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abortive. On the contrary it may be alleged, that this disease often resembles those of a low character, which are denominated typhus, and which are supposed, on all hands, to arise from contagion, and to be manifested in the spotted skin, in the derangement of the mental faculties, and in the black discharges from the stomach and the bowels. What still more corroborates this position is that, as in the typhus,-particularly that which has appeared of late years in our country,—it has personated every other disease: and when we add to all this, that the poor never remove the impurities of their neighbourhood, we must acknowledge that in all seasons the sources of contagion must be open, and that of course the disease, if contagious, may originate among them at all times. But the very contrary takes place.-Again, did the disease arise exclusively from the putrefaction of vegetable and animal matter, it would show itself in every year and in every district of our country, during the season favourable to that process. The subtlety of the causes, which produce these diseases precludes entirely the supposition of any certain influence from the circumstances above mentioned. Extreme heat, which relaxes the body, may be the direct cause of fever, and putrefaction only the occasional, or exciting cause. It is well known, that our system is eminently susceptible of being acted upon by stimulants, which are extremely subtle. The odour of whortleberries, for instance, has produced fainting; mania and nervous affections have been caused by the music of the harmonica; excessive debility has arisen from the sight of particular animals, even though innoxious; violent fevers have proceeded from the crews of different vessels visiting each other, though they were perfectly healthy before; and cattle free from disease coming from remote districts sometimes exhibit similar phenomena, when they are permitted to eat in the same pastures:-All of which proves pretty evidently, that the causes which unpin the chords, and destroy the harmony of the system, are too subtle to be accurately known. As the matters constantly eliminated from the body, therefore, are discharged because they are, in the first place, useless and unnecessary to our sustentation, and, in the second place, become highly offensive to our senses, it must in all cases be proper to guard against external contagion, and to consider the admission of a disease from abroad as not only a possible event,-but as an occurrence which is rendered probable both by analogy and by fact. At the same time, too, we should be equally on our guard, lest an enemy so insidious and so subtle should come upon us from within. Upon the whole, then, it is extremely difficult to know with precision the causes of fever; because, in the first place, they are insensible; be
cause, secondly, the progressive steps of their operation can hardly ever be accurately traced,—and because, thirdly, it may proceed, at different times, from many and varied sources; such as the constistution of the air, or of the earth, perhaps; the substance of our bodies (which vary, in all probability, in different seasons, and in different districts of country); the putrefaction of vegetable and of other substances; and lastly, the perspiration of animals in perfect health, or in disease. Such is the general outline of the facts and discussion which this subject has produced. They are of the greatest importance to our species, and must unquestionably lead to important results with regard to the regulation of our intercourse with foreign nations, as well as with one another.
In leaving this subject it may be proper to remark, that in consequence
of the excessive alternations and varieties of our climate, the malignant fevers of the summer, in its northern districts, are distinguished by rather a low type, and will not bear depletion; in the middle, they are more inflammatory; while in the south, again, they correspond with those in the north. And it is somewhat extraordinary that, from a contrary cause, a set of diseases produce weakness in the south, and will bear less debilitating remedies than the same diseases in the middle states. The remedies for malignant fever are nearly the same as were employed fifty years ago; with the exception that mercury is now more common, and is certainly effectual when it produces its peculiar operation on the mouth. This is true of fevers generally, though not without some exception; inasmuch as we discover cases, those particularly of intermittents, in which they continue, during salivation, unaftected by medicine. The fevers of a low type, which have of late years so often appeared in our country,-particularly in the north,—require, we think, a more specific examination. The common long protracted form of nervous or typhous fevers, which continue from ten days to two or three months, and which afflict Britain and the north of Europe, are not uncommon in our own country during the season of autumn. They are regular, however, and appear in scattered cases every year, succeeding to remittent fevers of the summer; or assuming their most dreadful form, from the first attack, in low and marshy situations. The low fevers which have appeared in the northern districts of the United States, exhibit, in general, their characteristic symptoms from the first attack, and sometimes terminate in no more than twelve hours. They personate every disease, even the common nervous affection of hysteria, megrim, and low spirits. In some instances, too, there is no symptom but debility; and the patient gradually sinks into his
grave without a murmur, often so listless and so feeble as to complain of the trouble of taking medicine, and to beg that he might die in peace. This disease, which has always occurred in the autumn and winter, continues, in damp situations, sometimes late in the spring, and, when the summers are cool, even till the latter end of June. In its treatment, depletion is almost always improper. External heat, liberally applied, gestation in a carriage, when practicable,--the application of blisters, where there are internal pains, and the administration of stimulants, such as wine, brandy, nourishing food, repeated frequently, but at short intervals, and continued when there are no signs of inflammation,--constitute the general practice which is observed towards the disease under consideration. Let the strength be supported; but avoid continuing the remedies till they produce oppression, confusion, or disturbance either of the faculties of the mind or of the body. This disease appeared in Connecticut in 1807, and went through the New England states like a besom of destruction. It has continued to appear, every winter and autumn, in every section of the United States-except their most western extremity; from which we have no positive information: North and South Carolina have experienced its ravages; and for the last three years it has been no less mortal in Virginia and in Pennsylvania.
Without entering into farther detail with regard to the diseases of this country, it may be observed generally that the malignant and bilious fevers triumph in the summer; whilst the typhus reigns over the dreary and unsettled seasons of winter and commencing spring. It may be said of our diseases as of our climate,--that every region exhibits all the varieties of heat, of cold, and of malady, which attack the human body, and that typhus appears in those seasons, when we are weakened by cold and moisture, and those of an opposite character, when excessive heat produces the same depression of the system. The appearance of intermediate genera is determined by the peculiarities of soil or of atmosphere. With this general view of the climate and diseases of the country we proceed to state the sources of medical information, together with our general character respecting it.
The northern states are distinguished for mental and bodily activity; and their colleges are more numerous, and better endowed than any others. In their large towns, the character of the profession is respectable,--as much so, perhaps, as in those of Europe; and in the country there is a great deal of accurate practical information respecting diseases, as they appear in particular neighbourhoods; while general learning or theoretical knowledge is very rarely to be found. In all districts there are many empirical practitioners, who live by vending nostrums, and deception of various kinds. As to medical science, the middle and southern states must be confessed, we think, to have the precedency. In natural history, the latter, particularly, excel; as a taste for the study appeared much earlier in the southern than in the northern districts of the country.
About the year 1740, Dr. Cadwallader wrote an essay upon the iliac passion, which has been mentioned with approbation, and since that time, the names of Tennant and Mitchell, of Virginia, have acquired celebrity. Dr. Bond, Gale, Lining, Chalmers, Garden, Colden, Ogden, Jones, and Maclurg, have produced respectable works upon various subjects connected with medicine; and more lately the professors of the New York and Pennsylvania schools have written with great credit and ability.
Our countrymen have been particularly distinguished for their development of the general relations subsisting between diseases,- for a more ample and correct view of nosology or systematic arrangement,--and for observations on the nature and cure of malignant fevers,-on quarantine, -on the use of mercury in diseases generally, on the nature of dropsy,-on the doctrine of cutaneous absorption,-on digestion, -and on madness. Besides treatises on these subjects, a great variety of miscellaneous tracts on others have occasionally appeared. Dr. Rush was certainly the most distinguished medical character of this country. He united a rare talent for observation, to great brilliancy of fancy; and it may be said with truth, that his work upon the yellow fever, contains more knowledge beautifully and perspicuously arranged and detailed, than any original medical work which has appeared since the time of Sydenham. The theories of the latter, like those of the former, were often defective, and prove certainly that his judgment and his talent for generalization was inferior to the other
powers of his mind. He has been honoured by many of the foreign poter tates of Europe; and for variety of observation,—for activity, industry, and genius, perhaps he has never been excelled in any country. Dr. Miller of New York is distinguished on the same subject. Dr. Mitchell and Dr. Caldwell have written creditably upon quarantine, and upon other physical and medical subjects. Dr. Currie of this city has collected much useful information on the diseases of this country; and Dr. Barton, jun. has written a book upon hospitals, containing a great variety of useful information, which cannot elsewhere be procured. Dr. Hosack, of New York, has also attained great eminence in his profession by a liberality of patronage in encouraging medical learning, unknown before in this country. He established a botanic garden, at a vast expense, from his private fortune: which was afterwards purchased by the state of New York: and he has written with great ability upon contagion, as well as upon other subjects. To great activity, he unites much learning; and is an ornament to his state and country. Since the late war, this gentleman and Dr. Mitchell have been made members of the royal society of London;—an honour to which Dr. Franklin, Mr. Rittenhouse, Colonel Humphreys, of this country have been admitted. It has been observed, that, since the late contest, the Americans, and, in particular, those who have been distinguished for learning or science, have met with a more gracious reception than they formerly did in the old world. Dr. Barton also has occupied an elevated place in the medical reputation of this country. His researches were principally directed to natural history; though upon the materia medica of the United States he has made collections which reflect great
upon his memory. His treatise on goitre is respectable; and though it does not throw much new light upon the subject, yet it deserves to be mentioned among those who do honour to our country.
In surgery Dr. Physic stands without a rival in this country, and as an operator particularly, perhaps without an equal in any country. In his department of medicine; (in which so much has already been done,) he has introduced several material im. provements; of which the practice of applying blisters to mortified flesh, and the mode of producing union by the introduction of a seton, between the ends of fractured bones, already become cartilaginous, and do not otherwise unite, are the most prominent.
There are several eminent teachers in the schools of Philadelphia and of New York; among whom may be mentioned Dr. Wistar, professor of anatomy, and the president of the American philosophical society in Philadelphia. He has introduced models of different parts of the body upon a large scale, to exhibit more clearly, and with greater precision, the various portions of their structure. His exertions for the propagation of medical knowledge; and, indeed, his acquirements, both general and professional, undoubtedly entitle him to a place in the first rank of medical celebrity. Dr. James is high as a teacher of midwifery.-There are several other medical gentlemen who would deserve to be particularly noticed, -were we not, in this paper, confined to a mere outline of the subject. Of these the most conspicuous are Dr. Chapman and Dr. Dorsey; the former of whom is distinguished for genius and eloquence,