Volume 4 — AN INQUIRY INTO THE Comparative State of Medicine IN PHILADELPHIA, BETWEEN THE YEARS 1760 AND 1766, AND THE YEAR 1805.

In estimating the progress and utility of medicine, important advantages may be derived from taking a view of its ancient, and comparing it with its present state. To do this upon an extensive scale, would be difficult, and foreign to the design of this inquiry. I shall therefore limit it, to the history of the diseases and medical opinions which prevailed, and of the remedies which were in use, in the city of Philadelphia, between the years 1760 and 1766, and of the diseases, medical opinions, and remedies of the year 1805. The result of a comparative view of each of them, will determine whether medicine has declined or improved, in that interval of time, in this part of the world.

To derive all the benefits that are possible from such an inquiry, it will be proper to detail the causes, which, by acting upon the human body, influence the subjects that have been mentioned, in those two remote periods of time.

Those causes divide themselves into climate, diet, dress, and certain peculiar customs; on each of which I shall make a few remarks.

After what has been said, in the history of the Climate of Pennsylvania, in the first volume of these Inquiries, it will only be necessary in this place briefly to mention, that the winters in Philadelphia, between the years 1760 and 1766, were almost uniformly cold. The ground was generally covered with snow, and the Delaware frozen, from the first or second week in December, to the last week in February, or the first week in March. Thaws were rare during the winter months, and seldom of longer duration than three or four days. The springs began in May. The summers were generally warm, and the air seldom refreshed by cool north-west winds. Rains were frequent and heavy, and for the most part accompanied with thunder and lightning. The autumns began in October, and were gradually succeeded by cool and cold weather.

The diet of the inhabitants of Philadelphia, during those years, consisted chiefly of animal food. It was eaten, in some families, three times, and in all, twice a day. A hot supper was a general meal. To two and three meals of animal food in a day, many persons added what was then called “a relish,” about an hour before dinner. It consisted of a slice of ham, a piece of salted fish, and now and then a beef-steak, accompanied with large draughts of punch or toddy. Tea was taken in the interval between dinner and supper.

In many companies, a glass of wine and bitters was taken a few minutes before dinner, in order to increase the appetite.

The drinks, with dinner and supper, were punch and table beer.

Besides feeding thus plentifully in their families, many of the most respectable citizens belonged to clubs, which met in the city in winter, and in its vicinity, under sheds, or the shade of trees, in summer, once and twice a week, and, in one instance, every night. They were drawn together by suppers in winter, and dinners in summer. Their food was simple, and taken chiefly in a solid form. The liquors used with it were punch, London porter, and sound old Madeira wine.

Independently of these clubs, there were occasional meetings of citizens, particularly of young men, at taverns, for convivial purposes. A house in Water-street, known by the name of the Tun tavern, was devoted chiefly to this kind of accidental meetings. They were often followed by midnight sallies into the streets, and such acts of violence and indecency, as frequently consigned the perpetrators of them afterwards into the hands of the civil officers and physicians of the city.

Many citizens, particularly tradesmen, met every evening for the purpose of drinking beer, at houses kept for that purpose. Instances of drunkenness were rare at such places. The company generally parted at ten o'clock, and retired in an orderly manner to their habitations. Morning drams, consisting of cordials of different kinds, were common, both in taverns and private houses, but they were confined chiefly to the lower class of people.

From this general use of distilled and fermented liquors, drunkenness was a common vice in all the different ranks of society.

The dresses of the men, in the years alluded to, were composed of cloth in winter, and of thin woollen or silk stuffs in summer. Wigs composed the covering of the head, after middle life, and cocked hats were universally worn, except by the men who belonged to the society of friends.

The dresses of the women, in the years before mentioned, consisted chiefly of silks and calicoes. Stays were universal, and hoops were generally worn by the ladies in genteel life. Long cloth or camblet cloaks were common, in cold weather, among all classes of women.

The principal custom under this head, which influenced health and life, was that which obliged women, after lying-in, “to sit up for company;” that is, to dress themselves, every afternoon on the second week after their confinement, and to sit for four or five hours, exposed to the impure air of a crowded room, and sometimes to long and loud conversations.

Porches were nearly universal appendages to houses, and it was common for all the branches of a family to expose themselves upon them, to the evening air. Stoves were not in use, at that time, in any places of public worship.

Funerals were attended by a large concourse of citizens, who were thereby often exposed to great heat and cold, and sometimes to standing, while the funeral obsequies were performed, in a wet or damp church-yard.

The human mind, in this period of the history of our city, was in a colonized state, and the passions acted but feebly and partially upon literary and political subjects.

We come now to mention the diseases which prevailed in our city between the years 1760 and 1766.

The cholera morbus was a frequent disease in the summer months.

Sporadic cases of dysentery were at that time common. I have never seen that disease epidemic in Philadelphia.

The intermitting fever prevailed in the month of August, and in the autumn, chiefly in the suburbs and neighbourhood of the city. In the year 1765, it was epidemic in Southwark, and was so general, at the same time, as to affect two thirds of the inhabitants of the southern states. This fact is mentioned by Dr. Bond, in a lecture preserved in the minutes of the managers of the Pennsylvania hospital.

The slow chronic fever, called at that time the nervous fever, was very common, in the autumnal months, in the thickly settled parts of the city.

The bilious fever prevailed, at the same time, in Southwark. The late Dr. Clarkson, who began to practise medicine in that part of the city, in the year 1761, upon hearing some of his medical brethren speak of the appearance of bilious remittents in its middle and northern parts, about the year 1778, said they had long been familiar to him, and that he had met with them every year since his settlement in Philadelphia[66].

The yellow fever prevailed in the neighbourhood of Spruce-street wharf, and near a filthy stream of water which flowed through what is now called Dock-street, in the year 1762. Some cases of it appeared likewise in Southwark. It was scarcely known in the north and west parts of the city. No desertion of the citizens took place at this time, nor did the fear of contagion drive the friends of the sick from their bed-sides, nor prevent the usual marks of respect being paid to them after death, by following their bodies to the grave. A few sporadic cases of the same grade of fever appeared in the year 1763.

Pneumonies, rheumatisms, inflammatory sore throats, and catarrhs were frequent during the winter and spring months. The last disease was induced, not only by sudden changes in the weather, but often by exposure to the evening air, on porches in summer, and by the damp and cold air of places of public worship in winter.

The influenza was epidemic in the city in the spring of the year 1761.

The malignant sore throat proved fatal to a number of children in the winter of 1763.

The scarlet fever prevailed generally in the year 1764. It resembled the same disease, as described by Dr. Sydenham, in not being accompanied by a sore throat.

Death from convulsions in pregnant women, also front parturition, and the puerperile fever, were common between the years 1760 and 1766. Death was likewise common between the 50th and 60th years of life from gout, apoplexy, palsy, obstructed livers, and dropsies. A club, consisting of about a dozen of the first gentlemen in the city, all paid, for their intemperance, the forfeit of their lives between those ages, and most of them with some one, or more of the diseases that have been mentioned. I sat up with one of that club on the night of his death. Several of the members of it called at his house, the evening before he died, to inquire how he was. One of them, upon being informed of his extreme danger, spoke in high and pathetic terms of his convivial talents and virtues, and said, “he had spent 200 evenings a year with him, for the last twenty years of his life.” These evenings were all spent at public houses.

The colica pictonum, or dry gripes, was formerly a common disease in this city. It was sometimes followed by a palsy of the upper and lower extremities. Colics from crapulas were likewise very frequent, and now and then terminated in death.

Many children died of the cholera infantum, cynanche trachealis, and hydrocephalus internus. The last disease was generally ascribed to worms.

Fifteen or twenty deaths occurred, every summer, from drinking cold pump water, when the body was in a highly excitable state, from great beat and labour.

The small-pox, within the period alluded to, was sometimes epidemic, and carried off many citizens. In the year 1759, Dr. Barnet was invited from Elizabeth-town, in New-Jersey, to Philadelphia, to inoculate for the small-pox. The practice, though much opposed, soon became general. About that time, Dr. Redman published a short defence of it, and recommended the practice to his fellow-citizens in the most affectionate language. The success of inoculation was far from being universal. Subsequent improvements in the mode of preparing the body, and treating the eruptive fever, have led us to ascribe this want of success to the deep wound made in the arm, to the excessive quantity of mercury given to prepare the body, and to the use of a warm regimen in the eruptive fever.

The peculiar customs and the diseases which have been enumerated, by inducing general weakness, rendered the pulmonary consumption a frequent disease among both sexes.

Pains and diseases from decayed teeth were very common, between the years 1760 and 1766. At that time, the profession of a dentist was unknown in the city.

The practice of physic and surgery were united, during those years, in the same persons, and physicians were seldom employed as man-midwives, except in preternatural and tedious labours.

The practice of surgery was regulated by Mr. Sharp's treatise upon that branch of medicine.

Let us now take a view of the medical opinions which prevailed at the above period, and of the remedies which were employed to cure the diseases that have been mentioned.

The system of Dr. Boerhaave then governed the practice of every physician in Philadelphia. Of course diseases were ascribed to morbid acrimonies, and other matters in the blood, and the practice of those years was influenced by a belief in them. Medicines were prescribed to thin, and to incrassate the blood, and diet drinks were administered in large quantities, in order to alter its qualities. Great reliance was placed upon the powers of nature, and critical days were expected with solicitude, in order to observe the discharge of the morbid cause of fevers from the system. This matter was looked for chiefly in the urine, and glasses to retain it were a necessary part of the furniture of every sick room. To ensure the discharge of the supposed morbid matter of fevers through the pores, patients were confined to their beds, and fresh, with cool air, often excluded by close doors and curtains. The medicines to promote sweats were generally of a feeble nature. The spiritus mindereri, and the spirit of sweet nitre were in daily use for that purpose. In dangerous cases, saffron and Virginia snake-root were added to them.

Blood-letting was used plentifully in pleurisies and rheumatisms, but sparingly in all other diseases. Blood was often drawn from the feet, in order to excite a revulsion of disease from the superior parts of the body. It was considered as unsafe, at that time, to bleed during the monthly disease of the female sex.

Purges or vomits began the cure of all febrile diseases, but as the principal dependence was placed upon sweating medicines, those powerful remedies were seldom repeated in the subsequent stages of fevers. To this remark there was a general exception in the yellow fever of 1762. Small doses of glauber's salts were given every day after bleeding, so as to promote a gentle, but constant discharge from the bowels.

The bark was administered freely in intermittents. The prejudices against it at that time were so general among the common people, that it was often necessary to disguise it. An opinion prevailed among them, that it lay in their bones, and that it disposed them to take cold. It was seldom given in the low and gangrenous states of fever, when they were not attended with remissions.

The use of opium was confined chiefly to ease pain, to compose a cough, and to restrain preternatural discharges from the body. Such were the prejudices against it, that it was often necessary to conceal it in other medicines. It was rarely taken without the advice of a physician.

Mercury was in general use in the years that have been mentioned. I have said it was given to prepare the body for the small-pox. It was administered by my first preceptor in medicine, Dr. Redman, in the same disease, when it appeared in the natural way, with malignant or inflammatory symptoms, in order to keep the salivary glands open and flowing, during the turn of the pock. He gave it likewise liberally in the dry gripes. In one case of that disease, I well remember the pleasure he expressed, in consequence of its having affected his patient's mouth.

But to Dr. Thomas Bond the city of Philadelphia is indebted for the introduction of mercury into general use, in the practice of medicine. He called it emphatically “a revolutionary remedy,” and prescribed it in all diseases which resisted the common modes of practice. He gave it liberally in the cynanche trachealis. He sometimes cured madness, by giving it in such quantities as to excite a salivation. He attempted to cure pulmonary consumption by it, but without success; for, at that time, the influence of the relative actions of different diseases and remedies, upon the human body, was not known, or, if known, no advantage was derived from it in the practice of medicine.

The dry gripes were cured, at that time, by a new and peculiar mode of practice, by Dr. Thomas Cadwallader. He kept the patient easy by gentle anodynes, and gave lenient purges, only in the beginning of the disease; nor did he ever assist the latter by injections till the fourth and fifth days, at which time the bowels discharged their contents in an easy manner. It was said this mode of cure prevented the paralytic symptoms, which sometimes follow that disease. It was afterwards adopted and highly commended by the late Dr. Warren, of London.

Blisters were in general use, but seldom applied before the latter stage of fevers. They were prescribed, for the first time, in hæmorrhages, and with great success, by Dr. George Glentworth.

Wine was given sparingly, even in the lowest stage of what were then called putrid and nervous fevers.

The warm and cold baths were but little used in private practice. The former was now and then employed in acute diseases. They were both used in the most liberal manner, together with the vapour and warm air baths, in the Pennsylvania hospital, by Dr. Thomas Bond. An attempt was made to erect warm and cold baths, in the neighbourhood of the city, and to connect them with a house of entertainment, by Dr. Lauchlin M'Clen, in the year 1761. The project was considered as unfriendly to morals, and petitions, from several religious societies, were addressed to the governor of the province, to prevent its execution. The enterprize was abandoned, and the doctor soon afterwards left the city.

Riding on horseback, the fresh air of the sea-shore, and long journies, were often prescribed to invalids, by all the physicians of that day.

I come now to mention the causes which influence the diseases, also the medical opinions and remedies of the present time. In this part of our discourse, I shall follow the order of the first part of our inquiry.

I have already taken notice of the changes which the climate of Philadelphia has undergone since the year 1766.

A change has of late years taken place in the dress of the inhabitants of Philadelphia. Wigs have generally been laid aside, and the hair worn cut and dressed in different ways. Round hats, with high crowns, have become fashionable. Umbrellas, which were formerly a part of female dress only, are now used in warm and wet weather, by men of all ranks in society; and flannel is worn next to the skin in winter, and muslin in summer, by many persons of both sexes. Tight dresses are uncommon, and stays are unknown among our women. It is to be lamented that the benefits to health which might have been derived from the disuse of that part of female dress, have been prevented by the fashion of wearing such light coverings over the breasts and limbs. The evils from this cause, shall be mentioned hereafter.

A revolution has taken place in the diet of our citizens. Relishes and suppers are generally abolished; bitters, to provoke a preternatural appetite, also meridian bowls of punch, are now scarcely known. Animal food is eaten only at dinner, and excess in the use of it is prevented, by a profusion of excellent summer and winter vegetables.

Malt liquors, or hydrant water, with a moderate quantity of wine, are usually taken with those simple and wholesome meals.

Clubs, for the exclusive purpose of feeding, are dissolved, and succeeded by family parties, collected for the more rational entertainments of conversation, dancing, music, and chess. Taverns and beer-houses are much less frequented than formerly, and drunkenness is rarely seen in genteel life. The tea table, in an evening, has now become the place of resort of both sexes, and the midnight serenade has taken place of the midnight revels of the young gentlemen of former years.

In doing justice to the temperance of the modern citizens of Philadelphia, I am sorry to admit, there is still a good deal of secret drinking among them. Physicians, who detect it by the diseases it produces, often lament the inefficacy of their remedies to remove them. In addition to intemperance from spiritous liquors, a new species of intoxication from opium has found its way into our city. I have known death, in one instance, induced by it.

The following circumstances have had a favourable influence upon the health of the present inhabitants of Philadelphia.

The improvements in the construction of modern houses, so as to render them cooler in summer, and warmer in winter.

The less frequent practice of sitting on porches, exposed to the dew, in summer evenings.

The universal use of stoves in places of public worship.

The abolition of the custom of obliging lying-in women to sit up for company.

The partial use of Schuylkill or hydrant water, for culinary and other purposes.

The enjoyment of pure air, in country seats, in the neighbourhood of the city. They not only preserve from sickness during the summer and autumn, but they render families less liable to diseases during the other seasons of the year.

And, lastly, the frequent use of private, and public warm and cold baths. For the establishment of the latter, the citizens of Philadelphia are indebted to Mr. Joseph Simons.

The following circumstances have an unfavourable influence upon the health of our citizens.

Ice creams taken in excess, or upon an empty stomach.

The continuance of the practice of attending funerals, under all the circumstances that were mentioned in describing the customs which prevailed in Philadelphia, between the years 1760 and 1766.

The combined influence of great heat and intemperance in drinking, acting upon passions unusually excited by public objects, on the 4th of July, every year.

The general and inordinate use of segars.

The want of sufficient force in the water which falls into the common sewers to convey their contents into the Delaware, renders each of their apertures a source of sickly exhalations to the neighbouring streets and squares.

The compact manner in which the gutters are now formed, by preventing the descent of water into the earth, has contributed very much to retain the filth of the city, in those seasons in which they are not washed by rain, nor by the waste water of the pumps and hydrants.

The timbers of many of the wharves of the city have gone to decay. The docks have not been cleaned since the year 1774, and many of them expose large surfaces to the action of the sun at low water. The buildings have increased in Water-street, and with them there has been a great increase of that kind of filth which is generated in all houses; the stores in this street often contain matters which putrify; from all which there is, in warm weather, a constant emission of such a fœtid odour, as to render a walk through that street, by a person who does not reside there, extremely disagreeable, and sometimes to produce sickness and vomiting.

In many parts of the vicinity of the city are to be seen pools of stagnating water, from which there are exhaled large quantities of unhealthy vapours, during the summer and autumnal months.

The privies have become so numerous, and are often so full, as to become offensive in most of the compact parts of the city, more especially in damp weather.

The pump water is impregnated with many saline and aërial matters of an offensive nature.

While these causes exert an unfriendly influence upon the bodies of the citizens of Philadelphia, the extreme elevation or depression of their passions, by the different issues of their political contests (now far surpassing, in their magnitude, the contests of former years), together with their many new and fortuitous modes of suddenly acquiring and losing property, predispose them to many diseases of the mind.

The present diseases of Philadelphia come next under our consideration.

Fevers have assumed several new forms since the year 1766. The mild bilious fever has gradually spread over every part of the city. It followed the filth which was left by the British army in the year 1778. In the year 1780, it prevailed, as an epidemic, in Southwark, and in Water and Front-streets, below Market-street[67]. In the years 1791 and 1792, it assumed an inflammatory appearance, and was accompanied, in many cases, with hepatic affections. The connection of our subject requires that I should barely repeat, that it appeared in 1793 as an epidemic, in the form of what is called yellow fever, in which form it has appeared, in sporadic cases, or as an epidemic, every year since. During the reign of this high grade of bilious fever, mild intermittents and remittents, and the chronic or nervous forms of the summer and autumnal fever, have nearly disappeared.

Inflammations and obstructions of the liver have been more frequent than in former years, and even the pneumonies, catarrhs, intercurrent, and other fevers of the winter and spring months, have all partaken more or less of the inflammatory and malignant nature of the yellow fever.

The pulmonary consumption continues to be a common disease among both sexes.

The cynanche trachealis, the scarlatina anginosa, the hydrocephalus internus, and cholera infantum, are likewise common diseases in Philadelphia.

Madness, and several other diseases of the mind, have increased since the year 1766, from causes which have been mentioned.

Several of the different forms of gout are still common among both sexes.

Apoplexy and palsy have considerably diminished in our city. It is true, the bills of mortality still record a number of deaths from the former, every year; but this statement is incorrect, if it mean a disease of the brain only, for sudden deaths from all their causes are returned exclusively under the name of apoplexy. The less frequent occurrence of this disease, also of palsy, is probably occasioned by the less consumption of animal food, and of distilled and fermented liquors, by that class of citizens who are most subject to them, than in former years. Perhaps the round hat, and the general use of umbrellas, may have contributed to lessen those diseases of the brain.

The dropsy is now a rare disease, and seldom seen even in our hospital.

The colica pictonum, or dry gripes, is scarcely known in Philadelphia. I have ascribed this to the use of flannel next to the skin as a part of dress, and to the general disuse of punch as a common drink.

The natural small-pox is nearly extirpated, and the puerperile fever is rarely met with in Philadelphia. The scrophula is much less frequent than in former years. It is confined chiefly to persons in humble life.

I proceed, in the order that was proposed, to take notice of the present medical opinions which prevail among the physicians of Philadelphia. The system of Dr. Boerhaave long ago ceased to regulate the practice of physic. It was succeeded by the system of Dr. Cullen. In the year 1790, Dr. Brown's system of medicine was introduced and taught by Dr. Gibbon. It captivated a few young men for a while, but it soon fell into disrepute. Perhaps the high-toned diseases of our city exposed the fallacy and danger of the remedies inculcated by it, and afforded it a shorter life than it has had in many other countries. In the year 1790, the author of this inquiry promulgated some new principles in medicine, suggested by the peculiar phænomena of the diseases of the United States. These principles have been so much enlarged and improved by the successive observations and reasonings of many gentlemen in all the states, as to form an American system of medicine. This system rejects the nosological arrangement of diseases, and places all their numerous forms in morbid excitement, induced by irritants acting upon previous debility. It rejects, likewise, all prescriptions for the names of diseases, and, by directing their applications wholly to the forming and fluctuating states of diseases, and the system, derives from a few active medicines all the advantages which have been in vain expected from the numerous articles which compose European treatises upon the materia medica. This system has been adopted by a part of the physicians of Philadelphia, but a respectable number of them are still attached to the system of Dr. Cullen.

A great change has taken place in the remedies which are now in common use in Philadelphia. I shall briefly mention such of them as are new, and then take notice of the new and different modes of exhibiting such as were in use between the years 1760 and 1766.

Vaccination has been generally adopted in our city, in preference to inoculation with variolous matter.

Digitalis, lead, zinc, and arsenic are now common remedies in the hands of most of our practitioners.

Cold air, cold water, and ice are among the new remedies of modern practice in Philadelphia.

Blood-letting is now used in nearly all diseases of violent excitement, not only in the blood-vessels, but in other parts of the body. Its use is not, as in former times, limited to ounces in specific diseases, but regulated by their force, and the importance of the parts affected to health and life; nor is it forbidden, as formerly, in infancy, in extreme old age, in the summer months, nor in the period of menstruation, where symptoms of a violent, or of a suffocated disease, manifested by an active or a feeble pulse, indicate it to be necessary.

Leeches are now in general use in diseases which are removed, by their seat or local nature, beyond the influence of the lancet. For the introduction of this excellent remedy into our city we are indebted to Mr. John Cunitz.

Opium and bark, which were formerly given in disguise, or with a trembling hand, are now, not only prescribed by physicians, but often purchased, and taken without their advice, by many of the citizens of Philadelphia. They even occupy a shelf in the closets of many families.

The use of mercury has been revived, and a salivation has been extended; with great improvements and success, to nearly all violent and obstinate diseases. Nor has the influence of reason over ignorance and prejudice, with respect to that noble medicine, stopped here. Cold water, once supposed to be incompatible with its use, is now applied to the body, in malignant fevers, in order to insure and accelerate its operation upon the salivary glands.

Wine is given in large quantities, when indicated, without the least fear of producing intoxication.

The warm and cold baths, which were formerly confined chiefly to patients in the Pennsylvania hospital, are now common prescriptions in private practice.

Exercise, country air, and the sea shore, are now universally recommended in chronic diseases, and in the debility which precedes and follows them.

Great pains are now taken to regulate the quantity and quality of aliments and drinks, by the peculiar state of the system.

Let us now inquire into the influence of the new opinions in medicine, and the new remedies which have been mentioned, upon human life.

The small-pox, once the most fatal and universal of all diseases, has nearly ceased to occupy a place in our bills of mortality, by the introduction of vaccination in our city. For the prompt adoption of this great discovery, the citizens of Philadelphia owe a large debt of gratitude to Dr. Coxe, and Mr. John Vaughan.

Fevers, from all their causes, and in all their forms, with the exception of the bilious yellow fever, now yield to medicine. Even that most malignant form of febrile diseases is treated with more success in Philadelphia than in other countries. It would probably seldom prove mortal, did a belief in its being derived from an impure atmosphere, and of its exclusive influence upon the body, while it prevailed as an epidemic, obtain universally among the physicians and citizens of Philadelphia.

The pulmonary consumption has been prevented, in many hundred instances, by meeting its premonitory signs, in weakness and feeble morbid excitement in the whole system, by country air, gentle exercise, and gently stimulating remedies. Even when formed, and tending rapidly to its last stage, it has been cured by small and frequent bleedings, digitalis, and a mercurial salivation.

The hydrocephalus internus, the cynanche trachealis, and cholera infantum, once so fatal to the children of our city, now yield to medicine in their early stages. The two former are cured by copious bleeding, aided by remedies formerly employed in them without success. The last is cured by moderate bleeding, calomel, laudanum, and country air.

The gout has been torn from its ancient sanctuary in error and prejudice, and its acute paroxysms now yield with as much certainty to the lancet, as the most simple inflammatory diseases.

The dropsy is cured by renouncing the unfortunate association of specific remedies with its name, and accommodating them to the degrees of excitement in the blood-vessels.

The tetanus from wounds is now prevented, in most cases, by inflaming the injured parts, and thereby compelling them to defend the whole system, by a local disease. Where this preventing remedy has been neglected, and where tetanus arises from other causes than wounds, it has often been cured by adding to the diffusible stimulus of opium, the durable stimuli of bark and wine.

Death from drinking cold water, in the heated state of the body, is now obviated by previously wetting the hands or feet with the water; and when this precaution is neglected, the disease induced by it is generally cured by large doses of liquid laudanum.

Madness, which formerly doomed its miserable subjects to cells or chains for life, has yielded to bleeding, low diet, mercury, the warm and cold baths, fresh air, gentle exercise, and mild treatment, since its seat has been discovered to be in the blood-vessels of the brain.

The last achievement of our science in Philadelphia, that I shall mention, consists in the discovery and observation of the premonitory signs of violent and mortal diseases, and in subduing them by simple remedies, in their forming state. By this means, death has been despoiled of his prey, in many hundred instances.

In this successful conflict of medicine with disease and death, midwifery and surgery have borne a distinguished part. They derive their claims to the gratitude of the citizens of Philadelphia from the practice of each of them being more confined, than formerly, to a few members of our profession. It is in consequence of the former being exercised only by physicians of regular and extensive educations, that death from pregnancy and parturition is a rare occurrence in Philadelphia.

I should greatly exceed the limits prescribed to this inquiry, should I mention how much pain and misery have been relieved, and how often death has been baffled in his attempts upon human life, by several late improvements in old, and the discovery of new remedies in surgery. I shall briefly name a few of them.

In cases of blindness, from a partial opacity of the cornea, or from a closure of the natural pupil, a new pupil has been made; and where the cornea has been partially opaque, the opening through the iris has been formed, opposite to any part of it, which retained its transparency.

The cure of fractures has been accelerated by blood-letting, and, where the union of a broken bone has not taken place from a defect of bony matter, it has been produced by passing a seton between the fractured ends of the bone, and effecting a union thereby between them. Luxations, which have long resisted both force and art, have been reduced in a few minutes, and without pain, by bleeding at deliquium animi.

Old sores have been speedily healed, by destroying their surfaces, and thereby placing them in the condition of recent accidents.

The fruitless application of the trepan, in concussions of the brain, has been prevented by copious bleeding, and a salivation.

A suppression of urine has been cured, by the addition of a piece of a bougie to a flexible catheter.

Strictures in the urethra have been removed by means of a caustic, also, in a more expeditious way, by dividing them with a lancet.

Hydrocele has been cured by a small puncture, and afterwards exciting inflammation and adhesion by an injection of wine into the tunica vaginalis testis.

The popliteal aneurism and varicose veins have both been removed by operations that were unknown a few years ago.

For the introduction of several of those new surgical remedies, and for the discovery and improvement of others, the citizens of Philadelphia are indebted to Dr. Physick. They are likewise indebted to him and Dr. Griffitts for many of the new and successful modes of practice, in the diseases that have been mentioned. Even the few remedies that have been suggested by the author of these inquiries, owe their adoption and usefulness chiefly to the influence of those two respectable and popular physicians.

Before I dismiss this part of our subject, I have only to add, that since the cure and extraction of the teeth have become a distinct branch of the profession of medicine, several diseases which have arisen from them, when decayed, have been detected and cured[68].

We have thus taken a comparative view of the medical theories and remedies of former and modern times, and of their different influence upon human life. To exhibit the advantages of the latter over the former, I shall mention the difference in the number of deaths in three successive years, at a time when the population of the city and suburbs was supposed to amount to 30,000 souls, and in three years, after the population exceeded double that number.

Between the 25th of December, 1771, and the 25th of December, 1772, there died 1291 persons.

Between the same days of the same months, in 1772 and 1773, there died 1344 persons.

Within the same period of time, between 1773 and 1774, the deaths amounted to 1021, making in all 3,656. I regret that I have not been able to procure the returns of deaths in years prior to those which have been mentioned. During the three years that have been selected, no unusually mortal diseases prevailed in the city. The measles were epidemic in 1771, but were not more fatal than in common years.

Between the 25th of December, 1799, and the 25th of December, 1800, there died 1525 persons.

Between the same days of the same months, in the years 1801 and 1802, there died 1362 persons.

Within the same period of time, between 1802 and 1803, the deaths amounted to 1796, making in all 4,883.

Upon these returns it will be proper to remark, that several hundreds of the deaths, in 1802 and 1803, were from the yellow fever, and that many of them were of strangers. Of 68 persons, who were interred in the Swedes' church-yard alone, one half were of that description of people. Deducting 500 from both those causes of extra-mortality in the three years, between 1799 and 1803, the increase of deaths above what they were in the years 1771 and 1774 is but 727. Had diseases continued to be as mortal as they were thirty years ago, considering the present state of our population, the number of deaths would have been more than 7,312.

To render the circumstances of the statement of deaths that has been given perfectly equal, it will be necessary to add, that the measles prevailed in the city, in the year 1802, as generally as they did in 1771.

From the history that has been given, of the effects of the late improvements and discoveries in medicine upon human life, in Philadelphia, we are led to appreciate its importance and usefulness. It has been said, by its enemies, to move; but its motions have been asserted to be only in a circle. The facts that have been stated clearly prove, that it has moved, and rapidly too, within the last thirty years, in a straight line.

To encourage and regulate application and enterprize in medicine hereafter, let us inquire to what causes we are indebted for the late discoveries and improvements in our science, and for their happy effects in reducing the number of deaths so far below their former proportion to the inhabitants of Philadelphia.

The first cause I shall mention is the great physical changes which have taken place in the manners of our citizens in favour of health and life.

A second cause, is the assistance which has been afforded to the practice of physic, by the numerous and important discoveries that have lately been made in anatomy, natural history, and chemistry, all of which have been conveyed, from time to time, to the physicians of the city, by means of the Philadelphia and hospital libraries, and by the lectures upon those branches of science which are annually delivered in the university of Pennsylvania.

3. The application of reasoning to our science has contributed greatly to extend its success in the cure of diseases. Simply to observe and to remember, are the humblest operations of the human mind. Brutes do both. But to theorize, that is, to think, or, in other language, to compare facts, to reject counterfeits, to dissolve the seeming affinity of such as are not true, to combine those that are related, though found in remote situations from each other, and, finally, to deduce practical and useful inferences from them, are the high prerogatives and interest of man, in all his intellectual pursuits, and in none more, than in the profession of medicine.

4. The accommodation of remedies to the changes which are induced in diseases by the late revolutions in our climate, seasons, and manners, has had a sensible influence in improving the practice of medicine in our city. The same diseases, like the descendants of the same families, lose their resemblance to each other by the lapse of time; and the almanacks of 1803 might as well be consulted to inform us of the monthly phases of the moon of the present year, as the experience of former years, or the books of foreign countries, be relied upon to regulate the practice of physic at the present time, in any of the cities of the United States.

5. From the diffusion of medical knowledge among all classes of our citizens, by means of medical publications, and controversies, many people have been taught so much of the principles and practice of physic, as to be able to prescribe for themselves in the forming state of acute diseases, and thereby to prevent their fatal termination. It is to this self-acquired knowledge among the citizens of Philadelphia, that physicians are in part indebted for not being called out of their beds so frequently as in former years. There are few people who do not venture to administer laudanum in bowel complaints, and there are some persons in the city, who have cured the cynanche trachealis when it has occurred in the night, by vomits and bleeding, without the advice of a physician. The disuse of suppers is another cause why physicians enjoy more rest at night than formerly, for many of their midnight calls, were to relieve diseases brought on by that superfluous meal.

6. The dispensary instituted in our city, in the year 1786, for the medical relief of the poor, has assisted very much in promoting the empire of medicine over disease and death. Some lives have likewise been saved by the exertions of the humane society, by means of their printed directions to prevent sudden death; also, by the medical services which have lately been extended to out-patients, by order of the managers of the Pennsylvania hospital.

7thly and lastly. A change, favourable to successful practice in Philadelphia, has taken place in the conduct of physicians to their patients. A sick room has ceased to be the theatre of imposture in dress and manners, and prescriptions are no longer delivered with the pomp and authority of edicts. On the contrary, sick people are now instructed in the nature of their diseases, and informed of the names and design of their medicines, by which means faith and reason are made to co-operate in adding efficacy to them. Nor are patients left, as formerly, by their physicians, under the usual appearances of dissolution, without the aid of medicine. By thus disputing every inch of ground with death, many persons have been rescued from the grave, and lived, years afterwards, monuments of the power of the healing art.

From a review of what has been effected within the last nine and thirty years, in lessening the mortality of many diseases, we are led to look forward with confidence and pleasure to the future achievements of our science.

Could we lift the curtain of time which separates the year 1843 from our view, we should see cancers, pulmonary consumptions, apoplexies, palsies, epilepsy, and hydrophobia struck out of the list of mortal diseases, and many others which still retain an occasional power over life, rendered perfectly harmless, provided the same number of discoveries and improvements shall be made in medicine in the intermediate years, that have been made since the year 1766.

But in vain will the avenues of death from those diseases be closed, while the more deadly yellow fever is permitted to supply their place, and to spread terror, distress, and poverty through the city, by destroying the lives of her citizens by hundreds or thousands every year. Dear cradle of liberty of conscience in the western world! nurse of industry and arts! and patron of pious and benevolent institutions! may this cease to be thy melancholy destiny! May Heaven dispel the errors and prejudices of thy citizens upon the cause and means of preventing their pestilential calamities! and may thy prosperity and happiness be revived, extended, and perpetuated for ages yet to come!

Footnotes: