NICHOLAS MESSENGER, a German, about 30 years of age, who had lately arrived in Philadelphia from his native country, was admitted into the Pennfylvania hofpital on the 31ft of October with a pulmonary confumption, brought on by a cold taken between two and three months before. All his fymptoms, which were a fevere cough, purulent expectoration, chills, fever, hoarseness, and a degree of weakness which confined him constantly to his bed, indicated a speedy and unfavourable issue of his disease. His pulfe was too active for cordial remedies. I prescribed for him a blister to his breast, and the fame mercu rial and antimonial medicine with nitre, that I prescribed in the cafe of Elizabeth Davis. The mercury gently affected his mouth on the 14th of the month. His pulfe felt its effects, and fuddenly affumed the typhus action. I now directed the mercury to be discontinued, and ordered him to take two grains of opium every night, and a folution of liquorice in water with laudanum, to eafe his cough during the day. I prescribed at the fame time, drinks of the moft cordial kind, particularly wine, and brandy toddy, and animal food of all kinds to be taken as often and in as large quantities as his ftomach would bear them. On the 21ft of the month, his pulfe became fuller and flower. On the 23d a diarrhoea, and a return of the weakness and frequency of his pulse induced me to order him to take three grains of opium at bedtime, and the chalk julep strongly impregnated with laudanum during the day. his bowels foon yielded to these remedies. cember his pulfe again became fuller and flower. On the 5th he appeared to be much better. He flept foundly for three hours at night, coughed less, and ate his food with an appetite. On the 8th he left his bed, and walked out of his ward. On the 12th his pulfe became regular, and all the fymptoms of difeafe left him, except a troublesome wakefulnefs which often follows a recovery from violent and dangerous diseases. On the 15th he not only faid he was well, but difcovered the figus of a complete recovery in the return of flesh, a florid complexion, and in an ability to take exercise. On the 15th of January 1805, he was discharged from the hospital, cured.

The complaint in On the 1ft of De

Both the above patients were seen during the whole course of my attendance upon them, by more than an hundred students of medicine. Upon these cafes, I fhall make the following remarks :

1. It is difficult to tell the precise state of the lungs in these cafes. It was evident a purulent expectoration took place in each of them. A fimilar iffue from ftimulating remedies should not be expected where the lungs are affected with tubercles, It is, however, in favour of those remedies, that confumptions. with that iffue from them, are less common in the United States than any others, more efpecially when they are of a recent

nature.

2. The ufe of the ftimulating remedies which have been mentioned, fhould be confined to a weak or typhus state of the pulfe. In its inflammatory state, they do harm, and in its hectic ftate, they are generally ineffectual. It is not peculiar to the pulmonary consumption to resist the power of medicine, before it puts on its worst symptoms, or reaches its laft ftage. This was the cafe with the Jewish leprofy, and is still obferved in feveral modern diseases.

3. It has been faid that there exists for every disease a specific remedy, and that fooner or later that remedy will be difcovered. Without combating this affertion, I will fay, that most diseases have a precise or appropriate time in which only, certain remedies do fervice. This remark applies with peculiar force to the pulmonary confumption, and it is because the remedies for this disease are administered without à due regard to the different, conftantly varying, and often opposite states of the pulse, that bleeding, emetics, riding on horseback, a milk and vegetable diet, fea voyages, labour, digitalis, a falivation, opium and stimulating drinks and diet not only fail of fuccefs, but often do harm. The fable of the wax, which attempted to acquire the hardness of the brick, by throwing itself into the fire, is big with inftruction to physicians under this head. We are lefs in want of new VOL. I.

Tt

medicines, than of a knowledge of the times and manner of giving old ones, to enable us to cure obftinate and mortal difeafes..

4. An increase in the fulness, and a diminution of the fre quency of the pulfe should always be confidered as a signal to proceed with the use of stimulating remedies in this disease. An increase of the frequency of the pulfe or a revival of its tenfion from the ufe of thofe remedies, fhould always lead us to difcontinue them.

5. Animal food was preferred in the above cases to bark and the common ftimulants of the shops, upon the account of its furnishing the materials for a quick and plentiful supply of blood, and thereby producing fulness and force in the bloodvessels, (now nearly exhausted of their irritability) by its direct ftimulus upon them, and thus enabling them to perform their healthy actions in every part of the body, and more especially in the lungs. Perhaps fome advantage is derived from the ftimulus of animal food upon the system by the pleasurable fenfation it excites upon the tongue. This fenfation is the more delightful, and the more diffused in its good effects, from the patients having been long deprived of animal food, and from their longing for it.

6. Left an improper use should be made of the prescription of brandy toddy in the cafe of Nicholas Messenger, I shall conclude these remarks by adding, that I never prescribe ardent fpirits as a cordial, except, where I wish to obtain a prompt or immediate effect from them, in which cafe they are to be preferred to wine, and are often more acceptable to the stomach than opium. In chronic diseases of weak morbid action, and in fimple debility without disease, ardent spirits cannot be taken long enough to produce a falutary effect, without endangering a subfequent attachment to them, and thus creating worse diseases than thofe they were taken to cure.

Obfervations on Mr. Goldfon's Pamphlet, &c. in a Letter to the Editor. By JOHN CHURCH, M. D.

Philadelphia, Feb. 1ft, 1805.

I

SIR,

RETURN you the pamphlet of Mr. Goldson, and with it my thanks for its perufal.

From what I had previously heard of this work, I was induced to think the author might be entitled to fome degree of credit, in calling the attention of medical characters to more minutely examine a disease, new as to its difcovery, and in which there may, no doubt, be fome circumstances which should be attended to and explained, of which we may at prefent be ignorant. But it is to be fincerely lamented, that this gentleman had not more maturely considered the subject before he committed it to the prefs, as it is, of all others, a fubject of such vaft importance to the happiness of mankind.

He has mentioned feveral cafes which have fallen under his particular care, of fmall-pox, as be fuppofed, occurring after vaccination. He relates them with a view of proving that the inoculated cow-pock has only a temporary influence on the human fyftem, although at the fame time he admits the permanent effects of the cafual cow-pock, than which, nothing more unphilofophical could have been promulgated. This attempt to disturb the peaceful interefts of fociety, by exciting in the minds of very many timid and anxious parents, groundless apprehenfion, and to retard the progrefs of vaccination, calls loudly for the friends of this practice to step forward promptly in its defence: for, as Mr. Ring very juftly obferves, "while unfavourable cafes are circulated with great industry, by the enemies of vaccine inoculation, or its pretended friends, it appears that the real friends of the practice are lulled into a state of false fecurity, and become rather remifs, and being convinced themfelves, imagine that the public are convinced alfo. Hence they leave the field to their more active opponents, who improve the favourable occafion to their own advantage."

The cafes Mr. Goldfon has stated to fupport his opinion, which are related in a manner, (in my opinion) unfatisfactory to every perfon but himself, leaves us room ftrongly to fufpect that fome of them never had the fmall-pox; and there certainly appears to be still greater room to doubt, whether several really ever had the cow-pock.

Mistakes of this kind have been by no means rare, and have given rife to various reports, which have been induftriously encouraged by ignorance or prejudice. Dr. Lettfom fays that many mistakes have been committed by practitioners; matter has been taken from the chicken-pox, and too frequently from the purulent fluid round the scab of the cow-pock; and in either case it is needless to say, inoculation, under fuch circumstances, is no fecurity against the small-pox.

To fhew that it is not in vaccine inoculation alone that miftakes have been made, even by practitioners of established character, I beg leave to give you the following cafes which occurred not long fince.

M

I was called on the of December laft to vifit the fecond daughter of capt. M―, a delicate little girl, about eight years of age. She had been ill two days, with confiderable fever, fickness, and occasional vomiting, with great uneasiness in the head, back, and limbs. Thefe fymptoms, by a little bleeding and the antiphlogistic treatment, were foon relieved, fo that on the third day she was able to fit up. Her fkin at this time was covered with an eruption which appeared much like small-pox : however, as her parents declared fhe had when young, been inoculated by a refpectable phyfician in the country, (Dr. Goldfborough, of New-Caftle) who I conceived could not have been miftaken, I fuppofed it poffible the eruption I then faw, might be varicellous. On the fecond day of the appearance of the eruption, it affumed fo much the femblance of fmall-pox, that I found no difficulty in making up my mind. The difease went regularly through its different stages, and the child, though extremely full, recovered without accident.

Ten or twelve days after the indifpofition of this girl, a younger child, a fon, was taken ill with the fame fymptoms;