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nerally precedes consumption. In the southernmost regions it is almost unknown. Hemorrhoids are often an affection of the old; and perhaps, indeed, it may be said that, with respect to this disease, as well as to others, not immediately connected with our variable climate, we resemble the inhabitants of Europe. With regard to the diseases peculiar to the sex the same remark may be made.
Apoplexy and palsy are often the result of intemperate habits; in the middle and southern states particularly. They are the diseases of which the aged die, in the concluding months of winter, as well as at the beginning of spring or of autumn. The active habits of our countrymen render hypochondria more rare than in Great Britain. In the northern states the tetanus or lockjaw, is uncommon, in summer, and never occurs in winter. In the middle states, it is dangerous to receive a wound, particularly a lacerated one during the warm season, without using stimulating remedies to prevent this dreadful disease. In the southern, it is not at all infrequent in summer, and it sometimes occurs even in winter. In the former seasons it often proceeds from a cause, viz. exposure to the night air, which in the northern states is never known to produce it. Of epilepsy, asthma, and St. Vitus's dance, there is nothing peculiar to be said with regard to our country. The water rash, and indigestion, are often the result of intemperance: they are confined to no particular district, or tract; and may be said to attack in the common forms and from the ordinary causes. Hydrophobia appears not unfrequently; and is often symptomatic,—though it most commonly arises from the bite of rabid animals.—Madness, indeed, may be supposed to arise in this country from the same occasional causes, as in Europe. It appears in families, and descends by hereditary succession; often disappearing in one branch, or generation, and making its appearance again in another. Sometimes, hightoned pride, intemperance, excessive headachs or eccentricity, in a parent, becomes mania in the next generation; while on the contrary, they leave a family in a reverse order. Religion and losses in business, may perhaps be the most frequent causes of this disease, though from its connexion with hereditary predisposition, it is often difficult to trace its causes with accuracy.
Dropsy is believed to be less common, than formerly, and is now a very manageable disease, where the constitution is not absolutely broken. It generally occurs among the poor, the irregular, and the intemperate. Rickets rarely appears; though it sometimes affects the negroes, and particularly negro children. Strofula occurs more frequently; and is generally manifested in diseased mesentery glandular swellings, and ulcers of the soft parts, with carious bone. With regard to the disease resulting from impure connexion, it may be supposed, that, in a country, where population is extended on a scale unknown in any other quarter of the globe, where all the delights of life rouse and stimulate the body, the diseases of a function so intimately connected with the general health should naturally be common. Accordingly, it may be said, that among the labouring classes, particularly in the cities, there are few individuals, who have not had their constitutions seriously affected by frequent contaminations, by injudicious exhibitions of mercury, or by suffering the malady to go imperfectly cured or totally neglected. To
give the general reader a view of the state of diseases in our country we would say, that malignant bilious fevers of remittent or an intermittent type prevail most in the summer and beginning of autumn; catarrhs, pleurisies, inflammations, rheumatisms, typhous fevers, in the approach and progress of winter, as well as in the commencement of spring,—and that the other diseases, which have been enumerated, are regulated in their appearance by irregularity of living, by the decay of nature, and by the other numerous and varying accidents of life and of climate. Accordingly in the north, where winter has the sway, the remittent fevers of the summer are more mild, and the inflammations more severe. But in the south, the contrary takes place,-the fevers being malignant and deadly; whilst inflammations, pleurisies, catarrhs, and consumptions, occur seldom or are entirely unknown. In the middle states, on the other hand, where the climate is alternately tropical and arctic, we have, according as the one or the other season prevails, the malignant fevers of the south, or the consumptions, the infiammations, and the pleurisies of the north.From this view of the climate and diseases of our country, it need not be said, that various districts have various degrees of health; that marshes, high-lands, and mountainous regions diversify, the temperature of the air, as well as the character of disease; that epidemics appear in districts, for many years blessed with health; and that while there are endemics, which never leave particular regions,—there are other regions which, at all seasons and in all years are entirely free from diseases of any kind. It is from this circumstance,
from the revolutions, in the maladies, which have afflicted particular parts of our country, that our medical character derives its pretensions to celebrity.
The prevalence of the typhous fever in New-England, of late years, and of the yellow fever in Philadelphia, in 1793, and in several succeeding years, afforded opportunities for the trial of medical skill which perhaps were never before excelled. Our practitioners were not unequal to the task which they found themselves obliged to undertake; nor did the results fall short of the expectation which the opportunities and the men would have led us to form. The views which the varying forms of these diseases have given of the principles and state of the human constitution, the extensive comparisons which it induced between the experience of ancient and of modern times, have elicited opinions on the subject of contagion and of disease generally, which will be of great and lasting benefit to the world. Its consequences upon commerce, in the promotion of correct views respecting quarantine, and, of course, upon agriculture and manufactures, render these doctrines peculiarly interesting
Formerly it was believed that the plague in Europe, the yellow fever in the West Indies, and the typhus which is confined to no particular districts of the globe, were caught by means of an infectious and occult something, communicated either by the contact of a person diseased, or by some subtle influence in the atmosphere. In Europe about half a century ago the great body of the profession did not condescend to examine accurately how this effect was produced: the matter was enveloped in mystery; and though the health, the perspiration, and the confinement of the sick in low, damp, neglected situations, were supposed to contribute to it; yet the ideas of medical men upon the subject were confused and indefinite; and no one had the courage to think of coming at the truth either by investigating the actual facts, or by reasoning from general principles. The immense collection of materials made by accurate observers from every quarter of the globe, and under every kind of circumstance, together with the happy general classification and views of the causes of disease, and of the principles of the system,-gave the physicians of America a great advantage over those who had preceded them on the other continent:and though from the subtlety of the causes which operate in producing these morbid changes, the attainment of absolute certainty is almost impossible, yet the industry and the genius which signalized the dismal time when those diseases prevailed, have done much to remove the obscurity in which they were before enveloped and have brought the whole subject of contagion before the public, accompanied with new and important observations. To delineate as exactly as we can, the present state of the doctrine concerning fevers, we proceed to observe, in the first place, that the human system consists of a mass of materials organized and regulated by certain fixed laws, and possessing properties peculiar and different from all other bodies. In every part there is constantly taking place a series of compositions and decompositions, of which our aliments and our drinks supply the subjects and materials. The useless portions are thrown out upon the surface of the body in the perspiration; from the lungs in the breath; and from the other emunctories in their appropriate discharges. The rejection, then, of substances which are useless to the system, forms one of the great operations of the living machine. From the unity and harmony of its constitution every sense regards as disagreeable the substances thus eliminated. As the body therefore is composed of matters which are collected from the external world, it is subject to various derangements, disorganizations, and diseases; of which fever is the most common and general. In its most usual form it consists first of a chilliness, which lasts from a few minutes to as many hours,-is then succeeded by a corresponding heat, which is equally general and various in its continuance, and is finally terminated by a perspiration which continues, like the other two symptoms, either longer or shorter, according to the constitution of the patient, or violence of the disease. Fever, then, is often simple. Its operations and effects, however, are complicated, and it personates all the affections of the body; insomuch that, in some instances, a high degree of healthful feeling is the precursor of approaching death. In this immense diversity of symptoms, the physician is often left without either sky or compass, and must take for his guide the predominant character of the diseases then prevailing; which, if properly understood, will, in general, conduct his patient successfully to health. With regard to the treatment, there are three distinguishing characteristics, on which it principally turns;—whether the fever is high, or moderate, or low. If the fever be high, it becomes necessary to abstract all those agents, which tend to strengthen and support the body; if low, it must be excited by food and drink of a stimulating nature; if moderate, the two extremes must be avoided, and according as the patient tends towards either, the treatment must be stimulating or the contrary. Such, then, is the general outline of the phenomena attending fevers--one of the most numerous classes of diseases to which the body is subject. The impurity of the air, and the putrefaction of animal and of vegetable substances surrounding us, have been supposed to be its causes. The disagreeable impressions made by the latter on the sense of smell, and its pernicious effects upon the lungs, when inhaled in respiration, render the opinion probable. From this
point has arisen the disputes among physicians in relation to contagion. Are diseases propagated by a subtle and occult substance which communicates its influence through the skin, like the matter of small-pox,--or by the putrefaction of vegetable and animal matter, acting through the medium of the breath, of the saliva, and of the food which carries it to the stomach? Whilst some imagine that bilious and malignant remittent fevers, are produced by vegetable and animal matter, in a state of putrefaction; others again, believe that agues are the only effects of such a cause, and refer to cold, in its vicissitudes, the various forms of this disease, which so extensively afflict the human species.
The plague, which is unquestionably a species of fever, is confidently believed to be communicated from the clothes of persons who have died of the disease; and it is no less certain, that the lower species, commonly known by the epithet nervous, and lately by the typhous fever, arises from the same cause,--the putrefaction of the animal secretions adhering to the clothing, for which it has a strong affinity. The question is important; for whilst one party believes it proceeds from the decomposition of matters every where around us, they assert, of course, that the disease has a domestic origin; and according as their belief is more or less exclusive, are more or less disposed to reject all quarantine laws, and to trust to those precautions which prevent its introduction from domestic sources: and, on the other hand, those who refer it only to the human body, regard foreign causes as the most probable, and are equally obstinate in thinking precaution at home to be unnecessary.
The arguments commonly adduced to prove that the yellow fever has its origin in animal and vegetable putrefaction, and not in contagion, are principally,—that it appears in marshy countries, where foreign intercourse is impossible,—that it does not spread in the West Indies, in the country places in America, nor in hospitals,-that it is impossible to communicate it by inoculation, or by swallowing the black matter ejected from the stomach,--that the yellow fever is similar to other diseases, which evidently arise from marshy ground and animal putrefaction,
that the disease never attacks whole neighbourhoods at once, but appears in a sparse and scattered manner over a city, that it is extinguished by cold weather, a fact which is incompatible with contagion, that it does not appear in situations, or in climates, where the heat is moderate, as in Great Britain or in France,--that physicians, who, were it contagious, must certainly have taken the disease, are seldom known to be infected, and that every attempt to arrest its progress, by the separation of the sick from the well, has proved completely