AN ACCOUNTOFTHE MEASLES,AS THEYAPPEARED IN PHILADELPHIA,IN THE SPRING OF 1789.

Footnotes:[74]II. Chron. xviii. 30.[75]Medical Commentaries, Philadelphia edition, vol. 7. p. 409.[76]Medicina Nautica, p. 301.[77]Medical Commentaries, Dobson's edition, vol. II. p. 476.[78]“Animal food, in a state of putridity, is amongst the most frequent causes of canine madness.”“Canine madness chiefly arises from the excessive number of ill-kept and ill-fed dogs.”Young's Annuals, vol. XVII. p. 561.[79]Bibliotheque Choisie de Medecine, tome XV. p. 210.[80]In the 6th volume of the Medical Observations and Inquiries, there is an account of a dissection of a person who had been destroyed by taking opium. “No morbid appearance (says Mr. Whateley, the surgeon who opened the body) was found in any part of the body, except that the villous coat of the stomach was very slightly inflamed.” The stimulus of the opium in this case either produced an action which transcended inflammation, or destroyed action altogether by its immense force, by which means the more common morbid appearances which follow disease in a dead body could not take place.[81]Medical Transactions, vol. ii. p. 192.[82]Ditto, p. 222.[83]Bibliotheque Choisie de Medecine, tome xv. p. 212.[84]Medical Essays of Edinburgh, vol. i. p. 226.[85]Medical Commentaries, vol. iii. p. 496.[86]Volume V.[87]The hoarse barking, or the total inability of mad dogs to bark, favours still further the idea that the mortal seat of the disease is in the glottis, and that the remedy which has been proposed is a rational one.

Footnotes:

[74]II. Chron. xviii. 30.

[75]Medical Commentaries, Philadelphia edition, vol. 7. p. 409.

[76]Medicina Nautica, p. 301.

[77]Medical Commentaries, Dobson's edition, vol. II. p. 476.

[78]“Animal food, in a state of putridity, is amongst the most frequent causes of canine madness.”“Canine madness chiefly arises from the excessive number of ill-kept and ill-fed dogs.”Young's Annuals, vol. XVII. p. 561.

[78]“Animal food, in a state of putridity, is amongst the most frequent causes of canine madness.”

“Canine madness chiefly arises from the excessive number of ill-kept and ill-fed dogs.”

Young's Annuals, vol. XVII. p. 561.

[79]Bibliotheque Choisie de Medecine, tome XV. p. 210.

[80]In the 6th volume of the Medical Observations and Inquiries, there is an account of a dissection of a person who had been destroyed by taking opium. “No morbid appearance (says Mr. Whateley, the surgeon who opened the body) was found in any part of the body, except that the villous coat of the stomach was very slightly inflamed.” The stimulus of the opium in this case either produced an action which transcended inflammation, or destroyed action altogether by its immense force, by which means the more common morbid appearances which follow disease in a dead body could not take place.

[81]Medical Transactions, vol. ii. p. 192.

[82]Ditto, p. 222.

[83]Bibliotheque Choisie de Medecine, tome xv. p. 212.

[84]Medical Essays of Edinburgh, vol. i. p. 226.

[85]Medical Commentaries, vol. iii. p. 496.

[86]Volume V.

[87]The hoarse barking, or the total inability of mad dogs to bark, favours still further the idea that the mortal seat of the disease is in the glottis, and that the remedy which has been proposed is a rational one.

The weather in December, 1788, and in January, 1789, was variable, but seldom very cold. On the first of February, 1789, at six o'clock in the morning, the mercury in Fahrenheit's thermometer fell 5° below 0, in the city of Philadelphia. At twenty miles from the city, on the Schuylkill, it fell 12° below 0, at the same hour. On the 19th and 20th of this month, there fell a quantity of snow, the depth of which, upon an average, was supposed to be about eight or ten inches. On the 23d, 24th, 25th, and 27th, the weather was very cold. The mercury fluctuated during these days between 4° and 10° above 0.

In the intervals between these cold days, the weather frequently moderated, so that the Delaware was frozen and thawed not less than fourtimes. It was not navigable till the 8th of March. There were in all, during the winter and month of March, sixteen distinct falls of snow.

In April and May there were a few warm days; but upon the whole, it was a very cold and backward spring. The peaches failed almost universally. There were no strawberries or cherries on the 24th of May, and every other vegetable product was equally backward. A country woman of 84 years of age informed me, that it was the coldest spring she had ever known. It was uncomfortable to sit without fire till the first of June.

The measles appeared first in the Northern Liberties, in December. They spread slowly in January, and were not universal in the city till February and March.

This disease, like many others, had itsprecursor. It was either a gum-boil, or a sore on the tongue. They were both very common, but not universal. They occurred, in some instances, several days before the fever, but in general they made their appearance during the eruptive fever, and were a sure mark of the approaching eruption of the measles. I was first led to observe this fact, from having read Dr. Quin's accurate account of themeasles in Jamaica. I shall now proceed to mention the symptoms of the measles as they appeared in the different parts of the body.

1. In thehead, they produced great pain, swelling of the eye-lids, so as to obstruct the eye-sight, tooth-ach, bleeding at the nose, tinnitus aurium, and deafness; also coma for two days, and convulsions. I saw the last symptom only in one instance. It was brought on by a stoppage of a running from the ear.

2. In thethroatandlungs, they produced a soreness and hoarseness, acute or dull pains in the breast and sides, and a painful or distressing cough. In one case, this cough continued for two hours without any intermission, attended by copious expectoration. In two cases, I saw a constant involuntary discharge of phlegm and mucus from the mouth, without any cough. One of them terminated fatally. Spitting of blood occurred in several instances. The symptoms of pneumonia vera notha and typhoides were very common. I saw two fatal cases from pneumonia notha, in both of which the patients died with the trunk of the body in an erect posture. I met with two cases in which there was no cough till the eruption made its appearance on the fourth day, and one whichwas accompanied by all the usual symptoms of the cynanche trachealis.

3. In thestomachthe measles produced, in many instances, sickness and vomiting. And

4. In thebowels, griping, diarrhœa, and, in some instances, bloody stools. The diarrhœa occurred in every stage of the disease, but it was bloody and most painful in its decline. I attended a black girl who discharged a great many worms, but without the least relief of any of her symptoms.

There was a great variety in this disease. 1. In thetimeof the attack of the fever, from thetimeof the reception of the contagion. In general the interval was fourteen days, but it frequently appeared before, and sometimes later than that period.

2. In thetime of the eruption, from the beginning of the fever. It generally appeared on the third and fourth days. In one case, Dr. Waters informed me, it did not appear till the eighth day.

3. In theabatementorcontinuanceof the fever after the eruption.

4. In thecolourandfigureof the eruption. In some it put on apalered, in others adeep, and in a few alividcolour, resembling an incipient mortification. In some there appeared red blotches, in others an equally diffused redness, and in a few, eruptions like the small-pox, called by Dr. Cullen, rubiola varioloides.

5. In thedurationof the eruption on the skin. It remained in most cases only three or four days; but in one, which came under my care, it remained nine days.

6. In themanner of its retrocession. I saw very few cases of its leaving the branny appearance so generally spoken of by authors on the skin.

7. Innot affectingmany persons, and even families who were exposed to it.

The symptoms which continued in many after the retrocession of the measles, were cough, hoarseness, or complete aphonia, which continued in two cases for two weeks; also diarrhœa, opthalmy, a bad taste in the mouth, a defect or excess of appetite, and a fever, which in some instances was of the intermitting kind, but which in more assumed the more dangerous form of the typhus mitior.Two cases of internal dropsy of the brain followed them. One was evidently excited by a fall. They both ended fatally.

During the prevalence of the disease I observed several persons (who had had the measles, and who were closely confined to the rooms of persons ill with them) to be affected with a slight cough, sore throat, and even sores in the mouth. I find a similar fact taken notice of by Dr. Quier.

But I observed further, many children to be affected by a fever, cough, and all the other symptoms of the measles which have been mentioned, except a general eruption, for in some there was a trifling efflorescence about the neck and breast. I observed the same thing in 1773 and 1783. In my note book I find the following account of the appearance of this disease in children in the year 1773. “The measles appeared in March; a catarrh (for by that name I then called it) appeared at the same time, and was often mistaken for them, the symptoms being nearly the same in both. In the catarrh there was in some instances a trifling eruption. A lax often attended it, and some who had it had an extremely sore mouth.”

I was the more struck with this disease, from finding it was taken notice of by Dr. Sydenham. He calls it a morbillous fever. I likewise find an account of it in the 2d article of the 5th volume of the Edinburgh Medical Essays. The words of the author, who is anonymous, are as follow. “During this measly season, several persons, who never had the measles, had all the symptoms of measles, which went off in a few days without any eruptions. The same persons had the measles months or years afterwards.” Is this disease a common fever, marked by the reigning epidemic, and produced in the same manner, and by the same causes, as the variolous fever described by Dr. Sydenham, which he says prevailed at the same time with the small-pox? I think it is not. My reasons for this opinion are as follow.

1. I never saw it affect any but children, in the degree that has been mentioned, and such only as had never had the measles.

2. It affected whole families at the same time. It proved fatal to one of three children whom it affected on the same day.

3. It terminated in a pulmonary consumption in a boy of ten years old, with all the symptomswhich attend that disease when it follows the regular measles.

4. It affected a child in one family, on the same day that two other members of the same family were affected by the genuine measles.

5. It appeared on the usual days of the genuine measles, from the time the persons affected by it were exposed to its contagion. And,

6. It communicated the disease in one family, in the usual time in which the disease is taken from the genuine measles.

The measles, then, appear to follow the analogy of the small-pox, which affects so superficially as to be taken a second time, and which produce on persons who have had them what are called the nurse pock. They follow likewise the analogy of another disease, viz. the scarlatina anginosa. In the account of the epidemic for 1773, published in the third volume of the Edinburgh Medical Essays, we are told, that such patients as had previously had the scarlet fever without sore throats, took the sore throat, and had no eruption, while those who had previously had the sore throat had a scarlet eruption,but the throat remained free from the distemper. All other persons who were affected had both.

From these facts, I have taken the liberty of calling it theinternal measles, to distinguish it from those which areexternal. I think the discovery of this new state of this disease of some application to practice.

1. It will lead us to be cautious in declaring any disease to be the external measles, in which there is not a general eruption. From my ignorance of this, I have been led to commit several mistakes, which were dishonourable to the profession. I was called, during the prevalence of the measles in the above-named season, to visit a girl of twelve years old, with an eruption on the skin. I called it the measles. The mother told me it was impossible, for that I had in 1783 attended her for the same disease. I suspect the anonymous author before-mentioned has fallen into the same error. He adds to the account before quoted the following words. “Others, who had undergone the measles formerly, hadat this timea fever of the erysipelatous kind, with eruptions like to which nettles cause, and all thepreviousand concomitant symptoms of the measles, from the beginning to the end of the disease.”

2. If inoculation, or any other mode of lessening the violence of the disease, should be adopted, it will be of consequence to know what persons are secure from the attacks of it, and who are still exposed to it.

I shall now add a short account of my method of treating this disease.

Many hundred families came through the disease without the help of a physician. But in many cases it was attended with peculiar danger, and in some with death. I think it was much more fatal than in the years 1773 and 1783, probably owing to the variable weather in the winter, and the coldness and dampness of the succeeding spring. Dr. Huxham says, he once saw the measles attended with peculiar mortality, during a late cold and damp spring in England. It was much more fatal (cæteris paribus) to adults than to young people.

The remedies I used were,

1.Bleeding, in all cases where great pain and cough with a hard pulse attended. In some I found it necessary to repeat this remedy. But I met with many cases in which it was forbidden bythe weakness of the pulse, and by other marks of a feeble action in the blood-vessels.

2.Vomits.These were very useful in removing a nausea; they likewise favoured the eruption of the measles.

3.Demulcentanddiluting drinks. These were barley water, bran, and flaxseed tea, dried cherry and raw apple water, also beverage, and cyder and water. The last drink I found to be the most agreeable to my patients of any that have been mentioned.

4.Blistersto the neck, sides, and extremities, according to the symptoms. They were useful in every stage of the disease.

5.Opiates.These were given not only at night, but in small doses during the day, when a troublesome cough or diarrhœa attended.

6. Where a catarrhal fever ensued, I used bleeding and blisters. In those cases in which this fever terminated in an intermittent, or in a mild typhus fever, I gave the bark with evident advantage. In that case of measles, formerly mentioned, which was accompanied by symptoms of cynanche trachealis,I gave calomel with the happiest effects. In the admission offresh airI observed a medium as to its temperature, and accommodated it to the degrees of action in the system. In different parts of the country, in Pennsylvania and New-Jersey, I heard with great pleasure of thecold airbeing used as freely and as successfully in this disease, as in the inflammatory small-pox. The same people who were so much benefited bycool air, I was informed, drank plentifully of cold water during every stage of the fever. One thing in favour of this country practice deserves to be mentioned, and that is, evident advantage arose in all the cases which I attended, from patients leaving their beds in the febrile state of this disease. But this was practised only by those in whom inflammatory diathesis prevailed, for these alone had strength enough to bear it.

The convalescent state of this disease required particular attention.

1.A diarrhœaoften continued to be troublesome after other symptoms had abated. I relieved it by opiates and demulcent drinks. Bleeding has been recommended for it, but I did not find it necessary in a single case.

2. Anopthalmiawhich sometimes attended, yielded to astringent collyria and blisters.

3. Where a cough or fever followed so slight as not to require bleeding, I advised a milk and vegetable diet, country air, and moderate warmth; for whatever might have been the relation of the lungs in the beginning of the disease to cold air, they were now evidently too much debilitated to bear it.

4. It is a common practice to prescribe purges after the measles. After the asthenic state of this disease they certainly do harm. In all cases, the effects of them may be better obviated by diet, full or low, suitable clothing, and gentle exercise, or country air. I omitted them in several cases, and no eruption or disease of any kind followed their disuse.

I shall only add to this account of the measles, that in several families, I saw evident advantages from preparing the body for the reception of the contagion, by means of a vegetable diet.

The latter end of the month of August, in the summer of 1789, was so very cool that fires became agreeable. The month of September was cool, dry, and pleasant. During the whole of this month, and for some days before it began, and after it ended, there had been no rain. In the beginning of October, a number of the members of the first congress, that had assembled in New-York, under the present national government, arrived in Philadelphia, much indisposed with colds. They ascribed them to the fatigue and night air to which they had been exposed in travelling in the public stages; but from the number of persons who were affected, from the uniformity of their complaints, and from the rapidity with which it spread through our city, it soon became evident that it was thedisease so well known of late years by the name of the influenza.

The symptoms which ushered in the disease were generally a hoarseness, a sore throat, a sense of weariness, chills, and a fever. After the disease was formed, it affected more or less the following parts of the body. Many complained of acute pains in thehead. These pains were frequently fixed between the eye-balls, and, in three cases which came under my notice, they were terminated by abscesses in the frontal sinus, which discharged themselves through the nose. The pain, in one of these cases, before the rupture of the abscess, was so exquisite, that my patient informed me, that he felt as if he should lose his reason. Many complained of a great itching in theeye-lids. In some, the eye-lids were swelled. In others, a copious effusion of water took place from theeyes; and in a few, there was a true ophthalmia. Many complained of great pains in oneear, and some of pains in bothears. In some, these pains terminated in abscesses, which discharged for some days a bloody or purulent matter. In others, there was a swelling behind each ear, without a suppuration.—Sneezingwas a universal symptom. In some, it occurred not less than fifty times in a day. The matter discharged from the nose was so acrid as toinflame the nostrils and the upper lip, in such a manner as to bring on swellings, sores, and scabs in many people. In some, the nose discharged drops, and in a few, streams of blood, to the amount, in one case, of twenty ounces. In many cases, it was so much obstructed, as to render breathing through it difficult. In some, there was a total defect oftaste. In others, there was a bad taste in the mouth, which frequently continued through the whole course of the disease. In some, there was a want ofappetite. In others, it was perfectly natural. Some complained of a soreness in their mouths, as if they had been inflamed by holding pepper in them. Some hadswelled jaws, and many complained of thetooth-ach. I saw only one case in which the disease produced acoma.

Many were affected with pains in thebreastandsides. A difficulty of breathing attended in some, and acoughwas universal. Sometimes this cough alternated with a pain in thehead. Sometimes it preceded this pain, and sometimes it followed it. It was at all times distressing. In some instances, it resembled the chin-cough. One person expired in a fit of coughing, and many persons spat blood in consequence of its violence. I saw several patients in whom the disease affected the trachea chiefly, producing great difficulty of breathing,and, in one case, a suppression of the voice, and I heard of another in which the disease, by falling on the trachea, produced a cynanche trachealis. In most of the cases which terminated fatally, the patients died of pneumonia notha.

Thestomachwas sometimes affected by nausea and vomiting; but this was far from being a universal symptom.

I met with four cases in which the whole force of the disease fell upon thebowels, and went off in a diarrhœa; but in general the bowels were regular or costive.

Thelimbswere affected with such acute pains as to be mistaken for the rheumatism, or for the break-bone-fever of 1780. The pains were most acute in the back and thighs.

Profuse sweatsappeared in many over the whole body in the beginning, but without affording any relief. It was in some instances accompanied by erysipelatous, and in four cases which came to my knowledge, it was followed by miliary eruptions.

Thepulsewas sometimes tense and quick, but seldom full. In a great majority of those whom I visited it was quick, weak, and soft.

There was no appearance in the urine different from what is common in all fevers.

The disease had evident remissions, and the fever seldom continued above three or four days; but the cough, and some other troublesome symptoms, sometimes continued two or three weeks.

In a few persons, the fever terminated in a tedious and dangerous typhus.

In several pregnant women it produced uterine hæmorrhages and abortions.

It affected adults of both sexes alike. A few old people escaped it. It passed by children under eight years old with a few exceptions. Out of five and thirty maniacs in the Pennsylvania hospital, but three were affected by it. No profession or occupation escaped it. The smell of tar and tobacco did not preserve the persons who worked in them from the disease, nor did the use of tobacco, in snuff, smoking, or chewing, afford a security against it.[88]

Even previous and existing diseases did not protect patients from it. It insinuated into sick chambers, and blended itself with every species of chronic complaint.

It was remarkable that persons who worked in the open air, such as sailors, and 'long-shore-men, (to use a mercantile epithet) had it much worse than tradesmen who worked within doors. A body of surveyors, in the eastern woods of Pennsylvania, suffered extremely from it. Even the vigour of constitution which is imparted by the savage life did not mitigate its violence. Mr. Andrew Ellicott, the geographer of the United States, informed me that he was a witness of its affecting the Indians in the neighbourhood of Niagara with peculiar force. The cough which attended this disease was so new and so irritating a complaint among them, that they ascribed it to witchcraft.

It proved most fatal on the sea-shore of the United States.

Many people who had recovered, were affected a second time with all the symptoms of the disease. I met with a woman, who, after recovering from it in Philadelphia, took it a second time in New-York, and a third time upon her return to Philadelphia.

Many thousand people had the disease who were not confined to their houses, but transacted business as usual out of doors. A perpetual coughing was heard in every street of the city. Buying and selling were rendered tedious by the coughing of the farmer and the citizen who met in market places. It even rendered divine service scarcely intelligible in the churches.

A few persons who were exposed to the disease escaped it, and some had it so lightly as scarcely to be sensible of it. Of the persons who were confined to their houses, not a fourth part of them kept their beds.

It proved fatal (with few exceptions) only to old people, and to persons who had been previously debilitated by consumptive complaints. It likewise carried of several hard drinkers. It terminated in asthma in three persons whose cases came under my notice, and in pulmonary consumption, in many more. I met with an instance in a lady, who was much relieved of a chronic complaint in her liver; and I heard of another instance of a clergyman whose general health was much improved by a severe attack of this disease.

It was not wholly confined to the human species. It affected two cats, two house-dogs, and one horse, within the sphere of my observations. One of the dogs disturbed his mistress so much by coughing at night, that she gave him ten drops of laudanum for several nights, which perfectly composed him. One of the cats had a vomiting with her cough. The horse breathed as if he had been affected by the cynanche trachealis.

The scarlatina anginosa, which prevailed during the summer, disappeared after the first of October; but appeared again after the influenza left the city. Nor was the remitting fever seen during the prevalence of the reigning epidemic.

I inoculated about twenty children for the small-pox during this prevalence of the influenza, and never saw that disease exhibit a more favourable appearance.

In the treatment of the influenza I was governed by the state of the system. Where inflammatory diathesis discovered itself by a full or tense pulse, or where great difficulty of breathing occurred, and the pulse was low and weak in the beginning of the disease, I ordered moderate bleeding. In afew cases in which the symptoms of pneumony attended, I bled a second time with advantage. In all these instances of inflammatory affection, I gave the usual antiphlogistic medicines. I found that vomits did not terminate the disease, as they often do a common catarrh, in the course of a day, or of a few hours.

In cases where no inflammatory action appeared in the system, I prescribed cordial drinks and diet, and forbad every kind of evacuation. I saw several instances of persons who had languished for a week or two with the disease, who were suddenly cured by eating a hearty meal, or by drinking half a pint of wine, or a pint of warm punch. In all these cases of weak action in the blood-vessels, liquid laudanum gave great relief, not only by suspending the cough, but by easing the pains in the bones.

I met with a case of an old lady who was suddenly and perfectly cured of her cough by a fright.

The duration of this epidemic in our city was about six weeks. It spread from New-York and Philadelphia in all directions, and in the course of a few months pervaded every state in the union. It was carried from the United States to several ofthe West-India islands. It prevailed in the island of Grenada in the month of November, 1789, and it was heard of in the course of the ensuing winter in the Spanish settlements in South-America.

The following winter was unusually mild, insomuch that the navigation of the Delaware was not interrupted during the whole season, only from the 7th to the 24th of February. The weather on the 3d and 4th days of March was very cold, and on the 8th and 9th days of the same month, the mercury in Fahrenheit's thermometer stood at 4° at 7 o'clock in the morning. On the 10th and 11th, there fell a deep snow. The weather during the remaining part of the month was cold, rainy, and variable. It continued to be variable during the month of April. About the middle of the month there fell an unusual quantity of rain. The showers which fell on the night of the 17th will long be connected in the memories of the citizens of Philadelphia with the time of the death of the celebrated Dr. Franklin. Several pleurisies appeared during this month; also a few cases of measles. In the last week of the month the influenza made its appearance. It was brought to the city from New-England, and affected, in its course, all the intermediate states. Its symptoms were nearly the same as they were in the preceding autumn, but in many peopleit put on some new appearances. Several persons who were affected by it had symptoms of madness, one of whom destroyed himself by jumping out of a window. Some had no cough, but very acute pains in the back and head. It was remarked that those who had the disease chiefly in the breast the last year, complained now chiefly of their heads, while those whose heads were affected formerly, now complained chiefly of their breasts. In many it put on the type of an intermitting fever. Several complained of constant chills, or constant sweats; and some were much alarmed by an uncommon blue and dark colour in their hands. I saw one case of ischuria, another of an acute pain in the rectum, a third of anasarca, and a fourth of a palsy in the tongue and arms; all of which appeared to be anomalous symptoms of the influenza. Sneezing, and pains in the ears and frontal sinus, were less common now than they were in the fall; but a pain in the eye-balls was a universal symptom. Some had a pain in the one eye only, and a few had sore eyes, and swellings in the face. Many women who had it, were affected by an irregular appearance of the catamenia. In two persons whom I saw, the cough was incessant for three days, nor could it be composed by any other remedy than plentiful bleeding. A patient of Dr. Samuel Duffield informed me, after his recovery,that he had had no other symptom of the disease than an efflorescence on his skin, and a large swelling in his groin, which terminated in a tedious abscess.

The prisoners in the jail who had it in the autumn, escaped it this spring.

During the prevalence of this disease, I saw no sign of any other epidemic.

It declined sensibly about the first week in June, and after the 12th day of this month I was not called to a single patient in it.

The remedies for it were the same as were used in the fall.

I used bleeding in several cases on the second, third, and fourth days of the disease, where it had appeared to be improper in its first stage. The cases which required bleeding were far from being general. I saw two instances of syncope of an alarming nature, after the loss of ten ounces of blood; and I heard of one instance of a boy who died in half an hour after this evacuation.

I remarked that purges of all kinds worked more violently than usual in this disease.

The convalescence from it was very slow, and a general languor appeared to pervade the citizens for several weeks after it left the city.

The month of December, 1790, was extremely and uniformly cold. In the beginning of the month of January, 1791, the weather moderated, and continued to be pleasant till the 17th, on which day the navigation of the Delaware, which had been completely obstructed by the ice, was opened so as to admit of the arrival of several vessels. During the month of December many people complained ofcolds; but they were ascribed wholly to the weather. In January four or five persons in a family were affected by colds at the same time; which created a suspicion of a return of the influenza. This suspicion was soon confirmed by accounts of its prevailing in the neighbouring counties of Chester and Montgomery, in Pennsylvania, and in the distant states of Virginia and Rhode-Island. It did not affect near so generally as in the two former times of appearance. There was no difference in the method of treating it. While the common inflammatory diseases of the winter bore the lancet as usual, it was remarked that patientswho were attacked by the influenza, did not bear bleeding in a greater proportion, or in a larger quantity, than in the two former times of its appearance in the city.

I shall conclude this account of the influenza by the following observations:

1. It exists independently of the sensible qualities of the air, and in all kinds of weather. Dr. Patrick Russel has proved the plague to be equally independent of the influence of the sensible qualities of the atmosphere, to a certain degree.

2. The influenza passes with the utmost rapidity through a country, and affects the greatest number of people, in a given time, of any disease in the world.

3. It appears from the histories of it which are upon record, that neither climate, nor the different states of society, have produced anymaterialchange in the disease. This will appear from comparing the account I have given, with the histories of it which have lately been given by Dr. Grey, Dr. Hamilton, Dr. A. Fothergill, Mr. Chisholm, and other modern physicians. It appears further, that even time itself has not been able materially tochange the type of this disease. This is evident, from comparing modern accounts of it with those which have been handed down to us by ancient physicians.

I have hinted in a former essay at thediminutivesof certain diseases. There is a state of influenza, which is less violent and more local, than that which has been described. It generally prevails in the winter season. It seems to originate from a morbid matter, generated in crowded and heated churches, and other assemblies of the people. I have seen a cold, or influenza, frequently universal in Philadelphia, which I have distinctly traced to this source. It would seem as if the same species of diseases resembled pictures, and that while some of them partook of the deep and vivid nature of mosaic work, others appeared like the feeble and transient impressions of water colours.

Footnote:[88]Mr. Howard informs us that the use of tobacco is not a preservative against the plague, as has formerly been supposed; of course that apology for the use of an offensive weed should not be admitted.

Footnote:

[88]Mr. Howard informs us that the use of tobacco is not a preservative against the plague, as has formerly been supposed; of course that apology for the use of an offensive weed should not be admitted.

Gentlemen,

My business in this chair is to teach the institutes of medicine. They have been divided into physiology, pathology, and therapeutics. The objects of the first are, the laws of the human body in its healthy state. The second includes the history of the causes and seats of diseases. The subjects of the third are the remedies for those diseases. In entering upon the first part of our course, I am met by a remark delivered by Dr. Hunter in his introductory lectures to his course of anatomy. “In our branch (says the doctor) those teachers who study to captivate young minds with ingenious speculations, will not leave a reputation behind them that will outlive them half a century.When they cease from their labours, their labours will be buried along with them. There never was a man more followed and admired in physiology, than Dr. Boerhaave. I remember the veneration in which he was held. And now, in the space of forty years, his physiology is——it shocks me to think in what a light it appears[89].” Painful as this premonition may be to the teachers of physiology, it should not deter them from speculating upon physiological subjects. Simple anatomy is a mass of dead matter. It is physiology which infuses life into it. A knowledge of the structure of the human body occupies only the memory. Physiology introduces it to the higher and more noble faculties of the mind. The component parts of the body may be compared to the materials of a house, lying without order in a yard. It is physiology, like a skilful architect, which connects them together, so as to form from them an elegant and useful building. The writers against physiology resemble, in one particular, the writers against luxury. They forget that the functions they know and describe belong to the science of physiology; just as the declaimers against luxury forget that all the conveniences which they enjoy beyond what are possessed in the most simple stage of society, belong to the luxuries of life.The anatomist who describes the circulation of the blood, acts the part of a physiologist, as much as he does, who attempts to explain the functions of the brain. In this respect Dr. Hunter did honour to our science; for few men ever explained that subject, and many others equally physiological, with more perspicuity and eloquence, than that illustrious anatomist. Upon all new and difficult subjects there must be pioneers. It has been my lot to be called to this office of hazard and drudgery; and if in discharging its duties I should meet the fate of my predecessors, in this branch of medicine, I shall not perish in vain. My errors, like the bodies of those who fall in forcing a breach, will serve to compose a bridge for those who shall come after me, in our present difficult enterprise. This consideration, aided by just views of the nature and extent of moral obligation, will overbalance the evils anticipated by Dr. Hunter, from the loss of posthumous fame. Had a prophetic voice whispered in the ear of Dr. Boerhaave in the evening of his life, that in the short period of forty years, the memory of his physiological works would perish from the earth, I am satisfied, from the knowledge we have of his elevated genius and piety, he would have treated the prediction with the same indifference that he would have done, had he been told, that in the same time, his nameshould be erased from a pane of glass, in a noisy and vulgar country tavern.

The subjects of the lectures I am about to deliver, you will find in a syllabus which I have prepared and published, for the purpose of giving you a succinct view of the extent and connection of our course. Some of these subjects will be new in lectures upon the institutes of medicine, particularly those which relate to morals, metaphysics, and theology. However thorny these questions may appear, we must approach and handle them; for they are intimately connected with the history of the faculties and operations of the human mind; and these form an essential part of the animal economy. Perhaps it is because physicians have hitherto been restrained from investigating, and deciding upon these subjects, by an erroneous belief that they belong exclusively to another profession, that physiology has so long been an obscure and conjectural science.

In beholding the human body, the first thing that strikes us, is itslife. This, of course, should be the first object of our inquiries. It is a most important subject; for the end of all the studies of a physician is to preserve life; and this cannot be perfectly done, until we know in what it consists.

I include in animal life, as applied to the human body,motion,sensation, andthought. These three, when united, compose perfect life. It may exist without thought, or sensation; but neither sensation, nor thought, can exist without motion. The lowest grade of life, probably exists in the absence of even motion, as I shall mention hereafter. I have preferred the termmotionto those of oscillation and vibration, which have been employed by Dr. Hartley in explaining the laws of animal matter; because I conceived it to be more simple, and better adapted to common apprehension.

In treating upon this subject, I shall first consider animal life as it appears in the waking and sleeping states in a healthy adult, and shall afterwards inquire into the modification of its causes in the fœtal, infant, youthful, and middle states of life, in certain diseases, in different states of society, in different climates, and in different animals.

I shall begin by delivering three general propositions.

I. Every part of the human body (the nails and hair excepted) is endowed with sensibility, or excitability, or with both of them. By sensibility is meant the power of having sensation excited by theaction of impressions. Excitability denotes that property in the human body, by which motion is excited by means of impressions. This property has been called by several other names, such as irritability, contractility, mobility, and stimulability.

I shall make use of the term excitability, for the most part, in preference to any of them. I mean by it, a capacity of imperceptible, as well as obvious motion. It is of no consequence to our present inquiries, whether this excitability be a quality of animal matter, or a substance. The latter opinion has been maintained by Dr. Girtanner, and has some probability in its favour.

II. The whole human body is so formed and connected, that impressions made in the healthy state upon one part, excite motion, or sensation, or both, in every other part of the body. From this view, it appears to be a unit, or a simple and indivisible quality, or substance. Its capacity for receiving motion, and sensation, is variously modified by means of what are called the senses. It is external, and internal. The impressions which act upon it shall be ennumerated in order.

III. Life is theeffectof certain stimuli acting upon the sensibility and excitability which are extended, in different degrees, over every externaland internal part of the body. These stimuli are as necessary to its existence, as air is to flame. Animal life is truly (to use the words of Dr. Brown) “a forced state.” I have said thewordsof Dr. Brown; for the opinion was delivered by Dr. Cullen in the university of Edinburgh, in the year 1766, and was detailed by me in this school, many years before the name of Dr. Brown was known as teacher of medicine. It is true, Dr. Cullen afterwards deserted it; but it is equally true, I never did; and the belief of it has been the foundation of many of the principles and modes of practice in medicine which I have since adopted. In a lecture which I delivered in the year 1771, I find the following words, which are taken from a manuscript copy of lectures given by Dr. Cullen upon the institutes of medicine. “The human body is not an automaton, or self-moving machine; but is kept alive and in motion, by the constant action of stimuli upon it.” In thus ascribing the discovery of the cause of life which I shall endeavour to establish, to Dr. Cullen, let it not be supposed I mean to detract from the genius and merit of Dr. Brown. To his intrepidity in reviving and propagating it, as well as for the many other truths contained in his system of medicine, posterity, I have no doubt, will do him ample justice, after the errors that are blended with them have beencorrected, by their unsuccessful application to the cure of diseases.

Agreeably to our last proposition, I proceed to remark, that the action of the brain, the diastole and systole of the heart, the pulsation of the arteries, the contraction of the muscles, the peristaltic motion of the bowels, the absorbing power of the lymphatics, secretion, excretion, hearing, seeing, smelling, taste, and the sense of touch, nay more, thought itself, are all the effects of stimuli acting upon the organs of sense and motion. These stimuli have been divided into external and internal. The external are light, sound, odours, air, heat, exercise, and the pleasures of the senses. The internal stimuli are food, drinks, chyle, the blood, a certain tension of the glands, which contain secreted liquors, and the exercises of the faculties of the mind; each of which I shall treat in the order in which they have been mentioned.

1. Of external stimuli. The first of these is light. It is remarkable that the progenitor of the human race was not brought into existence until all the luminaries of heaven were created. Light acts chiefly through the medium of the organs of vision. Its influence upon animal life is feeble, compared with some other stimuli to be mentioned hereafter;but it has its proportion of force. Sleep has been said to be a tendency to death; now the absence of light we know invites to sleep, and the return of it excites the waking state. The late Mr. Rittenhouse informed me, that for many years he had constantly awoke with the first dawn of the morning light, both in summer and winter. Its influence upon the animal spirits strongly demonstrates its connection with animal life, and hence we find a cheerful and a depressed state of mind in many people, and more especially in invalids, to be intimately connected with the presence or absence of the rays of the sun. The well-known pedestrian traveller, Mr. Stewart, in one of his visits to this city, informed me, that he had spent a summer in Lapland, in the latitude of 69°, during the greatest part of which time the sun was seldom out of sight. He enjoyed, he said, during this period, uncommon health and spirits, both of which he ascribed to the long duration, and invigorating influence of light. These facts will surprise us less when we attend to the effects of light upon vegetables. Some of them lose their colour by being deprived of it; many of them discover a partiality to it in the direction of their flowers; and all of them discharge their pure air only while they are exposed to it[90].

2. Sound has an extensive influence upon human life. Its numerous artificial and natural sources need not be mentioned. I shall only take notice, that the currents of winds, the passage of insects through the air, and even the growth of vegetables, are all attended with an emission of sound; and although they become imperceptible from habit, yet there is reason to believe they all act upon the body, through the medium of the ears. The existence of these sounds is established by the reports of persons who have ascended two or three miles from the earth in a balloon. They tell us that the silence which prevails in those regions of the air is so new and complete, as to produce an awful solemnity in their minds. It is not necessary that these sounds should excite sensation or perception, in order to their exerting a degree of stimulus upon the body. There are a hundred impressions daily made upon it, which from habit are not followed by sensation. The stimulus of aliment upon the stomach, and of blood upon the heart and arteries, probably cease to be felt, onlyfrom the influence of habit. The exercise of walking, which was originally the result of a deliberate act of the will, is performed from habit without the least degree of consciousness. It is unfortunate for this, and many other parts of physiology, that we forget what passed in our minds the first two or three years of our lives. Could we recollect the manner in which we acquired our first ideas, and the progress of our knowledge with the evolution of our senses and faculties, it would relieve us from many difficulties and controversies upon this subject. Perhaps this forgetfulness by children, of the origin and progress of their knowledge, might be remedied by our attending more closely to the first effects of impressions, sensation, and perception upon them, as discovered by their little actions; all of which probably have a meaning, as determined as any of the actions of men or women.

The influence of sounds of a certain kind in producing excitement, and thereby increasing life, cannot be denied. Fear produces debility, which is a tendency to death. Sound obviates this debility, and thus restores the system to the natural and healthy grade of life. The school-boy and the clown invigorate their feeble and trembling limbs by whistling or singing as they pass by a country church-yard, and the soldier feels his departing liferecalled in the onset of a battle by the noise of the fife, and of the poet's “spirit stirring drum.” Intoxication is frequently attended with a higher degree of life than is natural. Now sound we know will produce this with a very moderate portion of fermented liquor; hence we find men are more easily and highly excited by it at public entertainments where there is music, loud talking, and hallooing, than in private companies where there is no auxiliary stimulus added to that of the wine. I wish these effects of sound upon animal life to be remembered; for I shall mention it hereafter as a remedy for the weak state of life in many diseases, and shall relate an instance in which a scream suddenly extorted by grief, proved the means of resuscitating a person who was supposed to be dead, and who had exhibited the usual recent marks of the extinction of life.

I shall conclude this head by remarking, that persons who are destitute of hearing and seeing possess life in a more languid state than other people; and hence arise the dulness and want of spirits which they discover in their intercourse with the world.

3. Odours have a sensible effect in promoting animal life. The greater healthiness of the country,than cities, is derived in part from the effluvia of odoriferous plants, which float in the atmosphere in the spring and summer months, acting upon the system, through the medium of the sense of smelling. The effects of odours upon animal life appear still more obvious in the sudden revival of it, which they produce in cases of fainting. Here the smell of a few drops of hartshorn, or even of a burnt feather, has frequently in a few minutes restored the system, from a state of weakness bordering upon death, to an equable and regular degree of excitement.

4. Air acts as a powerful stimulus upon the system, through the medium of the lungs. The component parts of this fluid, and its decomposition in the lungs, will be considered in another place[91]. I shall only remark here, that the circulation of theblood has been ascribed, by Dr. Goodwin, exclusively to the action of air upon the lungs and heart. Does the external air act upon any other part of the body besides those which have been mentioned? It is probable it does, and that we lose our sensation and consciousness of it by habit. It is certain children cry, for the most part, as soon as they come into the world. May not this be the effect of the sudden impression of air upon the tender surface of their bodies? And may not the red colour of their skins be occasioned by an irritation excited on them by the stimulus of the air? It is certain it acts powerfully upon denudated animal fibres; for who has not observed a sore, and even the skin when deprived of its cuticle, to be affected, when long exposed to the air, with pain and inflammation? The stimulus of air, in promoting the natural actions of the alimentary canal, cannot be doubted. A certain portion of it seems to be necessarily present in the bowels in a healthy state.

5. Heat is a uniform and active stimulus in promoting life. It is derived, in certain seasons and countries, in part from the sun; but its principal source is from the lungs, in which it appears to be generated by the decomposition of pure air, and from whence it is conveyed, by means of the circulation, to every part of the body. The extensiveinfluence of heat upon animal life, is evident from its decay and suspension during the winter in certain animals, and from its revival upon the approach and action of the vernal sun. It is true, life is diminished much less in man, from the distance and absence of the sun, than in other animals; but this must be ascribed to his possessing reason in so high a degree, as to enable him to supply the abstraction of heat, by the action of other stimuli upon his system.

6. Exercise acts as a stimulus upon the body in various ways. Its first impression is upon the muscles. These act upon the blood-vessels, and they upon the nerves and brain. The necessity of exercise to animal life is indicated, by its being kindly imposed upon man in paradise. The change which the human body underwent by the fall, rendered the same salutary stimulus necessary to its life, in the more active form of labour. But we are not to suppose, that motion is excited in the body by exercise or labour alone. It is constantly stimulated by the positions of standing, sitting, and lying upon the sides; all of which act more or less upon muscular fibres, and by their means, upon every part of the system.

7. The pleasures we derive from our senses have a powerful and extensive influence upon human life. The number of these pleasures, and their proximate cause, will form an agreeable subject for two or three future lectures.

We proceed next to consider the internal stimuli which produce animal life. These are

I.Food.This acts in the following ways. 1. Upon the tongue. Such are the sensibility and excitability of this organ, and so intimate is its connection with every other part of the body, that the whole system is invigorated by aliment, as soon as it comes in contact with it. 2. By mastication. This moves a number of muscles and blood-vessels situated near the brain and heart, and of course imparts impressions to them. 3. By deglutition, which acts upon similar parts, and with the same effect. 4. By its presence in the stomach, in which it acts by its quantity and quality. Food, by distending the stomach, stimulates the contiguous parts of the body. A moderate degree of distention of the stomach and bowels is essential to a healthy excitement of the system. Vegetable aliment and drinks, which contain less nourishment than animal food, serve this purpose in the human body. Hay acts in the same manner in a horse.Sixteen pounds of this light food in a day are necessary to keep up such a degree of distension in the stomach and bowels of this animal, as to impart to him his natural grade of strength and life. Thequalityof food, when of a stimulating nature, supplies the place of its distension from its quantity. A single onion will support a lounging highlander on the hills of Scotland for four and twenty hours. A moderate quantity of salted meat, or a few ounces of sugar, have supplied the place of pounds of less stimulating food. Even indigestible substances, which remain for days, or perhaps weeks in the stomach, exert a stimulus there which has an influence upon animal life. It is in this way the tops of briars, and the twigs of trees, devoid not only of nourishing matter, but of juices, support the camel in his journies through the deserts of the eastern countries. Chips of cedar posts moistened with water have supported horses for two or three weeks, during a long voyage from Boston to Surinam; and the indigestible cover of an old Bible preserved the life of a dog, accidentally confined in a room at Newcastle upon Tyne, for twenty days. 5. Food stimulates the whole body by means of the process of digestion which goes forward in the stomach. This animal function is carried on by a process, in which there is probably an extrication ofheat and air. Now both these, it has been remarked, exert a stimulus in promoting animal life.

Drinks, when they consist of fermented or distilled liquors, stimulate from their quality; but when they consist of water, either in its simple state, or impregnated with any sapid substance, they act principally by distention.

II. The chyle acts upon the lacteals, mesenteric glands, and thoracic duct, in its passage through them; and it is highly probable, its first mixture with the blood in the subclavian vein, and its first action on the heart, are attended with considerable stimulating effects.

III. The blood is a very important internal stimulus. It has been disputed whether it acts by its quality, or only by distending the blood-vessels. It appears to act in both ways. I believe with Dr. Whytt, that the blood stimulates the heart and arteries by a specific action. But if this be not admitted, its influence in extending the blood-vessels in every part of the body, and thereby imparting extensive and uniform impressions to every animal fibre, cannot be denied. In support of this assertion it has been remarked, that in those personswho die of hunger, there is no diminution of the quantity of blood in the large blood-vessels.

IV. A certaintensionof the glands, and of other parts of the body, contributes to support animal life. This is evident in the vigour which is imparted to the system, by the fulness of the seminal vesicles and gall bladder, and by the distension of the uterus in pregnancy. This distension is so great, in some instances, as to prevent sleep for many days and even weeks before delivery. It serves the valuable purpose of rendering the female system less liable to death during its continuance, than at any other time. By increasing the quantity of life in the body, it often suspends the fatal issue of pulmonary consumption, and ensures a temporary victory over the plague and other malignant fevers; for death, from those diseases, seldom takes place, until the stimulus, from the distension of the uterus, is removed by parturition.

V. The exercises of the faculties of the mind have a wonderful influence in increasing the quantity of human life. They all act byreflectiononly, after having been previously excited into action by impressions made upon the body. This view of there-actionof the mind upon the body accords with the simplicity of other operations in the animaleconomy. It is thus the brain repays the heart for the blood it conveys to it, by re-acting upon its muscular fibres. The influence of the different faculties of the mind is felt in the pulse, in the stomach, and in the liver, and is seen in the face, and other external parts of the body. Those which act most unequivocally in promoting life are the understanding, the imagination, and the passions. Thinking belongs to the understanding, and is attended with an obvious influence upon the degree and duration of life. Intense study has often rendered the body insensible to the debilitating effects of cold and hunger. Men of great and active understandings, who blend with their studies temperance and exercise, are generally long lived. In support of this assertion, a hundred names might be added to those of Newton and Franklin. Its truth will be more fully established by attending to the state of human life in persons of an opposite intellectual character. The cretins, a race of idiots in Valais, in Switzerland, travellers tell us, are all short lived. Common language justifies the opinion of the stimulus of the understanding upon the brain: hence it is common to say of dull men, that they have scarcely ideas enough to keep themselves awake.

The imagination acts with great force upon the body, whether its numerous associations produce pleasure or pain. But the passions pour a constant stream upon the wheels of life. They have been subdivided into emotions and passions properly so called. The former have for their objects present, the latter, future good and evil. All the objects of the passions are accompanied with desire or aversion. To the former belong chiefly, hope, love, ambition, and avarice; to the latter, fear, hatred, malice, envy, and the like. Joy, anger, and terror, belong to the class of emotions. The passions and emotions have been further divided into stimulating and sedative. Our business at present is to consider their first effect only upon the body. In the original constitution of human nature, we were made to be stimulated by such passions and emotions only as have moral good for their objects. Man was designed to be always under the influence of hope, love, and joy. By the loss of his innocence, he has subjected himself to the dominion of passions and emotions of a malignant nature; but they possess, in common with such as are good, a stimulus which renders them subservient to the purpose of promoting animal life. It is true, they are like the stimulus of a dislocated bone in their operation upon the body, compared with the action of antagonist muscles stretched over bones, whichgently move in their natural sockets. The effects of the good passions and emotions, in promoting health and longevity, have been taken notice of by many writers. They produce a flame, gentle and pleasant, like oil perfumed with frankincense in the lamp of life. There are instances likewise of persons who have derived strength and long life from the influence of the evil passions and emotions that have been mentioned. Dr. Darwin relates the history of a man, who used to overcome the fatigue induced by travelling, by thinking of a person whom he hated. The debility induced by disease is often removed by a sudden change in the temper. This is so common, that even nurses predict a recovery in persons as soon as they become peevish and ill-natured, after having been patient during the worst stage of their sickness. This peevishness acts as a gentle stimulus upon the system in its languid state, and thus turns the scale in favour of life and health. The famous Benjamin Lay, of this state, who lived to be eighty years of age, was of a very irascible temper. Old Elwes was a prodigy of avarice, and every court in Europe furnishes instances of men who have attained to extreme old age, who have lived constantly under the dominion of ambition. In the course of a long inquiry which I instituted some years ago into the state of the body and mind in old people,I did not find a single person above eighty, who had not possessed an active understanding, or active passions. Those different and opposite faculties of the mind, when in excess, happily supply the place of each other. Where they unite their forces, they extinguish the flame of life, before the oil which feeds it is consumed.

In another place I shall resume the influence of the faculties of the mind upon human life, as they discover themselves in the different pursuits of men.

I have only to add here, that I see no occasion to admit, with the followers of Dr. Brown, that the mind is active in sleep, in preserving the motions of life. I hope to establish hereafter the opinion of Mr. Locke, that the mind is always passive in sound sleep. It is true it acts in dreams; but these depend upon a morbid state of the brain, and therefore do not belong to the present stage of our subject, for I am now considering animal life only in the healthy state of the body. I shall say presently, that dreams are intended to supply the absence of some natural stimulus, and hence we find they occur in those persons most commonly, in whom there is a want of healthy action in the system, induced by the excess or deficiency of customary stimuli.

Life is in a languid state in the morning. It acquires vigour by the gradual and successive application of stimuli in the forenoon. It is in its most perfect state about mid-day, and remains stationary for some hours. From the diminution of the sensibility and contractility of the system to the action of impressions, it lessens in the evening, and becomes again languid at bed-time. These facts will admit of an extensive application hereafter in our lectures upon the practice of physic.

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