ots are by the people of Savoy, and mad dogs by the inhabitants of fome parts of Indoftan.

I remarked formerly, that as this disease became more general, it appeared to be almost the only one prevailing. Yet from a view of its fymptoms, as predominating variously in different perfons, it would be no difficult matter to multiply its names, until the methodical nofology of Cullen himself, fhould cease to furnish it with titles. It might be denominated phrenitis; and indeed it was termed for a while by one phyfician "an epidemic phrenitis." Pleurify and "febris catarrhalis," were readi ly applied; dyfentery and cynanche maligna, rheumatism from the general pains, and typhus from muscular debility, and a thousand others were liberally bestowed on it. But in general, it was denominated "the fever," "that fever," and "that there fever :"-titles which the great Cullen has omitted, but which wiser physicians have adopted. This variety of names would lead to infinite mischief by thofe men, whose prescriptions were not regulated by symptoms, but by empirical preju dices. It was forgotten, that the character of the disease continued unchanged, although its fhades were fomewhat varied that it was still a highly inflammatory fever, although some of its fymptoms might appear moft oppreffive in different parts of the body; and that it still required the fame mode of treatment, varied only in proportion to its violence.

Although common remittents were very general, prior to the appearance of the yellow fever, yet they gradually disappeared, giving place, as it were, to the stronger epidemic. By the middle of September, I did not meet with a cafe of any other dif eafe, befides the yellow' fever, except the fmall-pox, which continued to prevail in a most extenfive and fatal manner. We have been taught by Sydenham to expect, according to the combination of circumstances, the defpotic prevalence of fome one particular epidemic, over every other disease, appearing in the fame feafon; and if we had not innumerable facts to refort to, in corroboration of his affertions, we might have inferred fuch a truth even à priori: For as the particular conftitution of the

-feafon admits the exiftence of a particular epidemic, it must give rife to certain fymptoms in preference to that of any others. These symptoms, as depending on the fame caufes must bear a near relation to each other, and characterize the epidemic, as inflammatory or otherwife. Should the disease be at any time of an inflammatory nature, though prevailing only sporadically, that difpofition of the atmosphere, which renders it epidemic, must also give additional inflammatory violence to its fymptoms. Diseases, which in the ufual routine of their appearance, are regarded with no especial apprehenfions as to their event, would now affume a more serious type, or through defect of the particular circumftances favouring their existence, they would entirely difappear. Such as remained must bear the general character of the season, and from a similarity of symptoms, demand a fimilarity of treatment. Two diseases, therefore, of an oppofite nature, cannot exist epidemically at the fame time. The more powerful, or that more especially produced and fupported by its fostering caufes, will drive away the weaker, or that which has lefs power for its fupport. We are not however to expect every manner of disease totally to vanish before the epidemic-" for when I affirm," fays Sydenham,*"that one epidemic is expelled by another, I do not mean, that the yielding disease becomes quite extinct, but only lefs frequent."

During the prevalence of the late yellow fever, it is to be remarked, the small-pox did not vanish, but retained its ground. But this is not an objection to the opinions hitherto advanced. Is not the yellow fever, a difeafe highly inflammatory? So is the fmall-pox. Was this remitting fever more inflammatory than ufual, from the particular conftitution of the feafon? So was the fmall-pox. As an inflammatory fever, were not the yellow fever and thefmall-pox the fame disease, with particular fymptoms differently modified? And, therefore, would

• Wallis's Edition, page 145.

not that cause, which increased the violence of the one, augment the vehemence of the other? And if one general power prevailed, whofe influence gave rife to fome most characteristic fymptoms, ought we not to expect it to reign equally over both diseases? In fact, the two disorders were accompanied with fymptoms common to them both, and, had the eruption attended the yellow fever in place of a yellow fkin, or vice verfa, they might have generally been claffed under the fame name. Hæmorrhages attended both, and very frequently, the foreness or pain in the epigastric region, was as troublesome in the one as in the other. That particular fymptom, which we have formerly quoted from fome authors-the dangerous diarrhoea occafionally accompanying the close of the yellow fever, was common in the small-pox, and I am informed, proved fatal in feveral inftances. It is unneceffary to continue a parallel of symptoms, as it would be almost a recapitulation of what I have formerly writter.

If the most oppreffive fymptom resembled dyfentery, it yielded only to the means which fucceeded in the more common form of yellow fever. The fame obfervation applies to its appearance under the form of fore throat. It clothed itself in the garb of gaftrodynia and tetanus, which obftinately oppofed every mode of relief, until the general plan of cure hitherto described, immediately overcame them. As the season advanced, and its constitution became changed, the yellow fever difappeared, and gave room for the return of fuch diseases, as ufually prevail in that season.

The yellow fever, evidently proved contagious in Baltimore in many inftances. Some families at the Point avoided it, by carefully precluding all communication with the fick. Veffels alfo, preferved their crews in health, by removing to a distance from the wharf, and preventing the mariners from going on shore. But, as foon as one affected perfon came on board, he quickly infected all, or the greater part of the crew. One man, contracted the fever on fhore, and carried it on board the ship Phoenix, whofe crew was previously in good health. He laid ill in the

cabin and died. The man, who nurfed him, caught the difeafe, and communicated it to the mariner, who attended him in his illness. The latter, went forward, and by lying fick one night in the hold among the remaining failors, communicated the fever to the whole crew. Five died out of twelve. The captain of the Swedish ship Refolution, preserved the health of all his men, by preventing their communication with the shore: but venturing there himself in the middle of September, he caught the disease, and carrying it on board his vessel, communicated it to his attendant before he died. It paffed thus, from one to another, till almost all the crew became difeafed. I believe, seven of them died.

Even in the town, every precaution fometimes failed in obviating the effects of contagion. I will mention only one or two inftances. Mr. Ogle, by fitting a short time on the third of October, with a man, who died in as healthy a spot as any that Baltimore affords-(in Old Town) caught the fever, and was feveral days in imminent danger of losing his life. On the fifth, Dr. Heineck's boy died; he contracted the disease, by nursing a fick man in town, a part of one night only. Mr. Sheerer died on the fame day: a young man, William Murphy, who nurfed through one night, took the disease on the evening of the fixth, and died before noon, the following day.

• a coun

I have had an opportunity of knowing but one or two inftances of its communication in the country. Mr. C try gentleman of great refpectability, informed me, that he had contracted the disease in town by fitting two hours by a fick man, and communicated it to fome of his family. One of his children died.

Mr. W -d, formerly a ftudent of medicine in this town, contracted the disease on the Point, and going home, on the eastern shore of this state, communicated it to fome of his family; himself and his coufin fell the victims of the fever.

The number of deaths in Baltimore by the fever, amounted to nearly three hundred and fixty. ADIEU!

Baltimore, Dec. 1794.

Dewees Obfervations on DR. DENMAN'S APHORISMS, on the Ufe of the Forceps.

I

To the Editor of the Philadelphia Medical Museum.

SIR,

SEND you a few obfervations on fome of the Aphorifms of Dr. Denman, on the use and application of the Forceps. My inducement to this, has been, a conviction long felt, of their imperfection, contradiction and ambiguity. I have not attempted to remedy these defects; but have, I trust, from a careful examination of them, pointed out what appeared faulty, and given fatisfactory reafons for my diffent. If they should not appear in the fame light to others, who may have perused them, I fhall be happy to have my own oversights pointed out, and will thank him who may fet me right, where I wish not to be wrong.

Dr. Denman has long, and justly, ranked among the first in this department of medicine. The prefent attempt is not with a view to diminish that fame, by calling in queftion, without referve, his talents or his doctrines; it is defigned merely to diminish the influence of precepts too limitedly conceived, and too negligently expreffed, in a fmall work, entitled "Aphorifms on the application and ufe of the Forceps," &c. Perfection falls not to the lot of man; and Dr. Denman himself acknowledges, that cafes for the ufe of Forceps occur but rarely in any one man's practice; he therefore did not contemplate a perfect fyftem, in his directions for their ufe. However fenfible he may have been, of the imperfection of his work, from the confiderations juft mentioned, the public had a right to look for principles that had been well ascertained, and directions without ambiguity or confufion. Situated as Dr. Denman ́ has been, we cannot suppose him ignorant of the many improve