of the bilious yellow fever, now yield to medicine. Even that most
malignant form of febrile diseases is treated with more success in
Philadelphia than in other countries. It would probably seldom prove
mortal, did a belief in its being derived from an impure atmosphere, and
of its exclusive influence upon the body, while it prevailed as an
epidemic, obtain universally among the physicians and citizens of
Philadelphia.
The pulmonary consumption has been prevented, in many hundred instances,
by meeting its premonitory signs, in weakness and feeble morbid
excitement in the whole system, by country air, gentle exercise, and
gently stimulating remedies. Even when formed, and tending rapidly to its
last stage, it has been cured by small and frequent bleedings, digitalis,
and a mercurial salivation.
The hydrocephalus internus, the cynanche trachealis, and cholera
infantum, once so fatal to the children of our city, now yield to
medicine in their early stages. The two former are cured by copious
bleeding, aided by remedies formerly employed in them without success.
The last is cured by moderate bleeding, calomel, laudanum, and country
air.
The gout has been torn from its ancient sanctuary in error and prejudice,
and its acute paroxysms now yield with as much certainty to the lancet,
as the most simple inflammatory diseases.
The dropsy is cured by renouncing the unfortunate association of specific
remedies with its name, and accommodating them to the degrees of
excitement in the blood-vessels.
The tetanus from wounds is now prevented, in most cases, by inflaming the
injured parts, and thereby compelling them to defend the whole system, by
a local disease. Where this preventing remedy has been neglected, and
where tetanus arises from other causes than wounds, it has often been
cured by adding to the diffusible stimulus of opium, the durable stimuli
of bark and wine.
Death from drinking cold water, in the heated state of the body, is now
obviated by previously wetting the hands or feet with the water; and
when this precaution is neglected, the disease induced by it is generally
cured by large doses of liquid laudanum.
Madness, which formerly doomed its miserable subjects to cells or chains
for life, has yielded to bleeding, low diet, mercury, the warm and cold
baths, fresh air, gentle exercise, and mild treatment, since its seat has
been discovered to be in the blood-vessels of the brain.
The last achievement of our science in Philadelphia, that I shall
mention, consists in the discovery and observation of the premonitory
signs of violent and mortal diseases, and in subduing them by simple
remedies, in their forming state. By this means, death has been despoiled
of his prey, in many hundred instances.
In this successful conflict of medicine with disease and death, midwifery
and surgery have borne a distinguished part. They derive their claims to
the gratitude of the citizens of Philadelphia from the practice of each
of them being more confined, than formerly, to a few members of our
profession. It is in consequence of the former being exercised only by
physicians of regular and extensive educations, that death from
pregnancy and parturition is a rare occurrence in Philadelphia.
I should greatly exceed the limits prescribed to this inquiry, should I
mention how much pain and misery have been relieved, and how often death
has been baffled in his attempts upon human life, by several late
improvements in old, and the discovery of new remedies in surgery. I
shall briefly name a few of them.
In cases of blindness, from a partial opacity of the cornea, or from a
closure of the natural pupil, a new pupil has been made; and where the
cornea has been partially opaque, the opening through the iris has been
formed, opposite to any part of it, which retained its transparency.
The cure of fractures has been accelerated by blood-letting, and, where
the union of a broken bone has not taken place from a defect of bony
matter, it has been produced by passing a seton between the fractured
ends of the bone, and effecting a union thereby between them. Luxations,
which have long resisted both force and art, have been reduced in a few
minutes, and without pain, by bleeding at deliquium animi.
Old sores have been speedily healed, by destroying their surfaces, and
thereby placing them in the condition of recent accidents.
The fruitless application of the trepan, in concussions of the brain, has
been prevented by copious bleeding, and a salivation.
A suppression of urine has been cured, by the addition of a piece of a
bougie to a flexible catheter.
Strictures in the urethra have been removed by means of a caustic, also,
in a more expeditious way, by dividing them with a lancet.
Hydrocele has been cured by a small puncture, and afterwards exciting
inflammation and adhesion by an injection of wine into the tunica
vaginalis testis.
The popliteal aneurism and varicose veins have both been removed by
operations that were unknown a few years ago.
For the introduction of several of those new surgical remedies, and for
the discovery and improvement of others, the citizens of Philadelphia are
indebted to Dr. Physick. They are likewise indebted to him and Dr.
Griffitts for many of the new and successful modes of practice, in the
diseases that have been mentioned. Even the few remedies that have been
suggested by the author of these inquiries, owe their adoption and
usefulness chiefly to the influence of those two respectable and popular
physicians.
Before I dismiss this part of our subject, I have only to add, that since
the cure and extraction of the teeth have become a distinct branch of the
profession of medicine, several diseases which have arisen from them,
when decayed, have been detected and cured[68].
[68] The late Mr. Andrew Spence was the first regular bred dentist that
settled in Philadelphia. There are now several well educated
gentlemen in the city of that profession.
We have thus taken a comparative view of the medical theories and
remedies of former and modern times, and of their different influence
upon human life. To exhibit the advantages of the latter over the former,
I shall mention the difference in the number of deaths in three
successive years, at a time when the population of the city and suburbs
was supposed to amount to 30,000 souls, and in three years, after the
population exceeded double that number.
Between the 25th of December, 1771, and the 25th of December, 1772, there
died 1291 persons.
Between the same days of the same months, in 1772 and 1773, there died
1344 persons.
Within the same period of time, between 1773 and 1774, the deaths
amounted to 1021, making in all 3,656. I regret that I have not been able
to procure the returns of deaths in years prior to those which have been
mentioned. During the three years that have been selected, no unusually
mortal diseases prevailed in the city. The measles were epidemic in 1771,
but were not more fatal than in common years.
Between the 25th of December, 1799, and the 25th of December, 1800, there
died 1525 persons.
Between the same days of the same months, in the years 1801 and 1802,
there died 1362 persons.
Within the same period of time, between 1802 and 1803, the deaths
amounted to 1796, making in all 4,883.
Upon these returns it will be proper to remark, that several hundreds of
the deaths, in 1802 and 1803, were from the yellow fever, and that many
of them were of strangers. Of 68 persons, who were interred in the
Swedes' church-yard alone, one half were of that description of people.
Deducting 500 from both those causes of extra-mortality in the three
years, between 1799 and 1803, the increase of deaths above what they were
in the years 1771 and 1774 is but 727. Had diseases continued to be as
mortal as they were thirty years ago, considering the present state of
our population, the number of deaths would have been more than 7,312.
To render the circumstances of the statement of deaths that has been
given perfectly equal, it will be necessary to add, that the measles
prevailed in the city, in the year 1802, as generally as they did in
1771.
From the history that has been given, of the effects of the late
improvements and discoveries in medicine upon human life, in
Philadelphia, we are led to appreciate its importance and usefulness. It
has been said, by its enemies, to move; but its motions have been
asserted to be only in a circle. The facts that have been stated clearly
prove, that it has moved, and rapidly too, within the last thirty years,
in a straight line.
To encourage and regulate application and enterprize in medicine
hereafter, let us inquire to what causes we are indebted for the late
discoveries and improvements in our science, and for their happy effects
in reducing the number of deaths so far below their former proportion to
the inhabitants of Philadelphia.
The first cause I shall mention is the great physical changes which have
taken place in the manners of our citizens in favour of health and life.
A second cause, is the assistance which has been afforded to the practice
of physic, by the numerous and important discoveries that have lately
been made in anatomy, natural history, and chemistry, all of which have
been conveyed, from time to time, to the physicians of the city, by means
of the Philadelphia and hospital libraries, and by the lectures upon
those branches of science which are annually delivered in the university
of Pennsylvania.
3. The application of reasoning to our science has contributed greatly to
extend its success in the cure of diseases. Simply to observe and to
remember, are the humblest operations of the human mind. Brutes do both.
But to _theorize_, that is, to _think_, or, in other language, to compare
facts, to reject counterfeits, to dissolve the seeming affinity of such
as are not true, to combine those that are related, though found in
remote situations from each other, and, finally, to deduce practical and
useful inferences from them, are the high prerogatives and interest of
man, in all his intellectual pursuits, and in none more, than in the
profession of medicine.
4. The accommodation of remedies to the changes which are induced in
diseases by the late revolutions in our climate, seasons, and manners,
has had a sensible influence in improving the practice of medicine in our
city. The same diseases, like the descendants of the same families, lose
their resemblance to each other by the lapse of time; and the almanacks
of 1803 might as well be consulted to inform us of the monthly phases of
the moon of the present year, as the experience of former years, or the
books of foreign countries, be relied upon to regulate the practice of
physic at the present time, in any of the cities of the United States.
5. From the diffusion of medical knowledge among all classes of our
citizens, by means of medical publications, and controversies, many
people have been taught so much of the principles and practice of physic,
as to be able to prescribe for themselves in the forming state of acute
diseases, and thereby to prevent their fatal termination. It is to this
self-acquired knowledge among the citizens of Philadelphia, that
physicians are in part indebted for not being called out of their beds so
frequently as in former years. There are few people who do not venture to
administer laudanum in bowel complaints, and there are some persons in
the city, who have cured the cynanche trachealis when it has occurred in
the night, by vomits and bleeding, without the advice of a physician. The
disuse of suppers is another cause why physicians enjoy more rest at
night than formerly, for many of their midnight calls, were to relieve
diseases brought on by that superfluous meal.
6. The dispensary instituted in our city, in the year 1786, for the
medical relief of the poor, has assisted very much in promoting the
empire of medicine over disease and death. Some lives have likewise been
saved by the exertions of the humane society, by means of their printed
directions to prevent sudden death; also, by the medical services which
have lately been extended to out-patients, by order of the managers of
the Pennsylvania hospital.
7thly and lastly. A change, favourable to successful practice in
Philadelphia, has taken place in the conduct of physicians to their
patients. A sick room has ceased to be the theatre of imposture in dress
and manners, and prescriptions are no longer delivered with the pomp and
authority of edicts. On the contrary, sick people are now instructed in
the nature of their diseases, and informed of the names and design of
their medicines, by which means faith and reason are made to co-operate
in adding efficacy to them. Nor are patients left, as formerly, by their
physicians, under the usual appearances of dissolution, without the aid
of medicine. By thus disputing every inch of ground with death, many
persons have been rescued from the grave, and lived, years afterwards,
monuments of the power of the healing art.
From a review of what has been effected within the last nine and thirty
years, in lessening the mortality of many diseases, we are led to look
forward with confidence and pleasure to the future achievements of our
science.
Could we lift the curtain of time which separates the year 1843 from our
view, we should see cancers, pulmonary consumptions, apoplexies, palsies,
epilepsy, and hydrophobia struck out of the list of mortal diseases, and
many others which still retain an occasional power over life, rendered
perfectly harmless, _provided_ the same number of discoveries and
improvements shall be made in medicine in the intermediate years, that
have been made since the year 1766.
But in vain will the avenues of death from those diseases be closed,
while the more deadly yellow fever is permitted to supply their place,
and to spread terror, distress, and poverty through the city, by
destroying the lives of her citizens by hundreds or thousands every year.
Dear cradle of liberty of conscience in the western world! nurse of
industry and arts! and patron of pious and benevolent institutions! may
this cease to be thy melancholy destiny! May Heaven dispel the errors and
prejudices of thy citizens upon the cause and means of preventing their
pestilential calamities! and may thy prosperity and happiness be revived,
extended, and perpetuated for ages yet to come!
* * * * *
INDEX.
A
Anthelmintics, i. 228
Arsenic, a remedy for cancerous sores, i. 240
Army of the United States, diseases of, i. 269
----, causes of, i. 272
----, remedies for, i. ibid.
Agriculture, the practice of, recommended to country physicians, i. 388
Age, old, observations on the state of the body and mind in, i. 427
----, its diseases, i. 446
----, ----, their remedies, i. 449
Air, cool, its good effects in the yellow fever of 1793, iii. 279
Association of ideas, its effects upon morals, ii. 45
B.
Barometer, its mean elevation in Philadelphia, i. 96
Blisters, their efficacy in obstinate intermittents, i. 179
----, ----, in the bilious fever of 1780, i. 128
----, ----, in the yellow fever of 1803, when applied in its early
stage, iv. 141
Bed, lying in, useful in the bilious fever of 1780, i. 128
Bleeding, its efficacy in the cure of obstinate intermittents, i. 179
----, ----, in the yellow fever of 1793, iii. 253
----, reasons for the practice, iii. 254
----, circumstances which regulated it, iii. 261
----, objections to it answered, iii. 269
----, gradual manner of abstracting blood recommended, iii. 273
Blood-letting, defence of it as a remedy for certain diseases, iv. 275
----, indicated in fevers, iv. ibid.
----, its good effects in fevers, iv. 277
----, objections to it answered, iv. 284
----, its comparative advantages, iv. 313
----, circumstances which should regulate its use, iv. 316
----, appearances of the blood, iv. 326
----, when forbidden, or to be used cautiously, iv. 344
----, its advantages in pregnancy, iv. 349
----, in parturition, iv. 353
----, during the cessation of the menses, iv. 356
----, in curing the disease induced by a large dose of opium, iv. 357
----, in curing the disease induced by poison, iv. ibid.
----, in diabetes, iv. ibid.
----, in dislocated bones, iv. 358
Blood, quantity drawn from several persons in 1797, iv. 37
----, appearances of it in 1793, iii. 256
----, ----, in 1794, iii. 404
C.
Civilization, diseases derived from it, i. 32
----, ----, not necessarily connected with it, i. 60
Climate of Pennsylvania, account of, i. 71
----, its changes, i. 76
----, its temperature, i. 78
----, its effects upon health and life, i. 108
Calomel, useful joined with emetics in scarlatina anginosa, i. 144
----, its effects as a purge, when combined with jalap, in the yellow
fever, iii. 241
----, objections to it answered, iii. 243
Contagious, the yellow fever not so, iv. 223
Cholera infantum described, i. 157
----, a form of bilious fever, i. 158
----, its remedies, i. 160
----, means of preventing it, i. 164
Cynanche trachealis, its different names, i. 169
----, appearances in the trachea after death, i. 170
----, its different grades, i. 171
----, its remedies in its forming state, i. ibid.
----, its remedies after it is formed, i. 172
----, favourable and unfavourable signs of its issue, i. 174
Consumption, pulmonary, thoughts on, i. 199
----, pulmonary, Indians, and persons who lead laborious lives, not
subject to it, i. 200
----, radical remedies for it in exercise, labour, and the hardships of
a camp and naval life, i. 204
----, its causes, ii. 62
----, not contagious, ii. 79
----, tracheal, described, ii. 84
----, its remedies, ii. 87
----, premonitory signs, ii. ibid.
----, of the remedies for its inflammatory state, ii. 89
----, of blood-letting, ii. ibid.
----, of a vegetable diet, ii. 104
----, of the remedies for its hectic state, ii. 107
----, for its typhus state, ii. 108
----, of its radical remedies, ii. 128
----, of exercise, ii. ibid.
----, of travelling, ii. 137
----, signs of its long or short duration, and of its issue in life and
death, ii. 144
----, its different ways of terminating in death, ii. 147
College of physicians, their letter to the citizens of Philadelphia,
declaring the existence of the yellow fever in the city, &c. in 1793,
iii. 82
----, their letter to the governor of the state, on the origin of the
yellow fever in 1793, iii. 197
----, their opinion of the origin of the fever in 1799, iv. 100
D.
Diseases of the Indians, i. 16
----, from civilization, i. 30
----, produced by ardent spirits, i. 343
----, of the military hospitals, during the revolutionary war between
Great-Britain and the United States, i. 269
----, of old age, i. 446
Drunkenness, a fit of it described, i. 338
----, remedies for it, i. 374
Disease, summer and autumnal, its sources, iv. 163
----, means of preventing it in its malignant forms, iv. 173
----, in its mild forms, iv. 198
----, in its intestinal forms, iv. 200
----, of preserving cities and communities from them, iv. 202
----, of exterminating them, iv. 210
----, from drinking cold water, i. 186
----, ----, how prevented, i. ibid.
----, ----, its cure, i. 185
Dropsies, their causes, ii. 151
----, divided into inflammatory, and of weak morbid action in the
blood-vessels, ii. 157
----, remedies for the inflammatory state of, ii. 160
----, ----, with weak morbid action in the blood-vessels, ii. 176
Dropsy of the brain, internal, ii. 192
----, its history, ii. 195
----, its causes, ii. 203
----, its cure, ii. 210
Distress, familiarity with it, its moral effects, ii. 46
Death, its proximate cause, ii. 447
E.
Emetics, useful in the bilious fever of 1780, i. 186
----, in the scarlatina anginosa of 1783 and 1784, i. 144
----, in the yellow fever of 1798, iv. 79
----, in the yellow fever of 1799, iv. 97
----, hurtful in the yellow fever of 1797, iv. 44
Exhalations, putrid, their sources and effects in producing the
summer and autumnal disease, iv. 163
F.