Medical Inquiries and Observations, Vol. 1 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

PART III.

We come now to the third part of this inquiry, that is, to mention the remedies for the evils which are brought on by the excessive use of distilled spirits.

These remedies divide themselves into two kinds.

I. Such as are proper to cure a fit of drunkenness, and

II. Such as are proper to prevent its recurrence, and to destroy a desire for ardent spirits.

I. I am aware that the efforts of science and humanity, in applying their resources to the cure of a disease, induced by an act of vice, will meet with a cold reception from many people. But let such people remember, the subjects of our remedies, are their fellow creatures, and that the miseries brought upon human nature, by its crimes, are as much the objects of divine compassion (which we are bound to imitate), as the distresses which are brought upon men, by the crimes of other people, or which they bring upon themselves, by ignorance or accidents. Let us not then, pass by the prostrate sufferer from strong drink, but administer to him the same relief, we would afford to a fellow creature, in a similar state, from an accidental, and innocent cause.

1. The first thing to be done to cure a fit of drunkenness, is to open the collar, if in a man, and remove all tight ligatures from every other part of the body. The head and shoulders should at the same time be elevated, so as to favour a more feeble determination of the blood to the brain.

2. The contents of the stomach should be discharged, by thrusting a feather down the throat. It often restores the patient immediately to his senses and feet. Should it fail of exciting a puking,

3. A napkin should be wrapped round the head, and wetted for an hour or two with cold water, or cold water should be poured in a stream upon the head. In the latter way, I have sometimes seen it used, when a boy, in the city of Philadelphia. It was applied, by dragging the patient, when found drunk in the street, to a pump, and pumping water upon his head for ten or fifteen minutes. The patient generally rose, and walked off, sober and sullen, after the use of this remedy.

Other remedies, less common, but not less effectual for a fit of drunkenness, are,

4. Plunging the whole body into cold water. A number of gentlemen who had drunken to intoxication, on board a ship in the stream, near Fell's point, at Baltimore, in consequence of their reeling in a small boat, on their way to the shore, in the evening, overset it, and fell into the water. Several boats from the shore hurried to their relief. They were all picked up, and went home, perfectly sober, to their families.

5. Terror. A number of young merchants, who had drunken together, in a compting-house, on James river, above thirty years ago, until they were intoxicated, were carried away by a sudden rise of the river, from an immense fall of rain. They floated several miles with the current, in their little cabin, half filled with water. An island in the river arrested it. When they reached the shore that saved their lives, they were all sober. It is probable terror assisted in the cure of the persons who fell into the water at Baltimore.

6. The excitement of a fit of anger. The late Dr. Witherspoon used to tell a story of a man in Scotland, who was always cured of a fit of drunkenness, by being made angry. The means chosen for that purpose, was a singular one. It was talking against religion.

7. A severe whipping. This remedy acts by exciting a revulsion of the blood from the brain, to the external parts of the body.

8. Profuse sweats. By means of this evacuation, nature sometimes cures a fit of drunkenness. Their good effects are obvious in labourers, whom quarts of spirits taken in a day, will seldom intoxicate, while they sweat freely. If the patient be unable to swallow warm drinks, in order to produce sweats, they may be excited by putting him in a warm bath, or wrapping his body in blankets, under which should be placed half a dozen hot bricks, or bottles filled with hot water.

9. Bleeding. This remedy should always be used, when the former ones have been prescribed to no purpose, or where there is reason to fear from the long duration of the disease, a material injury may be done to the brain.

It is hardly necessary to add, that each of the above remedies, should be regulated by the grade of drunkenness, and the greater or less degree, in which the intellects are affected in it.

II. The remedies which are proper to prevent the recurrence of fits of drunkenness, and to destroy the desire for ardent spirits, are religious, metaphysical, and medical. I shall briefly mention them.

1. Many hundred drunkards have been cured of their desire for ardent spirits, by a practical belief in the doctrines of the christian religion. Examples of the divine efficacy of christianity for this purpose, have lately occurred in many parts of the United States.

2. A sudden sense of the guilt contracted by drunkenness, and of its punishment in a future world. It once cured a gentleman in Philadelphia, who, in a fit of drunkenness, attempted to murder a wife whom he loved. Upon being told of it when he was sober, he was so struck with the enormity of the crime he had nearly committed, that he never tasted spiritous liquors afterwards.

3. A sudden sense of shame. Of the efficacy of this deep seated principle in the human bosom, in curing drunkenness, I shall relate three remarkable instances.

A farmer in England, who had been many years in the practice of coming home intoxicated, from a market town, one day observed appearances of rain, while he was in market. His hay was cut, and ready to be housed. To save it, he returned in haste to his farm, before he had taken his customary dose of grog. Upon coming into his house, one of his children, a boy of six years old, ran to his mother, and cried out, “O, mother! father is come home, and he is not drunk.” The father, who heard this exclamation, was so severely rebuked by it, that he suddenly became a sober man.

A noted drunkard was once followed by a favourite goat, to a tavern, into which he was invited by his master, and drenched with some of his liquor. The poor animal staggered home with his master, a good deal intoxicated. The next day he followed him to his accustomed tavern. When the goat came to the door, he paused: his master made signs to him to follow him into the house. The goat stood still. An attempt was made to thrust him into the tavern. He resisted, as if struck with the recollection of what he suffered from being intoxicated the night before. His master was so much affected by a sense of shame in observing the conduct of his goat to be so much more rational than his own, that he ceased from that time to drink spiritous liquors.

A gentleman, in one of the southern states, who had nearly destroyed himself by strong drink, was remarkable for exhibiting the grossest marks of folly in his fits of intoxication. One evening, sitting in his parlour, he heard an uncommon noise in his kitchen. He went to the door, and peeped through the key hole, from whence he saw one of his negroes diverting his fellow servants, by mimicking his master's gestures and conversation when he was drunk. The sight overwhelmed him with shame and distress, and instantly became the means of his reformation.

4. The association of the idea of ardent spirits, with a painful or disagreeable impression upon some part of the body, has sometimes cured the love of strong drink. I once tempted a negro man, who was habitually fond of ardent spirits, to drink some rum (which I placed in his way), and in which I had put a few grains of tartar emetic. The tartar sickened and puked him to such a degree, that he supposed himself to be poisoned. I was much gratified by observing he could not bear the sight, nor smell of spirits, for two years afterwards.

I have heard of a man, who was cured of the love of spirits, by working off a puke, by large draughts of brandy and water, and I know a gentleman, who in consequence of being affected with a rheumatism, immediately after drinking some toddy, when overcome with fatigue and exposure to the rain, has ever since loathed that liquor, only because it was accidentally associated in his memory with the recollection of the pain he suffered from his disease.

This appeal to that operation of the human mind, which obliges it to associate ideas, accidentally or otherwise combined, for the cure of vice, is very ancient. It was resorted to by Moses, when he compelled the children of Israel to drink the solution of the golden calf (which they had idolized) in water. This solution, if made, as it most probably was, by means of what is called hepar sulphuris, was extremely bitter, and nauseous, and could never be recollected afterwards, without bringing into equal detestation, the sin which subjected them to the necessity of drinking it. Our knowledge of this principle of association upon the minds and conduct of men, should lead us to destroy, by means of other impressions, the influence of all those circumstances, with which the recollection and desire of spirits are combined. Some men drink only in the morning, some at noon, and some only at night. Some men drink only on a market day, some at one tavern only, and some only in one kind of company. Now by finding a new and interesting employment, or subject of conversation for drunkards at the usual times in which they have been accustomed to drink, and by restraining them by the same means from those places and companions, which suggested to them the idea of ardent spirits, their habits of intemperance may be completely destroyed. In the same way the periodical returns of appetite, and a desire of sleep have been destroyed in a hundred instances. The desire for strong drink differs from each of them, in being of an artificial nature, and therefore not disposed to return, after being chased for a few weeks from the system.

5. The love of ardent spirits has sometimes been subdued, by exciting a counter passion in the mind. A citizen of Philadelphia had made many unsuccessful attempts to cure his wife of drunkenness. At length, despairing of her reformation, he purchased a hogshead of rum, and, after tapping it, left the key in the door of the room in which it was placed, as if he had forgotten it. His design was to give his wife an opportunity of drinking herself to death. She suspected this to be his motive, in what he had done, and suddenly left off drinking. Resentment here became the antidote to intemperance.

6. A diet consisting wholly of vegetables cured a physician in Maryland, of drunkenness, probably by lessening that thirst, which is always more or less excited by animal food.

7. Blisters to the ankles, which were followed by an unusual degree of inflammation, once suspended the love of ardent spirits, for one month, in a lady in this city. The degrees of her intemperance may be conceived of, when I add, that her grocer's account for brandy alone amounted, annually, to one hundred pounds, Pennsylvania currency, for several years.

8. A violent attack of an acute disease, has sometimes destroyed a habit of drinking distilled liquors. I attended a notorious drunkard, in the yellow fever, in the year 1798, who recovered with the loss of his relish for spirits, which has, I believe, continued ever since.

9. A salivation has lately performed a cure of drunkenness, in a person of Virginia. The new disease excited in the mouth and throat, while it rendered the action of the smallest quantity of spirits upon them painful, was happily calculated to destroy the disease in the stomach which prompts to drinking, as well as to render the recollection of them disagreeable, by the laws of association formerly mentioned.

10. I have known an oath, taken before a magistrate, to drink no more spirits, produce a perfect cure of drunkenness. It is sometimes cured in this way in Ireland. Persons who take oaths for this purpose are called affidavit men.

11. An advantage would probably arise from frequent representations being made to drunkards, not only of the certainty, but of the suddenness of death, from habits of intemperance. I have heard of two persons being cured of the love of ardent spirits, by seeing death suddenly induced by fits of intoxication; in the one case, in a stranger, and in the other, in an intimate friend.

12. It has been said, that the disuse of spirits should be gradual, but my observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly, and entirely. “Taste not, handle not, touch not,” should be inscribed upon every vessel that contains spirits, in the house of a man who wishes to be cured of habits of intemperance. To obviate, for a while, the debility which arises from the sudden abstraction of the stimulus of spirits, laudanum, or bitters infused in water, should be taken, and perhaps a larger quantity of beer or wine, that is consistent with the strict rules of temperate living. By the temporary use of these substitutes for spirits, I have never known the transition to sober habits to be attended with any bad effects, but often with permanent health of body, and peace of mind.

Footnotes:

[63] Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers, and others in the West-Indies.

[64] Treatise on Tropical Diseases.

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OBSERVATIONS
OF THE
DUTIES OF A PHYSICIAN,
AND THE METHODS OF
IMPROVING MEDICINE.
ACCOMMODATED TO THE PRESENT STATE OF SOCIETY AND MANNERS IN THE UNITED STATES.
Delivered in the University of Pennsylvania, February 7, 1789, at the conclusion of a course of lectures upon chemistry and the practice of physic.
PUBLISHED AT THE REQUEST OF THE CLASS.

GENTLEMEN,

I Shall conclude our course of lectures, by delivering to you a few directions for the regulation of your future conduct and studies, in the line of your profession.

I shall, first, suggest the most probable means of establishing yourselves in business, and of becoming acceptable to your patients, and respectable in life.

Secondly, I shall mention a few thoughts which have occurred to me on the mode to be pursued, in the further prosecution of your studies, and for the improvement of medicine.

I. Permit me, in the first place, to recommend to such of you as intend to settle in the country, to establish yourselves as early as possible upon farms. My reasons for this advice are as follow:

1. It will reconcile the country people to the liberality and dignity of your profession, by showing them that you assume no superiority over them from your education, and that you intend to share with them in those toils, which were imposed upon man in consequence of the loss of his innocence. This will prevent envy, and render you acceptable to your patients as men, as well as physicians.

2. By living on a farm you may serve your country, by promoting improvements in agriculture. Chemistry (which is now an important branch of a medical education) and agriculture are closely allied to each other. Hence some of the most useful books upon agriculture have been written by physicians. Witness the essays of Dr. Home of Edinburgh, and of Dr. Hunter of Yorkshire, in England.

3. The business of a farm will furnish you with employment in the healthy seasons of the year, and thereby deliver you from the tædium vitæ, or what is worse, from retreating to low or improper company. Perhaps one cause of the prevalence of dram or grog drinking, with which country practitioners are sometimes charged, is owing to their having no regular or profitable business to employ them, in the intervals of their attendance upon their patients.

4. The resources of a farm will create such an independence as will enable you to practice with more dignity, and at the same time screen you from the trouble of performing unnecessary services to your patients. It will change the nature of the obligation between you and them. While money is the only means of your subsistence, your patients will feel that they are the channels of your daily bread; but while your farm furnishes you with the necessaries of life, your patients will feel more sensibly, that the obligation is on their side, for health and life.

5. The exigencies and wants of a farm in stock and labour of all kinds, will enable you to obtain from your patients a compensation for your services in those articles. They all possess them, and men part with that of which money is only the sign, much more readily than they do with money itself.

6. The resources of a farm will prevent your cherishing, for a moment, an impious wish for the prevalence of sickness in your neighbourhood. A healthy season will enable you to add to the produce of your farm, while the rewards of an unhealthy season will enable you to repair the inconvenience of your necessary absence from it. By these means your pursuits will be marked by that variety and integrity, in which true happiness is said to consist.

7. Let your farms be small, and let your principal attention be directed to grass and horticulture. These afford most amusement, require only moderate labour, and will interfere least with your duties to your profession.

II. Avoid singularities of every kind in your manners, dress, and general conduct. Sir Isaac Newton, it is said, could not be distinguished in company, by any peculiarity, from a common well-bred gentleman. Singularity in any thing, is a substitute for such great or useful qualities as command respect; and hence we find it chiefly in little minds. The profane and indelicate combination of extravagant ideas, improperly called wit, and the formal and pompous manner, whether accompanied by a wig, a cane, or a ring, should be all avoided, as incompatible with the simplicity of science, and the real dignity of physic. There is more than one way of playing the quack. It is not necessary, for this purpose, that a man should advertise his skill, or his cures, or that he should mount a phaeton and display his dexterity in operating, to an ignorant and gaping multitude. A physician acts the same part in a different way, who assumes the character of a madman or a brute in his manners, or who conceals his fallibility by an affected gravity and taciturnity in his intercourse with his patients. Both characters, like the quack, impose upon the public. It is true, they deceive different ranks of people; but we must remember that there are two kinds of vulgar, viz. the rich and the poor; and that the rich vulgar are often upon a footing with the poor, in ignorance and credulity.

III. It has been objected to our profession, that many eminent physicians have been unfriendly to christianity. If this be true, I cannot help ascribing it in part to that neglect of public worship with which the duties of our profession are often incompatible; for it has been justly observed, that the neglect of this religious and social duty, generally produces a relaxation, either in principles or morals. Let this fact lead you, in setting out in business, to acquire such habits of punctuality in visiting your patients, as shall not interfere with acts of public homage to the Supreme Being. Dr. Gregory has observed, that a cold heart is the most frequent cause of deism. Where this occurs in a physician, it affords a presumption that he is deficient in humanity. But I cannot admit that infidelity is peculiar to our profession. On the contrary, I believe christianity places among its friends more men of extensive abilities and learning in medicine, than in any other secular employment. Stahl, Hoffman, Boerhaave, Sydenham, Haller, and Fothergill, were all christians. These enlightened physicians were considered as the ornaments of the ages in which they lived, and posterity has justly ranked them among the greatest benefactors of mankind.

IV. Permit me to recommend to you a regard to all the interests of your country. The education of a physician gives him a peculiar insight in the principles of many useful arts, and the practice of physic favours his opportunities of doing good, by diffusing knowledge of all kinds. It was in Rome, when medicine was practised only by slaves, that physicians were condemned by their profession “mutam exercere artem.” But in modern times, and in free governments, they should disdain an ignoble silence upon public subjects. The American revolution has rescued physic from its former slavish rank in society. For the honour of our profession it should be recorded, that some of the most intelligent and useful characters, both in the cabinet and the field, during the late war, have been physicians. The illustrious Dr. Fothergill opposed faction and tyranny, and took the lead in all public improvements in his native country, without suffering thereby the least diminution of that reputation, or business, in which, for forty years, he flourished almost without a rival in the city of London.

V. Let me advise you, in your visits to the sick, never to appear in a hurry, nor to talk of indifferent matters before you have made the necessary inquiries into the symptoms of your patient's disease.

VI. Avoid making light of any case. “Respice finem” should be the motto of every indisposition. There is scarcely a disease so trifling, that has not, directly or indirectly, proved an outlet to human life. This consideration should make you anxious and punctual in your attendance upon every acute disease, and keep you from risking your reputation by an improper or hasty prognosis.

VII. Do not condemn, or oppose, unnecessarily, the simple prescriptions of your patients. Yield to them in matters of little consequence, but maintain an inflexible authority over them in matters that are essential to life.

VIII. Preserve, upon all occasions, a composed or cheerful countenance in the room of your patients, and inspire as much hope of a recovery as you can, consistent with truth, especially in acute diseases. The extent of the influence of the will over the human body, has not yet been fully ascertained. I reject the futile pretensions of Mr. Mesmer to the cure of diseases, by what he has absurdly called animal magnetism. But I am willing to derive the same advantages from his deceptions, which the chemists have derived from the delusions of the alchemists. The facts which he has established, clearly prove the influence of the imagination, and will, upon diseases. Let us avail ourselves of the handle which those faculties of the mind present to us, in the strife between life and death. I have frequently prescribed remedies of doubtful efficacy in the critical stage of acute diseases, but never till I had worked up my patients into a confidence, bordering upon certainty, of their probable good effects. The success of this measure has much oftener answered, than disappointed my expectations; and while my patients have commended the vomit, the purge, or the blister which was prescribed, I have been disposed to attribute their recovery to the vigorous concurrence of the will in the action of the medicine. Does the will beget insensibility to cold, heat, hunger, and danger? Does it suspend pain, and raise the body above feeling the pangs of Indian tortures? Let us not then be surprised that it should enable the system to resolve a spasm, to open an obstruction, or to discharge an offending humour. I have only time to hint at this subject. Perhaps it would lead us, if we could trace it fully, to some very important discoveries in the cure of diseases.

IX. Permit me to advise you in your intercourse with your patients, to attend to that principle in the human mind, which constitutes the association of ideas. A chamber, a chair, a curtain, or even a cup, all belong to the means of life or death, accordingly as they are associated with cheerful or distressing ideas, in the mind of a patient. But this principle is of more immediate application in those chronic diseases which affect the mind. Nothing can be accomplished here, till we produce a new association of ideas. For this purpose a change of place and company are absolutely necessary. But we must sometimes proceed much further. I have heard of a gentleman in South-Carolina who cured his fits of low spirits by changing his clothes. The remedy was a rational one. It produced at once a new train of ideas, and thus removed the paroxysm of his disease.

X. Make it a rule never to be angry at any thing a sick man says or does to you. Sickness often adds to the natural irritability of the temper. We are, therefore, to bear the reproaches of our patients with meekness and silence. It is folly to resent injuries at any time, but it is cowardice to resent an injury from a sick man, since, from his weakness and dependence upon us, he is unable to contend with us upon equal terms. You will find it difficult to attach your patients to you by the obligations of friendship or gratitude. You will sometimes have the mortification of being deserted by those patients who owe most to your skill and humanity. This led Dr. Turner to advise physicians never to chuse their friends from among their patients. But this advice can never be followed by a heart that has been taught to love true excellency, wherever it finds it. I would rather advise you to give the benevolent feelings of your hearts full scope, and to forget the unkind returns they will often meet with, by giving to human nature—— a tear.

XI. Avoid giving a patient over in an acute disease. It is impossible to tell in such cases where life ends, and where death begins. Hundreds of patients have recovered, who have been pronounced incurable, to the great disgrace of our profession. I know that the practice of predicting danger and death upon every occasion, is sometimes made use of by physicians, in order to enhance the credit of their prescriptions if their patients recover, and to secure a retreat from blame, if they should die. But this mode of acting is mean and illiberal. It is not necessary that we should decide with confidence at any time, upon the issue of a disease.

XII. A physician in sickness is always a welcome visitor in a family; hence he is often solicited to partake of the usual sign of hospitality in this country, by taking a draught of some strong liquor, every time he enters into the house of a patient. Let me charge you to lay an early restraint upon yourselves, by refusing to yield to this practice, especially in the forenoon. Many physicians have been innocently led by it into habits of drunkenness. You will be in the more danger of falling into this vice, from the great fatigue and inclemency of the weather to which you will be exposed in country practice. But you have been taught that strong drink affords only a temporary relief from those evils, and that it afterwards renders the body more sensible of them.

XIII. I shall now give some directions with respect to the method of charging for your services to your patients.

When we consider the expence of a medical education, and the sacrifices a physician is obliged to make of ease, society, and even health, to his profession; and when we add to these, the constant and painful anxiety which is connected with the important charge of the lives of our fellow-creatures, and above all, the inestimable value of that blessing which is the object of his services, I hardly know how it is possible for a patient sufficiently and justly to reward his physician. But when we consider, on the other hand, that sickness deprives men of the means of acquiring money; that it increases all the expenses of living; and that high charges often drive patients from regular-bred physicians to quacks; I say, when we attend to these considerations, we should make our charges as moderate as possible, and conform them to the following state of things.

Avoid measuring your services to your patients by scruples, drachms, and ounces. It is an illiberal mode of charging. On the contrary, let the number and time of your visits, the nature of your patient's disease, and his rank in his family or society, determine the figures in your accounts. It is certainly just to charge more for curing an apoplexy, than an intermitting fever. It is equally just, to demand more for risking your life by visiting a patient in a contagious fever, than for curing a pleurisy. You have likewise a right to be paid for your anxiety. Charge the same services, therefore, higher, to the master or mistress of a family, or to an only son or daughter, who call forth all your feelings and industry, than to less important members of a family and of society. If a rich man demand more frequent visits than are necessary, and if he impose the restraints of keeping to hours, by calling in other physicians to consult with you upon every trifling occasion, it will be just to make him pay accordingly for it. As this mode of charging is strictly agreeable to reason and equity, it seldom fails of according with the reason and sense of equity of our patients. Accounts made out upon these principles, are seldom complained of by them. I shall only remark further upon this subject, that the sooner you send in your accounts after your patients recover, the better. It is the duty of a physician to inform his patient of the amount of his obligation to him at least once a year. But there are times when a departure from this rule may be necessary. An unexpected misfortune in business, and a variety of other accidents, may deprive a patient of the money he had allotted to pay his physician. In this case, delicacy and humanity require, that he should not know the amount of his debt to his physician, till time had bettered his circumstances.

I shall only add, under this head, that the poor of every description should be the objects of your peculiar care. Dr. Boerhaave used to say, “they were his best patients, because God was their paymaster.” The first physicians that I have known, have found the poor the steps by which they have ascended to business and reputation. Diseases among the lower class of people are generally simple, and exhibit to a physician the best cases of all epidemics, which cannot fail of adding to his ability of curing the complicated diseases of the rich and intemperate. There is an inseparable connection between a man's duty and his interest. Whenever you are called, therefore, to visit a poor patient, imagine you hear the voice of the good Samaritan sounding in your ears, “Take care of him, and I will repay thee.”

I come now to the second part of this address, which was to point out the best mode to be pursued, in the further prosecution of your studies, and the improvement of medicine.

I. Give me leave to recommend to you, to open all the dead bodies you can, without doing violence to the feelings of your patients, or the prejudices of the common people. Preserve a register of the weather, and of its influence upon the vegetable productions of the year. Above all, record the epidemics of every season; their times of appearing and disappearing, and the connection of the weather with each of them. Such records, if published, will be useful to foreigners, and a treasure to posterity. Preserve, likewise, an account of chronic cases. Record the name, age, and occupation of your patient; describe his disease accurately, and the changes produced in it by your remedies; mention the doses of every medicine you administer to him. It is impossible to tell how much improvement and facility in practice you will find from following these directions. It has been remarked, that physicians seldom remember more than the two or three last years of their practice. The records which have been mentioned, will supply this deficiency of memory, especially in that advanced stage of life when the advice of physicians is supposed to be most valuable.

II. Permit me to recommend to you further, the study of the anatomy (if I may be allowed the expression) of the human mind, commonly called metaphysics. The reciprocal influence of the body and mind upon each other, can only be ascertained by an accurate knowledge of the faculties of the mind, and of their various modes of combination and action. It is the duty of physicians to assert their prerogative, and to rescue the mental science from the usurpations of schoolmen and divines. It can only be perfected by the aid and discoveries of medicine. The authors I would recommend to you upon metaphysics, are, Butler, Locke, Hartley, Reid, and Beattie. These ingenious writers have cleared this sublime science of its technical rubbish, and rendered it both intelligible and useful.

III. Let me remind you, that improvement in medicine is not to be derived only from colleges and universities. Systems of physic are the productions of men of genius and learning; but those facts which constitute real knowledge, are to be met with in every walk of life. Remember how many of our most useful remedies have been discovered by quacks. Do not be afraid, therefore, of conversing with them, and of profiting by their ignorance and temerity in the practice of physic. Medicine has its Pharisees, as well as religion. But the spirit of this sect is as unfriendly to the advancement of medicine, as it is to christian charity. By conversing with quacks, we may convey instruction to them, and thereby lessen the mischief they might otherwise do to society. But further. In the pursuit of medical knowledge, let me advise you to converse with nurses and old women. They will often suggest facts in the history and cure of diseases, which have escaped the most sagacious observers of nature. Even negroes and Indians have sometimes stumbled upon discoveries in medicine. Be not ashamed to inquire into them. There is yet one more means of information in medicine which should not be neglected, and that is, to converse with persons who have recovered from indispositions without the aid of physicians. Examine the strength and exertions of nature in these cases, and mark the plain and home-made remedy to which they ascribe their recovery. I have found this to be a fruitful source of instruction, and have been led to conclude, that if every man in a city, or a district, could be called upon to relate to persons appointed to receive and publish his narrative, an exact account of the effects of those remedies which accident or whim has suggested to him, it would furnish a very useful book in medicine. To preserve the facts thus obtained, let me advise you to record them in a book to be kept for that purpose. There is one more advantage that will probably attend the inquiries that have been mentioned: you may discover diseases, or symptoms of diseases, or even laws of the animal economy, which have no place in our systems of nosology, or in our theories of physic.

IV. Study simplicity in the preparation of your medicines. My reasons for this advice are as follow:

1. Active medicines produce the most certain effects in a simple state.

2. Medicines when mixed frequently destroy the efficacy of each other. I do not include chemical medicines alone in this remark. It applies likewise to Galenical medicines. I do not say, that all these medicines are impaired by mixture, but we can only determine when they are not, by actual experiments and observations.

3. When medicines of the same class, or even of different classes, are given together, the strongest only produces an effect. But what are we to say to a compound of two medicines which give exactly the same impression to the system? Probably, if we are to judge from analogy, the effect of them will be such as would have been produced by neither, in a simple state.

4. By observing simplicity in your prescriptions, you will always have the command of a greater number of medicines of the same class, which may be used in succession to each other, in proportion as habit renders the system insensible of their action.

5. By using medicines in a simple state you will obtain an exact knowledge of their virtues and doses, and thereby be able to decide upon the numerous and contradictory accounts which exist in our books, of the character of the same medicines.

Under this head, I cannot help adding two more directions.

1. Avoid sacrificing too much to the taste of your patients in the preparation of your medicines. The nature of a medicine may be wholly changed by being mixed with sweet substances. The Author of Nature seems to have had a design, in rendering medicines unpalatable. Had they been more agreeable to the taste, they would probably have yielded long ago to the unbounded appetite of man, and by becoming articles of diet, or condiments, have lost their efficacy in diseases.

2. Give as few medicines as possible in tinctures made with distilled spirits. Perhaps there are few cases in which it is safe to exhibit medicines prepared in spirits, in any other form than in drops. Many people have been innocently seduced into a love of strong drink, from taking large or frequent doses of bitters, infused in spirits. Let not our profession be reproached in a single instance, with adding to the calamities that have been entailed upon mankind by this dreadful species of intemperance.

V. Let me recommend to your particular attention, the indigenous medicines of our country. Cultivate or prepare as many of them as possible, and endeavour to enlarge the materia medica, by exploring the untrodden fields and forests of the United States. The ipecacuanha, the Seneka and Virginia snake-roots, the Carolina pink-root, the spice-wood, the sassafras, the butter-nut, the thoroughwort, the poke, and the stramonium, are but a small part of the medicinal productions of America. I have no doubt but there are many hundred other plants which now exhale invaluable medicinal virtues in the desert air. Examine, likewise, the mineral waters, which are so various in their impregnation, and so common in all parts of our country. Let not the properties of the insects of America escape your investigation. We have already discovered among some of them, a fly equal in its blistering qualities to the famous fly of Spain. Who knows but it may be reserved for America to furnish the world, from her productions, with cures for some of those diseases which now elude the power of medicine? Who knows but that, at the foot of the Allegany mountain, there blooms a flower that is an infallible cure for the epilepsy? Perhaps on the Monongahela, or the Potomac, there may grow a root that shall supply, by its tonic powers, the invigorating effects of the savage or military life in the cure of consumptions. Human misery of every kind is evidently on the decline. Happiness, like truth, is a unit. While the world, from the progress of intellectual, moral, and political truth, is becoming a more safe and agreeable abode for man, the votaries of medicine should not be idle. All the doors and windows of the temple of nature have been thrown open by the convulsions of the late American revolution. This is the time, therefore, to press upon her altars. We have already drawn from them discoveries in morals, philosophy, and government; all of which have human happiness for their object. Let us preserve the unity of truth and happiness, by drawing from the same source, in the present critical moment, a knowledge of antidotes to those diseases which are supposed to be incurable.

I have now, gentlemen, only to thank you for the attention with which you have honoured the course of lectures which has been delivered to you, and to assure you, that I shall be happy in rendering you all the services that lie in my power, in any way you are pleased to command me. Accept of my best wishes for your happiness, and may the blessings of hundreds and thousands that were ready to perish, be your portion in life, your comfort in death, and your reward in the world to come.

---

AN
INQUIRY INTO THE CAUSE AND CURE
OF
SORE LEGS.

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 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 disease, by delivering and supporting the following propositions.

I. Sore legs are induced by general debility. 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 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 is 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 debility produced by intemperance in drinking ardent spirits, should appear first in the lower extremities. The 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 mortification on the legs.

II. Sore legs are connected with a morbid state of the whole system. This I infer,

1. From the causes which induce them, all of 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 disease; and the pulmonary consumption and apoplexy have often been preceded by the suppression of a 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.

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 some years ago.

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 weak morbid action takes place in the parts 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 before-mentioned exhibited remarkable proofs, 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 in that disease had been used to no purpose.

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.

VI. Rest in a recumbent posture of the body.

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 state 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 disease.

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, adhesive plasters so applied as to draw the sound edges of the sores together. This remedy has been used with great success by Dr. Physick, in the Pennsylvania hospital, and in his private practice.

IV. Above all, rest, and a horizontal posture of the leg. Too much cannot be said in favour 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, many years ago, informed me, that he confined him to his bed during the greatest part of the time that he was under his care.

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 a 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 its good effects after gun-shot wounds which are mentioned by Dr. Jackson[65]. 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 has been recommended in other diseases.

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. The manner in which I have directed it to be prepared and taken is as follows: To three or four heaped table-spoonsful of the malt, finely powdered and sifted, 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 disease.

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 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), compresses wetted with brandy, or ardent spirits of any kind, and, above all, the adhesive plasters formerly mentioned.

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 molasses. 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[66].

It is of the utmost consequence in the treatment of sore legs, to keep them clean, by frequent dressings 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 disease.

1. If it has been proved that sore legs are connected with a morbid state of the whole system, is it not proper to inquire, whether many other diseases supposed to be local, are not in like manner connected with the whole system; and if sore legs have been cured by general remedies, is it not proper to use them more frequently in local diseases?

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. 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, depend 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 disease than is commonly supposed to be necessary by physicians?

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. Unfortunately the morbid states of the arterial system, and the influence of those states upon the brain, 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.

Footnotes:

[65] Medical Journal, 1790.

[66] Medical Journal, Vol. VI.

---

AN ACCOUNT
OF THE
STATE OF THE BODY AND MIND
IN OLD AGE;
WITH
OBSERVATIONS ON ITS DISEASES,
AND THEIR REMEDIES.

Most of the facts which I shall deliver upon this subject, are the result of observations made during the term of five years, upon persons of both sexes, who had passed the 80th year of their lives. I intended to have given a detail of the names, manner of life, occupations, and other circumstances of each of them; but, upon a review of my notes, I found so great a sameness in the history of most of them, that I despaired, by detailing them, of answering the intention which I have purposed in the following essay. I shall, therefore, only deliver the facts and principles which are the result of the inquiries and observations I have made upon this subject.

I. I shall mention the circumstances which favour the attainment of longevity.

II. I shall mention the phenomena of body and mind which attend it; and,

III. I shall enumerate its peculiar diseases, and the remedies which are most proper to remove, or moderate them.

I. The circumstances which favour longevity, are,

1. Descent from long-lived ancestors. I have not found a single instance of a person, who has lived to be 80 years old, in whom this was not the case. In some instances I found the descent was only from one, but, in general, it was from both parents. The knowledge of this fact may serve, not only to assist in calculating what are called the chances of lives, but it may be made useful to a physician. He may learn from it to cherish hopes of his patients in chronic, and in some acute diseases, in proportion to the capacity of life they have derived from their ancestors[67].

2. Temperance in eating and drinking. To this remark I found several exceptions. I met with one man of 84 years of age, who had been intemperate in eating; and four or five persons who had been intemperate in drinking ardent spirits. They had all been day-labourers, or had deferred drinking until they began to feel the languor of old age. I did not meet with a single person who had not, for the last forty or fifty years of their lives, used tea, coffee, and bread and butter twice a day as part of their diet. I am disposed to believe that those articles of diet do not materially affect the duration of human life, although they evidently impair the strength of the system. The duration of life does not appear to depend so much upon the strength of the body, or upon the quantity of its excitability, as upon an exact accommodation of stimuli to each of them. A watch spring will last as long as an anchor, provided the forces which are capable of destroying both, are always in an exact ratio to their strength. The use of tea and coffee in diet seems to be happily suited to the change which has taken place in the human body, by sedentary occupations, by which means less nourishment and stimulus are required than formerly, to support animal life.

3. The moderate exercise of the understanding. It has long been an established truth, that literary men (other circumstances being equal) are longer lived than other people. But it is not necessary that the understanding should be employed upon philosophical subjects to produce this influence upon human life. Business, politics, and religion, which are the objects of attention of men of all classes, impart a vigour to the understanding, which, by being conveyed to every part of the body, tends to produce health and long life.

4. Equanimity of temper. The violent and irregular action of the passions tends to wear away the springs of life.

Persons who live upon annuities in Europe have been observed to be longer lived, in equal circumstances, than other people. This is probably occasioned by their being exempted, by the certainty of their subsistence, from those fears of want which so frequently distract the minds, and thereby weaken the bodies of old people. Life-rents have been supposed to have the same influence in prolonging life. Perhaps the desire of life, in order to enjoy for as long a time as possible, that property which cannot be enjoyed a second time by a child or relation, may be another cause of the longevity of persons who live upon certain incomes. It is a fact, that the desire of life is a very powerful stimulus in prolonging it, especially when that desire is supported by hope. This is obvious to physicians every day. Despair of recovery, is the beginning of death in all diseases.

But obvious and reasonable as the effects of equanimity of temper are upon human life, there are some exceptions in favour of passionate men and women having attained to a great age. The morbid stimulus of anger, in these cases, was probably obviated by less degrees, or less active exercises of the understanding, or by the defect or weakness of some of the other stimuli which keep up the motions of life.

5. Matrimony. In the course of my inquiries I met with only one person beyond eighty years of age who had never been married. I met with several women who had borne from ten to twenty children, and suckled them all. I met with one woman, a native of Herefordshire, in England, who was in the 100th year of her age, who had borne a child at 60, menstruated till 80, and frequently suckled two of her children (though born in succession to each other) at the same time. She had passed the greatest part of her life over a washing-tub.

6. Emigration. I have observed many instances of Europeans who have arrived in America in the decline of life, who have acquired fresh vigour from the impression of our climate, and of new objects upon their bodies and minds; and whose lives, in consequence thereof, appeared to have been prolonged for many years. This influence of climate upon longevity is not confined to the United States. Of 100 European Spaniards, who emigrate to South-America in early life, 18 live to be above 50, whereas but 8 or 9 native Spaniards, and but 7 Indians of the same number, exceed the 50th year of human life.

7. I have not found sedentary employments to prevent long life, where they are not accompanied by intemperance in eating or drinking. This observation is not confined to literary men, nor to women only, in whom longevity, without much exercise of body, has been frequently observed. I met with one instance of a weaver; a second of a silver-smith; and a third of a shoe-maker, among the number of old people, whose histories have suggested these observations.

8. I have not found that acute, nor that all chronic diseases shorten human life. Dr. Franklin had two successive vomicas in his lungs before he was 40 years old. I met with one man beyond 80, who had survived a most violent attack of the yellow fever; a second who had had several of his bones fractured by falls, and in frays; and many who had been frequently affected by intermittents. I met with one man of 86, who had all his life been subject to syncope; another who had for 50 years been occasionally affected by a cough[68]; and two instances of men who had been afflicted for forty years with obstinate head-achs[69]. I met with only one person beyond 80, who had ever been affected by a disease in the stomach; and in him it arose from an occasional rupture. Mr. John Strangeways Hutton, of this city, who died in 1793, in the 109th year of his age, informed me, that he had never puked in his life. This circumstance is the more remarkable, as he passed several years at sea when a young man[70]. These facts may serve to extend our ideas of the importance of a healthy state of the stomach in the animal economy; and thereby to add to our knowledge in the prognosis of diseases, and in the chances of human life.

9. I have not found the loss of teeth to affect the duration of human life, so much as might be expected. Edward Drinker, who lived to be 103 years old, lost his teeth thirty years before he died, from drawing the hot smoke of tobacco into his mouth through a short pipe.

Dr. Sayre of New-Jersey, to whom I am indebted for several very valuable histories of old persons, mentions one man aged 81, whose teeth began to decay at 16, and another of 90, who lost his teeth, thirty years before he saw him. The gums, by becoming hard, perform, in part, the office of teeth. But may not the gastric juice of the stomach, like the tears and urine, become acrid by age, and thereby supply, by a more dissolving power, the defect of mastication from the loss of teeth? Analogies might easily be adduced from several operations of nature, which go forward in the animal economy, which render this supposition highly probable.

10. I have not observed baldness, or grey hairs, occurring in early or middle life, to prevent old age. In one of the histories furnished me by Dr. Sayre, I find an account of a man of 81, whose hair began to assume a silver colour when he was but one and twenty years of age.

11. More women live to be old than men, but more men live to be very old, than women.

I shall conclude this head by the following remark:

Notwithstanding there appears in the human body a certain capacity of long life, which seems to dispose it to preserve its existence in every situation; yet this capacity does not always protect it from premature destruction; for among the old people whom I examined, I scarcely met with one who had not lost brothers or sisters, in early and middle life, and who were born under circumstances equally favourable to longevity with themselves.

II. I now come to mention some of the phenomena of the body and mind which occur in old age.

1. There is a great sensibility to cold in all old people. I met with an old woman of 84, who slept constantly under three blankets and a coverlet during the hottest summer months. The servant of prince de Beaufremont, who came from Mount Jura to Paris, at the age of 121, to pay his respects to the first national assembly of France, shivered with cold in the middle of the dog days, when he was not near a good fire. The national assembly directed him to sit with his hat on, in order to defend his head from the cold.

2. Impressions made upon the ears of old people, excite sensation and reflection much quicker than when they are made upon their eyes. Mr. Hutton informed me, that he had frequently met his sons in the street without knowing them, until they had spoken to him. Dr. Franklin informed me, that he recognized his friends, after a long absence from them, first by their voices. This fact does not contradict the common opinion, upon the subject of memory, for the recollection, in these instances, is the effect of what is called reminiscence, which differs from memory in being excited only by the renewal of the impression which at first produced the idea which is revived.

3. The appetite for food is generally increased in old age. The famous Parr, who died at 152, ate heartily in the last week of his life. The kindness of nature, in providing this last portion of earthly enjoyments for old people, deserves to be noticed. It is remarkable, that they have, like children, a frequent recurrence of appetite, and sustain with great uneasiness the intervals of regular meals. The observation, therefore, made by Hippocrates, that middle-aged people are more affected by abstinence than those who are old, is not true. This might easily be proved by many appeals to the records of medicine; but old people differ from children, in preferring solid to liquid aliment. From inattention to this fact, Dr. Mead has done great mischief by advising old people, as their teeth decayed or perished, to lessen the quantity of their solid, and to increase the quantity of their liquid food. This advice is contrary to nature and experience, and I have heard of two old persons who destroyed themselves by following it. The circulation of the blood is supported in old people chiefly by the stimulus of aliment. The action of liquids of all kinds upon the system is weak, and of short continuance, compared with the durable stimulus of solid food. There is a gradation in the action of this food upon the body. Animal matters are preferred to vegetable; the fat of meat to the lean, and salted meat to fresh, by most old people. I have met with but few old people who retained an appetite for milk. It is remarkable, that a less quantity of strong drink produces intoxication in old people than in persons in the middle of life. This depends upon the recurrence of the same state of the system, with respect to excitability, which takes place in childhood. Many old people, from an ignorance of this fact, have made shipwreck of characters which have commanded respect in every previous stage of their lives. From the same recurrence of the excitability of childhood in their systems, they commonly drink their tea and coffee much weaker than in early or middle life.

4. The pulse is generally full, and frequently affected by pauses in its pulsations when felt in the wrists of old people. A regular pulse in such persons indicates a disease, as it shows the system to be under the impression of a preternatural stimulus of some kind. This observation was suggested to me above thirty years ago by Morgagni, and I have often profited by it in attending old people. The pulse in such patients is an uncertain mark of the nature, or degree of an acute disease. It seldom partakes of the quickness or convulsive action of the arterial system, which attends fever in young or middle-aged people. I once attended a man of 77 in a fever of the bilious kind, which confined him for eight days to his bed, in whom I could not perceive the least quickness or morbid action in his pulse until four and twenty hours before he died.

5. The marks of old age appear earlier, and are more numerous in persons who have combined with hard labour, a vegetable or scanty diet, than in persons who have lived under opposite circumstances. I think I have observed these marks of old age to occur sooner, and to be more numerous in the German, than in the English or Irish citizens of Pennsylvania. They are likewise more common among the inhabitants of country places, than of cities, and still more so among the Indians of North-America, than among the inhabitants of civilized countries.

6. Old men tread upon the whole base of their feet at once in walking. This is perhaps one reason why they wear out fewer shoes, under the same circumstances of constant use, than young people, who, by treading on the posterior, and rising on the anterior part of their feet, expose their shoes to more unequal pressure and friction. The advantage derived to old people from this mode of walking is very obvious. It lessens that disposition to totter, which is always connected with weakness: hence we find the same mode of walking is adopted by habitual drunkards, and is sometimes from habit practised by them, when they are not under the influence of strong drink.

7. The breath and perspiration of old people have a peculiar acrimony, and their urine, in some instances, emits a fœtor of an offensive nature.

8. The eyes of very old people sometimes change from a dark and blue, to a light colour.

9. The memory is the first faculty of the mind which fails in the decline of life. While recent events pass through the mind without leaving an impression upon it, it is remarkable that the long forgotten events of childhood and youth are recalled and distinctly remembered.

I met with a singular instance of a German woman, who had learned to speak the language of our country after she was forty years of age, who had forgotten every word of it after she had passed her 80th year, but spoke the German language as fluently as ever she had done. The memory decays soonest in hard drinkers. I have observed some studious men to suffer a decay of their memories, but never of their understandings. Among these was the late Anthony Benezet of this city. But even this infirmity did not abate the cheerfulness, nor lessen the happiness of this pious philosopher, for he once told me, when I was a young man, that he had a consolation in the decay of his memory, which gave him a great advantage over me. “You can read a good book (said he) with pleasure but once, but when I read a good book, I so soon forget the contents of it, that I have the pleasure of reading it over and over; and every time I read it, it is alike new and delightful to me." The celebrated Dr. Swift was one of those few studious men, who have exhibited marks of a decay of understanding in old age; but it is judiciously ascribed by Dr. Johnson to two causes which rescue books, and the exercise of the thinking faculties from having had any share in inducing that disease upon his mind. These causes were, a rash vow which he made when a young man, never to use spectacles, and a sordid seclusion of himself from company, by which means he was cut off from the use of books, and the benefits of conversation, the absence of which left his mind without its usual stimulus: hence it collapsed into a state of fatuity. It is probably owing to the constant exercise of the understanding, that literary men possess that faculty of the mind in a vigorous state in extreme old age. The same cause accounts for old people preserving their intellects longer in cities, than in country places. They enjoy society upon such easy terms in the former situation, that their minds are kept more constantly in an excited state by the acquisition of new, or the renovation of old ideas, by means of conversation.

10. I did not meet with a single instance in which the moral or religious faculties were impaired in old people. I do not believe, that these faculties of the mind are preserved by any supernatural power, but wholly by the constant and increasing exercise of them in the evening of life. In the course of my inquiries, I heard of a man of 101 years of age, who declared that he had forgotten every thing he had ever known, except his God. I found the moral faculty, or a disposition to do kind offices to be exquisitely sensible in several old people, in whom there was scarcely a trace left of memory or understanding.

11. Dreaming is universal among old people. It appears to be brought on by their imperfect sleep, of which I shall say more hereafter.

12. I mentioned formerly the sign of a second childhood in the state of the appetite in old people. It appears further, 1. In the marks which slight contusions or impressions leave upon their skins. 2. In their being soon fatigued by walking or exercise, and in being as soon refreshed by rest. 3. In their disposition, like children, to detail immediately every thing they see and hear. And, 4. In their aptitude to shed tears; hence they are unable to tell a story that is in any degree distressing without weeping. Dr. Moore takes notice of this peculiarity in Voltaire, after he had passed his 80th year. He wept constantly at the recital of his own tragedies. This feature in old age, did not escape Homer. Old Menelaus wept ten years after he returned from the destruction of Troy, when he spoke of the death of the heroes who perished before that city.

13. It would be sufficiently humbling to human nature, if our bodies exhibited in old age the marks only of a second childhood; but human weakness descends still lower. I met with an instance of a woman between 80 and 90, who exhibited the marks of a second infancy, by such a total decay of her mental faculties, as to lose all consciousness in discharging her alvine and urinary excretions. In this state of the body, a disposition to sleep, succeeds the wakefulness of the first stages of old age. Dr. Haller mentions an instance of a very old man who slept twenty, out of every twenty-four hours during the few last years of his life.

14. The disposition in the system to renew certain parts in extreme old age, has been mentioned by several authors. Many instances are to be met with in the records of medicine of the sight[71] and hearing having been restored, and even of the teeth having been renewed in old people a few years before death. These phenomena have led me to suspect that the antediluvian age was attained by the frequent renovation of different parts of the body, and that when they occur, they are an effort of the causes which support animal life, to produce antediluvian longevity, by acting upon the revived excitability of the system.

15. The fear of death appears to be much less in old age, than in early, or middle life. I met with many old people who spoke of their dissolution with composure, and with some who expressed earnest desires to lie down in the grave. This indifference to life, and desire for death (whether they arise from a satiety in worldly pursuits and pleasures, or from a desire of being relieved from pain) appear to be a wise law in the animal economy, and worthy of being classed with those laws which accommodate the body and mind of man to all the natural evils, to which, in the common order of things, they are necessarily exposed.

III. I come now briefly to enumerate the diseases of old age, and the remedies which are most proper to remove, or to mitigate them.

The diseases are chronic and acute. The CHRONIC are,

1. Weakness of the knees and ancles, a lessened ability to walk, and tremors in the head and limbs.

2. Pains in the bones, known among nosological writers by the name of rheumatalgia.

3. Involuntary flow of tears, and of mucus from the nose.

4. Difficulty of breathing, and a short cough, with copious expectoration. A weak, or hoarse voice generally attends this cough.

5. Costiveness.

6. An inability to retain the urine as long as in early or middle life. Few persons beyond 60 pass a whole night without being obliged to discharge their urine[72]. Perhaps the stimulus of this liquor in the bladder may be one cause of the universality of dreaming among old people. It is certainly a frequent cause of dreaming in persons in early and middle life: this I infer, from its occuring chiefly in the morning when the bladder is most distended with urine. There is likewise an inability in old people to discharge their urine as quickly as in early life. I think I have observed this to be among the first symptoms of the declension of the strength of the body by age.

7. Wakefulness. This is probably produced in part by the action of the urine upon the bladder; but such is the excitability of the system in the first stages of old age, that there is no pain so light, no anxiety so trifling, and no sound so small, as not to produce wakefulness in old people. It is owing to their imperfect sleep, that they are sometimes as unconscious of the moment of their passing from a sleeping to a waking state, as young and middle-aged people are of the moment in which they pass from the waking to a sleeping state. Hence we so often hear them complain of passing sleepless nights. This is no doubt frequently the case, but I am satisfied, from the result of an inquiry made upon this subject, that they often sleep without knowing it, and that their complaints in the morning, of the want of sleep, arise from ignorance, without the least intention to deceive.

8. Giddiness.

9. Deafness.

10. Imperfect vision.

The acute diseases most common among old people, are,

1. Inflammation of the eyes.

2. The pneumonia notha, or bastard peripneumony.

3. The colic.

4. Palsy and apoplexy.

5. The piles.

6. A difficulty in making water.

7. Quartan fever.

All the diseases of old people, both chronic and acute, originate in predisposing debility. The remedies for the former, where a feeble morbid action takes place in the system, are stimulants. The first of these is,

I. Heat. The ancient Romans prolonged life by retiring to Naples, as soon as they felt the infirmities of age coming upon them. The aged Portuguese imitate them, by approaching the warm sun of Brazil, in South-America. But heat may be applied to the torpid bodies of old people artificially. 1st. By means of the warm bath. Dr. Franklin owed much of the cheerfulness and general vigour of body and mind which characterised his old age, to his regular use of this remedy. It disposed him to sleep, and even produced a respite from the pain of the stone, with which he was afflicted during the last years of his life.

2. Heat may be applied to the bodies of old people by means of stove-rooms. The late Dr. Dewit, of Germantown, who lived to be near 100 years of age, seldom breathed an air below 72°, after he became an old man. He lived constantly in a stove-room.

3. Warm Clothing, more especially warm bed-clothes, are proper to preserve or increase the heat of old people. From the neglect of the latter, they are often found dead in their beds in the morning, after a cold night, in all cold countries. The late Dr. Chovet, of this city, who lived to be 85, slept in a baize night-gown, under eight blankets, and a coverlet, in a stove-room, many years before he died. The head should be defended in old people, by means of woollen, or fur caps, in the night, and by wigs and hats during the day, in cold weather. These artificial coverings will be the more necessary, where the head has been deprived of its natural covering. Great pains should be taken likewise to keep the feet dry and warm, by means of thick shoes[73]. To these modes of applying and confining heat to the bodies of old people, a young bed-fellow has been added; but I conceive the three artificial modes which have been recommended, will be sufficient without the use of one, which cannot be successfully employed without a breach of delicacy or humanity.

II. To keep up the action of the system, GENEROUS DIET and DRINKS should be given to old people. For a reason mentioned formerly, they should be indulged in eating between the ordinary meals of families. Wine should be given to them in moderation. It has been emphatically called the milk of old age.

III. Young Company should be preferred by old people to the company of persons of their own age. I think I have observed old people to enjoy better health and spirits, when they have passed the evening of their lives in the families of their children, where they have been surrounded by grand-children, than when they lived by themselves. Even the solicitude they feel for the welfare of their descendants, contributes to invigorate the circulation of the blood, and thereby to add fuel to the lamp of life.

IV. Gentle Exercise. This is of great consequence in promoting the health of old people. It should be moderate, regular, and always in fair weather.

V. Cleanliness. This should by no means be neglected. The dress of old people should not only be clean, but more elegant than in youth or middle life. It serves to divert the eye of spectators from observing the decay and deformity of the body, to view and admire that which is always agreeable to it.

VI. To abate the pains of the chronic rheumatism, and the uneasiness of the old man's cough (as it is called); also to remove wakefulness, and to restrain, during the night, a troublesome inclination to make water, OPIUM may be given with great advantage. Chardin informs us, that this medicine is frequently used in the eastern countries to abate the pains and weaknesses of old age, by those people who are debarred the use of wine by the religion of Mahomet.

I have nothing to say upon the acute diseases of old people, but what is to be found in most of our books of medicine, except to recommend BLEEDING in those of them which are attended with plethora, and an inflammatory action in the pulse. The degrees of appetite which belong to old age, the quality of the food taken, and the sedentary life which is generally connected with it, all concur to produce that state of the system, which requires the above evacuation. I am sure that I have seen many of the chronic complaints of old people mitigated by it, and I have more than once seen it used with obvious advantage in their inflammatory diseases. These affections I have observed to be more fatal among old people than is generally supposed. An inflammation of the lungs, which terminated in an abscess, deprived the world of Dr. Franklin. Dr. Chovet died of an inflammation in his liver. The blood drawn from him a few days before his death was sizy, and such was the heat of his body, produced by his fever, that he could not bear more covering (notwithstanding his former habits of warm clothing) than a sheet in the month of January.

Death from old age is the effect of a gradual palsy. It shows itself first in the eyes and ears, in the decay of sight and hearing; it appears next in the urinary bladder, in the limbs and trunk of the body; then in the sphincters of the bladder and rectum; and finally in the nerves and brain, destroying in the last, the exercise of all the faculties of the mind.

Few persons appear to die of old age. Some one of the diseases which have been mentioned, generally cuts the last thread of life.

Footnotes:

[67] Dr. Franklin, who died in his 84th year, was descended from long-lived parents. His father died at 89, and his mother at 87. His father had 17 children by two wives. The doctor informed me, that he once sat down as one of 11 adult sons and daughters at his father's table. In an excursion he once made to that part of England from whence his family migrated to America, he discovered, in a grave-yard, the tomb-stones of several persons of his name, who had lived to be very old. These persons he supposed to have been his ancestors.

[68] This man's only remedy for his cough was the fine powder of dry Indian turnip and honey.

[69] Dr. Thiery says, that he did not find the itch, or slight degrees of the leprosy, to prevent longevity. Observations de Physique, et de Medecine faites en differens lieux de L'Espagne. Vol II. p. 17 i.

[70] The venerable old man, whose history first suggested this remark, was born in New-York in the year 1684. His grandfather lived to be 101, but was unable to walk for thirty years before he died, from an excessive quantity of fat. His mother died at 91. His constant drinks were water, beer, and cyder. He had a fixed dislike to spirits of all kinds. His appetite was good, and he ate plentifully during the last years of his life. He seldom drank any thing between his meals. He was never intoxicated but twice in his life, and that was when a boy, and at sea, where he remembers perfectly well to have celebrated, by a feu de joye, the birth-day of queen Anne. He was formerly afflicted with the head-ach and giddiness, but never had a fever, except from the small-pox, in the course of his life. His pulse was slow, but regular. He had been twice married. By his first wife he had eight, and by his second seventeen children. One of them lived to be 83 years of age. He was about five feet nine inches in height, of a slender make, and carried an erect head to the last year of his life.

[71] There is a remarkable instance of the sight having been restored after it had been totally destroyed in an old man near Reading, in Pennsylvania. My brother, Judge Rush, furnished me with the following account of him in a letter from Reading, dated June 23, 1792.

“An old man, of 84 years of age, of the name of Adam Riffle, near this town, gradually lost his sight in the 68th year of his age, and continued entirely blind for the space of twelve years. About four years ago his sight returned, without making use of any means for the purpose, and without any visible change in the appearance of the eyes, and he now sees as well as ever he did. I have seen the man, and have no doubt of the fact. He is at this time so hearty, as to be able to walk from his house to Reading (about three miles), which he frequently does in order to attend church. I should observe, that during both the gradual loss, and recovery of his sight, he was no ways affected by sickness, but, on the contrary, enjoyed his usual health. I have this account from his daughter and son-in-law, who live within a few doors of me.”

[72] I met with an old man, who informed me, that if from any accident he retained his urine after he felt an inclination to discharge it, he was affected by a numbness, accompanied by an uneasy sensation in the palms of his hands.

[73] I met with one man above 80, who defended his feet from moisture by covering his shoes in wet weather with melted wax; and another who, for the same purpose, covered his shoes every morning with a mixture composed of the following ingredients melted together: lintseed oil a pound, mutton suet eight ounces, bees-wax six ounces, and rosin four ounces. The mixture should be moderately warmed, and then applied not only to the upper leather, but to the soles of the shoes. This composition, the old gentleman informed me, was extracted from a book entitled, “The Complete Fisherman,” published in England, in the reign of queen Elizabeth. He had used it for twenty years in cold and wet weather, with great benefit, and several of his friends, who had tried it, spoke of its efficacy in keeping the feet dry, in high terms.

END OF VOLUME I.

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