Benjamin Rush

“ From the explanation that has been given of the instances of supposed contagion of the yellow fever, we are compelled to resort to certain noxious qualities in the atmosphere, as the exclusive causes of the prevalence, not only of that fever, but (with a few exceptions) of all other epidemic diseases. It is true, we are as yet ignorant of the precise nature of those qualities in the air which produce epidemics; but their effects are as certainly felt by the human body as the effects of heat, and yet who knows the nature of that great and universal principle of activity in our globe? ”

“ I once believed, upon the authorities of travellers, physicians, and schools of medicine, that it was a highly contagious disease. I am now satisfied this is not the case; but, from the greater number of people who are depressed and debilitated by poverty and famine, and who live in small and filthy huts [47] in the cities of the east, than in the cities of the United States, I still believe it to be more frequently communicated from an intercourse with sick people by the morbid excretions of the body, than the yellow fever is in our country. ”

“ I cannot conclude this head, without lamenting the want of laws in all our states, to compel physicians to make public the first cases of malignant fever that come under their notice. The cry of fire is not more useful to save a city from destruction, than the early knowledge of such cases would be to save it from the ravages of pestilential and mortal epidemics. Hundreds of instances have occurred, in all ages and countries, in which they might have been stifled in their birth, by the means that have been mentioned, had this practice been adopted. ”

“ I have frequently been surprised, in visiting English patients, to hear them say, when I have prescribed bleeding, that their physicians in England had charged them never to be bled. This advice excluded all regard to the changes which climate, diet, new employments, and age might induce upon the system. I am disposed to believe that many lives are lost, and numerous chronic diseases created in Great-Britain, by the neglect of bleeding in fevers. ”

“ It cures, without permitting a fever to put on those alarming symptoms, which excite constant apprehensions of danger and death, in the minds of patients and their friends. It is because these alarming symptoms are prevented, by bleeding, that patients are sometimes unwilling to believe they have been cured by it, of a malignant fever. Thus, the Syrian leper of old, viewed the water of Jordan as too simple and too common to cure a formidable disease, without recollecting that the remedies for the greatest evils of life are all simple, and within the power of the greatest part of mankind. ”

“ Why, if the yellow fever be derived from the West-Indies, was it not imported every year before 1791, and before the existence, or during the feeble and partial operation of quarantine laws? It is no answer to this question to say, that a war is necessary to generate the disease in the islands, for it exists in some of them at all times, and the seasons of its prevalence in our cities have, in many instances, [250] had no connection with war, nor with the presence of European armies in those and in other sickly parts of the globe. ”

“ Considering the great prejudices against blood-letting, I have wished to combat this fever with mercury alone. But, for reasons formerly given, I have been afraid to trust to it without the assistance of the lancet. The character of the fever, moreover, like that which the poet has ascribed to Achilles, is of “so swift, irritable, inexorable, and cruel” a nature, that it would be unsafe to rely exclusively upon a medicine which is not only of less efficacy than bleeding, but often slow and uncertain in its operation, more especially upon the throat and mouth. ”

“ Madness, which formerly doomed its miserable subjects to cells or chains for life, has yielded to bleeding, low diet, mercury, the warm and cold baths, fresh air, gentle exercise, and mild treatment, since its seat has been discovered to be in the blood-vessels of the brain.
The last achievement of our science in Philadelphia, that I shall mention, consists in the discovery and observation of the premonitory signs of violent and mortal diseases, and in subduing them by simple remedies, in their forming state. By this means, death has been despoiled of his prey, in many hundred instances. ”

“ Pinckard's, among whom are Pringle, Huck, and Hunter, might be adduced in support of the unity of bilious fever. But to multiply them further would be an act of homage to the weakness of human reason, and an acknowledgment of the infant state of our knowledge in medicine. As well might we suppose nature to be an artist, and that diseases were shaped by her like a piece of statuary, [27] or a suit of clothes, by means of a chissel, or pair of scissars, as admit every different form and grade of morbid action in the system to be a distinct disease. ”

“ Herberden has lately called in question the truth of all the stories that are upon record of the plague having been imported into England in the last century, and the researches of Sir Robert Wilson of the British army, and of Assellini, and several other French physicians, [270] have produced the most satisfactory proofs of its not being a contagious disease in its native country. A discovery more pregnant with blessings to mankind has seldom been made. Pyramids of error, the works of successive ages and nations, must fall before it, and rivers of tears must be dried up by it. ”

“ Long before it reduces the pulse, it often induces such a relaxation of the tone of the stomach and bowels as to accelerate death. To depend upon it therefore in the cure of inflammatory fever, whether acute or chronic, is like trusting to the rays of the sun to exhale the water of an overflowing tide, instead of draining it off immediately, by digging a hole in the ground. But there are cases in which the blood-vessels become so insolated, that they refuse to yield their morbid excitement to depletion from any outlet, except from themselves. ”

“ Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. ”

“ On the contrary, sick people are now instructed in the nature of their diseases, and informed of the names and design of their medicines, by which means faith and reason are made to co-operate in adding efficacy to them. Nor are patients left, as formerly, by their physicians, under the usual appearances of dissolution, without the aid of medicine. By thus disputing every inch of ground with death, many persons have been rescued from the grave, and lived, years afterwards, monuments of the power of the healing art. ”

“ It is equally true, that there are no half truths in medicine. This half-way practice of moderate bleeding, has kept up the mortality of pestilential fevers, in all ages, and in all countries. I have combated this practice elsewhere [59] , and have asserted, upon the authority of Dr. Sydenham, that it is much better not to bleed at all, than to draw blood disproportioned in quantity to the violence of the fever. ”

“ We learn the reason why, in some instances, the fever does not spread from a person who sickens or dies at sea, who had carried the seeds of it in his body from a sickly shore. It is because no febrile miasmata exist in the bodies of the rest of the crew to be excited into action by any peculiar smell from the disease, or by fear or fatigue, and because no morbid excretions are generated by the person who dies. ”

“ Parturition is a higher grade of disease than that which takes place in pregnancy. It consists of convulsive or clonic spasms in the uterus, supervening its inflammation, and is accompanied with chills, heat, thirst, a quick, full, tense, or a frequent and depressed pulse, and great pain. By some divines these symptoms, and particularly pain, have been considered as a standing and unchangeable punishment of the original disobedience of woman, and, by some physicians, as indispensably necessary to enable the uterus to relieve itself of its burden. ”

“ From a review of the commotions excited in the system by bleeding, a reason may be given why the physicians, who do not bleed in the depressed state of the pulse, have so few patients in what they call malignant fevers, compared with those who use a contrary practice. The disease, in such cases, being locked up, is not permitted to unfold its true character; and hence patients are said to die of apoplexy, lethargy, cholera, dysentery, or nervous fever, who, under a different treatment, would have exhibited all the marks of an ordinary malignant fever. ”

“ Fevers, in America, are more inflammatory than fevers, in persons of equal rank, in Great-Britain. A French physician once said, it was safer to draw a hogs-head of wine from a Frenchman's veins, than a quarter of a hundred pounds of beef from an Englishman's, meaning to convey an idea of the difference in the grades of morbid or inflammatory action in the diseases of the inhabitants of France and [325] England, and of the difference in the quantity of blood proper to be drawn in each of them. A similar difference exists between the grades of fever in Great-Britain and America. ”

“ But to theorize, that is, to think, or, in other language, to compare facts, to reject counterfeits, to dissolve the seeming affinity of such as are not true, to combine those that are related, though found in remote situations from each other, and, finally, to deduce practical and useful inferences from them, are the high prerogatives and interest of man, in all his intellectual pursuits, and in none more, than in the profession of medicine. ”

“ While I thus deny the yellow fever to be the offspring of a specific contagion, and of course incapable of being imported so as to become an epidemic in any country, I shall admit presently, that the excretions of a patient in this disease may, by [219] confinement, become so acrid as to produce, under circumstances to be mentioned hereafter, a similar disease in a person, but from this person it cannot be communicated, if he possess only the common advantages of pure air and cleanliness. ”

“ Where peculiar circumstances of business render it necessary for persons to inhale the morning air, care should be taken never to do it without first eating a cordial breakfast.
The intestinal state of our summer and autumnal disease requires several specific means to prevent it, different from those which have been advised to defend the blood-vessels from fever. Unripe and decayed fruit should be avoided, and that which is ripe and sound should not be eaten in an excessive quantity. Spices, and particularly Cayenne pepper, and the red pepper of our country, should be taken daily with food. ”

“ There is a state of fever in which an excess in the action of the blood-vessels is barely perceptible, but which often threatens immediate danger to life, by a determination of blood to a vital part. In this case I have frequently seen the scale turn in favour of life, by the loss of but four or five ounces of blood. The pressure of this, and even of a much less quantity of blood in the close of a fever, I believe, as effectually destroys life as the excess of several pounds does in its beginning.
In cases where bleeding does not cure, it may be used with advantage as a palliative remedy. ”

“ It is remarkable, that the dread of producing a dropsy by bleeding, is confined chiefly to its use in malignant fevers; for the men who urge this objection to it, do not hesitate to draw four or five quarts of blood in the cure of the pleurisy. The habitual association of the lancet with this disease, has often caused me to rejoice when I have heard a patient complain of a pain in his side, in a malignant fever. ”

“ Dow informed me, in his visit to Philadelphia in the year 1800, that the natives and old citizens of New-Orleans who retired into the country, and returned during the prevalence of the yellow fever in that city, the year before, were often affected by it, while all such persons as did not change their residence, escaped it. The danger from visiting an infected city is greater to persons who breathe an atmosphere of a uniform temperature, than one that is subject to alternate changes in its degrees of heat and cold. ”

“ As well might a traveller describe a foreign climate, by the state of the weather, or by the productions of the earth, during a single autumn, as a physician adopt a uniform opinion of the history, treatment, and prognosis of a fever, from its phenomena in any one country, or during a single season. ”

“ It prevails chiefly in cool and cold weather, but is never epidemic; for the excreted matters which produce the fever do not float in the external atmosphere, nor are they communicated, so as to produce disease, more than a few feet from the persons who exhale them. They are sometimes communicated by means of the clothes which have been worn by the sick, and there have been instances in which the fever has been produced by persons who had not been confined by it, but who had previously been exposed to all the causes which generate it. ”