any meafure fymptoms, and fometimes obviate preffing irriftimuli, which might fupport remove to fupport the tation, and we endeavour until fome vigour of the vital powers, happen; and this comprifes change may in the treatment of fever. all our knowledge fhould be ftrongly inclined In fuch cafes, I and endeavour to to purfue bolder means, It is however change the phaenoména. have aimed, evident; that moft phyficians continued fever, to in the treatment of in the habit, with-. bring on fudden changes Whilft leffer indications. out confulting venerable CULLEN the doétrines of the and the prevailed, the removal of fpafm, Y 4 giving --- Page 358 --- A P PE N D I X. giving of tone, were the great views of practitioners. OF ULCERS THE late ingenious Mr. JOHN HUNTER has furnifhed many curious remarks on morbid action. Let us take a fhort view of the treatment of ULCERS; and fee how far it is founded on our prin-. ciples.: Wounds, in whatever manner produced, from certain unknown caufes, in fome inftances become foul, and unhealthy ulcers. The matter fecreted in them iS either thin, acrid, or fanious. The peculiar modification ofaction, which then exifts in the veffels, difpofes them to this untoward difcharge. In thefe circumftances, a cure is not readily effected; the ulcer proceeds to acquire a worfe appearancc, and the aid of phyfic becomes requifite, to give it a better afpect. In thefe cafes, before we can do any thing of the leaft advaritage to the patient, a change muft be effeéted in the mode of aétion, by which the veffels muft be difpofed to another modification, more the veffels, difpofes them to this untoward difcharge. In thefe circumftances, a cure is not readily effected; the ulcer proceeds to acquire a worfe appearancc, and the aid of phyfic becomes requifite, to give it a better afpect. In thefe cafes, before we can do any thing of the leaft advaritage to the patient, a change muft be effeéted in the mode of aétion, by which the veffels muft be difpofed to another modification, more --- Page 359 --- - 3 A P P E N D I X. more favourable to the production of good pus. Many authors haye been convinçed, that this change- has been produced, certain by a management of heat, on the fecretion itfelf; independent totally of the action of the veffels. They became firmly perfuaded in this belief, fince more the publication of Sir JOHN PRINGLE; where fome experiments on this fubject are detailed. The medical charaéter" of Sir JOHN PRINGLE, ftands defervedly high, buthehas been milled by the he circumflances, on which grounded his theory. In thefe experiments, ferum was expofed to a regulated heat, and after fome time, a whitifh lum, was difcovered at the bottom coagu- of the crucible, with a foetid difagreeable fmell. From thefe appearances, it was concluded, that the mode in which had been pus was formed, difcovered, and that the whole procefs depended on modified heat to extravafated ferum. Mr.- applied BELL, of Edinburgh, in his treatife on ULCERS, a work of confiderable ufe and adopted this merit, has reafoning. To me, the matter appears altogether different. It would feem that the veffels of an inflamed themfelves, communicated tumour to the ferum, by a pecu- --- Page 360 --- A P P E N D I X, a peculiar action, the power or capability of becoming pus. And, that the nature of the difcharge from any ulcer depended, not on à regulated heat, but on the peculiar action, that may at the time exift, in the veffels of the part, or in the fyftem at Thus : large. in a foul ulcer, it happens that no impref. lion can be made on the difcharge, by any regulated heat, in any form whatever, yet the exhibition of the bark, produces aftonifhing effeêts in a fhort time. No one, I prefume, will argue, that bark in this inftance operated on the ferum itfelf, which may be fuppofed out ofits reach, and extravafated in the cavity of the ulcer. The favourable change appears evidently to rejult, from the aétion of the bark on the veffels, and fyftem in general, and changing the peculiar flate which gave rife to the untoward difcharge; by changing this modification of action, the veffels are enabled to endow the ferum, with the capability of becoming pus. We remark befides, that tumours undergo an intermediate ftage, before pus is produced; notwithftanding the application of poultices or fomentations. If heat alone could convert the ferum into pus, this intermediate ftage of inflammation change appears evidently to rejult, from the aétion of the bark on the veffels, and fyftem in general, and changing the peculiar flate which gave rife to the untoward difcharge; by changing this modification of action, the veffels are enabled to endow the ferum, with the capability of becoming pus. We remark befides, that tumours undergo an intermediate ftage, before pus is produced; notwithftanding the application of poultices or fomentations. If heat alone could convert the ferum into pus, this intermediate ftage of inflammation --- Page 361 --- A P P E N D I X. tion would by no means be neceffary. But or capability of becoming the difpofition ferum by the is communicated to the pus modification of veffels, and not by any after aétion of it, on the ferum, heat, or any Venereal fores afit is once fairly fecreted. commonly the moft unfavourable fume is acrid, thin, and afpect, and the difcharge In vain offenfive, until mercury be given. be applied, or bark admiwill poultices this medicine has been given. niftered, till action, which exifts That is, the peculiar conftitutes their efin venereal ulcers, and the ftate fential nature is not dependent on but on that of the veilels, of the ferum, mercury. which is only to be changed by remark too, that ferum is often We may in other cavities, and expofed extravafated heat, without becoming to confiderable aétion which creates pus. The peculiar in the veffels, when pus, not being prefent the necefary fuch extravafation happened, difpofition to form it was not beftowed. heat, in the form The utility of regulated and fomentations, is confirmed of poultices does not by experience, but ccrtainly Ence --- Page 362 --- A P P E N D I X. duce its effects, by acting on the extravafated ferum. The colleétions of water in droply, bear a ftrong analogy to ferum, yet we do not find that heat converts them into pus j the reafon is, that the veffels did not beftow that peculiar fomething, which is neceffary to this procefs * The admixture of folids, the diffolution of the veffels, and the addition of blood, do not afford any fatisfactory explanation of the phanomenon. The various fecretions of the glands, are performed by a peculiar modified action; ; for although the elements ofbile, urine, and femen, may by analyfis be difcovered in the blood, yet no one has ever deteéted them in their appropriate peculiar form 3 nor are they ever feen, before the veffels have performed their peculiar act, by which thefe fecretions are produced. The blood itfelf feems to derive from the aétion of the veffels, its COlour and determinate nature. They exert upon it a peculiar aétion, and fucceffive changes complete the procefs. The ftomach Vide Note I. feparates analyfis be difcovered in the blood, yet no one has ever deteéted them in their appropriate peculiar form 3 nor are they ever feen, before the veffels have performed their peculiar act, by which thefe fecretions are produced. The blood itfelf feems to derive from the aétion of the veffels, its COlour and determinate nature. They exert upon it a peculiar aétion, and fucceffive changes complete the procefs. The ftomach Vide Note I. feparates --- Page 363 --- A P. P E N D I X. the nutritious parts of the aliment, feparates into new qualities, by the adwhich change and the juice. mixture of bile pancreatic and furThe lacteals perform their part, of are effcêted in the progrefs ther changes the thoracic duét. Till the chyle, through which finally at. length, the grandoperation, effential nature of blood, is. determines the heart, and arteries. performned in the lungs, mafs, are deFrom this feeming uniform aétion of partirived various fluids, by the Frequent changes happen cular organs. when general health is in thefe fecretions, the colour of > thus by no means impaired; confiftence of bile, are the urine, and the in the mode hourly varying, from a change of action, in the glands which perform fecretions. Toa change in the aétion thefe be afcribed the foundaof the kidneys, may They are not always tion of gravel ftones. exifting in the effect of a nucleus, cafually of aétion in the the bladder. The mode to fefecretory veffels, difpofes particles, urine and themfelves from the parate if I may fo fpeak, the grar thus produces, Baron HALLER informs vellifh tendency. that the of females, promotes us, prefence and excites uneafy the feminal fecretion, fenfations --- Page 364 --- A P P E N D 1 I.X. fenfations in the glands themfelves. This unqueftionably proves, that a peculiar action is produced; and the immenfe flow of pale urine in hyfteric females, fhows, what increafed or varied action may perform. Ihave adduced thefe inftances, in fupport of the action of the folids, which appears to be the chiefagent in producing the Various animal phanomena 3 but practical benefits refult from correct reafoning. Thus the theory of Sir JOHN PRINGLE relative to pus, may on feveral occafions, lead to an inert or improper praétice. It would for inftance, lead to local applications, in cafes, where the fyftem at large ought to be aéted on; and we fhould be loling time in feeble efforts, inftead of purfuing a manly vigorous treatment. Thus fir, falfe theories are dangérous, and meritftrict attention. Whenever our practice is the refult of theory, it becomes us very narrowly to examine it. Phyficians, and among others Sir JOHN PRINGLE,! have been wonderfully deceived by the application of their inductions from experiments 5 the very principle of fuch experiments being erroneous. Ir mean experiments large ought to be aéted on; and we fhould be loling time in feeble efforts, inftead of purfuing a manly vigorous treatment. Thus fir, falfe theories are dangérous, and meritftrict attention. Whenever our practice is the refult of theory, it becomes us very narrowly to examine it. Phyficians, and among others Sir JOHN PRINGLE,! have been wonderfully deceived by the application of their inductions from experiments 5 the very principle of fuch experiments being erroneous. Ir mean experiments --- Page 365 --- - - A P P E N D I. X. periments made on various fubftances of the body; or on dead animal fleth, out is unphilofophical to reafon in this It ner, or to expeét any ufeful induétion man= any number of experiments, made from fances, whofe on fubqualities with refpect each other, are fo remarkably tq: We cannot hope for ufeful oppofite, this mode of difeovery, in inveftigation. The and dead fibre, differ fo animal admit, almoft, widely, as not to any common analogy, Experiments of this kind, may be ufeful commerce, and enable victuallers and to miffaries to preferve combe of the leaft provifions ; but cannot utility in medicinc, Camphor has been found in thefe trials, to fift the putrefaétion of animal re= has been fince fibres, and employed as an in fevers; but if it poffefes antifeptie this fort, it arifes from any power of a very different fource, from that to which we afcribe prefervative quality, with feth. Let it be refpect to dead obferved, that common culinary falt,in a remarkable the putrefaction of dead fleth. manner, re@ifts has thought of Yet noone preferibing it in feurvy, whichis often attributed to its ufe, Upon --- Page 366 --- A P P E N D I X. Upon the whole there is no credit due to experiments made on any fubject, except the living human body. In fome very broad analogies, from the brute creation, we may receive principles, though I am inclined to believe, that we have been led into errors, from profecuting too earneftly this manner of reafoning. The conftitution of brutes is very different from ours, and we are fubject to much fallacy, becaufe we muft be fatisfied with what we can obferve, without the benefit of interrogation. Upon the whole, it would appear, that in INTERMITTENTS, CONTINUED FEVERS, and ULCERS, we effect cures, not by direéting our efforts to a precife known. proximate caufe, but to effect a general change in the fyftem, and by altering all the circumftances banifh at length the morbid action. Let us attend to the progrefs and cure of L U E S V E N E R E A, And fee how it accords with thefe principles. The ve, without the benefit of interrogation. Upon the whole, it would appear, that in INTERMITTENTS, CONTINUED FEVERS, and ULCERS, we effect cures, not by direéting our efforts to a precife known. proximate caufe, but to effect a general change in the fyftem, and by altering all the circumftances banifh at length the morbid action. Let us attend to the progrefs and cure of L U E S V E N E R E A, And fee how it accords with thefe principles. The --- Page 367 --- A P P E N. D I X. The matter of Lues Venerea, when applied to certain parts of the body, produces morbid aétion, which charaétea peculiar and which yields to the rifes the difeafe, changes, experience has taught us, mercury It evidently arifes from concan produce. to the body, in an-active tagion applied generates and ftate ; and this contagion examine -produces the difeafe. When we the fubjeét more narrowly, a regular progrels is obferved in all the phanomena. foon after its application to The contagion, where by a power the fyftem, finds a neft, the veffels from unknown to us, it feduces in their ufual mode of adting, and produces to fecrete the venereal them a difpofition modification of action virus. This pectiliar it be, forms the in thefe veffels, whatever exhibits the morbid proximate caufe; ; and and In this manner chancres, phaenomena. are produced. other venereal appearances, of the living fyftem When a large portion of this action 5 the is under the influence till at of the virus is increafed, quantity a tendency to length, there appears general when the habit adopt the new impreffion ; be venereal. may. be faid not improperly to ExThis is the manner of its progrefs. Z perience --- Page 368 --- A P P E N D I X. perience has fortunately taught us, that this morbid action,, fo formidable to youth and pleafure, and fo dangerous to the procreative faculties, yields to the aétion.of mercury. The object of the phyfician is to change the morbid action, introduced by the venereal virus, and to fubftitute another fet of movements, fo as'to bring the fyftem back, to its ancient laws, and common action. But we cannot perceive the peculiar mode in which the virus acts, fo as to produce its phanomena, nor do we know the manner precifely in which mercury brings the fyftem to health, and cures the difeafe. Experiments have been made to afcertain, -whether there was any chemical affinity between the venereal virus and mercury, by which they might be difpofed to unite, and form an inadtive neutral. Thefe experiments, like all others made out of the body, "gave no fatisfaction. For, if it had been proved, that fuch attraction actually exifted'; little or no light, would be thrown on the fubject. It would not foilow by any means, that this combination took place in the living fyftem. We have numerous inftances in practice, where the local application , -whether there was any chemical affinity between the venereal virus and mercury, by which they might be difpofed to unite, and form an inadtive neutral. Thefe experiments, like all others made out of the body, "gave no fatisfaction. For, if it had been proved, that fuch attraction actually exifted'; little or no light, would be thrown on the fubject. It would not foilow by any means, that this combination took place in the living fyftem. We have numerous inftances in practice, where the local application --- Page 369 --- A P P E N D I X. is daily made, without cation of mercury. effeét, until the fyftem producing any good affected ; thât is, till anothér in genieral was the venereal movements. action. banifhed itfelf féem to poffefs a Nor does mercury by which, in all perfect fpecific power, cure. Thère are cafes, it would effect a which circumftances of the conftitution, aétion itfelf, by affedting either the morbid the of mercury, prevents or the operation Too much vigout, habit from récovering- impede and retard or too great debility, of mercury. I have the fuiccefsful operation habits, where feen inftances in ferophulous of. makthe utmoft difficulty occurred, and where there ing mercury at all ufeful; action, which in the morbid was fomething and procceded to the refifted all oppofition, full deftruction of the conftitution. is the confequence then, of Lues venerea, the ufual movements a contagion perverting the veffels of of the fyftem, and feducing into a new the part to which it is applied a matwhich induces them to fecrete action, that which excited the comter fimilar to habit. And mercury is anomotion in the affecting the fyftem, ther. power, which by in Z2 --- Page 370 --- A P 1e P E N D I X. in a more vigorous manner, banifhes the action of the venereal virus, and brings back the fyftem to its ufual obedience, to. its common laws. But the definite manner, in which it operates, we do not know, nor do we know the proximate caufe. No one will pretend to fay, whether the action of the veffels, where venereal ulcers arife, be quick, or flow, Or ofcillatory. There is 2 fecret modification of aétion in the, proximate caufe, which the wifeft of us have not been able to afcertain; nor the manner in which mercury banifhes it. We obferve, from experience, a number of circumftances which influence the favourable, or unfavourableefects of mercury; thefe as matters of fact, for we cannot account for them, guide our praétice, and influence our prefcriptions ; and this is all the knowledge we really poffefs. There are undoubted proofs, that the ftate of the body changesthe whole phaenomena of a difeafe, fo as to give the effects of one caufe a total different afpect. Thus the matter of lues, venerea applied to glandular or fecreting furfaces, brings on a morbid difcharge, with many other fymptoms' very different from of mercury; thefe as matters of fact, for we cannot account for them, guide our praétice, and influence our prefcriptions ; and this is all the knowledge we really poffefs. There are undoubted proofs, that the ftate of the body changesthe whole phaenomena of a difeafe, fo as to give the effects of one caufe a total different afpect. Thus the matter of lues, venerea applied to glandular or fecreting furfaces, brings on a morbid difcharge, with many other fymptoms' very different from --- Page 371 --- A P P E N D I X. the venereal chancre. Andiyet no from that the matter doubt can be entertained, the fame. which produces both, is entirely been adthat other opinions have I know, which may be very vanced on this fubject, remote ingenious, but are certainly very from the truth; as difcovered by experiment or analogy. next attend to the pheenomena of Let us a dreadful difeafe, the SMALL-POX matter of the fmall-pox, when inThe like the venereal virus, a troduced, forms, and there exerts its peculiar nidus for itfelf, of that by reducing the veffels parpowers, into a new action, by which ticular fpot induced to fecrete a fluid, every they are contagion. This way fimilar to the original from which forms a kind of magazinc, to be departicles of matter are fuppofed fome untached into the blood, thefe by known law of the fyftem, are direêted to furface where they form nefts to themthe fimilar to felves, and undergo a proce(s, the Z 3 --- Page 372 --- A P P E N D I X. the matter at firft lodged. Each fpot hâs its intermediate fage of inflammation, or its proximate caufe, or fecret action, by which the matter of fmall-pox is finally and completely produced. The fever of the finall-pox, which precedes the eruption, appears to me, to be the revolt of the fyftem from its common laws, to adopt the new or variolous action. It is doubtful perhaps, whether particles in a ripe formed ftate are really detached to the furface of the body 3 it is more probable, that the variolous matter aéts from the fpot in which it was at firft depofited by the intervention of the nervous fyftem or fympathy, and in this manner feduces the veffels of the fkin, where ifa tendency to inflammation happens to be prefent, the variolous action will become general, and a large quantity of the matter will be produced. This reafoning is countenanced, by obferving, that no matter, in a formed ftate, is difcovered in the early variolous puftule, which is a hard inflamed fpot, that produces, after a certain period, the matter of fmall-pox. The inflammation or peculiar aétion feems abfolutely neceffary to the production of the variolous matter. If this is to inflammation happens to be prefent, the variolous action will become general, and a large quantity of the matter will be produced. This reafoning is countenanced, by obferving, that no matter, in a formed ftate, is difcovered in the early variolous puftule, which is a hard inflamed fpot, that produces, after a certain period, the matter of fmall-pox. The inflammation or peculiar aétion feems abfolutely neceffary to the production of the variolous matter. If this is --- Page 373 --- A P P E N D I X. is. not true, the future difeafe, ought always to bear fome proportion to the quantity of matter at firft introduced, or afterwards generated in the nidus ; but it is known, fach has ever taken that no proportion place. Nor would the puftules ever require the intermediate procefs of inflammation, but would appear at once full of mature and fimall-pox. So that it is not quite ripe in clear, that matter is pofitively difperfed a formed ftate over the body. The proxiof the varioli, then, is a fecret mate caufe modified action, which induces the veffels and feparate the to adopt new movements, veffels under this variolous matter. The influence are, for the time made glandular, and every fpot may be juftly confidered as a gland fecreting a peculiar Auid. of the proxiWe are evidently ignorant caufe of thefe phaenomena, fo as to mate prefcribe for it, and banifh it. Experience has indeed fhewn us many circumftances, conneéted with the favourable or unfavourable progrefs of the difeafe, and thefe are embodied into regulations for our conduct in the treatment of it. But we do not further, we have no definite or deproceed cifive Z 4 --- Page 374 --- A P P E N D I X. cifive indication ; we cannot prevent the difeafe, but by Hying it, nor can we with certainty amend its fymaptoms, or pofitively cure it. The veffels on. the furface are the feats of the difeafe; on their condition much muft depend, and on the kind of action they adopt. The applicàtion of cold, in the manner ofthe celebrated Baron DIMSDALE, feems to put them in a very favourable condition fora mildfecretion. The inflammatcry flage is moderated; on which fo much depends in all difeafes, where matter is formed ; and the whole procefs is made more mild and gentle. The fpecies of action, which would produce a malignant kind, is thus changed, and a modificationintroduced, which conduéts the difeafe to a happy iffue. I have no doubt but fome important improvements may be yet made in the management of this formidable malady, The late ingenious and learned CULLEN, when treating of the fmall pox in his fvftem, rightly imagined, that a peculiar ftate of the veffels on the furface, regulated the future events of the difeafe. Thefe veffels certainly appear to be the prinçipal agents in the a malignant kind, is thus changed, and a modificationintroduced, which conduéts the difeafe to a happy iffue. I have no doubt but fome important improvements may be yet made in the management of this formidable malady, The late ingenious and learned CULLEN, when treating of the fmall pox in his fvftem, rightly imagined, that a peculiar ftate of the veffels on the furface, regulated the future events of the difeafe. Thefe veffels certainly appear to be the prinçipal agents in the --- Page 375 --- A P P E N D I X, of the variolous matter, and the production influence the iffue. It is therefore muft having fingular, that the variolous matter, be in the fyftem, cannot been once general the contaagain reproduced, by applying in the gion; this is one of the myfteries be animal ceconomy, which we may never There may however able fully to explain, which, be a chance of difcovering a remedy, in the lues venerea, may like mercury caufe, without counteraét the proximate Ithink through its ufual revolutions. going cannot be : a -doubt, that the variolous there *,in the manner we have difeafe is produced in been ftating ; and that improvement the manner of treating many difeafes may minutely, the laws refult from obferving which regulate morbid action. We have thus fhewn, that in many difeafes, although we evidentiy mark a peculiar morbid action, conftituting their proxicaufe, we are not fufficiently inmate yet mode, fo as to pretimate with its peculiar and therefore, fcribe for it, or change it; fome when direéted to that our pradtice, * Vide Note II. of --- Page 376 --- A P P E N D I X, ofits effedts, becomes feeble, as the caufe çontinues its operation. But when we attempt to change the whole given circumftances of the body, and introduce fudden and confiderable changes, we have a chance of banithing the difeafe from its. ftrong holds, and when its morbid aétion ceafes, the fyftem naturally adopts its ancient laws, and ufual movements. --- Page 377 --- 347 I N O T E S. NOTE I, fome circumftances in T AHERE are ULCERS, which I could VENEREAL blend in the difcuffion of not fo properly be added that fubjeet; : but which may that the vehere. It has been remarked, on difeafe, does not feem to depend, nereal of the matter which produced the nature or leffer vigour it; that is, on the greater the ftate of the of the virus, but on This I befyftem to which it is applied. lieve in general to be found true. mention one condition ofa I thall juft in which it may be pofible, venereal ulcer, much below its ufual that the virus, is and in this ftate, may, ftandard of vigour, in the virus, bring from want of ftrength This I confels is on a milder difeafe. which I have not been mere conjeéture, to afcertain from hitherto able, precifely experiment. but on This I befyftem to which it is applied. lieve in general to be found true. mention one condition ofa I thall juft in which it may be pofible, venereal ulcer, much below its ufual that the virus, is and in this ftate, may, ftandard of vigour, in the virus, bring from want of ftrength This I confels is on a milder difeafe. which I have not been mere conjeéture, to afcertain from hitherto able, precifely experiment. --- Page 378 --- N O T E S. experiment. This fituation occurs at the critical period, in which the venereal aétion is about to ceafe 5 and before a is effedted. It occurs in perfeét cure gonorrhceas, when about to degenerate into gleets 5 when the affeéted veffels, are I under that influence, where the fecreted compound ncither morbid, fluids, are ncr perfeétly healthy. Such a fate may really be fuppofed to exift, near the ceffation of gonorrhcas, and when venereal ulcers, lofing their characteriftic appearance, begin to put on the afpect of fimpie fores. It may be difficult to conceive that the veffels can be under the influence. cf a double action at the fame time; but in a ftate of difeafe, they always are, for the healthful movements of the vetlels are never wholly deftroyed, till death. Projeétile bodies are under the influence of two powers, the projectile itfelf; and the power of gravitation, the refult of which is the parabolic curve; it in the human may be thus body, two actions may exift, which at length terminate in the e uiual movements of the fyftem, E It has been' remarked in the Eaft Indies, and Ican bear teftimony to the fact, that the --- Page 379 --- a -N OT E S. venereal difeafes of Bombay, are more the and effects, *than violent in their progrefs Dr. other of that country ; in any quarter and KAY, of St. Helena, an experienced moft of obferver, remarked, that acute cafes he had feen, on their, the defperate had come from Bombay. return to Europe, difference owing ? is it To what is this the nature of the virus ? or in fomething to induced in the conftitution, by the peculiar climate ofthat ifland? NOTE II. It has been fuppofed, that the variolous its effects by fermentation, matter produced this who believe and there are fome at day, this doétrine. If it was in any degree the of fnall pox ought to true, quantity to the violence of bear fome proportion, and the fermenthe fever, or firft procefs; the furface, tation ought to produce on inftead of matter at once fully formed; necefwhich we obferve a regular procefs is maturate the which firft fary, to puftules fmall and inflamed. The ingenious appear remarked, andcandid baron DIMSDALE,has: that S ine. If it was in any degree the of fnall pox ought to true, quantity to the violence of bear fome proportion, and the fermenthe fever, or firft procefs; the furface, tation ought to produce on inftead of matter at once fully formed; necefwhich we obferve a regular procefs is maturate the which firft fary, to puftules fmall and inflamed. The ingenious appear remarked, andcandid baron DIMSDALE,has: that S --- Page 380 --- N O T E S. that the future difeafe, was generally in the inverfe ratio of the early fymptoms. In proportion, as the fymptoms in the arm; where the virus was inferted, were violent and rapid, in their progrefs, in the fame proportion the future difeafe was mild and fecure. This would not happen, if the difeafe was produced by fermentation. It is curious that matter in a formed ftate entering the circulation, as it docs when the fmall pox difappcars, produces fo little danger. It is true, there is fome com: motion, as the fecondary fever, feems evidently the confequence. It is alfo remarke able, that the fecondary fever, is more fevere, when the matter abforbed has not undergone the full procefs of maturation. Nor can we explain, how maturationi diminifhes the virulence of the virus, with refpeét to one individual; and yet poffeffes its full aétivity, when again applied to another perfon, to give the contagion. The kind of fmall pox is evidently connected with all the circumftances, which regulate inflammation. It is the effeét of a culiar action in the veffels of the fkin; 5 Sa therefore, that action muft be modified, when --- Page 381 --- L N:O T-EUS. when we would attempt to change the quaproduced. All the imlities of the matter been provements ofBaron DIMSDALE,have the ftate of the veffels direéted to regulate affect on:the furface ; and could in no way matter itfelf; and I have no the variolous improvements may doubt, but Atill greater be made from the ufe of mercury. yet NOTE III. which retard Among the impediments have not the progrefs of medicine, we records, which moft unfortumarked falfe medical hiftories. nately fill many of our falfe facts, Thefe prefent, if I may fo fpeak, facts fo as to millead ; and not Or reprefented but render his only pérplex the phyfician, It is not poflible on any efforts dangerous. account for the total other fappofition to univerfailure of medicines, recorded fuccefsful, in the hands of fome pracfally ufelefs in the hands of titionérs, and totally others. The hiftory of cicuta is one exr of this kind, and the fuccefs of corroample five fublimate, in all cutaneous difeafes, anether. Men, who thus deliberately millead, and I the phyfician, It is not poflible on any efforts dangerous. account for the total other fappofition to univerfailure of medicines, recorded fuccefsful, in the hands of fome pracfally ufelefs in the hands of titionérs, and totally others. The hiftory of cicuta is one exr of this kind, and the fuccefs of corroample five fublimate, in all cutaneous difeafes, anether. Men, who thus deliberately millead, and I --- Page 382 --- NOTES and difguife truth, for the fake of theory of fyftem, are atrocious confpirators againft the lives of the human race, and pollute the only true fource of knowledge. MEAD, and VAN SWIETEN, STORCK, and mahy others, have given us records of this kind. We cannot be too minute in deicribing the effeêts of medicines which are univerfaliy recommended; and all the circumftances of the perfons to whom they are prefcribed. It has been an unfortunate practice to conceal unficce/sful cajes; and one fide of the queftion has been only exhibited. This is an idle vanity of fuccefs, which is foon detected , whilft the veracity of the practitioners is rendered very queftionable. It anfwers the purpofes of. empericifm, but fhould be fpurned and rejected by a liberal profefion. NOTE IV. In the enumeration of cafes, where a fadden change, not founded on direét indication, produced very remarkable effedts, I omitted to mention one of a very fingular nature. A foldier in the Welch fufileers, - the --- Page 383 --- N O,T E S: been foralong timeaftheagdRegimenthall fits, which obfervedvery feéted with epileptic periods in returning. His companions regular thatheindulged themhimhoweverl believed, much, when he found felf, bys giving way too on. He embarked on board the fits coming to St. Doa veffel bound from Jamaica their ufual mingo, when the fits obferved One of the foldiers refolved to periods: he made a poker red hot play him a trick; and whilft the poor in the cook's furnace, in convulfive fufferer was grafping round motion, he put the poker into his hand, leaving on it all which he firmly grafped, felh ofhis the ikin, and a good deal of the the This foon waked him from fingersand the difepilepfy; his hand was cured, returned. This cafe was eafe never more officers related to me by two refpedtable who were prefent. The man now living, affeêted for feveral years with this had been this cafc, dreadful difeafe. Ido not adduce imitaas an inftance of pradice meriting tion; ; but to fhow the force of very powerful and fudden changes. A a --- Page 384 --- N O T E S. NOTE V. IT may perhaps be objeéted to the mode of prefcribing, for altering morbid action and producing changes, that we cannot often fay, what kind of action really exifts, whether we ought to quicken or to reftrain movements. An ingenious writer obferves, 66 that in a machine extremely com66 plex, formed by the combination of nu66 merous matter, diverfified in their s6 properties, in their proportions, in their modes 66 of adtion; the motions neceffarily be6c come extremely complicated, their dulce nefs as well as their rapidity, frequently 66. efcape the obfervation of thofe themfelves 66 in whom they take place." Nothing can apply more ftrictly to the movements of the human body, whether healthy or morbid. There are indeed few inftances in which we can perceive or afcertain precifely the kind of aétion which prevails. Habit, in this, as in. many other inftances tyrannizes over our native fenfibility, and deprives us ofthat acutenefs which accompanied birth. We evidently mark the fenfibility of infants, which is affected by the flighteft obfervation of thofe themfelves 66 in whom they take place." Nothing can apply more ftrictly to the movements of the human body, whether healthy or morbid. There are indeed few inftances in which we can perceive or afcertain precifely the kind of aétion which prevails. Habit, in this, as in. many other inftances tyrannizes over our native fenfibility, and deprives us ofthat acutenefs which accompanied birth. We evidently mark the fenfibility of infants, which is affected by the flighteft --- Page 385 --- - N O T E S. 355. The imprefion of the air, flighteft change: of the lungs, the action of the expanfion force of the heart, and light, the incréafed of their arteries, apperhaps the vibration uneafinefs, But pear in them to create to their habit foon rènders us" infenfible of We feel the contraétions movements. when its palpitations are the heart, only without confcioufanufual. - We refpire when nefs; and walking ris. often performed, fenfible of any we are. . not by any means changes, are thus exertion. Confiderable without our being conftantly going forward, We cannot confcious of their exiftence. toefcertain thefe changes, employ our fenfes, reafon and analogy, but we are taught by that they really exift, who would confine himThe philofopher diftinatly unfolded, felf, to what his fenfes accurate in his purmight indeed be more would be very. fuits; but his knowledge analogy and prolimited, without admitting fcience would be bability. Without thefc, confined' within very narrow limits. enabled to' fay But we are fometimes what kind of aétion with fome precifion, really A a 2 --- Page 386 --- N O T E S. reaily exifts, in particular circumftances of the human body. Thus, in inflammations of the aétive kind, we evidently fee, and feel, the aétion of the arteries increafed. - But there is fomething attending this action, which we do not comprehend. We cannot afcertain the peculiar modification of it, which induces it to produce pus in thofe inflamed parts. Thisis the myfterious part of the bufinefs. In fevers, the pulfe is often as frequent, and ftrong as in inflamed tumours ; yet pus is not produced, becaufe a fomething which exifted in the pulfe conneéted with inflammation, does not exift in fevers. In running or dancing, the pulfe is often accelerated, and beats as rapidly for a time as in Fever; yet the' head-ach and laffitude, with the other charaéters of real fever, are abfent; becaufe the peculiar ftate, in which fever confifts, is not at the time prefent. A flow of tears from the eye is caufed by an increafed action in the lachrymal veffels; but acrid fubftances applied to the cye do not produce fuch a plentiful flow, as when the tears have been caufed by grief or forrow. Becaufe, the peculiar adtion which produced them, does not exift in the application of acrid fubitances. X In real fever, are abfent; becaufe the peculiar ftate, in which fever confifts, is not at the time prefent. A flow of tears from the eye is caufed by an increafed action in the lachrymal veffels; but acrid fubftances applied to the cye do not produce fuch a plentiful flow, as when the tears have been caufed by grief or forrow. Becaufe, the peculiar adtion which produced them, does not exift in the application of acrid fubitances. X In --- Page 387 --- N 0 T E S. hemorrhage, we canoften difIn uterine fates of action; the one, an tinguifh two increafed energy ; the other, a diminifhed We infer the exiftaétion in the-veffels. of the firft, from a hard rapid pulfe, ence tenfe. We infer the fecond ftate, full and is low, flat, and weak; and when the pulfe which in thefé from theeffeas ofaftringents, to the hacircumftances ufually put a ftop Obfervation alone can inform morrhage. But granting, what we us, on thefe points: feldom know the premuft: allow, that we do well when we cile mode of aétion, we as the fyftem is then more effect a change, and proper ready to adopt its own healthy movements. raes Every means, then, ought to that afford any profpect of be employed, fo neceffary to the effedting thefe changes ; banifhment of difeafe, and the eftablifhment ofhealth. NOT E VI. On a careful perufal of Dr.. JAcKsoN's Fevers; it affords me the greateft book on of thinkfatisfaction to find, a coincidence which I have ing, in many particulars treated. --- Page 388 --- N O T E S. treated. He is the firft who boldly pufhed cold bathing in fevers, to an extent unknown to, former pradtitioners; he has explained the inceffant vomiting and its phenomena in the Yellow Fever on the principlcs I have been endeavouring to eftablifh. From him Ihave derived many ufeful hints, which I had conftantly in view, in the courfe of my experience. Whatever I have been able to : obferve confirms the general accuracy of his remarks; andIhold this no fmall proof of the fidelity of whatI have related. From Mr. JOHN HUNTER I drew my firft notions of morbid action, and endeavoured to apply his doctrine more eX= tenfively in difeafes; efpecially in fevers. 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Tranflated from the Latin of John Baptift Morgagni, Chief Profeffor of Anatomy; Manchefter Infirmary and Lunatic Hofpital, 2 vol. IIS Firft Lines of the Theory and Praétice of Philofophical Chemiftry. By John Berkenhout, M. D. 8vo, with Plates, 6d AnaThe deates and Caufes of Difafesinvefigated by tomy, in five Books; containing a great Variety of Dif fcétions with Remarks. Tranflated from the Latin of John Baptift Morgagni, Chief Profeffor of Anatomy; --- Page 404 --- 14 BOOKS PRINTED FOR CADELL AND DAVIES. and Prefident of the Univerfity of Padua By Benjamin Alexander, M. D. 3. vol. 4t0, Il 16s A full and plain Account of the Gout; from whence will be clearly feen the Folly, or the Balenefs, of all Prctenders to the Cure of it: in which every Thing material by the beft Writers on that Subjeét, is taken notice of, and accompanied with fome new and important Inftructions for its Relief; which the Author's Experience in the Gout, above thirty Years, has induccd him to impart. By Ferdinando Warner, LL. D. 3d Edit. 55 A Treatifc upon Gravel and on Gout, in which their Sources and Connexion are afcertained; with an Examination of Dr. Auftin's Theory ofStone, and other Critical Remarks. A Differtation on the Bile, and its Concretions; and an Enquiry into the Operations of. Solvents. By Murray Forbes, Member of the Surgeons Company, 6s An Account of the Efficacy of the Aqua Mephitica Alkalina ; or, Solution of fixed Alkaline Salt, faturated with fixable Air, in Calculous Diforders, and other Complaints ofthe Urinary Paffages. By W. Falconer, M. D. F. R. S. Phyfician to the General Holpital at Bath. 4th Edit. 3s An Enquiry into thc Nature, Caufes, and Method of Curc of Nervous Diforders. By Alexander Thompfon, M. D. 2S A new Enquiry into the Caufcs, Symptoms, and Cure of Putrid and Inflammatory Fevers, &c. &c. By Sir William Fordyce, M.I D. 4s Difeouries on the Nature and Cure of Wounds. I. OfGenerals: of procuring Adhefion, Wounded Arteries, Gun-fhot Wounds, Wounds with Sword, &cc. the Medical Treatment of Wounds. II. Of Particulars: : of Wounds of the Breaft, Wounds of the Belly, fitching an Inteftine, Wounds of the Head, Wounds of the Throat. IIl. Of dangerous Wounds oftne Limbs. Of the Queftion of Amputation. By John Bell, Surgeon, I vol. Royal 8vo, 75 6d in Boards. * * * In this Book are contained all thofc Accidents of Praéticeand leffer Operations which do not belong to a Syften of Surgery, but which, as thcy occur more frequently, are the more important. This Book, itis hoped, will be found particularly ufeful to Country Surgeons, and to Young Men entering into the Army and Navy. Engravings explaining the Anatomy of the Bones, Muf- the Queftion of Amputation. By John Bell, Surgeon, I vol. Royal 8vo, 75 6d in Boards. * * * In this Book are contained all thofc Accidents of Praéticeand leffer Operations which do not belong to a Syften of Surgery, but which, as thcy occur more frequently, are the more important. This Book, itis hoped, will be found particularly ufeful to Country Surgeons, and to Young Men entering into the Army and Navy. Engravings explaining the Anatomy of the Bones, Muf- --- Page 405 --- - Ve P4 PRINTED FOR CADELL AND DAVIES. 15 BOOKS Defcriptions. By John cles, and Joints, with copious in Boards Bell, Surgeon, 4t0, Cafes il IS and Obfervations in Midwifery. A Colleétion of M. D. 3 vol. with Cuts, 111 1S By Wm. Smellie, &c.c. PHILOSOPHY, MATHEMATICS, MECHANICS, Elements of the Philofophy of the Profeffor Human of Mind. Moral 1NZ Dugald Stewart, F. R. S. Edin. 4to, lofophyin the Univerfity of Edinburgh. Sir Iiaac s PrinAftronomy inade explained eafy to upon thofe who have not ftudied the. ciples, and By laincs Fergufon, F. R. S. IlluftraMathematics. A new Edit. Svo, 9S ted with 28 Introduction Copperplates. to Aftronomy, for young GentleAn eafy Ladies, fame. 3d Edit, 5s men and bythe in, 6 Sedlions, by the An Introduéion to Eleétricity, fame. Illuftrated with Plates, 4S Mechanics, Hydroftatics, Leêtures on Seleét Subjeôtsin with the Ufe of the Globes, Pneumatics, and Optics, and the Caleulation of the Mcan the Art of Dialling, Moons and Eclipfes, by the fame, Times of New andFull 75 6d Mcchanical Exercifes, fhewing how to conftruét Seleét Clocks, Orreries, and Sun 1- Dials, on plain and diffcrent &cc. &c. By the fame. With Coppercafy Principles, fhort Account of the Life ofthe Author, 5s plaies, and a Payments: on Schemes Oblervations Annuities on Reverfionary to Widows, and to Perfons in old for granting the Method of finding the Value of Affurances Ages on and on the National Debt. on Lives and Survivorfhip; new Tables of the Probabilities of To which are added, the different Rates of Human MorLife; and Effays on Situations, 8cc. Sc. By Richard Price, tality in F.R.S. different A new Edit. 2 vol. 8vo, 15S D.D. Do&trine of Annuities and Affurances on Lives The ftated and explained. By William and Survivorfhip, A8tuary to the Society for Equitable Affurances Morgan, Lives and Survivorfhips, 8vo, 6s on BOTANY, GARDENING, &c. AGRICULTURE, Farmer; or, a General Diationary of The Complete its Branches; containing thc various Hufbandry in cultivating all and improving every Species of Methods of the of both the old and new Land according to Precepts Thing valuable in the beft Hufbandry; comprifing every with a grcat Variety of Writers on the Subjedt : together for Equitable Affurances Morgan, Lives and Survivorfhips, 8vo, 6s on BOTANY, GARDENING, &c. AGRICULTURE, Farmer; or, a General Diationary of The Complete its Branches; containing thc various Hufbandry in cultivating all and improving every Species of Methods of the of both the old and new Land according to Precepts Thing valuable in the beft Hufbandry; comprifing every with a grcat Variety of Writers on the Subjedt : together --- Page 406 --- 16 BOOKS PRINTED FOR CADELL AND DAVIES. new Difcoverics and Improvements. 4th Edit. confiderably enlarged, and greatly improved, By a Society of Gentlemen, Members of the Society for the Encouragement of Arts, Manufaétures, and Commerce. With a great Number of Plates, Folio, 21 2S Praâtical Efays on Agriculture: containing an Account of Soils, and the Manner of corredting them ; an Account of the Culture ofall Field Plants, including the Artificial Graffes, according to the old and new Modcs of Huibandry, with every Improvement down to the fent Period; alfo an Account of the Cultureand INELRE ment of Grafs Lands; together with Oblervations on Inclofures, Fenccs, Farms, Farm -houfes, &c. Carefully colleéted and digefted from the moft eminent Authors, with experimental Remarks. By James, Adam, Efq. 2 v. 14S Every Man his own Gardener; being a new and much more complete Gardener's Calendar than any hitherto publifhed; containing not only an Account of what Work 1S neceffary to be done in the Hot-Houfe, Green-Houfe, Shrubbery, Kitchen, Flower, and Fruit-Gardens, for every Month in the Year, but alfo ample Dircalions for performing the faid Work according to, the neweft and moft approved Methods now in Praétice amongft thc beft Gatdeners. By Thomas Mawe, Gardener to his Grace the Duke of Leeds; and othcr Gardeners. 6th Edit. 5S An Introduétion to Botany; containing an Explanation of the Theory of that Science, and an Interpretation of its Technical Terms; extraéted from the Works of Dr. Linneus, and calculated to affift fuch as may be defirousofitudying thc Author's Method andImprovements. With Plates. 3d Edit, with a Gloflary, and other Additions. By James Lee, 75 6d Synopfis of the Natural Hiftory of Great Britain and Ircland: containing a Syftematic Arrangement and concifc Defeription of all the Animals, Vegetables, and Foffils, which have hitherto been difeoveredin thefe Kingdoms. By John Berkenhout, M. D. 2d Edit. 2 vol. 12S Clavis Anglica Lingua Botanice; or, a Botanical Lexicon. In which the Terms of Botany, particularly thofe occurring in the Works of Linnzeus, and other modern Writers, are applied, derived, explained, contrafted, and exemplified, by John Berkenhout, M. D. 2d Edit. 6s Hiflorical and Biographical Sketches of the Progrefs of Botany in England, from its Origin to the Introduétion of the Linnaan Syftem. By Richard Pulteney, M. D. F.R.S. 2 vol, 12s w7lo Fte --- Page 407 --- --- Page 408 --- --- Page 409 --- --- Page 410 --- --- Page 411 --- D797 M 479e --- Page 412 ---