had thus acquired of the bilious remitting fever, he was very
successful in the treatment of it. It was by instruction conveyed
by him to me with peculiar delicacy, that I was first taught the
advantages of copious evacuations from the bowels in that disease.
I had been called, when a young practitioner, to visit a gentleman
with him in a bilious pleurisy. A third or fourth bleeding, which
I advised, cured him. The doctor was much pleased with its effect,
and said to me afterwards, "Doctor, you and I have each a great
fault in our practice; I do not bleed enough, you do not purge
enough."
The yellow fever prevailed in the neighbourhood of Spruce-street wharf,
and near a filthy stream of water which flowed through what is now called
Dock-street, in the year 1762. Some cases of it appeared likewise in
Southwark. It was scarcely known in the north and west parts of the city.
No desertion of the citizens took place at this time, nor did the fear of
contagion drive the friends of the sick from their bed-sides, nor prevent
the usual marks of respect being paid to them after death, by following
their bodies to the grave. A few sporadic cases of the same grade of
fever appeared in the year 1763.
Pneumonies, rheumatisms, inflammatory sore throats, and catarrhs were
frequent during the winter and spring months. The last disease was
induced, not only by sudden changes in the weather, but often by exposure
to the evening air, on porches in summer, and by the damp and cold air of
places of public worship in winter.
The influenza was epidemic in the city in the spring of the year 1761.
The malignant sore throat proved fatal to a number of children in the
winter of 1763.
The scarlet fever prevailed generally in the year 1764. It resembled the
same disease, as described by Dr. Sydenham, in not being accompanied by a
sore throat.
Death from convulsions in pregnant women, also front parturition, and the
puerperile fever, were common between the years 1760 and 1766. Death was
likewise common between the 50th and 60th years of life from gout,
apoplexy, palsy, obstructed livers, and dropsies. A club, consisting of
about a dozen of the first gentlemen in the city, all paid, for their
intemperance, the forfeit of their lives between those ages, and most of
them with some one, or more of the diseases that have been mentioned. I
sat up with one of that club on the night of his death. Several of the
members of it called at his house, the evening before he died, to inquire
how he was. One of them, upon being informed of his extreme danger, spoke
in high and pathetic terms of his convivial talents and virtues, and
said, "he had spent 200 evenings a year with him, for the last twenty
years of his life." These evenings were all spent at public houses.
The colica pictonum, or dry gripes, was formerly a common disease in this
city. It was sometimes followed by a palsy of the upper and lower
extremities. Colics from crapulas were likewise very frequent, and now
and then terminated in death.
Many children died of the cholera infantum, cynanche trachealis, and
hydrocephalus internus. The last disease was generally ascribed to worms.
Fifteen or twenty deaths occurred, every summer, from drinking cold pump
water, when the body was in a highly excitable state, from great beat and
labour.
The small-pox, within the period alluded to, was sometimes epidemic, and
carried off many citizens. In the year 1759, Dr. Barnet was invited from
Elizabeth-town, in New-Jersey, to Philadelphia, to inoculate for the
small-pox. The practice, though much opposed, soon became general. About
that time, Dr. Redman published a short defence of it, and recommended
the practice to his fellow-citizens in the most affectionate language.
The success of inoculation was far from being universal. Subsequent
improvements in the mode of preparing the body, and treating the eruptive
fever, have led us to ascribe this want of success to the deep wound made
in the arm, to the excessive quantity of mercury given to prepare the
body, and to the use of a warm regimen in the eruptive fever.
The peculiar customs and the diseases which have been enumerated, by
inducing general weakness, rendered the pulmonary consumption a frequent
disease among both sexes.
Pains and diseases from decayed teeth were very common, between the years
1760 and 1766. At that time, the profession of a dentist was unknown in
the city.
The practice of physic and surgery were united, during those years, in
the same persons, and physicians were seldom employed as man-midwives,
except in preternatural and tedious labours.
The practice of surgery was regulated by Mr. Sharp's treatise upon that
branch of medicine.
Let us now take a view of the medical opinions which prevailed at the
above period, and of the remedies which were employed to cure the
diseases that have been mentioned.
The system of Dr. Boerhaave then governed the practice of every physician
in Philadelphia. Of course diseases were ascribed to morbid acrimonies,
and other matters in the blood, and the practice of those years was
influenced by a belief in them. Medicines were prescribed to thin, and to
incrassate the blood, and diet drinks were administered in large
quantities, in order to alter its qualities. Great reliance was placed
upon the powers of nature, and critical days were expected with
solicitude, in order to observe the discharge of the morbid cause of
fevers from the system. This matter was looked for chiefly in the urine,
and glasses to retain it were a necessary part of the furniture of every
sick room. To ensure the discharge of the supposed morbid matter of
fevers through the pores, patients were confined to their beds, and
fresh, with cool air, often excluded by close doors and curtains. The
medicines to promote sweats were generally of a feeble nature. The
spiritus mindereri, and the spirit of sweet nitre were in daily use for
that purpose. In dangerous cases, saffron and Virginia snake-root were
added to them.
Blood-letting was used plentifully in pleurisies and rheumatisms, but
sparingly in all other diseases. Blood was often drawn from the feet, in
order to excite a revulsion of disease from the superior parts of the
body. It was considered as unsafe, at that time, to bleed during the
monthly disease of the female sex.
Purges or vomits began the cure of all febrile diseases, but as the
principal dependence was placed upon sweating medicines, those powerful
remedies were seldom repeated in the subsequent stages of fevers. To this
remark there was a general exception in the yellow fever of 1762. Small
doses of glauber's salts were given every day after bleeding, so as to
promote a gentle, but constant discharge from the bowels.
The bark was administered freely in intermittents. The prejudices against
it at that time were so general among the common people, that it was
often necessary to disguise it. An opinion prevailed among them, that it
lay in their bones, and that it disposed them to take cold. It was seldom
given in the low and gangrenous states of fever, when they were not
attended with remissions.
The use of opium was confined chiefly to ease pain, to compose a cough,
and to restrain preternatural discharges from the body. Such were the
prejudices against it, that it was often necessary to conceal it in other
medicines. It was rarely taken without the advice of a physician.
Mercury was in general use in the years that have been mentioned. I have
said it was given to prepare the body for the small-pox. It was
administered by my first preceptor in medicine, Dr. Redman, in the same
disease, when it appeared in the natural way, with malignant or
inflammatory symptoms, in order to keep the salivary glands open and
flowing, during the turn of the pock. He gave it likewise liberally in
the dry gripes. In one case of that disease, I well remember the pleasure
he expressed, in consequence of its having affected his patient's mouth.
But to Dr. Thomas Bond the city of Philadelphia is indebted for the
introduction of mercury into general use, in the practice of medicine. He
called it emphatically "a revolutionary remedy," and prescribed it in all
diseases which resisted the common modes of practice. He gave it
liberally in the cynanche trachealis. He sometimes cured madness, by
giving it in such quantities as to excite a salivation. He attempted to
cure pulmonary consumption by it, but without success; for, at that time,
the influence of the relative actions of different diseases and remedies,
upon the human body, was not known, or, if known, no advantage was
derived from it in the practice of medicine.
The dry gripes were cured, at that time, by a new and peculiar mode of
practice, by Dr. Thomas Cadwallader. He kept the patient easy by gentle
anodynes, and gave lenient purges, only in the beginning of the disease;
nor did he ever assist the latter by injections till the fourth and fifth
days, at which time the bowels discharged their contents in an easy
manner. It was said this mode of cure prevented the paralytic symptoms,
which sometimes follow that disease. It was afterwards adopted and highly
commended by the late Dr. Warren, of London.
Blisters were in general use, but seldom applied before the latter stage
of fevers. They were prescribed, for the first time, in hæmorrhages, and
with great success, by Dr. George Glentworth.
Wine was given sparingly, even in the lowest stage of what were then
called putrid and nervous fevers.
The warm and cold baths were but little used in private practice. The
former was now and then employed in acute diseases. They were both used
in the most liberal manner, together with the vapour and warm air baths,
in the Pennsylvania hospital, by Dr. Thomas Bond. An attempt was made to
erect warm and cold baths, in the neighbourhood of the city, and to
connect them with a house of entertainment, by Dr. Lauchlin M'Clen, in
the year 1761. The project was considered as unfriendly to morals, and
petitions, from several religious societies, were addressed to the
governor of the province, to prevent its execution. The enterprize was
abandoned, and the doctor soon afterwards left the city.
Riding on horseback, the fresh air of the sea-shore, and long journies,
were often prescribed to invalids, by all the physicians of that day.
I come now to mention the causes which influence the diseases, also the
medical opinions and remedies of the present time. In this part of our
discourse, I shall follow the order of the first part of our inquiry.
I have already taken notice of the changes which the climate of
Philadelphia has undergone since the year 1766.
A change has of late years taken place in the dress of the inhabitants of
Philadelphia. Wigs have generally been laid aside, and the hair worn cut
and dressed in different ways. Round hats, with high crowns, have become
fashionable. Umbrellas, which were formerly a part of female dress only,
are now used in warm and wet weather, by men of all ranks in society; and
flannel is worn next to the skin in winter, and muslin in summer, by many
persons of both sexes. Tight dresses are uncommon, and stays are unknown
among our women. It is to be lamented that the benefits to health which
might have been derived from the disuse of that part of female dress,
have been prevented by the fashion of wearing such light coverings over
the breasts and limbs. The evils from this cause, shall be mentioned
hereafter.
A revolution has taken place in the diet of our citizens. Relishes and
suppers are generally abolished; bitters, to provoke a preternatural
appetite, also meridian bowls of punch, are now scarcely known. Animal
food is eaten only at dinner, and excess in the use of it is prevented,
by a profusion of excellent summer and winter vegetables.
Malt liquors, or hydrant water, with a moderate quantity of wine, are
usually taken with those simple and wholesome meals.
Clubs, for the exclusive purpose of feeding, are dissolved, and succeeded
by family parties, collected for the more rational entertainments of
conversation, dancing, music, and chess. Taverns and beer-houses are much
less frequented than formerly, and drunkenness is rarely seen in genteel
life. The tea table, in an evening, has now become the place of resort of
both sexes, and the midnight serenade has taken place of the midnight
revels of the young gentlemen of former years.
In doing justice to the temperance of the modern citizens of
Philadelphia, I am sorry to admit, there is still a good deal of secret
drinking among them. Physicians, who detect it by the diseases it
produces, often lament the inefficacy of their remedies to remove them.
In addition to intemperance from spiritous liquors, a new species of
intoxication from opium has found its way into our city. I have known
death, in one instance, induced by it.
The following circumstances have had a favourable influence upon the
health of the present inhabitants of Philadelphia.
The improvements in the construction of modern houses, so as to render
them cooler in summer, and warmer in winter.
The less frequent practice of sitting on porches, exposed to the dew, in
summer evenings.
The universal use of stoves in places of public worship.
The abolition of the custom of obliging lying-in women to sit up for
company.
The partial use of Schuylkill or hydrant water, for culinary and other
purposes.
The enjoyment of pure air, in country seats, in the neighbourhood of the
city. They not only preserve from sickness during the summer and autumn,
but they render families less liable to diseases during the other seasons
of the year.
And, lastly, the frequent use of private, and public warm and cold baths.
For the establishment of the latter, the citizens of Philadelphia are
indebted to Mr. Joseph Simons.
The following circumstances have an unfavourable influence upon the
health of our citizens.
Ice creams taken in excess, or upon an empty stomach.
The continuance of the practice of attending funerals, under all the
circumstances that were mentioned in describing the customs which
prevailed in Philadelphia, between the years 1760 and 1766.
The combined influence of great heat and intemperance in drinking, acting
upon passions unusually excited by public objects, on the 4th of July,
every year.
The general and inordinate use of segars.
The want of sufficient force in the water which falls into the common
sewers to convey their contents into the Delaware, renders each of their
apertures a source of sickly exhalations to the neighbouring streets and
squares.
The compact manner in which the gutters are now formed, by preventing the
descent of water into the earth, has contributed very much to retain the
filth of the city, in those seasons in which they are not washed by rain,
nor by the waste water of the pumps and hydrants.
The timbers of many of the wharves of the city have gone to decay. The
docks have not been cleaned since the year 1774, and many of them expose
large surfaces to the action of the sun at low water. The buildings have
increased in Water-street, and with them there has been a great increase
of that kind of filth which is generated in all houses; the stores in
this street often contain matters which putrify; from all which there is,
in warm weather, a constant emission of such a f[oe]tid odour, as to
render a walk through that street, by a person who does not reside there,
extremely disagreeable, and sometimes to produce sickness and vomiting.
In many parts of the vicinity of the city are to be seen pools of
stagnating water, from which there are exhaled large quantities of
unhealthy vapours, during the summer and autumnal months.
The privies have become so numerous, and are often so full, as to become
offensive in most of the compact parts of the city, more especially in
damp weather.
The pump water is impregnated with many saline and aërial matters of an
offensive nature.
While these causes exert an unfriendly influence upon the bodies of the
citizens of Philadelphia, the extreme elevation or depression of their
passions, by the different issues of their political contests (now far
surpassing, in their magnitude, the contests of former years), together
with their many new and fortuitous modes of suddenly acquiring and
losing property, predispose them to many diseases of the mind.
The present diseases of Philadelphia come next under our consideration.
Fevers have assumed several new forms since the year 1766. The mild
bilious fever has gradually spread over every part of the city. It
followed the filth which was left by the British army in the year 1778.
In the year 1780, it prevailed, as an epidemic, in Southwark, and in
Water and Front-streets, below Market-street[67]. In the years 1791 and
1792, it assumed an inflammatory appearance, and was accompanied, in many
cases, with hepatic affections. The connection of our subject requires
that I should barely repeat, that it appeared in 1793 as an epidemic, in
the form of what is called yellow fever, in which form it has appeared,
in sporadic cases, or as an epidemic, every year since. During the reign
of this high grade of bilious fever, mild intermittents and remittents,
and the chronic or nervous forms of the summer and autumnal fever, have
nearly disappeared.
[67] It appears, from the account given by Mr. White of the bilious
fever of Bath, that it prevailed several years in its suburbs,
before it became general in that city. It is remarkable, that
Southwark was nearly the exclusive seat, not only of the bilious
or break-bone fever of 1780, but of the intermitting fever in
1765, taken notice of by Dr. Bond, and of the yellow fever of
1805.
Inflammations and obstructions of the liver have been more frequent than
in former years, and even the pneumonies, catarrhs, intercurrent, and
other fevers of the winter and spring months, have all partaken more or
less of the inflammatory and malignant nature of the yellow fever.
The pulmonary consumption continues to be a common disease among both
sexes.
The cynanche trachealis, the scarlatina anginosa, the hydrocephalus
internus, and cholera infantum, are likewise common diseases in
Philadelphia.
Madness, and several other diseases of the mind, have increased since the
year 1766, from causes which have been mentioned.
Several of the different forms of gout are still common among both sexes.
Apoplexy and palsy have considerably diminished in our city. It is true,
the bills of mortality still record a number of deaths from the former,
every year; but this statement is incorrect, if it mean a disease of the
brain only, for sudden deaths from all their causes are returned
exclusively under the name of apoplexy. The less frequent occurrence of
this disease, also of palsy, is probably occasioned by the less
consumption of animal food, and of distilled and fermented liquors, by
that class of citizens who are most subject to them, than in former
years. Perhaps the round hat, and the general use of umbrellas, may have
contributed to lessen those diseases of the brain.
The dropsy is now a rare disease, and seldom seen even in our hospital.
The colica pictonum, or dry gripes, is scarcely known in Philadelphia. I
have ascribed this to the use of flannel next to the skin as a part of
dress, and to the general disuse of punch as a common drink.
The natural small-pox is nearly extirpated, and the puerperile fever is
rarely met with in Philadelphia. The scrophula is much less frequent than
in former years. It is confined chiefly to persons in humble life.
I proceed, in the order that was proposed, to take notice of the present
medical opinions which prevail among the physicians of Philadelphia. The
system of Dr. Boerhaave long ago ceased to regulate the practice of
physic. It was succeeded by the system of Dr. Cullen. In the year 1790,
Dr. Brown's system of medicine was introduced and taught by Dr. Gibbon.
It captivated a few young men for a while, but it soon fell into
disrepute. Perhaps the high-toned diseases of our city exposed the
fallacy and danger of the remedies inculcated by it, and afforded it a
shorter life than it has had in many other countries. In the year 1790,
the author of this inquiry promulgated some new principles in medicine,
suggested by the peculiar phænomena of the diseases of the United States.
These principles have been so much enlarged and improved by the
successive observations and reasonings of many gentlemen in all the
states, as to form an American system of medicine. This system rejects
the nosological arrangement of diseases, and places all their numerous
forms in morbid excitement, induced by irritants acting upon previous
debility. It rejects, likewise, all prescriptions for the names of
diseases, and, by directing their applications wholly to the forming and
fluctuating states of diseases, and the system, derives from a few active
medicines all the advantages which have been in vain expected from the
numerous articles which compose European treatises upon the materia
medica. This system has been adopted by a part of the physicians of
Philadelphia, but a respectable number of them are still attached to the
system of Dr. Cullen.
A great change has taken place in the remedies which are now in common
use in Philadelphia. I shall briefly mention such of them as are new, and
then take notice of the new and different modes of exhibiting such as
were in use between the years 1760 and 1766.
Vaccination has been generally adopted in our city, in preference to
inoculation with variolous matter.
Digitalis, lead, zinc, and arsenic are now common remedies in the hands
of most of our practitioners.
Cold air, cold water, and ice are among the new remedies of modern
practice in Philadelphia.
Blood-letting is now used in nearly all diseases of violent excitement,
not only in the blood-vessels, but in other parts of the body. Its use is
not, as in former times, limited to ounces in specific diseases, but
regulated by their force, and the importance of the parts affected to
health and life; nor is it forbidden, as formerly, in infancy, in extreme
old age, in the summer months, nor in the period of menstruation, where
symptoms of a violent, or of a suffocated disease, manifested by an
active or a feeble pulse, indicate it to be necessary.
Leeches are now in general use in diseases which are removed, by their
seat or local nature, beyond the influence of the lancet. For the
introduction of this excellent remedy into our city we are indebted to
Mr. John Cunitz.
Opium and bark, which were formerly given in disguise, or with a
trembling hand, are now, not only prescribed by physicians, but often
purchased, and taken without their advice, by many of the citizens of
Philadelphia. They even occupy a shelf in the closets of many families.
The use of mercury has been revived, and a salivation has been extended;
with great improvements and success, to nearly all violent and obstinate
diseases. Nor has the influence of reason over ignorance and prejudice,
with respect to that noble medicine, stopped here. Cold water, once
supposed to be incompatible with its use, is now applied to the body, in
malignant fevers, in order to insure and accelerate its operation upon
the salivary glands.
Wine is given in large quantities, when indicated, without the least fear
of producing intoxication.
The warm and cold baths, which were formerly confined chiefly to patients
in the Pennsylvania hospital, are now common prescriptions in private
practice.
Exercise, country air, and the sea shore, are now universally recommended
in chronic diseases, and in the debility which precedes and follows them.
Great pains are now taken to regulate the quantity and quality of
aliments and drinks, by the peculiar state of the system.
Let us now inquire into the influence of the new opinions in medicine,
and the new remedies which have been mentioned, upon human life.
The small-pox, once the most fatal and universal of all diseases, has
nearly ceased to occupy a place in our bills of mortality, by the
introduction of vaccination in our city. For the prompt adoption of this
great discovery, the citizens of Philadelphia owe a large debt of
gratitude to Dr. Coxe, and Mr. John Vaughan.