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G<r^*^p>S&
MEDICAL
INQUIRIES
AND
OBSERVATIONS.
By BENJAMIN R U S tt, M. D.
Professor of the Institutes of Medicine, and of Clinical Practice in the Universitt
OF PENNSYLVANIAr
VOLUME IL
PHILADELPHIA
PRINTED BY T. DOBSON, AT THE STONE-HOUSE, NO. 4 1, SOUTH SECOND- STREET.
? r? /!
<C&AaAdy A—
CONTENTS.
\. /IN inquiry into the influence of phyfual
caufes upon the moral faculty ', i
II. An inquiry into the effects offpirituous li- quors upon the human body, and their influ- ence upon the happinefs of fociety, 57
III. An inquiry into the caufes and cure of the pulmonary confumption, 83
IV. Obfervations on the fymptoms and cure of dropfies, 161
V. An inquiry into the caufes and cure of the internal drop fy of 'the brain , 199
VI. An account of the meafles, as they appear- ed in Philadelphia, in the year 1789, 229
VII. An account of the influenza, as it appear- ed in Philadelphia, in the years 1789,
1790, and 1 79 1, 245
VIII. An inquiry into the caufes of the increafe of bilious and remitting fevers, in Pennfyl- vania, 263
IX. An inquiry into the caufes and cure of fore legs, 2j S
X. An account of the fiate of the body and mind in old age, with obfer vat ions upon its
dif cafes and their remedies, 293
PREFACE.
THE candid reception of a fmall volume of Inquiries and Obfervations, publiih- ed in the year 1788, has encouraged me to offer a fecond to the public, with the fame ti- tle. Three of the inquiries were publifhed feveral years ago ; two * of them in pam- phlets, and the third f in the fecond volume of the American Philofophical Transactions. They are now republifhed, in their prefent form, at the requeft of feveral of my friends, with the addition, chiefly, of a few notes,
I am aware of the fate of every attempt to introduce new opinions into medicine. My apology for this aftempt in fome of the fol- lowing effays is, that I believe the want of fuccefs in the treatment of thcfe difeafes
which
* The inquiry into the influence of phyfical caufes on the moral faculty, and the inquiry into the influence of fpj. rituous liquors upon the human body, &c.
f The inquiry into the caufes of the increafe of hi and intermitting fevers in Pennfylvania.
ii PREFACE.
which are thought to be incurable, is occafi- oned, in mod cafes, by an attachment to fuch theories as are imperfect or erroneous. I do not lay, by a want of theory altogether, for it is impolnble for a phyfician feo prefcribe, without a theory of fome kind. I believe further, after all that has been faid againft theory, and in favour of fimple obfcrvation in medicine, that uniform and complete fuc- cefs can never be attained, but by combining with obfervation a perfect knowledge of all the caufes of difeafes. Perhaps it wrould be equally juft to afiert, that obfervation will always be extenfive, accurate, and ufeful, in proportion as it is directed by principles in medicine.
I ii ave one more excufe to offer for my temerity in propofmg the new opinions which are contained in the following inquiries, and that is, they were not fought for, but obtru- ded upon me, and that too in fpite of a con-* vlction of the certain lofs of reputation which fellows a change of opinion upon any fubjeel: ; for 1 well knew the world was not difpofed to admit as a j unification of this change, that
it
PREFACE, iii
it is always the neceffary efFecl: of the difco- very or adoption of new truths ; and that lia- bility in principles and pra&ice, in an imper- feci: fcience, is, for the mod part, the effecl: of a timid or flothful perfeverance in ignorance or error.
In departing in fome things from the fy- ftem of Dr. Cullen, in which 1 was educated, I do not relinquifh the whole of his princi- ples, much lefs do I rejecl indifcriminately the fyftems of authors, whether ancient or modern, of lefs reputation. Truth in medi- cine, as far as it has been difcovered, like truth in religion, appears to exift in greater or lefs proportions in different fyftems ; but the fabric which mail include a knowledge of the caufes and cure of every difeafe, remains yet to be completed, by an application to its unfi- nifhed parts, of the iuccelTive labors of Phy- ficians in generations, or perhaps ages, yet to come.
Had I yielded to perfonal confiderations, I mould have kept thefe papers a few years longer from the public eye, in order that they
i anight
iv PREFACE.
might have become more correct from the influence which time alone exerts upon all literary performances ; but I have preferred at every hazard, fending them thus early into the world, from a defire that my opinions and practice may be corrected, or fupported, by the auxiliary obfetvations and reafonings of my medical brethren ; and that feveral formidable difeafes may thereby be oppofed, not by an individual only, but by the confe- derated exertions of men of different talents, and fituations, in every part of the republic of medicine.
I had another reafon for committing thefe E flays to the prefs, in their prefent immature \ and that was, I have obferved freedom in thinking, to be neceflfarily connected with freedom in communicating the refult of in- quiries after truth. I confider this volume therefore, with all its imperfections, as a pledge of equal boldnefs, and I hope, of more fuccefs, in all future inveftigations.
Phil a del phi ta Atb July, 1793-
A N
INQUIRY
INTO THE INFLUENCE OF PHYSICAL CAUSES UPON THE MORAL FACULTY,
DELIVERED BEFORE THE
AMERICAN PHILOSOPHICAL SOCIETY,
Held in Philadelphia, on the 2 7th of February, 1786.
GENTLEMEN,
I" T was for the landable purpofe of exciting a fpi- rit of emulation and enquiry, among the mem- bers of our body, that the founders of our fociety, inflituted an annual oration. The talk of prepa- ring, and delivering this exercife, hath devolved, once more, upon me. I have fubmitted to it, not becaufe I thought myfelf capable of fulfilling your intentions, but becaufe I wiilied, by a teftimony of my obedience to your requefts, to atone for my long abfence from the temple of fcience.
The fubjecl: upon which I am to have the honor
of addreffing you this evening, is " An enquiry in-
Vol. II. A « to
2 INFLUENCE OF PHYSICAL CAUSE!
" to the influence of phyfical caufes upon the mo- ral faculty."
By the moral faculty I mean a power in the hu- man mind of diftinguifhing and chufing good and evil, or in other words, virtue and vice. It is a native principle, and though it be capable of im- provement by experience and reflection, it is not derived from either of them. St. Paul, and Ci- cero, ^ive us the moft perfect account of it that is to be found in modern or ancient authors. " For " when the Gentiles, (fays St. Paul) which have " not the law, do by nature the things contained " in the law, thefe, having not the law, are a law " unto themfelves ; which fhew the works of the
" law written in their hearts, their coiifLJenceS alfo
" bearing witnefs, and their thoughts the mean " while accufing, or elfe excufing another."*
The words of Cicero are as follow — " Eft igi- " tur hasc, judices, non fcripta, fed nata lex, quam " non didicimus, accepimus, legimus, verum ex na- " tura ipfa arripuimus, haufimus, expreflimus, ad " quam non do6H, fed facti, nou inftituti, fed imbuti " fumus."f This faculty is often confounded with - fcience, which is a diftincl and independent power of the mind. This is evident from the paflage
quoted
* Rom i. 14.15. f Oratio pro Milonc.
UPON THE MORAL FACULTY. 3
quoted from the writings of St. Paul, in which confeience is faid to be the witnefs that accufes or excufes us, of a breach of the law written in our hearts. The moral faculty is what the fchoolmen call the " regula regulans," — the confeience is their " regula regulata." Or, to fpeak in more modern terms, the moral faculty performs the office of a law- giver, while the bufmefs of confeience is to perform the duty of a judge. The moral faculty is to the confeience, what tafte is to the judgment, and fenfation to perception. It is quick in its opera- tions, and like the fenfative plant, acts without re- flection, while confeience follows with deliberate fteps, and meafures all her actions, by the unerring fquare of right and wrong. The moral faculty exercifes itfelf upon the actions of others. It ap- proves even in books, of the virtues of a Trajan, and difapproves of the vices of a Marius, while confeience confines its operations, only to its own actions. Thefe two powers of the mind are gene- rally in an exact ratio to each other, but they fometimes exift in different degrees in the fame per- fon. Hence we often find confeience in its full vigor, with a diminifhed tone, or total abfence of the moral faculty.
It has long been a queftion among metaphyfici-
ans, whether the confeience be feated in the will
©r in the underftanding. The controverfy can on-
K2 \y
4 Influence of physical causes
\y be fettled by admitting the will to be the feat oF the moral facility, and the undertlaadiug to be the feat of the confeknee. The myflcrious nature of the union of thofe two moral principles with the will and underftanding. is a fubje& foreign to the buiinefs of the prefent enquiry. —
As I confider virtue and vice to confjfliu ad:hny and not in opinion, and as this a&ion has its feat in the will, and not in the confeience. I lhall confine my enquiries chiefly to the influence of phyfica! caufes upon that moral power of the mind, which is connected with volition, although many of thefe caufes acl: likewife upon the conscience, as I mail fhew hereafter.— The flate of the moral fa- culty is viubie Id actions, which a3ecl the well-be- ing of fociety. The ftare of the confeience is in- viiible, and therefore removed beyond our invefti- gation.
The moral faculty has received different names from different authors. It is the c< moral fenfe" of Br. Hutchifon — the " fympathy" of Dr. Adam Smith — the " moral inftincV of RouiTeau — and " the light that Hghteth every man that cometh in- to the world" of St John. I have adopted the term of moral raculty from Dr. Beanie, becaufe I conceive it conveys with the mod perfpicuity, the
idea
UPON THE MORAL FACULTY. 5
idea of a power in the mind, of chufing good and evil.
Our books of medicine contain many records of
the effects of phylical caufes upon the memory —
the imagination — and the judgment. In fome in-
ftances we behold their operation only on one,—
in others on two, — and in many cafes upon the
whole of thefe faculties. Their derangement has
received different names, according to the number
or nature of the faculties that are affected. The
lofs of memory has been called " amnesia" — falfe
judgement upon one fubject. has been called " me-
" lancholia" — falfe judgement upon all fubjecte has
been called " mania" — and a defect of all the three
intelle&ual faculties that have been mentioned, has
received the name of " amentia." Perfons who
labour under the derangement, or want of thefe
powers of the mind, are confidered, very properly,
as fubjects of medicine ; and there are many cafes
upon record that prove, that their difeafes have
yielded to the healing art.
In order to illuftrate the effects of phyflcal caufes upon the moral faculty, it will be necef- fary firjl to (hew their effects upon the memory — the imagination and the judgment; and at the fame time to point out the analogy between their opera- tion
6 INFLUENCE OF PHYSICAL CAUSES
tion upon the intellectual powers of the mind, and the moral faculty.
i. Do we obferve a connection between the intellectual powers, and the degrees of confiftency and firmnefs of the brain in infancy and child- hood ? — The fame connection has been obferved between the ftrength as well as the progrefs of the moral faculty in children.
2. Do we obferve a certain fize of the brain, and a peculiar caft of features, fuch as the pro- minent eye, and the aquiline nofe, to be connected with extraordinary portions of genius ? — We ob- ferve a fimilar connection between the figure and temperament of the body, and certain moral facul- ties.— Hence, we often afcribe good temper and benevolence to corpulency, and irafcibility to fanguineous habits. Casfar thought himfelf fafe in the friendfliip of the " fleek-headed" Anthony and Dolabella; but was afraid to truft to the pro- feflions of the flender Caffius.
3. Do we obferve certain degrees of the intel- tectual faculties to be hereditary in certain fa- milies ? The fame observation has been frequently extended to moral qualities — Hence we often find certain virtues and vices as peculiar to families, through all their degrees of confanguinity, and
duration,
UPON THE MORAL FACULTY. 7
duration, as a peculiarity of voice— complexion— or fhape.
4. Do we obferve inftances of a total want of memory — imagination—and judgment, either from an original defect in the ftamina of the brain, or
from the influence of phyfical caufee ? The
fame unnatural defect is fometimes obferved, and probably from the fame caufes, of a moral faculty. The celebrated Servin whofe character is drawn by the Duke of Sully in his Memoirs, appears to be an inftance of the total abfence of the moral faculty, while the chafm, produced by this defect, feems to have been filled up by a more than com- mon extenfion of every other power of his mind. I beg leave to repeat the hiftory of this prodigy
of vice and knowledge. " Let the reader re-
" prefent to himfelf a man of a genius fo lively, and " of an underftanding fo extenfive,as rendered him " fcarce ignorant of any thing that could be known " —of fo vafl and ready a comprehenfion, that he " immediately made himfelf matter of whatever " he attempted— and of fo prodigious a memory, " that he never forgot what he once learned. He " pofTefled all parts of philofophy, and the ma- " thematics, particularly fortification and drawing. " Even in theology he was fo well Ikilled, that " he was an excellent preacher, whenever he had
a mind
8 INFLUENCE OF PHYSICAL CAUSES
" a mind to exert that talent, and an able difput-
" ant, for and againft the reformed religion indif-
" ferently. He not only underflood Greek — He-
" brew— and all the languages which we call
" learned, but alfo all the different jargons, or " modern dialects. He accented and pronounced
" them fo naturally, and fo perfectly imitated the " geftures and manners both of the feveral nations " of Europe, and the particular provinces of " France, that he might have been taken for a " native of all, or any of thefe countries : and this <c quality he applied to counterfeit all forts of per- " fons, wherein he fucceeded wonderfully. He " was moreover the bed comedian, and the greateft " droll that perhaps ever appeared. He had a ge- " nius for poetry, and had wrote many verfes. " He played upon almoft all inftruments— was'a " perfect matter of mufic — and fung mod agree - " ably and juflly. He likewife could fay mafs, " for he was of a difpofition to do, as well as to " know, all things. His body was perfectly well " fuited to his mind. He was light, nimble, and " dexterous, and fit for all exercifes. He could cc ride well, and in dancing, wreflling, and leap- " ing, he was admired. There are not any re- " creative games that he did not know, and he
" was /killed in almoft all mechanic arts. But
(i now for the reverfe of the medal. Here it ap-
" peared,
UPON THE MORAL FACULTY. 9
" peared, that he was treacherous— cruel- «cow- « ardly — deceitful — a liar— a cheat — a drunkard " and a glutton — a {harper in play — immerfed in " every fpecies of vice — ablafphemer — an atheift.
u In a word, in him might be found all the
" the vices that are contrary to nature — honour- — " religion — and fociety, — the truth of which he " himfelf evinced with his latefl breath ; for he " died in the flower of his age, in a common bro- " thel, perfectly corrupted by his debaucheries, " and expired with the glafs in his hand, curfmg, " and denying God*."
It was probably a (late of the human mind fuch as have been defcribed, that our Saviour alluded to in the difciple, who was about to betray him, when he called him " a devil. "Perhaps the effence of depravity in infernal fpirits,confi(ls in their being wholly devoid of a moral faculty. In them the will has probably loft the power of chufing f, as well as the capacity of enjoying moral good.lt is true, we read of their trembling in a belief of the exiilenceof z God, and of their anticipating future punifhment
by
* Vol. III. p. 216. 217.
t Milton fccms to have been of this opiuion. Hence, after afcribing repentance to Satan, he makes him declare, " Farewell remorfe : all good to me is loft,
41 Evil, be thou my good.''
Paradise Lcst, Eeok IV
10 INFLUENCE OF PHYSICAL CAUSES
by aflcing, whether they were to be tormented be- fore their time : But this is the eiFeft of confci- ence, and hence anfes anoiher argument in favour of this judicial power of the mind, being diftincl: from the moral faculty. It would feem as if the Supreme Being had prefeived the moral faculty in man from the ruins of his fall, on purpofe to guide him back again to Paradife, and at the fame time had conftituted the confcience, both in men and in fallen fpirits, a kind of royalty in his moral empire, on purpofe to (hew his property in all in- telligent creatures, and their original refemblance to himfelf. Perhaps the eiTence of moral depra- vity in man confiils in a total, bv.t temporary fuf- penfion of the power of confcience. Perfons in this fituation are emphatically faid in thefcriptures to be " pafl feeling" — and to have their confei- ences feared, with a " hot iron" — they are likewife faid to be " twice dead" — that is, the fame torpor or moral infenfibility, has feized both the moral faculty and the cor.fcience.
5. Do we ever obferve inftances of the exigence of only one of the three intellectual powers of the mind that have been named, in the abfence of the other two ? We obferve fomething of the fame kind with refpect to the moral faculty. I once knew a man, who discovered no one mark of rea-
fon
UPON THE MORAL FACULTY. II
fon, who poffefTed the moral fenfe or faculty in fo high a degree, that he fpent his whole life in acts of benevolence, He was not only inofFenfive, (which is not always the cafe with idiots) but he was kind and affectionate to every body. He had no ideas of time, but what were fuggefted to him by the returns of the dated periods for public wor- ship, in which he appeared to take great delight. He fpent feveral hours of every day in devotion, in which he was (o careful to be private, that he was once found in the mod improbable place in the world for that purpofe, viz. in an oven.
6. Do we obferve the memory, the imagina- tion and the judgment, to be affected by difeafes, particularly by fevers and madnefs ? Where is the phyfician, who has not feen the moral faculty af- fected from the fame caufes ! How often do we fee the temper wholly changed by a fit of Gck- nefs ! And now often do we hear perfons of the mod delicate virtue, utter fpeeches in the delirium of a fever, that are offenfive to decency, or good manners ! I have heard a well atteded hiftory of a clergyman of the mod exemplary moral charac- ter, who fpent the lad moments of a fever which deprived him both of his reafon and his life, in profane curfing and fwearing. I once attended a young woman in a nervous fever, who difcovered
after
12 INFLUENCE OF PFIYSICAL CAUSES
after her recovery, a lofs of her former habit of veracity. Her memory (a defect of which, might be fufpe&ed of being the caufe of this vice) was in ever)' refpeel: as perfect as it was before the at- tack of the fever*. The infiances of immorality in maniacs, who were formerly diftinguifhed for the oppofite character, are fo numerous, and well known, that it will not be neceifary to felecl: any cafes, to eftablifli the truth of the proportion con- tained under this head,
7. Do we obferve any of the three intellectual powers that have been named, enlarged by dif- eafes ? Patients in the delirium of a fever, often difcover extraordinary flights of imagination, and madmen often aftonim us with their wonderful acts of memory. The fame enlargement, fome- times, appears in the operations of the moral fa- culty. I have more than once heard the mofl fublime difcourfes on morality in the cell of an hof- pital, and who has not feen inftances of patients in acute difeafes, difcovering degrees of benevo- lence
* I have felc&ed this cafe from many others, which have come under my notice, in which the moral faculty appeared to be impaired by difeafes, particularly by the typhus of Dr Cullen, and by thofe fpecicsof pal fy which affect the brain.
UPON THE MORAL FACULTY. I J
lence and integrity, that were not natural to them in the ordinary courfe of their lives ?*
8. Do we ever obferve a partial infanity, or falfe perception on one fubjecl, while the judg- ment is found and correct, upon all others ? We perceive, in fome inflances, a fimilar defect in the moral faculty. There are perfons who are moral "in the higheft degree, as to certain duties, wh© neverthelefs live under the influence of fome one •vice. I knew an inftance of a woman, who was ex- emplary in her obedience to every command of the moral law, except one. She could not refrain from flealingr. What made this vice the more remark- able was, that {he was in eafy circumflances, and not addicted to extravagance in any thing. Such was her propeniity to this vice, that when fne could lay her hands upon nothing more valuable, fhe would often, at the table of a friend, fill her pockets fecretly with bread. As a proof "that her judgment was not affected by this defecl: in her moral faculty, fhe would both confefs and lament her crime, when detected in it.
9. Do
* Xenophon makes Cyrus to declare, in his lad moments, <( That the foul of man at the hour of death appears mcfi <c divine, and then fcrefees fomething of future e-yents.^
X 4 INFLUENCE OF PHYSICAL CAUSES
9. Do we obferve the imagination in many in- ftances to be affected with apprehcnfions of dan- gers that have no exiftence ? In like manner we obferve the moral faculty to difcover a fenfibility to vice, that is by no means proportioned to its de- grees of depravity. How often do we fee perfons labouring under this morbid fenfibility of the mo- ral faculty, refufe to give a direct anfwer to a plain qucftion, that related perhaps only to the wea- ther, or to the hour of the day, left they fhould wound the peace of their minds by telling a falfe- hood !
10. Do dreams affect the memory — the imagin- ation— and the judgment ? Dreams are nothing but incoherent ideas, occafioned by partial or im- perfect fleep. There is a variety in the fufpenfion of the powers of the mind in this flate of the fyf- tem. In fome cafes the imagination only is de- ranged in dreams — in others the memory is affect- ed and in others the judgment. But there
are cafes, in which the change that is produced in the ftate of the brain, by means of fleep, affects the moral faculty likewife ; hence we fometimes dream of doing and faying things when afleep, which we fhudder at, as foon as we awake. This fuppofed defection from virtue, exifts frequently m dreams where the memory and judgment are
fcarcely
UPON THE MORAL FACULTY. 15
fcarccly impaired. It cannot therefore be afcribed to the defertion of thofe two powers of the Blind. *-
ii. Do we read, in the accounts of travellers, of men, who in refpect of intellectual capacity and enjoyments, arc but a few degrees above brutes ? We read likewife of a fimilar degradation of our fpecies, in refpecl: to moral capacity and feeling. Here it will be neceffary to remark, that the low degrees of moral perception, that have been difco- vered in certain African and Ruffian tribes of men, no more invalidate our proportion of the univerfal and effential exigence of a moral faculty in the human mind, than the low ftate of their intellects prove, that rcafon is not natural to man. Their perceptions of good and evil are in an exact pro- portion to their intellectual powers. But I will go further, and admit with Mr. Locke*, that fome favage nations are totally devoid of the moral fa- culty, yet it will by no means follow, that this was the original conflitution of their minds. The appetite for certain aliments is uniform among all mankind. Where is the nation and the individual, in their primitive ftate of health, to whom bread is not agreeable ? But if we fliould find favages, or
indivi-
* Eflay concerning the Human Under/landing, Book T. Chap. HI.
l6 INFLUENCE OF PHYSICAL CAUSES
individuals, whofe ftomachs have been fo diforder- cd by intemperance, as to refufe this fimple and wholefome article of diet, fliall we afTert, that this was the original conftitution of their appetites ?— By no means. As well might we afTert, becaufe favages deflroy their beauty by painting and cut- ting their faces, that the principles of tafte do not exid naturally in the human mind. It is with vir- tue as with fire. It exifts in the mind, as fire does in certain bodies in a latent or quiefcent (late. As collifion renders the one fenfible, fo education fenders the other vifible. It would be as abfurd to maintain, becaufe olives become agreeable to many people from habit, that we have no natural appetites for any other kind of food, as to afTert that any part of the human fpecies exifl without a moral principle, becaufe in fome of them, it has wanted caufes to excite it into action, or has been perverted by example. There are appetites that are wholly artificial. There are taftes fo entirely vitiated, as to perceive beauty in deformity. There are torpid and unnatural paflions. Why, under certain unfavourable circumftances, may there not cxifh alfo a moral faculty, in a flate of fleep, or fubject to miftakes ?
The only apology I fliall make, for prefuming to
cBIFer from that juftly-celebrated oracle, who firft
2 unfolded
UPON THE MORAL FACULTY. 1J
unfolded to us a map of the intelle&ual world, {hall be, that the eagle eye of genius often darts its views beyond the notice of facts, which are accommodated to the {lender organs of percep- tion of men, who poffefs no other talent than that of obfervation.
It is not furprifmg, that Mr. Locke has con- founded this moral principle with reafon^ or that Lord Shaftfbury has confounded it with tofte, fince all three of thefe faculties agree in the objects of their approbation, notwithftanding they exifl in the mind independent of each other. The fa- vorable influence which the progrefs of fcience and tafte has had upon the morals, can be afcribed to nothing elfe, but to the perfect union that fub lifts in nature between the dictates of reafon — of tafte — and of the moral faculty. Why has the fpirit of humanity made fuch rapid progrefs for fome years pad in the courts of Europe ? It is be- caufe kings and their minifters have been taught to reafon upon philofophical fubjects. — Why have indecency and profanity been baniftied from the ftage in London and Paris ? It is becaufe immo- rality is an offence againft the highly cultivated tafte of the French and Englifh nations.
It muft afford great pleafure to the lovers of virtue, to behold the depth and extent of this
B moral
l8 INFLUENCE OF PHYSICAL CAUSES
moral principle in the human mind. Happily for the human race, the intimations of duty and the road to happinefs are not left to the flow opera- tions or doubtful inductions of reafon, nor to the precarious decifions of tafle ! Hence we often find the moral faculty in a flate of vigor, in perfons in whom reafon and tafte exifl in a weak, or in an uncultivated flate. It is worthy of notice like- wife, that while fecond thoughts are befl in mat- ters of judgment, jirft thoughts are always to be preferred in matters that relate to morality. Se- cond thoughts, in thefe cafes, are generally parlies between duty and corrupted inclinations. Hence Rouffeau has juftly faid, that " a well regulated moral inflinct is the furefl guide to happinefs."
It muft afford equal pleafure to the lovers of virtue to behold, that our moral conduct: and hap- pinefs are not committed to the determination of a
Angle legiilative power. The confcience, like
a wife and faithful legiflative council, performs the ofRce of a check upon the moral faculty, and thus prevents the fatal confequences of immoral actions.
An objection, I forefee, will arife to the doc- trine of the influence of phyfical caufes upon the moral faculty, from its being fuppofed to favor the
opinion
UPON THE MORAL FACULTY. 1 9
opinion of the materiality of the foul. But I do not fee that this doctrine obliges us to decide upon the queftion of the nature of the foul, any more than the facts which prove the influence of phyfi- cal caufes upon the memory — the imagination — or the judgment. I (hall, however remark upon this fubjecc, that the writers in favor of the im- mortality of the foul have done that truth great in- jury, by connecting it necefiarily with its immateri- ality. The immorrality of the foul depends upon the ivill of the Deity, and not upon the fuppcfed properties of fpirit. Matter is in its own nature as immortal as fpirit. It is refolveable by heat and mixture into a variety of forms ; but it requires the fame Almighty hand to annihilate it, that it did to create it. I know of no arguments to prove the immortality of the foul, but fuch as are de- rived from the Chriftian revelation1*. It would be as reafonable to aflfert, that the bafon of the ocean is immortal, from the greatnefs of its capa- city to hold water ; or that we are to live for ever in this world, becaufe we are afraid of dying, as to maintain the immortality of the foul, from the greatnefs of its capacity for knowledge and hap- pinefs, or from its dread of annihilation.
B 2 I
* " Life an <J immortality a> t broaght to Irghl otify till tbcgofpd." — 2 Tim. i.
20 INFLUENCE OF PHYSICAL CAUSES
I remarked in the beginning of this difcourfe, that perfons who were deprived of the juft exer- cife of memory — imagination— or judgment, were proper fubje&s of medicine ; and that there are many cafes upon record which prove, that the difeafes from the derangement of thefe faculties, have yielded to the healing art.
It is perhaps only becaufe the diforders of the moral faculty, have not been traced to a connec- tion with phyfical caufes, that medical writers have neglected to give them a place in their fyf- tems of nofology, and that fo few attempts have been hitherto made, to lefTen or remove them by phyfical as well as rational and moral remedies.
I fhall not attempt to derive any fupport to my opinions, from the analogy of the influence of phyfical caufes upon the temper and conduct of brute animals. The Facts which I mall produce in favor of the action of thefe caufes upon morals in the human fpecies, will, I hope, render unne- ceifary the arguments that might be drawn from that quarter.
I am aware, that in venturing upon this fubjecl,
I ftep upon untrodden ground. 1 feel as iEneas
did, when he was about to enter the gates of A- vernus, but without a Sibyl to inftruct. me in the
myfleries
UPON THE MORAL FACULTY. 21
myfteries that are before me. I forefee, that men who have been educated in the mechanic.il habits of adopting popular or eftablifhed opinions, will revolt at the doctrine I am about to deliver — while men of fenfe and genius will hear my propo- rtions with candor, and if they do not adopt them, will commend that bolduefs of enquiry, that prompted me to broach them.
I {hall begin with an attempt to fupply the de- fects of nofological writers, by naming the partial or weakened action of the moral faculty, mi- cronomia. The total abfence of this faculty, I fliall call a no mi a. By the law, referred to in thefe new genera of vefanice, I mean the law of nature written in the human heart, and which I formerly quoted from the writings of St. Paul.
In treating of the effects of phyfical caufes up- on the moral faculty, it might hel-p to extend our ideas upon this fubject, to reduce virtues and vi- ces to certain fpecies, and to point out the effects of particular fpecies of virtue and vice ; but this would lead us into a field too extenfive for the li- mits of the prefent enquiry. I fhall only hint at a few cafes, and have no doubt but the ingenuity of my auditors will fupply myfilence, by applying the reft.
It
22 INFLUENCE OF PHYSICAL CAUSES
It is immaterial, whether the phyfical caufes that are to be enumerated, act upon the moral fa- culty through the medium of the fenfes — the paf- ilons — the memory — or the imagination. Their influence is equally certain, whether they aft as remote, pre-difpofmg, or occafional caufes.
i. The effects of Climate upon the moral faculty claim our firit attention. Not only indivi- duals, but nations, derive a confiderable part of their moral, as well as intellectual character, from the different portions they enjoy of the rays of the fun. Irafcibility — levity — timidity — and indolence, tempered with occafional emotions of benevo- lence, are the moral qualities of the inhabitants of warm climates, while felfidmefs tempered with fmcerity and integrity, form the moral cha- racter of the inhabitants of cold countries.— The flate of the weather, and the feafons of the year alfo, have a vifible effect, upon moral fenfibility. The month of November, in Great Britain, rendered gloomy by conftaiit fogs and rains, has been thought to favor the perpetration of the worfl fpecies of murder, while the vernal fun, in middle latitudes, has been as gene- rally
UPON THE MORAL FACULTY. 23
rally remarked for producing gentlenefs and be- nevolence.
2. The effects of Diet upon the moral faculty are more certain, though lefs attended to, than the effects of climate. " Fullnefs of bread," we are told, was one of the predifpofing caufes of the vices of the cities of the plain. The fafls fo often inculcated among the Jews, were intended to lef- fen the incentives to vice ; for pride — cruelty — and fenfuality, are as much the natural confe- quences of luxury, as apoplexies andpalfies. But the quality as well as the quantity of aliment, has an influence upon morals ; hence we find the mo- ral difeafes that have been mentioned, are mod frequently the offspring of animal food. The prophet lfaiah feems to have been fenfible of this, when he afcribes fuch falutary effects to a tempe- rate and vegetable diet. " Butter and honey mall he eat," fays he, " thai he may know to refufe
the evil, and to chufe the good.'* But we have
many facts which prove the efficacy of a vegeta- ble diet upon the paffions. Dr. Arbuthnot affures us, that he cured feveral patients of irafcible tem- pers, by nothing but a prefcription of this fnnple and temperate regimen.
t. The
£4 INFLUENCE OF PHYSICAL CAUSES
3. The effects of certian Drinks upon the moral faculty are not lefs obfervable, than upon the intellectual powers of the mind. Fermented liquors of a good quality, and taken in a mode- rate quantity, are favorable to the virtues of can ■ dor, benevolence and generofity ; but when they are taken in excefs, or when they are of a bad quality, and drank even in a moderate quantity, they feldom fail of roufing every latent fpark of vice into action. The laft of thefe facts is fo noto- rious, that when a man is obferved to be ill-natur- ed or quarrelfome in Portugal, after drinking, it is common in that country to fay, that " he has drank bad wine." While occafional fits of in- toxication produce ill temper in many people, ha- bitual drunkennefs (which is generally produced by diftilled fpirits) never fails to eradicate veraci- ty and integrity from the human mind. Perhaps this may be the reafon why the Spaniards, in an- cient times, never admitted a man's evidence in a court of juftice, who had been convicted of drun- kennefs. Water is the univerfal fedative ©f tur- bulent pailions — it not only promotes a general equanimity of temper, but it compofes anger. I have heard feveral well-attefted cafes, of a draught of cold water having fuddenly compofed this vio- lent paflion, after the ufual remedies of reafon had been applied to no purpofe.
4. Ex-
UPON THE MORAL FACULTY. 25
4. Extreme Hunger produces the mod un- friendly effects upon moral fenfibility. It is imma- terial, whether it acts by inducing a relaxation of the folids, or an acrimony of the fluids, or by the combined operation of both thofe phyfical caufes. The Indians in this country whet their appetites for that favage fpecies of war, which is peculiar to them, by the dimulus of hunger; hence, we are told, they always return meagre and emaci- ated from their military excurfions. In civilized life we often behold this fenfation an overbalance for the redraints of moral feeling ; and perhaps this may be the reafon, why poverty, which is the mod frequent parent of hunger, difpofes fo gene- rally to theft ; for the character of hunger is taken from that vice — It belongs to it " to break through Hone walls." So much does this fenfation predo- minate over reafon and moral feeling, that Cardi- nal de Retz fuggefts to politicians, never to riik a motion in a popular afTembly, however wife or juft it may be, immediately before dinner. — That temper mud be uncommonly guarded, which is not didurbed by long abdinence from food. One of the worthied men I ever knew, who made his breakfad his principal meal, was peevifh and difa- greeable to his friends and family, from the time he left his bed, till he fat down to his morning re- pad, after which, chearfulnefs fparkled in his
countenance,
0.6 INFLUENCE OF PHYSICAL CAUSES
countenance, and he became the delight of all around him.
5. I hinted formerly, in proving the analogy between the effects of diseases upon'the intel- lects, and upon the moral faculty, that the latter was frequently impaired by fevers and madnefs. I beg leave to add further upon this head, that not only fevers and madnefs, but the hyfleria and hypochondriacs, as well as all thofe dates of the body, whether idiopathic or fymptomatic, which are accompanied with preternatural irritability — fenfibiiity — torpor— ftupor— or mobility of the nervous fyftem, difpofe to vice, either of the body or of the mind. It is in vain to attack thefe vices with lectures upon morality. They are only to be cured by medicine, — particularly by exer- cife, — the cold bath, — and by a cold or warm at- mofphere. The young woman, whofc cafe I men- tioned formerly, that loft her habit of veracity by a nervous fever, recovered this virtue, as foon as her fyftem recovered its natural tone, from the cold weather which happily fucceeded her fever*.
6. Idleness
-'■' There is a morbid ftate of excitability in the body during the convalefcence from fever, which is intimately connected with an undue propeniity to venereal pkafurcs. I have met with feveral inftaiicc:; of it. The marringe of the cele- brated
UPON THE MORAL FACULTY. 2J
6. Idleness is the parent of every vice. It is mentioned in the Old Teftamcnt as another of the the predifpofmg caufes of the vices of the cities of the plain. Labor of ail kinds, favors and facili- tates the practice of virtue. The country life is a happy life ; chiefly, becaufe its laborious employ- ments are favourable to virtue, and unfriendly to vice. It is a common practice, I have been told, for the planters in the Southern States, to conngn a houfe flave, who has become vicious from idle- nefs, to the drudgery of the field, in order to re- form him. The Bridewells and workhoufes of all civilized countries prove, that labor is not only
a very
brated Mr. Howard to a woman who was twice as old as him- felf, and very fickly, has been afcribed by his biographer, Dr. Aiken, to gratitude for her great attention to him in a fit of ficknefs. I am difpofed to afcribe it to a fudden pa- roxyfm of another paflion, which as a religious man, he could not gratify in any other, than in a lawful way. I have heard of two young clergymen who married the women who had nurfed them in fits of ficknefs. In both cafes there was great inequality in their years, and condition in life. Their motive was, probably, the fame as that which I have attributed to Mr. Howard. Dr. Patrick Hutfel takes notice of an uncommon degree of venereal excitability which fol- lowed attacks of the plague at Medina, in 1743, ul a^ r^nks of people. — Marriages, he fays, were more frequent after it than ufual, and virgins were, in fome inflances violated, who died of that diforder, byperfbns who hadjufl re from it.
2$ INFLUENCE OF PHYSICAL CAUSES
a very fevere, but the mod benevolent of all pu- nifhments, in as much as it is one of the mod fuit- able means of reformation. Mr Howard tells us in his Hiflory of Prifons, that in Holland it is a common faying, u Make men work and you will make them honed." And over the rafp and fpin- houfe atGrceningen, this fentiment is exprefTed (he tells us) by a happy motto :
" Vitiorum femina — otium — laborc exhauriendum."
The efFe&s of deady labor in early life, in creating virtuous habits, is dill more remarkable. The late Anthony Benezet of this city, whofe benevolence was the fentinel of the virtue, as well as of the happinefs of his country, made it a condant rule in binding out poor children, to avoid putting them into wealthy families, but always preferred ma- tters for them who worked themfelves, and who obliged thefe children to work in their prefence. If the habits of virtue, contra&ed by means of this apprenticefhip to labor, are purely mechanical, their efte&s are, neverthelefs, the fame upon the happinefs of fociety, as if they flowed from prin- ciple. The mind, moreover, when preferved by thefe means from weeds, becomes a more mellow foil afterwards, for moral and rational improve- ment.
7. The
UPON THE MORAL FACULTY. 20,
7. The effects of excessive sleep are intimate- ly connected with the effects of idlenefs upon the
moral faculty, hence we find that moderate,
and even fcanty portions of fleep, in every part of the world, have been found to be friendly, nor only to health and long life, but in many inflances to morality. The practice of the Monks, who of- ten fleep upon a floor, and who generally rife with the fun, for the fake of mortifying their fenfual ap- petites, is certainly founded in wifdom, and has of- ten produced the moflfalutary moral effects.
8. The effects of bodily pain upon the mo- ral, are not lefs remarkable than upon the intel- lectual powers of the mind. The late Dr Gregory, of the univerfity of Edinburgh, ufed to tell his pupils, that he always found his perceptions quick- er in a fit of the gout, than at any other time. The pangs which attend the diffoluticn of the body, are often accompanied with conceptions and expreffions upon the moft ordinary fubjects, that difcover an uncommon elevation of the intellectual powers. The effects of bodily pain are exactly the fame in roufmg and directing the moral facul- ty. Bodily pain, we find, was one of the reme- dies employed in the Old Teftament, for extirpat- ing vice and promoting virtue : and Mr Howard tells us, that he faw it employed fuccefsfully as a
means
30 INFLUENCE OF PHYSICAL CAUSES
means of reformation, in one of the prifons which he vifited. If pain has a phyiical tendency to cure vice, I fubm.it it to the confideration of parents and legiflators, whether moderate degrees of cor- poral punifhments, inflicted for a great length of time, would not be more medicinal in their effects, than the violent degrees of them, which are of fhort duration.
9. Too much cannot be faid in favour of Cleanliness, as a phyfical means of promoting virtue. The writings of Mofes have been called by military men, the bed cc orderly book" in the world. In every part of them we find cleanlinefs inculcated with as much zeal, as if it was part of the moral, inflead of the levitical law. Now, it is well-known, that the principal defign of every pre- cept and rite of the ceremonial parts of the Jew- ifh religion, was to prevent vice, and to promote virtue. All writers upon the leprofy, take notice of its connection with a certain vice. To this dif- eafe grofs animal food, particularly fwine's fiefh, and a dirty ikin, have been thought to be predifpo- fmg caufes— - hence the reafon, probably, why pork was forbidden, and why ablutions of the body and limbs were fo frequently inculcated by the jewifh law. Sir John Pringle's remarks, in his Oration upon Captain Cook's Voyage, deli- vered
UPON THE MORAL FACULTY. 31
vered before the Royal Society in London, are
very pertinent to this part of our fubjecl:.
" Cleanlinefs (fays he) is conducive to health, but " it is not fo obvious, that it alfo tends to good or- " der and other virtues. Such (meaning the iriip's " crew) as were made more cleanly, became more " fober, more orderly, and more attentive to " duty." The benefit to be derived by parents and fchoolmafters from attending to thefe facts, is too obvious to be mentioned.
10. I hope 1 mall be excufed in placing So- litude among the phvfical caufes which influ- ence the moral faculty, when I add, that I confine its effects to perfons who are irreclaimable by ra- tional or moral remedies. Mr Howard informs us, that the chaplain of the prifon at Liege in Germany allured him, " that the mod rrfra&ory C! and turbulent fpirits, became tractable andfub- " mifflve, by being clofely confined for four or five " days." — In bodies that are predifpofed to vice, the (limulus of cheerful, but much more of pro- fane fociety and conversation, upon the animal fpi- rits, becomes an exciting caufe, and like the ftroke of the flint upon the (leel, renders the fparks of vice both a£tive and vifiblc. By removing men out of the reach of this exciting caufe, they are often re- formed, especially if they are confine d long enough 4 to
32 INFLUENCE OF PHYSICAL CAUSES
to produce a fufficient chafm in their habits of vice. Where the benefit of reflection, and indru&ion from books, can be added to folitude and confine- ment, their good effects are dill more certain. To this philofophers and poets in every age have af- fented, by defcribing the life of a hermit as a life of paflive virtue.
1 1. Connected with folitude, as a mechanical means of promoting virtue, Silence deferves to be mentioned in this place. The late Dr Fother- gill, in his plan of education for that benevolent inditution at Ackworth, which was the lad care of his ufeful life, fays every thing that can be faid in favour of this necelfary difcipline, in the follow- words. " To habituate children from their early " infancy, to filence a nd attention, is of the great- " eft advantage to them, not only as a preparative " to their advancement in a religious life, but as " the groundwork of a well cultivated under- " (landing. To have the active minds of children " put under a kind of reftraint — to be accuftomed " to turn their attention from external objects, " and habituated to a degree of abdracted quiet, " is a matter of great confequence, and lading be- " nefit to them. Although it cannot be fuppofed, cc that young and active minds are always engaged " in filence as they ought to be, yet to be accuf- 2 fcJ domed
UPON THE MORAL FACULTY. 33
<c tomed thus to quietnefs, is no fmall point gained " M towards fixing a habit of patience, and recollec- w tion, which feldom forfakes thofe who have " been properly inftructed in this entrance of the " fchool of wifdom, during the refidue of their " days."
FoRthe purpofe of acquiring thisbranch of educa- tion, children cannot affociate too early, nor too often with their parents, or with their fuperiors in age, rank, and wifdom.
1 2. The effects of mufic upon the moral ficulty, have been felt and recorded in every country. Hence we are able to difcover the virtues and vi- ces of different nations, by their tunes, as certainly as by their laws. The effects of mufic, when fim- ply mechanical, upon the pafiions, are powerful and extenfive. Bat it remains yet to determine the degrees of moral ecftafy, that may be produ- ced by an attack upon the ear, the reafon, and the moral principle, at the fame time, by the com* bined powers of mufic and eloquence.
13. The eloquence of the pulpit is nearly allied to mufic in its effects upon the moral faculty. It is true, there can be no permanent change in the temper, and moral conduct, of a man, that is not derived from the underftanding and the will ; but Vol. IT. C we
34 INFLUENCE OF PHYSICAL CAUSES
we mud remember, that thefe two powers of the mind are moil available, when they are attacked through the avenue of the pafllons ; and thefe, we know, when agitated by the powers of eloquence, exert a mechanical action upon every power of the foul; Hence we find in every age and country, where chrlltianity has been propagated, the mod accomplished orators have generally been the mod fuccefsful reformers of mankind. There mud be a defect of eloquence in a preacher, who with the refources for oratory, which are contained in the Old and New Tcdaments, does not produce in every man who hears him, at lead a temporary love of virtue. I grant that the eloquence of the pulpit alone, cannot change men into chridians, but it certainly poffeiTes the power of changing brutes into men. Could the eloquence of the ftagehe properly directed, it is impoifible to con- ceive the extent of its mechanical effects upon mo- rals. ri he language and imagery of a Shakefpeare, upon moral and religious fubjects, poured upon the pafllons and the fenfes, in all the beauty and va- riety of dramatic reprefentation ! Who could refid, or d.fcribe their effects ?
14. Odors of various kinds have been obferv- cd to act in the mod fenfible manner upon the mo- ra1 faculty. Brydone tells us, upon the authority of a celebrated philofopher in Italy, that the pecu- liar
UPON THE MORAL FACULTY. $$
liar wicke Jnefs of the people who live in the neigh- bourhood of iEtna and Vefuvius, is occafioned chiefly by the fmell of the fulphur and of the hot exhalations which are confbnt'y difcharged from thofe volcanos. Agreeable odors, feldom Fail to infpire ferenity, and to compofe the angry fpirits — Hence the pleafure, and one of the advantages of a flower garden. The fmoke of tobacco is likewife of a compofing nature, and tends not only to pro- duce what is called a train in perception, but to hufli the agitated paiTions into filence and order — Hence the propriety of connecting the pipe or fe^ gar and the bottle together, in public company.
1 5. It wrill be fufficient only to mention light and
darknefs, to fugged facts in favor of the influence of each of them upon moral fenfibility. How of- ten do the peevifh complaints of the night in fick- nefs, give way to the compofing rays of the light of the morning ? Othello cannot murder Defde^ inona by candle-light, and wrho has not felt the effects of a blazing fire, upon the gentle pafhons ?
16. It is to be lamented, that no experiments have as yet been made, to determine the effects of all the different fpecies of Airs, which chemiflry has lately difcovered, upon the moral faculty. I have authority, from actual experiments, only to declare, that Dephlogifticated Air, when taken in- C 2 to
$6 INFLUENCE OF PHYSICAL CAUSES
to the lungs, produces cheerfulnefs, gentlenefs, and ferenity ofmind.
17. WiiATfliall we fay of the effecls of Medi- cines upon the moral faculty ? That many fubftances in the materia medica act upon the intellects, is well known to phyficians. Why mould it be thought impoffible for medicines, to act in like manner up- on the moral faculty ? May not the earth contain in its own bowels, or upon its furface, antidotes ? But I will not blend facts with conjectures. Clouds and darknefs ftill hang upon this part of my fub- ject.
Let it not be fufpected from any thing that I have delivered, that I fuppofe the influence of phy- fical caufes upon the moral faculty, renders the agency of divine influence unneceflary to our mo- ral happinefs. I only maintain, that the opera- tions of the divine government are carried on in the moral, as in the natural world, by the inftru- mentality of fecond caufes. I have only trodden in the footfteps of the infpired writers ; for moft of the phyfical caufes I have enumerated, are con- nected with moral precepts, or have been ufed as the means of reformation from vice, in the Old and New Teftaments. To the cafes that have been mentioned I (hall only add, that Nebuchad- nezzar was cured of his pride, by means of folkude
and
UPON THE MORAL FACULTY. $7
and a vegetable diet. — Saul was cured of his evil fpirit, by means of David's harp, and St. Paul ex- prefsly fays, " I keep my body under, and bring " it into fubjection, left that by any means, when I " have preached to others, I myfclf ihould be a " caft-away." But 1 will go cne ftep further, and add in favor of divine influence upon the moral principle, that in thofc extraordinary cafes, where bad men are faddenly reformed, without the in- ftrumentality of phyfical, moral, or ratio a! caufe, 1 believe that the organization of thofc parts of the body, which form the link that binds it to the foul, undergoes a phyfical change ;* and hence the ex- prefTion of a " new creature," which is made ufe of in the fcriptures to denote this change, is pro- per in a literal, as well as a figurative fenfe. It is probably the beginning of that perfect renovation of the human body, which is predicted by St Paul in the following words — " For our converfation " is in heaven, from whence we look for the Savi-
" our,
* St. Paul was fuddenly transformed from a perfecutor into a man of a gentle and amiable fpirit. The mariner in which this change was affected upon his mind, he tells us in the following words — " Neither circumcifion availeth " any thing, nor uncircumcifion, but a new creature. — " From henceforth let no man trouble me ; for I bear in l*my body, the marks of our Lord Jelus." Galatians, vi. 15- n.
3§ INFLUENCE OF PHYSICAL CAUSES
" our, who mall change our vile bodies, that they " may be fafhioned according to his own glorious " body." I mall not paufe to defend myfelf againft the charge of enthufiafm in this place ; for the age is at length arrived, fo devoutly wifhed for by Dr. Cheyne, in which men will not be de- terred in their refcarches after truth, by the ter- ror of odious or unpopular names.
I cannot help remarking under this head, that if the conditions of thofe parts of the human body which are connected with the human foul, influence morals, the fame reafon may be given for a virtu- ous education, that has been admitted for teaching mufic and the pronunciation of foreign languages, in the early and yielding (late of thofe organs, which form the voice and fpeech. Such is the effect of a moral education, that we often fee its fruirs in advanced flages of life, after the religious principles which were connected with it, have been renounced ; juft as we perceive the fame care in a furgeon in his attendance upon patients, after the fympathy which firft- produced this care, has ceaf- ed to operate upon his mind. Theboafted moral- ity of the Deifts, is I believe, in moft cafes, the off- fpring of habits, produced originally by the prin- ciples and precepts of Chriftianity. Hence appears the wildom of Solomon's advice — " Train up a
" child
UPON THE MORAL FACULTY. 39
11 child in the way he fhould go, and when he is " old he will not," I had almoft faid, he cannot " depart from it."
Thus have I enumerated the principal caufes', which aft mechanically upon morals. If from the combined action of phyfical powers that are opno- fed to each other, the mural fa u fy fhould become ftationary, or if the vinue or vice produced by them, (hould form a neutral quality, obmpofed of both of them, I hope it will not call in queftion the truth of our general proportions. I have only mentioned the effects of phyfical caufes in afimple date.*
It might help to enlarge our ideas upon this fubject, to take notice of the influence of the dif- ferent ftages of fociety, of agriculture and com- merce, of foil and fituation, of the different degrees of cultivation of tafte, and of the intellectual pow- ers, of the different forms of government, and laft- ly, of the different profeffions and occupations of mankind, upon the moral faculty ; but as tnefe act.
indirectly
* The do&rine of the influence of phyfical caufes on mo- rals is happily calculated to beget charity towards the fail- ings of our fellow creatures. Our duty to practife this, (it is true) is enforced by motives drawn from fciences, as well as from the precepts of chriftianity.
4® Influence of physical causes indireclly only, and by the intervention of caufes that are unconnected with matter, I conceive they are foreign to the bufinefs of the prefent enquiry. If they fhould vary the action of the fimple phyfi- cal caufes in any degree, I hope it will not call in queflion the truth of our general proportions, any more than the compound action of phyfical powers, that are oppofed to each other. There remain on- ly a few more caufes which are of a compound nature, hut fo nearly related to thofe, which are purely mechanical, that I {hall beg leave to trefpafs upon your patience, by giving them a place in my oration.
The effe&s of imitation, habit and affociation upon morals, would furnifh ample matter for inve- lligation. Confidering how7 much the fhape, tex- ture, and conditions of the human body, influence morals, I fubmit it to the confideration of the in- genious, whether in our endeavours to imitate moral examples, fome advantage may not 'be deri- ved, from our copying the features and external manners of the originals. What makes the fuc- cefs of this experiment probable is, that wre gene- rally find men, wrhofe faces refcmble each other, have the fame manners and difpofirions. I infer the polfibility of fuccefs in an attempt to imitate originals in a manner that has been mentioned, from the facility with which domeftics acquire a
refemblance
UPON THE MORAL FACULTY. 41
refemblance to their matters and miftreffes, not on- ly in manners, but in countenance, in thofe cafes where they are tied to them3 by refpeS, and auc- tion.— Hufbands and wives alio where they pof- fefs the fame fpecies of face, under circurnftances of mutual attachment, often acquire a refemblance to each other.
From the general deteftaticn in which hypecri- fy is held both by good and bad men, the mechani- cal effects of habit upon virtue, have not been furn- ciently explored. There are, I am perfuaded, ma- ny inftances where virtues have been afTumed by accident, or necefhty, which have become real from habit, and afterwards derived their nounfhrnent from the heart. Hence the propriety of Hamlet's advice to his mother —
" AfTume a virtue, if you have it not, " That monfter, cuflom, who all fenfe doth eat-, " Of habits evil, is angel, yet in this, " That to the ufe of actions fair and geod, w He likewife gives a frock or livery, " That aptly is put on — Refrain to-night3 Ci And that mall lend a kind of eafmefs, Ci To the next abftinc ce ; the next more eafy, cc For ufe can almoil change the ftamp e " tnre,
" And
4 2 INFLUENCE OF PHYSICAL CAUSES
" And maftcr even the devil, or throw him out, " With wondrous potency."
The influence of Association upon morals, opens an airple field for enquiry. It is from this principle, that we explain the reformation from theft and drunkenncfs in fcrvants which we fome- times fee produced by a draught offpirits in which tartar emetic had beeri fecretly diilblved. The recollection of the pain and ficknefs excited by the emetic, naturally afTociates itfelf with the fpi- rits, fo as to render them both equally the objects of averfion. It is by calling in this principle only, that we can account for the conduct of Mofes, in grinding the golden calf into a powder, and afterwards diffolviflg it (probably by means of hepar fulphuris) in water, and compelling the children of Ifrael to drink of it, as a puniiliment for their idolatry. This mixture is bitter and nau- feating in the higher! degree. An inclination to idolatry, therefore, could net be felt without be- in^ aflbciated with the remembrance of this difii- greeable mixture, and of courfe being rejected, with equal abhorrence. The benefit of corporal puniflunents, when they are oi a fliort duration, depends in part up their being connected by time and place, with the crimes for which they are in- flicted. Quick as the thunder follows the light-
niu i
UPON THE MORAL FACULTY. 43
ning, if it were poffible, mould punifhments fol- low the crimes, and the advantage of affociation would be more certain, if the (pot where they were committed, were made the theatre of their expiation. It is from the eiTe&s of this aiTociation, probably, that the change of place and company produced by exile and traiifportation, has fo ofi reclaimed bad men, after moral — rational — and phyfical means of reformation had been ufed to no purpofe.
As Sensibility is the avenue to the moral fa- cultv, every thing which tends to diminish it tends
alfo to injure morals. The Romans owed much
of their corruption to the fights of the contefts of their gladiators, and of criminals, with wild beads. For ihefe reafons, executions mould never be pub- lic. Indeed, I believe there are no public punifh- ments of any kind, that do not harden the hearts of fpectators, and thereby leflen the natural horror which all dimes at iirit excite in the human
..d.
Cruelty to brute animals is another means of deftroying moral fenfibility. The ferocity of ra- vages has been afcribed in part to their pecul mode of fubfiilence. Mr. Hogarth points cut in his ingenious prints, the connection between cru- elty to brute animals in youth, and murder
hood.
44 INFLUENCE OF PHYSICAL CAUSES
hood. The Emperor Domirian prepared his mind by the amufement of killing flies, for4 all thofe bloody crimes which afterwards difgraced his reign. I am fo perfectly fatisfied of the truth of a a connection between morals, and humanity to brutes, that I (hall find it difficult to reftrain my idolatry for that legiflature, that fhall firfl eftablifh a fyftem of laws, to defend them from outrage and opprefiion.
In order to preferve the vigor of the moral fa- culty, it is of the utmoff. confequence to keep young people as ignorant as pofnble of thofe crimes, that are generally thought mod difgraceful to human na- ture. Suicide, I believe, is often propagated by means of news-papers. For this reafon, I fliould be glad to fee the proceedings of our courts kept from the public eye, when they expofe, or puniih monflrous vices.
The laft mechanical method of promoting mo- rality that I ihali mention, is to keep fenfibility alive, by a familiarity with fcenes of diftrefs from poverty and difeafe. Companion never awakens in the human bofom, without being accompanied by a train of filler virtues — hence the wife man juftly remarks, that " By the fadnefs of the coun- tenance, the heart is made better."
A
UPON THE MORAL FACULTY. 45
A late French writer in his prediction of events that are to happen in the year 4000, fays " That <; mankind in that sera (hall be fo far improved by " religion and government, that the fick and the " dying, ftiall no longer be thrown together with " the dead, into fplendid houfes, but lhall be re- " lieved and protected in a connection with their " families and Society." For the honor of humanity, an inditution * deftined for that diftant period, has lately been founded in this city, that lhall perpetuate the year 1786 in the hiftory of Pennsylvania. Here the feeling heart — the tearful eye — and the cha- ritable hand, may always be connected together, and the name of Sympathy, inftead of being extin- guiflied in taxes, or expiring in a Solitary blaze by a Single contribution, may be kept alive, by con- ftant exerciSe. There is a neceffary connection be- tween animal Sympathy and good morals. The pried and the levite, in the New Teftament, would probably have relieved the poor man who fell among thieves, had accident brought them near enough to his wounds. The unfortunate Mrs. Bellamy was refcued from the dreadful pur- pofe of drowning herfelf, by nothing but the dif- treSs of a child, rending the air with its cries for
bread
A Public Difpenfary.
46 INFLUENCE OF PHYSICAL CAUSES
bread. It is probably owing in forae meafure td the connexion between good morals and fympathy that the fair fex in every age, and country, have been more diftinguifhed for virtue, than men — i for how feldom do we hear of a woman, devoid cf humanity ?
Lastly, Attraction, Composition, and Decomposition, belong to the p.ifTions as well as to matter. Vices of the fame fpecies attract each other with the mod force — hence the bad confequences of crouding young men (whofe pro- pensities are generally the fame) under one roof, in our modern plans of education. The effects of compofition and decomposition upon vices, appear in the meannefs of the fchool-boy, being often cured by the prodigality of a military life, and by the precipitation, of avarice, which is often pro- duced by ambition and love.*
If
* A citizen of Philadelphia had mad* many nnfuccefsful attempts to cure his wife of drinking ardent fpirits. At length, defpairing of her reformation j he purchafed a hogf- head of rum, and after tapping it, left the key in the door where he had placed it as if he had forgotten it. His de- fign Was to give he? an opportunity of deftroying herfelf, by drinking as much as fne pleafed. The woman fufp'Cted this to be his defign — and fuddenly left off drinking. An- ger here became the ntidore of intemperance*
UPON THE MORAL FACULTY. 47
If phyfical caufes influence morals in the man- ner we have defcribed, may they not alfo influence religious principles and opinions ? — I anf.ver in the affirmative ; and I have authority, from the records of phyfic, as well as from my own obferva- tions, to declare, that religious melancholy and madnefs, in all their variety of fpecies, yield with more facility to medicine, than fimply to polemical difcourfes, or to cafuiflical advice. — But this fub- ject is foreign to the bufinefs of the prefent en- quiry.
From a review of our fubjecl, we are led to contemplate with admiration, the curious ftruo ture of the human mind. How diftindr. are the number, and yet how united ! How fubordinate and yet how coequal are all its powers ! How wonderful is the action of the foul upon the body ! Of the body upon the foal ! — And of the divine fpirit upon both ! What a myftery is the mind of
man to itfelf ! O ! nature ! — Or to
fpeak more properly, O ! thou God of
Nature ! In vain do we attempt to fc;ui
thy immenfity, or to comprehend thy various modes of exhtence, when a tingle particle of light ifnied from thyself, and kindled into intelligence in thebofom of man, thus dazzles and confounds oar underftandin^s !
The
48 INFLUENCE OF PHYSICAL CAUSES
The extent of the mora! powers and habits in man is unknown. It is not improbable, but the human mind contains principles of virtue, which have never yet been excited into action. We be- hold with furprife the versatility of the human bo- dy in the exploits of tumblers and rope-dancers* Even the agility of a wild beaft has been demon- strated in a girl in France, and an amphibious na- ture has been difcovered in the human fpecies, in a young man in Spain. We lifren with aftonim- ment to the accounts of the memoirs of Mithri- dates, Cyrus, and Servin. We feel a veneration bordering upon divine homage, in contemplating the ilupendous understandings of Lord Verulam and Sir Ifaac Newton ; and our eyes grow dim, in attempting to purfue Shakefpeare and Milton in their imtneafurable flights of imagination. And if the hiftory of mankind does not furnifh fimilar in- uances of the verfatility and perfection of our fpe- cies in virtue, it is becaufe the moral faculty has been the fuhject of lefs culture and fewer experi- ments than the body, and the intellectual powers of the mind. From what has been faid, the rea- fon of this is obvious. Hitherto the cultivation of the moral faculty has been the bnfinefs of pa- rents, fchoolmafters and divines*. But if the 2 princi-
* The people common':/ called Oiiakers and the " Iciho-
difti,
UPON f HE MORAL FACULTY. 49
principles, we have laid down, be juil, the im- provement and extenfion of this principle mould be equally the bufinefs of the legiflator— the na- tural philofopher— and the phyfician ; and a phy- fical regimen fhould as necefTarily accompany a moral precept, as directions with refpect to the air — exercife— and diet, generally accompany pre- fcriptions for the confumption, and the gout. To encourage us to undertake experiments for the improvement of morals, let us recollect the fuc- cefs of philofophy in lerTening the number, and mitigating the violence of incurable difeafes. The intermitting fever, which proved fatal to two of the monarchs of Britain, is now under abfolute fubjection to medicine. Continual fevers are much lefs fatal than formerly. The fmall-pox is difarmed of its mortality by inoculation, and even the tetanus and the cancer have lately re- ceived a check in their ravages upon man- Vol. IL D kind.
difts, make ufe of the greateft number of phyfical remedies in their religious and moral discipline, of any feels of Chris- tians— and hence we find them every where diltinguifhed for their good morals. There are feveral excellent phyfical inftitutions in other churches ; and if they do not produce the fame moral effects, that we obferve from phyfical infli- tutions among thofe two modern feds, it mail be afcribed to their being more neglected by the members of thof* clmrches.
L 'J^R ASW/luencI of physical causes
&«&? 181feut m^jfcine has done more — It has Dentn'^^:(^K deep and gloomy abyfs of " rf^atla acquired frefh honours in his cold embraces. Witnefs the many hundred peo- ple who have lately been brought back to life, by the furcefsful efforts of the humane focieties, which are now eftablifhed in many parts of Eu- rope, and in fome parts of America. Should the fame induftry and ingenuity, which have produced thefe triumphs of medicine over difeafes and death, be applied to the moral fcience, it is highly probable, that mofl of thofe baneful vices, which deform the the human bread:, and convulfe the nations of the earth, might be baniflied from the world. I am not fo fanguine as to fuppofe, that it is poflible for man to acquire fo much perfection from fcience, religion, liberty and good govern- ment, as to ceafe to be mortal ; but I am fully perfuaded, that from the combined action of caufes, which operate at once upon the reafon, the moral faculty, the pafhons, the fenfes, the brain, the nerves, the blood and the heart, it is pofTible to produce fuch a change in his moral character, as fiiall raife him to a refemblance of angels — nay more, to the likenefs of God himfelf.
■ The State of Pennfylvania frill deplores the
lofs of a man, in whom not only reafon and reve- lation,
UPON THE MORAL FACULTY. jl
lation, but many of the phyfical eaufes that have been enumerated, concurred to produce fuch at- tainments in moral excellency, as have feldom ap- peared in a human being. This amiable citizen, confidered his fellow creature, man, as God's ex- tract, from his own works; and whether this image of himfelf, was cut out from ebony cr copper— whether he fpoke his own, or a foreign language— or whether he worfhipped his Maker with ceremonies, or without them, he ftill confi- dered him as a brother, and equally the object of his benevolence. Poets and hiitorians, who are to live hereafter, to you L commit his panegyric ; and when you hear of a law for abolifhing ilavery in each of the American States, fuch as was parTed in Pennfylvania, in the year 1780 — when you hear of the kings and queens of Europe, publifh- ing edicts for abolifhing the trade in human fouls — and laflly, when you hear of fchools and chur- ches with all the arts of civilized life, being efta- bliflied among the nations of Africa, then remem- ber and record, that this revolution in favour of human happinefs, was the effect of the labours — the publications — the private letters_and the pray- ers of Anthony Benezet-.—
D 2 I RE-
* This worthy man was defcended from an ancient and
honourable
52 INFLUENCE OF PHYSICAL CAUSES
I return from this digreffion, to addrefs my- felf in a particular manner to you, venerable sages and fellow citizens in the republic of letters. — The influence of philofophy, we have been told, has already been felt in courts. To increafe, and complete this influence, there is nothing more neceflary, than for the numerous
literary
honourable family that nourimed in the court of Lewis the XIV. With liberal profpects in life, he early devoted him- felf to teaching an Englifh fchool ; in which, for induftry, capacity and attention to the morals and principles of the youth committed to his care, he was without an equal. He published many excellent tracts againft the African trade, againft war, and the ufe of fpirituous liquors, and one in fa- vour of civilizing and chriftianifing the Indians. He wrote to the queen of Great Britain, and the queen of Portugal, to ufe their influence in their refpecliive courts to abolifh the African trade. He alfo wrote an affectionate letter to the king of Pruffia, to difuade him from making war. The hiftory of his life affords a remarkable inftance how much ic is poflible for an individual to accomplim in the world ; and that the mod humble ftations do not preclude good men from the mofl exteniive ufefu'nefs. He bequeathed his eftate (after the death of his widow) to the fnpport of a fchool for the education of negro children, which he had founded and taught for feveral years before he died. He departed this life in May 1784, in the 7 rft year of his age, in the meridian of his ufefulnefs, univerfally lamented by perfons of all ranks and denominations.
/
UPON THE MORAL FACULTY. 5$
literary focieties in Europe and America, to add the science of morals to their experiments and enquiries. The godlike fcheme of Henry the IV. of France, and of the illuftrious Queen Elizabeth of England, for eftabli (hing a perpetual peace in Europe, may be accomplished without a fyftem of jurifprudence, by a confederation of learned men, and learned focieties. It is in their power, by mul- tiplying the objects of human reafon, to bring the monarchs and rulers of the world, under their fub- jection, and thereby to extirpate war — flavery — and capital punifhments, from the lift of human evils. Let it not be fufpe&ed that I detract by this declaration, from the honour of the chriftian reli- gion. It is true — Chriftianity was propagated without the aid of human learning ; but this was one of thofe miracles, which was neceffary to efta- blifh it, and which, by repetition, would ceafe to be a miracle. They mifreprefent the chriftian re- ligion, who fuppofe it to be wholly an internal re- velation, and addreiled only to the moral powers of the mind. The truths of Chriftianity afford the greateft fcope for the human understanding, and they will become intelligible to us, only in propor- tion as the human genius is ftretched by means of philofophy, to its utmoft dimenfions. Errors may be oppofed to errors ; but truths, upon all fubjecls,
mutual!/
54 INFLUENCE OF PHYSICAL CAUSES
mutually fupport each other. And perhaps one reai'on, why fome parts of the Chriftian revelation are dill involved in obfeurity, may be occafioned by our i in per feci: knowledge of the phenomena, and laws of nature. The truths of philofophy and Chriftianity, dwell alike in the mind of the Deity, and realbn and religion are equally the offspring of his goodnefs. They mult, therefore, fland and fall together. By reafon, in the prefent inftance, I mean the power of judging of truth, as well as the power of comprehending it. Happy aera ! — When the divine and the philofopher fhall em- brace each other, and unite their labors, for the reformation and happinefs of mankind !
Illustrious councillors and senators of Pennfylvania ! * I anticipate your candid re- ception of this feeble eifort to increafe the quan- tity of virtue in our republic. It is not my bufi- nefs to remind you of the immenfe refources for greatnefs, which nature and Providence have be- ftowed upon our ftate. Every advantage which France has derived from being placed in the centre
of
* His excellency the prefilent, and fapreme executive council, and the members of the general afTembly ot Penn- fylvania, attended the delivery ot the oration, in the hall of the univeriity, by invitation from the philofophical focieiy.
UPON THE MORAL FACULTY. $$
of Europe, and whichBritain has derived from her mixture of nations, Pennfylvania has opened to her. 'But my bufinefs at prefent, is to fuggeft the means of promoting the happinefs, not the greatnefs the (late. For this purpofe, it is abfo- lutely neceffary that our government, which unites into one all the minds of the (late, fhould poffefs, in an eminent degree, not cnly the understanding, the paffions, and the will, but above all, the moral faculty, and the confcience of an individual. — No- thing can be politically right, that is morally wrong ; and no neceffity can ever fan&ify a law, that is contrary to equity. Virtue is the foul of a republic. To promote this, laws for the fuppreffion of vice and immorality will be as in- effectual, as the increafe and enlargement of gaols.' There is but one method of preventing crimes, and of rendering a republican form of govern- ment durable, and that is by diffeminating the feeds of virtue and knowledge through every part of the ftate, by means cf proper modes and places of education, and this can be done effectually only, by the interference and aid of the legiflature. I am fo deeply imprefTed with the truth of this opinion, that were this evening to be the lafl of my life, I would not only fay to the afylum of my anceflors^ and my beloved native country, with the
patriot
56 INFLUENCE OF PHYSICAL CAUSES
patriot of Venice, " Efto perpetua" — But I would add, as the laft proof of my affection for her, my parting advice to the guardians of her liberties, *c To eftablifh and fupport Public Schools in every part of the ftate,"
A N
INQUIRY
INTO THE
EFFECTS of SPIRITUOUS LIQUORS
UPON THE
HUMAN BODY,
And their Influence upon the HAPPINESS of SOCIETY.
A N
I N Q U I R Y, &c.
BY Spirits I mean all thofe liquors which arc obtained by diftillation from fermented jui- ces or fubftances of any kind. Thefe liquors were formerly ufed only in medicine— They now confti- tute a principal part of the drinks of many coun- tries.
Since the introduction of fpirituous liquors into fuch general ufe, phyficians have remarked that a number of new difeafes have appeared among
us,
'? A
> v I
60 EFFECTS. OF SPIRITUOUS LIQUORS ' £
us, and have defcribed many new fymptojSs as&j common to old difeafes. Spirits in their firf ope- w ration are flimulating upon the fyftem. They quicken the circulation of the blood, and, produce fome heat in the body. Soon afterwards, they become what is called fedative ; that is, they di- minifh the action of the vital powers, and thereby produce languor and weaknefs.
The effects of fpirituous liquors upon the hu- ■ man body, are fometimes flow in their appearance. A flrong conflitution, efpecially if it be affifted with conflant and hard labour, will counteract the deftrucYive effects of fpirits for many years, but in general they produce the following difeafes :
1 . AJlcknefs at thejiomach, and vomiting in the morning. This diforder is generally accompanied by a want of appetite for breakfaft. It is known by tremors in the hands, infomuch that perfons who labour under it, are hardly able to lift a tea cup to their heads, till they have taken a dofe of fome cordial liquor. In this diforder, a peculiar palenefs, with fmall red ftreaks, appear in the cheeks. The flefli of the face, at the fame time, has a peculiar fulriefs and flabbinefs, which are very different fromfound and healthy fat.
2. An
\ UPON THE HUMAN BODY. 6 1
l\ a. An univerfal dropfy. This diforder begins fW in the lower limbs, and gradually extends itferf throtalkout the whole body. I have been told that (he 'merchants in Charlcllon, South-Carolina, never%jtf the planters when fpirits have produced the firit fyniptom of this diforder upon them. It is very natural to fuppofe that induftry and virtue have become extinct in that .-man, whofe legs and feet are fwelled, from the ufe of fpirituous li- quors.
3. Obflruclion of the liver. This diforder pro- duces other difeafes, fuch as an inflammation, which fometimes proves fuddenly fatal-- the jaun- dice—and a dropfy in the belly.
4. Diabetes.
5. Pains in the limbs, accompanied by a fenfe of burning in the palms of the hands and foles of the feet. This difeafe has fometimes been called the Jamaica Rheumatifm.
6. Hoarfenefs and cough. Thefe complaints predifpofe to fatal attacks of Pneumonia Notha.
7. The Epilepfy. 8. Madnefs. 9. Palfy, and, 10. The Apoplexy, complete the group of difeafes produced by fpirituous liquors."*
I * It has heen remarked that thofe drunkards in whom a
fit
62 EFFECTS OF SPIRITUOUS LIQUORS
I do not aflert that thefe diforders are never produced by any other caufes, but I maintain that fpirituous liquors are the mod frequent caufes. of them, and that when a predifpofition to them is produced by other caufes, they are rendered more certain and more dangerous by the intemperate ufe of fpirits.
I have only named a few of the principal difor- ders which are produced by fpirituous liquors. It would take up a volume to defcribe how much other diforders natural to the human body, are in- creafed and complicated by them. Every fpecies of inflammatory and putrid fever, is rendered more frequent and more dangerous by the ufe of fpirituous liquors.
The danger to life from the difeafes which have been mentioned is well known. I do not think it extravagant therefore to repeat here, what has been often faid, that fpirituous liquors deftroy more lives than the fword. War has its intervals of deftru&ion — but fpirits operate at all times and fea- fons upon human life. The ravages of war are <? confined
fit of intoxication is terminated by fleep and ftupor, die of palfy, gout, and gravel ; while thofe in whom it terminates by copious fweats, vomitings or (tools, or by a difcharge of pale urine, pcrifli by diabetes and dropfy.
VPOtl THE HUMAN BODY, 63
confined to but one part of the human fpecies, viz. to men ; but fpirits aft too often upon per- fons who are exempted from the dangers of war by age or fex ; and billy, war deftroys only thofe perfons who allow the ufe of arms to be lawful, whereas fpirits infinuate their fatal effects among people, whofe principles are oppofed to the effu- fion of human blood.
But the effects of ardent fpirits upon the hu- man body, do not end in the deflruction of life. They derange and even deform a dead body fo as to render it a loathfome addition to the clay which conceals it from human view after death. This has been frequently demonftrated in the direction of perfons who have been deilroyed by the ufe of ardent fpirits. They harden and contract the fi- bres of the ftomach and bowels, or induce in them abfeeffes and gangrene — they produce fchirri in the vifcera — they contract the diameter of the fan- guiferous and bronchial veffels — they induce ojik •fications in the tendons, arteries, and pleura, and laflly — they produce a peculiar crifpnefs in the hair of the head, infomuch that the wig-makers in London give much lefs for it, than for the hair of fober people. «
I*
64 EFFECTS OF SPIRITUOUS LIQUORS
If we advance a ftep further and examine the effects of fpirituous liquors upon the mind, the profpect will be (till more diflreffing and terrible. Their firfl effects here, mew themfelves in the tern- per. I have conftantly obferved men who are in- toxicated in any degree with fpirits, to be peevifh and quarrelfome ; after a while they lofe by de- grees the moral fenfe* They violate promifes and engagements without fhame or remorfe. From thefe deficiencies in veracity and integrity, they pafs on to crimes of a more heinous nature. It would difhonour human nature only to name them.
The next operation of ardent fpirits is upon the under/landing. This fublime power of the mind is firfl debilitated in hard drinkers. — They difcover a torpor in every mental exertion, even when they are not under the immediate influence of fpirirs. To this debility in the underftanding fucceed the lofs of memory, and the perverfion of all the intellectual powers in melancholy and mad- nefs, and in fome cafes the total extinction of them in idiotifm.
Let us next turn our eyes from the effects of fpirits upon the body and mind, to their effects up- on property ; and here frefh fcenes of mifery open to our view. Among the inhabitants of cities, they pro- 2. duce
UPON THE HUMAN BODY. 65
ducc debts, difgrace, and bankruptcy. Among farmers, they produce idlenefs with its ufual con- fequences, fuch as houfes without windows, barns without roofs, gardens without enclofures, fields without fences, hogs without yokes, fheep without wool, meagre cattle, feeble horfes, and half clad dirty children, without principles, morals, or man- ners. This picture is not exaggerated. I appeal to the obfervations of my countrymen, whether fuch fcenes of wretchednefs do not follow the tracks of fpirituous liquors, in every part of the United States.
Thus have I in a few words pointed out the ef- fects of fpirituous liquors upon the bodies, minds, and eftates of my fellow-citizens. — Their mifchiefs may be fummed up in a few words. They fill our church-yards with premature graves, they deface the image of God in the foul, they de- range or deftroy the intellectual powers, they fill the fherifPs docket with executions, they croud our hofpitals with patients, and our jails with cri- minals, they lead to places of public ignomy and punifhment, and laftly, they people the regions— ■- but it belongs to another profefiion to (hew their terrible confequences in the future world.
After this melancholy detail of the pernicious ef- fects of fpirituou s liquors upon the body, it may not be Vol. II. E improper
66 EFFECTS OF SPIRITUOUS LIQUORS
improper to enumerate the ufual caufes which lead to their" intemperate ufe. They are, i. Expofurc to exceflive heat and cold. 2. Hard labour, dis- proportion ed to the ftrength of the body. 3. Hunger, more efpecially thofe degrees of it which have been excited by long intervals between meals.
4. Long fpeaking, or long fittings in company.
5. Smoking and chewing tobacco. 6. Taking me- dicines in ardent fpirits. 7. Breeding ficknefs.
8. Great domeftic care. I have of obferved this caufe to produce it, in feveral inftances in women.
9. Domeftic vexations, more efpecially conjugal infelicity. 1 o. The infection of company that is addicted to flrong drink. 11. Debt. 12. The corrodings of a guilty confcience ; and, 13. Soli- tude where the mind does not poffefs refources in itfelf, in books, or religion. It is remarkable that an intemperate ufe of ardent fpirits is feldom pro- duced by that grief which follows the death of relations or friends.
In the ufe of fpirits, there are certain progref-
five ftages which deferve to be mentioned. Men
begin generally by drinking them in a diluted ftate,
at dinner only. They next drink them in the fame
ftate in the afternoon and evening. In the courfe
of a few years, they call for them in the forenoon,
and foon afterwards before breakfaft, encreafing
their ftrength from time to time until they finally
drink
UPON THE HUMAN BODY. 6j
drink them in a undiluted ftate during every hour of the night. I have known feveral perfons who have palTed through all the above ftages of intem- perance, in whom the pulfe of life feemed to be fupported for feveral months before their death, only by drinking from one to two quarts of raw fpirits every night.
I (hall now proceed to combat fome prejudices in favour of the ufe of fprituous liquors.
The three occafions in which fpirits have been thought moft necefTary and ufeful are the follow- ing :
i . In very cold weather.
2. In very warm weather. And,
3. In times of hard labour.
1. There cannot be a greater error than to fuppofe that fpiruuous liquors leffen the effe£ts of cold upon the body. On the contrary, I main- tain that they always render the body more liable to be affe&ed and injured by cold. . The tem- porary warmth they produce, is always fucceeded by chillinefs. If any thing, befides warm cloath- ing and exercife, be necefTary to warm the body in cold weather, a plentiful meal of wholforae food is
E 2 a:
68 EFFECTS OF SPIRITUOUS LIQUORS
at all times fufficient for that purpofe. This, by flimulating the flomach, invigorates the whole fyftem, and thus renders it lefs fenfible of the cold.
2. It is equally abfurd to fuppofe that fpirituous liquors leffen the effects of heat upon the body* So far from it, they rather encreafe them. They add an internal heat to the external heat of the fun ; they difpofe to fevers and inflammations of the moft dangerous kind ; they produce preterna- tural fweats which weaken, inftead of an uniform and gentle perfpiration, which exhilarates the bo- dy. Half the difeafes which are faid to be produ- ced by warm weather, I am perfuaded are produ- ced by the fpirits which are fwallowed to lefTen its effects upon the fyftem.*
3-*
* " I aver from my own knowledge and cuftom (fays Dr. Mofely*) as well as the cuftom and obfervations of many- other people, that thofe who drink nothing but water, or make it their principal drink, are but little affected by the climate, and can undergo the greatefl fatigue without inconvenience. Thofe who ufe water for their common drink will never be fubject to troublefome or dangerous dif- eafes, and the only inconvenience attending water drink- f ers is, that their appetite is fo keen that they eat more than they ought."
« Rum
* Difeafes of tropical climates.
tTPON THE HUMAN BODY. 6g
3. I maintain with equal confidence, that fpiritu- ous liquors do not leffen the effects of hard labour upon the body. Look at the horfe, with every mufcle of his body fwelled from morning till night in the plough, or the team, does he make figns for fpirits to enable him to cleave the earth, or to climb a hill ? — No. He requires nothing but cool water and fubftantial food. There is nei- ther ftrength nor nourifliment in fpirituous liquors. If they produce vigour in labour, it is of a tranfi- ent nature, and is always fucceeded by a fenfe of weaknefs and fatigue. Thefe facts are founded in obfervation 5 for I have repeatedly feen thofc men perform the greatefl exploits in work both as to their degrees and duration, who never tailed fpirituous liquors,
But are there no conditions of the human bo- dy in which fpirituous liquors are required ? Yes,
there
« Rum (fays Dr. Bellf ) whether ufed habitually, mode- rately, or in exceflive quantities, in the Weft-Indies, al- ways diminifhes the ftrength of the body, and therefore renders the men more fufceptible of difeafe, and unfit for any fervice in which vigor or activity are required. "
$ Inquiry into the caufes which produce, and the means of preventing difeafes among Britifh officers, Coldicrs, and others in the Weft-Indies.
JO EFFECTS OF SPIRITUOUS LIQUORS
there are ; ill. In thofe cafes where the body has been exhaufled by any caufes, and faintnefs, or a floppage in the circulation of the blood has been produced, the fudden ftimulus of fpirits may be necefTary. In this cafe we comply flri&ly with the advice of Solomon, who confines the ufe of " ftrong drink," only to him " that is ready to pe- rifli !" and 2dly. When the body has been long expofed to wet weather, and more efpecially if cold be joined with it, a moderate quantity of fpirits is not only proper but highly ufeful to obviate debi- lity, and thus to prevent a fever. I take thefe to be the only two cafes that can occur, in which f}H- rituous liquors are innocent or neceffary.
But if we reject fpirits from being part of our drinks, what liquors (hall we fubflitute in the room of them ? For cuftom, the experience of all ages and countries, and even nature herfelf, all feem to demand drinks more grateful and more cordial than fimple water,
To this I (hall reply, by recommending in the room of fpirits, in the firft place,
i. CYDER. This excellent liquor contains a fmall quantity of fpirit, but fo diluted and blunted, by being combined with an acid and a large quan- tity of facharine matter and water, as to be per-
fe&lv
UPON THE HUMAN BODY. Jl
f e£ly inoffenfive and wholefome. It difagrees on- ly with perfons fubjecl: to the rheumatifra, but it may be rendered inoffenfive to fuch people by ex- tinguishing a red hot iron in it, or by dilutiag it with water. It is to be lamented that the late frofts in the fpring often deprive us of the fruit which affords this liquor. But the effects of thefe frofts have been in fome meafure obviated, by giving an orchard a north-weft expofure, fo as to check too early vegetation, and by kindling two or three large fires of brum and ftraw to the windward of the orchard, the evening before we expect a night of froft. This laft expedient, has in many inftan- ces within the compafs of my knowledge, preferv- ed the fruit of an orchard, to the great joy and emolument of the ingenious hufbandman.
2. BEER is a wholfome liquor compared with fpirits. The grain from which it is obtained is not liable like the apple, to be affected by froft, and therefore it can always be procured at a moderate expenfe. It abounds with nourifhment — hence we find many of the common people in Great Bri- tain, endure hard labour with no other food than a quart or three pints of this liqnor, with a few pounds of bread a-day.
3. WI NE is likewife a wholefome liquor, com- pared with fpirits. The low wines of France, I
believe
72 EFFECTS OF SPIRITUOUS LIQUORS
believe, could be drank at a lefs expence thanfpirits, in this country. The peafants in France, who drink thefe liquors in large quantities, are a healthy and fober body of people. Wines of all kinds yield, by chemical analyfis, the fame principles as cyder, but in different proportions ; hence they are both cordial and nourishing. It has been remarked, that few men ever become habitual drunkards up- on wine. It derives its relifh principally from company, and is feldom, like fpirituous liquors, drank in a chimney corner, or in a clofet. The effe&s of wine upon the temper are likewife in mod cafes, directly oppofite to thofe that were men- tioned of fpirituous liquors. It mud be a bad heart, indeed, that is not rendered more chearful and more generous, by a few glaffes of wine^
.*
4. MEL ASSES and WATER compofe an- other
* If two barrels of cyder frefh from the prefs, are boiled into one, and afterwards fermented, and kept for two or three years in a dry cellar, it affords a liquor which (accord- ing to the quality of the apple from which the cyder is made) has the tafte of Malaga or Rheniih wine. This liquor, when mixed with water, affords a very agreeable drink in fummer. I have taken the liberty to call it Pomona wine. Another me- thod of obtaining a pleafant wine from the apple; is to add to four and twenty gallons of new cyder, three gallons of a fyrup made from theexprefled juice of fweet apples. When thoroughly fermented, and kept for fome time, it becomes -fit for ufe.
UPON THE HUMAN BODY. JTf
other excellent fubftitute for fpirits. It is both cordial and nourifhing.
5. The SUGAR MAPLE tree affords a thin juice in fummer, which is cooling and refrefhing. It has long been ufed in Connecticut, for this pur- pofe in the time of harveft. The fettlers in the weftern counties of Pennfylvania and New- York, will do well to fuffer a few of the trees which yield this pleafant juice, to remain in all their fields. They may prove the means, not only of faving their children and grand-children many hundred pounds, but of faving their bodies from difeafe and death, and their fouls from mifery beyond the grave.
6. VINEGAR and WATER fweetened with fugar or melafles, is an agreeable drink in warm weather. I beg leave to recommend this whole- fome liquor to reapers in a particular manner. It is pleafant and cooling. It promotes perfpiration, and refills putrefaction. Vinegar and water con- ftituted the only drink of the foldiers of the Ro- man republic ; and it is well known that they marched and fought in a warm climate, and be- neath a load of arms that weighed 6olbs. Boaz, a wealthy farmer in Paleitine, we find, treated his reapers with nothing but bread dipped in vinegar.
Under
74 EFFECTS 0? SPIRITUOUS SPIRITS
Under this head, I fhould not negleft to recom- mend BUTTER MILK and WATER, Or SOUR MlLK
(commonly called bonneclabber) and water. It will be rendered more grateful by the addition of a little fugar. Punch is likewife calculated to leflen the effects of heat, and hard labour upon the body. The fpirit in this liquor is blunted by its union with the vegetable acid. Hence it pof- feflfes, not only the condiment parts, but mod of the qualities of cyder and wine. To render this liquor perfectly innocent and wholefome, it muft be drank iveak, in moderate quantities, and only in warm weather. Say not, that fpirits have become necelTary in harveft, from habit and the cuftom of the country. The cuftom of fwallowing this li- quid fire, is a bad one, and the habit of it may be broken. Let half a dozen farmers in a neigh- bourhood, combine to allow higher wages to their reapers than are common, and a fufficient quantity of any of the liquors I have recommended, and they may fbon abolifh the practice of giving them fpirits. They will in a little while be delighted with the good effe&s of their affociation. Their grain will be fooner and more carefully gathered into their barns, and an hundred difagreeable fcenes of ficknds and contrition will be avoided, which always follow in a greater or lefs degree the ufe of fpirituous liquors.
To
UPON THE HUMAN BODY. 75
To enable the body to fupport the wafte of its flrength by labour, the ftomach ihould be confkant- ly, but moderately, flimulated by aliment of a par- ticular kind. Labourers bear with great difficulty long intervals between their meals. They mould always eat four or five times a-day in time of har- veft, or at other feafons of great bodily exertion. The food at thefe times mould be folid, confid- ing chiefly of faked meat. The vegetables ufed with it Ihould pofTefs fome activity. Onions and garlic are of a moil cordial nature. Thefe vege- tables compofed part of the diet which enabled the Ifraelites to endure, in a warm climate, the heavy taiks impofed upon them by their Egyptian mailers. They were likewife eaten by the Roman farmers to repair the wafle of their ftrength by the toils of harveft. But further ; There are certain sweet substances which fupport the body in labour. The negroes in the Weft Indies grow fat and ftrong by drinking the juice of the fugar cane in the fea- fon of grinding it. The Jewifti foldiers were invi- gorated by occafionally eating raifms and figs. A bread compofed of wheat flour, melafles, and gin- ger, (compofing what is called ginger bread), and taken in final! quantities, during the day, is hap- pily calculated to obviate the debility which is fo apt to he brought on by labour. All thefe fub- ftances, whether of an animal or vegetable nature,
which
y6 EFFECTS OF SPIRITUOUS LIQUORS
which have been mentioned;, (hould be ufed by la- bouring people. They lefTen the neceflity for cordial drinks, and they impart equal and durable ftrength to every part of the fyfteni.
There are certain claffes of people to whom I beg leave to fuggefl a caution or two upon the ufe of fpirituous liquors.
i. Valetudinarians, efpeciallythofe who la- bour under diforders of the flomach and bowels, are very apt to fly to fpirits for relief. Let fuch people be cautious how they repeat this dangerous re- medy. I have known many men and women, of excellent characters and principles, who have been betrayed by occafional dofes of gin or brandy to eafe the cholic, into a love of fpirituous liquors, infomuch that they have afterwards fallen facri- iices to their fatal effects. The different prepara- tions of opium are a thoufand times more fafe and nmocent than fpirituous liquors, in all fpafmodic affections of the flomach and bowels. So appre- hensive am I of the danger of contracting a love for fpirituous liquors, by accufloming the flomach to their flimulus, that I think the fewer medicines ttc exhibit in fpirituous vehicles the better.
2. Some people, from living in countries fub- )c& to the intermitting fever, endeavour to fortify
themfelves
ttPON THE HUMAN £0DY. 77
themfelves againfl it by two or three glaffes of bit- ters made with fpirits every day. There is great danger of men becoming fots from this practice. Befides, this mode of preventing intermittents is by no means a certain one. A much better fecir- rity againfl them is to be found in the Jefuits bark. A tea-fpoonful of this excellent medicine taken every morning during the fickly feafon, has in many inflances preferved whole families, in the neighbourhood of rivers and mill-ponds, from fe- vers of all kinds. If Jefuits bark cannot be had, a gill or half a pint of a flrong infufion of centaury, camomile, wormwood, or rue, in water, with a little calamus mixed with it, may be taken with nearly the fame advantage as the bark, every morning. Thofe who live in a fickly part of the country, and cannot procure the bark, or any cf the bitters which have been mentioned,, I would advife to a- void the morning and evening air in the fickly months — to kindle fires in their houfes on damp days, and in cool evenings throughout the whole fummer, and to put on woollen cloih!ng about the firfl week in September. The laft part of thefe di- rections applies only to the inhabitants of the middle ftates. Thefe cautions, 1 am perfuaded, will be more effectual in preventing autumnal fe- vers than the befl preparations that can be made from bitters in fpirits.
" Men
78 EFFECTS OF SPIRITUOUS LIQUORS
3. Men, who follow profdGons that require a conftant exercife of the mind or body, or perhaps both, are very apt to feek relief from fatigue in fpirituous liquors. To fuch perfons 1 would beg leave to recommend the ufe of tea inftead of fpi- rits. This gentle flimulus, by reftoring excite- ment, removes fatigue, and invigorates the whole fyftem. I am no advocate for the general or ex- ceffive ufe of tea. When drank too ftrong, it is hurtful, efpecially to the female conftitution ; but when drank of a moderate degree of flrength, and in moderate quantities, with fugar and cream, or milk, I believe it is in general innocent, and at all times to be preferred to fpirituous liquors. An- thony Benezet, one of the mod induftrious fchool- mafters I ever knew, told me that he had been preferved from the love of fpirituous liquors by contracting a love for tea in early life. Three or four dimes taken in an afternoon, carried off the - fatigue of a whole day's labour in his fchool. This worthy gentleman lived to be 71 years of age, and afterwards died of an acute difeafe in the full exer- cife of all the faculties of his mind*.
To
* An old and intelligent fea captain, has left upon record, the following teflimony in favor of tea, coffee, and choco- late, in preference to fpirituous liquors, in fupporting the body under fatigue. " I have always obferved (fays he)
when
UPON THE HUMAN BODY. 79
To every clafs of my readers, I beg leave to fug- ged a caution againft the ufe of toddy. I acknow- ledge that I have known fome men, who, by limit- ing its ftrength conflantly by meafuring the fpirit and water, and who by drinking it only at their meals, have drunken teddy for many years without fuffering in any degree from it : but I have known many more who have been infenfibly led from drinking toddy for their conftant drink, to take drams in the morning, and have afterwards paid their lives as the price of their folly. I fhall feleft one cafe from among many, to (hew the or- dinary progrefs of intemperance in the ufe of fpi- rituous liquors. — A gentleman, once of a fair and fober character, in the city of Philadelphia, for many years drank toddy as his conftant drink* From this he proceeded to drink grog. After a while nothing would fatisfy him but flings made of equal parts of rum and water, with a little fugar. From flings he advanced to raw rum — and from
common
when failors drink tea it weans them from the thoughts erf drinking flrong liquors, aud pernicious grog, and with tea they are foon contented. Not fo, with whatever will in- toxicate, be it what it will. This has always been my re- mark. I therefore, always encouraged it without their know- ing why. Coffee has the fame good effect. Alfo cocoa, or
chocolate." Foreft's Voyage from Calcutta to ih Tyler qui
Archipelago.
L
8o EFFECTS OF SPIRITUOUS LIQUORS
common rum to Jamaica fpirits. Here he refted for a few months ; but at lad, he found even Ja- maica fpirits were not ftrong enough to warm his ftomach, and he made it a conftant practice to throw a table fpoonful of ground pepper into each glafs of his fpirits, in order (to ufe his own ex- preflion) " to take of their coldnefs." It is hard- ly neceffary to add, that he foon afterwards died a martyr to his own intemperance.
I mall conclude what has been faid of the ef- fects of fpirituous liquors with two obfervations — i. A people corrupted by ftrong drink cannot long be a free people. The rulers of fuch a com- munity will foon partake of the vices of that mafs from which they were fecreted, and all our laws and governments will fooner or later bear the fame marks of the effects of fpirituous liquors which were defcribed formerly upon individuals. I fubmit it therefore to the confideration of our rulers, whether more laws mould not be made to increafe the expenfe and lefTen the confumption of fpirituous liquors, and whether fome mark of pub- lic infamy mould not be inflicted by law upon every man, convicted before a common magiftrate ofdrunkennefs.
The fecond and Iaft obfervation I fhalloffer, is of a i ferious
UPON THE HUMAN EODY. 8 I
ferious nature. It has been remarked, that the Indians have diminiflied every where in America fince their connections with the Europeans. This has been juftly afcribed to the Europeans having introduced fpirituous liquors among them. Let thofe men, who are every day turning their backs upon all the benefits of cultivated fociety, to feek habitations in the neighbourhood of Indians, confider how far this wandering mode of life is produced by the fame caufe which has fcattered and annihilated fo many Indian tribes. Long life, and the fecure poffeilion of property, in the land of their anceftors, were looked upon as bleffings among the ancient Jews. For a fon to mingle his duft with the duft of his father, was to aft worthy of his inheritance ; and the profpecl: of this ho- nour often afforded a confolation even in death. However exalted, my countrymen, your ideas of liberty may be, while you expofe yourfelves by the ufe of fpirituous liquors to this confequence of them, you are nothing more than the pioneers, or in more flavifh terms, " the hewers of wood" of your more induflrious neighbours.
If the facts that have been dated, have produced in any of my readers, who have fuflered from the ufe of fpirituous liquors, a refolution to abftain from them hereafter, I mud beg leave to inform
Vol. II. F them,
82 EFFECTS OF SPIRITUOUS LIQUORS, &C.
them, that they rnuft leave them off fuddenly and entirely. No man was ever gradually reformed from drinking fpirits. He mud not only avoid tailing, but even fmclling them, until long habits of abflinence have fubdued his affection for them. To prevent his feeling any inconveniences from the fudden lofs of their ftimulus upon his (lomach, he mould drink plentifully of camomile or of any other bitter tea, or a few glaffes of found old wine every day. I have great pleafure in adding, that 1 have feen a number of people who have been effectually, reftored to health — to char after— and to ufefulnefs to their families an4te fociety, by fah lowing this advice.
/
A N
INQUIRY
IaTO ike
CAUSES amd CURE
OF THE
PULMONARY CONSUMPTION.
'QU0R5.
I N Q^ U I R Y, &c
TN an Effay, entitled " Thoughts on thePulmo- naryConfumption,"* I attempted to {hew that this diforder was the effect of caufes which indu- ced general debility, and that the only hope of difcovering a cure for it fhould be directed to fuch remedies as aft upon the whole fyftem. In the following inquiry, I (hall endeavour to eftablifh the truth of each of thofe opinions, by a detail of facts and reafonings, at which I only hinted in ray former effay.-
Th*
* Medical Inquiries and Obfervations.
86 PULMONARY CONSUMPTION.
The method I have chofen for this purpofe, is to deliver, and afterwards to fupport, a few gene- ral propofitions.
I fhall begin by remarking,
I. That the Pulmonary Confumption is a difeafe of debility.
This I infer, ift, From the remote and ex- citing caufes which produce it. The remote caufes are pneumony, catarrh, hxmoptyfis, rheumatifm, gout, ailhma, fcrophula, nervous and intermitting fevers, mealies, repelled humors from the furface of the body, the venereal difeafe, obftru&ed men- fes,. hidden growth about the age of puberty, grief, and all other debilitating paffions of the mind ;. hypochondriacs, improper lactation, exceffive eva- cuation of all kinds, more efpecially by ftool*, cold and damp air, external violence acting upon.
the
* J" ii" George Baker relates in the fecond volume cf the Medical Tranfactions, that Dr. Blanchard had informed Jam that he had fcen the confumption brought on ten per- fons out of ninety, by exceffive purging ufed to prepare the body for the fmall-pox. I have feen a cafe of confumption in a youth of 1 7, from the fpitting produced by the intempe- rate ufe of fe gars.
PULMONARY CONSUMPTION. 87
the body;* and finally every thing that tends directly or indirectly to impair the vigor of the fyftem.
The mofl frequent exciting caufe of confump- tion is the alternate application of heat and cold to the whole external furface of the body, bat all the remote caufes which have been enumerated, ope- rate as exciting caufes of confumption when they a<ft on previous debility. Original injuries of the lungs feldom induce this diforder except they flrfl Induce a debility of the whole fyftem by a trou- blefome and obftinate cough.
2. From the occupations and habits of perfons who are mod liable to this difjrder. Thefe are ftudious men, and mechanics who lead fedentary lives in confined places ; alfo women, and all per- sons of irritable habits, whether of body or mind.
5. FftOM the period in which perfons are moft liable to be affected by this diforder. This is ge- nerally
• * Dr. Lizfcl fay: that out of 360 patients whom he attsz
tween July 111,1758, and July 1(1,1760, in confumption^, the diforder was brought en one fourth of them, by falls, ifes, and ftraias received a year or two before the difeafs irancc.
88 PULMONARY CONSUMPTION.
nerally between the 18th and 36th year of life, a period in which the fyftem is liable in a peculiar manner to mod difeafes which induce the diforder, and in which indirect debility is oftener produced than in any other ftage of life, by the exceflive ex- ercifes of the body and mind in the purfuits of bu- fmefs or pleafure.
I have conformed to authors, in fixing the pe- riod of confumptions between the 18th and 36th year of life — but it is well known that it fometimes appears in children, and frequently in perfons be- yond the 40th, or even 50th year of life.
II. The pulmonary confumption is a primary difeafe of the whole fyftem. This I infer,
1. From the caufes which produce it, acting upon the whole fyftem.
2. From the fymptoms of general debility which always precede the affection of the lungs. Thefe fymptoms are a quick pulfe, efpecially to- wards evening 5 a heat and burning in the palms of the hands \ faintnefs, head-ach, ficknefs at fto- mach, and an occafional diarrhoea. I have fre- quently obferved each of thefe fymptoms for fe- veral months before I have heard of a fingle com- plaint in the bread.
3. From
PULMONARY CONSUMPTION. 89
3. From the pulmonary confumption alterna- ting with other difeafes which obvioufly belong to the whole fyftem. I fhall briefly mention thefe dif- eafes.
The Rheumatism. I have feen many cafes in which this difeafe and the confumption have al- ternately, in different feafons or years, afe£ted the fyftem. In the winter of 1792, three clinical patients in the Pennfylvania hofpital exemplified by their complaints the truth of this obfervation. They were relieved feveral times of a cough by pains in their limbs, and as often, the pains in their limbs feemed for a while to promife a cure to their pulmonic complaints.
The Gout has often been obferved to alternate with the pulmonary confumption, efpecially inper- fons in the decline of life. Dr. Sydenham defcribes a fhort cough continuing through the whole win- ter, as a fymptom of gouty habits. A gentleman from Virginia died under my care in the fpring cf 1788, in the 45th year of his age, with all the fymptoms of pulmonary confumption, which had frequently alternated with pains and a fwelling in his feet.
The pulmonary confumption has been obferved to alternate with madness. Of this I have feen
two
OO PULMONARY CONSUMPTION.
two inftances, in both of which, the cough, and expectoration were wholly fufpended during the continuance of the derangement of the mind. Dr. Mead mentions a melancholy cafe of the fame kind in a young lady ; and fimilar cafes are to be met with in other authors. In all of then the difeafe proved fatal. In one of the cafes which came un- der my notice, the fymptcms of confumption re- turned before the death of the patient.
I have likew'fe witnefT'd two cafes in which the return of reafon after madnefs, was fuddenly fuc- ceeded by a fatal pulmonary confumption. Per- haps the falfe hopes, and even the cheerfulnefs which fo univerfally occur in this diforder, may be refolved into a morbid (late of the mind, produced by> a general derangement of the whole fyflem. So univerfal are the delufion and hopes of patients with refpeel to the nature and ifTue of this diforder, that I have never met with but one man, who, up- on being afked what was the matter with him, an- fwered unequivocally, " that he was in a confump- tion !"
Again— Dr. Bennet mentions a cafe of "A phthifical patient who was feized with a violent PAIN in the teeth for two days, and in whom, during that time, every fymptom of a confumption, except the leanncfs of the body, altogether van-
iflied -,'J
PULMONARY CONSUMPTION. 9*
ilhed ;9* and he adds further, " that a defiuxion on the lungs had often been relieved by saliva- ry EVACUATIONS."*
I have feen fever al inftances in which the pul- monary fymptoms have alternated with Head-
Ach and Dyspepsia, alfo with pain and
noife in one of the Ears. This affection of the ears fometimes continues throughout the whole difeafe without any remiflion of the pulmonary fymptoms. I have feen one eafe of a difcharge of matter from the left ear without being accompani- ed by either pain or noife.
In all our books of medicine are to be found cafes of confumption alternating with Eruptions on the Skin.
And who has not feen the pulmonary fymptoms alternately relieved, and reproduced by the ap- pearance or ceffation of a diarrhoea, or pains in the Bowels ?
To thefe facts I fhall only add, under this head, as a proof of the confumption being a dif- eafe of the whole fyftem, that it is always more or
lefs
* Treatifc of the Nature and Cure of Confomptions — Exercitation X.
gl PULMONARY CONSUMPTION.
lefs relieved by the change which is induced in the fyftem by pregnancy.
4. I infer that the pulmonary confumption is a difeafe of the whole fyftem from its analogy with feveral other difeafes which, though accompanied by local affections, are obvioufly produced by a morbid ftate of the whole fyftem.
The Rheumatifm, the Gout, the Meafles, Small-pox, the different fpecies of Cynanche — all furnifh examples of the connection of local affec- tions with a general difeafe ; but the Apoplexy, and the Pneumony furnifh the mod ftriking analogies of local affection, fucceeding a general diforder of the fyftem in the pulmonary confump- tion.
The moft frequent caufe of apoplexy is a ge- neral debility of the fyftem, produced by intempe- rance in eating and drinking. The phenomena of the difeafe are produced by an effufion of blood or ferum, in confequence of a morbid diftenfion, or of a rupture of the veffels of the brain. The pul- monary confumption begins and ends in the fame way, allowing only for the difference of fituation and ftruclure of the brain and lungs. After the production of predifpofing debility from the action of the remote caufes formerly enumerated, the fluids are determined to the weakeft part of the
body.
PULMONARY CONSUMPTION. 93
body. Hence effufions of ferum cr blood take place in the lungs. When feritm is effufed, a pi- tuitous or purulent expectoration alone takes place ; — when blood is difcharged, a difeafe is produced which has been called Koemoptyfis. An effuiion of blood in the brain, brought on by the operation of general debility, has been called by Dr, Hoff- man, with equal propriety, a haemorrhage of the brain. The efFufion of blood in the lungs in con- fequence of the rupture of a blood vefTel is lefs fatal than the fame accident when it occurs In the brain, only becaufe the blood in the former cafe is more eafily difcharged from the fyftem. Where no rupture of abloodveffel isproduced, deathisnearly as fpeedyand certain in the onecafeasm :he other.* Difledlions fiiow many cafes of fuffocation and and death, from the lungs being pretematnralry fill- ed with blood or ferum. From this great analo- gy between the remote and proximate caufes of the two difeafes which have been defcribed, I have taken the liberty to call them both by the name of apoplexy. The only fymptom which does not accord with the derivation of the term, is, that in the apoplexy of the lungs, the patient does not fall
down
* I have feen two cafes of fudden death from Kcmoptyfis. In one of them there was \cry little blood difcharged through the mouth.
Q4 . PULMONARY CONSUMPTION.
down as if by an external ftroke, which is m oft frequently the cafe in the apoplexy of the brain.
The hiftcry of the remote and proximate caufes of pneumeny will furnifh us with a (lill more re- markable analogy of the connection between a lo- cal affecltion, and a general difeafe of the fyftem. The pneuraony is produced by remote exciting cau- fes, whicB aft on the whole fyftem. The whole arterial fyftem is frequently agitated by a fever in this diforder before a pain is perceived in the bread or fides, and this fever generally conftitutes the ftrength and danger of the difeafe. The expectoration which terminates the diforder in health, is always the effect of effufions pro- duced by a general difeafe, and even the vomicas, which fometimes fucceed a deficiency of bleeding in this diforder, always depend upon the fame ge- neral caufe. From this view of the analogy be- tween pneumoiry and pulmonary cor.fumpticn, it would feem that the two difeafes differed from each oilier only by the (hotter or longer operation of the caufes which induce them, and by the great- er or lefs violence and duration of their fymptoms. The pnucmony appears to be an acute confump- tion, and the confumption a chronic pneumony. From the analogy of the pulmonary confumption
with
PULMONARY CONSUMPTION, ' 95
■with the diminutive term cf certain fevers, I have taken the liberty of calling it a pnzcj:.ioi:icltla.
5. I infer that the pulmonary confumption is adifeafe of the whole fyilem, from its exiilence without ulcers in the lungs. Of this there are many cafes recorded in books of medicine.
Dr. Leigh informs us in his natural Iiiitory of Lancashire, that the confuniption was a very com- mon difeafe on the fea coaft of that country ; but that it was not accompanied cither by previous inflammation or ulcers in the lun?s. It was general- ly attended, he fays, by an unufual peevi&nejfs of temper. "
6". And laflly, I infer, that the pulmonary con- fumption is a difeafe of the whole fyftem, from its being relieved, or cured, only by remedies which act: upon the whole fyftem. This will appear, I hope, hereafter, when we come to treat of the cure cf this diibrder.
Let us now inquire how far the principles Ih ave laid down will apply to the fuppofed proximate caufes of confumption. Thefe caufes have been faid to be — an abfeefs in the lunss, hxtboptyfis. tubercles, catarrh, hereditary diathefis, contagion, and the matter of cutaneous eruptions or fores re- pelled
96 PULMONARY CONSUMPTION.
pelled, and thrown upon the lungs. I fhall make a few obfervations upon each of them.
1. An abfeefs in the lungs is generally the con* fequence of a neglected, or half cured pneumony. It is feldom fatal, where it is not connected with a predifpofition to confumption from general debili- ty, or where general debility is not previoufly in- duced by the want of appetite, fleep, and exercife, which fometimes accompanies that diforder of the lungs. This explanation of the production of confumption by an abfeefs in the lungs, will re- ceive further fupport from attending to the effects of wounds in the lungs. How feldom are they followed by pulmonary confumption ; and this only becaufe they are as feldom accompanied by predifpofmg general debility. I do not recollect a fmgle inflance of this diforder having followed a wound In the lungs, cither by the bayonet, or a bullet, during the late war. The recoveries which have fucceeded fuch wounds, and frequently un- der the mod unfavorable circumftances, {hew how very improbable it is that a much {lighter affection of the lungs fhould become the caufe of a pulmo- nary confumption.
A Britifli officer, whom I met in the Britifli
camp, a few days after the battle of Brandywine, in
2 September,
PULMONARY CONSUMPTION. 97
September, 1777, informed me that the furgeon general of the royal army had aflured him, that out of twenty-four foldiers who had been admitted into the hofpitals, daring the campaign of 1 jy6^ with wounds in their lungs, twenty-three of them had recovered. Even primary difeafes of the lungs often exift with peculiar violence, or conti- nue for many years without inducing a confumpti- on. I have never known but one inftance of the hooping cough ending in confumption, and all our books of medicine contain records of the adh- ma continuing for 20 and 30 years without termi- nating in that diforder. The reafon in both cafes, mud be afcribed to thofe two original diforders of the lungs not being accompaniedby general debility. One fact more will ferve to throw dill further light upon the fubject.. Millers are much afflicted with a cough from floating particles of flour con- flantly irritating their lungs, and yet they are not more fubjeft to confumptions than other labouring people. Hence " a miller's cough," is proverbial in fome places, to denote a cough of long continu- ance without danger.
1. The haemoptyfis is either a local difeafe, or it is the effect of general debility of the whole fy- ftem. When it is local, or when it is the dfect of caufes which induce a temporary or acute debility
Vol. II. G only
93 PULMONARY CONSUMPTION'.
only in the fyflem, it is feldom followed by con- sumption. The accidental difcharge of blood from the lungs, from injuries, and from an obftmction ofthemenfes in women, is of this kind. Many pcrfons are affected by this fpecies of hemorrhage once or twice in their lives, without fuffering any inconvenience from it afterwards. I have met with feveral cafes in which it has occurred for many years every time the body was expofed to any of the caufes which induce fudden, direct, or indirect debility, and yet no confumption has fol- lowed it. The late king of Pruflia informed Dr. Zimmerman that he had been frequently attacked by it during his feven years war, and yet he lived notwithstanding above twenty years afterwards without any pulmonary complaints. It is only in perfons who labour under chronic debility, that an hasmoptyfis is neceffarily followed by confump- tion.
3. I yield to the popular mode of expreffion
when I fpeak of a confumption being produced by
tubercles. But I maintain that they are the effecls
of general debility communicated to the bronchial
veffels which caufe them to effufe a preternatural
quantity of mucus. This mucus is fometimes
poured into the trachea from whence it is difchar-
ged by hawking, more efpecially in the morning ;
for
PULMONARY CONSUMPTION. 99
fork is effufed more copioufly during the languid hours of fleep than in the daytime. But this mucus is frequently effufed into the fubftance of the lungs, where it produces thofe tumours we call tubercles. When this occurs, there is either no cough* or a very dry one. That tubercles are formed in this way, I infer from the diffeclions and experi- ments of Dr. Starkf, who tells us, that he found them to confid of inorganic matter — that he was unable to difcover any connection between them and the pulmonary veffels, by means of the mi- crofcope or injections, and that they firfl opened into the trachea through the bronchial veffels. It is remarkable that the color and confidence of the matter of which they are compofed, is nearly the fame as the matter which is difcharged from the trachea, in the moid cough which occurs from a relaxation of the broncnial veffels.
I am aware that thefe tumours in the lungs have been afcri^ed to f.ropula. But the frequent oc- currence of confump'ions in perfons in whom no fcrophulous taint exided, isfufficient to refute this opinion. I have frequently directed my enqui- ries after this diforder in confumptive patients, and G 2 have
* See Med. Com. Vol. II. \ Clinical and Anatomical Obfervations, p. 26, 27. See alfo Morgagni, letter xxii. 21.
^fjf&ttY OF M4/?^
^
FouWlW PULMONARY CONSUMPTION.
Sq ^ have metr\y^%#ery few cafes which were produced ^^^^^^i^S-i^^probable that it may frequently be a predifpofmg caufe of confumption in Great Britain, but I am fure it is not in the United States of Ame- rica.
4. The catarrh is of two kind — acute and chro- nic, both of which are connected with general de- bility, but this debility is moll obvious in the chronic catarrh : hence we find it encreafed by every thing which acts upon the whole fyftem, fuch as cold and damp weather, fatigue, and above all by old age, and relieved or cured by exercife, and every thing elfe which invigorates the whole fyftem. This fpecies of catarrh often continues for twenty or thirty years without inducing pulmo- nary confumption, in perfons who purfue active occupations.
5. In the hereditary confumption there is either an hereditary debility of the whole fyftem, or an hereditary mal-conformation of the bread. In the latter cafe, the confumption is the effect of weak - nefs communicated to the whole fyftem, by the long continuance of difficult refpiration, or of fuch injuries being done to the lungs as are incompati- ble with health and life. It is remarkable, that
the
PULMONARY CONSUMPTION. lot
the confumptive diathefis is mere frequently deri- ved from paternal than maternal anceltors.
6. Physicians the mod diftinguiflied for accu- rate obfervations have agreed, that the pulmonary confumption may be communicated by contagion. However doubtful it may be in temperate, it can- not be controverted in warm climates. Morgagni informs us that, Valfalva (who was predifpofed to the confumption) was fo fatisfled of its contagious nature, that he conftantly avoided being prefent at the di£Te£tion of the lungs of perfons who had died of that diforder. I know that its progrefs in whole families has been afcribed to a famenefs of original conftitution, or mal-conformation of the bread in the members of the fame family, or the fatigue which is incurred by attending, and the grief which follows the lofs of relations who perifh by that diforder. Perhaps many of the cafes of confumption, which have been afcribed to conta- gion, may be accounted for by calling in the debi- litating operation of one or both of thofe caufes ; butthere are cafes ofthedifeafe being communicated by contagion, which cannot be refolved into the' influence of either fatigue or grief.
The late Dr. Beardfley, of Connecticut, in- formed me that he had known feveral black ilaves^
aitc
102 PULMONARY CONSUMPTION.
affected by a confum prion which had pre vioufly fvvept away feveral of the white members of the family to which they belonged. Inthefe flavesnofufpicion was entertained of the moftdiftant relationfhip totheper- fons fro n whom they had had contracted the difor- der; nor had fatigue or grief, from the caufes be- forementioned, been fuppofed to have had the lead fliare in debilitating their bodies. Admitting then contagion to aft as a remote caufe of confumption,- it does not militate againft the theory which I have aimed to eftablifh ; for if the contagion follow the analogy of all the other contagions that we are ac- quainted with, it mud acl by debilitating the whole fyftem. The approach of the jail fever and the plague is often indicated by general languor. The influenza and the meafles are always accompanied by general debility, but the fmaU pox furuifhes an analogy to the cafe in queftion more directly in point. The contagion of this diforder, whether received by the medium of the air or the fkin, never fails of producing a difeafe of the whole {y- flem, before it difcovers itfclf in affections of thofe parts of the body on which the contagion pro- duced its-nrft operation. — I am difpofed to believe, from feveral cafes which have come under my no- tice, that the contagion which produces the con- fumption feldom acts in lefs than two or three months after it is received into the fyftem. I once
attende
PULMONARY CONSUMPTION. IOJ
attended a lady, in whom the contagion did not difcover itfelf in the lungs for nearly a year after {he had been expofed to it, by attending a fitter who had died of the confumption. In this cafe the effects of fatigue, and of grief were entirely worn away from the fyftem by time, as well as by chearful fociety.
7. I grant that cutaneous humors, and the mat- ter of old fores, when repelled, or fuddenly healed, have in fome cafes fallen upon the lungs, and pro- duced confumption. But I believe, in every cafe where this has happened, the confumption was preceded by general debility, or that it was not induced, until the whole fyftem had been pre- vioufly debilitated by a tedious and diftrehmg cough,
If the reafonings founded upon the facts which have been mentioned be juft, then it follows,
III. That the cough, tubercles, ulcers, and pu- rulent or bloody difcharges which occur in the pulmonary confumption, are the effects and not the caufes of the difeafe ; and, that all attempts to cure it, by inquiring after tubercles and ulcers, or into the quality of the difcharges from the lungs, are as fruitlefs as an attempt would be to difcover the caufes or cure of dropfies,by an examination of the
qualites
J04 PULMONARY CONSUMPTION.
qualities of collections of water, or to find out the caufes and cure of fevers by the quantity or qua- lity of the difcharges which take place in thofe difeafes from the kidneys and ikin. I admit that the cough, ulcers, and tubercles, after they are formed, increafe the danger of the difeafe, by be- coming new caufes of ftimulus to the fyftem, but in this they are upon a footing with thofe effufions in the vifcera, which take place in the intermitting fever, which though they conftitute no part of its caufe, frequently produce fymptoms and a termina- tion which are wholly unconnected with the ori- ginal difeafe.
The tendency of general debility to produce a difeafe of the lungs appears in many cafes, as well as* in the pulmonary confumption. Dr. Lind tells us, that the lad ftage of the jail fever was often marked by a cough. I have feldom been difappointed in looking for a cough and a copious excretion pf mu- cus and phlegm after the 14th or 15th days of the nervous fever. Two cafes of hypocondriafis under my care, ended in fatal diiorders of the lungs. The debility of old age is generally accompanied by a troublefome cough, and the debility which precedes death, generally difcovers its lafl fymp- toms in the lungs, — hence, moil people die with what are called the Rattles. They are produced
by
PULMONARY CONSUMPTION. 1 05
by a fudden and copious effufion of mucus in the bronchial veiTels of the lungs.
Should it be aiked, why does general debility terminate by a diforder in the lungs, rather than in any other part of the body ? — I anfwer, — that it feems to be a law of the fyflem, that general de- bility fhould always produce as a fymptom fome local difeafe. This local difeafe fometimes mani- fefts itfelf in dyfpepfia, vas in the general debility which follows grief; — fometimes it difcovers it- felf in a diarrhcea as in the general debility which fucceeds tc fear. — Again it appears in the brain, — as in the general debility which fucceeds intemperance, and the conftant or violent exercife ' of the underflanding, or cf flimulating pailions; but it more frequently appears in the lungs, as the confequence of general debility. It would feem as if the debility in the cafes of confumption is feat- ed chiefly in the blood veiTels, while that debility which terminates in difeafes of the ftomach and bowels, is confined chiefly to the nerves, — and that the local affections of the brain arife from a debi- lity, invading alike the nervous and arterial fy- ftems. What makes it more probable, that the arterial fyflem is materially affected in the con- fumption is, that the diforder mod frequently oc- chirs in thofe periods cf life, and in thofe habits in
which
106 PULMONARY CONSUMPTION.
which a peculiar (late of irritability or excitability is fuppofed to be prefect in the arterial fyftem ; alfo in thofe climates in which there are the mod frequent viciiTitudes in the temperature of the weather. It is remarkable, that that the debility in the inhabitants of the Weft Indies, whether produced by the heat of the climate, or the ex- ceffive purfuits of bufinefs or pleafure, generally terminates in dropfy, or in fome diforder of the alimentary canal.
I have faid, that it feemed to be a law of the fy- ftem, that general debility mould always produce as a fymptom fome local affection. But to this law there are fomerimes exceptions : The Atro- phy appears to be a confumption without an affection of the lungs. — This diforder is frequent- ly mentioned by the writers of the 16th and 17th centuries by the name of Tabes. I have feen feve- ral inftances of it in adults, but more in children, and a greater number in the children of black than of white parents. The hectic fever, and even the night fweats, were as obvious in feveral of thefe cafes, as in thofe confumptions where general de- bility had difcovered itfelf in an affection of the lungs.
I come now to make a few obfervations upon
the
PULMONARY CONSUMPTION. I07
the cure of confumption ; and here I hope it will a, pear, that the theory which I have delivered admks of an early and very important application to practice.
If the confumption be a difeafe of general de- • bility, it becomes us to attempt the cure of it in its firfl flage, — that is, before it produce the fymp- toms of cough, bloody or purulent difcharges from the lungs, and inflammatory or hectic fever. The fymptoms which mark this firfl flage, are too fel- dom obferved ; or if obferved, they are too often treated with equal neglect by patients and phyfici- ans. I fhall briefly enumerate thcfe fymptoms. They are a flight fever encreafed by the lead: exer- cife, — a burning and drynefs in the palms of the hands, more efpecially towards evening, — rheumy eyes upon waking from fleep, — an encreafe of urine, — a drynefs of the fkin, more efpecially of the feet in the morning,* — an occafional flufk- ing in one, and fometimes in both cheeks, —
a
* The three laft mentioned fymptoms are taken notice of by Dr Ber.nct, in his Treatife upon the Nature and Cure of the Confumption as precnrfors of the diforder. Dr. Boerhaave ufed to tell his pupils that they had never deceiv- ed him.
f I have feen the hcarfsnsfs in one cafe the firfl fymptom of approaching confumption. In this fymptom it preferves
Io8 PULMONARY CONSUMPTION.
a hoarfenefsf — a flight or acute pain in thebreaft, — a fixed pain in one fide, or {hooting pains in both fides, — head-ach, — occafional fick and fainty fits, — a deficiency of appetite, and a general indif- pofition to exercife or motion of every kind.
It would be eafy for me to mention cafes in which every fymptom that has been enumerated has occurred within my own obfervations. I wilh them to be committed to memory by young prac- titioners ; and if they derive the fame advantages from attending to them, which I have done, I am fure they wijl not regret the trouble they have taken for that purpofe. It is probable, while a morbid (late of the lungs is fuppofed to be the proximate caufe of this diforder, they will not de- rive much reputation or emolument from curing it in its forming ftage ; but let them remember, that in all attempts to difcover the caufes and cures of difeafes, which have been deemed incurable, a phyfician will do nothing effectual until he acquire i perfect indifference to his own intereft. and i^me.
The remedies for cenfumption in this ftage of the diforder are fimple and certain. They coniift,
in
rhe ana-o^y of pneumony, which often comes on with a 11 .larfcnris, and fomeiirncs with paraphonia-.-
PULMONARY CONSUMPTION. IOO,
in a defertion of all the remote, and exciting caufes of the diforder, particularly fedentary em- ployments, damp or cold fituations, and whatever tends to weaken the fyftem. When the difeafe has not yielded to this defertion of its remote and exciting caufes, I have recommended the cold batb,Jleel, and bark with great advantage. How- ever improper or even dangerous thefe remedies may be after the difeafe affumes an inflammatory or hectic type, and produces an affection of the lungs, they are perfectly fare and extremely ufeful in the flate of the fyftem which has been defcrib- ed. The ufe of the bark will readily be admitted by all thofe practitioners who believe the pulmo- nary confumption to depend upon a fcrophulous diathefis. Should even the lungs be affected by fcrophulous tumors, it is no objection to the ufe of the bark; for there is no reafonwhy it fhould not be as ufeful in fcrophulous tumors of the lungs, as of the glands of the throat, provided it be given before thofe tumors have produced inflammation ; and in this cafe, no prudent practitioner will ever prefcribe it in fcrophula when feated even in the external parts of the body. To thefe remedies fhould be added a diet moderately ftimulating, and gentle exercife. I mall hereafter mention the dif- ferent fpecies of exercife, and the manner in which each of them fhould be ufed fo as to derive the ut-
mofl
110 PULMONARY CONSUMPTION.
moft advantage from them. I can fay nothing of the ufe of falt-water, or fea-air in this flage of the confumption from my own experience. 1 have heard them commanded by a phyfician of Rhode- Ifland ; and if they be ufed before the difeafe has difcovered itfelf in pulmonary affections, I can eafi- ly conceive they may do ferviee.
If the fimple remedies which have been men- tioned have been neglected, in the firft flage of the diforder, it generally terminates in different peri- ods of time, in pulmonary affections ; which (hew themfelves under one of the three following forms, —
i. A fever, accompanied by a cough, a hard pulfe, and a difcharge of blood, or mucous mat* ter from the lungs.
2. A fever of the hectic kind, accompanied by chilly fits, and night fweats, and a pulfe full, quick, and occafionally hard. The difcharges from the lungs in this flate of the diforder, are frequent- ly purulent.
3. A fever with a weak quick pulfe, a troublc- fome cough, and copious purulent difcharges from the lungs, a hoarfe and weak voice, and chilly fits
and
PULMONARY CONSUMPTION. I IT
and night fweats, alternating occafionally with a diarrhcea.
These three different forms of the pulmonary affection have been diftingnifhed by LJ^names of the firft, fecond, and third ftages of r^ea>nfump- tion ; but as they do not always fucceed each other in the order in which they have been mentioned, I (hall hereafter diftinguifh them by the name of fpecies, in conformity to our modern nomencla- tures of medicine, although it would be more pro- per, on fome accounts, to confider them as differ- ent Mates of the fyflem.
The firft I mall call the inflammatory — the fe- cond theHECTic,and the third the typhus fpecies. I have feen the pulmonary confumption come on fometimes with all the fymptoms of the fecond, and fometimes with the moll of the fymptoms of the third fpecies ; and I have feen two cafes in which a hard pulfe, and other fymptoms of inflammatory ac- tion appeared in the laft hours of life. It is agree- able to purfue the analogy of this difcrder with a pneumony, or an acute inflammation of the lungs. They both make their firft appearance in the fame feafons of the year. It is true, the pneumony mofl frequently attacks with inflammatory fymptoms ; tut it fometimes occurs with fymptoms which for-
3 bid
112 PULMONARY CONSUMPTION.
bid blood-letting, and I have more than once feen it attended by fymptoms which required the ufe of wine and bark. The pneumony is attended at firft by a dry cough, and an expectoration of ftreaks of blood — the cough in the confumption, in like manner, is at firft dry, and attended by a difcharge of blood from the lungs, which is more copious than in the pneumony, only becaufe the lungs are more relaxed in the former than in the latter dis- order. There are cafes of pneumony in which no cough attends. I have feen cafes of pulmona- ry confumption, in which nothing but a difficulty of breathing difcovered a morbid ilate of the lungs, and one in which there was an entire abfence of
cough.*
The
* In the year 1785, I attended a young lady who had complained of a pain in her right fide, and had frequent chills with a fever of the hectic kind. They all gave way to frequent and gentle bleedings. In the fummer of 1786, flie was feized with the fame complaints, and as fhe had great objections to bleeding, fhe confulted aphyfician who grati- fied her, by attempting to cure her by recommending exer- cife and country air. In the autumn fhe returned to the ci- ty much worfe than when fhe left it. I was again fent for, and found her confined to her bed wiih a pain in her right fide, but without the leafl cough or fever. Her pulfe was preternaturally flow. She could lie only on her left fide. She fometimes complained of acute flying pains in her head,
bowels,
PULMONARY CONSUMPTION. 113
The pneumony terminates in dMerent periods according to the degrees of inflammation, or the nature of the effufions which take place in the lungs— the fame obfervation applies to the pulmo- nary confumption. The fymptoms of the different fpecies of pneumony frequently run into each o- ther ; fo do the fymptoms of the three fpecies of confumption which have been mentioned. In fhort, the pneumony and confumption are alike in fo ma-
Vol. II. H ny
bowels, and limbs. About a month before her death, which was on the 3d of May 1787, her pulfe became quick, and me had a little necking cough, but without any difchargc » om her lungs. Upon my firft vifit to her in the preceding autumn, I had told her friends that I believed ihe had an abfccfs in. her lungs. The want of fever and coug afterwards how- ever gave me reafon to fufpect that I had been milLken0 The morning after h^r death, I received a meffage from her father, informing me that it had been among the lali re- quefls of his daughter, that the caufe of her death (hould be afcertained by my opening her body. I complied with this requeft, and in company with Dr. Hall, examined her tho- rax. We found the left lobe of the lungs perfectly found; therightlobe adhered to the pleura, in feparating of which, Dr. Hall plunged his hand into a large fac which contained about half a pint of purulent matter, and which had nearly deflroyed the whole fubftance of the right lobe of the lungs.
I have met with only two other cafes of confumption in which there was an abfence of a quick pulfe. In both of them the pulfe was regular to the laft day of life.
114 PULMONARY CONSUMPTION.
ny particulars, that they appear to refemble flia- dows of the fame fubftance. They differ only as the protracted fhadow of the evening does from that of the noon-day fun.
I know that it will be objected here that the confumption is fometimes produced by fcrophula, and that this creates an eiTential difference be- tween it and pneumony. I formerly admitted fcrophula to be one of the remote caufes of the confumption ; but this do^s not invalidate the pa- rallel which has been given of the two difeafes. The phenomena produced in the lungs are the fame as to their nature, whether they be produced by the remote caufe of fcrophula, or by the fudden action of cold and heat upon them.
No more happ ens in the cafes of acute and chro- nic pneumony, than what happens in dyfentery and rheumatifm. Thefe two lafl difeafes are for the mod part fo acute, as to confine the patient to his bed or his room, yet we often meet with both of them in patients who go about their ordinary bu- finefs, and, in fome inflances, carry their difeafes with them for two or three years.
The
PULMONARY CONSUMPTION. II5
The parallel which has been drawn between the pneumony and confumption, will enable us to un- derftand the reafon why the latter difjrder termi- nates in fuch different periods of time. The lefs it partakes of pneumony, the longer it continues, and vice verfa. What is commonly called in this country a galloping confumption, is a difeafe com- pounded of different degrees of confumption and pneumony. It terminates frequently in two or three months, and without many of the fymptoras which ufually attend the lad ftage of pulmonary confumption. But there are cafes in which pa- tients in a confumption are fuddenly matched away by an attack of pneu nony. I have met with one cafe only, in which, contrary to my expectation, the patient mended after an attack of an acute in- flammation of the lungs, fo as to live two years afterwards.
It would feem from th-fe fa^s. as if nature had preferred a certain gradation h iif afes, as well as in other parts of her works. There is fcarcely a dif- eafe in which there is not a certain number of grades, which mark the diftahce between health and the lowed fpecific deviation from it. Each of thefe grades has received different names, and has been confidered as a diftincl: difeafe, but more accurate furveys of the animal ceco- H 2 nomy
Il6 PULMONARY CONSUMPTION.
nomy have taught us, that they frequently de- pend upon the fame original caufes, and that they are only greater or lefs degrees of the fame dif- eafe.
I shall now proceed to fay a few words upon the cure of the different fpecies of pulmonary con- fumption. The remedies for this purpofe are of two kinds, viz. palliative and radical. I fhall firft mention the palliative remedies which be- long to each fpecies, and then mention thofe which are alike proper in them all. The palliative re- medies for the
I. Or inflammatory species, "are
i. Blood-letting. It may feem ftrange to recommend this debilitating remedy in a dif- eafe brought on by debility. Were it pro- per in this place, I could prove that there is no difeafe in which bleeding is prescribed, which is not induced by predifpofing debility in , commmon with the pulmonary confumption. I fhall only remark here, that in confequence of the exciting caufe a&ing upon the fyftem (rendered extremely excitable by debility) fuch a morbid and exceffive excitement is produced in the arte- ries as to render a diminution of the ftimulus of
the
PULMONARY CONSUMPTION. Ii;
the blood, abfolutely neceffary to reduce it. I have ufed this remedy with great fuccefs in every cafe of confumption, attended by a hard pulfe, or a pulfe rendered weak by a laborious tranfmif- fion of the blood through the lungs. In the months of February and March in the year 1 78 1, I bled a Methodift minifter, who was affected by this fpecies of confumption, fifteen times in the courfe of fix wTeeks. The quan- tity of blood drawn at each bleeding was never lefs than eight ounces, and it was at all times co- vered with an inflammatory emit. By the addition of country air, and moderate exercife, to this copi- ous evacuation, in the enfuing fpring he recovered his health, fo perfectly as to difcharge all the du- ties of his profeflion for many years, nor was he ever afflicted afterwards with a diforder in his breaft. I have in another inftance, bled a citizen of Philadelphia eight times in two weeks, in this fpecies of confumption, and with the happieft ef- fects. The blood drawn at each bleeding was al- ways fizy, and never lefs in quantity than ten ounces. To thefe cafes I might add many others of confumptive perfons who have been perfectly cured by frequent, and of many others whofe lives have been prolonged by occafional bleedings. — But I am forry to add, that I could relate many more cafes of confumptive patients, who have died
martyrs
I I 8 PULMONARY CONSUMPTION.
martyrs to their prejudices againft the ufe of this invaluable remedy. A common objection to it is, that it has been ufed without fuccefs in this dif- order. When this has been the cafe, I fufpect that it has been ufed in one of the other two fpe- cies of pulmonary cunfumption which have been mentioned, for it has unfortunately been too fa- fliionable among phyiicians to prefcribe the fame remedies in every ftage and fpecies of the fame diforder ; and this I take to be the reafon why the fame medicines, which in the hands of fome phyficians, are either inert, or inftruments of mif- chief, are, in the hands of others, ufed with more or lefs fuccefs in every cafe in which they are pre- ferred. Another objection to bleeding in the in- flammatory fpecies of confumption,is derived from the apparent and even fenfible weaknefs of the patient. The men who urge this objection > do not hefitate to take from fixty to an hundred ounces of bood from a patient in a pneumony in in the courfe of five or fix days, without confider- ing that the debility in the latter cafe is fuch as to confine a patient to his bed, while in the former cafe, the patient's ftrength is fuch as to enable him to walk about his houfe, and even to attend to his ordinary bufinefs. The difference between the debility in the two difeafes, confifts in its being acute in the one, and chronic in the other. It is
true,
PULMONARY CONSUMPTION. II9
true, the preternatural or convulfive action of the arteries is fomewhat greater in the pneu- mony, than in the inflammatory confumption ; but the plethora on which the neceflity of bleed- ing is partly founded, is certainly greater in the inflammatory confumption than in pneumony. — This is evident from women, and even nurfes, dif- charging from four to fix ounces of menftrual blood every month, while they are labouring with the moil inflammatory fymptoms of the diforder ; nor is it to be wondered at, fincc the appetite is frequently unimpaired, and the generation of blood continues to be the fame, as in perfect health.
Dr. Cullen recommends the ufe of bleeding in confumptions in order to lelfen the inflamma- tionofthe ulcers in the lungs,and thereby to difpofe them to heal. From the teftimonies of the re- ■ lief which bleeding affords in external ulcers and tumors accompanied by inflammation, I am dif- pofed to expect the fame benefit from it in inflamed ulcers and tumors in the lungs: Whether, there- fore, we adopt Dr Cullen's theory of confumption, and treat it as a local difeafe, or aflent to the one which I have delivered, flill repeated bleedings ap- pear to be equally necefTary and ufeful.
1 I HAVE
120 PULMONARY CONSUMPTION.
I have f.-.n two cafes of inflammatory con- fumption, attended by an hcemorrhage of a quart of blood from rhe lungs. I agreed at firft with the friends of thefe patients in expecting a rapid termination of their diforder in death, but to the joy and furprife of all connected with them, they both recovered. I afcribed their recovery wholly to the inflammatory action of their fyftems being fuidenly reduced by a fpontaneous difcharge of blood. Thefe facts, I hope, will ferve to eftablifh the ufefulnefs of blood-letting in the inflammatory ftate of confumpiion, with thofe phyficians who are yet difpofed to trufr. more to the fortuitous operations of nature, than to the decifions of reafon and ex- perience.
• I have always found this remedy to be more neceffary in the winter and firft fpring months, than at any other feafon. We obtain by means of repeated bleedings, fuch a mitigation of all the fymptoms as enables the patient to ufe exercife with advantage as foon as the weather becomes fo dry and fettled, as to admit of his going abroad every day.
The Hief obtained by bleeding, is fo certain in this fpecies of confumpticn, that I often ufe it
as
PULMONARY CONSUMPTION. 121
as a palliative remedy, where I do not expect it will perform a cure. I was lately made happy in finding, that I am not lingular in this practice. Dr. Hamilton, of Lynn Regis, ufed it with fuccefs in a confumption, which was the effect of a mod deplorable fcrophula, without entertaining the lead hope of its per- forming a cure*. In thofe cafes where inflamma- niatory action attends the lad fcene of the diforder, there is often more relief obtained by a little bleed- ing than by the ufe of opiates, and it is always a more humane prefcription, in defperate cafes, than the ufual remedies of vomits and blifters.
I'o-nce bled a fea captain,. whom I had declared to be within a few hours of his diffolution, in or- der to relieve him of uncommon pain, and difficul- ty in breathing. His pulfe was at the fame time hard. The evacuation, though it confuted of only four ounces of blood, had the wiflied for effect, and his death, I have reafon to believe, was ren- dered more eafy by it. The blood, in this cafe, was covered with a buffy coat.
The quantity of blood drawn in every cafe of inflammatory confumption, mould be determined
by
* Obfervations on fcrophulons affedtions,
122 PULMONARY CONSUMPTION.
by the force of the pulfe, and the habits of the pa- tient. I have feldom taken more than eight, but more frequently only fix ounces at a time. It is much better to repeat the bleeding once or twice a week, than to ufe it lefs frequently, but in larger quantities.
From many years experience of the efficacy of bleedine ;'i this fpecies of confumption, I feel my- felf authririfed to alTert, that where a greater pro- portion of perfons die of confumption when it makes it firft appearance in the lungs, with fymp- toms of inflammatory diathefis, than die of ordi- nary pneumonies, (provided exercife be ufed after- wards) it muft in nine cafes out often, be afcribed to the ignorance, or erroneous theories of phyfi- cians, or to the obftinacy or timidity of patients.
In fpeaking thus confidently of the neceiTity and benefits of bleeding in the inflammatory fpe- cies of confumption, I confine myfelf to obferva- tions made chiefly in the ftate of Pennfylvania. It ispoflible the inhabitants of European countries and cities, may fo far have palled the fiaiple ages of inflammatory diforders, as never to exhibit thofe fymptoms on which I have founded the indication of blood-letting. lam difpofed to believe more- over that in moll of the fouthern dates of America,
the
PULMONARY CONSUMPTION. I23
the inflammatory acYion of the arterial fyftem is of too tranfient a nature to admit of the repeated bleedings in the confumption which are ufed with fo much advantage in the middle and northern dates.
In reviewing the prejudices againfl: this excel- lent remedy in confumptions, I have frequently wiihed to difcover fuch a fubftitute for it as would with equal fafety and certainty take down the morbid excitement, and action of the arterial fy- ftem. I believe in the exiftence of fuch a remedy; hut until it be difcovered, it becomes us to combat the prejudices againfl: bleeding; and to derive all the advantages from it which have been mentioned.
a. A second remedy for the inflammatory fpecies of confumption fhould be fought for in a milk and vegetable diet. In thofe cafes where the milk does not lie eafy on the ftomach, it fhould be mix- ed with water, or it fhould be taken without its cheefy or oily parts, as in whey, or butter-milk, or it mould be taken without fkimming ; for there are cafes in which milk will agree with the flo- mach in this flate, and in no other. The oil of the milk probably helps to promote the folution of its curds in the ftom?xh. It is feldom in the pow- er of phyficians to prefcribe afles or goats milk in
this
124 PULMONARY CONSUMPTION
this diforder ; but a good fubftitute may be prepa- red for them by adding to cows milk a little fugar, and a third or fourth part of water, or of a weak infufio of green tea. The vegetables which are eaten in this fbre of the diforder, mould contain as little ftimulus as poffible. It would feem if the moderate portion of facharine matter which is contained in certain fruits fuch as ftrawberries, grapes, and fweet apples were peculiarly agreeable and uieful, for each cf thefe fruits has been faid to have cured the confumption. In thofe ca- fes where the ftomach is difpofed to dyfpepfia, a little animal food, alfo foft boiled eggs, may be ta- ken with fafety, mixed with vegetable aliment. Where there is no morbid a€e£Hon of the fto- mach, 1 have feen the white meats., eaten without encreafmg the inflammatory fymptoms of the dif- eafe. The tranfition from a full diet to milk and vegetables mould be gradual, and the addition of animal to vegetable aliment, mould be made with the fame caution. From the neglect of this direc- tion, much error, both in theory and practice, has arifen in the treatment of confumptions.
In every cafe it will be better for the patient to eat four or five, rather than only two or three meals in a day. A lefs ftimulus is by this means communicated to the fyftem, and lefs chyle is
mixed
PULMONARY CONSUMPTION. 1^5
mixed with the blood in a given time. Of fo much importance do I conceive this direction to be, t at I feldom prefcribe for*a chronic difeafe of any kind without enforcing it.
3. Vomits have been much commended by Dr. Read in this diforder. From their indiicrimi- nate ufe in every fpecies of confumption, I am fa- tisfled they have oftener done harm than good. In cafes where a patient objects to bleeding, or where a phyfician doubts of its propriety, vomits may always be fubftituted in its room with great advantage.
4. Nitre in moderate dofes often or fifteen grains taken three or four times a day, has fome- times done fervice in this diforder ; but I believe it has been only when the difeafe has' appeared with inflammatory fymptoms. Care ihould be taken not to perfevere too long in the ufe of this remedy as it is apt to impair the appetite. I have known one cafe in which it produced an obftinate dyfpep- fia, and a difpofition to the colic ; but it removed at the fame time, the fymptcms of pulmonary con- fumption.
5. Cold and dry air, when combined with the exercife of walking, deferves to be mentioned as an antiphlogiftic remedy. I have repeatedly
prefcribed
126 PULMONARY CONSUMPTION.
prefcribed it in this fpecies of the confujiption with advantage, and have often h id the pleafure of find- ing a fingle walk of two or three miles in a clear cold day, produce nearly the fame diminution of the force and frequency of the pulfe, as the iofs" of fix or eight ounces of blood.
I come now to treat of the palliative remedies which are proper in the
II. Or Hectic Species of Confumption. Here we begin to behold the-xjiforder in a new and more diftrefling form than in the fpecies which has been defcribed. There is in this fpecies of con- fumption the fame complication of inflammatory and typhus diathefis which occurs in the typhoid and puerperile fevers, and of courfe the fame dif- ficulty in treating it fucctfsfully ; for the fame re- medies do good and harm, according as the former or latter diathefis prevails in the fyftem*
All that I (hall fay upon this fpecies is, that the treatment of it fhould be accommodated to the predominance of inflammatory or typhus fymp- toms, for the hectic fpecies prefents each of them alternately every week, and fomeume? every* day to the hand or eye of a phyfician. When a hard pulfe with acute pains in the fide and bre&ft oc< ur, bleeding and other remedies for the inflammatory
fpecies1
PULMONARY CONSUMPTION. I 2?
(pedes muff be ufed ; but when the difeafe exhi- bits a predominance of typhus fymptoms, the re- medies for that fpecies to be mentioned immedi- ately, mould be prefcribed in moderate dofes. There are feveral palliative medicines which have been found ufefui in the hectic fpecies, but they are fuch as belong alike to the other two fpecies ; and therefore will be mentioned hereafter in a place afligned to them.
I am forry, however, to add, that where bleed- ing has not been indicated, I have feldom been able to afford much relief by medicine in this fpecies of confumption. I have ufed alternately the mofl gentle, and the moll powerful vegetable and me- tallic tonics to no purpofe. Even arfenic has failed in my hands of affording the lead alleviation of the hectic fever. I conceive the removal of this fever, to be the great defideratum in the cure of confumption, and fliould it be found after all our refearches to exift only in exercife, it will be no departure from a law of nature ; for I believe there are no difeafes of equal degrees of chronic debility, in which medicines are of any more effica- cy, than they are in the hectic fever of the pulmo- nary confumption.
128 PULMONARY CONSUMPTION.
I proceed now to fpcak of the palliative reme- dies which are proper in the
III. Or, Typhus Species of the Pulmonary Confumption.
The firft of thefe are stimulating medicines. However juft the complaints of Dr. Fothergill may be againft the ufe of balfams in the inflamma- tory and mixed fpecies of confumption, I am fatisfied that they are not only fafe, but ufeful likewife in mitigating the fymptoms of weak action in the arterial fyftem. I have therefore frequently prefcribed the balfam of copaivae, of Peru, the oil of amber, and different preparations of turpentine and tar in moderate dofes with obvious advantage. Garlic, the juice of dandelyon, a flrong tea made of horehound, and a decoction of the inner bark of the wild cherry tree ;* alfo bitters of all kinds,
have all been found fafe and ufeful tonics in this fpecies of the confumption. Even the Peruvian bark itfelf fo often and fo generally condemned in confumptions is always an innocent and frequently an active medicine where there is a total abfence of inflammatory diathefis in this diforder. With thefe medicines fhould be combined
2. A
* Primus Virginiana,
PULMONARY CONSUMPTION. 120,
2. A Cordial and Stimumating Diet. Milk and vegetables fo proper in the inflammatory, are improper when taken alone in this fpecies of coniumption. I believe they often accelerate that decay of appetite and diarrhoea, which form the clofing fcene of the diforder. I think I have feen advantages from the ufe, not only of frefh, but of faked animal food when prescribed in the total ab- fence of inflammatory diathefis. Oyfters, it has been faid, have performed cures of confumption. If they have, it muft have been only when they were eaten in that fpecies of it which is now under confideration. They are a moflfavoury and whole- fome article of diet in all difeafes attended with fymptoms of general debility. I have found the fame advantage from dividing the meals here that I mentioned under a former head. The exhibi- tion of food in this cafe, mould not be left to the calls of appetite, any more than the exhibition of a medicine. Indeed food may be made to fappiy the place of cordial medicines, by keeping up a conftant and gentle action in the whole fyftem. For this reafon, I have frequently advifed my patients never tofuffer their flomachs to be empty, even for a fingle hour. I have fometimes aimed to keep up the influence of a gentle action in the ftomach upon the whole fyftem, by advifmg them to eat in the night, in order to obviate the increafe of the
Vol. II. x I excre -
130 PULMONARY CONSUMPTION.
excretion in the lungs and of the cough in the morning, which are brought on in part by the in- creafe of debility from the long abftra&ion of the flimulus of aliment during the night.
However fafe and even ufeful the cordial me- dicines and diet which have been mentioned may appear, yet I am forry to add, that 1 have never feen any other advantages from them than a miti- gation of diftreffing fymptoms, except when they have been combined with fuitable and long con- tinued exercife. Even under this favourable cir- cumftance, they are often ineffectual ; for there frequently occurs in this fpecies of confumption, fuch a deilruction of the fubftance and functions of the lungs, as to preclude the poflibility of a re- covery by the ufe of any of the remedies which have been difcovered.
I have faid formerly that the three fpecies of confumption do not obferve any regular courfe in fucceeding each other. They are not only com- plicated in fome inftances, but they often appear and difappear half a dozen times in the courfe of tKe difeafe, according to the influence of the wea- ther, drefs, diet, and the pafTions, upon the fyftem. The great fecret, therefore, of treating this difor- der confifts in accommodating all the remedies that
have
PULMONARY CONSUMPTION. I3I
have been mentioned to the predominance of ei- ther of the three fpecies, or to the different ftates of the fyftem, as manifefted chiefly by the pulfe. It is in confequence of having obferved the evils which have refulted from the ignorance or neglect of this practice, that I have fometimes wifhed that it were poiTible to abolifh the feducing nomencla* ture of difeafes altogether, in order thereby to o- bligephyficians to conform exactly to the fluctuating ftate of the fyitem in all their prefcriptions ; for it is not more certain, that in all cultivated languages, every idea has its appropriate word, than that eve- ry (late of a difeafe has its appropriate dofe of me- dicine, the knowledge and application of which, can alone constitute rational, or enfure upiformly, fuccefsful practice.
I come now to fay a few words upon thofe pal- liative remedies which are alike proper in every fpecies of the Pulmonary Confumption.
The flrft Remedy under this head is a Dry Situation. A damp air, whether breathed in a room, or out of doors, is always hurtful in every fpecies of this diforder. A kitchen or a bed room below the level of the ground has often produced, and never fails to increafe a pulmonary confump- tion. 1 have often obferved a peculiar palenefs* I % (tJv
I32 PULMONARY CONSUMPTION.
(the firfl fymptom of general debility) to fliew itfelf very early in the faces of perfons who work or fleep in cellar kitchens or (hops.
2. Country Air. The higher and dryer the fituation which is chofen for the purpofe of enjoy- ing the benefit of this remedy, the better. Situa- tions expofed to the fea, fhould be carefully avoid- ed ; for it is a fingular fact, that while confumptive perfons are benefited by the fea air, when they breathe it on the ocean, they are always injured by that portion of it which they breathe on the fea-fhore. I fhall not paufe to inquire, why a mix- ture of land and fea-air is fo hurtful in the con- sumption, and at the fame time fo agreeable to per- fons in health, and fo medicinal in many other dif- eafes, but (hall difmifs this head by adding a fact which was communicated to me by Dr. Matthew Ir- vine of South-Carolina, and that is, That thofe fitu- ations which are in the neighbourhood of Bays or Rivers, where the fait and frefh waters mix their flreams together, are more unfavourable to con- fumptive patients than the fea-fhore ; and therefore mould be more carefully avoided by them in ex- changing city for country air.
3. Loose
pulmonary consumption. 133
3. Loose dresses, and a careful accommo- dation OF THEM TO THE CHANGES IN THE WEA- THER. Many fa£h might be mentioned to fhew the influence of compreffion and of tight ligatures of eve- ry kind, upon the different parts of the body ; alfo of too much, or too iittle cloathing, in producing, or increafing difeafes of every kind, more efpecially thofe which affect the lungs. Tight flays, garters, waiftbands, and collars, fhould all be laidafide in the confumption, and the quality of the cloathing fhould be fuited to the weather. A citizen of Maryland informed me, that he had twice had a return of a cough and fpitting of blood, by wearing his fum- mer cloaths a week after the weather became cool in the month of September. But it is not fufficient to vary the weight or quality of drefs with the feafons. It fhould be varied with the changes which take place in the temperature of the air every day, even in the fummer months, in middle latitudes. I know a citizen of Philadelphia, who has laboured under a confumptive diathefis near thirty years, who believes that he has leffen- ed the frequency and violence of pulmonic com- plaints during that time, by a careful accommoda- tion of his drefs to the weather. He has been obfer- ved frequently to change his waiftcoat and fhort cloaths twice or three times in a day, in a fummer month.
A
134 PULMONARY CONSUMPTION.
A repetition of colds, and thereby an increafe of the diforder, will be prevented by wearing flan- nel next to the ikin in winter, and muflin in the fummer, either in the form of a fhirt or a waift- coat : where thefe are ebje&ed to, apiece of flan- nel, or of fofr fheepfkin, fhould be worn next to the bread. They not only prevent colds, but fre- quently remove chronic pains from that part of the body.
4. Artificial evacuations by means of blis- ters andrssuJ?. 1 fufpecl: theufefulnefs of thefe re- medies to be chiefly confined to theinflammatory'and hedtic fpecies of confumption. In the typhus fpe- cies, the fyftem is too wer.k to fuftain the discharges of either of them. Frefh blifters fhould be preferred to fuch as are perpetual, and the iffues, to be ufe- ful fhould be large. They are fuppofed to afford relief by diverting a preternatural fecretion and excretion of mucus or pus from the lungs, to an artificial emunftory in a lefs vital part of the body.
5. Certain Fumigations and Vapors. An accidental cure of a pulmonary affection by the fmoke of rofm, in a man who bottled liquors, raifed for a while the credit of the firft of thofe remedies. I have tried it, but without much permanent
effea
PULMONARY CONSUMPTION. 135
effect. I think I have feen the pain in the breaft relieved by receiving the vapor from a mixture of equal parts of tar, bran, and boiling watet into the lungs. The fulphureous and faline air of Stabias, between Mount Vefuvius and the Mediterranean fea, and the effluvia of the pine forefts of Lybia, were fuppofed in ancient times to be powerful re- medies in confumptive complaints ; but it is pro- bable, the exercife ufed in travelling to thofe coun- tries, contributed chiefly to the cures which were afcribed to foreign matters acting up^p the lungs.
6. Lozenges, Syrups, and Demulcent Teas. Thefe are too common and too numerous to be mentioned.
7. Opiates. It is a miftake in practice, found- ed upon a partial knowledge of the qualities of opium, to adminifter it only at night, or to fuppofe that its effects in compofing a cough, depend upon its inducing fleep. It mould be given in frnall dofes during the day, as well as in larger ones at night. The dofe mould be proportioned to the degrees of action in the arterial fyftem. The lefs this action, the more opium may be taken with fafety and advantage.
8. Die-
1^6 PULMONARY CONSUMPTION.
8. Different Positions of the body have been found to be more or lefs favourable to the abatement of the cough. Thefe pofirions fhould be carefully fought for, and the body kept in that which procures the mod freedom from coughing. I have heard of an inftance, in which a cough which threatened a return of an hcemorrhage from the lungs, was perfectly compofed for two weeks, by keeping the patient nearly in one pofture in bed ; but I have known more cafes in which relief from coughing was to be obtained only by an erect pofture of the body.
9. Considerable relief will often be obtained from the patient's sleeping between blankets in winter, and on a matrass in fummer. The former prevent frefh colds from night fweats ; the latter frequently checks them altogether. In cafes, where a fufficient weight of blankets, to keep up an agreeable warmth, cannot be borne without reflraining eafy and full acts of inspiration, — the patient mould fleep under a light feather bed, or an eider down coverlit. They both afford more warmth than double or treble their weight of blankets.
However comfortable this mode of producing warmth in bed may be, it does not protect the
lungs
PULMONARY CONSUMPTION. 137
lungs from the morbid effects of the diflant points of temperature of a warm parlour in the day time, and a cold bed-chamber at nighr. To produce an equable temperature of air at all hours, I have frequently advifed my patients, where going to a warm climate, was not practicable, to pafs their nights as well as days in an open (love room, in which nearly the fame degrees of heat were kept up at all hours. I have found this practice, in feveral cafes, a tolerable fubftitute for a warm cli- mate.
10. The moderate ufe of the lungs, in Read- ing, Public Speaking, Laughing, and Sing- ing. The lungs, when debilitated, derive equal benefit with the limbs, or other parts of the body, from moderate exercife. I have mentioned in an- other place * feveral facts which fupport this opi- nion. But too much pains cannot be taken to in- culcate upon our patients, to avoid all excefs in the ufe of the lungs, by long, or loud reading — fpeak- ina— or fmging — or by fudden and violent burfts of laughter. I {hall long lament the death of a female patient, who had difcovered many hopeful figns of a recovery from a confumption, who
relapfed
* An account of the effects of common fait in the cure of
hoemoptyfis.
yisd. Inquiries and Obfervations.
I38 PULMONARY CONSUMPTION.
relapfed, and died in confequence of burfling ablood-vefTel in her lungs, by a fudden fit of laugh- ter.
11. Are there any advantages to be derived from the excitement of certain passions in the treatment of confumptions ? Dr. Blane tells us, that many confumptive perfons were relieved, and that fome recovered, in confequence of the terror which was excited by a hurricane in Barbadoes, in the year 1780. It will be difficult to imitate, by artificial means, the accidental cures which are recorded by Dr. Blane ; but we learn enough from them to infpire the invigorating paffions of hope and confidence in the minds of our patients, and to recommend to them fuch exercifes as pro- duce exertions of body and mind analogous to thofe which are produced by terror. Van Swieten and Smollet relate cures of confumptions, by pa- tients falling into (beams of cold water. Perhaps in both inflances, the cures were performed only by the fright and confequent exertion produced by the fall. This is only one inflance out of many which might be mentioned, of partial and unequal aclion being fuddenly changed into general and equal excitement in every part of the fyftem. The cures of confumptions which have been performed
by
PULMONARY CONSUMPTION. 139
by a camp life*, have probably been much affifted bv the commotions in the paflions which were ex- cited by the various and changing events of war.
Before I proceed to fpeak of the radical cure of the confumption, it will be necelfary to obferve, that by means of the palliative remedies which have been mentioned, many perfons have been re- covered, and fome have had their lives prolonged by them for many year?. In all thefe cafes I have found, upon inquiry, that the diforder was attend- ed with but little general debility, and that it fre- quently recurred as foon as the patient left off the ufe of his remedies, unlefs it were prevented by ne- ceffary or voluntary exercife.
It is truly fnrprifmg to obferve how long fome perfons have lived, who have been affected by a confumptive diathefis, and by frequent attacks of many of the mod troublefome fymptoms of this diforder. Van Swieten mentions the cafe of a man, who had lived thirty years in this ftate. Mor- ton relates the hiftory of a man, in whom the fymptoms of confumption appeared with but little variation or abatement from his early youth till the 70th year of his age ; and Bennet fays, he
knew
'" Medical Inquiries and Obfervations.
140 PULMONARY CONSUMPTION.
knew an inflance of this diforder which continued fixi y years. I prefcribed for one of my pupils four and twenty years ago, in a confumption, who, du- ring the greatefr. part of the time that has elapfed fince, has feldom paffed a year without fpitting blood, nor a week without coughing, who now en- joys a tolerable fliare of health. In this cafe, the fatal tendency of the diforder was conftantly op- pofed by rural exercifes, by a cordial, but tempe- rate diet, and (during the abfence of inflammatory action in his pulfe) by the occafional ufe of Peru- vian bark.
I am led here to mention another inflance of the analogy between pneumony and the pulmonary confumption. We often fee the fame frequency of recurrence of both diforders in habits which arcpredifpofed to them. I have attended a Ger- man citizen of Philadelphia, in feveral fits of the pneumony, who has been confined to his bed eight and twenty times, by the fame diforder, in the courfe of the fame number of years. He has, for the mod part, enjoyed good health in the inter- vals of thofe attacks, and always appeared, till lately, to poflefs a good conftitution. In the cafes of the frequent recurrence of pneumony, no one has fufpefted the difeafe to have originated in a morbid ftate of the lungs ; on the contrary, it ap- pears
PULMONARY CONSUMPTION. 141
pears evidently to be produced by xhefudden in- fluence ofthefamecaufes, which by acting with Iefs force, and for a longer time, produce the pulmona- ry confumption. The name of pneumony is taken from the principal fymptom of this diforder, but it is as certainly a difeafe of the whole arterial fyf- tem as the confumption ; and I add further, that it is as certainly produced by general predifpoflng debility. The hardnefs and fulnefs of the pulfe do not militate againlt this afTertion, for they are al- together the effects of a morbid and cenvahive ex- citement of the fanguiferous fyftem. The f:rength manifefted by the pulfe is moreover partial, for every other part of the body difcovers, at the fame time, figns of extreme debility.
It would be eafy, by purfuing this fubjeft a lit- tle further, to mention a number of facts which, by the aid of principles in phyfiology and paihology, which are univerfally admitted, would open to us a new theory of fevers, but this would lead us too far from the fubject before us. I (hall only re- mark, that all that has been faid of the influence of general debilitating caufes upon the lungs, both in pnuemony and confumption, and of the alternation of the confumption with other general difeafes, will receive great fupport from confidering the lungs •only as a p.irr of the whole external furface of the
body
I42 PULMONARY CONSUMPTION.
body, upon which moil of the remote and exciting caufes of both difeafes produce their firft effe&s. This extent of the furface of the body, not only to the lungs, but to the alimentary canal, was firft taken notice of by Dr. Boerhaave; but was unhappily neglected by him in his theories of the difeafes of the lungs and bowels. Dr. Keilfuppofes, that the lungs, from the peculiar ftru&ure of the bronchial vefTels, and air veficles, expofe a furface to the a&ion of the air, equal to the extent of the whole external and vifible furface of the body.
Thus have I mentioned the ufual palliative re- medies for the confumption. Many of thefe re- medies have, under certain circumdances, been faid to have cured the difeafe, but I fufpecl: that fuch cures have taken place only when the difor- der has partaken of an intermediate nature be- tween a pnuemony and a true pulmonary confump- tion. Such connecting (hades appear between the extreme points of many other difeafes. In a for- mer effay,* I endeavoured to account for the trans- mutation (if I may be allowed the expreffion) of the pneumony into the confumption, by afcribing
it
* Inquiry into the dileafes and remedies of the Indians of North America; and a comparative view of their difea- fes and remedies with thofc of civilized nations. P. 43.
PULMONARY CONSUMPTION. 14^
it to the increafe of the debilitating refinements of civilized life. This opinion has derived conftant fupport from every obfervation I have made con- nected with this fubjec"t, fince its firft publication, in the year 1772.
I come now to treat of the radical remedies for the pulmonary confumption.
In an elTay formerly alluded to*, I mentioned the effects of labour, and the hardlhips of a camp or naval life, upon this diforder. As there muft fre- quently occur fuch objections to each of thofe re- medies, as to forbid their being recommended or adopted, it will be neceffary to feek for fubftitutes for them in the different fpecies of exercife. Thefc are, aflrue, pajfrce, and mixed. The active, in- cludes walking, and the exercife of the hands and feet in working or dancing. The paffive includes rocking in a cradle, fwinging, failing, and riding in carriages of different kinds. The mixed is con- fined chiefly to riding on horfe-back.
I have mentioned all the different fpecies of ex- ercife, not becaufe I think they all belong to the
clafs
* Thoughts upon the pulmonary confumption. Med. Inq. ami Olfervations,
144 PULMONARY CONSUMPTION.
clafs of radical remedies for the confumption, but becaufe it is often neceffary to ufe thofe which are paffive, before we recommend thofe of a mixed or active nature. That phyfician does not err more who advifes a patient to take phyfic, without fpeci- fying its .qualities and dofes, than the phyfician does who advifes a patient, in a confumption, to ufe ex- ercife, without fpecifying its fpecies and degrees. From the neglect of this direction, we often find confumptive patients injured inftead of being reliev- ed by exercifes, which, if ufed with judgment, might have been attended with the happieft ef- fects.
I have before fuggefted that the flimulus of every medicine, which is intended to excite action in the fyftem, mould always be in an exact ratio to its excitability. The fame rule fhould be applied to the ftimulus of exercife. I have heard a well attefted cafe of a young lady, upon whofe confump- tion the firft falutary impreffion was made by rocking her in a cradle ; and I know another cafe in which a young lady, in the loweft ftate of that debility which precedes an affection of the lungs, was prepared for the ufe of the mixed and active exercifes, by being firft moved gently back- wards and forwards in a chariot without horfes, for an hour every day. Swinging appears to act 4 in.
PULMONARY CONSUMPTION. 145
in the fame gentle manner. In the cafe of a gar- diner, who was far advanced in a confumption, in the Pennfylvania hofpital, I had the pleafure of obferving its good effefts, in an eminent degree. It fo far reflored him, as to enable him to complete his recovery by working at his former occupa- tion.
In cafes of extreme debility, the following or- der Ihould be recommended in the ufe of the dif- ferent fpecies of exercife.
1. Rocking in a cradle, or riding on an elaftic board — commonly called a chamber horfe.
2. Swinging.
3. Sailing.
4. Riding in a carriage.
5. Riding on horfeback.
6. Walking.
7. Running — Dancing, &c.
In the ufe of each of thofe fpecies of exercife
great attention Ihould be paid to the degree or force
of action with which they are applied to the body.
Vox-. II. K For
146 Pulmonary consumption.
For example, — in riding in a carriage, the exercife will be lefs in a four-wheel carriage than in a fingle horfe chair, and lefs when the horfes move in a walking, than a trotting gait. In riding on horfe- back, the exercife will be lefs or greater according as the horfe walks, paces, canters, or trots, in paf- fing over the ground.
I have gocd reafon to believe, that an Englifh fea captain, who was on the verge of the grave with the confumption, in the fpring of the year 1790, owed his perfect recovery to nothing but the above gradual manner, in which, by my advice, he made ufe of the exercifes of riding in a carriage and on horfeback. I have feen many other cafes ©f the good effects of thus accommodating exer- cife to debility ; and I am forry to add, that I have feen many cafes in which from the neglect of this manner of ufmg exercife, mod of the fpecies and degrees of it, have either been ufelefs, or done harm. However carelefsly this obfervation may be read by phyficians, or attended to by patients, I conceive no direction to be more necelfary in the cure of confumptions. I have been thus particular in detailing it, not only becaufe I believe it to be important, but that I might atone to fociety for that portion of evil which I might have prevented
b/
PULMONARY CONSUMPTION. 147
\yj a more drift attention to it in the firft years of my practice.
The more the arms are ufed in exercife the better. One of the proprietary governors of Penn- fylvania, who laboured for many years under a con- sumptive diathefis, derived great benefit from fre- quently rowing himfelf in a fmall boat, a few miles up and down the river Schuilkill. Two young men, who were predifpofed to a confumption, were per- fectly cured by working (leadily at a printing prefs in this city. Perhaps the fuperior advantages of riding on horfeback, in this diforder, may arife in part from the conftant and gentle ufe of the arms in the management of the bridle and the whip.
Much has been faid in favour of fea voyages in confumptions. In the mild degrees of the dif- order they certainly have done fervice, — but I fuf- pect the relief given, or the cures performed by them,mould be confined chiefly to feafaring people, who add to the benefits of a conflant change of pure air, a (hare of the invigorating exercifes of navigating the fhip. I have frequently heard of confumptive patients reviving at fea, probably from the tranfient effects of fea ficknefs upon the whole fyilcm, and growing worfe as foon as they
K 2 came
I4§ PULMONARY COSUMPTION1.
\
came near the end of their voyage. It would feern as if the mixture of land and fea airs was hurtful to the lungs in every fituation and condition in which it could be applied to them. Nor is this peculiar and morbid operation of land and fea airs upon the human body confined only to confump- tive people. I crofTed the Atlantic ocean in the year 1 766, with a fea captain, who announced to his paffengers the agreeable news that we were near the Britifh coafl before any difcovery had been made of our fituation by founding, or by a change in the colour of the water. Upon afking him upon what he founded his opinion, — he faid, that he had been fneezing, which he added, was the fign of an approaching cold, and that in the courfe of upwards of twenty years, he had never made the land (to ufe the feaman's phrafe) with- out being aifecled in a fimilarmanner. Ihave vifited many fick people in Philadelphia foon after their arrival from fea, who have informed me, that they had enjoyed good health during the greateft part of their voyage, and that they had contracted their indifpofitions after they came within fight of the land. I mention thefe facts only to fhew the ne- ceffity of advifmg c'onfumptive patients,who under- take a fea voyage for the recovery of their health, not to expofe themfelves upon deck in the morn- ing and at night, after they arrive within the re- gion5
■ 0
-PULMONARY CONSUMPTION. 1 49
gion in which the mixture of the land and fea airs may be fuppofed to take place.
I subscribe, from what I have obferved, to the bold declaration of Dr. Sydenham, in favor of the efficacy of riding on horfeback, in the cure of confumption. I do not think the exiftence of ul- cers, or even tubercles in the lungs, when recent, or of a moderate fize, the lead objection to the ufe of this excellent remedy. Ulcers in the lungs are not neceffarily fatal, and tubercles have no ma- lignity in them which mould render their removal impracticable by this fpecies of exercife. The firft queftion, therefore, to be afked by a phyfician who vifits a patient in this diforder mould be, not, what is the ftate of his lungs, but, is he able to ride on horfeback.
There are two methods of riding for health in this diforder. The firft is by fhort excurfions ; the fecond is, by long journies. In flight oon- fumptive affections, and after a recovery from an acute illnefs, mon excurfions are fufficient to re- move the exifting debility; but in the more advan- ced ftages of confumption, they are feldom effec- tual, and frequently do harm by exciting an occa- fional appetite without adding to the digeftive powers. They moreover keep the fyftem con-
ftantly
I50 PULMONARY CONSUMPTION*
ftantly vibrating by their unavoidable inconftaney\ between diftant points of tone and debility*, and they are unhappily accompanied at all times from the want of a fucceffion of frefli objects to divert the mind, by the melancholy reflexion that they are the fad, but neceffary conditions of life.
In a confumption of long continuance or of gjeat danger, long journies on horfe back are the the mod effectual modes of exercife. They afford a conftant fucceflion of frefli objects and company, which divert the mind from dwelling upon the dan- ger of the exiiting malady ; they are moreover at- tended by a conftant change of air, and they are not liable to be interrupted by company, or tranfi- ent changes in the weather, by which means ap- petite and digeflion, action and power all keep pace with each other. It is to be lamented that the ufe of this excellent remedy is frequently op- pofed by indolence and narrow circumftances in both fexes, and by the peculiarity of fituation and temper in the female fex. Women are attached to their families by ftronger ties than men. They
cannot travel alone. Their delicacy, which is in-
creafed
* The bad effects of inanflant exercife have been taken notice of in the gout. Dr. Sydenham fays, when it is ufect only by fits and itarts in this diforder, it does harm.
X»ULMONARY CONSUMPTION. 15!
creafed by ficknefs, is liable to be offended at every ftage, — and laflly, they fooner relax in their ex- ertions to prolong their lives than men. Of the truth of the lad obfervation, Sir William Hamil- ton has furnifhed us with a finking illuftration. He tells us, that in digging into the ruins pro- duced by the late earthquake in Calabria, the wo- men who periuied in it, were all found with their arms folded as if they had abandoned themfelves immediately to defpair and death ; whereas, the men were found with their arms extended, as if they had refilled their fate to the lafl moment of their lives. It would feem from this facl, and ma- ny others of a fimilar nature which might be rela- ted ; that a capacity of bearing pain and diflrefs with fortitude and refignation, was the didingui fil- ing char a£teri flic of the female mind ; while a dif- pofition to refifl and overcome evil belonged in a more peculiar manner to the mind of man. I have mentioned this peculiarity of circumflances and temper in female patients, only for the fake of convincing phyficians that it will be neceffary for them to add all the force of eloquence to their ad- vice, when they recommend journies to women in preference to all other remedies, for the recovery of their health.
Persons
152 PULMONARY CONSUMPTION.
Persons, moreover, who purfue aftive employ- ments, frequently object to undertaking journies, from an opinion that their daily occupations are fufficient to produce all the falutary effects we expect from artificial exercife. It will be highly neceffary to correct this miftake, by affuring fuch perfons that, however ufeful the habitual exercife of an active, or even a laborious employment may t»e to preferve health, it mud always be exchanged for one which excites new impreflions, both upon the mind and body in every attempt to refiore the fyftem from that debility which is connected with pulmonary confumption.
As travelling is often rendered ufelefs, and even hurtful in this difeafe from being purfued in an im- proper manner, it will be neceffary to furnifh our patients with fuch directions as will enable them to derive the greatefl benefit from their journies. I (hall therefore, in this place, mention the fub- flance of the directions which I have given in wri- ting for many years to fuch confumptive patients as undertake journies by my advice.
1, To Avoid Fatigue. Too much cannot be faid to enforce this direction. It is the hinge on. which the recovery or death of a confumptive pa- tient frequently turns. I repeat it again, there-
forea
PULMONARY CONSUMPTION. 1J3
fore, that patients ihould be charged over and over when they fet off on a journey, as well as when they ufe exercife of any kind to avoid fa- tigue. For this purpofe, they ihould begin by travelling only a few miles in a day, and increafe the diftance of their ftages as they increafe their ftrength. By neglecting this practice, many per- fons have returned from journies much worfe than when they left home, and many have died in ta- verns, or at the houfes of their friends on the road. Travelling in ftage-coaches is feldom fafe for a confumptive patient. They are often crouded ; they give too much motion ; and they afford by their fhort delays and diflant ftages, too little time for reft, or for taking the frequent refrefhment which was formerly recommended.
2. To Avoid travelling too foon in the Morning, and after the Going down of the Sun in the Even- ing ; and if the weather be hot, never to travel in the middle of the day. The fooner a patient breakfafts after he leaves his bed the better; and in no cafe ihould he leave his morning ftage with an empty ftomach.
3. If it ihould be neceffary for a patien.t to lie down, or to ileep in the day time, he ihould be adyifcd to undrefs bimfelf, and to cover his bo^y
be.
154 PULMONARY CONSUMPTION.
between fheets or blankets. The ufual ligatures of garters, flocks, kneebands, waiftcoats and fhocs, are very unfriendly to found fleep ; hence perfons who lie down with their cloaths on, often awake from an afternoon's nap in terror from dreams, or in a profufc fweat, or with a head-ach or fick ftomach ; and generally out of humor. The furveyors are fo fenfible of the truth of this remark, that they always undrefs themfelves when they fleep in the woods. An intelligent gentleman of this profeffion informed me that he had fre- quently feen young woodfmen who had refufed to conform to this practice, fo much indifpofed in the morning, that after the experience of a few nights, they were forced to adopt it.
Great care fhould be taken in fleeping, whe* ther in the day time, or at night, never to lie down in damp fheets. Dr. Sydenham excepts the dan- ger from this quarter, when he fpeaks of the ef- ficacy of riding on horfeback in curing the con- fumption.
4. Patients who travel for health in this di£ order fhculd avoid all large companies, more efpeci* ally evening and night parties. The air of a contaminated room, phlogifticated by the breath of fifteen or twenty perfons, and by the fame number
of
PULMONARY CONSUMPTION. I55
of burning candles, is poifon to a confumptive pa- tient. To avoid impure air from every other fource, he mould likewife avoid ileeping in a croud- ed room, or wfth curtains around his bed, and even with a bed-fellow.
5. Travelling, to be effectual in this difor- order, mould be conducted in fuch a manner as that a patient may efcape the extremes of heat and cold. For this purpofe he fiiould pafs the winter, and part of the fpring in Georgia or South-Carolina, and the fummer in New Hamp- ihire, MalTachufetts, or Vermont, or if he pleafes, he may (till more effectually fhun the fummer heats by crofting the lakes, and travelling along the fhores of the St. Lawrence to the city of Quebec. He will thus efcape the extremes of heat and cold, particularly the lefs avoidable one of heat ; for I have conftantly found the hot month of July to be as unfriendly to confumptive patients in Pennfylvania, as the variable month of March. By thefe means too he will enjoy nearly an equable temperature of air in every month of the year ; and his fyftem will -be free from the inconvenience of the alternate ac- tion of heat and cold upon it.- The autumnal months mould be fpent in New-Jerfey or Pennfyl- vania,
la
I $6 . PULMONARY CONSUMPTION.
In thefe journies from north to fouth, oy from fouth to north, he mould be careful, for reafons before mentioned, to keep at as great a diftan.ee as poffible from the fea coafr. Should this inquiry fall into the hands of a Britifh phyfician, I would beg leave to fugged to him, whether more advantages would not acrue to his confumptive patients from advifing them to crofs the Atlantic ocean, and afterwards to purfue the tour which I have recommended, than by fending
them to Portugal, France, or Italy Here
they will arrive with fuch a mitigation of the vi- olence of the diforder, in confequence of the length of their fea voyage, as will enable them immediately to begin their journies on horfeback. Here they will be expofed to fewer temptations to intemperance, or to unhealthy a- nrufements, than in old European countries. And, Jaflly, in the whole courfe of this tour, they will travel among a people related to them by a fame- nefs o^ language and manners, and by ancient or modera ties of citizenfhip. Long journies for the recovery of health under circumftances fo agreeable, fhould certainly be preferred to travel- ling among Grangers of different nations, langua- ges, and manners on the continent of Europe.
6. To render travel-ling on horfeback effectual jn a confumption, it mould be continued with mo- derate
PULMONARY CONSUMPTION. t $J
derate intervals horn fix to twelve months. But the cure fliould not be reded upon a Angle journey. It fliould be repeated every two or three years ', till our patient has paffed the confumptive ftages of life. Nay, — he muft do more, he muft acquire a habit of riding conftantly, both at home and abroad, or to life the words of Dr. Fuller " he muft, like a