IT was for the landable purpose of exciting a spi­rit of emulation and enquiry, among the mem­bers of our body, that the founders of our society, instituted an annual oration. The task of prepa­ring, and delivering this exercise, hath devolved, once more, upon me. I have submitted to it, not because I thought myself capable of fulfilling your intentions, but because I wished, by a testimony of my obedience to your requests, to atone for my long absence from the temple of science.

THE subject upon which I am to have the honor of addressing you this evening, is ‘An enquiry in­to [Page 2] the influence of physical causes upon the mo­ral faculty.’

BY the moral faculty I mean a power in the hu­man mind of distinguishing and chusing good and evil, or in other words, virtue and vice. It is a native principle, and though it be capable of im­provement by experience and reflection, it is not derived from either of them.—St. Paul, and Ci­cero, give us the most perfect account of it that is to be found in modern or ancient authors. ‘For when the Gentiles, (says St. Paul) which have not the law, do by nature the things contained in the law, these, having not the law, are a law unto themselves; which shew the works of the law written in their hearts, their consciences also bearing witness, and their thoughts the mean while accusing, or else excusing another.’ ^*

THE words of Cicero are as follow— ‘Est igi­tur haec, judices, non scripta, sed nata lex, quam non didicimus, accepimus, legimus, verum ex na­tura ipsa arripuimus, hausimus, expressimus, ad quam non docti, sed facti, non instituti, sed imbuti sumus.’ ^† This faculty is often confounded with science, which is a distinct and independent power of the mind. This is evident from the passage [Page 3] quoted from the writings of St. Paul, in which conscience is said to be the witness that accuses or excuses us, of a breach of the law written in our hearts. The moral faculty is what the schoolmen call the "regula regulans,"—the conscience is their "regula regulata." Or, to speak in more modern terms, the moral faculty performs the office of a law­giver, while the business of conscience is to perform the duty of a judge. The moral faculty is to the conscience, what taste is to the judgment, and sensation to perception. It is quick in its opera­tions, and like the sensative plant, acts without re­flection, while conscience follows with deliberate steps, and measures all her actions, by the unerring square of right and wrong. The moral faculty exercises itself upon the actions of others. It ap­proves even in books, of the virtues of a Trajan, and disapproves of the vices of a Marius, while conscience confines its operations, only to its own actions. These two powers of the mind are gene­rally in an exact ratio to each other, but they sometimes exist in different degrees in the same per­son. Hence we often find conscience in its full vigor, with a diminished tone, or total absence of the moral faculty.

IT has long been a question among metaphysici­ans, whether the conscience be seated in the will or in the understanding. The controversy can on­ly [Page 4] be settled by admitting the will to be the seat of the moral faculty, and the understanding to be the seat of the conscience. The mysterious nature of the union of those two moral principles with the will and understanding, is a subject foreign to the business of the present enquiry.—

AS I consider virtue and vice to consist in action, and not in opinion, and as this action has its seat in the will, and not in the conscience, I shall confine my enquiries chiefly to the influence of physical causes upon that moral power of the mind, which is connected with volition, although many of these causes act likewise upon the conscience, as I shall shew hereafter.—The state of the moral fa­culty is visible in actions, which affect the well-be­ing of society. The state of the conscience is in­visible, and therefore removed beyond our investi­gation.

THE moral faculty has received different names from different authors. It is the "moral sense" of Dr. Hutchison—the "sympathy" of Dr. Adam Smith—the "moral instinct" of Rousseau—and "the light that lighteth every man that cometh in­to the world" of St John. I have adopted the term of moral faculty from Dr. Beattie, because I conceive it conveys with the most perspicuity, the [Page 5] idea of a power in the mind, of chusing good and evil.

OUR books of medicine contain many records of the effects of physical causes upon the memory— the imagination—and the judgment. In some in­stances we behold their operation only on one,— in others on two,—and in many cases upon the whole of these faculties. Their derangement has received different names, according to the number or nature of the faculties that are affected. The loss of memory has been called "amnesia"—false judgement upon one subject has been called "me­lancholia"—false judgement upon all subjects has been called "mania"—and a defect of all the three intellectual faculties that have been mentioned, has received the name of "amentia." Persons who labour under the derangement, or want of these powers of the mind, are considered, very properly, as subjects of medicine; and there are many cases upon record that prove, that their diseases have yielded to the healing art.

IN order to illustrate the effects of physical causes upon the moral faculty, it will be neces­sary first to shew their effects upon the memory— the imagination and the judgment; and at the same time to point out the analogy between their opera­tion [Page 6] upon the intellectual powers of the mind, and the moral faculty.

1. DO we observe a connection between the intellectual powers, and the degrees of consistency and firmness of the brain in infancy and child­hood?—The same connection has been observed between the strength as well as the progress of the moral faculty in children.

2. DO we observe a certain size of the brain, and a peculiar cast of features, such as the pro­minent eye, and the aquiline nose, to be connected with extraordinary portions of genius?—We ob­serve a similar connection between the figure and temperament of the body, and certain moral facul­ties.—Hence, we often ascribe good temper and benevolence to corpulency, and irascibility to sanguineous habits. Caesar thought himself safe in the friendship of the "sleek-headed" Anthony and Dolabella; but was afraid to trust to the pro­fessions of the slender Cassius.

3. DO we observe certain degrees of the intel­tectual faculties to be hereditary in certain fa­milies? The same observation has been frequently extended to moral qualities—Hence we often find certain virtues and vices as peculiar to families, through all their degrees of consanguinity, and [Page 7] duration, as a peculiarity of voice—complexion— or shape.

4. DO we observe instances of a total want of memory—imagination—and judgment, either from an original defect in the stamina of the brain, or from the influence of physical causes?—The same unnatural defect is sometimes observed, and probably from the same causes, of a moral faculty. The celebrated Servin whose character is drawn by the Duke of Sully in his Memoirs, appears to be an instance of the total absence of the moral faculty, while the chasm, produced by this defect, seems to have been filled up by a more than com­mon extension of every other power of his mind. I beg leave to repeat the history of this prodigy of vice and knowledge.— ‘Let the reader re­present to himself a man of a genius so lively, and of an understanding so extensive, as rendered him scarce ignorant of any thing that could be known —of so vast and ready a comprehension, that he immediately made himself master of whatever he attempted—and of so prodigious a memory, that he never forgot what he once learned. He possessed all parts of philosophy, and the ma­thematics, particularly fortification and drawing. Even in theology he was so well skilled, that he was an excellent preacher, whenever he had [Page 8] a mind to exert that talent, and an able disput­ant, for and against the reformed religion indif­ferently. He not only understood Greek—He­brew— and all the languages which we call learned, but also all the different jargons, or modern dialects. He accented and pronounced them so naturally, and so perfectly imitated the gestures and manners both of the several nations of Europe, and the particular provinces of France, that he might have been taken for a native of all, or any of these countries: and this quality he applied to counterfeit all sorts of per­sons, wherein he succeeded wonderfully. He was moreover the best comedian, and the greatest droll that perhaps ever appeared. He had a ge­nius for poetry, and had wrote many verses. He played upon almost all instruments—was a perfect master of music—and sung most agree­ably and justly. He likewise could say mass, for he was of a disposition to do, as well as to know, all things. His body was perfectly well suited to his mind. He was light, nimble, and dexterous, and fit for all exercises. He could ride well, and in dancing, wrestling, and leap­ing, he was admired. There are not any re­creative games that he did not know, and he was skilled in almost all mechanic arts.—But now for the reverse of the medal. Here it ap­peared, [Page 9] that he was treacherous—cruel—cow­ardly—deceitful—a liar—a cheat—a drunkard and a glutton—a sharper in play—immersed in every species of vice—a blasphemer—an atheist. —In a word, in him might be found all the the vices that are contrary to nature—honour— religion—and society,—the truth of which he himself evinced with his latest breath; for he died in the flower of his age, in a common bro­thel, perfectly corrupted by his debaucheries, and expired with the glass in his hand, cursing, and denying God ^*.’

IT was probably a state of the human mind such as have been described, that our Saviour alluded to in the disciple, who was about to betray him, when he called him "a devil." Perhaps the essence of depravity in infernal spirits, consists in their being wholly devoid of a moral faculty. In them the will has probably lost the power of chusing ^†, as well as the capacity of enjoying moral good. It is true, we read of their trembling in a belief of the existence of a God, and of their anticipating future punishment [Page 10] by asking, whether they were to be tormented be­fore their time: But this is the effect of consci­ence, and hence arises another argument in favour of this judicial power of the mind, being distinct from the moral faculty. It would seem as if the Supreme Being had preserved the moral faculty in man from the ruins of his fall, on purpose to guide him back again to Paradise, and at the same time had constituted the conscience, both in men and in fallen spirits, a kind of royalty in his moral empire, on purpose to shew his property in all in­telligent creatures, and their original resemblance to himself. Perhaps the essence of moral depra­vity in man consists in a total, but temporary sus­pension of the power of conscience. Persons in this situation are emphatically said in the scriptures to be "past feeling"—and to have their consci­ences feared, with a "hot iron"—they are likewise said to be "twice dead"—that is, the same torpor or moral insensibility, has seized both the moral faculty and the conscience.

5. DO we ever observe instances of the existence of only one of the three intellectual powers of the mind that have been named, in the absence of the other two? We observe something of the same kind with respect to the moral faculty. I once knew a man, who discovered no one mark of rea­son, [Page 11] who possessed the moral sense or faculty in so high a degree, that he spent his whole life in acts of benevolence. He was not only inoffensive, (which is not always the case with idiots) but he was kind and affectionate to every body. He had no ideas of time, but what were suggested to him by the returns of the stated periods for public wor­ship, in which he appeared to take great delight. He spent several hours of every day in devotion, in which he was so careful to be private, that he was once found in the most improbable place in the world for that purpose, viz. in an oven.

6. DO we observe the memory, the imagina­tion and the judgment, to be affected by diseases, particularly by fevers and madness? Where is the physician, who has not seen the moral faculty af­fected from the same causes! How often do we see the temper wholly changed by a fit of sick­ness! And now often do we hear persons of the most delicate virtue, utter speeches in the delirium of a fever, that are offensive to decency, or good manners! I have heard a well attested history of a clergyman of the most exemplary moral charac­ter, who spent the last moments of a fever which deprived him both of his reason and his life, in profane cursing and swearing. I once attended a young woman in a nervous fever, who discovered [Page 12] after her recovery, a loss of her former habit of veracity. Her memory (a defect of which, might be suspected of being the cause of this vice) was in every respect as perfect as it was before the at­tack of the fever ^*. The instances of immorality in maniacs, who were formerly distinguished for the opposite character, are so numerous, and well known, that it will not be necessary to select any cases, to establish the truth of the proposition con­tained under this head.

7. DO we observe any of the three intellectual powers that have been named, enlarged by dis­eases? Patients in the delirium of a fever, often discover extraordinary flights of imagination, and madmen often astonish us with their wonderful acts of memory. The same enlargement, some­times, appears in the operations of the moral fa­culty. I have more than once heard the most sublime discourses on morality in the cell of an hos­pital, and who has not seen instances of patients in acute diseases, discovering degrees of benevo­lence [Page 13] and integrity, that were not natural to them in the ordinary course of their lives? ^*

8. DO we ever observe a partial insanity, or false perception on one subject, while the judg­ment is sound and correct, upon all others? We perceive, in some instances, a similar defect in the moral faculty. There are persons who are moral in the highest degree, as to certain duties, who nevertheless live under the influence of some one vice. I knew an instance of a woman, who was ex­emplary in her obedience to every command of the moral law, except one. She could not refrain from stealing. What made this vice the more remark­able was, that she was in easy circumstances, and not addicted to extravagance in any thing. Such was her propensity to this vice, that when she could lay her hands upon nothing more valuable, she would often, at the table of a friend, fill her pockets secretly with bread. As a proof that her judgment was not affected by this defect in her moral faculty, she would both confess and lament her crime, when detected in it.

[Page 14]9. DO we observe the imagination in many in­stances to be affected with apprehensions of dan­gers that have no existence? In like manner we observe the moral faculty to discover a sensibility to vice, that is by no means proportioned to its de­grees of depravity. How often do we see persons labouring under this morbid sensibility of the mo­ral faculty, refuse to give a direct answer to a plain question, that related perhaps only to the wea­ther, or to the hour of the day, lest they should wound the peace of their minds by telling a false­hood!

10. DO dreams affect the memory—the imagin­ation—and the judgment? Dreams are nothing but incoherent ideas, occasioned by partial or im­perfect sleep. There is a variety in the suspension of the powers of the mind in this state of the sys­tem. In some cases the imagination only is de­ranged in dreams—in others the memory is affect­ed—and in others the judgment.—But there are cases, in which the change that is produced in the state of the brain, by means of sleep, affects the moral faculty likewise; hence we sometimes dream of doing and saying things when asleep, which we shudder at, as soon as we awake. This supposed defection from virtue, exists frequently in dreams where the memory and judgment are [Page 15] scarcely impaired. It cannot therefore be ascribed to the desertion of those two powers of the mind.

11. DO we read, in the accounts of travellers, of men, who in respect of intellectual capacity and enjoyments, are but a few degrees above brutes? We read likewise of a similar degradation of our species, in respect to moral capacity and feeling. Here it will be necessary to remark, that the low degrees of moral perception, that have been disco­vered in certain African and Russian tribes of men, no more invalidate our proposition of the universal and essential existence of a moral faculty in the human mind, than the low state of their intellects prove, that reason is not natural to man. Their perceptions of good and evil are in an exact pro­portion to their intellectual powers. But I will go further, and admit with Mr. Locke ^*, that some savage nations are totally devoid of the moral fa­culty, yet it will by no means follow, that this was the original constitution of their minds. The appetite for certain aliments is uniform among all mankind. Where is the nation and the individual, in their primitive state of health, to whom bread is not agreeable? But if we should find savages, or [Page 16] individuals, whose stomachs have been so disorder­ed by intemperance, as to refuse this simple and wholesome article of diet, shall we assert, that this was the original constitution of their appetites?— By no means. As well might we assert, because savages destroy their beauty by painting and cut­ting their faces, that the principles of taste do not exist naturally in the human mind. It is with vir­tue as with fire. It exists in the mind, as fire does in certain bodies in a latent or quiescent state. As collision renders the one sensible, so education renders the other visible. It would be as absurd to maintain, because olives become agreeable to many people from habit, that we have no natural appetites for any other kind of food, as to assert that any part of the human species exist without a moral principle, because in some of them, it has wanted causes to excite it into action, or has been perverted by example. There are appetites that are wholly artificial. There are tastes so entirely vitiated, as to perceive beauty in deformity. There are torpid and unnatural passions. Why, under certain unfavourable circumstances, may there not exist also a moral faculty, in a state of sleep, or subject to mistakes?

THE only apology I shall make, for presuming to differ from that justly-celebrated oracle, who first [Page 17] unfolded to us a map of the intellectual world, shall be, that the eagle eye of genius often darts its views beyond the notice of facts, which are accommodated to the slender organs of percep­tion of men, who possess no other talent than that of observation.

IT is not surprising, that Mr. Locke has con­founded this moral principle with reason, or that Lord Shaftsbury has confounded it with taste, since all three of these faculties agree in the objects of their approbation, notwithstanding they exist in the mind independent of each other. The fa­vorable influence which the progress of science and taste has had upon the morals, can be ascribed to nothing else, but to the perfect union that subsists in nature between the dictates of reason—of taste—and of the moral faculty. Why has the spirit of humanity made such rapid progress for some years past in the courts of Europe? It is be­cause kings and their ministers have been taught to reason upon philosophical subjects.—Why have indecency and profanity been banished from the stage in London and Paris? It is because immo­rality is an offence against the highly cultivated taste of the French and English nations.

It must afford great pleasure to the lovers of virtue, to behold the depth and extent of this [Page 18] moral principle in the human mind. Happily for the human race, the intimations of duty and the road to happiness are not left to the slow opera­tions or doubtful inductions of reason, nor to the precarious decisions of taste! Hence we often find the moral faculty in a state of vigor, in persons in whom reason and taste exist in a weak, or in an uncultivated state. It is worthy of notice like­wise, that while second thoughts are best in mat­ters of judgment, first thoughts are always to be preferred in matters that relate to morality. Se­cond thoughts, in these cases, are generally parlies between duty and corrupted inclinations. Hence Rousseau has justly said, that "a well regulated moral instinct is the surest guide to happiness."

IT must afford equal pleasure to the lovers of virtue to behold, that our moral conduct and hap­piness are not committed to the determination of a single legislative power.—The conscience, like a wise and faithful legislative council, performs the office of a check upon the moral faculty, and thus prevents the fatal consequences of immoral actions.

AN objection, I foresee, will arise to the doc­trine of the influence of physical causes upon the moral faculty, from its being supposed to favor the [Page 19] opinion of the materiality of the soul. But I do not see that this doctrine obliges us to decide upon the question of the nature of the soul, any more than the facts which prove the influence of physi­cal causes upon the memory—the imagination— or the judgment. I shall, however remark upon this subject, that the writers in favor of the im­mortality of the soul have done that truth great in­jury, by connecting it necessarily with its immateri­ality. The immortality of the soul depends upon the will of the Deity, and not upon the supposed properties of spirit. Matter is in its own nature as immortal as spirit. It is resolveable by heat and mixture into a variety of forms; but it requires the same Almighty hand to annihilate it, that it did to create it. I know of no arguments to prove the immortality of the soul, but such as are de­rived from the Christian revelation ^*. It would be as reasonable to assert, that the bason of the ocean is immortal, from the greatness of its capa­city to hold water; or that we are to live for ever in this world, because we are afraid of dying, as to maintain the immortality of the soul, from the greatness of its capacity for knowledge and hap­piness, or from its dread of annihilation.

[Page 20]I remarked in the beginning of this discourse, that persons who were deprived of the just exer­cise of memory—imagination—or judgment, were proper subjects of medicine; and that there are many cases upon record which prove, that the diseases from the derangement of these faculties, have yielded to the healing art.

IT is perhaps only because the disorders of the moral faculty, have not been traced to a connec­tion with physical causes, that medical writers have neglected to give them a place in their sys­tems of nosology, and that so few attempts have been hitherto made, to lessen or remove them by physical as well as rational and moral remedies.

I shall not attempt to derive any support to my opinions, from the analogy of the influence of physical causes upon the temper and conduct of brute animals. The facts which I shall produce in favor of the action of these causes upon morals in the human species, will, I hope, render unne­cessary the arguments that might be drawn from that quarter.

I am aware, that in venturing upon this subject, I step upon untrodden ground.——I feel as Aeneas did, when he was about to enter the gates of A­vernus, but without a Sibyl to instruct me in the [Page 21] mysteries that are before me. I foresee, that men who have been educated in the mechanical habits of adopting popular or established opinions, will revolt at the doctrine I am about to deliver— while men of sense and genius will hear my propo­sitions with candor, and if they do not adopt them, will commend that boldness of enquiry, that prompted me to broach them.

I shall begin with an attempt to supply the de­fects of nosological writers, by naming the partial or weakened action of the moral faculty, MI­CRONOMIA. The total absence of this faculty, I shall call ANOMIA. By the law, referred to in these new genera of vesaniae, I mean the law of nature written in the human heart, and which I formerly quoted from the writings of St. Paul.

IN treating of the effects of physical causes up­on the moral faculty, it might help to extend our ideas upon this subject, to reduce virtues and vi­ces to certain species, and to point out the effects of particular species of virtue and vice; but this would lead us into a field too extensive for the li­mits of the present enquiry. I shall only hint at a few cases, and have no doubt but the ingenuity of my auditors will supply my silence, by applying the rest.

[Page 22]IT is immaterial, whether the physical causes that are to be enumerated, act upon the moral fa­culty through the medium of the senses—the pas­sions—the memory—or the imagination. Their influence is equally certain, whether they act as remote, pre-disposing, or occasional causes.

1. THE effects of CLIMATE upon the moral faculty claim our first attention. Not only indivi­duals, but nations, derive a considerable part of their moral, as well as intellectual character, from the different portions they enjoy of the rays of the sun. Irascibility—levity—timidity—and indolence, tempered with occasional emotions of benevo­lence, are the moral qualities of the inhabitants of warm climates, while selfishness tempered with sincerity and integrity, form the moral cha­racter of the inhabitants of cold countries.— The state of the weather, and the seasons of the year also, have a visible effect upon moral sensibility. The month of November, in Great Britain, rendered gloomy by constant fogs and rains, has been thought to favor the perpetration of the worst species of murder, while the vernal sun, in middle latitudes, has been as gene­rally [Page 23] remarked for producing gentleness and be­nevolence.

2. THE effects of DIET upon the moral faculty are more certain, though less attended to, than the effects of climate. "Fullness of bread," we are told, was one of the predisposing causes of the vices of the cities of the plain. The fasts so often inculcated among the Jews, were intended to les­sen the incentives to vice; for pride—cruelty— and sensuality, are as much the natural conse­quences of luxury, as apoplexies and palsies. But the quality as well as the quantity of aliment, has an influence upon morals; hence we find the mo­ral diseases that have been mentioned, are most frequently the offspring of animal food. The prophet Isaiah seems to have been sensible of this, when he ascribes such salutary effects to a tempe­rate and vegetable diet. "Butter and honey shall he eat," says he, "that he may know to refuse the evil, and to chuse the good."—But we have many facts which prove the efficacy of a vegeta­ble diet upon the passions. Dr. Arbuthnot assures us, that he cured several patients of irascible tem­pers, by nothing but a prescription of this simple and temperate regimen.

[Page 24]3. THE effects of CERTIAN DRINKS upon the moral faculty are not less observable, than upon the intellectual powers of the mind. Fermented liquors of a good quality, and taken in a mode­rate quantity, are favorable to the virtues of can­dor, benevolence and generosity; but when they are taken in excess, or when they are of a bad quality, and drank even in a moderate quantity, they seldom fail of rousing every latent spark of vice into action. The last of these facts is so noto­rious, that when a man is observed to be ill-natur­ed or quarrelsome in Portugal, after drinking, it is common in that country to say, that "he has drank bad wine." While occasional fits of in­toxication produce ill temper in many people, ha­bitual drunkenness (which is generally produced by distilled spirits) never fails to eradicate veraci­ty and integrity from the human mind. Perhaps this may be the reason why the Spaniards, in an­cient times, never admitted a man's evidence in a court of justice, who had been convicted of drun­kenness.—Water is the universal sedative of tur­bulent passions—it not only promotes a general equanimity of temper, but it composes anger. I have heard several well-attested cases, of a draught of cold water having suddenly composed this vio­lent passion, after the usual remedies of reason had been applied to no purpose.

[Page 25]4. EXTREME HUNGER produces the most un­friendly effects upon moral sensibility. It is imma­terial, whether it acts by inducing a relaxation of the solids, or an acrimony of the fluids, or by the combined operation of both those physical causes. The Indians in this country whet their appetites for that savage species of war, which is peculiar to them, by the stimulus of hunger; hence, we are told, they always return meagre and emaci­ated from their military excursions. In civilized life we often behold this sensation an overbalance for the restraints of moral feeling; and perhaps this may be the reason, why poverty, which is the most frequent parent of hunger, disposes so gene­rally to theft; for the character of hunger is taken from that vice—It belongs to it "to break through stone walls." So much does this sensation predo­minate over reason and moral feeling, that Cardi­nal de Retz suggests to politicians, never to risk a motion in a popular assembly, however wise or just it may be, immediately before dinner.—That temper must be uncommonly guarded, which is not disturbed by long abstinence from food. One of the worthiest men I ever knew, who made his breakfast his principal meal, was peevish and disa­greeable to his friends and family, from the time he left his bed, till he sat down to his morning re­past, after which, chearfulness sparkled in his [Page 26] countenance, and he became the delight of all around him.

5. I hinted formerly, in proving the analogy between the effects of DISEASES upon the intel­lects, and upon the moral faculty, that the latter was frequently impaired by fevers and madness. I beg leave to add further upon this head, that not only fevers and madness, but the hysteria and hypochondriasis, as well as all those states of the body, whether idiopathic or symptomatic, which are accompanied with preternatural irritability— sensibility—torpor—stupor—or mobility of the nervous system, dispose to vice, either of the body or of the mind. It is in vain to attack these vices with lectures upon morality. They are only to be cured by medicine,—particularly by exer­cise,—the cold bath,—and by a cold or warm at­mosphere. The young woman, whose case I men­tioned formerly, that lost her habit of veracity by a nervous fever, recovered this virtue, as soon as her system recovered its natural tone, from the cold weather which happily succeeded her fever ^*.

[Page 27]6. IDLENESS is the parent of every vice. It is mentioned in the Old Testament as another of the the predisposing causes of the vices of the cities of the plain. LABOR of all kinds, favors and facili­tates the practice of virtue. The country life is a happy life; chiefly, because its laborious employ­ments are favourable to virtue, and unfriendly to vice. It is a common practice, I have been told, for the planters in the Southern States, to consign a house slave, who has become vicious from idle­ness, to the drudgery of the field, in order to re­form him. The Bridewells and workhouses of all civilized countries prove, that LABOR is not only [Page 28] a very severe, but the most benevolent of all pu­nishments, in as much as it is one of the most suit­able means of reformation. Mr Howard tells us in his History of Prisons, that in Holland it is a common saying, "Make men work and you will make them honest." And over the rasp and spin-house at Groeningen, this sentiment is expressed (he tells us) by a happy motto: ‘"Vitiorum semina—otium—labore exhauriendum."’ The effects of steady labor in early life, in creating virtuous habits, is still more remarkable. The late Anthony Benezet of this city, whose benevolence was the sentinel of the virtue, as well as of the happiness of his country, made it a constant rule in binding out poor children, to avoid putting them into wealthy families, but always preferred ma­sters for them who worked themselves, and who obliged these children to work in their presence. If the habits of virtue, contracted by means of this apprenticeship to labor, are purely mechanical, their effects are, nevertheless, the same upon the happiness of society, as if they flowed from prin­ciple. The mind, moreover, when preserved by these means from weeds, becomes a more mellow soil afterwards, for moral and rational improve­ment.

[Page 29]7. THE effects of EXCESSIVE SLEEP are intimate­ly connected with the effects of idleness upon the moral faculty,—hence we find that moderate, and even scanty portions of sleep, in every part of the world, have been found to be friendly, not only to health and long life, but in many instances to morality. The practice of the Monks, who of­ten sleep upon a floor, and who generally rise with the sun, for the sake of mortifying their sensual ap­petites, is certainly founded in wisdom, and has of­ten produced the most salutary moral effects.

8. THE effects of BODILY PAIN upon the mo­ral, are not less remarkable than upon the intel­lectual powers of the mind. The late Dr Gregory, of the university of Edinburgh, used to tell his pupils, that he always found his perceptions quick­er in a fit of the gout, than at any other time. The pangs which attend the dissolution of the body, are often accompanied with conceptions and expressions upon the most ordinary subjects, that discover an uncommon elevation of the intellectual powers. The effects of bodily pain are exactly the same in rousing and directing the moral facul­ty. Bodily pain, we find, was one of the reme­dies employed in the Old Testament, for extirpat­ing vice and promoting virtue: and Mr Howard tells us, that he saw it employed successfully as a [Page 30] means of reformation, in one of the prisons which he visited. If pain has a physical tendency to cure vice, I submit it to the consideration of parents and legislators, whether moderate degrees of cor­poral punishments, inflicted for a great length of time, would not be more medicinal in their effects, than the violent degrees of them, which are of short duration.

9. TOO much cannot be said in favour of CLEANLINESS, as a physical means of promoting virtue. The writings of Moses have been called by military men, the best "orderly book" in the world. In every part of them we find cleanliness inculcated with as much zeal, as if it was part of the moral, instead of the levitical law. Now, it is well-known, that the principal design of every pre­cept and rite of the ceremonial parts of the Jew­ish religion, was to prevent vice, and to promote virtue. All writers upon the leprosy, take notice of its connection with a certain vice. To this dis­ease gross animal food, particularly swine's flesh, and a dirty skin, have been thought to be predispo­sing causes—hence the reason, probably, why pork was forbidden, and why ablutions of the body and limbs were so frequently inculcated by the Jewish law. Sir John Pringle's remarks, in his Oration upon Captain Cook's Voyage, deli­vered [Page 31] before the Royal Society in London, are very pertinent to this part of our subject.— ‘Cleanliness (says he) is conducive to health, but it is not so obvious, that it also tends to good or­der and other virtues. Such (meaning the ship's crew) as were made more cleanly, became more sober, more orderly, and more attentive to duty.’ The benefit to be derived by parents and schoolmasters from attending to these facts, is too obvious to be mentioned.

10. I hope I shall be excused in placing SO­LITUDE among the physical causes which influ­ence the moral faculty, when I add, that I confine its effects to persons who are irreclaimable by ra­tional or moral remedies. Mr Howard informs us, that the chaplain of the prison at Liege in Germany assured him, ‘that the most refractory and turbulent spirits, became tractable and sub­missive, by being closely confined for four or five days.’—In bodies that are predisposed to vice, the stimulus of cheerful, but much more of pro­fane society and conversation, upon the animal spi­rits, becomes an exciting cause, and like the stroke of the flint upon the steel, renders the sparks of vice both active and visible. By removing men out of the reach of this exciting cause, they are often re­formed, especially if they are confined long enough [Page 32] to produce a sufficient chasm in their habits of vice. Where the benefit of reflection, and instruction from books, can be added to solitude and confine­ment, their good effects are still more certain. To this philosophers and poets in every age have as­sented, by describing the life of a hermit as a life of passive virtue.

11. CONNECTED with solitude, as a mechanical means of promoting virtue, SILENCE deserves to be mentioned in this place. The late Dr Fother­gill, in his plan of education for that benevolent institution at Ackworth, which was the last care of his useful life, says every thing that can be said in favour of this necessary discipline, in the follow-words. ‘To habituate children from their early infancy, to silence and attention, is of the great­est advantage to them, not only as a preparative to their advancement in a religious life, but as the groundwork of a well cultivated under­standing. To have the active minds of children put under a kind of restraint—to be accustomed to turn their attention from external objects, and habituated to a degree of abstracted quiet, is a matter of great consequence, and lasting be­nefit to them. Although it cannot be supposed, that young and active minds are always engaged in silence as they ought to be, yet to be accus­tomed [Page 33] thus to quietness, is no small point gained towards fixing a habit of patience, and recollec­tion, which seldom forsakes those who have been properly instructed in this entrance of the school of wisdom, during the residue of their days.’

FOR the purpose of acquiring this branch of educa­tion, children cannot associate too early, nor too often with their parents, or with their superiors in age, rank, and wisdom.

12. THE effects of music upon the moral faculty, have been felt and recorded in every country. Hence we are able to discover the virtues and vi­ces of different nations, by their tunes, as certainly as by their laws. The effects of music, when sim­ply mechanical, upon the passions, are powerful and extensive. But it remains yet to determine the degrees of moral ecstasy, that may be produ­ced by an attack upon the ear, the reason, and the moral principle, at the same time, by the com­bined powers of music and eloquence.

13. THE eloquence of the pulpit is nearly allied to music in its effects upon the moral faculty. It is true, there can be no permanent change in the temper, and moral conduct of a man, that is not derived from the understanding and the will; but [Page 34] we must remember, that these two powers of the mind are most assailable, when they are attacked through the avenue of the passions; and these, we know, when agitated by the powers of eloquence, exert a mechanical action upon every power of the soul. Hence we find in every age and country, where christianity has been propagated, the most accomplished orators have generally been the most successful reformers of mankind. There must be a defect of eloquence in a preacher, who with the resources for oratory, which are contained in the Old and New Testaments, does not produce in every man who hears him, at least a temporary love of virtue. I grant that the eloquence of the pulpit alone, cannot change men into christians, but it certainly possesses the power of changing brutes into men. Could the eloquence of the stage be properly directed, it is impossible to con­ceive the extent of its mechanical effects upon mo­rals. The language and imagery of a Shakespeare, upon moral and religious subjects, poured upon the passions and the senses, in all the beauty and va­riety of dramatic representation! Who could resist, or describe their effects?

14. ODORS of various kinds have been observ­ed to act in the most sensible manner upon the mo­ral faculty. Brydone tells us, upon the authority of a celebrated philosopher in Italy, that the pecu­liar [Page 35] wickedness of the people who live in the neigh­bourhood of Aetna and Vesuvius, is occasioned chiefly by the smell of the sulphur and of the hot exhalations which are constantly discharged from those volcanos. Agreeable odors, seldom fail to inspire serenity, and to compose the angry spirits— Hence the pleasure, and one of the advantages of a flower garden. The smoke of tobacco is likewise of a composing nature, and tends not only to pro­duce what is called a train in perception, but to hush the agitated passions into silence and order— Hence the propriety of connecting the pipe or se­gar and the bottle together, in public company.

15. IT will be sufficient only to mention light and darkness, to suggest facts in favor of the influence of each of them upon moral sensibility. How of­ten do the peevish complaints of the night in sick­ness, give way to the composing rays of the light of the morning? Othello cannot murder Desde­mona by candle-light, and who has not felt the effects of a blazing fire, upon the gentle passions?

16. IT is to be lamented, that no experiments have as yet been made, to determine the effects of all the different species of Airs, which chemistry has lately discovered, upon the moral faculty. I have authority, from actual experiments, only to declare, that Dephlogisticated Air, when taken in­to [Page 36] the lungs, produces cheerfulness, gentleness, and serenity of mind.

17. WHAT shall we say of the effects of Medi­cines upon the moral faculty? That many substances in the materia medica act upon the intellects, is well known to physicians. Why should it be thought impossible for medicines, to act in like manner up­on the moral faculty? May not the earth contain in its own bowels, or upon its surface, antidotes? But I will not blend facts with conjectures. Clouds and darkness still hang upon this part of my sub­ject.

LET it not be suspected from any thing that I have delivered, that I suppose the influence of phy­sical causes upon the moral faculty, renders the agency of divine influence unnecessary to our mo­ral happiness. I only maintain, that the opera­tions of the divine government are carried on in the moral, as in the natural world, by the instru­mentality of second causes. I have only trodden in the footsteps of the inspired writers; for most of the physical causes I have enumerated, are con­nected with moral precepts, or have been used as the means of reformation from vice, in the Old and New Testaments. To the cases that have been mentioned I shall only add, that Nebuchad­nezzar was cured of his pride, by means of solitude [Page 37] and a vegetable diet.—Saul was cured of his evil spirit, by means of David's harp, and St. Paul ex­pressly says, ‘I keep my body under, and bring it into subjection, lest that by any means, when I have preached to others, I myself should be a cast-away.’ But I will go one step further, and add in favor of divine influence upon the moral principle, that in those extraordinary cases, where bad men are suddenly reformed, without the in­strumentality of physical, moral, or rational causes, I believe that the organization of those parts of the body, which form the link that binds it to the soul, undergoes a physical change; ^* and hence the ex­pression of a "new creature," which is made use of in the scriptures to denote this change, is pro­per in a literal, as well as a figurative sense. It is probably the beginning of that perfect renovation of the human body, which is predicted by St Paul in the following words— ‘For our conversation is in heaven, from whence we look for the Savi­our, [Page 38] who shall change our vile bodies, that they may be fashioned according to his own glorious body.’ I shall not pause to defend myself against the charge of enthusiasm in this place; for the age is at length arrived, so devoutly wished for by Dr. Cheyne, in which men will not be de­terred in their researches after truth, by the ter­ror of odious or unpopular names.

I cannot help remarking under this head, that if the conditions of those parts of the human body which are connected with the human soul, influence morals, the same reason may be given for a virtu­ous education, that has been admitted for teaching music and the pronunciation of foreign languages, in the early and yielding state of those organs, which form the voice and speech. Such is the effect of a moral education, that we often see its fruits in advanced stages of life, after the religious principles which were connected with it, have been renounced; just as we perceive the same care in a surgeon in his attendance upon patients, after the sympathy which first produced this care, has ceas­ed to operate upon his mind. The boasted moral­ity of the Deists, is I believe, in most cases, the off­spring of habits, produced originally by the prin­ciples and precepts of Christianity. Hence appears the wisdom of Solomon's advice— ‘Train up a [Page 39] child in the way he should go, and when he is old he will not,’ I had almost said, he cannot "depart from it."

THUS have I enumerated the principal causes, which act mechanically upon morals. If from the combined action of physical powers that are oppo­sed to each other, the moral faculty should become stationary, or if the virtue or vice produced by them, should form a neutral quality, composed of both of them, I hope it will not call in question the truth of our general propositions. I have only mentioned the effects of physical causes in a simple state. ^*

IT might help to enlarge our ideas upon this subject, to take notice of the influence of the dif­ferent stages of society, of agriculture and com­merce, of soil and situation, of the different degrees of cultivation of taste, and of the intellectual pow­ers, of the different forms of government, and last­ly, of the different professions and occupations of mankind, upon the moral faculty; but as these act [Page 40] indirectly only, and by the intervention of causes that are unconnected with matter, I conceive they are foreign to the business of the present enquiry. If they should vary the action of the simple physi­cal causes in any degree, I hope it will not call in question the truth of our general propositions, any more than the compound action of physical powers, that are opposed to each other. There remain on­ly a few more causes which are of a compound nature, but so nearly related to those, which are purely mechanical, that I shall beg leave to trespass upon your patience, by giving them a place in my oration.

THE effects of imitation, habit and association upon morals, would furnish ample matter for inve­stigation. Considering how much the shape, tex­ture, and conditions of the human body, influence morals, I submit it to the consideration of the in­genious, whether in our endeavours to imitate moral examples, some advantage may not be deri­ved, from our copying the features and external manners of the originals. What makes the suc­cess of this experiment probable is, that we gene­rally find men, whose faces resemble each other, have the same manners and dispositions. I infer the possibility of success in an attempt to imitate originals in a manner that has been mentioned, from the facility with which domestics acquire a [Page 41] resemblance to their masters and mistresses, not on­ly in manners, but in countenance, in those cases where they are tied to them, by respect, and affec­tion.—Husbands and wives also where they pos­sess the same species of face, under circumstances of mutual attachment, often acquire a resemblance to each other.

FROM the general detestation in which hypocri­sy is held both by good and bad men, the mechani­cal effects of habit upon virtue, have not been suffi­ciently explored. There are, I am persuaded, ma­ny instances where virtues have been assumed by accident, or necessity, which have become real from habit, and afterwards derived their nourishment from the heart. Hence the propriety of Hamlet's advice to his mother—

THE influence of ASSOCIATION upon morals, opens an ample field for enquiry. It is from this principle, that we explain the reformation from theft and drunkenness in servants which we some­times see produced by a draught of spirits in which tartar emetic had been secretly dissolved. The recollection of the pain and sickness excited by the emetic, naturally associates itself with the spi­rits, so as to render them both equally the objects of aversion. It is by calling in this principle only, that we can account for the conduct of Moses, in grinding the golden calf into a powder, and afterwards dissolving it (probably by means of hepar sulphuris) in water, and compelling the children of Israel to drink of it, as a punishment for their idolatry. This mixture is bitter and nau­seating in the highest degree. An inclination to idolatry, therefore, could not be felt without be­ing associated with the remembrance of this disa­greeable mixture, and of course being rejected, with equal abhorrence. The benefit of corporal punishments, when they are of a short duration, depends in part up their being connected by time and place, with the crimes for which they are in­flicted. Quick as the thunder follows the light­ning, [Page 43] if it were possible, should punishments fol­low the crimes, and the advantage of association would be more certain, if the spot where they were committed, were made the theatre of their expiation. It is from the effects of this association, probably, that the change of place and company produced by exile and transportation, has so often reclaimed bad men, after moral—rational—and physical means of reformation had been used to no purpose.

AS SENSIBILITY is the avenue to the moral fa­culty, every thing which tends to diminish it tends also to injure morals.—The Romans owed much of their corruption to the sights of the contests of their gladiators, and of criminals, with wild beasts. For these reasons, executions should never be pub­lic. Indeed, I believe there are no public punish­ments of any kind, that do not harden the hearts of spectators, and thereby lessen the natural horror which all crimes at first excite in the human mind.

CRUELTY to brute animals is another means of destroying moral sensibility. The ferocity of sa­vages has been ascribed in part to their peculiar mode of subsistence. Mr. Hogarth points out in his ingenious prints, the connection between cru­elty to brute animals in youth, and murder in man­hood. [Page 44] The Emperor Domitian prepared his mind by the amusement of killing flies, for all those bloody crimes which afterwards disgraced his reign. I am so perfectly satisfied of the truth of a a connection between morals, and humanity to brutes, that I shall find it difficult to restrain my idolatry for that legislature, that shall first establish a system of laws, to defend them from outrage and oppression.

IN order to preserve the vigor of the moral fa­culty, it is of the utmost consequence to keep young people as ignorant as possible of those crimes, that are generally thought most disgraceful to human na­ture. Suicide, I believe, is often propagated by means of news-papers. For this reason, I should be glad to see the proceedings of our courts kept from the public eye, when they expose, or punish monstrous vices.

THE last mechanical method of promoting mo­rality that I shall mention, is to keep sensibility alive, by a familiarity with scenes or distress from poverty and disease. Compassion never awakens in the human bosom, without being accompanied by a train of sister virtues—hence the wise man justly remarks, that "By the sadness of the coun­tenance, the heart is made better."

[Page 45]A late French writer in his prediction of events that are to happen in the year 4000, says ‘That mankind in that aera shall be so far improved by religion and government, that the sick and the dying, shall no longer be thrown together with the dead, into splendid houses, but shall be re­lieved and protected in a connection with their families and society.’ For the honor of humanity, an institution ^* destined for that distant period, has lately been founded in this city, that shall perpetuate the year 1786 in the history of Pennsylvania. Here the feeling heart—the tearful eye—and the cha­ritable hand, may always be connected together, and the flame of sympathy, instead of being extin­guished in taxes, or expiring in a solitary blaze by a single contribution, may be kept alive, by con­stant exercise. There is a necessary connection be­tween animal sympathy and good morals. The priest and the levite, in the New Testament, would probably have relieved the poor man who fell among thieves, had accident brought them near enough to his wounds. The unfortunate Mrs. Bellamy was rescued from the dreadful pur­pose of drowning herself, by nothing but the dis­tress of a child, rending the air with its cries for [Page 46] bread. It is probably owing in some measure to the connection between good morals and sympathy that the fair sex in every age, and country, have been more distinguished for virtue, than men— for how seldom do we hear of a woman, devoid of humanity?—

LASTLY, ATTRACTION, COMPOSITION, and DECOMPOSITION, belong to the passions as well as to matter. Vices of the same species attract each other with the most force—hence the bad consequences of crouding young men (whose pro­pensities are generally the same) under one roof, in our modern plans of education. The effects of composition and decomposition upon vices, appear in the meanness of the school-boy, being often cured by the prodigality of a military life, and by the precipitation, of avarice, which is often pro­duced by ambition and love. ^*

[Page 47]IF physical causes influence morals in the man­ner we have described, may they not also influence religious principles and opinions?—I answer in the affirmative; and I have authoriry, from the records of physic, as well as from my own observa­tions, to declare, that religious melancholy and madness, in all their variety of species, yield with more facility to medicine, than simply to polemical discourses, or to casuistical advice.—But this sub­ject is foreign to the business of the present en­quiry.

FROM a review of our subject, we are led to contemplate with admiration, the curious struc­ture of the human mind. How distinct are the number, and yet how united! How subordinate and yet how coequal are all its powers! How wonderful is the action of the soul upon the body! Of the body upon the soul!—And of the divine spirit upon both! What a mystery is the mind of man to itself!—O! nature!—Or to speak more properly,—O! THOU GOD OF NATURE!—In vain do we attempt to scan THY immensity, or to comprehend THY various modes of existence, when a single particle of light issued from THYSELF, and kindled into intelligence in the bosom of man, thus dazzles and confounds our understanding!—

[Page 48]THE extent of the moral powers and habits in man is unknown. It is not improbable, but the human mind contains principles of virtue, which have never yet been excited into action. We be­hold with surprise the versatility of the human bo­dy in the exploits of tumblers and rope-dancers. Even the agility of a wild beast has been demon­strated in a girl in France, and an amphibious na­ture has been discovered in the human species, in a young man in Spain. We listen with astonish­ment to the accounts of the memoirs of Mithri­dates, Cyrus, and Servin. We feel a veneration bordering upon divine homage, in contemplating the stupendous understandings of Lord Verulam and Sir Isaac Newton; and our eyes grow dim, in attempting to pursue Shakespeare and Milton in their immeasurable flights of imagination. And if the history of mankind does not furnish similar in­stances of the versatility and perfection of our spe­cies in virtue, it is because the moral faculty has been the subject of less culture and fewer experi­ments than the body, and the intellectual powers of the mind. From what has been said, the rea­son of this is obvious. Hitherto the cultivation of the moral faculty has been the business of pa­rents, schoolmasters and divines ^*. But if the [Page 49] principles, we have laid down, be just, the im­provement and extension of this principle should be equally the business of the legislator—the na­tural philosopher—and the physician; and a phy­sical regimen should as necessarily accompany a moral precept, as directors with respect to the air—exercise—and diet, generally accompany pre­scriptions for the consumption, and the gout. To encourage us to undertake experiments for the improvement of morals, let us recollect the suc­cess of philosophy in lessening the number, and mitigating the violence of incurable diseases. The intermitting fever, which proved fatal to two of the monarchs of Britain, is now under absolute subjection to medicine. Continual fevers are much less fatal than formerly. The small-pox is disarmed of its mortality by inoculation, and even the tetanus and the cancer have lately re­ceived a check in their ravages upon man­kind. [Page 50] But medicine has done more—It has penetrated the deep and gloomy abyss of death, and acquired fresh honours in his cold embraces.—Witness the many hundred peo­ple who have lately been brought back to life, by the successful efforts of the humane societies, which are now established in many parts of Eu­rope, and in some parts of America. Should the same industry and ingenuity, which have produced these triumphs of medicine over diseases and death, be applied to the moral science, it is highly probable, that most of those baneful vices, which deform the the human breast, and convulse the nations of the earth, might be banished from the world. I am not so sanguine as to suppose, that it is possible for man to acquire so much perfection from science, religion, liberty and good govern­ment, as to cease to be mortal; but I am fully persuaded, that from the combined action of causes, which operate at once upon the reason, the moral faculty, the passions, the senses, the brain, the nerves, the blood and the heart, it is possible to produce such a change in his moral character, as shall raise him to a resemblance of angels—nay more, to the likeness of GOD himself. —The State of Pennsylvania still deplores the loss of a man, in whom not only reason and reve­lation, [Page 51] but many of the physical causes that have been enumerated, concurred to produce such at­tainments in moral excellency, as have seldom ap­peared in a human being. This amiable citizen, considered his fellow creature, man, as God's ex­tract, from his own works; and whether this image of himself, was cut out from ebony or copper—whether he spoke his own, or a foreign language—or whether he worshipped his Maker with ceremonies, or without them, he still consi­dered him as a brother, and equally the object of his benevolence. Poets and historians, who are to live hereafter, to you I commit his panegyric; and when you hear of a law for abolishing slavery in each of the American States, such as was passed in Pennsylvania, in the year 1780—when you hear of the kings and queens of Europe, publish­ing edicts for abolishing the trade in human souls —and lastly, when you hear of schools and chur­ches with all the arts of civilized life, being esta­blished among the nations of Africa, then remem­ber and record, that this revolution in favour of human happiness, was the effect of the labours— the publications—the private letters—and the pray­ers of ANTHONY BUNEZET ^*.—

[Page 52]I RETURN from this digression, to address my­self in a particular manner to you, VENERABLE SAGES and FELLOW CITIZENS in the REPUBLIC OF LETTERS.—The influence of philosophy, we have been told, has already been felt in courts. To increase, and complete this influence, there is nothing more necessary, than for the numerous [Page 53] literary societies in Europe and America, to add the SCIENCE of MORALS to their experiments and enquiries. The godlike scheme of Henry the IV. of France, and of the illustrious Queen Elizabeth of England, for establishing a perpetual peace in Europe, may be accomplished without a system of jurisprudence, by a confederation of learned men, and learned societies. It is in their power, by mul­tiplying the objects of human reason, to bring the monarchs and rulers of the world, under their sub­jection, and thereby to extirpate war—slavery— and capital punishments, from the list of human evils. Let it not be suspected that I detract by this declaration, from the honour of the christian reli­gion. It is true—Christianity was propagated without the aid of human learning; but this was one of those miracles, which was necessary to esta­blish it, and which, by repetition, would cease to be a miracle. They misrepresent the christian re­ligion, who suppose it to be wholly an internal re­velation, and addressed only to the moral powers of the mind. The truths of Christianity afford the greatest scope for the human understanding, and they will become intelligible to us, only in propor­tion as the human genius is stretched by means of philosophy, to its utmost dimensions. Errors may be opposed to errors; but truths, upon all subjects, [Page 54] mutually support each other. And perhaps one reason, why some parts of the Christian revelation are still involved in obscurity, may be occasioned by our imperfect knowledge of the phaenomena, and laws of nature. The truths of philosophy and Christianity, dwell alike in the mind of the Deity, and reason and religion are equally the offspring of his goodness. They must, therefore, stand and fall together. By reason, in the present instance, I mean the power of judging of truth, as well as the power of comprehending it. Happy aera!— When the divine and the philosopher shall em­brace each other, and unite their labors, for the reformation and happiness of mankind!—

ILLUSTRIOUS COUNCILLORS and SENATORS of Pennsylvania! ^* I anticipate your candid re­ception of this feeble effort to increase the quan­tity of virtue in our republic. It is not my busi­ness to remind you of the immense resources for greatness, which nature and Providence have be­stowed upon our state. Every advantage which France has derived from being placed in the centre [Page 55] of Europe, and which Britain has derived from her mixture of nations, Pennsylvania has opened to her. But my business at present, is to suggest the means of promoting the happiness, not the greatness the state. For this purpose, it is abso­lutely necessary that our government, which unites into one all the minds of the state, should possess, in an eminent degree, not only the understanding, the passions, and the will, but above all, the moral faculty, and the conscience of an individual.—No­thing can be politically right, that is morally wrong; and no necessity can ever sanctify a law, that is contrary to equity. VIRTUE is the soul of a republic. To promote this, laws for the suppression of vice and immorality will be as in­effectual, as the increase and enlargement of gaols. There is but one method of preventing crimes, and of rendering a republican form of govern­ment durable, and that is by disseminating the seeds of virtue and knowledge through every part of the state, by means of proper modes and places of education, and this can be done effectually only, by the interference and aid of the legislature. I am so deeply impressed with the truth of this opinion, that were this evening to be the last of my life, I would not only say to the asylum of my ancestors, and my beloved native country, with the [Page 56] patriot of Venice, "Esto perpetua"—But I would add, as the last proof of my affection for her, my parting advice to the guardians of her liberties, "To establish and support PUBLIC SCHOOLS in every part of the state."

BY Spirits I mean all those liquors which are obtained by distillation from fermented jui­ces or substances of any kind. These liquors were formerly used only in medicine—They now consti­tute a principal part of the drinks of many coun­tries.

SINCE the introduction of spirituous liquors into such general use, physicians have remarked that a number of new diseases have appeared among [Page 60] us, and have described many new symptoms as common to old diseases. Spirits in their first ope­ration are stimulating upon the system. They quicken the circulation of the blood, and produce some heat in the body. Soon afterwards, they become what is called sedative; that is, they di­minish the action of the vital powers, and thereby produce languor and weakness.

THE effects of spirituous liquors upon the hu­man body, are sometimes slow in their appearance. A strong constitution, especially if it be assisted with constant and hard labour, will counteract the destructive effects of spirits for many years, but in general they produce the following diseases:

1. A sickness at the stomach, and vomiting in the morning. This disorder is generally accompanied by a want of appetite for breakfast. It is known by tremors in the hands, insomuch that persons who labour under it, are hardly able to lift a tea cup to their heads, till they have taken a dose of some cordial liquor. In this disorder, a peculiar paleness, with small red streaks, appear in the cheeks. The flesh of the face, at the same time, has a peculiar fulness and flabbiness, which are very different from sound and health sat.

[Page 61]2. AN universal dropsy. This disorder begins first in the lower limbs, and gradually extends itself throughout the whole body. I have been told that the merchants in Charleston, South-Carolina, never trust the planters when spirits have produced the first symptom of this disorder upon them. It is very natural to suppose that industry and virtue have become extinct in that man, whose legs and feet are swelled, from the use of spirituous li­quors.

3. Obstruction of the liver. This disorder pro­duces other diseases, such as an inflammation, which sometimes proves suddenly fatal—the jaun­dice—and a dropsy in the belly.

4. Diabetes.

5. Pains in the limbs, accompanied by a sense of burning in the palms of the hands and soles of the feet. This disease has sometimes been called the Jamaica Rheumatism.

6. Hoarseness and cough. These complaints predispose to fatal attacks of Pneumonia Notha.

7. THE Epilepsy. 8. Madness. 9. Palsy, and, 10. The Apoplexy, complete the group of diseases produced by spirituous liquors. ^*

[Page 62]I do not assert that these disorders are never produced by any other causes, but I maintain that spirituous liquors are the most frequent causes of them, and that when a predisposition to them is produced by other causes, they are rendered more certain and more dangerous by the intemperate use of spirits.

I have only named a few of the principal disor­ders which are produced by spirituous liquors. It would take up a volume to describe how much other disorders natural to the human body, are in­creased and complicated by them. Every species of inflammatory and putrid fever, is rendered more frequent and more dangerous by the use of spirituous liquors.

THE danger to life from the diseases which have been mentioned is well known. I do not think it extravagant therefore to repeat here, what has been often said, that spirituous liquors destroy more lives than the sword. War has its intervals of destruction—but spirits operate at all times and sea­sons upon human life. The ravages of war are [Page 63] confined to but one part of the human species, viz. to men; but spirits act too often upon per­sons who are exempted from the dangers of war by age or sex; and lastly, war destroys only those persons who allow the use of arms to be lawful, whereas spirits insinuate their fatal effects among people, whose principles are opposed to the effu­sion of human blood.

BUT the effects of ardent spirits upon the hu­man body, do not end in the destruction of life. They derange and even deform a dead body so as to render it a loathsome addition to the clay which conceals it from human view after death. This has been frequently demonstrated in the dissection of persons who have been destroyed by the use of ardent spirits. They harden and contract the fi­bres of the stomach and bowels, or induce in them abscesses and gangrene—they produce schirri in the viscera—they contract the diameter of the san­guiferous and bronchial vessels—they induce o [...] ­fications in the tendons, arteries, and pleura, and lastly—they produce a peculiar crispness in the hair of the head, insomuch that the wig-makers in London give much less for it, than for the hair of sober people.

[Page 64]IF we advance a step further and examine the effects of spirituous liquors upon the mind, the prospect will be still more distressing and terrible. Their first effects here, shew themselves in the tem­per. I have constantly observed men who are in­toxicated in any degree with spirits, to be peevish and quarrelsome; after a while they lose by de­grees the moral sense. They violate promises and engagements without shame or remorse. From these deficiencies in veracity and integrity, they pass on to crimes of a more heinous nature. It would dishonour human nature only to name them.

THE next operation of ardent spirits is upon the understanding. This sublime power of the mind is first debilitated in hard drinkers.—They discover a torpor in every mental exertion, even when they are not under the immediate influence of spirits. To this debility in the understanding succeed the loss of memory, and the perversion of all the intellectual powers in melancholy and mad­ness, and in some cases the total extinction of them in idiotism.

LET us next turn our eyes from the effects of spirits upon the body and mind, to their effects up­on property; and here fresh scenes of misery open to our view. Among the inhabitants of cities, they pro­duce [Page 65] debts, disgrace, and bankruptcy. Among farmers, they produce idleness with its usual con­sequences, such as houses without windows, barns without roofs, gardens without enclosures, fields without fences, hogs without yokes, sheep without wool, meagre cattle, feeble horses, and half clad dirty children, without principles, morals, or man­ners. This picture is not exaggerated. I appeal to the observations of my countrymen, whether such scenes of wretchedness do not follow the tracks of spirituous liquors, in every part of the United States.

THUS have I in a few words pointed out the ef­fects of spirituous liquors upon the bodies, minds, and estates of my fellow-citizens.—Their mischiefs may be summed up in a few Words. They fill our church-yards with premature graves, they deface the image of God in the soul, they de­range or destroy the intellectual powers, they fill the sheriff's docket with executions, they croud our hospitals with patients, and our jails with cri­minals, they lead to places of public ignomy and punishment, and lastly, they people the regions— but it belongs to another profession to shew their terrible consequences in the future world.

AFTER this melancholy detail of the pernicious ef­fects of spirituous liquors upon the body, it may not be [Page 66] improper to enumerate the usual causes which lead to their intemperate use. They are, 1. Exposure to excessive heat and cold. 2. Hard labour, dis­proportioned to the strength of the body. 3. Hunger, more especially those degrees of it which have been excited by long intervals between meals. 4. Long speaking, or long sittings in company. 5. Smoking and chewing tobacco. 6. Taking me­dicines in ardent spirits. 7. Breeding sickness. 8. Great domestic care. I have of observed this cause to produce it, in several instances in women. 9. Domestic vexations, more especially conjugal infelicity. 10. The infection of company that is addicted to strong drink. 11. Debt. 12. The corrodings of a guilty conscience; and, 13. Soli­tude where the mind does not possess resources in itself, in books, or religion. It is remarkable that an intemperate use of ardent spirits is seldom pro­duced by that grief which follows the death of relations or friends.

IN the use of spirits, there are certain progres­sive stages which deserve to be mentioned. Men begin generally by drinking them in a diluted state, at dinner only. They next drink them in the same state in the afternoon and evening. In the course of a few years, they call for them in the forenoon, and soon afterwards before breakfast, encreasing their strength from time to time until they finally [Page 67] drink them in a undiluted state during every hour of the night. I have known several persons who have passed through all the above stages of intem­perance, in whom the pulse of life seemed to be supported for several months before their death, only by drinking from one to two quarts of raw spirits every night.

I shall now proceed to combat some prejudices in favour of the use of sprituous liquors.

THE three occasions in which spirits have been thought most necessary and useful are the follow­ing:

1. IN very cold weather.

2. IN very warm weather. And,

3. IN times of hard labour.

1. THERE cannot be a greater error than to suppose that spirituous liquors lessen the effects of cold upon the body. On the contrary, I main­tain that they always render the body more liable to be affected and injured by cold. The tem­porary warmth they produce, is always succeeded by chilliness. If any thing, besides warm cloath­ing and exercise, be necessary to warm the body in cold weather, a plentiful meal of wholsome food is [Page 68] at all times sufficient for that purpose. This, by stimulating the stomach, invigorates the whole system, and thus renders it less sensible of the cold.

2. IT is equally absurd to suppose that spirituous liquors lessen the effects of heat upon the body. So far from it, they rather encrease them. They add an internal heat to the external heat of the sun; they dispose to fevers and inflammations of the most dangerous kind; they produce preterna­tural sweats which weaken, instead of an uniform and gentle perspiration, which exhilarates the bo­dy. Half the diseases which are said to be produ­ced by warm weather, I am persuaded are produ­ced by the spirits which are swallowed to lessen its effects upon the system. ^*

[Page 69]3. I maintain with equal confidence, that spiritu­ous liquors do not lessen the effects of hard labour upon the body. Look at the horse, with every muscle of his body swelled from morning till night in the plough, or the team, does he make signs for spirits to enable him to cleave the earth, or to climb a hill?—No. He requires nothing but cool water and substantial food. There is nei­ther strength nor nourishment in spirituous liquors. If they produce vigour in labour, it is of a transi­ent nature, and is always succeeded by a sense of weakness and fatigue. These facts are founded in observation; for I have repeatedly seen those men perform the greatest exploits in work both as to their degrees and duration, who never tasted spirituous liquors.

BUT are there no conditions of the human bo­dy in which spirituous liquors are required? Yes, [Page 70] there are; 1st. In those cases where the body has been exhausted by any causes, and faintness, or a stoppage in the circulation of the blood has been produced, the sudden stimulus of spirits may be necessary. In this case we comply strictly with the advice of Solomon, who confines the use of "strong drink," only to him "that is ready to pe­rish!" and 2dly. When the body has been long exposed to wet weather, and more especially if cold be joined with it, a moderate quantity of spirits is not only proper but highly useful to obviate debi­lity, and thus to prevent a fever. I take these to be the only two cases that can occur, in which spi­rituous liquors are innocent or necessary.

BUT if we reject spirits from being part of our drinks, what liquors shall we substitute in the room of them? For custom, the experience of all ages and countries, and even nature herself, all seem to demand drinks more grateful and more cordial than simple water.

TO this I shall reply, by recommending in the room of spirits, in the first place,

1. CYDER. This excellent liquor contains a small quantity of spirit, but so diluted and blunted, by being combined with an acid and a large quan­tity of sacharine matter and water, as to be per­fectly [Page 71] inoffensive and wholesome. It disagrees on­ly with persons subject to the rheumatism, but it may be rendered inoffensive to such people by ex­tinguishing a red hot iron in it, or by diluting it with water. It is to be lamented that the late frosts in the spring often deprive us of the fruit which affords this liquor. But the effects of these frosts have been in some measure obviated, by giving an orchard a north-west exposure, so as to check too early vegetation, and by kindling two or three large fires of brush and straw to the windward of the orchard, the evening before we expect a night of frost. This last expedient, has in many instan­ces within the compass of my knowledge, preserv­ed the fruit of an orchard, to the great joy and emolument of the ingenious husbandman.

2. BEER is a wholsome liquor compared with spirits. The grain from which it is obtained is not liable like the apple, to be affected by frost, and therefore it can always be procured at a moderate expense. It abounds with nourishment—hence we find many of the common people in Great Bri­tain, endure hard labour with no other food than a quart or three pints of this liquor, with a few pounds of bread a-day.

3. WINE is likewise a wholesome liquor, com­pared with spirits. The low wines of France, I [Page 72] believe, could be drank at a less expence than spirits, in this country. The peasants in France, who drink these liquors in large quantities, are a healthy and sober body of people. Wines of all kinds yield, by chemical analysis, the same principles as cyder, but in different proportions; hence they are both cordial and nourishing. It has been remarked, that few men ever become habitual drunkards up­on wine. It derives its relish principally from company, and is seldom, like spirituous liquors, drank in a chimney corner, or in a closet. The effects of wine upon the temper are likewise in most cases, directly opposite to those that were men­tioned of spirituous liquors. It must be a bad heart, indeed, that is not rendered more chearful and more generous, by a few glasses of wine ^*.

4. MELASSES and WATER compose an­other [Page 73] other excellent substitute for spirits. It is both cordial and nourishing.

5. The SUGAR MAPLE tree affords a thin JUICE in summer, which is cooling and refreshing. It has long been used in Connecticut, for this pur­pose in the time of harvest. The settlers in the western counties of Pennsylvania and New-York, will do well to suffer a few of the trees which yield this pleasant juice, to remain in all their fields. They may prove the means, not only of saving their children and grand-children many hundred pounds, but of saving their bodies from disease and death, and their souls from misery beyond the grave.

6. VINEGAR and WATER sweetened with sugar or melasses, is an agreeable drink in warm weather. I beg leave to recommend this whole­some liquor to reapers in a particular manner. It is pleasant and cooling. It promotes perspiration, and resists putrefaction. Vinegar and water con­stituted the only drink of the soldiers of the Ro­man republic; and it is well known that they marched and fought in a warm climate, and be­neath a load of arms that weighed 60lbs. Boaz, a wealthy farmer in Palestine, we find, treated his reapers with nothing but bread dipped in vinegar. [Page 74] Under this head, I should not neglect to recom­mend BUTTER MILK and WATER, or SOUR MILK (commonly called bonneclabber) and WATER. It will be rendered more grateful by the addition of a little sugar. PUNCH is likewise calculated to lessen the effects of heat, and hard labour upon the body. The spirit in this liquor is blunted by its union with the vegetable acid. Hence it pos­sesses, not only the constituent parts, but most of the qualities of cyder and wine. To render this liquor perfectly innocent and wholesome, it must be drank weak, in moderate quantities, and only in warm weather. Say not, that spirits have become necessary in harvest, from habit and the custom of the country. The custom of swallowing this li­quid fire, is a bad one, and the habit of it may be broken. Let half a dozen farmers in a neigh­bourhood, combine to allow higher wages to their reapers than are common, and a sufficient quantity of any of the liquors I have recommended, and they may soon abolish the practice of giving them spirits. They will in a little while be delighted with the good effects of their association. Their grain will be sooner and more carefully gathered into their barns, and an hundred disagreeable scenes of sickness and contention will be avoided, which always follow in a greater or less degree the use of spirituous liquors.

[Page 75]TO enable the body to support the waste of its strength by labour, the stomach should be constant­ly, but moderately, stimulated by aliment of a par­ticular kind. Labourers bear with great difficulty long intervals between their meals. They should always eat four or five times a-day in time of har­vest, or at other seasons of great bodily exertion. The food at these times should be solid, consist­ing chiefly of salted meat. The vegetables used with it should possess some activity. Onions and garlic are of a most cordial nature. These vege­tables composed part of the diet which enabled the Israelites to endure, in a warm climate, the heavy tasks imposed upon them by their Egyptian masters. They were likewise eaten by the Roman farmers to repair the waste of their strength by the toils of harvest. But further; There are certain SWEET SUBSTANCES which support the body in labour. The negroes in the West Indies grow fat and strong by drinking the juice of the sugar cane in the sea­son of grinding it. The Jewish soldiers were invi­gorated by occasionally eating raisins and figs. A bread composed of wheat flour, melasses, and gin­ger, (composing what is called ginger bread), and taken in small quantities, during the day, is hap­pily calculated to obviate the debility which is so apt to be brought on by labour. All these sub­stances, whether of an animal or vegetable nature, [Page 76] which have been mentioned, should be used by la­bouring people. They lessen the necessity for cordial drinks, and they impart equal and durable strength to every part of the system.

THERE are certain classes of people to whom I beg leave to suggest a caution or two upon the use of spirituous liquors.

1. VALETUDINARIANS, especially those who la­bour under disorders of the stomach and bowels, are very apt to fly to spirits for relief. Let such people be cautious how they repeat this dangerous re­medy. I have known many men and women, of excellent characters and principles, who have been betrayed by occasional doses of gin or brandy to ease the cholic, into a love of spirituous liquors, insomuch that they have afterwards fallen sacri­fices to their fatal effects. The different prepara­tions of opium are a thousand times more safe and innocent than spirituous liquors, in all spasmodic affections of the stomach and bowels. So appre­hensive am I of the danger of contracting a love for spirituous liquors, by accustoming the stomach to their stimules, that I think the fewer medicines we exhibit in spirituous vehicles the better.

2. SOME people, from living in countries sub­ject to the intermitting fever, endeavour to fortify [Page 77] themselves against it by two or three glasses of bit­ters made with spirits every day. There is great danger of men becoming sots from this practice. Besides, this mode of preventing intermittents is by no means a certain one. A much better secu­rity against them is to be found in the Jesuits bark. A tea-spoonful of this excellent medicine taken every morning during the sickly season, has in many instances preserved whole families, in the neighbourhood of rivers and mill-ponds, from fe­vers of all kinds. If Jesuits bark cannot be had, a gill or half a pint of a strong infusion of centaury, camomile, wormwood, or rue, in water, with a little calamus mixed with it, may be taken with nearly the same advantage as the bark, every morning. Those who live in a sickly pan of the country, and cannot procure the bark, or any of the bitters which have been mentioned, I would advise to a­void the morning and evening air in the sickly months—to kindle fires in their houses on damp days, and in cool evenings throughout the whole summer, and to put on woollen clothing about the first week in September. The last part of these di­rections applies only to the inhabitants of the middle states. These cautions, I am persuaded, will be more effectual in preventing autumnal fe­vers than the best preparations that can be made from bitters in spirits.

[Page 78]3. MEN, who follow professions that require a constant exercise of the mind or body, or perhaps both, are very apt to seek relief from fatigue in spirituous liquors. To such persons I would beg leave to recommend the use of TEA instead of spi­rits. This gentle stimulus, by restoring excite­ment, removes fatigue, and invigorates the whole system. I am no advocate for the general or ex­cessive use of tea. When drank too strong, it is hurtful, especially to the female constitution; but when drank of a moderate degree of strength, and in moderate quantities, with sugar and cream, or milk, I believe it is in general innocent, and at all times to be preferred to spirituous liquors. An­thony Benezet, one of the most industrious school-masters I ever knew, told me that he had been preserved from the love of spirituous liquors by contracting a love for tea in early life. Three or four dishes taken in an afternoon, carried off the fatigue of a whole day's labour in his school. This worthy gentleman lived to be 71 years of age, and afterwards died of an acute disease in the full exer­cise of all the faculties of his mind ^*.

[Page 79]TO every class of my readers, I beg leave to sug­gest a caution against the use of TODDY. I acknow­ledge that I have known some men, who, by limit­ing its strength constantly by measuring the spirit and water, and who by drinking it only at their meals, have drunken toddy for many years without suffering in any degree from it: but I have known many more who have been insensibly led from drinking toddy for their constant drink, to take drams in the morning, and have afterwards paid their lives as the price of their folly. I shall select one case from among many, to shew the or­dinary progress of intemperance in the use of spi­rituous liquors.—A gentleman, once of a fair and sober character, in the city of Philadelphia, for many years drank toddy as his constant drink. From this he proceeded to drink grog. After a while nothing would satisfy him but slings made of equal parts of rum and water, with a little sugar. From slings he advanced to raw rum—and from [Page 80] common rum to Jamaica spirits. Here he rested for a few months; but at last, he found even Ja­maica spirits were not strong enough to warm his stomach, and he made it a constant practice to throw a table spoonful of ground pepper into each glass of his spirits, in order (to use his own ex­pression) "to take of their coldness." It is hard­ly necessary to add, that he soon afterwards died a martyr to his own intemperance.

I shall conclude what has been said of the ef­fects of spirituous liquors with two observations— 1. A people corrupted by strong drink cannot long be a free people. The rulers of such a com­munity will soon partake of the vices of that mass from which they were secreted, and all our laws and governments will sooner or later bear the same marks of the effects of spirituous liquors which were described formerly upon individuals. I submit it therefore to the consideration of our rulers, whether more laws should not be made to increase the expense and lessen the consumption of spirituous liquors, and whether some mark of pub­lic infamy should not be inflicted by law upon every man, convicted before a common magistrate of drunkenness.

THE second and last observation I shall offer, is of a [Page 81] serious nature. It has been remarked, that the Indians have diminished every where in America since their connections with the Europeans. This has been justly ascribed to the Europeans having introduced spirituous liquors among them. Let those men, who are every day turning their backs upon all the benefits of cultivated society, to seek habitations in the neighbourhood of Indians, consider how far this wandering mode of life is produced by the same cause which has scattered and annihilated so many Indian tribes. Long life, and the secure possession of property, in the land of their ancestors, were looked upon as blessings among the ancient Jews. For a son to mingle his dust with the dust of his father, was to act worthy of his inheritance; and the prospect of this ho­nour often afforded a consolation even in death. However exalted, my countrymen, your ideas of liberty may be, while you expose yourselves by the use of spirituous liquors to this consequence of them, you are nothing more than the pioneers, or in more slavish terms, "the hewers of wood" of your more industrious neighbours.

IF the facts that have been stated, have produced in any of my readers, who have suffered from the use of spirituous liquors, a resolution to abstain from them hereafter, I must beg leave to inform [Page 82] them, that they must leave them off suddenly and entirely. No man was ever gradually reformed from drinking spirits. He must not only avoid tasting, but even smelling them, until long habits of abstinence have subdued his affection for them. To prevent his feeling any inconveniences from the sudden loss of their stimulus upon his stomach, he should drink plentifully of camomile or of any other bitter tea, or a few glasses of sound old wine every day. I have great pleasure in adding, that I have seen a number of people who have been effectually restored to health—to character—and to usefulness to their families and to society, by fol­lowing this advice.

IN an Essay, entitled "Thoughts on the Pulmo­nary Consumption," ^* I attempted to shew that this disorder was the effect of causes which indu­ced general debility, and that the only hope of discovering a cure for it should be directed to such remedies as act upon the whole system. In the following inquiry, I shall endeavour to establish the truth of each of those opinions, by a detail of facts and reasonings, at which I only hinted in my former essay.

[Page 86]THE method I have chosen for this purpose, is to deliver, and afterwards to support, a few gene­ral propositions.

I shall begin by remarking,

I. THAT the Pulmonary Consumption is a disease of debility.

THIS I infer, 1st, From the remote and ex­citing causes which produce it. The remote causes are pneumony, catarrh, haemoptysis, rheumatism, gout, asthma, scrophula, nervous and intermitting fevers, measles, repelled humors from the surface of the body, the venereal disease, obstructed men­ses, sudden growth about the age of puberty, grief, and all other debilitating passions of the mind; hypochondriasis, improper lactation, excessive eva­cuation of all kinds, more especially by stool ^*, cold and damp air, external violence acting upon [Page 87] the body; ^* and finally every thing that tends directly or indirectly to impair the vigor of the system.

THE most frequent exciting cause of consump­tion is the alternate application of heat and cold to the whole external surface of the body, but all the remote causes which have been enumerated, ope­rate as exciting causes of consumption when they act on previous debility. Original injuries of the lungs seldom induce this disorder except they first induce a debility of the whole system by a trou­blesome and obstinate cough.

2. FROM the occupations and habits of persons who are most liable to this disorder. These are studious men, and mechanics who lead sedentary lives in confined places; also women, and all per­sons of irritable habits, whether of body or mind.

3. FROM the period in which persons are most liable to be affected by this disorder. This is ge­nerally [Page 88] between the 18th and 36th year of life, a period in which the system is liable in a peculiar manner to most diseases which induce the disorder, and in which indirect debility is oftener produced than in any other stage of life, by the excessive ex­ercises of the body and mind in the pursuits of bu­siness or pleasure.

I have conformed to authors, in fixing the pe­riod of consumptions between the 18th and 36th year of life—but it is well known that it sometimes appears in children, and frequently in persons be­yond the 40th, or even 50th year of life.

II. THE pulmonary consumption is a primary disease of the whole system. This I infer,

1. FROM the causes which produce it, acting upon the whole system.

2. FROM the symptoms of general debility which always precede the affection of the lungs. These symptoms are a quick pulse, especially to­wards evening; a heat and burning in the palms of the hands; faintness, head-ach, sickness at sto­mach, and an occasional diarrhoea. I have fre­quently observed each of these symptoms for se­veral months before I have heard of a single com­plaint in the breast.

[Page 89]3. FROM the pulmonary consumption alterna­ting with other diseases which obviously belong to the whole system. I shall briefly mention these dis­eases.

THE RHEUMATISM. I have seen many cases in which this disease and the consumption have al­ternately, in different seasons or years, affected the system. In the winter of 1792, three clinical patients in the Pennsylvania hospital exemplified by their complaints the truth of this observation. They were relieved several times of a cough by pains in their limbs, and as often, the pains in their limbs seemed for a while to promise a cure to their pulmonic complaints.

THE GOUT has often been observed to alternate with the pulmonary consumption, especially in per­sons in the decline of life. Dr. Sydenham describes a short cough continuing through the whole win­ter, as a symptom of gouty habits. A gentleman from Virginia died under my care in the spring of 1788, in the 45th year of his age, with all the symptoms of pulmonary consumption, which had frequently alternated with pains and a swelling in his feet.

THE pulmonary consumption has been observed to alternate with MADNESS. Of this I have seen [Page 90] two instances, in both of which, the cough, and expectoration were wholly suspended during the continuance of the derangement of the mind. Dr. Mead mentions a melancholy case of the same kind in a young lady; and similar cases are to be met with in other authors. In all of them the disease proved fatal. In one of the cases which came un­der my notice, the symptoms of consumption re­turned before the death of the patient.

I have likewise witnessed two cases in which the return of reason after madness, was suddenly suc­ceeded by a fatal pulmonary consumption. Per­haps the false hopes, and even the cheerfulness which so universally occur in this disorder, may be resolved into a morbid state of the mind, produced by a general derangement of the whole system. So universal are the delusion and hopes of patients with respect to the nature and issue of this disorder, that I have never met with but one man, who, up­on being asked what was the matter with him, an­swered unequivocally, "that he was in a consump­tion!"

AGAIN—Dr. Bennet mentions a case of "A phthisical patient who was seized with a violent PAIN IN THE TEETH for two days, and in whom, during that time, every symptom of a consumption, except the leanness of the body, altogether van­ished;" [Page 91] and he adds further, "that a desluxion on the lungs had often been relieved by SALIVA­RY EVACUATIONS." ^*

I have seen several instances in which the pul­monary symptoms have alternated with HEAD­ACH and DYSPEPSIA,—also with pain and noise in one of the EARS. This affection of the ears sometimes continues throughout the whole disease without any remission of the pulmonary symptoms. I have seen one case of a discharge of matter from the left ear without being accompani­ed by either pain or noise.

IN all our books of medicine are to be found cases of consumption alternating with ERUPTIONS ON THE SKIN.

AND who has not seen the pulmonary symptoms alternately relieved, and reproduced by the ap­pearance or cessation of a diarrhoea, or pains in the BOWELS?

TO these facts I shall only add, under this head, as a proof of the consumption being a dis­ease of the whole system, that it is always more or [Page 92] less relieved by the change which is induced in the system by pregnancy.

4. I infer that the pulmonary consumption is a disease of the whole system from its analogy with several other diseases which, though accompanied by local affections, are obviously produced by a morbid state of the whole system.

THE Rheumatism, the Gout, the Measles, Small-pox, the different species of Cynanche—all furnish examples of the connection of local affec­tions with a general disease; but the APOPLEXY, and the PNEUMONY furnish the most striking analogies of local affection, succeeding a general disorder of the system in the pulmonary consump­tion.

THE most frequent cause of apoplexy is a ge­neral debility of the system, produced by intempe­rance in eating and drinking. The phaenomena of the disease are produced by an effusion of blood or serum, in consequence of a morbid distension, or of a rupture of the vessels of the brain. The pul­monary consumption begins and ends in the same way, allowing only for the difference of situation and structure of the brain and lungs. After the production of predisposing debility from the action of the remote causes formerly enumerated, the fluids are determined to the weakest part of the [Page 93] body. Hence effusions of serum or blood take place in the lungs. When serum is effused, a pi­tuitous or purulent expectoration alone takes place; —when blood is discharged, a disease is produced which has been called Haemoptysis. An effusion of blood in the brain, brought on by the operation of general debility, has been called by Dr. Hoff­man, with equal propriety, a haermorrhage of the brain. The effusion of blood in the lungs in con­sequence of the rupture of a blood vessel is less fatal than the same accident when it occurs in the brain, only because the blood in the former case is more easily discharged from the system. Where no rupture of a blood vessel is produced, death is nearly as speedy and certain in the one case as in the other. ^* Dissections show many cases of suffocation and and death, from the lungs being preternaturally fill­ed with blood or serum. From this great analo­gy between the remote and proximate causes of the two diseases which have been described, I have taken the liberty to call them both by the name of apoplexy. The only symptom which does not accord with the derivation of the term, is, that in the apoplexy of the lungs, the patient does not fall [Page 94] down as if by an external stroke, which is most frequently the case in the apoplexy of the brain.

THE history of the remote and proximate causes of pneumony will furnish us with a still more re­markable analogy of the connection between a lo­cal affection, and a general disease of the system. The pneumony is produced by remote exciting cau­ses, which act on the whole system. The whole arterial system is frequently agitated by a fever in this disorder before a pain is perceived in the breast or sides, and this fever generally constitutes the strength and danger of the disease. The expectoration which terminates the disorder in health, is always the effect of effusions pro­duced by a general disease, and even the vomicas, which sometimes succeed a deficiency of bleeding in this disorder, always depend upon the same ge­neral cause. From this view of the analogy be­tween pneumony and pulmonary consumption, it would seem that the two diseases differed from each other only by the shorter or longer operation of the causes which induce them, and by the great­er or less violence and duration of their symptoms. The pnuemony appears to be an acute consump­tion, and the consumption a chronic pneumony. From the analogy of the pulmonary consumption [Page 95] with the diminutive term of certain fevers, I have taken the liberty of calling it a PNEUMONICULA.

5. I infer that the pulmonary consumption is a disease of the whole system, from its existence without ulcers in the lungs. Of this there are many cases recorded in books of medicine.

DR. Leigh informs us in his natural history of Lancashire, that the consumption was a very com­mon disease on the sea coast of that country; but that it was not accompanied either by previous inflammation or ulcers in the lungs. It was general­ly attended, he says, by an unusual peevishness of temper.

6. AND lastly, I infer, that the pulmonary con­sumption is a disease of the whole system, from its being relieved, or cured, only by remedies which act upon the whole system. This will appear, I hope, hereafter, when we come to treat of the cure of this disorder.

LET us now inquire how far the principles I have laid down will apply to the supposed proximate causes of consumption. These causes have been said to be—an abscess in the lungs, haemoptysis, tubercles, catarrh, hereditary diathesis, contagion, and the matter of cutaneous eruptions or sores re­pelled, [Page 96] and thrown upon the lungs. I shall make a few observations upon each of them.

1. AN abscess in the lungs is generally the con­sequence of a neglected, or half cured pneumony. It is seldom fatal, where it is not connected with a predisposition to consumption from general debili­ty, or where general debility is not previously in­duced by the want of appetite, sleep, and exercise, which sometimes accompanies that disorder of the lungs. This explanation of the production of consumption by an abscess in the lungs, will re­ceive further support from attending to the effects of wounds in the lungs. How seldom are they followed by pulmonary consumption; and this only because they are as seldom accompanied by predisposing general debility. I do not recollect a single instance of this disorder having followed a wound in the lungs, either by the bayonet, or a bullet, during the late war. The recoveries which have succeeded such wounds, and frequently un­der the most unfavorable circumstances, shew how very improbable it is that a much slighter affection of the lungs should become the cause of a pulmo­nary consumption.

A British officer, whom I met in the British camp, a few days after the battle of Brandywine, in [Page 97] September, 1777, informed me that the surgeon general of the royal army had assured him, that out of twenty-four soldiers who had been admitted into the hospitals, during the campaign of 1776, with wounds in their lungs, twenty-three of them had recovered. Even primary diseases of the lungs often exist with peculiar violence, or conti­nue for many years without inducing a consumpti­on. I have never known but one instance of the hooping cough ending in consumption, and all our books of medicine contain records of the asth­ma continuing for 20 and 30 years without termi­nating in that disorder. The reason in both cases, must be ascribed to those two original disorders of the lungs not being accompanied by general debility. One fact more will serve to throw still further light upon the subject. Millers are much afflicted with a cough from floating particles of flour con­stantly irritating their lungs, and yet they are not more subject to consumptions than other labouring people. Hence "a miller's cough," is proverbial in some places, to denote a cough of long continu­ance without danger.

2. THE haemoptysis is either a local disease, or it is the effect of general debility of the whole sy­stem. When it is local, or when it is the effect of causes which induce a temporary or acute debility [Page 98] only in the system, it is seldom followed by con­sumption. The accidental discharge of blood from the lungs, from injuries, and from an obstruction of the menses in women, is of this kind. Many persons are affected by this species of haemorrhage once or twice in their lives, without suffering any inconvenience from it afterwards. I have met with several cases in which it has occurred for many years every time the body was exposed to any of the causes which induce sudden, direct, or indirect debility, and yet no consumption has fol­lowed it. The late king of Prussia informed Dr. Zimmerman that he had been frequently attacked by it during his seven years war, and yet he lived notwithstanding above twenty years afterwards without any pulmonary complaints. It is only in persons who labour under chronic debility, that an haemoptysis is necessarily followed by consump­tion.

3. I yield to the popular mode of expression when I speak of a consumption being produced by tubercles. But I maintain that they are the effects of general debility communicated to the bronchial vessels which cause them to effuse a preternatural quantity of mucus. This mucus is sometimes poured into the trachea from whence it is dischar­ged by hawking, more especially in the morning; [Page 99] for it is effused more copiously during the languid hours of sleep than in the day time. But this mucus is frequently effused into the substance of the lungs, where it produces those tumours we call tubercles. When this occurs, there is either no cough ^* or a very dry one. That tubercles are formed in this way, I infer from the dissections and experi­ments of Dr. Stark ^†, who tells us, that he found them to consist of inorganic matter—that he was unable to discover any connection between them and the pulmonary vessels, by means of the mi­croscope or injections, and that they first opened into the trachea through the bronchial vessels. It is remarkable that the color and consistence of the matter of which they are composed, is nearly the same as the matter which is discharged from the trachea, in the most cough which occurs from a relaxation of the bronchial vessels.

I am aware that these tumours in the lungs have been ascribed to scropula. But the frequent oc­currence of consumptions in persons in whom no scrophulous taint existed, is sufficient to refute this opinion. I have frequently directed my enqui­ries after this disorder in consumptive patients, and [Page 100] have met with very few cases which were produced by it. It is probable that it may frequently be a predisposing cause of consumption in Great Britain, but I am sure it is not in the United States of Ame­rica.

4. THE catarrh is of two kind—acute and chro­nic, both of which are connected with general de­bility, but this debility is most obvious in the chronic catarrh: hence we find it encreased by every thing which acts upon the whole system, such as cold and damp weather, fatigue, and above all by old age, and relieved or cured by exercise, and every thing else which invigorates the whole system. This species of catarrh often continues for twenty or thirty years without inducing pulmo­nary consumption, in persons who pursue active occupations.

5. IN the hereditary consumption there is either an hereditary debility of the whole system, or an hereditary mad-conformation of the breast. In the latter case, the consumption is the effect of weak­ness communicated to the whole system, by the long continuance of difficult respiration, or of such injuries being done to the lungs as are incompati­ble with health and life. It is remarkable, that [Page 101] the consumptive diathesis is more frequently deri­ved from paternal than maternal ancestors.

6. PHYSICIANS the most distinguished for accu­rate observations have agreed, that the pulmonary consumption may be communicated by contagion. However doubtful it may be in temperate, it can­not be controverted in warm climates. Morgagni informs us that, Valsalva (who was predisposed to the consumption) was so satisfied of its contagious nature, that he constantly avoided being present at the dissection of the lungs of persons who had died of that disorder. I know that its progress in whole families has been ascribed to a sameness of original constitution, or mal-conformation of the breast in the members of the same family, or the fatigue which is incurred by attending, and the grief which follows the loss of relations who perish by that disorder. Perhaps many of the cases of consumption, which have been ascribed to conta­gion, may be accounted for by calling in the debi­litating operation of one or both of those causes; but there are cases of the disease being communicated by contagion, which cannot be resolved into the influence of either fatigue or grief.

THE late Dr. Beardsley, of Connecticut, in­formed me that he had known several black slaves, [Page 102] affected by a consumption which had previously swept away several of the white members of the family to which they belonged. In those slaves no suspicion was entertained of the most distant relationship to the per­sons from whom they had had contracted the disor­der; nor had fatigue or grief, from the causes be­forementioned, been supposed to have had the least share in debilitating their bodies. Admitting then contagion to act as a remote cause of consumption, it does not militate against the theory which I have aimed to establish; for if the contagion follow the analogy of all the other contagions that we are ac­quainted with, it must act by debilitating the whole system. The approach of the jail fever and the plague is often indicated by general languor. The influenza and the measles are always accompanied by general debility, but the small pox furnishes an analogy to the case in question more directly in point. The contagion of this disorder, whether received by the medium of the air or the skin, never fails of producing a disease of the whole sy­stem, before it discovers itself in affections of those parts of the body on which the contagion pro­duced its first operation.—I am disposed to believe, from several cases which have come under my no­tice, that the contagion which produces the con­sumption seldom acts in less than two or three months after it is received into the system. I once [Page 103] attended a lady, in whom the contagion did not discover itself in the lungs for nearly a year after she had been exposed to it, by attending a sister who had died of the consumption. In this case the effects of fatigue, and of grief were entirely worn away from the system by time, as well as by chearful society.

7. I GRANT that cutaneous humors, and the mat­ter of old sores, when repelled, or suddenly healed, have in some cases fallen upon the lungs, and pro­duced consumption. But I believe, in every case where this has happened, the consumption was preceded by general debility, or that it was not induced, until the whole system had been pre­viously debilitated by a tedious and distressing cough.

IF the reasonings founded upon the facts which have been mentioned be just, then it follows,

III. THAT the cough, tubercles, ulcers, and pu­rulent or bloody discharges which occur in the pulmonary consumption, are the effects and not the causes of the disease; and, that all attempts to cure it, by inquiring after tubercles and ulcers, or into the quality of the discharges from the lungs, are as fruitless as an attempt would be to discover the causes or cure of dropsies, by an examination of the [Page 104] qualities of collections of water, or to find out the causes and cure of fevers by the quantity or qua­lity of the discharges which take place in those diseases from the kidneys and skin. I admit that the cough, ulcers, and tubercles, after they are formed, increase the danger of the disease, by be­coming new causes of stimulus to the system, but in this they are upon a footing with those effusions in the viscera, which take place in the intermitting fever, which though they constitute no part of its cause, frequently produce symptoms and a termina­tion which are wholly unconnected with the ori­ginal disease.

THE tendency of general debility to produce a disease of the lungs appears in many cases, as well as in the pulmonary consumption. Dr. Lind tells us, that the last stage of the jail fever was often marked by a cough. I have seldom been disappointed in looking for a cough and a copious excretion of mu­cus and phlegm after the 14th or 15th days of the nervous fever. Two cases of hypocondriasis under my care, ended in fatal disorders of the lungs. The debility of old age is generally accompanied by a troublesome cough, and the debility which precedes death, generally discovers its last symp­toms in the lungs,—hence, most people die with what are called the Rattles. They are produced [Page 105] by a sudden and copious effusion of mucus in the bronchial vessels of the lungs.

SHOULD it be asked, why does general debility terminate by a disorder in the lungs, rather than in any other part of the body?—I answer,—that it seems to be a law of the system, that general de­bility should always produce as a symptom some local disease. This local disease sometimes mani­fests itself in dyspepsia, as in the general debility which follows grief;—sometimes it discovers it­self in a diarrhoea as in the general debility which succeeds to fear.—Again it appears in the brain,—as in the general debility which succeeds intemperance, and the constant or violent exercise of the understanding, or of stimulating passions; but it more frequently appears in the lungs, as the consequence of general debility. It would seem as if the debility in the cases of consumption is seat­ed chiefly in the blood vessels, while that debility which terminates in diseases of the stomach and bowels, is confined chiefly to the nerves,—and that the local affections of the brain arise from a debi­lity, invading alike the nervous and arterial sy­stems. What makes it more probable, that the arterial system is materially affected in the con­sumption is, that the disorder most frequently oc­curs in those periods of life, and in those habits in [Page 106] which a peculiar state of irritability or excitability is supposed to be present in the arterial system; also in those climates in which there are the most frequent vicissitudes in the temperature of the weather. It is remarkable, that that the debility in the inhabitants of the West Indies, whether produced by the heat of the climate, or the ex­cessive pursuits of business or pleasure, generally terminates in dropsy, or in some disorder of the alimentary canal.

I HAVE said, that it seemed to be a law of the sy­stem, that general debility should always produce as a symptom some local affection. But to this law there are sometimes exceptions: The Atro­phy appears to be a consumption without an affection of the lungs.—This disorder is frequent­ly mentioned by the writers of the 16th and 17th centuries by the name of Tabes. I have seen seve­ral instances of it in adults, but more in children, and a greater number in the children of black than of white parents. The hectic fever, and even the night sweats, were as obvious in several of these cases, as in those consumptions where general de­bility had discovered itself in an affection of the lungs.

I COME now to make a few observations upon [Page 107] the CURE of consumption; and here I hope it will appear, that the theory which I have delivered admits of an early and very important application to practice.

IF the consumption be a disease of general de­bility, it becomes us to attempt the cure of it in its first stage,—that is, before it produce the symp­toms of cough, bloody or purulent discharges from the lungs, and inflammatory or hectic fever. The symptoms which mark this first stage, are too sel­dom observed; or if observed, they are too often treated with equal neglect by patients and physici­ans. I shall briefly enumerate these symptoms. They are a slight fever encreased by the least exer­cise,—a burning and dryness in the palms of the hands, more especially towards evening,—rheumy eyes upon waking from sleep,—an encrease of urine,—a dryness of the skin, more especially of the feet in the morning, ^*—an occasional flush­ing in one, and sometimes in both cheeks,— [Page 108] a hoarseness ^†—a slight or acute pain in the breast, —a fixed pain in one side, or shooting pains in both sides,—head-ach,—occasional sick and fainty fits,—a deficiency of appetite, and a general indis­position to exercise or motion of every kind.

IT would be easy for me to mention cases in which every symptom that has been enumerated has occurred within my own observations. I wish them to be committed to memory by young prac­titioners; and if they derive the same advantages from attending to them, which I have done, I am sure they will not regret the trouble they have taken for that purpose. It is probable, while a morbid state of the lungs is supposed to be the proximate cause of this disorder, they will not de­rive much reputation or emolument from curing it in its forming stage; but let them remember, that in all attempts to discover the causes and cures of diseases, which have been deemed incurable, a physician will do nothing effectual until he acquire a perfect indifference to his own interest and fame.

THE remedies for consumption in this stage of the disorder are simple and certain. They consist, [Page 109] in a desertion of all the remote, and exciting causes of the disorder, particularly sedentary em­ployments, damp or cold situations, and whatever tends to weaken the system. When the disease has not yielded to this desertion of its remote and exciting causes, I have recommended the cold bath, steel, and bark with great advantage. How­ever improper or even dangerous these remedies may be after the disease assumes an inflammatory or hectic type, and produces an affection of the lungs, they are perfectly safe and extremely useful in the state of the system which has been describ­ed. The use of the bark will readily be admitted by all those practitioners who believe the pulmo­nary consumption to depend upon a scrophulous diathesis. Should even the lungs be affected by scrophulous tumors, it is no objection to the use of the bark; for there is no reason why it should not be as useful in scrophulous tumors of the lungs, as of the glands of the throat, provided it be given before those tumors have produced inflammation; and in this case, no prudent practitioner will ever prescribe it in scrophula when seated even in the external parts of the body. To these remedies should be added a diet moderately stimulating, and gentle exercise. I shall hereafter mention the dif­ferent species of exercise, and the manner in which each of them should be used so as to derive the ut­most [Page 110] advantage from them. I can say nothing of the use of salt-water, or sea-air in this stage of the consumption from my own experience. I have heard them commended by a physician of Rhode-Island; and if they be used before the disease has discovered itself in pulmonary affections, I can easi­ly conceive they may do service.

IF the simple remedies which have been men­tioned have been neglected, in the first stage of the disorder, it generally terminates in different peri­ods of time, in pulmonary affections; which shew themselves under one of the three following forms.—

1. A fever, accompanied by a cough, a hard pulse, and a discharge of blood, or mucous mat­ter from the lungs.

2. A fever of the hectic kind, accompanied by chilly fits, and night sweats, and a pulse full, quick, and occasionally hard. The discharges from the lungs in this state of the disorder, are frequent­ly purulent.

3. A fever with a weak quick pulse, a trouble­some cough, and copious purulent discharges from the lungs, a hoarse and weak voice, and chilly fits [Page 111] and night sweats, alternating occasionally with a diarrhoea.

THESE three different forms of the pulmonary affection have been distinguished by the names of the first, second, and third stages of the consump­tion; but as they do not always succeed each other in the order in which they have been mentioned, I shall hereafter distinguish them by the name of species, in conformity to our modern nomencla­tures of medicine, although it would be more pro­per, on some accounts, to consider them as differ­ent states of the system.

THE first I shall call the INFLAMMATORY—the se­cond the HECTIC, and the third the TYPHUS species. I have seen the pulmonary consumption come on sometimes with all the symptoms of the second, and sometimes with the most of the symptoms of the third species; and I have seen two cases in which a hard pulse, and other symptoms of inflammatory ac­tion appeared in the last hours of life. It is agree­able to pursue the analogy of this disorder with a pneumony, or an acute inflammation of the lungs. They both make their first appearance in the same seasons of the year. It is true, the pneumony most frequently attacks with inflammatory symptoms; but it sometimes occurs with symptoms which for­bid [Page 112] blood-letting, and I have more than once seen it attended by symptoms which required the use of wine and bark. The pneumony is attended at first by a dry cough, and an expectoration of streaks of blood—the cough in the consumption, in like manner, is at first dry, and attended by a discharge of blood from the lungs, which is more copious than in the pneumony, only because the lungs are more relaxed in the former than in the latter dis­order. There are cases of pneumony in which no cough attends. I have seen cases of pulmona­ry consumption, in which nothing but a difficulty of breathing discovered a morbid state of the lungs, and one in which there was an entire absence of cough. ^*

[Page 113]THE pneumony terminates in different periods according to the degrees of inflammation, or the nature of the effusions which take place in the lungs—the same observation applies to the pulmo­nary consumption. The symptoms of the different species of pneumony frequently run into each o­ther; so do the symptoms of the three species of consumption which have been mentioned. In short, the pneumony and consumption are alike in so ma­ny [Page 114] particulars, that they appear to resemble sha­dows of the same substance. They differ only as the protracted shadow of the evening does from that of the noon-day sun.

I KNOW that it will be objected here that the consumption is sometimes produced by scrophula, and that this creates an essential difference be­tween it and pneumony. I formerly admitted scrophula to be one of the remote causes of the consumption; but this does not invalidate the pa­rallel which has been given of the two diseases. The phenomena produced in the lungs are the same as to their nature, whether they be produced by the remote cause of scrophula, or by the sudden action of cold and heat upon them.

NO more happens in the cases of acute and chro­nic pneumony, than what happens in dysentery and rheumatism. These two last diseases are for the most part so acute, as to confine the patient to his bed or his room, yet we often meet with both of them in patients who go about their ordinary bu­siness, and, in some instances, carry their diseases with them for two or three years.

[Page 115]THE parallel which has been drawn between the pneumony and consumption, will enable us to un­derstand the reason why the latter disorder termi­nates in such different periods of time. The less it partakes of pneumony, the longer it continues, and vice versa. What is commonly called in this country a galloping consumption, is a disease com­pounded of different degrees of consumption and pneumony. It terminates frequently in two or three months, and without many of the symptoms which usually attend the last stage of pulmonary consumption. But there are cases in which pa­tients in a consumption are suddenly snatched away by an attack of pneumony. I have met with one case only, in which, contrary to my expectation, the patient mended after an attack of an acute in­flammation of the lungs, so as to live two years afterwards.

IT would seem from these facts, as if nature had preferred a certain gradation in diseases, as well as in other parts of her works. There is scarcely a dis­ease in which there is not a certain number of grades, which mark the distance between health and the lowest specific deviation from it. Each of these grades has received different names, and has been considered as a distinct disease, but more accurate surveys of the animal oeco­nomy [Page 116] have taught us, that they frequently de­pend upon the same original causes, and that they are only greater or less degrees of the same dis­ease.

I SHALL now proceed to say a few words upon the cure of the different species of pulmonary con­sumption. The remedies for this purpose are of two kinds, viz. PALLIATIVE and RADICAL. I shall first mention the palliative remedies which be­long to each species, and then mention those which are alike proper in them all. The palliative re­medies for the

I. OR INFLAMMATORY SPECIES, ARE

1. BLOOD-LETTING. It may seem strange to recommend this debilitating remedy in a dis­ease brought on by debility. Were it pro­per in this place, I could prove that there is no disease in which bleeding is prescribed, which is not induced by predisposing debility in commmon with the pulmonary consumption. I shall only remark here, that in consequence of the exciting cause acting upon the system (rendered extremely excitable by debility) such a morbid and excessive excitement is produced in the arte­ries as to render a diminution of the stimulus of [Page 117] the blood, absolutely necessary to reduce it. I have used this remedy with great success in every case of consumption, attended by a hard pulse, or a pulse rendered weak by a laborious transmis­sion of the blood through the lungs. In the months of February and March in the year 1781, I bled a Methodist minister, who was affected by this species of consumption, fifteen times in the course of six weeks. The quan­tity of blood drawn at each bleeding was never less than eight ounces, and it was at all times co­vered with an inflammatory crust. By the addition of country air, and moderate exercise, to this copi­ous evacuation, in the ensuing spring he recovered his health, so perfectly as to discharge all the du­ties of his profession for many years, nor was he ever afflicted afterwards with a disorder in his breast. I have in another instance, bled a citizen of Philadelphia eight times in two weeks, in this species of consumption, and with the happiest ef­fects. The blood drawn at each bleeding was al­ways sizy, and never less in quantity than ten ounces. To these cases I might add many others of consumptive persons who have been perfectly cured by frequent, and of many others whose lives have been prolonged by occasional bleedings.— But I am sorry to add, that I could relate many more cases of consumptive patients, who have died [Page 118] martyrs to their prejudices against the use of this invaluable remedy. A common objection to it is, that it has been used without success in this dis­order. When this has been the case, I suspect that it has been used in one of the other two spe­cies of pulmonary consumption which have been mentioned, for it has unfortunately been too fa­shionable among physicians to prescribe the same remedies in every stage and species of the same disorder; and this I take to be the reason why the same medicines, which in the hands of some physicians, are either inert, or instruments of mis­chief, are, in the hands of others, used with more or less success in every case in which they are pre­scribed. Another objection to bleeding in the in­flammatory species of consumption, is derived from the apparent and even sensible weakness of the patient. The men who urge this objection, do not hesitate to take from sixty to an hundred ounces of bood from a patient in a pneumony in in the course of five or six days, without consider­ing that the debility in the latter case is such as to confine a patient to his bed, while in the former case, the patient's strength is such as to enable him to walk about his house, and even to attend to his ordinary business. The difference between the debility in the two diseases, consists in its being acute in the one, and chronic in the other. It is [Page 119] true, the preternatural or convulsive action of the arteries is somewhat greater in the pneu­mony, than in the inflammatory consumption; but the plethora on which the necessity of bleed­ing is partly founded, is certainly greater in the inflammatory consumption than in pneumony.— This is evident from women, and even nurses, dis­charging from four to six ounces of menstrual blood every month, while they are labouring with the most inflammatory symptoms of the disorder; nor is it to be wondered at, since the appetite is frequently unimpaired, and the generation of blood continues to be the same, as in perfect health.

DR. CULLEN recommends the use of bleeding in consumptions in order to lessen the inflamma­tion of the ulcers in the lungs, and thereby to dispose them to heal. From the testimonies of the re­lief which bleeding affords in external ulcers and tumors accompanied by inflammation, I am dis­posed to expect the same benefit from it in inflamed ulcers and tumors in the lungs: Whether, there­fore, we adopt Dr Cullen's theory of consumption, and treat it as a local disease, or assent to the one which I have delivered, still repeated bleedings ap­pear to be equally necessary and useful.

[Page 120]I HAVE seen two cases of inflammatory con­sumption, attended by an hoemorrhage of a quart of blood from the lungs. I agreed at first with the friends of these patients in expecting a rapid termination of their disorder in death, but to the joy and surprise of all connected with them, they both recovered. I ascribed their recovery wholly to the inflammatory action of their systems being suddenly reduced by a spontaneous discharge of blood. These facts, I hope, will serve to establish the usefulness of blood-letting in the inflammatory state of consumption, with those physicians who are yet disposed to trust more to the fortuitous operations of nature, than to the decisions of reason and ex­perience.

I HAVE always found this remedy to be more necessary in the winter and first spring months, than at any other season. We obtain by means of repeated bleedings, such a mitigation of all the symptoms as enables the patient to use exercise with advantage as soon as the weather becomes so dry and settled, as to admit of his going abroad every day.

THE relief obtained by bleeding, is so certain in this species of consumption, that I often use it [Page 121] as a palliative remedy, where I do not expect it will perform a cure. I was lately made happy in finding, that I am not singular in this practice. Dr. Hamilton, of Lynn Regis, used it with success in a consumption, which was the effect of a most deplorable scrophula, without entertaining the least hope of its per­forming a cure ^*. In those cases where inflamma­matory action attends the last scene of the disorder, there is often more relief obtained by a little bleed­ing than by the use of opiates, and it is always a more humane prescription, in desperate cases, than the usual remedies of vomits and blisters.

I ONCE bled a sea captain, whom I had declared to be within a few hours of his dissolution, in or­der to relieve him of uncommon pain, and difficul­ty in breathing. His pulse was at the same time hard. The evacuation, though it consisted of only four ounces of blood, had the wished for effect, and his death, I have reason to believe, was ren­dered more easy by it. The blood, in this case, was covered with a buffy coat.

THE quantity of blood drawn in every case of inflammatory consumption, should be determined [Page 122] by the force of the pulse, and the habits of the pa­tient. I have seldom taken more than eight, but more frequently only six ounces at a time. It is much better to repeat the bleeding once or twice a week, than to use it less frequently, but in larger quantities.

FROM many years experience of the efficacy of bleeding in this species of consumption, I feel my­self authorised to assert, that where a greater pro­portion of persons die of consumption when it makes it first appearance in the lungs, with symp­toms of inflammatory diathesis, than die of ordi­nary pneumonies, (provided exercise be used after­wards) it must in nine cases out of ten, be ascribed to the ignorance, or erroneous theories of physi­cians, or to the obstinacy or timidity of patients.

IN speaking thus confidently of the necessity and benefits of bleeding in the inflammatory spe­cies of consumption, I confine myself to observa­tions made chiefly in the state of Pennsylvania. It is possible the inhabitants of European countries and cities, may so far have passed the simple ages of inflammatory disorders, as never to exhibit those symptoms on which I have founded the indication of blood-letting. I am disposed to believe more­over that in most of the southern states of America, [Page 123] the inflammatory action of the arterial system is of too transient a nature to admit of the repeated bleedings in the consumption which are used with so much advantage in the middle and northern states.

IN reviewing the prejudices against this excel­lent remedy in consumptions, I have frequently wished to discover such a substitute for it as would with equal safety and certainty take down the morbid excitement, and action of the arterial sy­stem. I believe in the existence of such a remedy; but until it be discovered, it becomes us to combat the prejudices against bleeding; and to derive all the advantages from it which have been mentioned.

2. A SECOND remedy for the inflammatory species of consumption should be sought for in a MILK and VEGETABLE DIET. In those cases where the milk does not lie easy on the stomach, it should be mix­ed with water, or it should be taken without its cheesy or oily parts, as in whey, or butter-milk, or it should be taken without skimming; for there are cases in which milk will agree with the sto­mach in this state, and in no other. The oil of the milk probably helps to promote the solution of its curds in the stomach. It is seldom in the pow­er of physicians to prescribe asses or goats milk in [Page 124] this disorder; but a good substitute may be prepa­red for them by adding to cows milk a little sugar, and a third or fourth part of water, or of a weak infusion of green tea. The vegetables which are eaten in this state of the disorder, should contain as little stimulus as possible. It would seem if the moderate portion of sacharine matter which is contained in certain fruits such as strawberries, grapes, and sweet apples were peculiarly agreeable and useful, for each of these fruits has been said to have cured the consumption. In those ca­ses where the stomach is disposed to dyspepsia, a little animal food, also soft boiled eggs, may be ta­ken with safety, mixed with vegetable aliment. Where there is no morbid affection of the sto­mach, I have seen the white meats eaten without encreasing the inflammatory symptoms of the dis­ease. The transition from a full diet to milk and vegetables should be gradual, and the addition of animal to vegetable aliment, should be made with the same caution. From the neglect of this direc­tion, much error, both in theory and practice, has arisen in the treatment of consumptions.

IN every case it will be better for the patient to eat four or five, rather than only two or three meals in a day. A less stimulus is by this means communicated to the system, and less chyle is [Page 125] mixed with the blood in a given time. Of so much importance do I conceive this direction to be, that I seldom prescribe for a chronic disease of any kind without enforcing it.

3. VOMITS have been much commended by Dr. Read in this disorder. From their indiscrimi­nate use in every species of consumption, I am sa­tisfied they have oftener done harm than good. In cases where a patient objects to bleeding, or where a physician doubts of its propriety, vomits may always be substituted in its room with great advantage.

4. NITRE in moderate doses of ten or fifteen grains taken three or four times a day, has some­times done service in this disorder; but I believe it has been only when the disease has appeared with inflammatory symptoms. Care should be taken not to persevere too long in the use of this remedy as it is apt to impair the appetite. I have known one case in which it produced an obstinate dyspep­sia, and a disposition to the colic; but it removed at the same time, the symptoms of pulmonary con­sumption.

5. COLD and dry air, when combined with the exercise of walking, deserves to be mentioned as an antiphlogistic remedy. I have repeatedly [Page 126] prescribed it in this species of the consumption with advantage, and have often had the pleasure of find­ing a single walk of two or three miles in a clear cold day, produce nearly the same diminution of the force and frequency of the pulse, as the loss of six or eight ounces of blood.

I COME now to treat of the palliative remedies which are proper in the

II. OR HECTIC SPECIES of Consumption. Here we begin to behold the disorder in a new and more distressing form than in the species which has been described. There is in this species of con­sumption the same complication of inflammatory and typhus diathesis which occurs in the typhoid and puerperile fevers, and of course the same dif­ficulty in treating it successfully; for the same re­medies do good and harm, according as the former or latter diathesis prevails in the system.

ALL that I shall say upon this species is, that the treatment of it should be accommodated to the predominance of inflammatory or typhus symp­toms, for the hectic species presents each of them alternately every week, and sometimes every day to the hand or eye of a physician. When a hard pulse with acute pains in the side and breast occur, bleeding and other remedies for the inflammatory [Page 127] species must be used; but when the disease exhi­bits a predominance of typhus symptoms, the re­medies for that species to be mentioned immedi­ately, should be prescribed in moderate doses. There are several palliative medicines which have been found useful in the hectic species, but they are such as belong alike to the other two species; and therefore will be mentioned hereafter in a place assigned to them.

I AM sorry, however, to add, that where bleed­ing has not been indicated, I have seldom been able to afford much relief by medicine in this species of consumption. I have used alternately the most gentle, and the most powerful vegetable and me­tallic tonics to no purpose. Even arsenic has failed in my hands of affording the least alleviation of the hectic fever. I conceive the removal of this fever, to be the great desideratum in the cure of consumption, and should it be found after all our researches to exist only in exercise, it will be no departure from a law of nature; for I believe there are no diseases of equal degrees of chronic debility, in which medicines are of any more effica­cy, than they are in the hectic fever of the pulmo­nary consumption.

[Page 128]I PROCEED now to speak of the palliative reme­dies which are proper in the

III. OR, TYPHUS SPECIES of the Pulmonary Consumption.

THE first of these are STIMULATING MEDICINES. However just the complaints of Dr. Fothergill may be against the use of balsams in the inflamma­tory and mixed species of consumption, I am satisfied that they are not only safe, but useful likewise in mitigating the symptoms of weak action in the arterial system. I have therefore frequently prescribed the balsam of copaivae, of Peru, the oil of amber, and different preparations of turpentine and tar in moderate doses with obvious advantage. Garlic, the juice of dandelyon, a strong tea made of horehound, and a decoction of the inner bark of the wild cherry tree; ^* also bitters of all kinds, have all been found safe and useful tonics in this species of the consumption. Even the Peruvian bark itself so often and so generally condemned in consumptions is always an innocent and frequently an active medicine where there is a total absence of inflammatory diathesis in this disorder. With these medicines should be combined

[Page 129]2. A CORDIAL and STIMUMATING DIET. Milk and vegetables so proper in the inflammatory, are improper when taken alone in this species of consumption. I believe they often accelerate that decay of appetite and diarrhoea, which form the closing scene of the disorder. I think I have seen advantages from the use, not only of fresh, but of salted animal food when prescribed in the total ab­sence of inflammatory diathesis. Oysters, it has been said, have performed cures of consumption. If they have, it must have been only when they were eaten in that species of it which is now under consideration. They are a most savoury and whole­some article of diet in all diseases attended with symptoms of general debility. I have found the same advantage from dividing the meals here that I mentioned under a former head. The exhibi­tion of food in this case, should not be left to the calls of appetite, any more than the exhibition of a medicine. Indeed food may be made to supply the place of cordial medicines, by keeping up a constant and gentle action in the whole system. For this reason, I have frequently advised my patients never to suffer their stomachs to be empty, even for a single hour. I have sometimes aimed to keep up the influence of a gentle action in the stomach upon the whole system, by advising them to eat in the night, in order to obviate the increase of the [Page 130] excretion in the lungs and of the cough in the morning, which are brought on in part by the in­crease of debility from the long abstraction of the stimulus of aliment during the night.

HOWEVER safe and even useful the cordial me­dicines and diet which have been mentioned may appear, yet I am sorry to add, that I have never seen any other advantages from them than a miti­gation of distressing symptoms, except when they have been combined with suitable and long con­tinued exercise. Even under this favourable cir­cumstance, they are often ineffectual; for there frequently occurs in this species of consumption, such a destruction of the substance and functions of the lungs, as to preclude the possibility of a re­covery by the use of any of the remedies which have been discovered.

I HAVE said formerly that the three species of consumption do not observe any regular course in succeeding each other. They are not only com­plicated in some instances, but they often appear and disappear half a dozen times in the course of the disease, according to the influence of the wea­ther, dress, diet, and the passions, upon the system. The great secret, therefore, of treating this disor­der consists in accommodating all the remedies that [Page 131] have been mentioned to the predominance of ei­ther of the three species, or to the different states of the system, as manifested chiefly by the pulse. It is in consequence of having observed the evils which have resulted from the ignorance or neglect of this practice, that I have sometimes wished that it were possible to abolish the seducing nomencla­ture of diseases altogether, in order thereby to o­blige physicians to conform exactly to the fluctuating state of the system in all their prescriptions; for it is not more certain, that in all cultivated languages, every idea has its appropriate word, than that eve­ry state of a disease has its appropriate dose of me­dicine, the knowledge and application of which, can alone constitute rational, or ensure uniformly, successful practice.

I COME now to say a few words upon those pal­liative remedies which are alike proper in every species of the Pulmonary Consumption.

THE first Remedy under this head is a DRY SITUATION. A damp air, whether breathed in a room, or out of doors, is always hurtful in every species of this disorder. A kitchen or a bed room below the level of the ground has often produced, and never fails to increase a pulmonary consump­tion. I have often observed a peculiar paleness, [Page 132] (the first symptom of general debility) to shew itself very early in the faces of persons who work or sleep in cellar kitchens or shops.

2. COUNTRY AIR. The higher and dryer the situation which is chosen for the purpose of enjoy­ing the benefit of this remedy, the better. Situa­tions exposed to the sea, should be carefully avoid­ed; for it is a singular fact, that while consumptive persons are benefited by the sea air, when they breathe it on the ocean, they are always injured by that portion of it which they breathe on the sea-shore. I shall not pause to inquire, why a mix­ture of land and sea-air is so hurtful in the con­sumption, and at the same time so agreeable to per­sons in health, and so medicinal in many other dis­eases, but shall dismiss this head by adding a fact which was communicated to me by Dr. Matthew Ir­vine of South-Carolina, and that is, That those situ­ations which are in the neighbourhood of Bays or Rivers, where the salt and fresh waters mix their streams together, are more unfavourable to con­sumptive patients than the sea-shore; and therefore should be more carefully avoided by them in ex­changing city for country air.

[Page 133]3. LOOSE DRESSES, AND A CAREFUL ACCOMMO­DATION OF THEM TO THE CHANGES IN THE WEA­THER. Many facts might be mentioned to shew the influence of compression and of tight ligatures of eve­ry kind, upon the different parts of the body; also of too much, or too little cloathing, in producing, or increasing diseases of every kind, more especially those which affect the lungs. Tight stays, garters, waistbands, and collars, should all be laid aside in the consumption, and the quality of the cloathing should be suited to the weather. A citizen of Maryland informed me, that he had twice had a return of a cough and spitting of blood, by wearing his sum­mer cloaths a week after the weather became cool in the month of September. But it is not sufficient to vary the weight or quality of dress with the seasons. It should be varied with the changes which take place in the temperature of the air every day, even in the summer months, in middle latitudes. I know a citizen of Philadelphia, who has laboured under a consumptive diathesis near thirty years, who believes that he has lessen­ed the frequency and violence of pulmonic com­plaints during that time, by a careful accommoda­tion of his dress to the weather. He has been obser­ved frequently to change his waistcoat and short cloaths twice or three times in a day, in a summer month.

[Page 134]A REPETITION of colds, and thereby an increase of the disorder, will be prevented by wearing flan­nel next to the skin in winter, and muffin in the summer, either in the form of a shirt or a waist­coat: where these are objected to, a piece of flan­nel, or of soft sheepskin, should be worn next to the breast. They not only prevent colds, but fre­quently remove chronic pains from that part of the body.

4. ARTIFICIAL EVACUATIONS by means of BLIS­TERS and ISSUES. I suspect the usefulness of these re­medies to be chiefly confined to the inflammatory and hectic species of consumption. In the typhus spe­cies, the system is too weak to sustain the discharges of either of them. Fresh blisters should be preferred to such as are perpetual, and the issues, to be use­ful should be large. They are supposed to afford relief by diverting a preternatural secretion and excretion of mucus or pus from the lungs, to an artificial emunctory in a less vital part of the body.

5. CERTAIN FUMIGATIONS and VAPORS. An accidental cure of a pulmonary affection by the smoke of rosin, in a man who bottled liquors, raised for a while the credit of the first of those remedies. I have tried it, but without much permanent [Page 135] effect. I think I have seen the pain in the breast relieved by receiving the vapor from a mixture of equal parts of tar, bran, and boiling water into the lungs. The sulphureous and saline air of Stabiae, between Mount Vesuvius and the Mediterranean sea, and the effluvia of the pine forests of Lybia, were supposed in ancient times to be powerful re­medies in consumptive complaints; but it is pro­bable, the exercise used in travelling to those coun­tries, contributed chiefly to the cures which were ascribed to foreign matters acting upon the lungs.

6. LOZENGES, SYRUPS, and DEMULCENT TEAS. These are too common and too numerous to be mentioned.

7. OPIATES. It is a mistake in practice, found­ed upon a partial knowledge of the qualities of opium, to administer it only at night, or to suppose that its efforts in composing a cough, depend upon its inducing sleep. It should be given in small doses during the day, as well as in larger ones at night. The dose should be proportioned to the degrees of action in the arterial system. The less this action, the more opium may be taken with safety and advantage.

[Page 136]8. DIFFERENT POSITIONS OF THE BODY have been found to be more or less favourable to the abatement of the cough. These positions should be carefully sought for, and the body kept in that which procures the most freedom from coughing. I have heard of an instance, in which a cough which threatened a return of an hoemorrhage from the lungs, was perfectly composed for two weeks, by keeping the patient nearly in one posture in bed; but I have known more cases in which relief from coughing was to be obtained only by an erect posture of the body.

9. CONSIDERABLE relief will often be obtained from the patient's SLEEPING BETWEEN BLANKETS in winter, and on a MATRASS in summer. The former prevent fresh colds from night sweats; the latter frequently checks them altogether. In cases, where a sufficient weight of blankets, to keep up an agreeable warmth, cannot be borne without restraining easy and full acts of inspiration,—the patient should sleep under a light feather bed, or an eider down coverlit. They both afford more warmth than double or treble their weight of blankets.

HOWEVER comfortable this mode of producing warmth in bed may be it does not protect the [Page 137] lungs from the morbid effects of the distant points of temperature of a warm parlour in the day time, and a cold bed-chamber at night. To produce an equable temperature of air at all hours, I have frequently advised my patients, where going to a warm climate, was not practicable, to pass their nights as well as days in an open stove room, in which nearly the same degrees of heat were kept up at all hours. I have found this practice, in several cases, a tolerable substitute for a warm cli­mate.

10. THE MODERATE use of the lungs, in READ­ING, PUBLIC SPEAKING, LAUGHING, and SING­ING. The lungs, when debilitated, derive equal benefit with the limbs, or other parts of the body, from moderate exercise. I have mentioned in an­other place ^* several facts which support this opi­nion. But too much pains cannot be taken to in­culcate upon our patients, to avoid all excess in the use of the lungs, by long, or loud reading—speak­ing—or singing—or by sudden and violent bursts of laughter. I shall long lament the death of a female patient, who had discovered many hopeful signs of a recovery from a consumption, who [Page 138] relapsed, and died in consequence of bursting a blood-vessel in her lungs, by a sudden fit of laugh­ter.

11. ARE there any advantages to be derived from the excitement of certain PASSIONS in the treatment of consumptions? Dr. Blane tells us, that many consumptive persons were relieved, and that some recovered, in consequence of the terror which was excited by a hurricane in Barbadoes, in the year 1780. It will be difficult to imitate, by artificial means, the accidental cures which are recorded by Dr. Blane; but we learn enough from them to inspire the invigorating passions of hope and confidence in the minds of our patients, and to recommend to them such exercises as pro­duce exertions of body and mind analogous to those which are produced by terror. Van Swieten and Smollet relate cures of consumptions, by pa­tients falling into streams of cold water. Perhaps in both instances, the cures were performed only by the fright and consequent exertion produced by the fall. This is only one instance out of many which might be mentioned, of partial and unequal action being suddenly changed into general and equal excitement in every part of the system. The cures of consumptions which have been performed [Page 139] by a camp life ^*, have probably been much assisted by the commotions in the passions which were ex­cited by the various and changing events of war.

BEFORE I proceed to speak of the radical cure of the consumption, it will be necessary to observe, that by means of the palliative remedies which have been mentioned, many persons have been re­covered, and some have had their lives prolonged by them for many years. In all these cases I have found, upon inquiry, that the disorder was attend­ed with but little general debility, and that it fre­quently recurred as soon as the patient left off the use of his remedies, unless it were prevented by ne­cessary or voluntary exercise.

IT is truly surprising to observe how long some persons have lived, who have been affected by a consumptive diathesis, and by frequent attacks of many of the most troublesome symptoms of this disorder. Van Swieten mentions the case of a man, who had lived thirty years in this state. Mor­ton relates the history of a man, in whom the symptoms of consumption appeared with but little variation or abatement from his early youth till the 70th year of his age; and Bennet says, he [Page 140] knew an instance of this disorder which continued sixty years. I prescribed for one of my pupils four and twenty years ago, in a consumption, who, du­ring the greatest part of the time that has clapsed since, has seldom passed a year without spitting blood, nor a week without coughing, who now en­joys a tolerable share of health. In this case, the fatal tendency of the disorder was constantly op­posed by rural exercises, by a cordial, but tempe­rate diet, and (during the absence of inflammatory action in his pulse) by the occasional use of Peru­vian bark.

I AM led here to mention another instance of the analogy between pneumony and the pulmonary consumption. We often see the same frequency of recurrence of both disorders in habits which are predisposed to them. I have attended a Ger­man citizen of Philadelphia, in several fits of the pneumony, who has been confined to his bed eight and twenty times, by the same disorder, in the course of the same number of years. He has, for the most part, enjoyed good health in the inter­vals of those attacks, and always appeared, till lately, to possess a good constitution. In the cases of the frequent recurrence of pneumony, no one has suspected the disease to have originated in a morbid state of the lungs; on the contrary, it ap­pears [Page 141] evidently to be produced by the sudden in­fluence of the same causes, which by acting with less force, and for a longer time, produce the pulmona­ry consumption. The name of pneumony is taken from the principal symptom of this disorder, but it is as certainly a disease of the whole arterial sys­tem as the consumption; and I add further, that it is as certainly produced by general predisposing debility. The hardness and fulness of the pulse do not militate against this assertion, for they are al­together the effects of a morbid and convulsive ex­citement of the sanguiferous system. The strength manifested by the pulse is moreover partial, for every other part of the body discovers, at the same time, signs of extreme debility.

IT would be easy, by pursuing this subject a lit­tle further, to mention a number of facts which, by the aid of principles in physiology and pathology, which are universally admitted, would open to us a new theory of fevers, but this would lead us too far from the subject before us. I shall only re­mark, that all that has been said of the influence of general debilitating causes upon the lungs, both in pnuemony and consumption, and of the alternation of the consumption with other general diseases, will receive great support from considering the lungs only as a part of the whole external surface of the [Page 142] body, upon which most of the remote and exciting causes of both diseases produce their first effects. This extent of the surface of the body, not only to the lungs, but to the alimentary canal, was first taken notice of by Dr. Boerhaave; but was unhappily neglected by him in his theories of the diseases of the lungs and bowels. Dr. Keil supposes, that the lungs, from the peculiar structure of the bronchial vessels, and air vesicles, expose a surface to the action of the air, equal to the extent of the whole external and visible surface of the body.

THUS have I mentioned the usual palliative re­medies for the consumption. Many of these re­medies have, under certain circumstances, been said to have cured the disease, but I suspect that such cures have taken place only when the disor­der has partaken of an intermediate nature be­tween a pnuemony and a true pulmonary consump­tion. Such connecting shades appear between the extreme points of many other diseases. In a for­mer essay, ^* I endeavoured to account for the trans­mutation (if I may be allowed the expression) of the pneumony into the consumption, by ascribing [Page 143] it to the increase of the debilitating refinements of civilized life. This opinion has derived constant support from every observation I have made con­nected with this subject, since its first publication, in the year 1772.

I COME now to treat of the RADICAL REMEDIES for the pulmonary consumption.

In an essay formerly alluded to ^*, I mentioned the effects of labour, and the hardships of a camp or naval life, upon this disorder. As there must fre­quently occur such objections to each of those re­medies, as to forbid their being recommended or adopted, it will be necessary to seek for substitutes for them in the different species of exercise. These are, active, passive, and mixed. The active, in­cludes walking, and the exercise of the hands and feet in working or dancing. The passive includes rocking in a cradle, swinging, sailing, and riding in carriages of different kinds. The mixed is con­fined chiefly to riding on horse-back.

I HAVE mentioned all the different species of ex­ercise, not because I think they all belong to the [Page 144] class of radical remedies for the consumption, but because it is often necessary to use those which are passive, before we recommend those of a mixed or active nature. That physician does not err more who advises a patient to take physic, without speci­fying its qualities and doses, than the physician does who advises a patient, in a consumption, to use ex­ercise, without specifying its species and degrees. From the neglect of this direction, we often find consumptive patients injured instead of being reliev­ed by exercises, which, if used with judgment, might have been attended with the happiest ef­fects.

I HAVE before suggested that the stimulus of every medicine, which is intended to excite action in the system, should always be in an exact ratio to its excitability. The same rule should be applied to the stimulus of exercise. I have heard a well attested case of a young lady, upon whose consump­tion the first salutary impression was made by rocking her in a cradle; and I know another case in which a young lady, in the lowest state of that debility which precedes an affection of the lungs, was prepared for the use of the mixed and active exercises, by being first moved gently back­wards and forwards in a chariot without horses, for an hour every day. Swinging appears to act [Page 145] in the same gentle manner. In the case of a gar­diner, who was far advanced in a consumption, in the Pennsylvania hospital, I had the pleasure of observing its good effects, in an eminent degree. It so far restored him, as to enable him to complete his recovery by working at his former occupa­tion.

IN cases of extreme debility, the following or­der should be recommended in the use of the dif­ferent species of exercise.

1. Rocking in a cradle, or riding on an elastic board—commonly called a chamber horse.

2. Swinging.

3. Sailing.

4. Riding in a carriage.

5. Riding on horseback.

6. Walking.

7. Running—Dancing, &c.

IN the use of each of those species of exercise great attention should be paid to the degree or force of action with which they are applied to the body. [Page 146] For example,—in riding in a carriage, the exercise will be less in a four-wheel carriage than in a single horse chair, and less when the horses move in a walking, than a trotting gait. In riding on horse­back, the exercise will be less or greater according as the horse walks, paces, canters, or trots, in pas­sing over the ground.

I HAVE good reason to believe, that an English sea captain, who was on the verge of the grave with the consumption, in the spring of the year 1790, owed his perfect recovery to nothing but the above gradual manner, in which, by my advice, he made use of the exercises of riding in a carriage and on horseback. I have seen many other cases of the good effects of thus accommodating exer­cise to debility; and I am sorry to add, that I have seen many cases in which from the neglect of this manner of using exercise, most of the species and degrees of it, have either been useless, or done harm. However carelessly this observation may be read by physicians, or attended to by patients, I conceive to direction to be more necessary in the cure of consumptions. I have been thus particular in detailing it, not only because I believe it to be important, but that I might atone to society for that portion of evil which I might have prevented [Page 147] by a more strict attention to it in the first years of my practice.

THE more the arms are used in exercise the better. One of the proprietary governors of Penn­sylvania, who laboured for many years under a con­sumptive diathesis, derived great benefit from fre­quently rowing himself in a small boat, a few miles up and down the river Schuilkill. Two young men, who were predisposed to a consumption, were per­fectly cured by working steadily at a printing press in this city. Perhaps the superior advantages of riding on horseback, in this disorder, may arise in part from the constant and gentle use of the arms in the management of the bridle and the whip.

MUCH has been said in favour of sea voyages in consumptions. In the mild degrees of the dis­order they certainly have done service,—but I sus­pect the relief given, or the cures performed by them, should be confined chiefly to seafaring people, who add to the benefits of a constant change of pure air, a share of the invigorating exercises of navigating the ship. I have frequently heard of consumptive patients reviving at sea, probably from the transient effects of sea sickness upon the whole system, and growing worse as soon as they [Page 148] came near the end of their voyage. It would seem as if the mixture of land and sea airs was hurtful to the lungs in every situation and condition in which it could be applied to them. Nor is this peculiar and morbid operation of land and sea airs upon the human body confined only to consump­tive people. I crossed the Atlantic ocean in the year 1766, with a sea captain, who announced to his passengers the agreeable news that we were near the British coast before any discovery had been made of our situation by sounding, or by a change in the colour of the water. Upon asking him upon what he founded his opinion,—he said, that he had been sneezing, which he added, was the sign of an approaching cold, and that in the course of upwards of twenty years, he had never made the land (to use the seaman's phrase) with­out being affected in a similar manner. I have visited many sick people in Philadelphia soon after their arrival from sea, who have informed me, that they had enjoyed good health during the greatest part of their voyage, and that they had contracted their indispositions after they came within sight of the land. I mention these facts only to shew the ne­cessity of advising consumptive patients, who under­take a sea voyage for the recovery of their health, not to expose themselves upon deck in the morn­ing and at night, after they arrive within the re­gion [Page 149] in which the mixture of the land and sea airs may be supposed to take place.

I SUBSCRIBE, from what I have observed, to the bold declaration of Dr. Sydenham, in favor of the efficacy of riding on horseback, in the cure of consumption. I do not think the existence of ul­cers, or even tubercles in the lungs, when recent, or of a moderate size, the least objection to the use of this excellent remedy. Ulcers in the lungs are not necessarily fatal, and tubercles have no ma­lignity in them which should render their removal impracticable by this species of exercise. The first question, therefore, to be asked by a physician who visits a patient in this disorder should be, not, what is the state of his lungs, but, is he able to ride on horseback.

THERE are two methods of riding for health in this disorder. The first is by short excursions; the second is, by long journies. In slight con­sumptive affections, and after a recovery from an acute illness, short excursions are sufficient to re­move the existing debility; but in the more advan­ced stages of consumption, they are seldom effec­tual, and frequently do harm by exciting an occa­sional appetite without adding to the digestive powers. They moreover keep the system con­stantly [Page 150] vibrating by their unavoidable inconstancy, between distant points of tone and debility ^*, and they are unhappily accompanied at all times from the want of a succession of fresh objects to divert the mind, by the melancholy reflection that they are the sad, but necessary conditions of life.

IN a consumption of long continuance or of great danger, long journies on horse back are the the most effectual modes of exercise. They afford a constant succession of fresh objects and company, which divert the mind from dwelling upon the dan­ger of the existing malady; they are moreover at­tended by a constant change of air, and they are not liable to be interrupted by company, or transi­ent changes in the weather, by which means ap­petite and digestion, action and power all keep pace with each other. It is to be lamented that the use of this excellent remedy is frequently op­posed by indolence and narrow circumstances in both sexes, and by the peculiarity of situation and temper in the female sex. Women are attached to their families by stronger ties than men. They cannot travel alone. Their delicacy, which is in­creased [Page 151] by sickness, is liable to be offended at every stage,—and lastly, they sooner relax in their ex­ertions to prolong their lives than men. Of the truth of the last observation, Sir William Hamil­ton has furnished us with a striking illustration. He tells us, that in digging into the rums pro­duced by the late earthquake in Calabria, the wo­men who perished in it, were all found with their arms folded as if they had abandoned themselves immediately to despair and death; whereas, the men were found with their arms extended, as if they had resisted their fate to the last moment of their lives. It would seem from this fact, and ma­ny others of a similar nature which might be rela­ted; that a capacity of bearing pain and distress with fortitude and resignation, was the distinguish­ing characteristic of the female mind; while a dis­position to resist and overcome evil belonged in a more peculiar manner to the mind of man. I have mentioned this peculiarity of circumstances and temper in female patients, only so the sake of convincing physicians that it will be necessary for them to add all the force of eloquence to their ad­vice, when they recommend journies to women in preference to all other remedies, for the recovery of their health.

[Page 152]PERSONS, moreover, who pursue active employ­ments, frequently object to undertaking journies, from an opinion that their daily occupations are sufficient to produce all the salutary effects we expect from artificial exercise. It will be highly necessary to correct this mistake, by assuring such persons that, however useful the habitual exercise of an active, or even a laborious employment may be to preserve health, it must always be exchanged for one which excites new impressions, both upon the mind and body in every attempt to restore the system from that debility which is connected with pulmonary consumption.

AS travelling is often rendered useless, and even hurtful in this disease from being pursued in an im­proper manner, it will be necessary to furnish our patients with such directions as will enable them to derive the greatest benefit from their journies. I shall therefore, in this place, mention the sub­stance of the directions which I have given in wri­ting for many years to such consumptive patients as undertake journies by my advice.

1. TO Avoid Fatigue. Too much cannot be said to enforce this direction. It is the hinge on which the recovery or death of a consumptive pa­tient frequently turns. I repeat it again, there­fore, [Page 153] that patients should be charged over and over when they set off on a journey, as well as when they use exercise of any kind to avoid fa­tigue. For this purpose, they should begin by travelling only a few miles in a day, and increase the distance of their stages as they increase their strength. By neglecting this practice, many per­sons have returned from journies much worse than when they left home, and many have died in ta­verns, or at the houses of their friends on the road. Travelling in stage-coaches is seldom safe for a consumptive patient. They are often crouded; they give too much motion; and they afford by their short delays and distant stages, too little time for rest, or for taking the frequent refreshment which was formerly recommended.

2. TO Avoid travelling too soon in the Morning, and after the Going down of the Sun in the Even­ing; and if the weather be hot, never to travel in the middle of the day. The sooner a patient breakfasts after he leaves his bed the better; and in no case should he leave his morning stage with an empty stomach.

3. IF it should be necessary for a patient to lie down, or to sleep in the day time, he should be [...] to undress himself, and to cover his body [Page 154] between sheets or blankets. The usual ligatures of garters, stocks, kneebands, waistcoats and shoes, are very unfriendly to sound sleep; hence persons who lie down with their cloaths on, often awake from an afternoon's nap in terror from dreams, or in a profuse sweat, or with a head-ach or sick stomach; and generally out of humor. The surveyors are so sensible of the truth of this remark, that they always undress themselves when they sleep in the woods. An intelligent gentleman of this profession informed me that he had fre­quently seen young woodsmen who had refused to conform to this practice, so much indisposed in the morning, that after the experience of a few nights, they were forced to adopt it.

GREAT care should be taken in sleeping, whe­ther in the day time, or at night, never to lie down in damp sheets. Dr. Sydenham excepts the dan­ger from this quarter, when he speaks of the ef­ficacy of riding on horseback in curing the con­sumption.

4. PATIENTS who travel for health in this dis­order should avoid all large companies, more especi­ally evening and night parties. The air of a contaminated room, phlogisticated by the breath of fifteen or twenty persons, and by the same number [Page 155] of burning candles, is poison to a consumptive pa­tient. To avoid impure air from every other source, he should likewise avoid sleeping in a croud­ed room, or with curtains around his bed, and even with a bed-fellow.

5. TRAVELLING, to be effectual in this disor­order, should be conducted in such a manner as that a patient may escape the extremes of heat and cold. For this purpose he should pass the winter, and part of the spring in Georgia or South-Carolina, and the summer in New Hamp­shire, Massachusetts, or Vermont, or if he pleases, he may still more effectually shun the summer heats by crossing the lakes, and travelling along the shores of the St. Lawrence to the city of Quebec. He will thus escape the extremes of heat and cold, particularly the less avoidable one of heat; for I have constantly found the hot month of July to be as unfriendly to consumptive patients in Pennsylvania, as the variable month of March. By these means too he will enjoy nearly an equable temperature of air in every month of the year; and his system will be free from the inconvenience of the alternate ac­tion of heat and cold upon it. The autumnal months should be spent in New-Jersey or Pennsyl­vania.

[Page 156]IN these journies from north to south, or from south to north, he should be careful, for reasons before mentioned, to keep at as great a distance as possible from the sea coast. Should this inquiry fall into the hands of a British physician, I would beg leave to suggest to him, whether more advantages would not acrue to his consumptive patients from advising them to cross the Atlantic ocean, and afterwards to pursue the tour which I have recommended, than by sending them to Portugal, France, or Italy—Here they will arrive with such a mitigation of the vi­olence of the disorder, in consequence of the length of their sea voyage, as will enable them immediately to begin their journies on horseback. Here they will be exposed to fewer temptations to intemperance, or to unhealthy a­musements, than in old European countries. And, lastly, in the whole course of this tour, they will travel among a people related to them by a same­ness of language and manners, and by ancient or modern ties of citizenship. Long journies for the recovery of health under circumstances so agreeable, should certainly be preferred to travel­ling among strangers of different nations, langua­ges, and manners on the continent of Europe.

6. TO render travelling on horseback effectual in a consumption, it should be continued with mo­derate [Page 157] intervals from six to twelve months. But the cure should not be rested upon a single journey. It should be repeated every two or three years, till our patient has passed the consumptive stages of life. Nay,—he must do more, he must acquire a habit of riding constantly, both at home and abroad, or to use the words of Dr. Fuller "he must, like a Tartar, learn to live on horseback, by which means he will acquire in time the constitu­tion of a Tartar ^*."

WHERE benefit is expected from a change of climate, as well as from travelling, patients should reside at least two years in the place which is chosen for that purpose. I have seldom known a residence for a shorter time in a foreign climate do much service.

TO secure a perfect obedience to medical advice, it would be extremely useful if consumptive pa­tients could always be acompanied by a physician. Celsus says, he found it more easy to cure the dropsy in slaves than in freemen, because they more readily submitted to the restraints he im­posed upon their appetites. Madness has become a curable disorder in England, since the physicians of that country have opened private mad-houses, [Page 158] and have taken the entire and constant direction of their patients into their own hands. The same successful practice would probably follow the treatment of consumptions, if patients were con­stantly kept under the eye and authority of their physicians.—The keenness of appetite, and great stock of animal spirits, which those persons frequently possess, hurry them into many excesses which defeat the best concerted plans of a re­covery;—or, if they escape these irregularities, they are frequently seduced from our direc­tions by every quack remedy which is recom­mended to them. Unfortunately the cough be­comes a signal of their disorder, at every stage of their journey, and the easy or pleasant prescriptions of even hostlers and ferrymen, are often substituted to the self-denial and exertion which have been im­posed by physicians. The love of life in these cases seems to level all capacities; for I have ob­served persons of the most cultivated understand­ings to yield in common with the vulgar to the use of these prescriptions.

I CANNOT conclude this inquiry without ad­ding, that the author of it derived from his pa­ternal ancestors a predisposition to the pulmonary consumption, and that between the 18th and 43d years of his age, he has occasionally been afflicted [Page 159] with many of the symptoms of that disorder which he has described:—By the constant and faithful use of most of the remedies which he has recommended, he has enjoyed for several years nearly an uninter­rupted exemption from pulmonary complaints. In humble gratitude, therefore, to that BEING, who condescends to be called the preserver of men, he thus publicly devotes the result of his experience and inquiries to the benefit of such of his fellow crea­tures as may be afflicted with the same disorder, sincerely wishing that they may be as useful to them, as they have been to the author.

HAVING for many years been unsuccessful in all the cases, except two, of internal dropsy of the brain, which came under my care, I began to en­tertain doubts of the common theory of this disor­der, and to suspect that instead of being considered as an idiopathic dropsy, the effusion of water should be considered only as the effect of a primary inflam­mation or congestion of blood in the brain.

I MENTIONED this opinion to my colleague Dr. Wistar in the month of June 1788, and taught it the winter following in my lectures. The year afterwards I was confirmed in it by hearing that the [Page 202] same idea had occurred to Dr. Quin. I have since read Dr. Quin's treatise on the dropsy of the brain with great pleasure, and consider it as the first dawn of light which has been shed upon the the­ory of this disorder. In pursuing this subject, therefore, I shall avail myself of Dr. Quin's dis­coveries, and endeavour to arrange the facts and observations I have collected in such a manner, as to form a connected theory from them, which I hope will lead to a new and more successful mode of treating this disease.

I SHALL begin this Inquiry by delivering a few general propositions.

1. THE Internal Dropsy of the Brain is a disor­der confined chiefly to children.

2. IN children the brain is larger in proportion to other parts of the body, than it is in adults; and of course a greater proportion of blood is sent to it in childhood, than in the subsequent periods of life.—The effects of this determination of blood to the brain appear in the mucous discharge from the nose, and in the sores on the head and behind the ears, which are so common in childhood.

[Page 203]3. IN all febrile diseases there is a preternatural determination of blood to the brain. This occurs in a more especial manner in children; hence the reason why they are so apt to be affected by con­vulsions in the eruptive fever of the small-pox, in dentition, in the diseases from worms, and in the first paroxysm of intermitting fevers.

4. IN fevers of every kind, and in every stage of life, there is a disposition to effusion in that part to which there is the greatest determination. Thus in inflammatory fever, effusions take place in the lungs and in the joints. In the bilious fever they occur in the liver, and in the gout in every part of of the body. The matter effused is always influ­enced by the structure of the part in which it takes place.

THESE propositions being premised, I should have proceeded to mention the remote causes of this disorder; but as this inquiry may possibly fall into the hands of some gentlemen who may not have access to the description of it as given by Dr. Whytt, Dr. Fothergill, and Dr. Quin, I shall intro­duce a history of its symptoms taken from the last of those authors. I prefer it to the histories by Dr. Whytt and Dr. Fothergill, as it accords most [Page 204] with the ordinary phaenomena of this disorder in this country.

TO this history I shall add a few facts, which are the result of observations made by myself, or communicated to me by my medical brethren.— These facts will serve to shew that there are many deviations from the history of the disorder which has been given, and that it is indeed as Dr Quin has happily expressed it, of "a truly proteiform" nature.

[Page 209]I HAVE not found the dilated and insensible pu­pil, the puking, the delirium, or the strabismus, to attend universally in this disease.

I SAW one case in which the appetite was un­impaired from the first to the last stage of the dis­order.

I HAVE met with one case in which the disorder was attended by blindness, and another by double vision.

I HAVE observed an uncommon acuteness in hearing to attend two cases of this disorder. In one of them the noise of the sparks which were discharged from a hiccory fire, produced great pain and startings which threatened convulsions.

I HAVE seen three cases in which the disease terminated in hemiplegia. In two of them it proved fatal in a few days—in the third it has con­tinued for nearly eighteen months.

I HAVE met with one case in which no preter­natural slowness, or intermission was ever perceiv­ed in the pulse.

[Page 210]I HAVE seen the disease in children of nearly all ages. I once saw it in a child of six weeks old. It was preceded by the cholera infantum.

IN the month of March 1771, I obtained a gill of water from the ventricles of the brain of a ne­ero girl of nine years of age, who died of this dis­order, who complained in no stage of it of a pain in her head or limbs, nor of a sick stomach. The disorder in this case was introduced suddenly by a pain in the breast, a fever, and the usual symptoms of a catarrh.

DR. WISTAR informed me that he had likewise met with a case of internal dropsy of the brain, in which there was a total absence of pain in the head.

DR. CARSON informed me that he had attended a child in this disorder that discovered, for some days before it died, the symptom of hydrophobia.

DR. CURRIE obtained, by dissection, seven oun­ces of water from the brain of a child which died of this disorder; in whom he assured me no dilata­tion of the pupil, strabismus, sickness, or loss of ap­petite had attended, and but very little head-ach.

[Page 211]THE causes which induce this disease, act either directly on the brain, or indirectly upon it, through the medium of the whole system.

THE causes which act directly on the brain are falls or bruises upon the head, certain positions of the body, and childish plays which bring on con­gestion or inflammation, and afterwards an effusion of water in the brain.

THE indirect causes of this disorder are more numerous, and more frequent, though less suspect­ed, than those which have been mentioned. The following diseases of the whole system appear to act indirectly in producing an internal dropsy of the brain.

1. INTERMITTING, remitting, and continual fe­vers. Of the effects of these fevers in inducing this disorder, many cases are recorded by Lieu­taud. ^*

MY former pupil, Dr. Woodhouse, has furnish­ed me with a dissection in which the disease was evidently the effect of the remitting fever. That species or state of continual fever which has been distinguished by the name of typhus, is often the [Page 212] remote cause of this disorder. The languor and weakness in all the muscles of voluntary motion, the head-ach, the inclination to rest and sleep, and the disposition to be disturbed, or terrified by dreams, which are said to be the precursors of wa­ter in the brain, I believe are frequently symptoms of a typhus fever which terminates in an inflamma­tion, or effusion of water in the brain.—The histo­ry which is given of the typhus state of fever in children by Dr. Butter ^*, seems to favor this opi­nion.

2. THE Rheumatism. Of this I have known two instances. Dr. Lettsom has recorded a case, from the same cause ^†. The pains in the limbs, which are supposed to be the effect, I suspect, are frequently the cause of the disorder.

3. THE Pulmonary Consumption. Of the con­nection of this disease with an internal dropsy of the brain, Dr. Percival has furnished us with the following communication ^‡: ‘Mr. C—'s daugh­ter, aged nine years, after labouring under the phthisis pulmonalis four months, was affected [Page 213] with unusual pains in her head. These rapidly increased so as to occasion frequent screamings. The cough, which had before been extremely violent, and was attended with stitches in the breast, now abated, and in a few days ceased al­most entirely. The pupils of the eyes became dilated, a strabismus ensued, and in about a week death put an end to her agonies. Whether this affection of the head arose from the effusion of water or of blood, is uncertain, but its influence on the state of the lungs is worthy of notice.’ Dr. Quin likewise mentions a case from Dr. Cullen's private practice, in which an internal dropsy of the brain followed a pulmonary con­sumption. Lieutaud mentions, three cases of the same kind ^†, and two in which it succeeded a ca­tarrh ^‡.

4. Eruptive Fevers. Dr. Odier informs us ^‖, that he had seen four cases in which it had followed the small pox, measles, and scarlatina. Dr Lett­som mentions a case in which it followed the small [Page 214] pox ^*, and I have seen one in which it was obvi­ously the effects of debility induced upon the sy­stem by the measles.

5. WORMS. Notwithstanding the discharge of worms gives no relief in this disorder, yet there is good reason to believe, that it has, in some in­stances, been produced by them.

6. FROM the dissections of Lieutaud, Quin, and others, it appears further, that the internal dropsy of the brain has been observed to succeed each of the following disorders—viz. The colic— palsy—melancholly—dysentery—dentition—inso­lation—scrophula—and the sudden healing of old sores. I have seen two cases of it from the last cause, and one in which it was produced by the action of the vernal sun alone upon the system.

FROM the facts which have been enumerated, and from dissections to be mentioned hereafter, it ap­pears, that the disease in its first stage is the effect of causes which produce a less degree of that in­flammation which constitutes phrenitis, and that its second stage is the effect of a less degree of that ef­fusion, which produces serous apoplexy in adults. [Page 215] The former partakes of the nature of the chronic inflammation of Dr. Cullen, and of the asthenic inflammation of Dr. Brown. I have taken the li­berty to call it Phrenicula, from its being a dimi­nutive species or state of phrenitis. It bears the same relation to phrenitis when it arises from indi­rect causes, which pneumonicula does to pneu­mony,—and it is produced nearly in the same manner as the pulmonary consumption, by debili­tating causes which act primarily on the whole sy­stem. The peculiar size and texture of the brain, seem to invite the inflammation and effusions which follow debility, to that organ in childhood, just as the peculiar structure and situation of the lungs invite the same morbid phaenomena, after the body has acquired its growth, in youth and middle life. In the latter stage which has been mentioned, the internal dropsy of the brain par­takes of some of the properties of apoplexy. It differs from it in being the effect of a slow, instead of a sud­den effusion of water or blood, and in being the ef­fect of causes which are of an acute instead of a chronic nature. The more advanced persons are in life who are affected by this disorder, the more it approaches to the nature of the common apo­plexy, by a speedy termination in life or death. Dr. Cullen has called it simply by the name of "apoplexia hydrocephalica." I have preferred for [Page 216] this stage of the disorder the term of chronic apo­plexy; for I believe with Dr. Quin, that it has no connection with an hydropic diathesis of the whole system. I am forced to adopt this opinion, from my having never seen it accompanied by dropsical effusions in other parts of the body, nor a general dropsy accompanied by an internal dropsy of the brain. No more occurs in this disease than takes place when hydrothorax follows an inflammation of the lungs, or when serous effusions follow a in­flammation of the joints. I do not suppose that both inflammation, and effusion always attend in this disorder; on the contrary, dissections have shewn some cases of inflammation, with little or no effusion, and some of effusion without inflamma­tion. Perhaps this variety may have been pro­duced by the different stages of the disease in which death and the inspection of the brain took place. Neither do I suppose, that the two stages which have been mentioned, always succeed each other in the common order of inflammation and ef­fusion. In every case where the full tense—slow and intermitting pulse occurs, I believe there is inflammation; and as this state of the pulse occurs in most cases in the beginning of the disorder, I suppose the inflammation, in most cases, to precede the effusion of water. I have met with only one case in which the slow and [Page 217] tense pulse was absent; and out of six dis­sections of patients whom I have lost by this dis­order, the brains of four of them exhibited marks of inflammation.

HAVING adopted the theory of this disease, which I have delivered several years ago, I re­solved upon such a change in my practice as should accord with it. The first remedy indicated by it was

I. BLOOD-LETTING. I shall briefly mention the effects of this remedy in all the cases in which I have prescribed it.

IT has been remarked, that Pennsylvania for some years past, has become more sickly than formerly. Fevers, which a few years ago appear­ed chiefly on the banks of creeks and rivers, and in the neighborhood of mill-ponds, now appear in parts remote from them all, and in the highest si­tuations. This change with respect to the heal­thiness of our country, may be traced to the three following causes.

1. THE establishment and increase of mill-ponds. There are whole counties in Pennsylvania in which [Page 266] intermittents were unknown, until the waters in them were dammed, for the purpose of erecting mill-ponds.

2. THE cutting down of wood, under certain circumstances, tends to render a country sickly. It has been remarked, that intermittents on the shores of the Susquehannah, have kept an exact pace with the passages which have been opened for the propagation of marsh effluvia, by cutting down the wood which formerly grew in its neighbour­hood. I remember the time, when intermittents were known only within half a mile, in some pla­ces, of that river. They are now to be met with ten miles from it, in the same parts of the state.

I BEG a distinction to be made here between clearing and cultivating a country. While clearing a country makes it sickly, in the manner that has been mentioned, cultivating a country, that is, draining swamps, destroying weeds, burning brush, and ex­haling the unwholsome and superfluous moisture of the earth, by means of frequent crops of grain, grasses, and vegetables of all kinds, render it heal­thy. I could mention, in support of these facts, several countries in the United States, which have passed through each of the stages that have been described. The first settlers received these coun­tries [Page 267] from the hands of nature pure and healthy. ^* Fevers soon followed their improvements, nor were they finally banished, until the higher degrees of cultivation that have been named took place. I confine myself to those countries only where the salutary effects of cultivation were not rendered abortive by the neighbourhood of mill-ponds.

A third cause of the late increase of bilious and intermitting fevers, must be sought for in the differ­ent and unequal quantities of rain which have fall­en within these last seven years. While our creeks and rivers, from the uniformity of our seasons, were confined to steady bounds, there was little or no exhalation of febrile miasmata from their shores. But the dry summers of 1780, 1781, [Page 268] and 1782, by reducing our creeks and rivers far below their ancient marks; while the wet springs of 1784 and 1785, by swelling them both beyond their natural heights, have, when they have fall­en, as in the former case, left a large and extensive surface of moist ground exposed to the action of the sun, and of course to the generation and exha­lation of febrile miasmata. The history of epide­mics in foreign countries, favours this opinion of the cause of their increase in Pennsylvania. The inhabitants of Egypt are always healthy during the overflowing of the Nile. Their fevers appear only after the recess of the river. It is remark­able that a wet season is often healthy in low, while it is sickly in hilly countries. The reason is obvi­ous. In the former the rains entirely cover all the moist grounds, while in the latter, they fall only in sufficient quantity to produce those degrees of moisture which favour febrile exhalations. The rains which fall in the summer are rendered harm­less only by covering the whole surface of marshy ground. The rains which fall in our state after the middle of September, are so far from produ­cing fevers, that they generally prevent them. The extraordinary healthiness of the last autumn, I believe, was occasioned by nothing but the ex­traordinary quantity of rain that fell during the autumnal months. The rain probably acts at this [Page 269] season by diluting, and thus destroying, the febrile miasmata that were produced by the heat and moi­sture of the preceding summer. In support of the truth of this third cause of the increase of fe­vers in Pennsylvania, I have only to add a fact lately communicated to me by Dr. Franklin. He informed me, that in his journey from Passey to Havre de Grace, last summer, he found the coun­try through which he travelled, unusually sickly with fevers. These fevers, it was generally sup­posed, were produced by the extrordinary dry weather, of which the public papers have given us such melancholy and frequent accounts.

I COME now to suggest a few hints for obviating and preventing fevers, and for rendering our coun­try again healthy. For this purpose, I beg leave to recommend, in the first place, the planting of trees around all our mill ponds, (besides cleaning them occasionally) in order to prevent the diseases that have justly been ascribed to them. Let the trees be planted in the greatest number, and closest together, to leeward of the ordinary current of the summer and autumnal winds. I have known several instances of families being preserved from fevers by an accidental copse of wood standing between a mill-pond and a dwelling-house, and that in cases too where the house deri­ved [Page 270] no advantage from an high situation. The trees around or near a mill-pond, act perhaps in a small degree mechanically. By sheltering the pond from the action of the sun, they lessen exhalation, as well as obstruct the passage of the vapors that are raised, to the adjacent parts. But they act likewise chemically. It has been demonstrated that trees absorb unhealthy air, and discharge it in a highly purified state in the form of what is now called "dephlogisticated" air. The willow tree, according to Mr. Ingenhauzs, has been found to purify air the most rapidly of any tree that he has subjected to his experiments. The ra­pidity of its growth, its early verdure, and the late fall of its leaf, all seem to mark it likewise as a tree highly proper for this purpose.

A SECOND method of preventing fevers, is to let the cultivation always keep pace with the clear­ing of our lands. Nature has in this instance, connected our duty, interest, and health together. Let every spot covered with moisture from which the wood has been cut, be carefully drained, and afterwards ploughed and sowed with grass seed; let weeds of all kinds be destroyed, and let the waters be so directed as to prevent their stagnating in any part of their course.

[Page 271]THESE are the two principal means of extirpa­ting intermitting and bilious fevers from our coun­try, but as these means are slow in their operation, I shall subjoin a few directions for preventing fe­vers till the above remedies can take effect.

1. WHETHER the matter which produces fe­vers be of an organic nature, I do not pretend to determine, but it is certain, that fire, or the smoke or heat which issue from it, destroy the effects of marsh miasmata upon the human body; hence we find cities more healthy than country places, and the centre of cities more healthy than their sub­urbs in the sickly months. To derive the utmost possible benefit from this method of preventing sickness, I would advise large fires to be made every evening, of brush, between the spots from whence the exhalations are derived, and the dwelling house, and as near to the latter as is safe, and not disagreeable. This practice should be continued till the appearance of two or three frosts, for frosts, as well as heavy rains in the autumnal months, ne­ver fail to put a stop to the progress of intermit­tents.

DURING the sickly season, fires should be like­wise kept in every room in the dwelling house, even in those cases where the heat of the weather [Page 272] makes it necessary to keep the doors and windows open.

2. LET me advise my countrymen in sickly situ­ations, to prefer woollen and cotton to linen clothes in the summer and autumnal months. The most sickly parts of the island of Jamaica have been ren­dered more healthy, since the inhabitants have adopted the use of woollen and cotton garments instead of linen.

DURING the late war, I knew many officers, both in the British and American armies, who esca­ped fevers in the most sickly places, by wearing woollen shirts or waistcoats constantly next to their skins. I have heard the present diminution of the human body in strength and size, compared with its ancient vigor and form, ascribed in part to the introduction of linen garments. I am not disposed to controvert this opinion, but I am sure of the efficacy of woollen clothes in wet and cold climates in preventing fevers of all kinds. The parliament of Great Britain compels every body that dies within the island to be buried in a woollen shirt or winding sheet. The law would be much wiser if it compelled every body to wear woollen garments next to their skins during life, and linen after death.

[Page 273]3. THE diet in the sickly months should be ge­nerous. Wine and beer should be the drinks of this season instead of spirits and water. I do not think that fruit and vegetables of any kind produce fevers, but as the season of the year produces lan­guor and weakness, a larger quantity of animal food than usual is best calculated to oppose them. Salt­ed meat, for this reason, is preferable to fresh meat. Food of all kinds eaten during the sickly months, should be well seasoned.

4. THE evening air should be avoided as much as possible. Even the morning air before the sun rises, should not be breathed, until the body has been fortified with a little solid aliment, or a draught of bitters. These bitters should be made of centaury, wormwood, camomile, or the bark of the willow or dogwood trees infused in water. Bit­ters made with spirits, or even wine, cannot be taken in a sufficient quantity to do service without producing intoxication, or the deadly habit of lov­ing and drinking spirituous liquors.

5. TOO much cannot be said in favour of clean­liness, as means of preventing fevers. The body should be bathed or washed frequently. It has been proved in the highlands of Jamaica, that add­ing salt to water, renders it more powerful in pre­venting [Page 274] diseases when applied to the body. Equal pains should be taken to promote cleanliness in every species of apparel. Offal matters, especially those which are of a vegetable nature, should be removed from the neighbourhood of a dwelling house. The dung of domestic animals, during its progress towards manure may be excepted from this direction. Nature, which made man and these animals equally necessary to each others sub­sistence, has kindly prevented any inconvenience from their living together. On the contrary, to repay the husbandman for affording a shelter to these useful and helpless animals, nature has done more. She has endowed their dung with a power of destroying the effects of marsh exhalations, and of preventing fevers. The miserable cottagers in Europe who live under the same roof, and in some instances in the same room with their cattle, are always healthy. In Philadelphia, fevers are less known in the neighbourhood of livery stables, than in any other part of the city. I could mention a family that has lived near thirty years near a livery stable in a sickly part of the city, that has never known a fever but from the measles or small-pox.

HOWEVER trifling these complaints may appear, they compose a large class of the diseases of a numerous body of people. Hi­therto the persons afflicted by them have been too generally abandoned to the care of empirics, either because the disease was considered as beneath the notice of physicians, or because they were unable to cure it. I would rather ascribe it to the latter, than to the former cause, for pride has no natural fellowship with the profession of medicine.

THE difficulty of curing sore legs has been con­fessed by physicians in every country. As far as my observations have extended, I am disposed to as­cribe this difficulty to the uniform and indiscrimi­nate [Page 278] mode of treating them, occasioned by the want of a theory which shall explain their proxi­mate cause. I shall attempt in a few pages to de­liver one, which however imperfect, will I hope lay a foundation for more successful inquiries upon this subject hereafter.

I SHALL begin my observations upon this dis­order, by delivering and supporting the following propositions.

I. SORE LEGS are a disease of general debility, which, for the most part, is of the indirect kind. This I infer from the occupations and habits of the persons who are most subject to them. They are day-labourers, and sailors, who are in the habit of lift­ing great weights; also washer-women, and all other persons, who pass the greatest part of their time upon their feet. The blood vessels, and muscular fibres of the legs are thus overstretched, by which means either a rupture, or such a lan­guid action in the vessels is induced, as that an ac­cidental wound from any cause, even from the scratch of a pin or the bite of a mosquito, will not easily heal. But labourers, sailors, and washer-women, are not the only persons who are afflicted with sore legs. Hard-drinkers of every rank and description are likewise subject to them. Where [Page 279] strong drink, labour, and standing long on the feet are united, they more certainly dispose to sore legs, than when they act separately. In China, where the labour which is performed by brutes in other countries is performed by men, varices on the legs are very common among the labouring people. Perhaps, the reason why the debility induced in the legs produces varices instead of ulcers in these people, may be owing to their not adding the de­bilitating stimulus of strong drink to that of exces­sive labour.

IT is not extraordinary that the indirect debi­lity produced by intemperance in drinking ardent spirits, should appear first in the lower extremities. The indirect debility produced by intemperance in the use of wine, makes its first appearance in the form of gout, in the same part of the body. The gout, it is true, discovers itself most frequently in pain only, but there are cases in which it has terminated in ulcers, and even mortifications on the legs.

II. SORE LEGS are a disease of the whole sy­stem. This I infer,

1. From the causes which induce them, all of [Page 280] which act more or less upon every part of the body.

2. FROM their following or preceding diseases which obviously belong to the whole system. Fe­vers and dysenteries often terminate critically in this disorder; and the pulmonary consumption and apoplexy have often been preceded by the sup­pression of an habitual discharge from a sore leg. The two latter diseases have been ascribed to the translation of a morbific matter to the lungs or brain: But it is more rational to ascribe them to a previous debility in those organs, by which means their ves­sels were more easily excited into action and effu­sion by the stimulus of the plethora, induced upon the system in consequence of the confinement of the fluids formerly discharged from the leg in the form of pus. This plethora can do harm only where there is previous debility; for I maintain that the system (when the solids are exactly toned) will always relieve itself of a sudden preternatural accumulation of fluids by means of some natural emunctory. This has been often observed in the menorrhagia, which accompanies plentiful living in women, and in the copious discharges from the bowels and kidneys which follow a suppression of the perspiration.

[Page 281]3. I INFER it, from their appearing almost uni­versally in one disease, which is evidently a disease of the whole system, viz. the scurvy.

4. FROM their becoming in some cases the out­lets of menstrual blood, which is discharged in con­sequence of a plethora which affects more or less every part of the female system.

5. I INFER it from the symptoms of sore legs, which are in some cases febrile, and affect the pulse in every part of the body with preternatural fre­quency or force. These symptoms were witnessed, in an eminent degree, in two of the patients who furnished subjects for clinical remarks in the Penn­sylvania hospital in the course of the last winter.

6. I INFER that sore legs are a disease of the whole system, from the manner in which they are sometimes cured by nature and art. They often prove the outlets of many general diseases, and all the remedies which cure them, act more or less up­on the whole system.

IN all cases of sore legs there is a tonic and atonic state of the whole system. The same state of ex­cessive or deficient action takes place in the parts [Page 282] which are affected by the sores. The remedies to cure them, therefore, should be general and local.

IN cases where the arterial system is affected by too much tone, the general remedies should be,

I. BLOOD-LETTING. Of the efficacy of this remedy in disposing ulcers suddenly to heal, the two clinical patients beforementioned, exhibited re­markable proofs last winter, in the presence of all the students of medicine in the university. The blood drawn was sizy in both cases. I have not the merit of having introduced this remedy into practice in the cure of ulcers. I learned it from Sir John Pringle. I have known it to be used with equal success in a sore breast, attended by pain and inflam­mation, after all the usual remedies for that disorder had been used to no purpose. I anticipate here a repetition of an objection to this remedy by per­sons who cannot, at first sight, reconcile excessive action in the arterial system with the debility which predisposes to it. I refer the reader for a defence of it, to what was said upon the subject of bleeding in the inflammatory species of consumption. It will only be necessary to add in this place, that indirect, like direct debility, when of short duration, never fails to produce such a degree of excitability, or vibratility (if I may be allowed to coin a word) in [Page 283] the blood-vessels, as to dispose them to be thrown into excessive action by the least increase in the force or number of the stimuli which act upon the human body.

II. GENTLE PURGES.

III. NITRE. From fifteen to twenty grains of this medicine should be given three times a-day.

IV. A TEMPERATE diet, and a total abstinence from fermented and distilled liquors.

V. COOL and pure air.

THE local remedies in this state of the system should be,

I. COLD water. Dr. Rigby has written largely in favour of this remedy when applied to local in­flammations. From its good effects in allaying the inflammation which sometimes follows the punc­ture which is made in the arm in communicating the small pox, and from the sudden relief it affords in the inflammatory species of the ophthalmia and in the piles, no one can doubt of its efficacy in sore legs, accompanied by inflammation in those ves­sels, which are the immediate seat of the disorder.

[Page 284]II. SOFT poultices of bread and milk, or of bread moistened with lead water. Dr. Underwood's method of making a poultice of bread and milk should be preferred in this case. He directs us first to boil the milk, then to powder the bread, and throw it into the milk, and after they have been intimately mixed, by being well stirred and boiled together, they should be poured out and spread upon a rag, and a knife dipped in sweet oil or lard, should be run over them. The solidity and con­sistence of the poultice is hereby better preserved, than when the oil or lard is mixed with the bread and milk over the fire.

III. When the inflammation subsides, dry lint should be applied to the sore, and confined by means of a soft plaster of wax and sweet oil.

IV. ABOVE all, rest, and an horizontal posture of the leg. Too much cannot be said in favor of this re­medy in this species of sore legs. Nannoni, the fa­mous Italian surgeon, sums up the cure of sore legs in three words, viz. "Tempo, riposo, e pazienza;" that is, in time, rest and patience. A friend of mine, who was cured by this surgeon, of a sore leg, about thirty years ago, informed me, that he confined him to his bed, during the greatest part of the time that he was under his care.

[Page 285]IN sore legs, attended by too little general and local action, the following remedies are proper.

I. BARK. It should be used plentifully, but with a constant reference to the state of the system; for the changes in the weather, and other acciden­tal circumstances often produce such changes in the system, as to render its disuse for a short time fre­quently necessary.

II. MERCURY. This remedy has been suppos­ed to act by altering the fluids, or by discharging a morbid matter from them, in curing sore legs. But this is by no means the case. It appears to act as an universal stimulant; and if it prove most useful when it excites a salivation, it is only because in this way it excites the most general action in the system.

III MINERAL TONICS—such as the different preparations of iron, copper, and zinc.

IV. GENTLE EXERCISE. Rest, and a recum­bent posture of the body, so proper in the tonic, are both hurtful in this species of sore legs. The efficacy of exercise, even of the active kind, in the cure of sore legs, accompanied by deficient ac­tion in the vessels, may easily be conceived from [Page 286] its good effects after gun-shot wounds which are mentioned by Dr. Jackson. ^* He tells us, that those British soldiers who had been wounded at the battle of Guilford, in North-Carolina, who were turned out of the military hospitals and fol­lowed the army, soonest recovered of their wounds. It was remarkable that if they delayed only a few days on the road, their wounds grew worse, or ceased to heal.

IN the use of the different species of exercise the same regard should be had to the state of the system which was recommended in a former disorder.

V. A NUTRITIOUS and moderately stimulating diet, consisting of milk, saccharine vegetables, ani­mal food, malt-liquors, and wine.

WORT has done great service in sore legs. I am at a loss to determine whether it acts by con­veying a quantity of gently stimulating and nutri­tious matter into the system, or by correcting a scorbutic diathesis in the blood. The manner in which I have directed it to be prepared and taken is as follows—To three or four [...] table-spoonsful of the malt, finely powdered and sifted, [Page 287] add two table spoonsful of brown sugar, and three or four of Madeira, Sherry, or Lisbon wine, and a quart of boiling water. After they have stood a few hours, it may be drunken liberally by the pa­tient, stirring it each time before he takes it, so that the whole substance of the malt may be conveyed into the stomach. A little lime-juice may be ad­ded, if the patient requires it, to make it more pleasant. The above quantity may be taken once, twice, or three times a day at the pleasure of the patient, or according to the indication of his dis­order.

VI. OPIUM. This remedy is not only useful in easing the pain of a sore leg, but co-operates with other cordial medicines in invigorating the whole system.

THE local applications should consist of such substances as are gently escarotic, and which excite an action in the torpid vessels of the affected part. Arsenic, precipitate, and blue vitriol, have all been employed with success for this purpose. Dr. Grif­fitts informed me, that he has frequently accom­plished the same thing in the Dispensary by ap­plications of tartar emetic. They should all be used, if necessary, in succession to each other; for there is often the same idiosyncrasy in a sore leg to cer­tain topical applications, that there is in the sto­mach [Page 288] to certain aliments. After the use of these remedies, astringents and tonics should be applied, such as an infusion of Peruvian, or white-oak bark; the water in which the smiths extinguish their irons, lime-water, bread dipped in a weak solution of green vitriol (so much commended by Dr. Un­derwood) and compresses wetted with brandy, or ardent spirits of any kind.

TIGHT bandages are likewise highly proper here. The laced stocking has been much used. It is made of strong coarse linen. Dr. Underwood gives several good reasons for preferring a flannel roller to the linen stocking. It sets easier on the leg, and yields to the swelling of the muscles in walking.

IN scorbutic sores on the legs, navy surgeons have spoken in high terms of an application of a mixture of lime-juice and melasses. Mr. Gillespie commends the use of lime or lemon-juice alone, and ascribes many cures to it in the British navy during the late war, after every common application had been used to no purpose. ^*

IT is of the utmost consequence in the treatment of sore legs, to keep them clean, by frequent dressings [Page 289] and washings. The success of old women is oftener derived from their great attention to cleanliness, in the management of sore legs, than to any specifics they possess which are unknown to physicians.

WHEN sore legs are kept from healing by affec­tions of the bone, the treatment should be such as is recommended by practical writers on surgery.

I SHALL conclude this inquiry by four observa­tions, which are naturally suggested by what has been delivered upon this disorder.

1. IF it has been proved that sore legs are, in most cases, diseases of the whole system, is it not proper to inquire, whether many other diseases supposed to be local are not in like manner diseases of the whole system? And if sore legs have been cured by general remedies, is it not proper to use them more frequently in other local diseases?— I am led to make this remark by having seen two instances of tumors, the one on the breast, and the other in the prostate gland, nearly cured by long journies.

2. IF there be two states of action in the arteries in sore legs, it becomes us to inquire, whether the same opposite states of action do not take place in many diseases in which they are not suspected. I have [Page 290] before observed, that they occur in the scrofula. It would be easy to prove, that they exist in seve­ral other local diseases.

3. IF the efficacy of the remedies for sore legs which have been mentioned, depends upon their being accommodated exactly to the state of the ar­terial system, and if this system be liable to fre­quent changes, does it not become us to be more attentive to the state of the pulse in this disorder than is commonly supposed to be necessary by physicians?—Indeed, if one of the principles I have aimed to establish in this and several of the foregoing essays be just, that is, that all prescrip­tions should be suited to the state, and not to the name, of a disease, it follows that success in the practice of physic will depend chiefly upon the oc­casional change of the dose, or quality of a medi­cine with the changing state of the whole system.

4. IT has been a misfortune in medicine, as well as in other sciences, for men to ascribe ef­fects to one cause, which should be ascribed to many. Hence diseases have been attributed ex­clusively to morbid affections of the fluids by some, and of the muscles, and nerves by others. Unfor­fortunately the morbid states of the arterial system, and the influence of those states upon the brain— [Page 291] the nerves—the muscles—the lymphatics—the glands—the viscera—the alimentary canal—and the skin, as well as the reciprocal influence of the morbid states of each of those parts of the body upon the arteries, and upon each other, have been too much neglected in most of our systems of phy­sic. I consider the pathology of the arterial system as a mine. It was first discovered by Dr. Cullen. The man who attempts to explore it, will probably impoverish himself by his researches; but the men who come after him, will certainly obtain from it a treasure which cannot fail of adding greatly to the riches of medicine.