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Un des symboles suivants apparaltra sur la dernidre image de cheque microfiche, selon le cas: le symbole — ► signifie "A SUIVRE", le symbols V signifie "FIN". Les cartes, planches, tableaux, etc., peuvent dtre filmte d des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seul clich6, il est ffilmd d partir de I'angle supdrieur gauche, de gauche d droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes sulv&nts illustrent la m6thode. 1 2 3 4 5 6 MEDICAL )t\ SKETCHES OF THE I CAMPAIGNS OP 1813, 13, 14. TO WHICH ARE ADDED, SURGICAL CASES; OBSERVATIONS ON MILITARY HOSPITALS; AND FLYING HOSPITALS ATTACHED TO A MOVING ARMY. ALSO, AN APPENDIX, COMPRISING A DISSERTATION ON DYSENTERY; WHICH OBTAINED THE BOYLSTONIAN PRIZE MEDAL FOR THE YEAR 180« AND OBSERVATIONS ON THE WINTER BPIDEMIC OF 1815-16, ' DENOMINATED PERIPNEUMONIA NOTHA; AS IT APPEARED AT SHARON AND ROCHESTER, State of Massachusetts. i: . ■'< iy\ BY JAMES MATil^. M. D. A. A. S. Hospital Surgeon of the Army, Member of the Massachusetts Medical Sockty« and Corrt'Sjioudiiig Member of the Georgiua Medical Society. ^A. ;'i dedham: -'^ PRINTED BY H. MANN AND CO, ' 1816. •' ^ ■-.w,- district of Massachusetts^ to wit: Dutrict CItrk'f Offlrr, BE IT HEMEMBERED, tlint on the Twinty-sixth day of August, mid in ilit Korty-fiiit Vonr oi'tlif Iniliptnilijiiue of tbe United Slattg u^Amtriea, JAMES MANNof tlic «aid District, has (U'lMsiutl in tlii!> Office the' Title of a Book, the right whereof he claims as Author, iu tlm AV'oiils fulloniii);, to ivit : " Meilical Sketches of the Camp«inis of 1812, 13, 14. To whidi arc a(!ded. Surreal caseqi " OhservHtions on Militar)- IIosi>iials ; ami Flying Hospitals attai'lud tu a movini; Army. " Also, iui Api)eiidix,coni|)ri!iing a Uiswilution on liysinti ry; which obtainid the Boylstoidan " Pri/.f Medal for the year 1806. Ami ubs. rviitions on tht Winttr Epidiniic of 1815, 16. di> "nominated Piripnt'iimonia Motlui ; as it appiiind at Sharon and Ruihestcr, Sl^te of Mussa- "ihusetts. By JAMKS MANN, M. D. A. A. S. Hospital Surgion of tlie Amiy, M. niber " of the Ma«sa'vliUK'tt( Medical Society, and Corrtspouding Memwr of the Georgian Sledicd *' Society." tn Conformity to the Act of the Cong^'ss of the United States, entitled, " An Act for the £ncoiinig(.'ment oi'Ltarninf;, by ateuring the Copies of Maps, Charts aiHl Books, to the Autliori and Proprietors of such Copii s, during the Times therein nic ntiontd :" and also to an Act eiw titlul, " An Act suppK-nientHry to an Act, entitli d. An Act for the Encouragi m. nt of L< anunr, by securing th» Copies of Mjijts, Chnrls luid Books, to the Authors and Proprirtors of such Copits durint; ihi tinns thireia memiomti; ami extending the Benefits thi reoi to the Art: of Uenguing, £»rrA>his and EtcfaibK Hiawricoi, anl utbtcr rrints." Ckrl- ■^rthe Uistrict : :^ of ;iir io Detroit, these sheets were hurried through the press, buiue typographical errors have consequently escaped notice; the most essential will appear subjoined under Errata. No apolo- gy will be made for the work in general ; that something of the kind may be better executeil, is desirable. The communica- tions from Doctors Hunt, Lovell, Fuller, Whitridge, Pur- cell and March, need nothing to recommend them ; as upon perusal, they will be found interesting to the physician, and •reditable to the authors. To Horatio Gates Stafford, Esq. my acknowledgment? Are particularly due. The statistical observations comprised in the book, are abstracts from a Gazetteer of the State of New- York, written by him, and published by South wick, in 1813; as Well as a few historical facts, relative to the first settlements ; ^'hich were more especially introduced, to give distant readersr some idea, whnt dangers and difficulties the first settlers had to encounter; and the astonishing rapid increase of the North- western district of New-York. Upon the last subjects, much might have been added, but they are more appropriate to a ge- ographical work. For a particular description of the state of Kew-York at large, and especially the new settlements in the Korthern and Western counties, less generally known, the read- er is referred to that circumstantial and comprehensive Gazett- eer, which, by competent juilges, is considered most correct. f iv ADVERTISRMENT. The note on tlie >vinter epiilemic, at Sharon and Rochester. in Ihe State of Massacliiisetts, was not contemplated ia the lirst prospectus of the book ; the transantiuns at tliose places having occurred since it was published ; but will be no less interesting to medical readers, especially in those parts of New-England, where the epidemic made dreadful ravages. The stimulating practice in that disease, had previously, on the frontiers, been op- posed with some warmth. In the last instance, it has not been treated with too much severity ; although this absurd, destruct- ive practice, in many instances, had been adojtted by gentlemen of high standing as physicians ; whose medical knowledge 1 res- pect, and friendship highly esteem. ERRATA. i*age 14— 2d line from top, {or forinacca, rehd farinacca. 34_10th line from bottom, {or facal resid fecal. 3* — 18th line from bottom, for cnchriale read inchriale. 54 — 15th line from top, for various read iimncroits. 5!) — 8tli line from top, for jvait read wailed. 70— 16th line from bottom, for ipcracuanhnft nrrr read ipecacuanha was. TO MAJOR GENERAL DEARBORN. t1 Sir — The tried patriot, who dared to resist the oppressive measures of a despotic government, demands our reverence. At an early period of life, when your country required the aid of all its citizens to secure its independence, you relinquished your medical pursuits, and abandoned every domestic enjoyment, for tlie perilous and uncertain events of war. You have heheld the sceptre of a king broken, and his crown trodden under foot. You have seen a despotic power crouch to rational liberty, and the ])rinciples of the inalienable rights of man, emerging from that thraldom, which a blind fuith in hereditary power im|)osed on the mind. The American revolution, in which you bore a cons|)icuou3 part, was not merely a victory of arms, but a glo- rious triumph of lurinciple. .■^" The warm advocates of a democratic form of government, have not been disappointed ; they have rejoiced in the unex- ampled prosperity of the nation, under a novel regimen, while more than thirty years of successful experiment have demonstra- ted, that a rejiresentative government, is adequate to meet every exigency of the nation, and under the most threatening dangers, to call forth her resources to oppose them. •^' m ^} 90 MAJOR OFNKRATi nBARBORI^. Aflor a lone jieriod of prosperous peace, war was again pro. voke«'.. To avenge the insults and aggressions of an imperious and haughty enemy, arms were resorted to. Fiora what class of citizens was it to have heen expecteti, the government woulil select a leader for its army ? But from the few existing veterans, \Yho«e military talents and prowess, had been already proved on Ihe tented field, and in the day of battle. A few only of that long catalogue of heroes, -.vhose memories will always be cn« gnven on the hearts of the nation, still lived. Prom this rem- nant, you, Sir, was selected, and promoted to the high grade of M.vjoH GBNF.RAii in the army. It belongs to those who have witnessed the |)erplexities and embarrassments attending the orsinnization of an undisciplined body of men, to appreciate your mrrits. Tills rude assemblage of troops under your command, learnt the tirst rudiments of war, and were taught to beat the most celebrated veterans of Euro|)e. You was a witness of the effects of eight months' discipline. Your early and rapid movements in 1813, preserved Sa«kett'fl Harbor and the fleet on liake Ontario. The plans of attack prescribed by yourself, on Little York and Fort George, bear testimony to your mili- tary talents ; and how much, under able Generals, the American soMiery were capable of accomplishing. The very brilliant victory of their arms, soon compelled the enemy to sue for peace. At the termination of a war, honorable to the nation, you rcr tired to domestic enjoyment, accompanied with the benedictiona of the army, and full approbation of your country ; and with the pleasing consolation, that no officer has presumed to exhibit pub- licly, an allegation against you, nor by private insinuations, at-. temj)ted to detract from your well deserved (ixmph TO MAJOR CIENP.RAL DGARBORtC -ylj * if at liny perlo rnjoy llir aiiiin-mt' Butiafaction resulting from the rctroapeclion of n lite devoted to your country, well spent in her aervice; while it is with peculiar pleftsiire, these «li«'el8, expressive of my hi'^h respects, ami wishes for the con- tinuance of your happiness in this, as well ns that life which is anticipated by all christians, an- to you inarribcd by your moat ouedienl servant, JAMES MANN. 1*RELIMINAIIY OBSERVATIONS. vwvww^vvv TO trnce the vnrioiiB cnusea, which Involved the United States in the lute war with Great Britain, is the province of the political histurian. It has Ix'en u question, whether It was ^ood policy, to o|)|>08e ,vith menacing altitude, the atriiresaions of uii enemy previous to maturing warlike preparations for defence. There are periods when the most important concerns of u na- tion, under all governments, will be controled l>y puhlic opinion. Such was the state of alfairs, at that evei memorable epocha, when the war, which terminated in the independence of the United States, was commenced. Under a republican govern- ment, the voice of the (teople will dictate the measures to be pursued. Provocations, similar in their consequences to those, which excited the revolutionary war, existed in 1812. A state ef war was demanded by tlie nation, at a period, when no prep- arations for even defensive operations had been made ; whea military equipments were to be furnished, and an army to be re- cruited. To systemHfize llie various deparlments of which, was an employment which required months to accomi)li3h. That military character, which had liecn acquired by the nation, dur- ing a war of seven years to establish its independence, was lost. An uninterrupted peace of thirty yeais had obliterated almost every vestige of military knowledge. The art of war slumbered with the heroes of the revolution. Martial renown was unknown, except on the pages of the impartial and faithful historian ; while the records of military deeds and glory, in the United States, like fancied tales, excited wonder and p'easure, rather than eli- cited that patriotic fire, which warms the breast f T ^he soldier, and glows in the soul of the hero,destined to protect the r <• and avenge the wrongs done his country. Habits of subordination cannot be immediately acquired by «xen taken into the field from domestic employment. Recruits^ i1 1 m^m Vi m rBELIUIMA&T OBBERVATIONB. asBemhled froAi dictricta remote Trom each other, possessing lo- «al prejudices, and dissimilar manners, could not in a moment be Tvell disciplined. To orgaiiize an army, composed of such heter- ogeneous materials, with oflficers, who had yet to learn the duties of the camp and tield, was a laborious task. It was an employ- ment, which called into requisition much patience and persever- ance. In the execution of these duties, through the campaign, profound wisdom and judicious management were displayed bj the Commanding General. The medical, with other departments of the army, at the com- mencement of the war, wanted a system. Military hospitals were to be founded by gentlemen, little versed in hospital estab- lishments, for an army. These were evils, the necessary con- sequence of our civil polity, and long period of peace ; and which, all new military establishments have to encounter. The acceptance of an appointment of hospital surgeon in the army, placed me in a novel situation. An order from Major General Dearborn was received, to repair to Greenbush, State of New- York, the place assigned for the general rendezvous, and superintend the medical department of the northern army. The mere orgn nidation of hospitals wak the least perplexing part of duty. The illy defined powers, with which the hospital sur- geons were invested, even in their own department, subjected them to many disagreeable interferences of the officers of the line. Collisions will always exist, between officers of different departments of an army ; when their several powers and duties are not explicitly pointed out. Officers, tenacious of authority, assume as much as may be implied by rules and regulations. In addition to multi[)lied embarrassments, the various duties attached to the office of hospital surgeon, with those merely pro- fessional, was always so pressing, that little time was allowed to record, particularly, the diseases and medical transactions of the army, as they occurred. It is a matter of regret, that many interesting cases have bee^v lost, which might have rendered the following sketches more comprehensive, perhaps useful; for want of which, only a general view of the diseases, which pre- vailed during the war will be given, with such treatments «( COine under my observation. PRBLIMINART OBSERVATTONlt. VU An extensive field Tor investigating the causes of diseases in« cident to armies, tlieir prevention and cure, was open during th« revolutionary contest, but was not improved Tor our benefit. The physicians and surgeons of that eventful period neglected to transmit to us their experience and observations. Excepting a few remarks interspersed in works of Dr. Rush, all to us is lost. At the commencement of that war, the mortality which prevail- ed among the troops was greater than the Inst. The forms of diseases, in all probability, were similar. The medical staff of the army of 1812, possessing no documents relative to the man- agement of military hospitals, nor the diseases to which our ar- mies were exposed, to direct them to the most suitable means of obviating, or the most successful methods of treating them» which in many instances, assumed forms different from those which occur in domestic practice, necessarily had recourse to European treatises on military hospitals and diseases of th9 camp. The practice, on the eastern continent, in diseases ap- parently similar, is, in many instances, illy adapted to the cure of the diseases peculiar to the United States. We are led fur- ther to observe, that while we consult practical authors, some regard should be had to climates and local situations, where their observations were made. Hence, a knowledge of geography in general, and topography, are particularly important to the phy- sician and surgeon, to become acquainted with the connection which subsists between climates and constitutions, in exploring the manner diseases are affected thereby, inasmuch as looal sit- uations and climates produce varieties in the human constitu- tion, which diversify the forms of disease. - "■' The medical philosopher is not ignorant that the diseases of different climates assume forms which are peculiar to their local position ; that the treatment of the diseases of one climate, is not always applicable to ihose of a different ; also, the diseases of the same climate in different years, and during the varying seasons of the vear, are not always to be treated in a similar manner. The last observations are particularly applicable to tlie Unit- ed States, whose extensive territories and districts embrace within their linits, a vast variety of climates ; interspersed with I' " 'H in ^i^: It, 1 } I IW« viii FRKLtMlNAEV OBHFRVATI0N8. large improved tracts, vast rimstB in tlie wildest comliiion, ami extensive ten i lories in iutermediHte states, from nature in her rutlcst attire, to the highest grades ofcultivution. Sydenham, an accurate observer of tlie nature of diseases, >vhile noticing the changes produced in their forms Uy transi* tions of seasons and weather, observed that the fevers of his time, year succeeding year, required dilTerent methoils of prac- tice. He, likewise, cured dysentery at one period, by cathar- tics, at another by opium. Our own practice confirms the just- ness ofthealwve observations. Intermittent fever amoiij; the •oldiers we siiali select as one disease; which at Grc bush in 1812, at Lewislovvn on the Niagara in 1813, at Burlington in 1814, required different methods of treatment. > Experience has taught us, the health of men is more or less affected by change of climate. Soldiers, ordered on service to a district whose temperature differs from that to wliich they had, from early life, been habituated, are more sulyect to its endemic diseases, and have severer attacks from them, than the natives. The winter epidemics on the northern frontiers, it was remark- ed, were more mortal among the troops from South of Delaware river, than those from the New-England states. This fact was most evident, during the winter epidemic 1813-14, in the lOth Regiment, at Plattsburgh. In the distribution of troops, it is important that regard be had to their habits, and the climates to which they may be ordered for duty. " Diseases are so modi- fied and varied by different situations and local posil?ons, habits of life, constitution, age and temperament, as well as transitions of climate and weather, their various forms are almost infinite." , An epidemic, which takes its general features from a pesti- lential state of atmosphere, when it invades a vast extent of country, assumes a variety of forms ; whence originate among physicians seisms, varient opinions, and opposite, as well as in- decisive methods of practice. When these disagreements exist in the same district, incalculable evils are often the conse- quence. But 80 far as they are applicable to the several dis- tricts, where they exist, the apparent difference of treating the disease may be correct. The winter epidemic of 1812-13, was PRELIMIKAKT OBSERTATI0N», IK. ample proof of the above remark. On the northern frontiers, it assumed forms highly inflammatory, accompanied not only with strong arterial action, but higher degrees of stenic Kathcsis, in which the lungs were so gorged with blood, that the heart and arteries almost ceased to act, inducing at the extremities and on the surface of the body, torpidity and coldness ; symptoms, bear- ing the semblance of a typhoid state of disease. In the vicinity of New- York city, the disense supervened with symptoms less inflammatory. At Washington city, the disease exbihi.. few or little symptoms of inflammation, and was considered a form of typhus fever. This epidemic most generally obtiiinrd the game nosological appellation ; but in different districts of the country was qualified by some specific name, which was suppos< ed to be applicable to its existent form. In addition to its gen- eric denomination, pneumonia ; it was called at one place, p^teu- monia notha ; at another, pneumonia typhoides ; malignant pleti- risy at a third; and at a fourth, bilious pneumonia. It was also denominated a highly malignant bilious fever, from a persua- sion that the organs, subservient to the secretion of the bile, or a redundance of that fluid, wa^ a cause of the derangement. These varient opinions may be seen in communications upon the epidemic 1812, 13, I'l, published in the Medical Reposi- tory, New-York. This epidemic, when it firet appeared on the northern fron- tiers, was accompanied with symptoms so uncommon, that some physicians were induced to consider it a new or anomalous dis- ease. It was not correctly understood by the surgeons of the army, until its nature was ascertained by dissections of those who were its victims. After the morbid states of the viscera were demonstrated, the physicians adopted a practice more suc- cessful ; while these examinations were proofs convincing, that this mortal disease had, heretofore, been known in Europe ; a most accurate description of which, John Bkll has given in his anatomy of the human body, which may be found in his 1st vol. New- York edition, page 136. ■ ■■ " A correct history of an extensive epidemic cannot be obtain- ed, except from collected statements from the various sections .«i! fc I PRELIMINARY OaSRRVATIONB. of a country ^here it lias prevailed. How important then, that the forms of disease, with their treatment, be reported iu every territory, that they, severally, may he furnished with a method of practice best adapted to its climate or local position ! Such medical documents may be highly useful, so far as they may be particularly applicable to the various climates of an extensive eountry. The surgeons, attached to the army, ihe last war, would be well employed to impi-ove the present time to commence a his- tory of the diseases attendant on a military life. A fund of use- ful ( 'jservations might with little industry be collected, and pre- served for the benefit of future generations. Its value would be enhanced proportionate to the additions which may be made to the general stock ; in which every surgeon of Ihe army should feel he has an interest. The Sketches are a partial exhibition of the diseases on the northern frontiers, to which district the author was attached dur- ing the war; being abstracts of medical observations made at those points only, where he was a witness of them, ^Yitll reports from a few gentlemen of the medical department, w lo were con- versant with the diseases as they appeared in camp a ' the mil- itary hospitals ; to whom particular acknowledgments will be made, in due place, for their aid and matter furnished for this compilation. ■■'> • ■ ; .Although the sketches may be considered as comprising a small portion compared with the great body of facts which may be adduced ; yet, however small, they may prove of some bene- fit to medical science. A record of incorrect practice, faithfully detailed, may be improved, like a beacon to a mariner, to avoid dangers and erroneous tracks. These sketches may be further useful to the science of medi- cine, to excite others, who were attached to the medical de- partment of the army, possessing matter of greater importance, and more leisure and talents, to appropriate them to this highly important subject — the preservation from disease and death, of that valuable and most necessary class of citizens, who are em- ployed to protect the rishta of the nation, and support its inde- pendence. MEDICAL SKETCHES. ^^Is, exposed during the heat of the day, and fogs of the night oa deck, to avoid the suffocating state of air in the hold. Some ot whom, when received into the hospital, were in a bad condition. For these patients were prescribed cathartics of sulphate of soda ; BUper-tartrite of potash and manna; many of whom required stimulants, diluted brandy, wine. To one were administered from one to two pints of wine daily, for two weeks ; and by this stimulus only was supported, and apparently from a dying state, vjM eventually restored to health. In all cases of this disease,* 3 1 .*•' L ll MEDICAL SKETCHES, animal nutriment, even in the form of sotipa, was prohibited. Preparationa of the forin;"ea and milk were experienced the moat appropriate regimen. A milk ; . t. {!. 4 If MEDICAL SKETCHED. unorgntiizcd stale or the liuupitnl, at this |HTio«I, did not admit ul' it> cm|>loynieiit. After recovery, the patients were not secured from the diseuse. Kxposurps to >vel and cold, sulijected them to renewed nttiicka. The fuMowing prcscriptioni under ditTereut circutnstanceB were administered. (See note b.) ,, , Measles shewed themselves among the soldiers, in a few ia- stanct'S, at (jreenbush. The disease was mild, and generalljr little or no mtdicul aid was required. Bleeding in two or three instances was necessary ; so was a cathartic of calomel Hnd jalap, or sulphate of soda. Where a cough was troublesome, a tea-spoonful of equal parts of antimoniul wine, and compound tincture of opium, was beneficial to remove the irritation on the luugs, after fever had subsided. It has been already observed, the sudden rhange of weather in October introduced additional forms of disease among th« men. We have to notice one of more I'ormidal le and more questionable 8ymi)tom8; i>>kujuin.ia, or inflammation within the breast. This disease w:is, in some instances, accompanied with diarrhoea; or superveneil where diarrluea previously existed; which last disease had not entirely diaappeared. The aliove oomiiination of morbid actions, never, or st blom occurs in do- mestic practice, in the New-England states. The following were the most prominent symptoms ; piiin in the . hrsi ; in some cases one side, in others both were aflecled ; short and difficult respiration ; dry cough ; the pul?e of those, whose condition was most alarming, was small and hard ; the heat of the body and extremities not above the standard of health, sometimes below. The above symptoms, with diarrhoea, whichi in a few instances, attended, seemed to forbid the employment pf the lancet ; but subsequent practice justified its use. When this remedy wag omitted, other auxiliaries were of little or no benefit. A ques- tion at this period was made, whether there can be a state of inflammation, where the heat of the body and extremities, at the early onset of the disease, is below that of health, and the pulse email. The success which followed eleven successive bleedi ings of four ounces each, in a case of the above description, dem- q(0^rated the a^rmativcv This was a soldier of the 25tb regi-, CAMPAIGN OP 181B. If in<>Dt, viho wat admitted iuto the huBpital, arier havini; been bled aixtrcn ounces nt one time, by hit own surgeon or r«f;i> inent; and who, when he accompanitrd the man into (he ho8|ii- (al, obaerved, tliat bleeding had been employe*), as far ai the condition of the man would Justify. This was also my opinion, upon tirst examination of the cese ; but, after all other means had failed to procure .elief, and the oppression still continuing upon the breast, bleeding was again employed, and repeated. Arterial action in this instance was not increased, ns the ves- sels w^re unloaded by blood-letting, as was often the case. The pulse however, did not sink, but remained stationary. Encour- agement was therefore given, to pursue depletion with caution; until difficult respiration was removed. This practice was at first adopted as a Justifiable experiment, in a most deB[ierate case. Calomel, antimonials, and blisters were freely employed through the course of the disease. This disease, when it first appeared at Greenbush, was not considered as being connected with an epidemic stMti of atmos- phere. The following theory was suggested by the extraordi- nary symptoms, under which the disefise apjeared. Long and unremitted exposures to cold in tents overcame the action of the arteries, at their minute extremities. The caloric upon the Burface of the body was expended more rapidly, than it wag evolved by the vital powers; while the pulmonic vessels be- came crowded with blood, and extravas'Ued blood mixed with mucus formed congestions within the bronchise. The heart gorged with blood, struggled with diminished efforts to remove its load, and the whole system was pervaded with torpor. Whs this a state of inflammation ? The symptoms did not correspond with those, common to inflammation ; while dissections demonstrated similar morbid appearances, on the important organs of life, which are connected with well known symptoms of inflamma- tion. (See note c.) - • ' *. : ^ What is inflammation, but a repletion of the sanguiferous vessels of some animated organ ; and, iu some instances, an elonga- tion of its component vessels, having the appearance of being HG^ formed. Xbia repletion commences at a point of resist* »i r' 'If' f 18 MEDICAL BKETCHEfl. ancr to the circiilaf'on in the minute arterirg, prodiiced on the first attacli, by a' ttraction oi' caloric. Thin is most evident, hy the gradual enlargement or the diseased parts, with pain and liiKher degrees or heat, which usually accompany the local dis- cHse. The piiin of distension is a stimulus, whitji, in common cases, excites Ity nasOciation the heart and arteries to increas- ed action; these are the most common phenomena. To tallt of iulliimmalion where there is no inorensed heat, is considered paradoxical. Is it diflicult to understand, that wheie the Itlood vessels are greatly surcharged, or gorged, the nervous filaments, immediately connected with the gorged vessels, might by their compression, be deprived of their inherent powers of communicating sensation, and become insusceptible of pain ; and that a torpor, accompanied with coldness, or death of thn part, may follow ? By depletion, the compression is removed, the vessels resume their action, the pulse becomes more full, pain is increased, and a glow of heat is gradually ditTused through- out the whole system. This state is unquestionably inflamma- tion. Will that state, wiiich preceded depletion, be considered less inflammatory, or less disposed to inflammation? When tliere is compression on the bruin, the source of sensorial power is im- paired, and the mental faculty, immediately connected with it, suspended. Whereas, when the compression is upon the ner- vous filaments of an org^in, less connected with life, as the lungs or liver, the meiUal faculty does not immediately sufler, and may not be impaired, even at the point of death. Those, who fell victims to this most violent form of pneumonia, retained their senses to the last mo.Tient. How is torpor, the consequence of a gorged state of the lungs, to be overcome ? Wot by stimu- lants, while the engorgement exists ; because, if the nervous filaments are susceptible of the least sensation, and the gorged blood vessels connected with them capable of being excited, their state of engorgement will (hereby be confirmed ; while a disease, already most dangerous, will become irremediable. But, by removing the compression by bleeding, the nervous filaments may recover their powers of sensation, if those powers have not beea too long interrupted ; while excited arterial actioo, and CAMPAIGN OF 1812. If jneretBcd pain which eniuo, ar« evUt«ace that one point i« gained ; and by further depleliona cautiously employed, difficult ret|»iration is overcome ; bo as the system may lie restored to a state, in which mure obvious remedies are indicated. The sub- ject matter of the above form of disease will b« more fidly con- sidered, when its most violent forms, as they appeared the fol- lowing winter, shall be more particularly described. A particular history of the states of disease amoii^; the troops on the frontiers, from September to the last of December, can- not he given in detail. It was reported Ity the Buri;eons attached to regiments, that dysentery, diarrhoea nnd fever, continued to attack the men. The most prevailing disease, with which the right wing of the army was afflicted, when it was encamped at Plattsburgh, and Champlain, was the measles. It wus stated, nearly one third of the troops were seized with this disease. It was accompanied with symptoms more severe, as the weather became colder, in the month of Noveml)er : while the conva- lescents from it were predisposed to the reception of a disease, under the form of i>ne(;moma; and, in conjunction with an epidemic state of atmosphere, and other more obviouo i ~iting causes, the army, generally, were aulijected to its most violent forms. A catarrhal alTection at that time, (.Innuury 1st, 1813,) was universal among the men. Tiiis epidemic was first noticed at Greenbush cantonment, the last of October, ns has been be- fore observed. In proportion to increase of cold, this disease became more frequent and severe. It may be necessary to observe, the winter epidemic of 1812, 13, was a form of disease, distinct from that, which, in the north- ern districts of the eastern states, the preceding winters, hnd been known by the name of spotted fever ; although the exciting causes may have been similar. I« the spotted fever, mental de- raugement was an almost general concomitant of the disease. In many instances, this affection of the bram was the first symp- tom of morbid action. Whereas, pneumonia, es,)ecially among the troops, was never accompanied with mental derangement, at its first attack, and but seldom in its more advanced stages ; nor ubtil the laborious r^'spiratioo, which was a most prominent 20 MEDICAL SKETCHES. tymptom, at the first attack bad somewbat subsided, or the p* tient at the point r^i death. f ' :^j: j '^' ^l^ ; .. " i \^r.*\ ? I-M^vt '■■ This epidemic appeared under the forms of both sthenic and asthenic diathesis ; altbouj^h under the last, it was often, if not al' nvays, deceptive ; which led the physicians, in many instances, to a most incorrect practice ; a practice which never mitigated the rvmptoms, but always precipitated the patient into an incur- able state. The varieties of this disease induced, depended on prior habits and temperaments. In many of the first cases at Burlington, where General Chandler's brigade had taken quar- ters for the winter, (where I was a spectator of its ravages) the disease proved fatal, in two, three, and four days, by the vio- lence of the first attack ; in some instances, in less than twenty- four hours, after the first symptoms of indisposition supervened. A soldier, attached to the hospital as a nurse, complained that he had taken cold, and that he feu an oppression at his breast ; so little was his indisposition, that he went to the lake shore, distant sixty rods, returned with two buckets of water, flung himself on his bed, and died in six minutes, apparently in a state of suffocation. There wero other instances of deaths, almost as sudden. The following were the most coLspicuoas features of the dis- ease, under its most deadly form. At the first attack, the heaC of the body and extremities, were below the standard of health ; the pulse contracted and hard ; sometimes scarcely perceptible r respiration extremely laborious ; not apparently so much froni^ sharp pains tht'ough the sides and breast, as from a sense of suf> fbcation. The patients say, upon enquiry, that they do not suf- fer from extreme pain, but a weight upon the chest ; an oppres- sion from inability to inhale the air ; a sensation, oue might im- agine, similar to that which might be produced by breathing air deprived of its oxygene. The suffocation on the first attack may be accounted for, by Supposmg the lungs in a condition which rendered this organ incapable of ai)sorbing, or transmitting through its membranes, the vital principle of the atmospheric air ; or, in consequence of the engorgement of the bronchtse, the air ^as excluded from their smaller ramif.catiou9. This state oT CAMPAIGN OP 1812. 21 the Itincs wns made m >st evident, by many dissections of those, who hiul died l»y the dispose. The appearances were engorge- m»on a place, it comes with all the frequency and de- struction of an epidemic disease ; and the sudden and unexpect- ed deaths are terrible." In like form, it appeared in the army on the frontiers ; and with no less violence were its attacks inade upon the inhabitants scattered over a very extensive dis- trict of country, from lake Erie down to lake Champlain; over Vermont, the northern counties of Connecticut, Massachusetts., and New-Hampshire. " The pulse is weak," continues Bell ; " the cough is slight j the difficulty of breathing more aaxious than painful, ariBing 4 \ \ se TVIEniGAL SKETCHES. Ill t ■! from Inability fo inhale «he nir ; the face sunk in the rpatnpea, and flusiied, or rather of a hirid colour, exce|»! w'len c-Hifiveroiia, i)ale andsiDow; the sii'Tocatlon is sudden ; the lunffs have a liver- like solid consistenf^e ; they have no longer the cellnl'ir apnear- ance of hin;r8 ; for their hronchiae are crammed with hlood ; their common celliil «r texture is also full of exuded hlood; they are dense, solid ai.d heavy, and they sink in water. The heart is 30 curbed in its action, that it'gives liut a sm dl. fcehle, Iremb- liujQj pulse; and even i: ii few days, the heart is woinlerfidly diluted Hud enlar£;ed, aiul fdled with fluid and grumous Idood." The physician, in these cases, hesitated, and cauTniusly era* ployed the lancet. Here however, it may he necess iry lo olj- aerve, that there were two states of this most dangerous form of disease,- which were somewhat similar, as reg irds the pulse, ' ut which were essentially different. In one, with its apparent Hveakcess, there was a hardness ; it was called a rontracted h ird pulse, hy some a siifled pulse, and should he distinguished f/ora the other, which was weak and soft ; in both, the pulse was «mall. , In the first state, accompanied with most laborious and suffo* cated respiration, there was fio expectoration, nor much pain in the chest. Here a cautious use of the lancet was required. Here, not only the pulmonic vessels were crowded with blood, but the bronchisB were loaded with bloody mucus ; the heart «nd arteries ceased to act, not because they were debilitated, but because they were surcharged with blood. This state was attended with coldness and torpor. Heat could not be perma- nently restored by any means, but by the abstraction of blood, at the commencement of the disease. Blood however, should be taken away with caution. When bleeding was employed to the quantity of four or six ounces, at short intervals of four, six, oc eight hours, it gave the gorged vessels 0[iportunity to free them- selves from the 0])pres3ive load; and, more certainly, when warm applications had been previously made and continued upon the surface and extreniities of the boily. By the above Qieans, the pulse became fuller and heat was restored ; when a Tail Weei'ln§ mgbt, in some cases he employed, not oaly witK CAMPAIGN OP 1812. J enPfty, hut with benefit. As soon as warmth and the circulat'ioE 6f the blood were reslored to the surface and extremities, the ' patient was considered in a curable condition ; wherein, ap^ pro!)rinle reinctlies mi!j;ht be administered ; beins such as arft Bsudly em')loved in uneumonic affections with fever. In crises where death had immediately followed the above firm ttoms of contracted hard pulse, torpor, and 2;eneral cold- ness, varioiis dissections have demonstrateil the highest state of distention of the pulmonic vessels, with 'dood ; and of ' chi- al enijorirem'Mit with bloody mucus. The lungs assL 1 the appearance of inll immition. By what menns m ly these formi* ^ ihle congestions within that congeries of air and blood vessels, of which the lungs are composed, be resolved, except by bleed- ing? Without the employment of the lancet, other auxiliary remedies proved ineffectual. The bleeding should l)e small and repeated, until the pulse becomes fuller, and the heat of the body ]s increased above the healtiiy standard ; when the patient may bear a larger quantity. The patient sometimes fainted with the loss of eight ounces of blood at first ; who, subsequently, was bled sixteen ounces, without any collapse of the vessels. The num- ber taken down with this most formid able state of disease was few, comjiared with the m dtitude seized. A fortunate adminis* tration of stimulants, in a solitary Instance only, within my knowledge, proved successful ; while their indiscriminate use induced a most deadly practice. Such was the practice in (he army, for a short period. Brandy, wine, and soups were the remedies administered, in every form of these pneumonic affec- tions. Prior to these potent stimulants, emetics, cathartics, and blisters were em;)loyed. The iancet was prohibited under ev* «ry form of this epidemic. It has been ol)served, the physicians, at the first appearance •f this epidemic, doubted the propriety of bleeding. Their doubts were removed by the superior success which followed the use of the lancet; while stimulants proved fatal. It is wot^ thy of notice, in two cases, which came under my obseivation, where blood-letting was cautiously employed, the providential ojpeolD^ of the orifice^ during a restless night, produced so rnueh ¥k u ilEDICAL SKETCHES. relief, (even the removal of every alarming symptom) as led to a persuasion, that, in some instances, where the disease hud proved fatal, bleeding, from too great timidity, had been imi^rop* criy neglected ; and, in others, employed with too much cuu- tiOQ. The above form of this epidemic was considered by some, typhoid, or asthenic. A typhous fever is always accomiianied fvith a prostration of strength, and low delirium. Will a disease be considered typhous, where the patient is able to vralk the room, and continue this exercise, even a few minutes previous to death ? Is that disease typhous, which is relieved by bleed- ing ? This form of the disease, in some cases, demanded as ma- ny ounces of blood, in the course of the treatment, as is often drawn from a person in severe pneumonia, accompanied with high degrees of heat, strong arterial action, and acute pain. Yet, in this uncommon form of disease, it was inexpedient to take more than two, four, six, or eight ounces at once. The above quantities were taken away, every two, four, or six hours, pro re nata ; until permanent relief was procured. Sometimes after tlie first bleeding, the pulse became fuller, and the heat of the body increased. This favourable circumstance, however, did not usually follow, until after the third, or fourth bleediug. It was not arterial action, but the state of respiration which gov- erned the employment of the lancet in this form of disease. Whenever the tepid bath could be employed, it proved benefi- cial, in the cold and torpid state of the system, to restore warmth to the surface of the body, and action to the extreme vessels. The progress of this form of the diseuse, was most rapid. It assumed in a few hours the strongest marked symptoms of dis- solution. It may be added, that even when sulTocatioii and rat- ling supervened, and, at the moment death was closing the scene, and the heart and arteries ceased to perform their offices, that muscular strength was not remarkably impaired ; nor was the mind deranged. The conflict, exhibited in some instancet by the patient, was most distressing. Several have been seen to -walk the room a few hours, and even a few minutes^ previous to death ; possessing a keen sense of their irremediable state, and inevitable dissolution. CAMPAIGN OP 1812, ed The number taken down vith this most formiilable state of the epidemic were few, compared with the multitude seized. Id the second state of the disease, and wliere there was a weak sort pulse, bleeding was injurious ; yet the antiphlogistio regimen was necessary. Here the respiration was dithcult, but not BuQbcated ; accompanied with pain in the side, and ex- pectoration of bloody mucus ; the bronchiae were not so crowd- ed, as to be incapacitated to free themselves from the load with which they were oppressed; the heat of the body waa never much above the common standard of health. This form of the disease was frequently accompanied with diarrhoea; where drastic purges were prohibited, and milder cathartics ad- ministered with great caution. The diarrhoea, at times, was so profuse, that cathartics were injurious ; while it was necessary to check these alvine discharges by opium. The diarrhoea, which accompanied the disease, was not critical ; nor was it shecked, as the fever abated, except by opium ; continuing ob* stinate, in some instances, efter return of appetite. This per- verse diarrhoea, according to the report of Doctor Lovell, yielded to lime-water. Emetics of ipecacuanha, were beneficial to promote expectoration; and repeated blisters of the highest importance to counteract pain. Stimulants were improper, uo* til difficult respiration was removed, and expectoration became copious. During convalescency, wine in small quantity, wan an appropriate remedy, and grateful to the patient. The above forms of the disease were similar to the pneumonUL notha of the ancients. It is not unworthy of notice, that its at- tacks were most severe upon those, who were in habits of intent perate potations of spirituous liquors. * The third form of this disease shewed itself with less ques* tionable symptoms. At the first onset of the disease, there were strong rigors, with acute pain through the chest. The rigors were soon followed by much heat, strong pulse, cough, and no expectoration. The efforts of coughing always increased the pain in the breast. The above symptoms promptly demanded blood-letting from sixteen, to thirty-two ounces. If any mitiga- tieu was procured by this operation, some expectoration of mu* \i 1 I s» MEDICAL SKETCHES. ' I cutt sfreaked with blood followed Evening exncerhntiona fre'* ^uf ntly required a repetitioo of the luncet. In a few instances, two qunrts were drawn from the arm of the patient, in forty- sight hours, with ( best effect — the removal of every alarm- ing symptom. But, when this mosi nportant remedy, bleedinp was omitted, the patient most generally died in the first stage of the disease, ivifh an abscess within the lungs; or, if he survived the bursting •f the abscess, life was firotracted, possibly, some weeks ; when ibe died with hectic emaciation. The following case ia interesting. A physician, who joined the army, at a late period of the epidemic, observed, that by the aid of emetics, cathartics, blisters, and calomel, in large and imall doses, without blood-letting, he was able to cure the fever. The importance and necessity of this evacuation was forcibly irged. Notwithstanding, he obstinately persisted in his own plan of practice, until four of bis first patients had succumbed Huder his prescriptions. The fifth was an interesting young man, who had, during a former sickness, been attended by ray- eelf. The fourth day after he was taken down, and when recov- ery was despaired of by his physician, I was called in consulta- tion. The case, at this period, was most desperate ; when my opinion was unreservedly given, that bleeding, at an earlier fltage, would have saved his patient. If so, why will you not bleed him now, replied his physician. Because bleeding, under his circumstances, had become an uncertain remedy ; and, in as much as the reputation of this evacuation was but recently es- tablished, as a remedy in this disease, it would be reluctantly employed by myself, in a case, where it was my strong appre- beusion, it would not succeed. In this case, as the disease had been of four days duration, with a full soft pulse, laborious res- piration, and a hectic flush on the countenance, my persuasion was, that suppuration had superveneled, was my reply. The anxious looks, with mixed expression of anguish and re^ mwm CAMPAIGN OF 1812. fir proof, nnd tone of despair, sunk deep into mj heart ; it wns like an electric shock to my frame. The Teelings of responsiUility DO longer opposed the emotiuns of sensibility, all fictive for (he fate of the amiable young man. He was immediately bled six* teen ounces. The following day sixteen ounces were again tak- en away. Bleeding was repeated to the amount of seventy ounces in four days; when he convalesced, was able to leav© his bed some hours in the day, and walk his room, with a re- turning appetite. Orders at this time, to march to a distant post, precluded me from knowing, whether his health was fully rein- stated, or whether it deteriorated to a hectic decline; which might have been expected, from the profuse ex|>ectorationS| which succeeded the resolution of inflamm:ition within the breast. A cathartic of calomel and jalap, or calomel /;(?r .ve was admin- istered, after the first bleeding, in this form of disease. This it was necessary to repeat. As soon as the fever with pain was reduced by bleeding, and cathartics, calomel, and tartrite r)f an- timony were given, with, or without opium, to pnimote ex|»ecto- ration; and when a gentle spitting wns produced, the remiine of pain in the breast gradually removed ; ditficult respiration abated, and a gentle moisture upon the skin supervened. Equal parts of antimooial wine, and compound tincture of opium, prov- ed an excellent medicine, in this state of the disease. When the antimony occasioned too loose a state of the bowels, Dover^s powders, in small doses, were sulrstituted. After the inflamma- tory state of the disease was subdued, by the above means, es- pecially, where nausea, er anorexy existed, emetics of ipecacu- anha, were advantageously administered ; with intention of pro- moting expectoration, and determining the circulation to the extreme vesselr Blisters, in the course of the disease, were in- dispensable to remove stiches in the breast and sides, after blood- letting was carried to its full extent; believing with others, that '^ there is a blistering, as well as a bleeding, and emetic period in fevers ; the bounds of which being ascertained, should never be intruded upon by each other. Where stimulants were demanded, as they never were while %ere was difiicult resplratioo} a mixture of spirit, nitii il\ih IJI M ' "t 1 ■.ft 1^ 11 m 28 MEDICAL SKETCHEJI. If I ,1 1 and aqua ammonia, six parts of the first, and one of the last, viM an appropriate medicine. ' ' ^ • ' • ' i Coughs, in a few instances, were obstinate, after there was a resolution of fever. These were gradually subdued by a tea- spoonful of a mixture of equal parts of antimonifLI wine and com- pound tincture of opium, administered every four or six hours, pro re nata ; or as often as the urgency of the cough required. Mucilaginous drinks sweetened with honey, or liquorice, were directed in all forms of the disease. Hcctick emaciations, and gradual decay, in some instances, followed Chis epidemic. Some few were to be found in our Iios|>ital8, twelve months after the fimt attack of the disease, where death eventually closed the scene. During which period, infirm life was chequered with revivinjp hope, painful anxiety, and severe distress. More dependence was placed upon a dietetic management, to restore the convalescents to health, than difTusable stimulants. Bleeding was opposed in cases of attack of this epidemic, at the time of its first appearance, by some physicians of respecta- bility, in the vicinity of the army. A warm interest was excit- ed against the practice, at Albany ; where the epidemic was considered by some, as a malignant, bilious fever. The first case, which was reported by a physician at that place, was of a citizen, who was takei. ill at Greeubush encamp- ment. This was represented as a bilious fever, of a malignant type. This case was examined by some of the medical gentle- men of the hospital, previous to his removal to Albany; who stated to me, that he did not labour under all the symptoms, which, in the hospital, were denominated pneumonia; under which, without the use of the lancet, few, if any recovered. The above man was bled, and died under the hands of his physician, who adduced this, as a case where bleeding did not succeed. Incorrect, or not, the above case proved nothing against bleeding. As it was well understood, that many, attacked with the real ep- idemic, died under the prescription of the same physician, who were not bled. That an epidemic should have assumed an appearance some- what different in form, among citizens in a cify, svith an exteji^ CAMPAIGN OP 1812. ^ live population, rrom that in camp, produced by the same remote and predisposing causes, may be readily accounted for, from the circumstance, tliut epidemic diseases are, generally, mont preva- lent among that class of citizens of every age, sex, and constitut tion, whose circumstances in life do not admit them to the en* joyment of all tiie necessnrios and comforts, for healthy BU|)|)ort<. Cold lodgings, coarse and spare diet, and dirty houses, predis- pose the body to a form of disease, somewhat different from Ihav which appears among men fed with a full ration of animal food^^ and superabundance of ardent spirits. It was a fortunate circumstance, that there was no essential difference of opinion, as to the nature of the disease, and method of practice among the physicians of the army, after it was well understood. Its nature had been anticipated, before demonstra- tions were made by dissections ; so that the daily employment of bleeding, and its attendant success warranted a continuance of the practice, in opposition to preconceived opinion, founded merely on theoretic doctrines. , w .1, The predis|)osing causes of extensive endemic diseases, are involved in obscurity. They are not confined to any season. An epidemic state of atmosphere, is known by effects produced. When no obvious causes can be assigned for epidemic diseases, astronomical in ^ucnces, unsatisfactory as they are, have beea resorted to as causes, by the poets of antiquity, and more modr ern philosophers. Hence comets, in all ages, have been viewn cd as portentous signs, which forebode both natural and moral evils. The varying aspects of the planets, have, from time immemorial, been consulted upon the most trivial, as well as the more important affairs of men. Those remotely revolvr ing orbs, even at this day, are considered as powerful agents, operating upon our globe, and through the medium of its atmos- phere, diffusing pestiferous influences on animate and inanimate nature. These vagaries and more elaborated theories are in- offensive acd pleasantly amusing ; but do not obviate one evil, nor bestow one blessing upon the human race, even if they were demonstrated truths. The more obvious exciting causes, which are more under our control, are to be explored ; that when 5 i^, I ^0 MEDICAL SKETCHES. !:i known, th^y may be obviated ; three several cames will be no- ticed hereafter. ' The substance of the above sketches uf the epidemic vim published in the New-York Rcposiury in 1R13; more precision has been here observed in pointing out the several forms of the epidemic, as it appeared among the troops. A remarkable coincidence uf opinion, respecting the natiiri* and treatment of this epidemic, is exhibited in the following communication of Doctor Hilas Filler, of the 3d Kegiment, when on the Niagara frontier. It was first published in the Aatn-B at Albany, and republished in the Medical Repositu- RY at New-York. It is here introduced to shew, that this dis- ease was viewed in the same light, and treated in a similar man- ner by him, at the distance of three hundred miles, as it was, at the some period, viewed and treated by myself. .' " This sickness," observes Doctor Fuller, " is not, as has been represented, confined wholly to the army. The soldiers have only shared in a wide spreading and alarming epidemic, l>ervading a vast extent of country : the mortality of which is without example in this part of (he st»te. The disease appears evidently to depend on some peculiar state of atmosphere, as a remote cause ; and an exposure to wet, cold, and fatigue, as an exciting cause. In proportion as these causes have taken place, a more or less violent form of the disease is produced. The moGt common form under which it has presented ilself, is that of sthenic pneumonia ; the most fatal and unmanageable of the ptnmiom'a 7io;/{a of the old books. •- ^ ' ' " Under this last form, it has but seldom appeared ; and not- withstanding, it is evidently produced by the same remote and exciting causes, there is a strongly marked difference in the phenomena of them. " Those advanced in years, ajid in a particular manner, those, who have weakened, or broken down their constitutions by au intemperate use of spirits, are sulyects of this asthenic form o( this epidemic. " The asthenic form, most commonly commences with cohi \ftci' some time, tl'.cre is a sense of heat. In some (Cring. seu^e )f; Ji! CAMPAIGN OP 1812. .11 he DRtiirc Tol lowing legiment, ?d in the Ikpobitu- it this die- nilar man- it was, at ot, as has ie soldiers epidemic, which is je appears there, as a gue, as an len place, ed. The elf, is that ible of the and i\ol- mote and ce in the tier, those, ons by au c form of with col(5 ^ In Bomp instances, tlie common symptoms or ptrt.xia are noticed. Tlie pulse, however, for the most part is small, and the heat not high- er in degree than natural. During the I'iourso of the disease^ respiration is extremely laborious, with slight erratic pains through the chest. " A sense of weight, and fullness is felt through the whole extent of the thorax, which arc increased in an insupportable degree, while the patient is in a horizontal position. There is a peculiar paleness and wildness of aspect not easily described. In some cases, a diarrhti'a adds to the list of morbid phenomena. Some have expired while sitting and walking, apparently from suffocation. " In the above described cases, the lancet has been employed with caution. Bleeding, however, has been attended with ad- vantage. The pulse has become fuller, after the first bleeding, while its repetition with other remedies has completed the cure, " An attentive scheme, by the use of caloniel, nauseating closes of emetic tartar, epispaslics, fomentation of the extremi- ties and the lungs, in the form of vapour, has been generally pur- sued, and in some instances with success. It is, however, to be regretted, that notwithstanding every exertion, a very consider- able number of cases have put on formidable symptoms in a few - hours, such as rattling in the throat, a greatly altered counte- nance, and, fin -Uy, have terminated in death, in the course of one day. " Upon laying open the chesf of some who died under thj«^ form of disease, congestions, inflammation, and adhesions have presented themselves. " The'above cases, when compared with the sthenic form of the disease, so fur as my observation extends, have appeared only, in the proportion of one to fifty. This epidemic, in its sthenic form, is not always a pneumonia. The fever has some- times appeared without any local affection, under the type of SYNocHA. In a few instances, the inflammation has attacked the brain and its meninges, producing pheenitib. Inflamma- tion followed with suppuration in the throat, and frontal sinuses are varieties of the disease. Distinctions, however, like these^ 'ii, nf ■■! w ;}2 MKDICAL HKETCHEB. fi are of little practical utility, ns local inflammations arc invi»< riably rcmQvt* of ilH Hcvrral stages, which present themntlves in the onler of coltl, hot, and low stage. " The sthenic form of this disease, in ushered in by a cold ftnd shivering fit, rather remarkable in force and duration, which, if followed by increased hent, frpquency and strength of pulse, pain in the side, ditlicuit respiration, cough and expectoration, for the most part streaked with blood, a more or less violent form of the disease may be expected. ** The first intention is to remove the cold stage ; this ts ef- fected by bathing the fet-l in warm water, by [ilacing the patient in bed,' and by the freipient nH«;'of vinegar whey for drink. This last is a simple, safe, but jiowerful sudorific, producing its effects >vithout danger from its stimulating (|iiality. These means properly applied, shorten the duration of the cold stage, of course, lessen the hot and febrile stage, which succeeds ; and mitigate inflammation and pain wherever seated. Stimulants, especially astringents, as the patient's life is endangered there- by, should here be avoided. These last, when em|)loyed in any considerable degree, increase inflammation and render the ef- fects of suitable remedies uncertain. As soon as the cold stage is removed, and re-action upon the surface takes place, accom- panied with beat higher in degree than natural — flushed coun- tenance~hardno8B, fullness, and frequency of the pulse — cough, difficulty of respiration — pain in the head or side — or even when the disease shews itself only by an increase of arterial action, immediate recourse must be had to the hfncet. The bleeding must be repeated ;[^ro re nafa. After venesection, should there foe much heat, sul|)hate of soda, (glaubers salts) may be admin- istered for a cathartic ; after which, calomel may be employed either as a purgative, or an alterative, aa the case indicates, Vf'iih antimonials in nauseating doa(>^. Full vomits s^^ould not be given until proper evacuations have been made. Puking, previous to any evacuation, while the vessels are distended, and hignly excited, may be productive of fatal consequences, by CAMPAIGN OF 18ia. 3'i £U|>(urinK (he hloml veMels of (he brain or lung*. Nitre, crenm (artur, demulcent drinks, and diluenti should not be overlooked in this stage o( the disease. ** When expectoration is difficult, and the lungs loaded with viscid pidegm, the steams oC equal parts of vinegar and water may lie inhaled with atl vantage. ■ " As soon as the violence of inflammation is, in some meas- ure abated, epispastics should he applied to the |/aiti<>i| pitrt. These it may be necessary to repeat, as the nature of the case may require. If we can j)lace any reliance upon our own knowl- edge, or have the least confidence in medical science, it must b» conceded that this form of epidemic is of an inflammatory char- acter, requiring depletion and the antiphlogistic treatment for its cure. In this state, we have not been governed in the em- ployment of the lancet, wholly by the pulse, which, in some in- stances, is rendered small by the obstruction of the capillary circulation, by congestions, and general torpor. When a reso- lution of the inflammation is not obtained by the employment of the above means, the disease terminates fatally, io eight or nine days. ' * ** The sinking stage of the disease is known by the smallness of the pulse, coldneo.a of the extremities, dark or shining a\y- pearance of the tongue, extreme debility, with some degree of delirium, and subsultus tehdinum. Here the patient should b« supported with wine whey, wine and water, &c. carefully avoid- ing the extremes of too high, or too low excitement. '' An over proportion of excitement will increase the local af- fection, which is supposed still to exist in a degree, wliile the want of it will leave the patient to languish, and sink under a general debility. Calomel, in small doses, so as to produce some degree of ptyalism, gentle emetics of ipecacuanha, epispas- tics, laudanum and eccoprotics, properly timed prove serviceable in this stage and are, in a great proportion of cases, attended "with success. In the cure of this disease, much depends on judiciously timing the remedies. " This disease has prevailed in camp among the soldiers, and in our towns and villages ajnong citizens under similar symp- f? n n ■I H MEDICAL SKETCHES. ' 'I5 toms ; and it is a well known fact, that more of the latter, tu proportion to the nuinl)er sick in this vicinity, have fallen vie* tims to this disease than the former." . * . Jaundice was a common complaint, during the convalescent gtate of this epidemic. The tunica adnata of the eyes, and the skin were yellow ; even where calomel had been employed, during the course of (he disease. Its continuance in small dos- es, was experienced beneficial ;' as were emetics of ipecacuanha,, occasionally repealed. Obstructions in the ductus contmunis choledocus, were (he cause of this regurgitation of bile ; which exhibited itself throughout the lymphatic vessels, upon the su^ face. This is one evidence, among others, which may be ad- duced, that during the disease, there was a want, instead of re- dundance of bile in the intestinal tube. The yellowness did not super\ ene, until a resolution of fever was elfected ; and the liver with the other secretory organs resumed its proper office. In constqueuce of concretions, or inspissat'ons, which existed in the common biliary duct, the cause of the disease, the bile was refused a passage to the duodenum ; and accumulating in itj proper reservoir, was reverted into the general circula- tion ; whence, was absorbed into the lymphatics. This seconda- ry complaint, readily yielded to remedies, commonly employed in this disease. The most efficient of which, were emetics of ipecacuanha. Jaundice is a symtomatic disease, the eflect of concretions, or canculi lodged or formed in the common biliary duct. The bile which shews itself upon the surface, is not absorbed into the lymphatics from the intestines. During the yellowness, the fae- cal evacuations are generally white or clay-coloured. Cases of disease occur, where the intestinal evacuations are dark, brown, or greenish, or these combined. These appear- ances accompany indigestion, and deficient secretion of gastric and intestinal liquors, as in febrile diseases. These morbid evacuations have been su[)posed to be vitiated bile ; whereas, thejT exist where there is deficiency of this fluid. When there are high grades of febrils disease, all tlie secretory glands are deranged, and cease to perform their offices, and beeome torpid. CAMPAIGN OF 1812. 36 One of the r-ost important, in the economy of the living body, ig the liver. A deficiency of bile, is not only a symptom of dig- eased action, but becomes also, a concomitant cause of fever. Whenever the intestinal evacuations, under this state of dis- ease, exhibit a shew of bile, a resolution of the disease may be expected. Hemorrhagia from the intestines indicates a torpid stale of the liver, when the blood passes from that viscus, without resist- ance. It occurs sometimes, in the last stage of typhous fever ; wherein, from one to four pounds of blood have been evacuated in forty eight hours. From two to four grains of acetite of lead, with one grain of opium, have been experienced an excellent remedy. Then a blister, on the region of the liver ; bark and wine. ' ' "" ! - ' The liver of inebriates becomes torpid. Having lost its se- creting powers, the blood sometimes pours in torrents, through the ductus communis cholcdocus into the duodenum ; thence, evac- uated per anxim. In these cases, hemorrhagia may prove saluta- ry, by obviating a more formidable disease — apoplexy. An enebriate, after large potations of ardent spirits, was found apo- plectic in his bed. Intestinal hemorrhagia soon succeeded, and removed the effects of the spiritous excitement on the brain. Pf the causes of diseases, as they appeared in the army, the following 'I'bservations suggest themselves. It c;,.:iot be too often repeated, an intemperate use of ardeui spirits, is among the exciting causes of violent disease. A disease, which might have been mild, generated only by unavoidable causes, became severe, by alcoholic excitement. A man in a convalescent state from the epidemic of the winter left the hospital without permission, and returned to his quarters, where he drank half a pint of whiskey. A recurrence of fever was excited, with the most formidable symptoms. He was sent back to the hospital, where in twelve hours he died — a victim to folly and impru- dence. Immoderate potations of spirits, by weakening the sensorial powers, and inducing general debility, become a predisponent III '% 30 MEDICAL SKETCHED t MS;.! - II cause of disease. They are likewise an exciting cause, at the time they are taken into the stomach, by excess of stimulation ] and vhen superadded to remote atmospheric, and more ohviouv cjiuses, induce, where there is morbid action, a most violent disease. Not a few, who were subjected to the epidemic of the winter 1812-13, fell victims to that disease, from this exciting cause. An irregularity must not be passed by without notice. It was observed at times during the war, that non-commissioned officers, whose duty it was to issue the ration of spirits to the men, performed it by ol)liging them to drink the whole at once, rather than submit to the more slow task of pouring it into their santeens. This was performed in the morning before breakfast. This disorderly practice was not countenanced by officers, who regarded the health of the men under their immediate command; oonsequently, the practice was not general. My opinion long has been, that ardent spirits are an unneces- sary part of a ration. This allowance, as a part of a ration, is ■ot however, the evil which demands a remedy. It is the abuse of spirits. Sutlers unrestrained, as they frequently are, destroy more lives by these liquors, than are lost by other causes to which soldiers are exposed ; and, so long as ardent spirits are permitted to be publicly sold in the vicinity of a cantonment, these evils cannot be remedied by any restrictions, under which sutlers may be placed. A soldier habitually intemperate, is al- ways industrious to procure the means of indulging his appetite. All his cunning and every artifice are put into requisition to obtain the inebriating draught. Reputation, honour, health, and even life are sacrificed to his gratification. Examples may be furnished to demonstrate, that ardent spirits are a useless [)art of a soldier's ration. At those periods, during the revolutionary w^ar, when the army received no pay for their services, and possessed not the means to procure spirits, it was healthy. The 4th Massachusetts regiment at that eventful period, of which I was the surgeon, lost in three years, by sick- ness, not more than 5 or 6 men. It was at a time when the army was destitute of money. During the winter of 79, 80, there il|ll I CAMPAIGN OP 1812. 2t wns only one occurrence of fever in the regiment; ami that was a pneumonia of a mild form. It was observable the last war, from l)eceml)er 181 I, to April 1815, the soldiers at Plattsburgh were not attacked with fevers as they had been the preced- ing winters. The troops, during this period, were not paid; a fortunate circumstance to the army ; arising from a want of funds. Tliis embarrassment, which was considered a national calamity, proved a blessing to the soldier. When he is found poor in money, it is always the case that he abouuils in health. A fact worth recording ! Deserters from the British army, of wliom some hundreds came to our posts, exhibited marks of high health; while those of our soldiers were pallid and emaciated. The tlitference was too obvious to have escaped the observation of the officers of the army. It led me to seek the cause. Upon enquiry it was learnt, that spirits were no part of the ration of the British soldier; that these liquors could not be procured in the upper province of Can- ada for money. While, in addition to their daily rations, our soldiers, when they had money in their pockets, had free access to spirits at the stores of the sutlers. Diseases and mortality generally, but not necessarily, followed the pay-masters of the army. With means to make themselves comfortable, soldiers frequently render their lives wretched. It may be esteemed medical heresy by some, to declare it is my opinion, that ardent spirits should not be used as a common beverage, diluted or not. Habits are unconquerably stubborn. Long established |)ropensities will not yield to the voice of rea- son. Temperance is one of the pr.'icepts inculcated by our di- vine master; and the doctrine has been preached by his disci- ples. Still, with all the heavy denunciations of heaven against the sin of inebriation, but few reform. This vice ia a growing evil. -^ ..>,.. The time was when ardent spirits were not known. Then the salubrious fountains of water were resorted to by the healthy and athletic to satiate their thirst. The early productions of the still, it is highly probable, were employed as medicine. They now hold a distinguished place in tlie materia mcdica, ami 6 m m\ ;i.i. 1.' 1 ii % • r I Jsi i m II! 38 MEDICAL SKETCHES. !'., i'l i !! i I! '1i were they confined to the store-houses of druggists, and the dis- pensaries of physicians, the sphere or tlieir utility would be vast- ly enlarged. ■ Cleanliness is the lire of an army ; while filth and dirt are among its disease-generating causes. The observance of clean- liness in domestic life is of the highest ini)>ortance to secure the body in health. is no less valuable as a menu of snpitorting the strength and efficient force of an army in actual service. Filth and dirt become more active destroyers of life when they cooperate with pestilential states of atmosfihere, or insalubrious gasses, the production of unhealthy climates or noxious situa- tions. Cleanliness should be enforced U[ion soldiers with most rigid laws. That code under the Jewish dispensation, enjoining ablutions and purifications, was obeyed as a religious rite ; it has been quoted as a system well adapted to a cam|i. It has been observed, that those regiments which have been subjected to rigid discipline, s d where cleanliness has been strongly en- forced, have enjoyed higher states of health than those who have been inattentive to this duty. A man cannot be made a good soldier unless he is made to keep himself clean. This is better effected by infusing into hib soul a pride for neatness of dress and appearance, than by punishment for neglect ; though the last is sometimes necessary. Good discipline is better maintain- ed among a body of men by what is termed Cesprit du corps, than by austerity and severity. A good soldier will be ambitious to execute his duty with fidelity ; he will feel that he has not de- graded himself by assuming the profession of arms. To form within him this state of mind, he should be taught to obey the civil laws of his country, and to respect the interests of the citi- zen ; and to violate either is not only criminal, but extremely dishonorable. He should realize, that his country beholds him as an honorable protector of its rights, and ajxist avenger of its wrongs. A treatment, which is due to a rational being, not such as a slave or a servile subject of a tyrant receives, will impress upon a soldier exalted sentiments of honor and justice, so necessary to secure his warmest attachment, and faithful services to the state. CAMPAIGN OP 1812. 30 The refitiments of heavy and light nrtillery suffered less by dis- ease (lurinj: tlie war, than any other regiments on the northern frontiers. It is unnecessary to ohstrve, these regiments have been always subject to correct discipline; and their better health may be much imputed to cleanliness. Their quarters and en- campments were generally in the best state; the men were, mostly, neat and clean in their dress and appearance. Thero was one regiment on the frontiers, which at one time counted nine hundred strong, but was reduced by a total want of good police to less than two hundred fit for duty in the course of two months. This regiment, in its appearance, was at that time dirty in the extreme. To save the remnant, if possible, General Dearborn found it necessary to place it under the com- mand of Colonel Miller (now General) by annexing it to his regiment. At one period more than three hundred and forty of this reginze' t were iu hospitals ; in addition to these, a large number were reported sick in camp. At the close of the war, this regiment had established a high reputation. Its good disci- pline and bravery, were excelled by none. Health is impaired, and fatal diseases are the consequence of unequal and variable excitements in the system, produced by any cause ; either acting as a preternatural stimulus on the stom- ach, the skin, or the lungs. Such are lai^e potations of spirits. Such are accumulations of filth and dirt, when in contact with the skin. Such are those emanations which proceed from sub- stances in a state of putrefaction, when received into the lungs. Under the above circumstances, cold, in an especial manner, produces its deleterious effects. Unequal excitements in the animal system are induced by transition of seasons, as well as weather. These transitions, with the cooperation of pestilential states of atmosphere and oth- er causes better understood, produce diseased actions, destroy health, and accelerate death. These fatal evils, the cause of a part of which being cold, mF^y in some degree be obviated by warm cloathing. More especially the sudden changes of weather to which sol- diers are unavoidably exposed in the field, and the formidable ti: 40 MEDICAL SKETCHES. I J \ 1 ' ll h\f !■; 1,1 iliseases uhicli are the consequence, might he nn inducement lu government, as it is for the highest interest of the nation, to guard the health of the army, and preserve the services of the men in the field, to furnish them annually with a pair of woollen shirts. A garment of wnoi next the skin would secure the body from cold more cfl'ectually than three garmmts of the same thick- ness worn over linen. Wool is not a good conductor of heat ; consequently, under all circumstances of cold and wet, it retains the natural heat of the body. The additional expense of woollen shirts to the nation w ould i)e but small, which would be remunerated by this imjjrovement; not only in the saving of bounties paid to necessary recruits to supply the loss occasioned by sickness and its consequences ; but more especially in obviating the wounds too frequently in- ilicted by death of a friend or connection. • The substance of the last observation was jiublished in the MEnicAL REPCsiTony, at New-York, in connection with com- munications upon the winter epidemic of 1812, 13. The senti- ments herein adduced had been previously communicated to of- ficers of high grade in ^the army. What influence the sugges- tion had at that time to effect the proposed improvement, is to me unknown. The winter following, however, with much grat- ification, it was understood that a pair of woollen shirts, in con- formity to the proposition, was made by government a part of cloathing allowed the soldier. This garment was worn by offi- cers also, even during the summer months, while in tents. Having experienced from woollen garments next the skin the greatest benefits, while exposed in my tent on the northern fron- tiers, during every canT|iaign, and witnessed its salutary effects iu others while m the field, an additional improvement is urged, for the consideration of government. That the soldiers destined to perform duty on {lie northern and western frontiers be entire- ly furnished with woollen garme.its. There are a few days on- ly, during a campaign, that men Avould be incommoded by the increased heat of woollen garments; then only a few hours in 1 he day. Men in tents during the hot seasons experience little ineon f CAMPAIGN OP 1812. 41 I, venience from those garmenls of wool next the skin, wliich is overbalanced by their advantageous effects, while exposed to cold and rain on necessary duty. Checks of perspiration, or an al)straction of heat from tl>e surfnceof the body, cooperate with a variety of other causes to produce diseases, which these gar- ments would obviate. Woollen garmenls are most important and necessary for men employed on expeditions, in the wilder- derness, when at war wilh hostile savages; where, destitute of tenis, they are unavoidably exposed to weather, both wet and cold. Clothed in wool, during all seasons, soldiers would enjoy higher degrees of health. We should behold them more hardy and robust, enduring the severest hardships, the most fatiguing marches, and the inclemency of seasons, without attacks of disease. If an unequal excitement exists in the system during a state of fever, it is most evident that cold, or an abstraction of heat from the surface, is among the most hurtful agents. It is also evident, that while the surface of the body is under a state of exhaustion by cold, an excess of stimulants taken into the stomach does not diminish, butincreases (he dangerous state. The deleterious effects produced by the above hurtful agents are proportionate to the degrees of exhaustion on the surface, and the exciting powers received into the stomach. Hence ardent spirits become more hurtful agents during the severe frosts of winter, than during the heat of summer. The two first hurtful agents in conjunction during winter, in- duce the most dangerous forms of our winter epidemics. These epidemics, therefore, are most fatal to men whose vital energies have been most frequently exhausted ; they are accom- panied by engorgement of some viscus important to life, and fee- ble action of the arteries at their extremities. ' This state is sometimes attended with a deficient venous ah- sorption ; hence the spots which are seen in the skin. When robust men, who have not often been exposed to those hurtful powers, become subjected to them, a dangerous fever en- sues with strong arterial action. During its violence, either the brain or the lungs are endangered by its excess. ! H hi ^rn r 1 ■ ' ; <' i I iHi' ' 1 m '/ ii( ■ ! i^> 4f MEDICAL SKETCHES. \h When hurtful agents operate upon a body exposed to them during the heat of summer, the excess of unequal excitements is not so great; becHuse the degrees of hurtful powers are rela- tively less than during winter, yet sufficiently great to induce a dangerous fever. This state however does not necessarily precipitate the boily to a most sudden death ; l>ut a destruction of an organ important to life slowly progresses. Although death does not immediately ensue, yet it is as certain ; provided the diseased state is left to its own operation. Of this description are the fevers of summer and autumn. These last states of fever, however, are under the influence of additional hurtful agents, which depend on local causes for their existence ; such as marsh miasmata, and putrid effluvia. These last described states of fever have for causes other co- operating hurtful agents; as bad nutriment, excessive fatigues, long watchings, and mental depressions, &;c. The hurtful agents of winter above mentioned exhibit their effects immediately upon the lungs or the brain, mediately upon the muscular system by pains in greater or lesser degrees, pro- portionate to the powers of tho£>e agents. The above agents during summer and autumn, exhibit their first deleterious effects most frequently upon the intestines; their second throughout the system by association. In all states of fever the first indication is to remove the hurtful agents. The cold upon the surface and extremities is obviated by artificial heat ; various modes of applying heat have been employed. Those means, by which heat is most equally diffu- sed, are to be preferred. The suitable application ^ icat, in the cold stage of fever, is the first mean to be employed to equalise excitement. The second indication is to obviate the tendency to death, the effect of engorgement by evacuations ; as cautious bleedings, in cases where arterial action is suppressed at the extremities, and by cathartics ; or bold bleedings, where the arteries act with force at their extremities ; and by drastic purges. These are the second means employed to equalise excitement. CAMPAIGN OP 1812. 43 The third indication is to remove the remains of unequal ex< citement, (he consequence o( hurtful agents, by means less pow* erful than those above mentioned, but Avhich are adapted to par- ticular affections, the efifects of diseased action, the consequence of association of parts. These are opium, blisters, emetics, eccoprotics, antimonials, and calomel in small doses. These are the third means em- ployed to equalise excitement in the system. The fourth indication is to obviate debility, the effects of the hurtful agents ; or of those means, which are necessarily em- ployed to counteract the tendency to death. These are either natural or artificial stimulants. The first if nutriment, whioh is permiinent. The last are vinous liquors, or spirits, which are diffusible and transient. These stimulants require caution in their administration ; and are to be adapted to the state of debility, or excitability of the system. The following extracts of reports will shew the state of the hospitals, under my direction, during the winter 1812-13. " The hospital department at Plattsburgh has not been des- titute of the common supplies, which are usually furnished the sick of an army ; while every requisition, made for hospital stores, has been promptly answered. During the month of November, ample supplies of stores, as wine, spirits, sugar, molasses, rice, tea, and chocolate, were ordered by General Dearborn, to be forwarded to Plattsburgh, under the charge of Doctor Wilson, hospital surgeon's mate. In December, an additional quantity was, by orders, directed to the same post, and Burlington. Upon an interview with Doctor Wilson, when inspecting the hospital at Plattsburgh, in the month of Jan- uary 1813, who then had the charge of the hospital at that post; information was given, that the supplies of November had not been expended. The hospital under his direction is found in the best state. The beds are amply furnished, the wards clean, the kitchen neat. No less credit is due to Doctor Lovell, sur- geon of the 9th regiment, under whose charge the hospital at Burlington is placed, on account of its good condition, and the unremitted attention bestowed ou the sick." 1 1 M 44 MEDICAL SKETCHEH. i^ i|i " The huBpitui at Greuubtisli h in goud unler, and tlie pa iienla comrortable." At this period, in an official report, it waH also stated, " that no army was ever better supplied, with hoHpitai storeu, tliaii timt on the frontiers." Therefore, a want of necessaries could not justly have been ussii^ned a cause of the great mortality, ns was rumored at a distance from the army. It might have been expected at such a period, that the number of deaths would have been vastly exaggerated ; but, when It was most evident, that erroneous reports were imposed upon the pub- lic, with design to render government and its otticers odious, to cITect the purposes of a party, the evil retpiired a remedy. It was well known at the commencement of the war, that Uiere were men in service on the frontiers, who exerted their talents to render the army disreputable ; to create discontent- Int:<.^ and encourage insubordination among the soldiers. The officers of the regular army were not implicated in this charge. The following is a correct statement — a detachment of the New- York militia was not furnished with hospital stores, agreeably to a requisition of its surgeon. In this case, the officer com- manding the regiment refused to conform to a regulation adopt- ed for the government of the hospital de[)artment ; which was, that requisitions for stores should have the signature of the com- mandants of corps. The surgeon of this regiment of militia, in a letter addressed to myself, feelingly, and politely regretted the " untoward disposition," of his commanding officer, which pre- . vented him such supplies as he required. For the want of these, no one could have been made accountable, except his perverse and obstinate commanding officer. The above recited transaction gave rise to a report, as was intended, injurious in its consequences to the public service. Exaggerated accounts of deaths in the army, with a similar view, were crowded into the public papers ; when the mortality among citizens was scarcely noticed by them. From these sources, it \t highly probable, that Doctor Gallup obtained his information, respecting the ravages of the pneumonic epidemic, at Burlington. (See note d.) t I ■• :^!l CAMPAIGN OP 1812. 4ft Tiie Kr^atrst mortality in the army was in tjie month of De- eemlx^r, IB12; at a period when allmulants were employed na rardicine. The evacimtina; niul antiphlogistic practice was adopted the firsi week in January ; during which month, mor- tality had neiirly censed, as the disease was generally under the control of remedies, although the number on the sick reports was not diminished. This lust fact was evident, by the month- ly regimental reports. The numlier of deaths reported in the 2Ut regiment, for December, 1812, was thirty -three. The number reported in the same regiment, for January, 1813, was three. If we take the re|)ort8 of the 21 st regiment, as the ratio for Decemlier and January, the deaths were as eleven to one. Then as the whole number of deaths, agreeably to oflicial re- ports, in the month of Deceml>er at Burlington, was one hund- red and lifty ; so in the month of January, the deaths did not exceed fourteen. It is a truth, that in a ho8|)ita1, which coi»- taincd one hundred men, there was not one death the two last weeks in January. The reports of deaths were less in Februa- ry, than the preceding month ; three only died in the same hos- pital, during the last month. During the mouth of March, there were but few cases of the epidemic. From the preceding statements, which are the most correct, which can at this time be given, it is evident, that the number of deaths from the indt week in November, 1812, to the last of February, ISlit, at Burlington, did not exceed two hundred. It has been estimated, that during the above period, about two hundred died at Plattsburgh. From a correct report, made at Greenbush, of deaths from the first of August, 1812, to the last of February, 1813, the whole number was eighty-nine. A general account of the weather, from July to November 1812, has been noticed. December was severely cold. The second week in January 1813, there was rain and thaw. From the middle of January, to the middle of February, the weather, on the border of Lake Champlain, was cold, and little variable. The order in which the several forms of disease supervened, during the campaign 1812, is as follows: Dysentery, diarrhoea, and fever, in the month of July, August, and September. Dlarj ^P'i v > t '; If ' 40 MEDICAL SKETCHED 1/' rtiflsa anil pneumonia, diarrhcca and rheumatalgia, and measles^ in October and November. Pneumonia notha, and severe pneu- monia, in December 1812, and January and February 1813; -whicli were the prevailing winter epidemioifc • • ill END OF CAMPAIGN 181!^ I lit p* t • .' <.^v . •. CAMPAIGN OP 1813. HAVING iDspected the hoBpitnls at Plftttshurgh niul Bur; Kngton, duty made it requisite for me to retnrn on the 10th of Pebruarj, 1813, to Greenbush, where the direction of the hogr pital employed most of my time the remainder of that month. The sicic, who had been comf(>rtal)ly accommodated in one of the common barracks, were now removed to the new hospital. The regiment of dragoons, under the command of Col. Burns, and a detachment of light artillery, commanded by Major (now Colonel) EusTis, had taken quarlerd for the winter at this cau^ tonment. The soldiers of these regiments, particularly those of the light artillery, had severely suffered by the epidemic pneumonia. After my return from Lake Champlain, there were many severe cases of the disease at this post. The surgeon, under whose charge the hospital had been placed, during my absence, ex- posed himself to reprehension, by inattention to duty. This was supposed, by the officers of light artillery, to have been one cause of a number of sudden deaths in that corps. It was med- itated to prefer charges against the delinquent. These were suppressed, while preparations to obey orders, from the Con»- niander in Chief to march, absorbed every other consideratioB of minor consequence. The movement of tlie troops from Greenljush, at this season, March 2, 1813, preceded by General Dearborn to Sackett's Harbour, on Lake Ontario, indicated that active operations would commence early the ensuing campaign. This march, a distance of nearly two hundred miles, wa« accomplished in tlve ii :'■ 49 MEDICAL SKETCHES. 1 m ':i ' 1 V - ^ 1 jl : :. 1. ■ i : 11 , ill J 1^: 1 ^'i^ i'lil ; and six days. The greatest part of which was performed dur- ing a Btorm of snow, or weather severely cohl. The direction of the line of march was on the Mohawk turnpilte. The Mohawk empties into the Hudson, six miles north of Aibaiiv, lititween the towns of Troy and Waterford, by several mouths. Two miles above these outhMs is Calioos falls. These falls are seen at the distance of two or three miles, and combin- ed with the surrounding hills, the adjacent Hats, and the small villages on the banks of th« river, with its divided branches, winding their courses between little islands at its mouth, exhi- bit a landscape pleasingly picture sque. A nearer view of the uninterrupted sheet of water, two hundred yards in width, fal- ling from u height of seventy feet, is a scene truly sublime. One mile below the falls, the river is passed over by a hand- some bridge. Schen 3Ctady, an incorporated city, is situated on the banks of the ^ ohawk, twelve miles above the falls. It was, original- ly, settled by the Dutch ; and is one of the most ancient towns in the state of New-York. Its early inhabitants severely suffer- ed by the Indian wars, and their depredations. The town, con- sisting of sixty- three houses, was destroyed in February 1(390, by a party of French and Indians from Canada. This was a frontier post, until the conclusion of the revolutionary war. Since which, it has wonderfully increased. Its population in 1810, by the census, was 5909. The great turnpike, from Al- bany up the Mohawk, passes through this town, and here cros- ses that river, over a fiuperb wooden bridge, 997 feet in length, roofed over throughout its extent. The lands in its vicinity ai-e nearly level, the soil rich. On the west, the city plat is washed by the Mol-awk ; over which are extensive alluvial lands, under good cuitivation. On the east, the lands are sandy and light loam, barrtn, and litl'e cultivated for several miles, covered with yellow pines of diminished growth. The city is built ou streets, regularly laid out in squares, and contains be- tween five and six hundred houses mostly of brick ; three edifi- ces for the College, which is in an improving state, by liberal public and private endowments ; from its position and increos- CAMPAIGN OV 181fl. 4» ing importance, it will become within a few years, the f^rst lit- erary institution in the United States. Here are four houses for divine worship. The courts for the county are held at this city. Boat navigation up the Mohawk commences here. From this place to Albany is a portage of sixteen miles, occasioned by the Cahoos falls, which intervene between the Mohawk and Hudson. With the aid of four short canals, boat navigation up this riv- er is continued to Wood-Creek, through Oneida lake, and Os- wego river ; a distance of more than two hundred miles. The canal at Little Falls, seventy -one miles west from Albany, is one mile in length ; upon which are several locks, which give a rise of more than forty feet. The canal, which connects the upper branch of the Mohawk, with the Ontario at Rome, one hundred and eight miles N. W. from Albany, is one and a half mile in length, with a lock at each end. The lift at the eastern is ten feet ; that at the western, eight feet. At Wood-Creek are four other locks. As we ascend the Mohawk, on the turnpike, a number of creeks are passed ; over which are safe, durable, and handsome bridges. The country bounding this river, until you pass Little Falls, is broken, gradually sloping from the alluvial flats, until it rises to hills and heights mountainous. These elevated lands are good for wheat and pastures. The flats and alluvials, immedi- ately bordering the river, are rich and excellent ; very product- ive in every species of corn and grass. Extensive farms, tine settlements, and handsome villages, pre- sent themselves to the view of the traveller, as he advances up the Mohawk. These are interspersed with pcrpendiculf"" led- ges of rocks, topped with projecting fragments, threatening in their aspect; dreadful precipices, which cause the pallid chill; araall streams of water spouting from the lofty clefts of rocks ; and bolder cascades, rolling from rude cragged steeps, to please the eye and excite admiration. Fifteen miles above Schenectady is Amsterdam, a handsome II jt^i f,l- .1 l:J, 1 i fiii 50 MEDICAL SKETCHES. ▼illage, Hitiialed on the north sale of the Mohawk. Here the turnpike crosses Chuctenunda creek, a small rivulet. One hund* red rods above its mouth, the stream fulls one hundred and twen- ty feet ; on which are a numlier of mill-seals. There are now in operation at this place, hve mills for grain, four saw-mills, two fulling-mills, two oil mills, a tri[)-hammer, and an extensive iron manufactory. 'I'his place may accommodate an increased num- ber of water works, to aid manufactories. Eight miles above Amsterdam, the turnpike passes Kingsbury, a village of little nole ; and two miles farther, immediately on the bank of the Mohawk, Cahnawaga village of aboriginal mem- ory, as being once the residence of a part of the Mohawk tribe of liidians ; where at this day, are to be seen their orchards of apple-trees. These last villages are within the limits of Johns- town. The principal village of this town is situated four miles jiorlh of these ; where the courls of the county hold their ses- sions. The last is a very beautiful village, a place of consider- able traffic, which increases with the population of the country. About fifty years ago, Sir VVit,liam Johnson conducted a few setllers to this tract, then a wilderness; who enjoyed their new habitation in peace but a short period. They were conv pellod, during the revolutionary war, to seek places of more se- curity, in the older towns on the Hudson, and at Schenectady ; and did not return until Johnson, the leader of the enemies o4" Ihe revolution in the northern district of New-York, with the hostile Indians under his control, were expelled the country. After passing some fine settlements, well built conmiodious houses, and farms under a good cultivation, we arrive at Little Falls, a compact settlement of fifty houses, unpleasant, surround- ed with broken crags and huge rocks; a site commodious for niauul'actoritri, which rocpiire the aid of water. This is a vil- lage of the town of H(^rkiuier, of considerable note, having a population in 1310, of nearly three thousand inhabitants, seven- ty-ei;^lit miles from Albany. Here tiie alluvial grounds, on the bonier of the Mohawk, are very extensive. They were known by the fiiot settlers of this countr}^ by the name of German flats, as were other alhivials, at diifircnt jminls up this river to Rome., CAMPAIGN OP 1813. 51 *the genei-ftl face of the country presents a rich soil, i^Itivated by the hands uf an industrious yeomanry. This is an ohl set- tled town. The village of Herkimer is very pleasant, exhibit- ing considerable taste and opulence. In its vicinity, the turn- pike crosses West-Canada creek, %vhich empties itself into the Mohawk from the north. The next most important town, through which the Mohawk turnpike passes, is the village of Utica, within the bounds of Whitestown, ninety-three miles from Albany. This village, from its (irst beginning, which was since the revolutionary war, has increased to a size which surpasses belief. One, knowing the state of this country thirty years ago, ignorant of its rapid improvement, might naturally suppose, that at a distance of our hundred miles west from Albany, he would find himself buried in a wilderness, where nature is beheld in its most rude and savage state. The sceneries up the Mohawk are circumscribed in all directions, by diversified broken ranges of hills, and in- tervening vallies. While travelling on a road up and dowir. and whether rising on hills, or descending to the plains below, no distant prospects are to be seen. But as we approach the head of the Mohawk, a new world, in a high state of cultivation, is displayed to the sight. Those stupendous mountains and precipices, which accompanied us from stage to stage up the Mo- hawk, are either left behind, or gradually sink anil are lost in the vast extensive plains 'efore us. We view the surrounding and more remote sceneries not only with delight, but with won- der and amazement. The transition, though not very sudden? is like enchantment. Utica is situated on the south side of the Mohawk. Having passed over a level road, twelve miles or more, we enter the village over a durable roofed bridge. The surrounding country is a vast plain, open in all directions, having no intervening hills, and few tracts of wood-land, to intercept the sight. This champaign country extends to Lake Erie, two hundred miles west. Every thing is new ; at the same time, taste, riches, and opulence, are generally displayed. These are proofs demonstra- live of a coil highly luxuriant, and a populaliou very iudustri- I . ! I ■■( ■ I' Ih, « MEDICAL SKETCHES. ii ' Ii i I M mi "n 1 ■ I out. The artisan, as well as the husbandman and merchant^ here increase in riches. Mills, factories, and mechanic shops, are seen in all direction's. In this village are two houses for divine worship. y .. : -, - v During the revolutionary war, this was the site of Port Schuy- ler, whicli will be long known in history. Utica contains be- tween three and four hundred houses compact, and a i>opulation of two thousand souls. The commerce of the extensive west- ern country concentrates at this |)oint, about fifteen miles belovr the head of boat navigation on the Mohawk. Whiteshorough, the second village as to importance, within the limits of Whitestown, and situated four miles north-west of Utica, seems on account of the uninterrupted population, to be 9. continuation of the last village. Its tirsl settler was Hugh White, afterwards a Judge of one of the courts. He emigrated from Connecticut, in the year 1785 ; and was the first who had /esolution to adventure into these dreary regions, unfrequented, except by savage beasts, and more savage men. Whitesborough village is beautiful and elegant. It comprises •ne hundred houses, and seven hundred inhabitants. New-Hartford, the third village, is situated west from Utica. This also, is a continuation of the last. Farms, in a state of high (tultivatioii, here present themselves to the view of the passing traveller. Whitestown, with its villages, UMca, Whitesborough, and New-Hartford, exhibit more important improvements in com^ merce, manufactories and agriculture, than any town of the same age, in the state of New-York, perhaps in the United States. The public buildings are superb, and many of the private man- sions finished in a style of elegance. They are such as would be thought ornamental in the older towns of the Atlantic States. The face of the country, with its various improvements and em- bellishments, give the spectator some idea of its wealth and presr ent resources, and what may be its future opulence, arising from their rapid increase. But when he reflects ujion the recent date of their origin, the many dangers, hardships and privations, the first settlers had to encounter, to make themselves only com- CAMPAIGN OP 1813. 53 fortable, he is struck with admiration ; and when he learns, that Uiese vast improvements, from a wild state, nre the proiluce of only thirty years of industrious labour, he is lost in astonish* Dient Uf)on the ancient site of fort Stanwix stands the handsome village of Rome., thirteen miles N. W. from Utica. During the revolutionary war, it was an out-post surroundeil with vast for- ests in the wildest state, now encircled with luxuriant helds ; T\hich amply repay the industrious husbandman with abundant harvest for his labour. Fort Stanwix was built by the British in 1738; and was evacuated at the close of the French war, af- ter the conquest of Canada, and was suffered to fall to ruin ; but during the war with Britain, was rebuilt, and maintained as a frontier garrison by the revolutionists ; and with a number dT posts, from fort Schuyler to Schenectady, on the Mohawk, form*- cd a communicating line of fortifications, to prevent surprise, and protect the interior settlements from incursions and deprev dations of the enemy, and his savage allies. The first settlers of Rome were Dutch. Its present popula- tion consists of emigrants from the eastern states ; as do those of Whitestown and its villages. The Mohawk passes withia half a mile of its village, composed of thirty houses ; on which are seats for water machinery, which adds value to the position. It was in this town, that General Herkim«:r was killed in an action with the Indians, during the revolutionary war. The canal, which unites the head waters of the Mohawk and Wood- Creek, passes through this town. From Utica, the course of Sackelt's Harbour is nearly N. N. West ; to Otswego on Lake Ontario, is nearly west. After leaving the upper branches of the Mohawk, and passing the high lands, which separate its waters from the smaller streams of Black River, which empties into Sackett's Harbour ; the coun- try down is variously uneven, mountainous, precipitous, and rugged with rocks. The forests are variegated with several species of hard and soft woods, and evergreens. Many scene- ries pass in review of the traveller, as he progresses down Black River. 6 !v , 1 '■ I- I } \l I 5i I^IEDICAL SkETCrfER This river has its sources in the high lands, norllj of Littl* Falls and the Mohawk. Its course is N. N. W ; and empties itself into a large bay, in which is Sackett's Harbour, ninety miles from Utica, and one hundred and ninety six miles N. W; from Albany. Twelve miles north from Utica, is the town of Trenton, re- markable on account of a cataract in the vicinity of the village. The water tumbles over successive strata of rocks, from an emi- nence of one hundred feet. The rapids below are confiP"i within contracted limits by rocks which rise per|)endicularly one hundred feel or more, overspread with evergreens. The scene from below, although circumscribed within narrow bounds, by the surrounding broken highlands and cragged precipices, is romantic ; uhile the whole assemblage is truly 9ublime. The soil of this town is good ; the forests are variegated with vari- ous species of both hard and soft wood, and evergreens. Its ' principal village contains about eighty houses. On the route down Black River from Trenton, we pass Bow- en's settlements, Steuben, Boonville and Leyden ; the last is thirty three miles from Utica, and one hundred and fifteen N. W. from Albany, comprising a tract of country, with thinly scatter- ed settlements, and inconsiderable villages. The next town of much consequence, is Martinsburgh, forty eight miles from Utica, and one hundred and thirty N. W. from Albany ; it is in a fine state of cultivation. The face of the land is gently rising and falling. The soil is rich. The count- ry from this to Brownville abounds with lime-stone. The vil- lage of Martinsburgh contains between thirty and forty houses, county buildings, a house of public worship, two distilleries, a saw-mij,, grain-mill, paper-mill, taverns and stores. Fifty seven miles north from Utica, we arrive at Lowville, one hundred and fifty-nine miles N. W. from Albany, one of the most imi)roved towns on Black River. The village, laid out in squares, is beautiful, comprising fifty houses ; many built in a style of taste and elegance. Here is an academy ; the building is handsome. An elegant and spacious edifice is improved as an hotbl. The lands, which lie in gentle swells and ea«y vales, are ■ j^feasa H veys ( H only t H Aud af 1 B thiuly H cmerg I 1 ^" ^^ 9 *''^'' ^" S low is Wm two h IB 9 (ten y 9 cardin i9 Copen mM is disl ^H Th( 9 Bii'^S> 8 "^* ^ on the ^H twelv( ■ The ( ^H srecte H of brie H are el H brick, 1 ed as ■ its of t 1 mills, 1 with a ^ are go ■ are in H terials I Black 1 from h '^ is carr "i river ! •1 r i ^' ' CAMPAIGN OP 1813. .$5 (^feasant. The soil is of giiperior quRlity. Th'^s dislrict con- veys to the mind of the trRveller, that its inimliitnnts enjoy not only the neccssariea anil conveniences of life, but possess wealth «U(i affluence. Six miles north of Lowville is Denmarlv ; the setllemonts are thinly scattered, exhibiting a country but just bee^innins; to emerge from its wild state. However, over an area of twenlj' two thousnnd acrrs, the ac;preeate population is considerable. On Deer creek, which cm])tie8 into Black river, is a perpendic- ular fall of one hundred and seventy-five feet. The stream ht'r low is bounded the distance of eighty rods, by calcarious rocks, two hundred feet in height. Here, since its first settlement, (ten years) have been erected six saw-mills, two grain-mills, two carding machines, two clothiers works, three s;)inning-machine6. Copenhagen a small village, lies above llic falls. Denmark is distant one hundred and fifty-six miles N. W. from Albany. The distance from Denmark to Watertown is aliout twenty Biile^, and one hundred and seventy-six miles N. W. from Alba ny. This is a pleasant growing village, situated immediatelj' on the south side of Black River. From a wilderness, within twelve years, it has become a place of considerable importance. The courts for the county have their sessions here ; where is erected a commodious court-house of wootl, and an arsenal buill of brick. The village also contains sixty houses, some of which are elegant; likewise a spacious and well built academy ol brick, which in March, April, June and July, 1813, was improv- ed as an hospital for the United States army. Within the lim- its of the village, are a paper-mill, two corn mills, three saw- mills, a carding machine^ three taimeries, and a printing-office, with a number of mechanic shops. The lands in this vicinity are good ; cultivation is in an improving state ; the inhabitants- are indurlrious and becoming rich. Lime-stDne and other ma- terials for building are found in abundance, from the sources of Black River to its mouth. Watertown is situated four miles from boat navigation on Lake Ontario. A considerable traffic is carried on between this place and Montreal, by the lake and Tiver St. Lawrence.^. PWIfWWPP'""" !•■ 66 jMEDICAI. rSKETCIlEK. t ill i Ml |i From Wntcrtoun to SacKelt's Hurboiir, we pass Browiivillc. a town of great extent, comprising within its limila, a lengtli ot twenty-four milcB, and a bretuUh of twenty-two. It is bounded on the N. W. by St. Lawrence, S. W. l)y Lake Ontario, soutk by Black Itiver, on the east by the town of Le Rny. The soil is rich and fertile. Within tiic limits of this town, there arc no liills ; the surface of the earth gently uneven. This town was first settled about fourteen years ago, by John Brown, from Pennsylvania ; since which, its population has increased in an astonishing manner. Tliere were by the census, in 1810, 1G02 inhabitants, mostly emigrants from Pennsylvania, and the New- England States. This town is well watered, and abounds with lime-stone, as docs all the country in this vicinity. Several islands in Lake Ontario and St. Lawrence, are within the lim- its of Brownville. The village situated on the north of Black River, contains thirty houses, a number of stores and mills, and is a place of considerable mercantile business, which is carried on with Montreal, by St. Lawrence. This is a pleasant village, and will from its situation, become in a few years, a place of great im[»ortancc. , • General Brown is the son of JoUn Buown, from whom this town derived its name. From a private citizen, in the course of three years, he was elevated to the first grade in the army. The battles fought on the Niagara, by the army under his com- mand, have given to the American soldiery, a character for pa- tience, perseverance, and undaunted bravery, surpassed by none. A military hospital was established at Brownville, two last years of the war. Its position was favorable to such an estab- lishment ; as there is a water communication between this place and Sacket's Harbour, the centre of active operations on the northern frontiers. The country in this vicinity, especially those posts bordering on the bays of Lake Ontario, like all new countries, are con- sidered unhealthy. Sackett's Harbour was the only secure port for a navy on the lake; where Commodore Chauncey had hauled up the armed flotilla, during the cold season, waiting the breaking up of win- iSl'i CAMPAIGN OP 1813. 5,r fer, \o r*»-aMUmp operations against the enemy. To this flotilla, was adiled h ship of twenty-eiijht c;uns, l)niU. entirely of green timber from the wilderness, within three months ; and which was in preparation to sail, as soon as the ol'structions formed hy ice were removed. Sacket's Harhour was protected by two bat- teries, and two block-houses. This post, the preceding; cam- paign, had been occupied hy militia. The hospital, so denom- inated, was in a tilthy condition. From information, the win- ter epiilcmic had proved very mortal among the troops. The disease at this period, (iMarch 10, 1813,) had not disappeared. The few existing cases were attended with symptoms less formi- dable than at its commencemrnt. Information had been received, that the enemy was conceft- trating his disposable force, at Kin^iston, Upper Canada, distant thirty miles. Apprehensive of an attack from him, General Dearborn ordered a temporary hospital establishment at Water- town, twelve miles east of the harbour, on black river, where the sick would be less exposed to depredations of the enemy. This precaution was more necessary, as the sick could not be accom- modated at the harbour, within the line of defence. An hospital sufficiently capacious to accommodate 100 patients, was, within ten days, estalilislied; to which the sick at the harbour were re- moved. Among the number were about 20 of General Pike's brigade, who, on their route from Plattslmrgh, by way of Chatau- gay ixM Malone, in the month of March, had badly frozen their feet and toes; which, in almost every case, mortified, and requir- ed amputation. At this hospital two cases of the winter epi- demic were admitted, when the disease was at its last stage. In both cases there were large expectorations of mucus uniformly mixed with blood. Respiration was difllcult ; diarrhoea accom- panied the disease. A pill of one grain of calomel and opiuni '• was directed night and morning : also small doses of antimonial wine and camphorated tincture of opium, were administered at intervals of three or four hours, as an expectortant ; likewise blisters and gentle emetics. Under the employment of the above means, with the addition of a soft nutritive diet, and wine, these men were restored to hes^lth. Tlie most prevalent disease at I ' » !'■! J» MEDICAL SKETCHED. Ml 1 '1 tli'iB period, March and April, vsere cougiis, fevers of tlie synocIr-> aI type, diarrhinns. On tlie 23d April, nn ordci- »va8 received, to place the ho8|>ilal under the charge of surgeon's mate, March, and lO repair to Sacketl's Harbour ; where, having arrived, information was ob- tained, that sixteen hundred men, destined for a secret expedi- lion, had embarked on Imard the fleet, and that commodore Chauncy waited only for n fair wind to sail. This armament, to %vhich I was attached, wns commanded by General Dearborn, being coraiwsed of a part of General Pike's brigade, one battalion of Colonel Kiplev's regiment, two companies of New-York and Ealtinwre volunteers, 200 riflemen, and two companies of light artillery. On the 23th of April, the fleet weighed anchor, with a favoural)le breeze, and steered their course to the head of Lake Ontario. On the 27lh, at day-break, were in sight of the Light House, at the entrance of the bay of Litlle York, in Upper Can- ada. At eight o'clock this morning, the fleet dropped anchor opponUe the batteries, at six hundred yards distance, when the signal for debarkation was displayed. Miijor Forsyth, with two hundred of his battalion of riflemen in baileaus composed the advance. General Pike, who com- manded the attack on shore, with three battalions of the Olh, 1 .'>lh, and I61h regiments succeeded the advance, supported by Co'o- ncl (now General) Ripley, with one battalion, composed of 21nt regiment, and two companies ol" Baltimore and New-York volun- teers, under Colonel Mc'C lure, one company of artillery, com* mandcd by Major (now Colonel) Eustis. Major Forsyth, on approaching the shore, met a severe resist- ance from three hundred British regulars,seven hundred Canadian militia, and a small body of Indians, who occupied the high ^anks on the lake shore. Under a heavy lire from the enemy, this coqis made good its landing, and most gallantly maintained lis ground twenty minutes, unsupported, until General Pike and Colonel Ripley gained the land, when the enemy's line in suc- cession broke, fell back, rallied, was thrown into confusion, and r(!trealed with precipitation. General Pike immediately formed his army in open column, and pursued the fiigitivesi During CAMPAIGN OP 18lir. S9 ihc attack oti shoro, th<5 enemy's l)atterifs wore silenced by the well-Jlirected fire of the lijjlit nrmed ichoonere of the fleet, at which time a small magazine took fire. A ship and brig could not approach within battering distance, on account of shoal water. Our column, at the distance of four hundreil yanis from the ert- emy's batteries, halted with a view to reconnoitre their (loaition, and wait the bringing up of two pieces of artillery, under Mtjor Eustis, who had to encounter many olistacles from fallen timber and miry grounds. At this moment, the enemy's principal mag- azine exploded. By this catastrophe, General Pike, an ofTiccr of superior merit, and heid in the highest estimation by the nr* my, received a mortal wound, which he survived a' few hours*. The effects of this explosion were drca'Iful. Sixty rank and filo were found dead on the field, and one hundred and eighty wound- ed and mangled in a most wretched and deplorable manner, by the fall of stones which formed the magazine; to which the ene- my, when he evacuated the battery, set fire, by mean of a train or slow match, prepared for the event of abandoning the works. The effect was similar to the springing of a mine. The remnant of the British army fled with the commanding of- ficer, the Governor of Upper Canada, who was the first to make his escape. The commanding officer of the Canadian militia,, who had retreated to the town, sent a flag, with terms of capita-* lation, when hostilities immediately ceased. One article which was acceded ♦o by General Dearborn, was, that private property should be respected, and all public property be given up. This article, conciliatory to the feelings of the inhabitants of Little York, and magnanimous on the part of the victorious General, was not violated ;n any of its parts, except in one or two instan- ces, by a few licentious soldiers. These outrageous acts were dis- coantenanced in forcible language, in General Orders ; and on the spot satisfactory indemnification was made, as soon as the damages were ascertained by the sufferers. A very different representation of the transaction at Little York has been given. It is not a little astouisbing, that an hfe- ^j)rian should thus conmit himself as the author. 1'^ ii; '^ 60 IVIEDICAL SKETCHES. H; . j! ' i ll; ! Hi It is no npuluj^y for this outraj^c uii truth, that the «ul«B(Hnc«2 of th(! alniBive paragraph was extracted frurn a daihf newspaper devoteii to a party oppoaed to the war. The statement oi' (he hiii« (orian, at the time of ils publicatiim, had lieen repeatedly con- tradicted hy oHicial documents ; and ils ralsity has since been proved by une(|ijivocal declarations of oillcers of hif^h grade and respectable standing in (he army, who held commands in thvith all its malignancy. Its poison is ditluaed. It has been, and will be read witliout the apologetical note, for the criminal publication of mere newspaper re[iort3, unsupported by oflicial documents. Besides, the note is only a partial retraction of the erroneous statement made by the author, which is, that General Dearborn was immediately con)|)elled to evacuate the place, with considerable loss ; while the truth is, the oljject of the ex- pedition, the capture of the enemj^'s fleet, and destruction of his stores, was effected in all its parts. (See Note K.) The army, with the wounded and sick, after having undisturb- ed possession of tlie place four days, re-embarked. The follow- ing night a gale of wind commenced, with rain, and continued with violence, which prevented the fleet from sailing until 7th May. After a pleasant passage of twelve hours, the fleet came to anchor opposite the mouth of the Niagara; upon (he 8th the wounded and bickwere landed, and encamped in tents, two miles east of the fort, where they remained until after the capture of Fort George, in Upper Canada. Previous to further movements of the army, while arrange- ments were making to attack Fort George, General Dearborn hud been severely seized with a fever of the synocljal type, wluch contiued him to his bed more than a fortnight ; from CAMPAIGN OP 1813. ei which he wnB not rrrovennl when Uu* nrmy wis in I'cndinniii to movr. Nutwilhfllnnilinp: liiii l>n() Htnte of hcttllh, he acr(>ni|i»ni> rd the ex|HMliti(>n ni^niniit l<\irt (jieorp in o|i|NMition to the o|iin- iun of hifl phyHJciuns, and nuHinst icinonstrxnctH or the ofl'icers of his nrmy ; persuaded, hr they were, timt the nnavoitlable cx- l>oi«iire to Nv^atlier nnd fiitij^iie attendin<{ ^^oldd, under his state of debility, prochice a rela[)se, and endanger liis life, whereby •ubsecjuent oiieratiuns of the army ng: inat the enemy might be retarded. The assault upon Fort Oeorc;e was commenced on the 25th, and continued the 20th, from Fort Niagara and other batteries recently erected, by a heavy cannonade under the direction of Colonel (now Hrigadier General) M. Poktj". The fire was bo well directed, that Fort George was silencetl ; the Block House and other buildings were set on fire by hot shot, and consumed. This was preparatory to the grand assault. May 27th the army crossed the strait in three divisions, under the immediate com- mand of General Lkwis. The brigades of Generals Boyd and WiNDKR composed the columns of attack, preceded by a detach- ment of six hundred men, commanded by Colonel (now Gener- al) Scott. The brigade of General Chandler was a column of reserve. These several brigades embarked in boats at dawn of day, four miles east of the outlet of Niagara Strait. The boats mov- ed across tlie moutli of the Strait, in a line parallel with the north sliore on the Canada side, at a distance of two miles from the land in a west direction, until they were opposite the point desig- nated for del)arkation. The boats then wlieeled by brigades to the south, and approacheu the shore in good order. This point was one mile north of the village of Newark. The move- ment of "ie troops, exposed to the full view of the enemy, gave him time to form his line most advantageously to oppose, from the high bank of the lake shore, their landing. The enemy's line was supported on his right flank by a battery ; opposed to which was an armed schooner, v.hile four armeU scboeuers covered the lunUing of the army. Hi i I I t ei MEDICAL SKETCHES. HI ■ I i ] 1 ,1 .1 Colonel (now General) Sgoxx, with the lipht trocps, effected his landing under a blaze of musketry from two thousand British regulars and Canadian militia ; and twice attempted to rise the bank, but fell back, and waited for the first brigade under Gen- eral Boyd ; when the enemy, repulsed at every point, retreated in disorder. The enemy was pursued through the village of Newark, to within three miles of Queenstown, when the pursu- ing troops were ordered to retire, by the orders of General Lkwis. After the action there were found on the field of battle, of the United States' troops 27 killed, and 87 wounded; of the British 102 killed, and 175 wounded. The enemy halted the following night at Queenstown ; whence, after collecting his scattered troops, the next morning at dawn of day, he took up his line of march to Burlington Heights, at the head of the lake. On the 28th two brigades under the command of General Chandler were ordered to pursue the retreating enemy. At C tony Creek a subsequent battle ensued, unfortunate in the result, although the enemy was beaten. Generals Chandler and Winder were made prisoners. . , The«e several actions gave us an additional number of wound- ed men. Many capital operations were performed, both upon the Americans and British, after these several actions. The lands in the vicinity of Niagara were wet at this season of the year. Upon this wet ground the flying hospital was en- camped, for want oi better accommodations. Many of those wounded at Little York died with typhous fever, accompanied with diarrhoea. The condition of the wounds generally was bad. Hnving experienced in the short period of four weeks, that our present encampment was unsuitable for a hospital, and its un- healthy i)Osition having been reported to the Commander in Chief, an order was received subsequent Ut the last battles, v hich had vastly increased, the list of sick and wounded, to explore? situation more healthy. Lewistown, eight miles up from the outlet of the Strait, presented the most eligible, on that frontier. At this point on the Strait, and one mile east on the ridge road, the land is more elevated, gravelly and dry. To this place the sick and CAMPAIGN OP 1813. 63 wounded, about two hundred, were removed from Fort Niagara, the middle of June. By the first of August the patients were in- creased in number to between six and seven humlrcd, and were comfortably accommoank o» ihe Niagara, ex- tending from the fort to the village, nearly on the lake shore. The surrounding country is flat, and the cnmp vras deprived of the benefit of the lake breezes, from the position of Newark. During the month of June, it rained almost incessantly ; while Ihe latter part of July, and the whole of August, were extremely hot; the whole of September however, was remarkably mild and pleasant. Thus after having been wet for nearly a month, the troops were exposed for six or seven weeks to intense heat ilurinjr the day, and at night, to a cold and chilly atmosphere, in consequence of the fog arising from the lake and river. Tlie enemies' advance being within a short distance of the camp, the details for duty were large, and skirmishes taking place at the piquets every morning ; the soldiers were, for a length of time, stationed at the several works, for several hours before day-light ; and thus exposed to the effects of a cold damp atmosphere, at the time the system is most susceptible of morbid impressions. The diseases consequent to this alternate exposure to a dry, hot, and cold damp atmosphere, were such as might have been ex- pected ; typhous and intermittent fevers, diarrhoea and dysente- ry. A detachment of artillery, stationed at the right wing near the lake, was particularly exposed to the heat of the day, and dampness of the night, and sutfered much from typhus and in- termitteuls. I do not recollect a single instance, in which ty- phus came on with a sudden and complete paroxism. It at- tacked in a slow and insidious manner, which almost invariably denotes an obstinate and long continued fever ; and in which we are seldom to expect a crisis. The symptoms were those, denominated typhus gravior ; although severe, they were gen- erally regular. In some cases however, delirium came on very early, and was much more severe than the other symptoms. 1( was of that species, attended with an obvious increase of arterial action in the brain ; and relieved by the application of cold, or blisters to the part effected. The disease began to subside about the fourteenth day, and gradually disappeared during the third i] u u -!l' I': n 1 5 I tf8 MEDICAL SKETCHEH. week ; but in some cases, no symptoms of recovery were to be noticed, until the end of the third week." " The treatment adopted was, with a few variations, that rec- ommended by FoRUTCE, in his dissertations of fever, and the success was complete ; not one case of death occurring of this complaint, in the corps to which I was attached." " The cases of intermittents were numerous, and generally of the tertian type ; not however very obstinate. The remedies employed were emetics, opium, bark, and Fowler's solution. Opium, and particularly bark, had not a very good effect. I was particularly unsuccessful with the latter ; whereas, the mineral solution universally succeeded, both in those cases, where other medicines had failed, and those where it was used alone. I shall have occasion to observe the contrary effects of the medi- cines, during the campaign on this frontier, in 1814. That this Avas not owiiig to the quality of the medicine, would appear evi- dent from their having been procured from different places, and not shewing any defect of power in other com[)laint3." " These diseases, however, though severe, bore but a small proportion to the usual pestilences of our army, diarrhoea, and dysentery. During two years and a half, I was on the frontiers, at every post from Buffalo to Burlington, Vermont, these com* plaints almost invariably absorbed all others. They were the only ones which could be called our camp diseases. All others arose from obvious or local causes, and were as common to the citizen as the soldier." " By dysentery, is not meant that idiopathic form of disease described in books, as an almost invariably attendant on a camp ; for during the whole war, I saw idiopathic dysentery but once ; and then it was contincd to the militia under General Porter, in the latter part of 1814. The complaint above referred to, consisted simply of dysenteric symptoms, consequent upon the violence or long continuance of simple diarrhoea. The two complaints would sometimes alternate very early ; but the symp- toms of dysentery were easily removed at this period, by the simplest means. After the diarrhoea had continued several weeks or mouths, the mucous coat of the rectum became inflamed, ■11 CAMPAIGN OF 1813. 99' fn consequence of perpetual irritation; and tinally, ulceration tooli place, aa appeareil on dissection. Tliout^b the rectum was the part principally affected, in many cases, (he whole intestinal canal bore marks of inl1;imm;ition ; being covered with large spots of a dark or livlowder, continued for a long time, repeating the remedy first used, as occasion required. This was the only treatment that appeared to be generally at- tended with any success. It should be added, however, that many who had so far recovered, as to be reported fit for light duty, would be taken with so violent a relapse, as to sink in one night ; while others would die suddenly, without any adequate cause discoverable, either before or after death. "During the whole of October, and part of November, most of t)ie troops were exposed to excessive fatigue, and almost inces- •ant rains, in open boats on the lake. On their arrival at the French mills, about the 14th of November, the weather became intensely cold, and remained so during the winter months." Typhous fever, dysentery, diarrhoea, and these variously com- bined were the prevailing 'jected to the above forms of disease; their causes were, but in part, connected with the life and habits of a soldier ; or the casualties to which he TT CAMPAIGN OP 1813. 71 trns unavoidflhiy exposed. Tlirse disrases were consequently eonsldered endemic, on the Niapnra frontier, and excited l>y additional causes, than those uhich depended on local situation, vicrc most severe among the troops. The bowel complaints, among the inhabitants, were supposed by them, to have been produced by the water on that frontier. It was the sentiment of the first settlers, that the water possossrs a purgative quality. This opinion w s current also in the army. The citizens stat- ed, that the new settlers were always attacked with these disor- ders of the bowels, the first summer after their arrival ; and that but few escaped them. Lime-stone, or calcareous rock, a snh- stratum of the enrth in the viciiiily of Ontario, which the waters hold in a state of solution, was conjectured by some, a cause of th«se complaints of the bowels. A more probalde cause of these endemic diseases is, in my opinion, the proiiuction of vegetable putrefaction ; with which the springs, rivulets, large rivers, and the waters of Ontario, are impregnated during the summer and autumnal months. The clearing the lands of their forests, and cultivation of the soil, by producing earlier evaporations of wa-i ters from their surface, before the heat of the summer is so high in degree, as to produce a putrefactive process u|)on vegetable substances, in a state of decay, will obviate these complaints of the bowels, and likewise those autumnal fevers, to which the inhabitants are subjected. * The intermittents and synochal forms of disease, which su- pervened during the months of September and October, were more immediately under the control of remedies, than typhus, diarrhoea, and dysentery. The first forms of disease appeared among several officers, who were permitted to leave the encamp- ment at Fort George, soon after they were indisposed. Where- as, the privates were generally attended by their own surgeons, in the regimental hospitals, and were seldom removed to the flying hospital, until their diseases had progressed to the last stage. These synochal fevers were accompanied with pain in the head, increased :^eat, fullness and hardness of the pulse ; all of which indicated an excess of excitemeDt, which demanded t ,! U: 1 'Mi''' !'^'! ' ilii 72 MEDICAL 8KETCHEH. bleeding, and an antiphlogistic r(>(;iin(!ii. In niuRt canet, wliicb fell under my uliservation, hluod-lcttinc; to the i{ii;iiitily of Hixleeu ounceB, a cutlmrtic of cnloin<;l nnd .iHliip, removed the exeees of excilrmenl, and placed the pittieiit in n condition, in which an- timonials in smull doscfl, removed the rem: i.ia of d'scuHed uctioii. Aijout the same period, a case called my attention, which had been of some duration, periiapa twelve or fourteen days. What the symptonnt were, at the first onset of the disease, I did not leom. This patient was extremely debilitated, when he waB removed to the flyinc; hospital encampment. At this period, the puiso was contracted, (pjick and hard; the skin dry, and cool in the mornings, but hot in the eveninps. These symptoms were attended with delirium. Some infl immalion on the ey< s indi- cated an excess of excitement on the brain, as did the other eymptoms, especially delirium. A blister was applied upon the neck ; one grain of calomel niji;hl and morning, and one fourth of a grain of tartrite ef antimony, every four hours, were pre- scribed. The delirium coniinued with watchl'iduess ; the above medicines Mere directed the second and third day. The disease remained in statu quo. The bark and wine were proposed liy a surgeon of the army. The experiment was acceded to by my- self, but not with a high degree of confidence. As had been anticipated, the before mentioned febrile symptoms were all ag- gravated ; while the remissions were shortened, and the fever assumed a more continued form. A cathartic was then admin- istered, the antimonials in small doses were again resorted to, and were continued. The paroxisms of fever, under this last process, daily lessened, and gradually disappeared, with an abatement of delirium, and a return of appetite. This is one case among many, which might be recorded, where the bark and wine have been injudiciously administered, within my own observation. The |)Mctice of administering bark, during remissions of fever, is in conformity to that of Cii^lkn. Long experience has convinced me, that the practice of intro- ducing bark and wine, as soon as there is a remission of fever, will not generally succeed in the autumnal .mixed fevers, as they appear in the eastern and uortheru states. After there is CAMPAIGN OF 1818. a complete reBolulion of fever, Ihi'se remediog nre proper, Bome* times iiHlispciiHililc to give tune to tlie slomacli, aud excite the organs subservient tu digestion into action. Summary of the counts which were helvurd to he active in the pro* duciion of the various diseases oil the Niagara, during the cantf paign tf/* 1813. IsT. Pnr.DISPONF.WT. The debilitating eflVcIs of the e|.idemic of the preceding winter. From these tlie soldiers hnd not fully recovered, liefore they were subjected to severe duty, during inclement weather in the month of March, when on their routes from the interior to the frontiers, and exposures on the lake in open transports, as well as in the field. 2d. hurtfttl agents. These acted as both [tredisjtonent and exciting causes, and generally mi^ht have been obviated. 1. Bad bread. It wns notorious that the bread on the Niagara was made of damnged flour ; such as was either not nutritious, or cihsolutely deleterious. It was also believed, that the flour conr tained in some instances an earthy substance, and that this ad- ulterating substance was plaster of Paris (gypsum.) 2. Bad water, impregnated with the |)roduction of vegetable putrefaction, more or less active in producing the endemic dis- eases of the country. 3. TJu cjffluviafrom the sinks, materials of animal production* with which the circumambient air was replete. This evil might have been remedied by a rigid police, and more thorough cover- ing of the sinks, or by a change of position, a distance of one or two hundred yards. 3o. EXCITEMENTS. As more immediate causes, 1. Heat and cold, alternating with each other, and inducing m the system unequal excitement. Both these powers were more active in producing their deleterious effects, when combined li •^k ^ ii i r If I m^ 74 MEDICAL SKETCHES. lR?ith molsttire, In thn form of raina, fopj-, nml tirwg. Thr rffpcU of hoitt nnil cold miglit have beun in somu decree obviated, by woolen K!irin(>nta. a. Falii^tiffi of body, and severe hardships, comprising tlie whole routine of duly, botli by dny and night. These >vero unavoida- ble. 3. Inebriation. Tlie cffrclB of ardent splriln were Imlh pre* (liBponent, and immediate. Tlic«e, when received into the atom* och in undue ()uantilieB, induced on (he brain endorsement; or when they were repeatedly drank to nn excess alwrt of absolute intoxication, general deliility. These last agents were more ac- tive in the production of violent diseases, than many of tiie oth' er deleterious |)ower8 combined. " The several causes above enumerated, will suggest, at first view, the forms of disease which occur to those exposed to their inlhienccB, or subjected to their agency. It is to be observed, few recent causes of either diarrhoea, dys- entery or typhous fever fell under our observation in hospital practice. As we are giving skelches of diseases as they appear- ed to lis, it must not be exjiected, that these will be detailed from their commencement, throu.i^h all their several stages, in a Bystematic order. The practical physician must not look for new theories, nor will he be instructed by many practical ol)ser- vations, which are not to be met with in books found in the li- hrary of every medical man. The olyect here intended is to exhibit what was done in cer- tain slates of disease, and under certain circumstances ; not what should have been directed to the patient, under different states and circumstances. It must l)e remembered, the means of af- fording relief to the distressed in an army are few, compared wi^h those which jjrescnt themselves in domestic practice. The patients, generally ordered to our hospitals, were such as had been unsuccessfully treated by the fegimental surgeons in camp, where the accommodations were less eligible than in tb*' hospitals, with all their defects. Flying hospitals attached to au army, from their instability, cannot be expected to be in the highest possible order. It is the work of months and persevering CATVrPAinW OP 1813. f5 Uhow, ns well as itiireinittcd attention, to render two hundred untients very comfortuhlu in a permiiiient liospita!. But when the number is increased to five hundrcermanent ; although the obstinacy of the disease was very discouraging, yet by perseverance, it was in most cases overcome. In cases where nausea indicated an emetic, ipecacuanhas were preferred to any other, and where cathartics were demanded to obviate tenes- mal irritation, .nanna and cream, tart, combined in solution, or ol ricini, were the most suitable. To remove pain, the conse- quence of chronic inflammation on the mucaus coats of the intes- tines, blisters sometimes acted as a counter stimulus, and gave re- lief. !n all cases the patients were put on a soft nutritious diet. No article prescribed proved so beneficial as milk and its prep- arations. It was most grateful to the |)atienls; it was an article they could take, when other kinds of food were rejected. By milk alone, it was iny persu;*.bion, that many lives were saved, which, without it, would have been lost. I have been highly gratified, as well as astonished, to sec? with what avidity m Ik was devoured by those enfeebled by diseases, who had not been accustomed to it whe;? in health. These patients were dnily in- djlged, also, vith wine or diluted spirits, in moderate quanti- ties. CAMPAIGN OP 1313. ft During Ihe month of May a number of patients were admitted into the hospital, from those regiments who had been previously er use of mercury, and also, because it in- volves an important surgical operation. 1 shall describe the case in as brief a manner as possible. : - < *' Thomas Broughton, of the 6th regiment of U. S. infantry, a sprightly lad of about seventeen years of age, fell into my hands upon the Niagara frontier, (Lewistown hospital,) in July last, with a disease at that time wholly mercurial. I could not, with certainty or precision, ascertain the nature of the dis&asc, which occasioned the exhibition of the mineral ; but believe it was a febrile c" nplaint. *' When he was first placed under my .charge, he was extreme- ly weak and emaciated, had a slight cough, attended with a pro- fuse diarrhoea, cheerful, and in good spirits, feared nothing — which, by the by, is characteristic of most soldiers, but was re- markably Ibo case in this instance. Mortification had taken place iu the buccinator muscle of his right cheek, and under his jaw, and h;*fl been progressing several days. The hole in his cheek, occasioned by tbe sloughing, (when I first saw him,) was about three quarters of an inch in diameter, perfectly round, and had the appearance of being cut out with a knife, or some sharp instrument. That under his jaw, about Uie size of a goose (iuill. ilili \n CAMPAIflN OF 1813. 89 '« I placed him under the charge of a raithfiil nurse, whose sole oare was to attend this one patient. I directed his mouth (which was very offensive) to be kept perfectly clean, by in- jecting into his mouth, and through each of these orifices, warm water, diluted brandy, «S:c. by means of a small syringe. I or- dered at first gr. xxv, and afterwanls gt. c. l. Fowl. min. solut. to be mixed with a little water, and his mouth syringed with it: I directed a repetition of this quantity five or six timfs a day, taking care that it was not swallowed. In the interim to be washed every half hour with tine. cine, oflic. " Bark (cine, oft'.) and wine or brandy was given him inter- nally, in large quantities : — the tine. opii. was also administered larinc(>nt mus* cics, to wiiidi it was Htill firndy attaclicd ; after which, with a •i\%rv^ motion, loijetiier with a little extension upon the Iione, I was enabled to separate it from the sound portioti (»f the maxilla inferior about half way between the angle of the jaw, and the condyloid process. " The parts were then brou^lit tojjethcr, their cdpcs kept in conl.ict by means of the interrupted suture, at the nnple of the month, and Uy strips of adhesive plaster through the remainder of the incision. Perhaps the twisted suture would have been better, but this I was unal>lc to employ for want of hare-lip pins. TJie dressings were then applied, and the jiatient taken to bis quarters, placed in bed upon his left side, and kept in that situa* tion to prevent the saliva from insinuating itself between the lips of the wound. The wound healed by the first irdention through the principal part of its course. The fistulous openings both soon closed, and the pulient gradually recovered without much disfiguration. The chism has been filled up by ossifift matter, thrown out l)y the secerning arteries; ossification seems already to have commenced, .and it is probable a new bone will eventually supply the place of the old one by the process of os- teogeny. He now eats and converses very well, which before were performed with difficulty. His general health is good, and the contour of his face is daily improving, so that there is a pros- pect of his yet becoming (juite a handsome man." (Signed) J. B. WHITRIDGE, Assistant Hospital Snr^con, To James Manv, Hospital Stirgeon, 17. S. Army, at Burlinglun, Vermont, I have so frequently witnessed the injurious effects of merca- rials, particularly calomel, when a«lministered to soldiers in the field, it is my decided opinion, it never should be employed to men under such circumstances, except in combination with some -■'otive cathartic. To soldiers under typhous fever, or of an in- 12 80 MEDICAL SKETCHES. niimmalory fypc, it wna equally injiirioufl when claily reprafrd. liif«t«a(l of rcrru'dyinc; those diseaaes of »ho howela, wliirh pre- vailed in tnir armies on Ihe frontiers, wljen exhihiteil to mt ii ex- posed to all the casualties of n cam(>, those com;tlaiut8 deteri- orated l»y its fre<|ueiit repetition. Sy|ihililic discasea were hut seldom permanently cured hy it, during campaigns. Tliis was in;ide most evident to the surgeons of hospitals, hy the nunihers admitted with these complaints, wliich had heen of some months duration, after the army retired into winter quarters. ill I ^'i The foUomn:^ SypliilHic cases rvcrc recorded In/ Doctor IMarch of the Hospital department^ and are here inserted to slicw the injurious effects of mercurial practice in lenls. CASK FIRST. " RicliarA ^lahhar, private of the 10th regiment, Avns ad/nit- ted into general hospital, at Greenhush, Octol)er 13, IB 12, with the venereal disease. lie had administered him hy a regiment- al surgeon, five or six doses of calomel ; also had used an injec- tion of a solution of the acetite of lead. October 15th — Ilia mouth hat' hecome very sore, having also a profuse ptyalism ; a ♦lose of suits was prescribed. 17th — The mouth extremely sore; gums and face much swollen; the saliva profuse and mixed with blood; ellluvia consocpient ujwn salivation, very disagreeable. A solution of alum was used as a gargle. 18th — Mouth still extremely sore; blood and saliva flowing continually, 'i'he discharge was not less than a pint, or a pint and half in twenty- four hours. Bark and wine were directed. 19th — Mouth and face as yesterday. Bark and wine continued. A decoction of white oak bark in which alum was dissolved, was prescril)- ed for a wash and gargle for the mouth. 201h — Bleeding had somewhat abated. Medicines as yesterday. 21st — Symptom? coutiiuied the same, and the same medicines repeated, with tlie addiiion of a dose of sulphate of soda for a cathartic. From llie 22(1 to the 24lh, the last medicines were continued, except ing the cathartic ; two teeth fell out of his jaw, followed by a discharge of pus mixed, with blood and saliva. 271h — Sulphate of soda for a catliartic. 2olh — Hemorrhage considerably abat CAMPAION OP \H\A. n uA; hMk nml wine continue*!. HOlli — IMiicIi hotter; bark n ml wine na lu'tun\ Olst — Cntliarlio of 8iil|»hate of uixla. Novon*- brr let — Convah'scctl fait. The o.ntl«artic» 8«cnuHl of great benefit; the succeedinc; days took hnrit ami wine. 4tli — Took a (lose of eulpliate of aoda. From tltis time recovery was rapiiV, ami the ptyalism had almost ceased; and by the t7lb of N07 vember he was entirely recovered from the venereal affectiori, and also from the distressing eiTecta of mercury. This ca [V 6^ 23 WeST MAIN STRf ET WEBSTER, N.Y. 14580 (716) 872-4503 % ^ s Sb MEDICAL SKETCHES. m§ ing syniplotn or disease, at the same time the niercuiial acliou on the glands of the mouth was aggravated." In Himilar cases oi' ihis disease, the nitro-muriate of gokl has since been employed with the best effect, without the unpleas- ant salivation produced by mercurials. A discriminating line between those cases where calomel is admissible, and those where it may prove injurious, even under the most favourable circumstances, is not always correctly drawn. Calomel, in full doses for a cathartic, is a powerful and safe remedy in sthenic diathesis. But its administration in small doses, with a view of removing the primary strong diseas- ed action of this diathesis, by inducing a new mercurial action, previous to its reduction by depleting the blood vessels, and evacuating the contents of the intestines, will frequently defeat the intention. I have witnessed a febrile disease of the sthenic diathesis to increase during the continued exhibition of calomel in small do- ses, until the mouth was very much inOamed; so that it was not easy to determine whether the existent state of the disease Avaa the effect of its original cause, or the consequence of mercurial excitement. It has been also observed, in asthenic fevers attended with great debility, with torpor of the stomach and bowels, and pro- fuse diarrhwa — that calomel increased the dangerous state. ! i ABUSE OF TARTRITE OF ANTIMONY. I : it 'i PaiNfii.E, in his " diseases of the army," noticed the injuri- ous effects of antimonials, or their inetficiency to cure the disea- ses incident to soldiers, when exposed in camp. It is with re- gret that I feel myself bound to record the bad consequences of the administration also of tartrite of antimony, in one of the hos- pital wards .at Lewistown. A young surgeon, upon taking charge of this ward of about 60, observed to me that these bow- el complaints ^YOuld readily yield to emetic tartar, in small do- CAMPAIGN OP 1813. 89 ses. He was cautioned not to employ this medicine. It vim observed, tliese diseases were not recent affections ; and havfng lieen of dome duration^ evacuants had been carried to their full extent, previous to their admittance into the hospital ; and Tur- tliermorc, antimonials were, but in few instances, admissible in field practice, while men were exposed to the transitions of wea- ther in tents. These precautions were disregarded. The fol- lowing weekly report, out of 500 patients, gave 10 deaths; 9 of whom were out of the above ward of GO. — The succeeding week 8 deaths were reported ; 6 of whom out of the same ward. At this time 1 was confined to my tent, and unable directly to correct the abuse by prescribing to the sick. The other two gentlemen. Surgeons Whitridge and Vanhovenburgh, had more in their wards than they were able to attend and do them strict justice. Having been informed that I was dissatisfied with so dispro- portionate ill success, as was exemplified by reports ; this young surgeon wished to be informed the practice pursued by myself. Too feeble to enter into a minute detail of practice most suitable in these diseases of the bowels, he was referred to Doctors Whit- ridge and Vanhovenburgh, whose practice had been accompan- ied with more success. From the Ist of July to the 30th of December, the number of sick admitted into the general hospital at Lewistown, were be- tween 950 and 1000. During this period, 59 deaths were re- ported — nearly half of whom died in a small ward of 60 patients in the course of about three weeks ; most of these by an impru- dent and injudicious administration of tartrte of antimony. It has been observed that intermittents were among the forms of disease on the Niagara, during this camiiaign. A compan}^ of volunteers stationed at Schlosser, one mile from the great cat- aract, during the summer months, were nearly all attacked with intermittent fevers of the tertian type. There are, in this vicin- ity, extensive swamps and stagnant waters. Twenty-five pri- vates of this company were admitted at one time into the gener- al hospital, sick with this disease ; who, previous to their admit- tance, had been deatitu;.;2 of medical aid. A few cases among 'I iMi !! '.fgy(^«gpP9q^Vn"Pn^f">q"KV«qr- 4» MEDICAL SKETCHES. / '■ illit I ill-;' ^ ti!:. the number were found, which, during the hot stage of the fevcr^ exhibited great Increase of iieat and arterial excitement. These were bled, apparently, with benefit. Emetics and cathartics tvere prescribed for tJie whole; the first, with intention ofcouii- teracting the cold stage of the fever, were administered at its ac- cession ; the last, with a view of removing irritation from the intestines, and reducing sthenic diathesis ; and both, having for our object a more equalised excitement. After these evacua- tions had been carried to an extent which was judged sufficient, bark, snakeroot, aromatics, and wine were directed, in moderalo and larger quantities during the intermission of fever; not, how- ever, with all the benefit which was expected. The last medi- cines, in a few instances, arrested the paroxisms a short period only; while, in general, they had no elfeci. Not one experien- ced a permanent cure by the above means. After being thus disappointed with remedies in most common use, recourse Avas had to Fowler's mineral solution, a remedy held in high estimation for the cure of intermittent fevers. Thifl experiment made by us at this time confirmed the great reputa- tion which this arsenical preparation had acquired, in the hand^ of other physieans. This potent medicine acted almost like a charm. It did not fail in one instance, to remove the paroxisms of fever Avithin five or six days, some of whom had taken tlie bark a fortnight, or more, without permanent eflect. Ina few- cases two or tliree doses of from five to ten drops of the mineral solution effectually removed tlie paroxisms. The convalescents from this fever were benefitted by the bark and wine, inasmuch as the stomach and digestive powers were imjjroved by their use. After the retrograde march of the army from Stony Creek, no expedition against the enemy was undertaken, except the disas- trous movement of a detachment to the Beaver dams ; at which place, 600 men under the command of Colonel Borstler, after a feeble resistance, surrendered to an inferior force. While waiting the arrival of the Heet from Sackett's harbour, under the command of Commodore Chauncy, to co-operate with 4he army ; and the drying of the roads, which had been irapasao. CAMPAIGN OP 1813. n fele for waggons, most necessary for the transportation of provi- aioiis, in a contemp'iHted expedition against the enemy at Bur- lin'i;ton heights, in the event of any failure of assistance from the fleet; General Dearborn was employed the month of June and part of July, in making prei)aration3 for the expedition, by or- giinizing and disciplining the troops, a considerable part of whom had been recruited the preceding winter. In the mean time the encampment was secured against surprise. Fort George was re- duced in its dimensions, and its lines of defence strengthened l)y a deep ditch and palisades. These preparations were in for- wardness to recommence operations against the enemy, wliich were momently and anxiously anticipated by the officers of the army, when General Dearborn was removed from this com- mantl.* From this period, 14th July, until the first week in September, when General Wilkinson assumed the command, the army at Fort George consumed ihe most eligible season of this summer and ai:lumn, for effective service; cooped within the narrow lim- its of a Tew acres of land, by a force of the enemy not exceeding one half its strength. And under constant ap|)rehension of an attack, placed itself wholly in a state of defence. This appar- ent pusillanimity, or want of energy on the part of the army, emboldened the enemy to insult it, by repeated attacks upon its advanced piquets, night after night, during the above period; and on the 24th of August, a general attack was made on the lines by Sir George Prevost, and was repulsed with loss. This petit guerre kept the army in constant alarm, and sub- * The removal of Major General Dearborn from this coramanti, was exceedingly regretted by the officers of the army. Whatever miglit have been the object of this procedure, subsequent events have demon,stratcd that its policy was very injudicious General Dearborn, at the time of his re- moval, had recovered his health ; and preparations were in forwardness to recommence activfe operations against the enemy ; which had been delayed iu consequence of tiie badness of the roads, almost impassable for waggons, until the month of July, waiting the arrival of the fleet to cooperate with Irim. The fulle!;t evidence which can be given, that the General possessed llie entire t-orfidence of the army, is the affectionate address to him, signed by General Boyd and every field officer present, when he took his leaved IP 1 ■'• i-1 \m ; t it. I i 02 MEDICAL SKETCHES. Ml ■ 'i ' '■ i 111' W','.. jectcd the troops to vexatious fatigues, unremitted duty, and mul- ti|died exposures, which prevented them frum taking tlieir nec- essary repose. Under the above mortifying circumstances, the army, in con- sequence of its stationary position, suffered from diseases, aggra- vated by filth accumulated in its vicinity. From this last period, arrangements were ordered for some im- portant movement. These were actively and unremittedly ex- ecuted. Boats, in particular, were wantiiig for (he transporta- tion of at least four thousand men. Those attiiched to the ar- my were repairing, wliile others from various parts were collect- ing. The object of the expedition was kept a profound secret. It called forth variant opinions, and excited lively anticipations, that the reputation and honor, which had been lost by inglorious inactivity, would be retrieved by some bold and decisive stroke upon the enemy. These animating sensations were highly ex- alted by the annunciation of the capture of the enemy's llotilla on lake Erie, by Commodore Perry ; and the surrender of the British forces in the vicinity of Maiden, to General Harrison. These sanguine expectations were almost realised when those glorious events were succeeded by reports that General Harri- son had already embarked on board transports a part of his divi- sion, to form a junction with that of General Wilkinson. With this united force, it was expected the srmy would recommence otfensive operations, against which the enemy could have made but a feeble resistance. These high wrought anticipations were only visionary sug- gestions of the soldier, ardent in the cause of his country, and emulous of fame and glory. These, which seemed to have been ahead)/ within the grasp of the army, were thrown at a distance, by the orders of the commander in chief, to embark the troops, including the convalescents, and move down lake Ontario, to Grenadier Island ; this place being assigned a general rendez- vous for the army. *' Obedience to orders is tne first and last duty of a soldier."' It was, nevertheless, deeply regretted by the officers, that "^T^^^^m CAMPAIGN Of 1813. 93 j'*iW' t!i^ tittnj, respectable as it was, should retire in the presence of the enemy, much inferiour in force. And after having gained, >vith some loss, and a high degree of .honor, one of his most important [)Osts, and held possession of it five months, should abandon the conquest, witiiout accomplishing the prima- ry object of the campaign ; by either destroying, or capturing that division of the enemy which composed his right wing, in Upper Canada. When an enemy exhibits great military tak nts, we are dispos- ed to allow him all the credit due him, in a martial point of view, even when by lirtful deceptions and judicious manago- ment, with a force inferior, he was enabled to apparently check the offensive operations of our army, and compel it to place it- self in a position entirely defensive. This inactivity while the army was under the command of General Bovn, upon whom it devolved when General Dcae- BORN retired, excited at the time severe public animadversions. General Bovo had in possession the means of his own justifica- tion ; he owed it to the high station he held in the army, as well as the nation, to have brought to public view at an earlier peri- od those documents from higher authority, which governed him in the measures he adopted, while he commanded at Niagara. The orders Avhich he received from the department of war, it more publicly known, Avould exonerate him from that censure, with which he is now loaded in the opinion of the public, who, on national concerns, are too much disposed to pronounce judg- ment, before they hear the cause. (See Note F.) General Wilkinson, at the time he issued his orders to move down Lake Ontario, directed the sick and convalescents, too fee- ble to accompany the army, should be sent to Lewistown, under ray charge, with an order to " furnish them with winter quarters out of the reach of the enemy," in a situation which I might es- teem most eligible. The last weeks of October were most uncomfortable for tlie sick in tents. The weather liad become cold, rainy and boister- ous. Winter, with its dreary attendants, progressed in No- vember with rapid movement. The convalescents, from typhous and diarrhoea, in consequence of the sudden trausiUom of ^>§ath- 13 n i ■■!- , I I 11 •'4 MEDICAL SKETCHES. 1 1 ' I. I I ii'l er, had renewed attacks of disease under the Torm of pneumonia; coughs had become general among them. These changes deter* mined me, after spending some days to select a secure position, and prepare quarters for the approaching winter, to break up the encampment at Lewistown. We had at this time about three hundred and fifty in the hospital, including the sick, convales* cents and invalids. The last were subjects for discharge, in consequence of wounds and other disabilities. After selecting one hundred who had so far recovered from wounds and bodily infirmities, as to be able to perform a Journey of three hundred miles to Greenbush, the remainder were ordered to Eleven Mile Creek, called Williamsville. These arrangements were communicated to Colonel (now General) Scott, who had been left in command at Fort George, and met with his full api)robation. To the assistant quarter master Ge leral of the post, he gave his order to furnish the neces' sary means of transportation. The invalids destined for Green-* bush were committed to the charge of Lieutenant Archer, regi- mental pay master, and Doctor Hugo. The remainder of the sick and convalescents, two hundred and fifty in number, some of whom very debilitated, were transported to Schlosser, a dis- tance of eight miles, in waggons ; thence to Black Rock, in boats ; from the last place in waggons to Williamsville. This was a tedious journey of forty miles for sick men, many of whom were destitute of cloathing, suitable for the approaching inclem- ent season. Previous to this movement, the roads, bad at best, had been rendered almost impassable by heavy rains. During the journey the weather was cold and wet. The evening on which the sick arrived at Black Rock, a storm of rain commenced, with a violent wind from the west, which raised the waters of the strait at the outlet of Lake Erie, eight feet in two hours ; which swept the baggage belonging to the men, and a quantity of hos- pital stores, that had been deposited during the night at the landing, down the river. This loss was severely felt by many, who, previous to this unfortunate casualty, had exceedingly suf- fered for want of clothing. It left them without a change of gar- {foents of any description. Tiie hospital department by this sud- ■ ■■WWJII II CAMPA.IGN OP 1813. ey were maHon worlc. Througli the whole extent of the river to tlie fnlls, the banlcs do not slope, as is usual ; from whose •ummit there is no passage to the water's edge, except where ar- tificial roads have been constructed. The distance Trom the fi^lIs to Black rock, a village o{ ten or fifteen houses, tlie river banks are from Tour to twelve feet high. At some points, marshes, which terminate in low 8wam|)s, bor- der the river ; over which the river road, during wet seasons, ii miry and almost impassable for waggoqa. Buffalo, two miles above Black Rock, previous to the war was a considerable vil* lage, rapidly increasing in population and trade, beautifully situ- ated on n creek of the same name. At the time it was burnt by the British army in December, 1813, it comprised between one and two hundred houses. The whole of the thiuly scattered settle- m(?n{s on the Niagara were at the same time |)illnged and burnt. Directly op^tosite Fort Niagara, on the Canada side, the beauli- fid village of Newark presents ilself to view. The whole coun- try on the Canada side \& under a good state of cultivation, and pleasant. From Newark, after passing a number of fine farms and settlements, we arrive at Qucenslown, opposite Lewistown. This is a cliarniing little village. An adjoining eminence, known by the name of Queenetown Heights, commands a most fixtensive [)rospect. From this place the eye comprehends, at one scoiJC, the whole country to the borders of Lake Ontario north distant eight miles, variegated with woods and cultivated lauds, and to the village of St. Davids west four miles, which j)rosper:t overlooks the vast toreals beyond. At the same time a full view of the Niagara meandering to the lake, the waters of Ontario, as well as the remote high lands of Little York, 'Ustant Ibiiy miles. All these combined render this a most delightful situation. The sceneries from this elevated ridge will enlarge and extend; and for many years will become more and more beautifully picturesque, as improvements progress. Queenstown Heights will long be remembered in the annals of history, where the first imj)orlant battle, after the declaration of war, was fought [. iffrpfi^^^pwvi ^pi4Pi^ji^ CAMPAIGN OP 18131 tfd On ihe Caftada side, between a small body of United States' troo|>s and New-York volurteen, under the command of Gener- al Van Ranbclakr, and the Britiah under the command oTGe^ neral Rbock ; in which ill-conducted, unfortun^xte action, unpro^ pitiouB to the arms of the United States, five hundred men we:e either killed or taken prisoners of war ; and in which the Brit- kh General lost his life. Lewistown is a handsome site for a town, the name of which '* only bears, comprising, before this fronlie * wasdevasted, a few lug houses. Situated as it is, at the hend of navigation of T^ake Ontario, it will become a place of importance, as a deposit for goods transported to and from the shores of the lakes west, as well as the country east. The exuberant productions of this fertile country will here concentrate. The portage from (lie navigable waters of Ontario to Erie, is eight miles. From Lewistown, as we proceed south up the Niagara, an em- inence isabrnptly ascended one hundred feet, or more, above (he tract which borders Ontario, and more than one hundred nud nrty feet above its waters. The traveller, when climbing this precipice, feels that from its summit he would find a descent somewhat proportionate to the ascent. He is both disappointed and astonished to learn, that the precipice ascend* * is but the edge, or abutment of a vast and exteimive plain, or table of land, which contains within its enormous excavation, the waters of Erie, three hundred miles in length, and one hundreil miles in breadth, which disenabogue themselves from Erie, tiirougli the strait or river above described, to Lake Ontario. This abutment extends east a great distance, and with some broken inequalities, gradually loses itself in lands descending in gentle swells from the south. To possess a correct idea of the general face of the country which comprehends the waters of Ontario and Erie, it will be nnderstcod they are severally con- tained in two vast basins, t;upported in two extensive plains, OT pore strictly speaking, gently undulato .ands. One ? f which, with an elevation of one hundred and tii'ly feet, seems as iflap- ped on the lower, while the waters of the upper arc restruiued by lands on the north the distance of Lewistown from Lake ■T^^mnmm^w^ % t i i !t ■ } i 3 j i |h j i It ■! 1 ' loo MEDICAL SKETCHES. Erie, bounded by the above described precipice) or abutment. ThiB abutment, for its greater security, is strengthened by lay- ers of roclis from its foundation stratum sttper stratum, coated tvitli earth, which, through a long series of ages, has been washed by rains from the summit. This abutment, after being divided by JMiagara river, at Lewistown i^, on the Canada side of the river from Queenstown, extended ns far as the heights of Burlington, at the west -^rtremity of Ontario. ' f ■••/"' The cataract, eight miles south of Lewistown, is one of the wonders of this continent. To give a just descrifition of this a» mazing fall of water, exhibiting a sheet 600 yards in width, di- vided by Goat's island, rolling from a perpendicular precipice to a vast and awful chasm 150 feet deep, might appear a vain at- tempt after the very correct descriptions which have been al- ready published. The picture of this sublime natural exhibi- tion, had been painted in a language so picturesque, its reality to my view, was leas majestic, than what had been formed on the imagination. Observations similar, have been expressed by others aftei visiting this cataract. The rapifla, on the American side above the falls, are in ex- tent half a mile. Where, in broken sheets, the waters seem in full career, white with foams, down a huge bed of broken rocks, in a descent of 50 or 60 feet, bounding over crags and steeps, Avith a movement accelerated as they approach the brink of the precipice. Above these rapids tiie river is two miles wide, where the waters pressed by broader torrents, seem, by their impetuous race down a declined plane, to be accelerated to unite with the preceding contending floods, in one tumultuous stunning roar. The waters, on the Canada side, in their course, perform, with increased celerity, their race to meet the awful conOicting scene. The accumulated body of water on the Canada side is so for- cibly pressed forward by floods behind, and quickened by its movement on a descending plane, and accelerated by its ov.n vo- luminous weight, as it approaches the cataract, that it fhoots over the precipice, forming, at the distance of 40 or 50 feet from its perpendicular, a curved white sheet. On the United States' ■T^^wp^iPWUIH U CAMPAIGN OP 1813. 101 •!de, the water fulls in a thinner perpendicular sheet. The grand fidls are divided by Goat island. The sheet on the Ame- rica n side forms au angle of 120 degrees with that on the Cana- da at Goat island. r. ; ,.; .. , . i a . » .. The uninterrupted conflicting current of this broail cataract immediately below (he falls, exhibits a scene, although less ma- jestic, still more awful. From this thundering precipitated tor- rent, in wild commotion, rises a foum to half the height of the precipice; where, intermixed with air, the lighter sprays are sus- pended in clouds and become the e|)ort of the winds. These clouds are seen thirty miles. The vast sheet of water, precipi- tated by its weight to the t)ottom of the gulph, seems lost for a short time ; then swelling from beneath the superincumbent wa- ters, bursts u|>on the surface in spouts, forming figures of various and cnanging shapes, which move in every direction, and in hurried disorder and giddy whirls dance upon the wave ; while the great body of the flood, emerging at some distance below the falls, pursues its rapid course. Sixty rods below the falls, the ri- ver is passed in a small boat with safety. With wonder we view a mountain's summit; and the sublime precipice, from its base, affords delight. But, when we oast ouc eyes down on deep sounding caverns, or on yawnirg broad chasms below, all is apprehension. Our heads turn giddy ; w* tremble in every joint; we seize on every bush, and cling to ev- ery tree, as we approach the brink ; and still feel we may be precipitated in a moment to the dreadful gulph. Such is the force of association of ideas, that the body irresistibly becomes the sport of its influence. Two miles above the falls the Ghippawa empties its waters. A signal victory was gained over the British army at this place, 5th of July, 1814, by a detachment of General Brown's divi- sion, led by the intrepid General Scott. Four miles north of Chippawa, on the heights of Bridgewater, the 25th of July fol- lowing, was fought a second battle, in which Generals Brown, Scott, Rii-ley, Porter and Miller were conspicuously en- gaged ; and in which there was exhibited a most brilliant dis- play of undaunted courage and cool bravery by the whole armj* 14 ■iS i:,! !, 1! ' 1 1 t 'i 1 ■ ,' Iff ■ ■tf ( 1 mm 102 MEDICAL SIETCHES. m i!'f II ; ' { After Generals Bboi»n and Scott were wonndeJ, the command devolved on General Ripley, who with n\ hundred and fifty of hifl own brigade and volunteers under the command of General Porter, charged the British line, three times their number, and repulsed it at every point. In this action. General Millbr, with the 2l8t regiment, distinguislied himself in a particular manner, by a charge with the bayonet, upon a battery of nine pieces of artillery, which fell into his hands. The killed and wounded of both armies were great for the numbers engaged. Fort Erie, situated opposite Buffaloe, will ever be remembered in history, for the gallant defence made by General Ripley, during five weeks ; as well as a subsequent repulse the enemy met with, when he assailed the works defended in a most gallant manner by troops under the command of Generals Gaines and Riptey; also on account of the successful sortie made by orders of General Brown upon the enemy's batteries, which compelled him to raise the siege. The country which borders the Ontario east of Niagara, from eight to twelve miles from its shores is flat, intersected by ra- vines, at distances of two, four, and six miles ; formed by waters which, in times of rains and freshets, run from the high lands south. These ravines communicate with the lake by creeks, which originally were land-marks of distances from the Niagara down the lake shore ; at this day are known by the name of two miles, four miles creeks, according to their respective distances. The same mode of estimating distances from Niagara west has obtained on the Canada side. The flat lands above mentioned are wet into mid summer, except where openings into the forests have been made for cultivation. These improvements are nei- ther frequent nor extensive. Not over four or five years had settlements been made on this frontier previous' to the war. This tract is known by the name of Holland purchase. The whole of this territory, comprising a diversity of soil, has the reputation of being the most fertile in the northern states ; perhaps not inferior to any in America, productive in all kinds of grains, and every species of fruit which grow in New-England. The meadows particularly are luxriaat. The crops of wheat on \1. ' "¥ CAMPAIGN OP 1818. 103 every goil are abundant, amply remunerating the husbandman for his labor. The Torests are composed of large and lorty beach, maple, and the aspiring elm, interspersed with groves of nuyestic oaks. ^ The lands in the vicinity of Port Niagara, and on the borders of the strait to Lewistown, were very wet until the middle of July, in 1813j in consequence of repeated rains, when the weath>^ er became dry and hot. The waters on the surface of the ground soon evaporate To seek for causes of an obstruction of the ancient outlet of these waters, previous to the existent Niagara, anx,c'*r \ ti i CAMPAIGN OF 1813. 105 A BuddRii accumulation or the waters not onlf of Eric, but the upper lakes would have been a consequence of an obstruc- tion or its most ancient outlet. The increasing flood would con- tinu illy encroHch upon the bordering lands, until the old outlet was opened, or a new one formed at some point ; that point was, where the banks o( the vast basin of Erie were the lowi38t. ^uch being the state of the waters, at this ancient period, the current of the overwhelming flood of Erie irresistibi/ forced its passage to Ontario; by which event the channel of Niagara was opened. Lake Ontario, extending then to its ancient bounds, exp^ienced an increase of its waters from Erie through its recently formed outlet. What were the consequences of the rise of waters in Ontario, with all which has been adduced, are conjectural; ne- vertheless, the present appearances warrant every suppositioa which has been advanced. To account for the recession of the waters of Ontario, from its ancient banks, an additional flood was necessary to accomplish go great a work — an enlargement of its own outlet the St. Law- rence. It was not only the accumulated waters of Erie, but those of Huron and Superior with their tributary streams which aided. The channel of St. Lawrence deepened and enlarged by these overwhelming floods, as soon as those of the upper lakes had subsided to, or probably below their most natural level ; the waters of Ontario sunk below their ancient bounds, as the St. Lawrence was necessarily enlarged and deepened. In consequence of the increased depth of the St. Lawrence, lake Champlain, communicating with it by the Sorel, experien- ced a similar recession of its waters from its ancient banks. There is presumptive evidence that all the high plains on its borders, extending to the mountainous parts, were, at a very re- mote period of time, submerged. (See Note G.) Some point on the Niagara frontier will, one day, become the grand emporium of this north-western territory. If we may be allowed to form an opinion from the existent astonishing im- provements, that period is not very remote. The fertility of the soil not excelled by any f . ae United States, intersected by riv- ers capable of boat navigatioo, bordering on inland waters not It Is ft! I . I i II If/ J 10* MEDICAL SKETCHES. ■r^'< mi Hii if; i > ;.^!! inferior in extent to seas, navigable for vessels of the largest bur* thens, and possessing the advantages of a navigable comtnunica> tiop, excepting the short distance of seven miles, with the At- la: tic ocean, will, within a few years, be capable of affording to the nation resources which may rival, and even surpass those of the Atlantic states of the same extent of navigable waters. This is not a mere speculative suggestion, nor a wild antici< pation of an extravagant imagination. The sentiment admits of actual demonstration. This tract, embracing an extent from Utica, near the source of the Mohawk, to Buffalo, the east extrem • ity of Lake Erie, thence to Detroit, a length of five hundred miles, and a width of 150 to 200, twenty years previous to the lata war, was a wilderness unfrequented by civilized man. But at the present period many parts of it are in the highest state of cultivation. New towns and villages, which in point of popula- tion equal, and of ornamental appearance, surpass the ancient villages in the Atlantic states, are interspersed amidst the vast forests of this district. Should we ca^t our eyes stil further west, and look only a few years into futurity, we shall see, by anticipation, settlements no less important on the waters of the Michigan, and even to the western extremity of Superior ; when a commerce will necessari- ly require vessels whose aggregate of tonnage will not be less than that on the whole Atlantic shores. < What is there to prevent, if luxury and thirst of opulence keep pace with Improvements ? The soil of this district, being much superior, is capable of supporting, on a territory of equal magnitude, a population vastly more numerous than that in the Atlantic states can. The productions of the earth, with the same labor, are three and four fold. ' A free navigation of these waters to the ocean would, even at this period, be of infinite importance to the United States, while the consequences of the natural advantages which this territory possesses will increase with the population of the country. To possess a correct opinion of the value of this country, which the command of these western lakes and rivers, communicating tvith the Atlantic, would give, the parts pf the whole district ijyt !/ ^li ■ n^JKIV • CAMPAIGN OP 1813. 107 relation to each other, and the extent of an inland navigation iatimately connected mth a foreign, must be viewed. The pol- itician cannot be convinced with any representation short of oc- eular demonstration. While in his closet, with even >ro. / A »P^^»WPP» ■ I II li||J.»»8 devotee of Hacchus was, that rum to him was a f;ood god. Not many days had passed, when this mivn, being attacked with a violent pain in his side, the etfect of severe labor, and lib- eral potations of spirits, under the rays of a hot sun, sent for me in haste. My astonishm>'nt was expressed he should cull the aid of a physician, having his IDOL at hand ; affecting to be unwilling to prescribe, when I had so potent a DEITY as a competitor ; from whose assistance he had heretofore experienced so much benefit. The man was tantalized until confession was extorted, he had tried his favorite medicine without good effect, and in vain. This was too evident to have been mistaken. An acknowledgment of the fact only was required. As soon as he was convinced of his folly, the requisite means to mitigate distress were administered. Intermittent fevers, dysentery, diarrhoea and jaundice may be considered the endemic diseases of this frontier. Jaundice, however, is most generally a secondary disease, subsequent to iotermittents and diarrhoeas, frequently accompanied with an enlargement of the liver. Rheumatism and rheumatalgia are also common : they attack, during the cold seasons of the year, those who indidge in the use of ardent s^tirits. This i&sufficieiit 11 !■■ '/iTT. n lie MEDICAL SKETCHES. evidpncc, (hnt ihvnv liqiiorH, lakpn to excrss, do nol oDvinto dii- intcn, bul arc highly injurious. As 8|»rinj; o|>niB, l»y Ihr gonial iniluences or th« nun, (hn hist iliwonscs liisiipiieHr. 'I'his fict de* inouslralfB, that the excitement ot'spiritH is more deleterious t« animni life during the cold, than (he hot seasons. The several tyjies of fever H|»|iear under more nggrnvaled formi on the north-western frontiers, than in the New-Ung'aml slates, under the same latitudes. The greater humidity of the atmos- phere, in the viciwity of the lakes, comldned with the hurtful *\gentB licretofore enumtrated, is assigned as a cause. Jill i ^■^ 1 Thb last week of Novemher, I departed from the Niagara frontier, to follow the divsion of General Wilkinson. After leaving Williamaville, thirty miles east, we arrive at Batavia, a new well built village, surroundei! with farms extensively 0|)en- ed, comprising a soil of the best quality. The village contains 40 houses, a hantlsome court house. Jail and a county arseiial. It is a place of consulerable business. Over a tract of territory of 20 miles square within the limits of the town, according to the census of 1810, there are 3645 inhabitants. The head branches of Tonnewonta river rise in this town, which running west em[)- ties itself into the Niagara, ten miles north of Black Rock. On this river is a town of the Seneca Indians. This village is sit- uated 256 miles west from Albany. Ten miles east lies Le Roy Tillage, comprising 30 houses in the town of Caledonia, -Avhich has a population, by the census of 1810, of 2353 inhabitants, ^^his village is 246 mill Vom Albany; the Genesee river is its eastern boundu/y, where commences that stupendous work of na^ ture, which extending to Lewistown, distant 76 miles, forms the grtat barrier or abutment, which confines the waters of Erie in its own basin, excepting a breach which has been made through it by Niagara river. This ridge, throughout its whole distance, overlooks the alluvial lands which border Ontario, and when the forests are cut down for cultivation, will command more beauti- fol uointerrupted sceneries than can be found perhaps in the if i .^l CAMPAtON OF 1«13. II "mmin^f»^r»»^wi»i \Vi known worM. The county of Oenesee betwern forty nn<» fifty mil^-B Bt|imre, 14 yenrs niroa wildprnpn, contninn a po|iiilHl!nn, liy Ihe ceriBiiB of 1810, of 12,044 inhnliitnntii, nml n taxnble |iro|iRrw ty of ll«p«'P millioriB of ilollnra. (Joni'BPe rivrr is versed, and the traveller immediately from the Atlantic shores, he would have viewed new, as being less improved. Thus, the mind is vario v and oppositely affected by the same objects. What renders the most remote new settlements, when first be- held, more astonishing is, they are approached through an uncul- tivated wilderness, 'Ireary to the lonely traveller ; and while his mind is shrouded in darkness proportionate to the gloomy shades of the forests, which bend over his head, the cheering light of aa open country suddenly bursts upon his eyes ; the extensive im- provements before him announce a village near, in which he ex- pects to find, knowing its recent date, a few ,og houses, or more decent comfortable habitations covered with boards. But this exhilarating light, as of a new world, with mansions of painted wooil work and bricks, erected with taste, and in an elegant style of modern architecture, rich and superb, astonishes the beholder. These enlivening sceneries are more extensively upened as we approach Utica from the west. The transition is not less pleas- ing than the Elysian fields were to Mneas, after traversing the dismal regions of Avernus. Upon my arrival at Utica, information was obtained, that the flo- tilla conveying the army, instead of crossing the St. Lawrence to Kingston, as had been expected by those unacquainted with the real design of this expedition, had directed its course down the St. Lawrence ; having now evitlently for its object, the reduction of Montreal. The disappointment was universally felt and ex- pressed by all not immediately connected with the army. My own feelings compelled me to concur with the prevailing public opinion, that the campaign of this year, which had early opened with flattering prospects — prospects propitious to our arms, un- der the command of General DparborNj would close with irrepar- ) Ih'I Wi:| J J M'i ^P^l ISMI '.. > 11« MEDICAL SKETCHES. i % ' 1 lis able (HsTistera ; productive of disappointment mortiryine; to nation* al feelings, as well as lasting disgrace to the projectors of the ex* pedition. Little is hazarded, when it ia declared, this unfortun* ate movement of the army was made in direct opposition to the sentiments and opinions of the major part of the officers of the army. ■»■• ■'' ■ , :— ^' • . ■ . ' . ■■ ^ •• v ■'• ^r-,; - The road from Utica direct to Montreal was bad, and the ac- commodations worse. It was expected, at the last place, or some otiier point between Ogdensburgh and Chateaugay, the army might take a position. Having been advised the enemy had, in some instances, crossed small parties upon the south bank of the St. Lawrence, in the rear of our army, during its progress down, and some hazard apprehended from these marauders, a more circuitous route, by Albany and Lake Champlain, was pur> sued. After this unpleasant journey of nearly five hundred miles, I arrived at Plattsburgh the first week of December; where an effort was made to place the hospitals, now in extreme disorder, under some regulations. In the execution of which duty, many obstacles pr^-ented themselves, while the division of General Hampton, still in tents, were occupied in erecting their 1 arracks. The requisitions upon the Quarter Master Gen- eral's department were so pressing to furnish materials for bar- racks, little or nothing adequate to the erection of hospitals, could be obtained. My most pressing ren'onstrances, for the neglect of the hospital department, were not or could not be regarded, so long as the barracks for the troops were considered the primary object. The first consideration, with officers of every grade, should be to provide comfortable accommodations for their sick. The healthy and robust can better endure exposures to cold and inclement seasons in tents. Under these comfortless coverings, many, enfeebled by diseases, who might have been preserved, in wanner habitations, were daily sinking to the grave. At this period, the lOth regiment, the only one from south of Delaware at this post, suffered extremely by the prevailing mortality. The disease was similar to that of the preceding winter. My stay here was of too short duration, to form an opinion of the practice CAMPAIGN OP 1813. lif adopted ; more especially, as the most of my time was employed to provide more suitable quarters for the sick of this division. Orders received from General Wilkinson, (who had then tak- en quarters at Malone, eighteen miles south of French Mills, and fifty miles from Plattsliurgh) hastened my departure for that place, where 1 reported myself the 15th of December. The General had contemplated to establish hospitals for the sick of his division, in this pleasant village. In pursuance of orders, the Assistant Qtiarter Master General had appropriated an academy, the arsenal and two pri houses, to hospital [lur- poses. Within ten days, these builu. .„s, sufficiently capacious to accommodate 250 men, were made comfortable ; in which each patient had a separate bed. The wards were warm, even during the utmost severity of cold. The sick admitted here, ex- cept such as were ruite exhausted by disease, daily improved in their health, by the change from cold lodgings in tents, to more temoerate in houses. The above establishment was placed un- der my direction. To Captain Dwicht, A. Q. M. General, who promptly afforded every assistance in his province to bestow^ and the circumstances of the country would alIow» this establish* ment was much indebted. l This division of the army witnessed a series of Unfortunatfr movements after the capture of Fort George, until it retired into winter quarters at French Mills. To combat the elements, was attended with more losses than to fight the enemy. The unsea- sonable expedition of the army, down the St. Lawrence, was not the final evil which it had to encounter. We shall, here, give a retrospective view of the general health of the army, when it embarked on board the flotilla at Niagara* A large proportion of the soldiers were convalescent, and could but illy endure the fatigues and exposures in open boats, during the passage down Lake Ontario, to Grenadier Island. The weather was cold, accompanied with rain, the whole route. The flotilla was scattered. The boats transporting this army were, wholly, at the mercy of the winds and waves ; and were not col«. lected within a fortnight of each other, at the place of rendez* Tous. While on their tedious passage, attended with great bsor 16 i'i ;'i>iii r. f ' fi Hill 1; 118 MEDICAL i^KETCHES. aril and serious disasters, many of the convulescents relapsed in* to fomter, or were seized with new diseases. Some of the most indisposed were transported from Grenadier Island to Sacketfs liarbonr, and there left in hospitals. From Grenadier Island, the flotilla, progressing down the St< Lawrence, met with no serious obstructions from the enemy. Three hundred boats passed the batteries at Prescott, opposite Ogdensburgh, under a tremendous fire, with the loss of one man killed and two wounded. General Wilkinson, from the time he took command of the army at Fort George, until his embarka- tion, was sick. At Grenadier Island, he became more indispo- sed ; and during his movement down, was mostly confined to his bed. It hiiving been ascertained that the enemy with his dis- posable force was in pursuit of the army ; with a view to pre- vent its rear from being molested, General Boyd was ordered with detachments from his own, and General Covington's brig- ades to land and beat them. In pursuance to orders, a landing was eiTected with about 1200 men; who, in Williamstown, on the Canada shore of St. Lawrence, engaged a superior force. The field of battle was conlested three hours. At the com- mencement of the action, the enemy was beaten ; but neither army in the event gained any important advantage; but, in which, were displayed by the officers and men generally, the highest degrees of courage, against superior discipline and force ; and in which the enemy claimed a victory. By their strong position and superior management they frustrated the object of this rencounter, when General Boyd was ordered to reembark the army. The attack was so severely felt by the British, the retrograde much of this detachment was effected without molest- ation. In the battle fell, much lamented, General Covington, a brave and accomplished officer. The loss on either side was stated to have been five hundred killed and wounded. Those of the United States' troops badly wounded were left on the . field of battle. This action closed the hostile operations of the army against the enemy this campaign. It belongs to officers versed in high military tacticks, to reconcile the plan of invading an enemy'^ CAMPAIGN OP 1813. ni country, and entering it nt its centre of population, during an in>- clement season of the year, and when its severity was rapidly progressing, with an array feeble, destitute of clothing and pro- visions : — in which, when possession was gained, it would have to contend with a far superior force at every point ; and where resources could not be obtained, except by way of Champlain ; nor from that quarter without opening a communication by the strong posts of Isle au Noix and Stone Mill, by force of arnriB. Doctor LovELL further observes, that " during the whole of October, and part of November, most of the troops wete subject- ed to excessive fatigues, and exposed in open hoats on the lake, when it rained almost every day. On their arrival at the French Mills, about the 14th of November, the weather became- intensely cold, and remained so all the winter. In addition to the great fatigue to which the soldiers had been exposed, espe- cially the division from Fort George, most of them had lost their blankets and extra clothing, on their march, or in the action of*. 11th November, at Creistler's lields, in Canada. Even the sick had no covering except tents, from the period they debarked at the Mills, yntil the 1st of January in the severe latitude of 43 degrees. Provisions were scarce, and of a bad quality. Medi- cine and hospital stores were not to be found, having been lost or destroyed during the passage down the St. Lawrence. Un- der these circumstances sickness and mortality were very great. A morning report now before me gives 75 sick out of a smalt corps of 160. The several regiments of the army, in their re- turns, exhit)ited a proportional number unlit for duty. Of the 75 referred to, 39 were reported of diarrhoea and dysentery ; 18 of pneumonia; 6 of typhus, and 12 of paralysis of all the ex- tremities. Many of the paralytics, on our arrival at the Mills, were attended with mortification of the toes and feet. In a few of these, the pain was severe ; w'herein opium not only relieved' the pain, but checked tlie progress of mortification. StimulantSj both internally and externally, were beneficial ; and when these remedies were assisted by a nutritious diet, warm lodging and clothing, a cure was effected. The last complaint, general* ly» seized those, wJio, previously had been extremely rediicpdi IJ H' 120 MEDICAL SKETCHES. I Ad. I ;:i*^ by disease ; and utuler our unavoidablj bad situtatioo, frequent-' ]y in a fev/ days proved fatal." The statement given by Doctor Lovell was confirmed by ^spital Surgeon Ross, the senior of the medical department, iccomi)anied the army down the St. Lawrence, lu the vicinity of the French Mills, the cjuntry vras a wilder- ness. Huts and hospitals were necessary, to render the army comfortable. The erection of these was a work of great labour, and required several weeks to com()lete. A supply of hospital stores could not be obtained nearer than Albany, a distance of 250 miles. The want ol' these necessaries, for the support of the very wretched and enfeebled soldier, was most severely felt. The poor subsistence, which the bread of the worsta^piality afforded, was almost the only support which could be bad for nearly seven "weeka. These accumulated evils the army encountered with much patience and heroic fortitude. Now it was tne chief surgeon, who was with the flotilla, found himself loaded with a weight of censure ; of which he should be fairly exonerated, so far as he was blamed for the loss or waste of medicine and hospital stores on the St. Lawrence. It was abundantly demonstrated, that no separate transportation for these stores, although expressly ordered by the Commander in Chiefs had been provided ; but that they had been improvidently distributed throughout' the boats of the flotilla, and for the security of which no oflicer had been, nor could have been made accountable. The deaths, sickness, and distress at French Mills, excited general alarm. The great mortality had obvious causes for its cxistencci In all such cases, censure will fall on some depart- ment. And as each was disposed to exonerate itself, upon which was blame more probably to have alighted, than the medical — than upon the surgeons of the army, under whose immediate care the victims of disease were daily prostrated ? There are to be found some, who, ignorant of the effects of medicine on the hu- man constitution, are too prone to believe, its exhibition may be equally efficacious, under every circumstance and condi- Ijoa to which the patient may be subjected. Hence it was in^ a is 'jIPHWI CAMPAIGN OP 1813. m correctly inFtirreil, when men vrere beheld expiring under the pr('8cri[)tioni of the surgeons, the mortality was a consequence of injudicious management, or neglect of duty. Predi8|)Osition9 to disease, the effects of obvious causes, the comfortless condi- tions of men exposed to cold, wanting the common necessaries of life to support them, in their exhausted states, were seldom taken into consideration. Doctor LoYv.hi.^ one of the must able and attentive surgeons of the army, emphatically observed, '* It was imiKmsible for the sick to be restored, with nothing to sub* sist upon exc«pt damaged bread." At the time the division of General Wilkinsow was delay- ed at Grenadier Island; and the flotilla put in motion down the St. Lawrence, General Hampton's division penetrated from lake Champlain, on a bad road, some parts of which almost im- passable by nature, in the direction of Chateaugay, to the bounds of Canada, where it met with some opposition from the Cana- dian militia and Indians. After a feeble effort to repel the ene- my, and advance into the lower Province ; a retrograde march to Plattsburgh, from whence the army had previously moved, was ordered. By this unfortunate, imbecile attempt to invade the lower Province of Canada by General Hampton, some loss was experienced, and less honour was acquired. Whether this appar- ent vacillancy of judgment resulted from insuperable obstacles, unforeseen and not anticipated, or a matured determination not to co-operate with General Wilkinson, has not as yet been de- veloped. For the'disasters which attended the army, and the non-accom- plishment of the object of this movement, General Wilkinsow has been arraigned before a court martial, composed of officers of a high grade and most respectable standing ; and of the host of charges and specifications preferred against him, has been ac- quitted. Success, however, often makes the celebrated general ; while want of success, in the public estimation, ensures his con- demnation. The documents exhibited before the court, upon his trial, are a full exposition of all the important circumstances relating to the movement of his division, from Fort George, up- j i- ; 11" I. ' jOr ff» * 1/ H^Ki S ',' 4 'i 1 1 ' RHII ' niRfJ in ' \ Wm I itl^H^ 1 HlM' M B^^^H»!'jnB ^H-^ ^^R«1^ 1'^B ^BT .'■ 1; -: I'll U,-''. 122 MEDICAL SKETCHES. 1:}^ r I I mi i\\ the campaign terminated ; and, when made public, will give stability to floating public opinion. The medical Bketchce of this campaign will be concluded with the substance of a comtnunication made to an ofllcerofhigh grade, at the French Mills. iS ' v'^v jl ^ ; *'i •'.. . . h'- . The greatest evils, to which the army has been sulijectetl since the war, are diseases and their consequent mortalily. <^ ' " '■ How are these to be remedied ? is a question of the highest moment. As causes and effects are intimately connected, by the removal of the first, the last cease< Long ex|R)8ures to in- clement weather, independent of other causes, are sufficient to produce a catalogue of diseases. But in the event of active op- erations, these causes are not under our control. The unavoid- able casualties to which an army at times may be subjected, dur- ing cold seasons, may be partially remedied by additional cloth- ing. It may not be as generally known as it should be, that, a large proportion of the army were not, when lirst enlisted, fit for sol- diers. At the time of entering the service, many of them wera incapable of enduring the fatigues and hardships incident to war, during all seasons of the year. Many of these, habitually intem- perate, with constitutions broken down by inebriation and its consequent diseases ; whose bloated countenances exhibited false and insidious marks of health, contribute to fill our hospitals. It has already fallen to my lot, since the commencement of the war, to recommend more than two hundred of the above descrip- tion for discharge ; many of whom had not been enliikted three months, and had performed only a few days' march, during the most pleasant season of the year. It has been too much an ob- ject with oflicers on the recruiting service, to fill up tlteir rolls with numbers; without reflecting, that the strength of an army consists in able-bodied men. These infirm men were always a dead weight, requiring a detachment of the more efficient, as nurs- es, or attendhnts. A body of five thousand composing our troops, seldom have furnished more than three thousand capable of ac- tive duty in the field. Government has the means of remedying the last evil. CAMPAIGN OP 1813. 123 The health oT men depends much on the officers immediately commanding companies. Their cleanliness has not at all time« been promptly attended to. The most suitable manner of pre- paring their diet has been neglected. An improvement in the dietetic management would be made, should each corps ami regi- ment detail a police officer to inspect daily, the kitchens, and enforce upon the men the importance of preparing their rations in a manner most conducive to their healths. A surgeon may be ordered to accompany the police officer, when employed oa this duty of culinary inspection. A surgeon of regiment should not feel his duty ends with his prescriptions for the day ; but to obviate disease, as well as to cure, is a part of his province. Less trouble and expense are required to employ prophylactic means, than cure diseases. The quarters of soldiers are generally too much crowded. To place 1 or 20 men in a room 1 U feet square, is very injudicious. Officers arc not fully sensible of the evils \Shich arise from close rooms, charged with contaminated air. It is an opinioQ too prevalent in the army, that, in this cold season, men cannot be made too warm ; the closer they are stowed the better, be- cause warmer, has been often alleged; without reflecting, that UDOxygenated air is more injurious to healtli, than al)solute qold^ in pure air. The evils Which originate from crowded rooms, and which accumulate during the long nights of winter, are not remedied by breathing a purer air, during the active employ* ments of the day. The constitutions of men, subjected to these transitions, shew their morbid eilects, by coughs and pneumatic fevers; which, when the causes are of long continuance, assume forms the most mortal, rapid in their progress, terminating the fatal scene, sometimes in the short space of 24 hours. Such were the morbid effects of the pneumonia of 1812. Such have been described, at various periods, under its most mortal form, the spotted fever, by many physicians of respectability ; partic- ularly by North and Gallup. Here the disease, like a devour- ing element, quickly dissolves the Cabric of the constitution, or, like an explosion of a loaded mine, subverts from their basis the foundations of life in a moment. \y' ii i|' I ■V \ "I y'\ i I mi i 124 MEDICAL SKETCHES. An ill-timed distribution of clothing it among the cfinsfs of disease. It tins been found, the woolen garments allowed the soldiers have not been issued until the warm weather of summer commenced, hen winter finds them either naked, or cind In their summer dresses, perishing with cokl. It may he added, the allowance of clothing is not sudlcient to proi(>ct the men on the northern frontiers from the severe frosts of this inclement cli- inate. It cannot be too frequently Repeated, an intemperate use of ardent sinrits, is also among the destructive evils attached to our armies. The high excitement produced by ardent spirits is more ii\jurious to life in cold, than hot seasons of the year ; a- pecially if drank when the system is exhausted of its vital heat by cold. This most noxious of all causes of disease, to which t)ur army is exposed, may be obviated by prohibiting sutlers to •ell these deleterious liquors in the vicinity of the cantonment. To elucidate the correctness of the above jmsitions does not require the aid of philosophic demonstration. It is only ne- vessary to present them to the eye of the understanding, and they cannot fail to be comprehended. The above, however, fire only a partial representation of the causes of disease and death. » ••' ' ' , . To exonerate the medical staff of the army from censure, is toot my design. For a neglect of duty they may sometimes «tand chargeable. Not more should be placed to their account, than is just. Is a soldier sick under circumstances already de* Bcribed, and does he die under the hands of his surgeon ? his death is too often imputed, either to his ignorance or inatten- tion, by officers who are no less, perhaps moie greatly deserving of blame. L is a disingenuous fact, the surgeons of the army fire made mere scape'-goats, on whom are heaped a multitude of sins ; which, without a figure of speech, art; imputable to causes* over which they have no control. ' END OF CAMPAIGN iai3* w^ T i -V Vifi lA Mil.iW f^K* . 1 . • »• f- •! •„ . >. ■ .,Ml|r» wi (.'li . , '• til . \-ji'>A'..- ' ,/ ' CAMPAIGN OF 1814. I ,.> wwwvwwvvw^wv At M alone HoBpital, on the 1st of February, 1814, the miraher of sick had increased to 450. For an additional number of 200 sent from French Mills, rooms were wanted ; which were promptly provided by Captain Dwioht, A. Q. M. General; who continued to give me his assistance. In addition to diseases already enumerated the preceding can> paign, (among which, diarrhoeas were the most prevalent,) was the pneumonia of 1812-13. The disease was accompanied with all the same symptoms under which it appeared the preceding winter ; but, its attacks were less frequent. There were two ca- ses where the patient did not survive 12 hours after the first io^ disposition supervened. There were a few cases of disease which assumed the form of spotted fever — in which the brain seemed to be the seat of disease; a mental derangement having been the first alarming symptom, without any pneumonic afTec^' tion. The progress of the symptoms was so rapid, that no deci> eive mode of practice was adopted. All of these died within the first 24 hours. Two of the number, within six hours. A nurse in the hospital, apparently in good health in the morning at 9 oViock, became deranged ; soon after comatose, at 3 P. M. was a corpse. Many of the sick had swelled feet and legs ; some of these were accompanied with mortifications; the conse- quence of long confinement and inactivity in the boats, wet an4 cold, during the passage of the army down Lake Ontario and the river St. Lawrence. Six or seven weeks elapsed before the men were made cortir fortable in their barracks, at the Mills. . By this time, provisions had arrived fVom Plattsburgh and Utica, of a better quality than 17 I I h : ;|||: Hi it ■ < ■ '< \» MEDICAL SKETCHES. if|i } bad previously been iuued. Am[ile luppUes of hospital storei \vere received from Albany, uuder the charge of Doctor Low, AMiitant to the Apothecary General. The men daily improv- ed in tlieir appearance ; time was had to clean themselves; while order and discipline assumed the place of afiparent confusioa imd bustle, which, during the building of huts, seemed to exist. This relaxation from severe toils and labour was l)ut momen- tary. About the 0th of February, an order was issued to leave this cantonment. One division, under the command of General BiiuwN, moved up tlie Bt. Lawrence to Sackett's Harbour ; the other, under the immediate command of the Commander in Chier, directed its march to Plattsburgh. In consequence of this retrograde movement of the army from French Mills, the hospital, at Malone, at this time, under good fegulatione was broken up, and the sick were ordered to proceed on routco destined for their "eapective regiments. Those for Plattsburgh and Burlington were accompanied by myself. It was no inconsiderable task to transport 450 sick men, or more, at this season of the year, through a country almost destitute of inhabitants, a distance of 70 miles. Some of whom were ex- tremely reduced with fevers and diarrhoeas. Others were conva- lescent. The few accommodations on this route were wretch* ed. The inhabitants, although kind, were not under circum- stances to furnish means to render the situation of sick men ev- en comfortable. Nothing was omitted within their abilities, to meliorate their miserable condition. Knowing that so large a detachment of sick and invalids could not be cov( red at night, if they moved in a body ; the sleigliS which transported them were successively put in mo- tion, in small divisions. Their line of movement, three days forming, extended the whole distance from Malone. The first division arrived ^t Plattsburgh, the place of their destination, aliout the time the lust commenced its progress. About 20 very sick, who were left in the hospitals, under the care of a citizen physician, were made prisoners of war by the British ; who im- mediately followed the retrograde march of the army, as far as Ualoue. Those left in the hospitals were not molested in their mtmr CAMFAtON OP 1814, m ^non», but were only obliged to sign their parolei. The greal^ tr part of whom, nfter five and aiiL weeki, joined the hospital at BiirliiiRton. During thia movement of the aicic, aix died, while ninny improved in their healtha ; notwilhalauding it anowed or rained during the whole journey. ^. •, f^<^^ U|K)n the 10th of February, !■ arrived at Burlington ; where about hnlf of this detachment of aick had arrived. There werev then in the hospital here, about ItiO of General Hampton's dU vision. After preparntiona were made Tor our increasing number, foi whose accommodation, in addition to tJie hospital house, 20 rooms of the common barracks were provided, the wards wera inB|iected,nnd the men classed and distributed according to their diseases and conditions. The epidemic of 1812-18 was among the prominent diseasea also, in tliia hospital. Although it was not so generally preva* lent as the preceding winter, there were some strongly marked cases, sudden in their onset, with suffocated respiration, con- tracted pulse, cold extremities, and a heavy dull pain in the chest. My attention was called to one case, of " ^ew hours duration. After directing heated woolen clothes to his extremities, bleed- ing was directed ; when it was understood, there had been some disagreement between four or five young gentlemen attached to the hospital, respecting the proper method of treatment. All oi' whom, excepting one, objected to bleeding ; having never wit- Dessed its employment under similar states of disease; and con- sequently were strangers to its beneficial effects. The quantity- first taken away was eight ounces. About one hour after the operation, I visited the man, and found him relieved, as to the laborious respiration. In the evening of the same day, difficult respiration had returned with increased heat and fuller pulse ; when eight ounces were again taken away. The day following, he was bled eight ounces the third time^ After which, he con- valesced, and in three days was able to walk his viard, having a returning appetite. The foJUowiog days, five or six similar caseB were treated ia I* T ^•mm t m 128 iMKDICAL SKETCHES. ;(; :-i like mftitner, under my imraedinte direction ; who allM recover- ei\. After these successful exhibitions of bteedinj^ in these pneumonic diseaees, no further opposilion was mnde to the use of the lan«et in hospital practice, in similar forms of disease. I do not hesitate to say, that more than one hundred were saved by this oj)eration. We had this disease completely under our con- trol, if seasonable application was made. The auxiliary reme- dies were a cath. of jalap and calomel ; calomel and opium in small doses ; autimonial wine and camphorated tine, of opium, as expectorants ; and blisters upon the chest. Small emetics, after bleeding and evacuations by the bowels, were occasionally employed. The epidemic of this winter, as heretofore, fell up- on those with the greatest force, who were either advanced in years, or intemperate. ' ' "^ '^"' ».rr •,, . Intermittents shewed themselves, in a few instances, dpring the months of Febru .ry and March, 1814. Some of these cases •were admmitted patients, who had been treated by regimental Surgeons in quarters ; wherein the disease appeared obstinate — > not yielding to remedies commonly employed. Previous to their admittance, emetics and cathartics had been administered ; after which, the bark, aromatics, bitters and wiue in large quan- tity without any benefit. Their treatment in the hospital was commenced with Fowler's mineral solution ; not with those good effects, however, which had been experienced from its employ- ment, on former occasions, at Lewistown, on the Niagara. This unsuccessful practice, by the most usual mean?, persuaded me that these intermittents partook of the type of the prevailing pneumonia. Sydenham and Rush have observed, that during epidemics, all complaints assume tire nature of the prevailing disease. Recourse was next had to remedies employwl in the epidemic pneumonia; as bleeding, calomel in small doses, and antimonials. This practice was more especially adopted, inas- wiuch as these intermittent fevers were accompanied with some »Uo;bt affections of the lungs. The patients with these intermittents were bled from 12 to 16 •onces during the exacerbation of the febr'le stage. Then jalap gr. X. calomel gr. x. were administered for a cathartic j or sijJ- CAMPAIGN OF 1814. 129 phate or soda ; or ol. ricini. From one to two grains of calomel were administered every six or eight hours, and interme».- lA-.:^*^ .,.^'.. . :. .. ... _^. < CASE SECONO. ■■' !-- -i- • • Oliver Spekcer, 29th regiment, had been subjected to epi* lepsy seven months. During which period, he had been treated in the hospital by a routine of evacuants, antispasmodics, tonics and blisters, without any benefit. The following was his treat- ment. ,,,, ..;■■> / ed. These dropsical swellings appeared under forms of general anasarca, or ascites, or both combined. ■'» '••** a' *'rj* ..i..* Previous to taking direction of the hospital at Burlington, in February, 1814, acetite of lead had become a con^mon pre8crip« tion, in the hospital practice, in cases of chronic diarrhoea. Prej- udices against the internal use of acetite of lead, from education, I had always possessed. To Ihe indiscriminate employment of this medicine, in the above disease, strong objections were op- posed. Soon after taking charge of this hosjiital there were no- ticed, when visiting the wards, an astonishing number among six hundred patients, some of whom young men afflicted with drop^ sical swellings. The circumstance led me to enquire, the condi- tions of these patients, when admitted into the hospital. It was made known, they all had diarrliocas ; and as soon as the diar- rhoeas were stopped, the body and lower extremities became bloated, oedematous and dropsical. It was also ascertainedj that these diarrhoeas had been checked, while under the use of acetite of lead. There was no hesitation in my mind to believe, these dropsies were a consequence of the sudden check of dischargeir from the bowels, caused by tlie injudicious administration of this poisonous drug. ■■ . < The acetite of lead has been intro)UCceMk 8ome few, however, resisted every mean employed. That these ilropsies were the consequence of the sudden check of diarrhoeas by acetite of lead, was most evident ; for, as soon as the diar- rhoeas returned by the employment of cathartics, the swellingt subsided. It was observed also, there was a strong constipation uf the bowels, especially a rigid contraction of the sphincter ani ; which was not overcome, except by frequent repetition of ca> thartics. Whenever a diarrhoea was induced by medicine, these flropsical swellings rapidly disappeared. ;«i. * :~>. < *:vr-'-^. :v>n(^| The deleterious effects of acetite of lead were most evident, in two cases, circumstantially reported by Doctor Henry Hunt» liospital surgeon in the army. His communication has been, already, published in the Medical Re|)ository, at New York. To one of these I was called, occasionally, in consultation. It is here inserted, in connection with other injurious effects of thb potent medicine. *' General Hospital, Burlington, Vt. Sept. 15, 1814. " The following is a statement which was given me, [writes Doctor Hunt,^ by Major Bcbeb, one of the sufferers, at my first interview with him, which was several mouths after the com- mencement of the disease. . ^ . fV, ,*.:4 &.si *' About the middle of November last. Colonel Johnson and myself were attacked with diarrhoea, and consulted at Malone a surgeon, (then belonging to the army,) who g^ve us a box of as- tringent pills about the size of large peas (afterwards discovered to be the acetite of lead) with directions to take ihem frequently, until our disease was checked. On an average we took five or six a day. Much relief was procured by them, and by the last of the month we returned to duty at French Mills, apparently cured. We were so much pleased with these pills, that each of us took a large box on our departure, and frequently afterwards had recourse to them, whenever our disease shewed a disposition to return. *' On the 5th of December, Colonel Johnson was attacked with a violent pain in his stomach and bowels, attended with » OAMPAION OP 1814.' 133 l! firequent diflposition to puke, and a powerrul tenesnus. Medical aid was immediately procured, and the most prompt and active remedies were applied without relief. The symptoms daily in> creased in violence, and he lingered seven days, tortured with excruciating pain, and retained his senses until he died. '* After the death of my friend (not knowing the cause of his death, or the composition of the pills) I frequently resorted to my box. Early in January, being much exposed to cold and wet weather, I was suddenly seized with a pain in my side, which was supposed to be the pleurisy : for thb I was bled and blistered with considerable relief. Soon afterwards I waa taken with sickness at my stomach, attended with flatulences, and a violent pain in my bowels, with tenesmus. A copious discharge of sweet saliva soon followed this attack, and continued some time. During this month I suffered great pain in my stomach and bowels, likewise in all my joints, and bunches of knots arose over my abdomen. My bowels were costive, and my appetite entirely destroyed. For these I took pills of calomel until my mouth was sore, and a latge dose of sulphur was given daily ; the operation of which never failed to increase the pain in my bowels. Injections were used with some palliation ; but the sphincter ani soon became so contracted, that the pipe was witk pain and difficulty introduced. " About the middle of February I left French Mills, and a6- rived at this place (Burlington) the 20th, in great pain. I waa again salivated without relief, and afterwards took Dover's ik>w« (lers during the month of March. My disease continued to grow more violent and alarming, with pain and numbness in my ev tremities, and an abscess on each of my legs. • ; '- *■■*> v «,• *' In April I took wine and bark, but had no appetite to eat. The symptoms all continued, and I could not sleep, without the aid of large quantities of opium." - Doctor Hunt, in continuance of his communication, says, " I was cali.^d on to visit the Major about the middle of May. He was lyirrT in bed, and looked pale and emaciated, his eyes were sunk, his cheeks hollow, and his countenance directed. 18 fi'; it -I J f .' 134 MEDICAL SKETCHES. I i { \ i|. ; Wi *' He told me he vfas in violent pain, which could not be pal« liated without taking two or three grains of opium every three or four hours. His bowels were obstinately costive, and he was obliged to take some purgative medicine every day ; the opera- tion of which was severely painful, (the sphincter ani being still much contracted.) Food was loathsome to bim,and he had pro- fuse perspirations, for which he was taking wine and bark. A deep seated abscess was formed on one leg, and a superficial ulcer on the other. The gastrocnemii muscles were enlarged and in- durated, and bia arms partially paralizeik y, r •■,..,;: - , I soon discovered that the wine and biark aiggravated his dis- ease, and substituted milder tonics, until I had tried the whole list of metalic and vegetable tonics, without auy good effect ; when I was obliged to abandon th«>ni altogether, although his feeble pulse, cold skin, and great debility fully justified the practice. *' I endeavored to restore his appetite, by lessening the quan- tity of opium, and substituting the tine, of hops, as much as pos- sible. Sweet oil was given every day, for the constipation of bis bowels, large blisters were applied over the abdomen, for the pain 'y- and his arms were freely blistered for the paralysis. His legs w«re washed with a decoction of galls twice a day, and lightly dressed, (the irritation being so great, that the slightest touch was painful to him) His appetite was frequently coaxed by some delicacy, and the sweet oil was frequently alternated by magnesia and rhubarb. ... ^i.-^^,.. " This treatment was regularly puhiited until the last of June ; and although he suffered much pain during that time, he was evidently much better, and his appetite improved. He slept much better at night, and took but little opium; lie had no pro- fuse perspirations ; the sphincter ani was more relaxed, and his legs were nearly ciu^ed. The pain in his bowels was less fre- quent, and not so violent. He was cheerful, and talked of soon returuiiig to his duty, it-.- »J«t v. rA.'i,-.'i!f!»t,^.. tvi tjiuA rt^-v,!'! " July 4th. I was sent for in great haste to visit him. When I entered his room, I was astonisheil at his altered appearaace. His countenance was pale and fallen; he was silting up in hit bed, struggling for breath ; his body was covered with cold and IPMJIIJJIll I I CAMPAIGN OP 1814. U5 clammy sweats ; and he had a most anxious and dcspondini; look. In a few words he informed me that he was suddenly seized with a violent pain in his stomach and brenet ; that he could not breathe, and must die in a few moments. I immedl- ntely gave him large quantities of telher and laudanum ; applied flannel dipped in hot spirits to his stomach and breast, and or- dered anodine injections to be frequently and copiously used, until the paiu subsided, this treatment gradually relieved him during the day ; at night a large blister was applied over the stomach and breast, and the aether and laudanum continued. " The injections brought away from his bowels large quanti- ties of dark and hardened feeces. They were repeated every day during this month, with the happiest effect ; and it was as- tonishing what masses of these dark and indurated faeces were evacuated during this time. " About the latter end of this month he complained of great difficulty in voiding his urine, and was always obliged to make strong efforts for several minutes before he could accomplish his wishes ; when the urine would suddenly start in a full and co- pious stream. .•■■—■■■■ .-- ■ - " August — In the commencement of this month, his thorax and abdomen were entirely relieved from all uneasiness, and he was again flattering himself, that his disease was subdued ; when he was suddenly seized with a violent pain in his left hand and arm, attended with an emphysematous swelling. This continu* ed' until the middle of the month, without the least abatement, when a similar affection commenced in the right knee ; and in proportion to the increase of pain and swelling in this part, those of the hand and arm diminished. He was tortured Avith the most agonizing pain the rest of the month, which nothing but large quantities of opium could lull for a moment. Repeated blisters and other applications were used without any relief. ' ' " September 1st. Is much emaciated and exhausted by want of sleep. His left foot and knee are also affected with great pain and swelling. > - .'. ■ •• " 6th. The pain and swelling have pervaded all his extrem- ities. Opium can no longer lull his pain, and nothing but death now seems to oflfer him any hope of relief. 1 1 >i> i k '4 IH h * m \\\ 136 MEDICAL SKETCHES. ** 8lh. Rii extremitiei are completely paralized. ^ «^^ *' loth. Ii affected vtMh erysipelas, and is (gradually sinking Into a state of insensibility. In this state he lingered until the 13lh, when he expired nvithout a struggle. > •»*M . I;. , v;V»;^».»./*» iMrrhj-lJ " HENRY HUNT, ,,^, " Hospital Surgeon U, S. Army. I.I '•«'#>«( I V*. >t««'f*- *' P. S. In addition to the above cases, I have seen several others produced by the same cause, since I have been on this Trontier. Chronic diarrhoea is a common complaint on the bord- ers of Lake Champlain, and the sugar of lead was, at one time, a fashionable remedy among the surgeons of the army. It was often given to the men, while in the tented field, and exposed to all the varieties of this fickle climate. Without being caution- ed, and, ignorant of its baneful effects, no doubt some of them used it improperly. , »„,., ..,, >,. ..,„ ....*♦.„«., ««.4,* ., " No one appreciates more highly than I do, this valuable ar- ticle of the materia medica ; but great caution ought to be ob- served in its administration, without which much is to be fear- ed, that it will oftener prove a hane, than an antidote to man ; especially, as some physicians express doubts of its deleteriouv efifects." ,, , , . H. H. &c. «April20th, 1315." , , The above effects of acetite of lead, at Burlington hospital, brought to mind two cases of colica pictonum, which occurred at Lewistown, on the Niagara, the preceding summer, when di- arrhoea was the prevailing epidemic, and sugar of lead was by some employed as a remedy. One of these expired on the ivA day after the attack. The other, by the use of cath.'^rtics ; calomel in large doses ; olium ricini ; injections frequently re- peated, and warm baths, recovered. Having no suspicion at the time, that these attacks might have been occasioned by the pre- vious employment of medicine, no enquiries were made, what their states had been previous to their seizure. It was, however, conjectured at the time by myself, that these complaints might have been produced by adulterated wine, which was sold at the M! CAMPAIGN OP 1814. 137 ttorei and by sutlers oT the armj ; as it is well known, that wine- sellers Trequently sweeten their low and sour wines, by acetite of The case of Major Beebe requires a more full exposition. When he first arrived at Burlington, in February, he was at- tended by myself. At that time he was not extremely reduced. A journey of ninety miles, added to the stimulants with which he had indulged himself, to resist the inclemency of the weather during the route, had induced a high degree of arterial action, and considerable increase of heat There was a small abscess on one leg, and a large intumescence on the other, in an incipi- ent state. To reduce the sthenic diathesis, which evidently ex- isted, blood-letting and a cathartic were prescribed. The relief procured by these was small and temporary. After administer- ing some small doses of antimonials, it was agreed, in consulta- tion with two physicians of the army, to put him upon small doses of calomel, until his mouth became sore. Thin was again advised, as he had found some benefit by this process, when first employed at Constable, near French Mills. His greatest painful suffering seemed to arise from the forming abscess ; upon which emolient poultices were appUied several days. These had little or no effect to bring it to a state of maturation ; when a blister over the swelling was directed with no better success ; after which was applied a stimulating plaster of the gums. The pain increased with the enlargement of the swelling, until a deep seated fluctuation was distinctly perceived under the gas- trocnemius muscle. It is to be noticed, that even now the su- perincumbent teguments were not inflamed, the skin not in the least discoloured. An opening was made into the encysted mat- ter, which was sanious instead of being purulent, as was expect-^ ed. No relief was procured by this operation, but the swelling continued extremely painful. The sore was dressed with a sim> pie pledgit of cerate. After the calomel was employed to an extent which had been proposed, and no relief procured by all the means employed, he was advised to warm baths, to remove general wandering pains. These not giving relief proportionate to the trouble of employing i 1 ill n I' w i. . iii Til Iff' m .J: « 138 MEDICAL HKETCUES. U'l llllll i| (h«m, were strenuously ohjeclnd to hy the patient, bolug appre* hensive he was weakened by them. He was then put on a course of Dover's powders. While en- der their influence the patient seemed to be in a better condi- tion, than I had seen him. There was sutTicient ipecacuanha in this |)rcpnration to counteract the restrictive powers of the opium, which was necessary to procure a respite from pain ; al- so some sleep. By this medicinv*^ the necessity of cathartini wns obviated; at the same time the powders induced a gentle diaphoresis upon the skin, universally, which previous to their administration had been dry and hard. :,tr.j «; urtr, ,»? .1 -tiiu i > AUiinugh I could with propriety pronounce him in a favoura- able condition, having more appetite, and less pain ; yet he was very impatient under his circumstnnci s. His Tncnds advised him to invite a physician to consult upon his case. Upon an interview my plan was opposed. Tlie bark, wine, spirits, and opium were proposed in large quantities. To these 1 objected, under existing circumstances. My principal objec- tions arose Trom the constipated state of the bowels and rigidity of the sjihincter ani. The patient h:id his choice. He prefer- red the stimulating process, as being more congenial to his own sentiments, that they were necessary to give strength, as they were more agreeable to his propensities. In consequence of some indecorous language of the consulting physician who was a citizen, I refused to visit the Major again, in the character of a piiysician. However, the last stimulating prescriber was event- ually dismissed wi^h a load of imprecations from his patient, nf- ter he had taken bark, wine, spirits and opium, until he was disgusted with the sight of them, and with no melioration of his condition. These medicines had the eifect to place his stomach and bowels in an irremediable state, in which Doctor Hunt found them, when he made his lirst visit. If wc may be allowed to theorise in what manner the acetite of lead may act to imhice dropsies, when administered to pa- tients extremely reduced by chronic diarrhoea, we shall observe, that tlie increased evacuations from the internal, diminished those .upon the cxtejmal surface of the body, during the course CAMPAIGN OP 1814. tat uf the diarrhoea, the tkin waa remarkably dry. Unlcfls perspira- tion wai restored, as diarrhcea vras cheeked, there was an accu- mulation of lymph in the large and small cavities of the body ; whence hydro-thorax, ascites, and anasarca. Perhaps there is not in the materia medica, a more powerful and permanent as- tringent, than sugar of leiul. May not this |iotcnt medicine bn equally efficacious as an astringent, and less deleterious, in com- bination with some article whose known effect is to determine the material of perspiration to the skin i such ns ipecacuanha. The tepid bath may be an appro|)riate remedy, while the |)atirnt is under the effects of the acetite of lend. The above is 8Ui;gest- cd to those who are persuaded, that sugar of lead is not, in any ca{|e„an unsafe internal medicine. Opium has been advised to obviate the colic pains, which sugar of lead, freriuently induces, when continued a long time. Doctor Fishicu, President of the Massachusetts Medical Society, in a commun cation published with their papers, has related several cases of < olica pictonuni, in which opium in large quantilies was administered, nut only with safety until pain was overcome, but with happy effects. He obviated the restrictive powers of opium on the iutcatinch;, by some cathartic medicine. In hemorrlin,«;ic disr.tses, as ms- Dorrhagia, and hemo-phlhysis, the acetite of lead is now resorted to as a safe remedy : here a few doses generally will cure IImj disease, without any subsequent bad effects ; but since expcri- encing that sulphate of copper is equally efficneious in these dis- eases, and in my estimation a snfer remedy, it is substituted in my practice in all those hemorrhagic diseases, where, formerly, the acetite of lead was emploj'ed. I( ~H^'i';\r.i rn" <'i •> Rheumatalgia was a frequent disease in the hospital at Bur- lington, in the winters of 1813 — 14. The patients dated the or- igin of this complaint from some period of the movement of the array from Niagara to French Mills. It has already been notic- ed, that ^1 111 CAMPAIGN OP laM. 141 monthl, ftnd were nccompnnieil with nil the vnriouB •ymptomsof confirmfd him. Hume or thene patients had bcrn in the hospi- tal leveral months previous to my taking the charge of it, tvith obstinate chnncres and nlcrrs, arcompan:ed with pains in ditYcr- enl parts of the hody, and cxceeuingly emaciated. These men liad already gone tliroiigli with repeated coursi's of mercurials, under every form, without any abatement of the disease ; to vrhich had been added, tonicd, bark, sarsaparillii, guaicum, Arc. with little or no benefit. After the above reports had been circumntantially made by the surgeons who last proBcribed for these patients, 1 believed it useless to employ mercurials, or common medicines any further. The reputation, which the nirtro-muriute of gold hnd acquired in most obstinate cases of this disease in the city of New-York, foI> lowed by favourable reports of its use from Doctor Low of Alba- ny, determined me to give this last medicine n trial npon our hospital patients. They all were placed under the care of hos* pital surgeon's mate Walkf.r, from whonr. 1 had the satisfaction to learn, within a fortnight, the greater part were either entirely cured, or in a happy way of recovery. In a short time after they were all reported well. j ■ • , -ri- ^ .-^ At the close of the year 1S14, a patient placed hhnsclf under my care, wlio had peiformed his duty the whole campaign under this disease; and while in the use of mercurials, had exposed himself to all the varying changes of weather. At the time I was called to advise in his case, there was upon the glans penis an obstinate nicer, which had destroyed half of it ; while tha chancre continued to progress. The patient was directed to take a pill composed of bread and Jth grain of the nitro-muriate of gold, night and morning. The ulcer, in a few days, assumed a healthy appearance, and healed in three weeks. The winter following a second patient, who had exposed him* leir, during the preceding campaign, while taking medicine for the cure of a syphilitic disorder, asked my advice, on account of an ulcer in his groin, of four months duration; when he was •nlered the nitro-muriate of gold ; which, rn sevea days, chang* ... , 19 i4lll«iHI :'l#li' II,.' 'r\ 142 MEDICAL SKETCHES. n lil ! 4'i €(1 its appearance Tor the better ; and, in the course of fourteen days, completely efTected a cure. , .,„(.>.. Phthisis pulraonalis, in a few instances, followed the winter epidemic, denominated pneumonia. It generally had a fatal ter- mination. Life was, in some instances, prolonged by a soft nu- tritious regimen, wine, and diluted brandy. Hope of recovery \ras always entertained by the patient to the last expiring mo- ment. Such was, as has ever been described, this insidious and flattering disease. -.'i.i At the commencement of the war, most unfavourable repre- sentati' ^s were publicly made, of every department of the army. The medical, in connexion with others, was exhibited in re- proachful language. The bad management of hospitals was a subject of severe animadversion. The physicians and surgeons of the army were either ignorant of their professions, or inatten- tive to their duly. The distresses of the sick were portray- ed in gloomy colours. The number of deaths in consequence of disease, although the mortality was great, was vastly exaggerated. Such were the statements given to the public, by characters oppof'd to the war; the object of which was, to defeat the meas- ures of the government, by di?couraging the recruiting of the army. Man, under all situations, is subject to disease and its concom- itant evils. That the soldier in the field is more exposed to dis- asters, than the citizen at his ease, is believed and acknowledg- ed by all. Candour would have made allov ances for the extra- ordinary mortality, which has visited the army, and not have imfplicated the officers of the medical department, nor the im- providence of government, as being instrumental to these scenes of distress. It should be remembered, that in addition to unavoidable ex- posures of the army, during long rapid marches, and water- transportations, as well as tiie other duties of the camp and field, as being causes of sickness and deaths ; a consi(|l.erabIe proper* tion of the soldiers, when enlisted, were either too old or in- firm to endure those fatigues. Many of them became fit sub- jects for hospitals, as soon as they commenced their military eer CAMPAIGN OF 1814. 143 vices. This last circumstance was an evil more especially of the first campaign, when a healthy young man would not en- gage in the army, where dangers in many shapes assail him, for a less compensation than he could receive in domestic employ- ment, safe from harm, and no way exposed to severe hardships. Wherefore many men were mustered as loldiera, who, in conse- quence of bad habits, and intirm constitutions, cmdd find no oth- er employment. When the numerous decrepid men, of whom our array has been composed, are taken into consideration, the number of deaths were fewer than might have been expected, by those acquainted with these facts; and we are, notwithstanding all the inconven- iences to which the sick were subjected in tii^ camp and fields persuaded, even during the extreme mortality of the v inter 1812 — lU, the number of deaths in the army did not exceed, propor- tlonably, the number among citizens in any dislrict where the epidemic prevailed ; but much less than in some. Had these mortal visitations been confined to the army, those who have reasoned themselves into a belief, that the war was unjust, might with some propriety have proclaimed, that divine providence in wrath executed judgment, and inflicted retributive justice upon the aggressors. It was not only absurd, but impious, to assign for events subject to divine control, the feeble agency of man. Such is the pestilence which walks in darkness, and exhibits its progress only by its direful effects. Independent of diseases produced by pestilential states of at- mosphere, there were periods when the condition of the soldier was wretched. On the field of battle, tortured by the anguish of his wounds — during inclement seasons, exposed to frosts and raging storms — while preparing quarters for winter, in wild and frigid regions — the hardships of a so lierarepevere. Such were his sufferings; such were his painful toils and labours on extra- onliuiiry occasions. Such were the sacrifice^ he made for the public good. His country demaiidci them of him- Similar were the sacrifices made during tha revolutionary war. Then the offerings ou the altars of Liberty were honorably noticed. Theathe memory of the self-devoted hero was cherished,, while I. 'I '/ III y s! V !MI III nv i -H U4 MEDICAL SKETCHES. his hard fate was lamented. At that momentous period, when the nation was contending Tor her Liberties and Independence^ the sufferings of her armies were severer than in the last war, equally struggling with a powerful enemy for her rights. Dur- ing the adventurous times of the first, the sensibilities/and pas- sions of the people were not excited to counteract the just meas- ures of the government, to oppose the violent aggressions of a savage and infuriated enemy. The exaggerated accounts of deaths on the northern frontiers, and in the hospital at Burlington, with which some of the weekly papers were pregnant during periods of the war, have meverbeea contradicted. I have to regret that few of the official reports of the general hospitals are to be found. Copies of those made at Malone, near the French Mills, and at Burlington, for the months of January, February, March and April, of 1814, are all which are at this time in my possession. Into these hospi- tals, the largest proportion of the sick of the army were admitted, after the close of the unfortunate campaign of 1813. While the army were in cantonments at French Mills, the sick, as soor as hospitals were established, were ordered to Malone. After the army, udder the immediate command of General Wilkinson, and the division of General Hampton, retrograded from the lines of Canada, the sick were generally sent to Burlington hospital, except those attached to the division of General Brown, who were ordered from the Mills to Sackett's Harbour. :\ An abstract of the hospital report of the sick at Malone, from 1st Jan. to 9 th Feb 1814, --_--. Report at Burlington for January, Do. for February, Do. for March, Do. for April, There remained in the hospital at Burlington upon the 30th April, IGl patients, not 50 of whom required medical aid. Adnuttcd. Deaths. 380 20 180 7 671 17 931 29 630 22 M CAMPAIGN OF 1814. 145 From the first of May to the last of July, 1814, the numbers on the sick reports weekly diminiahed. For the month of June or July, (which I do not now recollect,) not one death was re- ported, at Ghazy and Champlain, when the strength of the army- exceeded 6000 men. It was not until the middle of August, that our old visitors, dysentery and diarrhooa made their appear- ance among the troops. ■'. '. When the army under the command of General Izard retro- graded from Champlain to Plattsburgh, the la^t week in August, and continued its route to Sackett's Harbour, the sick of that di- vision were left at Plattsburgh, under my direction, with only one assistant capable of duty. Upon the 1st of September, the returns of the sick, including the regimental and hospitals re- ports, were 921. The British army followed General Izard'b retrograde march. Upon the 6th of September, Plattsburgh was invested with an army of between 14 and 15,000 men; when the sick unable to perform garrison duty were ordered to be transported to Crab Island, about two miles from the fortifications ; as they could not be covered within the lines of defence. At this time the general hospital reports alone counted 720 men. General M'Comb, learning that General Prevost, Commander in Chief of the British forces, was in full march over the line, had no doubt this powerful army, with the co-operation of the fleet, was destined to take possession of the post at Plattsburgh; which, at that time, was the depot of the munitions of war, for an army of ten thousand men, and which no time was had to re- move, after General Izard marched to the west. The day previous to the investment of the post, General M'CoMB ordered a detachment of 300 men under the command of Major Wools, to cross the Sarenac, and advance upon tlie en- emy, who were met at Beeckman's town, distant eight miles.. Major Wool* fell back, skirmishing, until he arrived at the low- er bridge over the Sarenac, where its passage was disputed from ten o'clock in the morning until evening. Here Lieutenant KuNT received a mortal wound while emploved iu taking up n I ! 'ill ni-l I i ! ♦ i] • i ! i ' )!' J iM ' T 140 MEDICAL SKETCHES. ;'t 1 u I the planks of the bridge ; uhich he survived two days { the only officer of the army killed during the investment. ^ -^ Between the 6th and 10th, feints were made by the British to cross the river at the several fortling places ; in consequence re*^ peatcd skirmishings took place between the light troops. On the 10th, the enemy fell back from the river, and firing ceased between the advanced piquets of the hostile armies pre* paratory to the ensuing attack. On the 1 1 th, the British fleet under the command of Commo- dore DowNiE, bore down upon Commodore MACDONouan. At the same time the enemy, with a division of 2000 men, evinced hia determination to cross the river, five miles south of the forti- fications. He gained the southern bank without much opposi- tion. The enemy, having advanced its column about one mile from the river, was met by the volunteers from Vermont, under General Strong, and the drafted militia of the northern counties of New York, under the command of General Moeres. The enemy retreated with considerable loss in killed, wounded, and prisoners ; and recrossed the river with precipitation. During this gallant resistance made by the volunteers and mi- litia, a heavy tire was opened from seven batteries upon the for- tifications, some of which within the distance of 400 yards. These movements and operations on land were simultaneour> Avith the attack of the British Commodore, upon the fleet under the command of Commodore Macdonough. These combined assaults exhibited one vast military effort oi the British general to gain the ascendency of the waters, and the borders of Lake Champlain. .. „ ';,.:..>, The tire, which was unceasingly vomited from the mouths of two hundred pieces of cannon, was terrible. The whole exhibi- tion on water and land, in addition to the uninterrupted cracks of musketry, in the forests south of the fortifications, to a specta- tor in full view of the fleets and batteries, was awfully grand. The army of General M'Comb seemed regardless of the can- nonade against themselves ; but were interested spectators of the conflict on the lake, looking forward to the event with ex- treme anxiety, well-knowing, that the security of this important CAMPAIGN OP 1814. U1 post much depended on the success of the fleet. Two full hours victory was held in suspfjnse ; when an huzza on board the ship Saratoga announced its victory over its antagonist the British Commodore^s sfaip, the Confiance. The brilliancy of this ac- tion was never surpassed, especially as the event was of the highest importance to the nation. It belongs to the historian to do ample justice to the com- manders of the land and navy forces ; who directed, under Prov- idence, the destinies of that day. These transactions are here noticed, as being connected with the general movements of the several divisions of the army on the frontiers. This memorable action gave full employment to the surgeons of the army and navy. The wounded of both fleets, as well as the army, were ordered to Crab Island encampment, under my immediate charge. Within four days more than thirty am- putations were performed on the United States^ troops and sea- men, and the British prisoners of war. A variety of gun-shot wounds came under my observation ; some of which will be re- corded, as being important to the young surgeon. It is worthy of remark, that the convalescents of the army, after this glorious victory, recovered their healths in a rapid manner. This was most evident among a number, who had been ordered into the fortifications, at the time the post was in- vested. These men suffered no inconvenience from exposures day and night without tents, although it rained part of the time. Similar occurrences have been noticed, as effects of exhilirat- ing excitements on the mind, pn luced by important victoria over an enemy. It has been before noticed, that diseases of the bowels first ap- eared in this campaign about the middle of August. The troopR previously had not been subjected to hard duty, until the earth was dry. The preceding campaign the troops were attacked with the same complaints in the month of May, the men having been put on most severe duty, as early as March. Having an opportunity this campaign, to see men sick with these diseases, during the first stage of indisposition ; it was learnt, they super- vened, without a loss of appetite on their first attack, and when r^ TWP ■1 tU iai M 1 ■III M llli H [ '■■I: ■■ till, w IHff'J Nf i I •!:l ^T m^m' 9 IV 148 MEDICAL SKETCHES. f , 1 - immediately attended to were readily removed. Soldiers gefi? erally did not report themselves siclc, while they were able to take their common rations, which orten were c^evoured with im- paired appetites. The Consequences were totelindigestion, loss of appetite, and gradual increase of their hov/et complaints. To these sypmtoms were added increase of lieat and dry skin. Where these derangements of the fuc&tions were not obviated, fever deteriorated, and assumed a typhoid ibrm. These fevers became typhous, also, where attempts were made to check the iliarrhaea by early administration of astringents and stimulants ; more especially ardent spirits and opium, previous to evacuating the stomach and bowels by emetics and cathartics. When high* ly excited by ardent spirits, these complaints were accompanied with accelerated action of the arteries, and assumed a synochal form of fever, wherein bleeding was indicated* ; ;,) ji; nn;; i 7.^. The diseases of this campaign, as has been noticed, did not supervene, until the greatest heat of summer had commenced. We know from experience that transitions, from one temperature to another when sudden, induce unequal excitement in the sys- tem. This effect was most evident, when the body was envel- oped in a moist atmophere. Subjected to rains and cold fogs, the pores of the body become impervious to the matter of perspiration, caused by loss of heat upon the surface, then by a collapse or spasm of the minute vessels of the skin. TIip glands, subservient to the secretion of the perspirable matter, cease to perform their offices. The other secretory org.uis, by association, are also deranged. The liver partakes of this gener- al affection, and neglects to execute its appropriate functioni'< made most evident by the appearance of the faecal evacuation?, which, in simple diarrhoea, were generally white or clay colour- ed ; the dejections accompanied with griping pains and tenes- mus, were dark, sanious, slimy, and streaked with blood. These several appearances depend on degrees of derangement within the intestines, and morbid secretions of inflamed vessels ; not on states of the bile. !.<'or want of digestion, every article of food taken into the stomach was converted into an irritating material, which induced inflammation on the villous coats of the bowels, CAMPAIGN OP 1814. 141 nvhich were vellicated, more or leM proportionate to the de;rea €f the deleterious power. Dejection! of a natural colour were favourable appearances, inaamuch as they demonstrated that the liver still continued to perform its secretory offices. When these dejections were accompanied with large secretions of bile, from its superabundance leas (hinger was apprehended, than Avhen there was no evidence of bile in the evacuations ; the bile it is believed may prove salutary by washing from the intestinal canal offending materials. After a similar manner, a flood of tears wash irritating materials from the eyes. These salutary effects of bile, a cathartic furnished by nature, have long since been noticed by physicians, inasmuch as bilious diarrhoeas, frequently accompany the resolution of acute dis* eases. That these diseases of the intestines were accompani«3d with inflammation of their internal coats, was inferred from pain, ten- esmus, mucous evacuations, heat and soreness at the inferior portion of the rectum; and, especially from dissections of some who were victims to these diseases. During the wet season, which, this campaign, commenced the last of August, and continued into September, it was not possi- ble to treat these diseases with success, while the sick were ia tents. These complaints, under such exposures, frequently run on a length of time, and become habitnal ; and under a chronic, form, were obstinate, and resisted ail remedies ; white the pa- tients were exposed to rains, and the night fogs of the lakes. The most efficient remedy, employed under my observation, for these habitual diarrhosas of the bowels, was Dover^s powders repeated every four, six, or eight hours, as the symptoms demanded. It was now, as heretofore experienced, a safe and frequently an effi- cient medicine, productive of no new disease. Whereas, when these diseases were suddenly checked by astringents, and espe- cially by acctile of lead, dropsical swellings supervened. Chronic diarrhoeas were cured with the greatest safety by such medicine as promoted perspiration, combined with those which were pacific, and took off irritation. To this intention, Dover's powder was admirably adapted. To possess the full effects if 20 .i;l 'f !i^. r r ^' I II : III 150 MEDICAL SKETCHES. this powder, or any appropriate medicine, the patient should be placed in a dry situation, kept warm, and fed with a soft farina- ceouB diet. Perhaps nothing, as nutriment, was preferable to milk and its soft preparations. When the patients were re- duced by excessive evacuations, stimulants were highly impor- tant to support the powers of life, such as wine and diluted spirits. To these were added anodynes at night ; and ia some cases frequently repeated through llie day. . ! h' :: >: I have always experienced, that even after a return of appe- tite, animal nutriment,, prepared in the softest manner, was not well adapted to restore the convalescents from this disease to health. The last observation is not confined to army practice. ill ' :ir'ij GENERAL CURATIVE INDICATIONS. Ist. — To remove the irritating causes of inflammation from the bowels; 'A. by evacuations. , . , ,j ,, ,, ft. emetics ; ^ , , < » j i , .,,'.■• > '. " , .^ . '. » i » • I ,' i * b. cathartics. , B. By restoring to tlie skin its secretory offices, by , , a. avoiding cold and wet J ■ ...li . , !« / ;. b. tepid baths; , ;. ,.>;!. i.' ^. • !• h; i - 1 c. mtidicine, which determine to the surface ; or promote J,. ^ ,. perspiration; Dover's powder. -■; VI* 1 CAMPAIGN OP 1814. rjij fK B. by stimulants, as a. ardent spirits ; i ' * . uU' n ■ ■ * b. vinous liquors ; ' * ' »■, i • ' i-i, C. by nutriment, at jn' * ' •. a. farinacea, and their preparations ; > b. milk, and its several preparations more beneficial, than- ,<0 most kinds of nutriment ; >;ut c. animal nutriment; prohibited until the diseased organs *' ■ * are restored to their healthy actions. It has been observed, that typhous fever sometimes accompa- nied these complaints of the bowels. This form of disease re> quired some additional treatment. The following were its most conspicuous symptoms. Hot and dry skin ; pulse not fuller than in health, but accelerated f eyes suffused with blood ; tongue brown and dry. These symptoms were accompanied with pain in the head, and throughout the dorsal muscles, and the extrem- ities. The patient when moved, complained of soreness through- «ut the body. Delirium or coma, sometimes accompanied the febrile state, and shewed that the brain partook of the general derangement. After evacuating the stomach and bowels, by emetics and ca- tliartics, the following formula was adopted in liospital practice with much success. .' ' ! R. Calometgr. y. "' • Opium gr. v. , ' : S ' Tart. Ant. gr. ii. Misce, fiant put. x. capiat, una, quaque secunda vel tcrlia hora. By the employment of tho iibove medicine, the skin became soft; the tongue moist; and pain in the head, b^^ic, and extrem- ities abated. When delirium supervened, blisters upon the neck and head itrere necessary; as were sinapisms to the soles of the feet. In some cases, ipecacuanha was substituted for the tartrite of antimony, in the above formula ; especially when the antimony irritated, or ran ofif by the bowels. After a resolution of fever, known by a gentle diaphoresis, a moist tongue, and a removal of delirium ; or where a coldness supervened,, stimulants were introduced. A mixture of spt. iut> >lill1 lii Ia><( m fi iWi m \m ! ■:H f;; i'l 15^ BIEDICAL SKETCHES. tlul. five parlB, and aqua nmmonia oire part, vra» hcrr; enl;iIoye(i ; also r,|)t. lavcnd. comp. and a decoction oT serpent virgin, (nris- iolochia scrpentaria) likewise, line. cort. comp. and wine. As Hoon as the slomacli ^vas capable or receiving the bark,(cinehon.) in powder, it became an important remedy. But when the bark in substance offended, its inrusion or oomfiound tincture was substituted ; and in cases where tlie bark did not agree with the •tonuch, coiombo root was employed with advantage. Anodynes eould not be dispensed with in the last stages; and in states of irritability induced comiiosure and sleep, which seemed to re- fresh the patient. /. The following report of the state of disceaes at Bttrlington, Vcr* mont, in the mttunutt 1814, was made hy Hospital Surgeotis niatCy PuRCELii. *• In consequence of the precipitate removal of the sick to Crab Island, in conformity to the orders of General Mc^Comb of the 5th of September, the day (irevious to the investment of Plattshurgh by the British army ; no straw was procured for their accommodation. The sick were consequently lodged andfr tents upon wet ground, during two or ihree days of wet weather, 'when straw was furniahed from Grand Island in lake Champinin. " Many of the troops were labouring, at this time, under fe- vers of different forms ; and diarrh cus. But as the disease progressed, the symptoms were more aggravated. The fever assumed a typhoid type, with total loss of appetite, great thirst, parched brown tongue, sordes on the teeth, increased heat of the skin — and in the last stage, sores on the nates, hips, and os sacrum, so deep as to expose, in some ca- ses, the bones. " In the milder forms of the disease, a cathartic and emetic were beneficial ; and followed with a soft nutritious diet, the pa- tient soon recovered. This happy termination of the disease was not very frequent. " In the severer forms, a repetition of a cathartic was found necessary. After which were administered lartrite of antimony and nitre, in small doses, frequently repeated. This medicine, with tepid diluks, while the patient was couQned to his bad be- ^mi\j\ \ '■' 1 > T : '^ 164 MEDICAL SKETCHES. • ii) tweon l)lankc(0, frequently brought oa a Tree perspiration ; by Avhicli, the patient found himself relieved from all the attendant lymploms of diHease. But, \v]«ere no ease was procured hy the •hove means, an anodyne, the following night, was proper and advantageous, and seemed to etTect all which had been wishiMl fur by the precedin*^ medicine. I|)ecacuanhH, oo much recoiiv inended by authors in this disease, was seldom of any use unless U was combined with opium in the form of Dover's powder. " Where the sick were extremely reduced, and no apparent relief was obtained by active medicine, and efforts of some du- ration to evacuate, accompanied with tenesmus and violent gripes, Yijere fruitless ; injections composed of arrow root, water, and laudanum, ^vere found very beneficial, agreeably to the fol- lowing formula: — To half a pint of water were added a table- spoonful of arrow root and sixty drops of laudanum. The fore- going enema was thrown up the rectum three or four times a day. It removed the tenesmus and gripes, and Communicated to the l)owels> a soolhing sensation, by overcoming the spasms, a con- sr(|Uoncc of extreme irritability of the intestines, more particu- lariy the rectum. " When dysentery was accompanied with typhous fever, ac- companied with great heat, no prescription seemed to fulfil our luu'ative intention, of equalising the excitement, so well at the following:— • - > ' "R. Sal. nit. 5 i. . ,1,,, .: , Tart. Antim. gr. iii. » ,.i .! Gum Opium, gr. vi. -.) (,..; i» .-> t Calomel, gr. viii. Mlsec, divide in chart x ; capiat, una, quaque lerlia Iiora. • '■ This, with soft nutritious drinks, was, in most cases, follow- ed by salutary eflbcts ; a reduction of heat, soft skin, > ad moist tonguo and moutii. •' The common saline mixture was albO administered. Afr ioon as the fever subsided, and the stools became less frequent, and of a more natural appearance, tonics combined with refrig- erants were resorted to. IJAMPAIGN OF laU. I5ih ,ui,j««i . >' i* " R. Sulphas martis 3 "'• •• ' ^ • ;..>i,]; .1 . ,. 8pt. nit. dulcia ^ M. •, < < i ' ' ■ ;. \^^ , »•< Carbon. potMsa; 5 **• * ' Alaints ; and unless they were very mild, the disease in a majority of cases proved mortal. "As soon as fever subsided, and the evacuations became nrore natural, an infudien of Colombo root became an appropriate med- icine; and if the patient was reduced, wine or diluted brandy was directed. An anodyne pill at night, even in tlup state, was necessary. " The utmost caution, as to the dietetic management, was highly necessary. Nature was not always correct in her callfi, in this disturbed condition of the bowels ; the patients frequent- ly demanded articles which proved very iigurious. It was fre- quently the case that the sick would obtain from their attendants cider, beer, &c. These weak fermenting drinks always proved injurious. If the patients wished for acidulated beverage, vine- gar diluted with water was grateful ; it allayed thirst, and never proved detrimental. , ' .> • " Ardent spirits, in the first stages of the disease, were prohib- ited ; and when given by the over otiicious nurse, invariably angmented all the 8ymi)toms of disease. '* It was but seldom the bark [cinchona] could be used with :.<)fety in the disease, more especially in powder; as it occasion- ed severer pains in the bowels, and where they had become calm, induced an irregularity which was obstinate, and with difficulty removed. " When typhous fever made its appearance, unconnected with dysenteric symptoms, there was more or less simple diarrhcea. At the first attack, the patient complained of pain in the head and small of the back, nausea at the stomach, drowsiness, bitter taste in the mouth, the tongue covered with a white fur on its lUti ^1 :jf«i.i T?WH ,1 i Ilii! '/T^ \m\ Blf !! : ; 151 MEDICAL SK£TUUE6. Torepart, and a dark brown colour towards its base. The patient did not often complain of rigors passing over himself. If, how- ever, rigors occurred, more or less inflammation of some of the viscera generally accompanied the disease ; and as it progressed, became more violent, with small frequent pulse, disordered head, cold extremities, sordes on the teeth, delirium, stupor, subsultus tendinum, and involuntary discharges of both fieces and urine. With these last symptoms the fatal scene was closed. ** The treatment in the first stage of typhus was commenced by an emetic of fifteen graiiis of ipecacuanha, with two grains of tartrite of antimony. This not only operated as an emetic, but as a cathartic. If the latter did not follow, and the strength of the patient permitted, the employment of a cathartic, neutral iaits, or clium ricini was administered. These remedies com- monly relieved, in some measure, the pain in the head, and the patient appeared better. After which were prescribed sal nitri and tart, antim. in small and repeated doses ; and if the head continued to be aifected, a blister on the nape of (he neck. If the eKtremities were cold, and a preternatural heat of the chest and head existed, warm flannels were applied to the former, and cold vinegar and water were sponged over the latter parts. A •diaphoretic, composed of one drachn* jf carbonate of potash, iialfft pint of vinegar, with the same quantity of water, was di- rected, of which a table spoonful was given every two hours. But no medicine seemed to answer as well as the prescription in dysentery, when fever was combined with it; viz. nitras po- iassa; 5 i* ^^rt. antim. gr. iii. gum opium gr. vi. submuriate of mercury gr. viii ; these were combined and divided into tea powders, of which one was given every three hours. *• The above prescriptions, pursued two or three days, changed the appearance of the tongue from a dry brown colour to a moist, and of a more natural appearance. " Some were admitted into the hospital so much reduced un- tler the above described form of the disease, that the above prac- tice could not be pursued. In these low cases the emetic and cathartic were inadmissible ; the patients were supported with weak toddy, making use of the last mentioned prescriptionst CAMPAIGN OF 1814. 157 In tlie latter stagfs of typhus, the patients were supported by a soft nutritive diet; in Bome cases blisters were applied to the wrist, and sinapisms to tlie feet. The patients were ordered a liberal use of diluted sj»irits, with a decoction of the serpentaria. *' In some cases, the patients were disturbed with frightful dreams ; in which o|)ium did not succeed to procure sleej), but in which emlirocatlons of volatile spirits upon the head had the desirable effect. Where diarrhoea continued after abatement of fever, Dover's powders were a5a '< We fbund it necessary to confine the patients labouring un« der diarrhoea, to warm drink», soft diet, and in bed. The prep> arations of the farinacea and milk were only allowed them. While mentioning milk, we, from experience, found that no ar- ticle of diet was superiour, not only in this, but other diseases to which soldierii were subjected. The sick soldier acce|)ted of this, in which a little oat-meal was boiled a few minutes, when he refused every other kind of nutriment offered. This alone constituted the nourishment of these sick patients several days ; and we are persuaded was, in many instances, conducive to their restoration to health. " In some instances, jzreat thirst attended this disease, when no quantities of mild drinks seemed to abate the intolerant sen-r sation ; nothing contributed to give immediate relief, so soon aa spirits and water; but if spirits were largely diluted, this bever- age did not have the desired effect." This was the silisfrigida of Darwin. " In curing this disease, or checking the evacuations when they had become chronic, great caution was necessary. Drop-' sical swellings, anasarca, ascites, supervened on those, where the discharges were suddenly and permanently checked by astriur gents. This was more particularly the case, where the patient was advanced in years. Whenever these occurred, drastic pur- ges, by producing a recurrence of the former disease, reduced the swellings ; after which, it was found most necessary to check diarrhoea in a gradual manner, by small doses of rhubarb ; and at the same time, the following tonic preparation : — " R. Sul[)h. martis ^ ss. Carb. pottas. ^ i. Tine, ealom. f^ i. Tine. laud. gt. Ixxx. roisce. " A table spoonful of the above composition was given four times in a day ; and occasionally, diluted brandy. When the legs and thighs were much enlarged, as soon as they began to subside, were rubbed with equal parts of spirits and water ; when a spiral bandage was neatly applied upon the limb, beginning at the toes and extending it to the groin. This application wa» ill all cases found highly beneficial." 5r 1 160 MEDICAL SKETCHES. m A Report of Hospital Surfrcon liOVELi., of the state of dis- eases among the troojts on the Niagara frontier^ during Ihc campaign of 1814, is as follows : — *' The troops engaged in this l»ri!liant campaign on tlie Nia- gara, began to collect there about the beginning of April, under the command of General Scott. They were encamped on an eminence norUi of Buffalo villafT;e, having a thick wood in front, which extended to the barik of the river, the ground being in part swampy and wet. On the left of the encampment was a large marsh, extending from the high ground to die margin of the lake. The winds from the lake, at this season, were remark- ably cold and chilling ; resembling, in sensation, e actly the east winds which prevail on the Atlantic during the spring; and had an astonishing effect upon vegetation. The trees around the encampment having the appearance of winter, while those five or six miles from the lake shore, were covered with verdure. Notwithstanding this, the troops were remarkably healthy ; only one or two deaths occurring before they crossed the Niagara, on the 3d of July — even the demon diarrhoea ap|)eared to have been exorcised by the mystical power of strict discipline and rigid po- lice. " In June a number of new recruits joined the army ; and sev- eral were collected from the various hospitals ; the latter princi- pally composed of the miserable refuse of society, who never had energy enough to demonstrate that they lived, and scarcely enough to prove that they existed. With these last detacli- menls, arrived our old acquaintances, which however were easily checked; and much seldomer returned, than in any former cam- paign. This was undoubtedly to be attributed to the improve- ment in police. " During June, the weather became very warm, and a thick fog arose from the marsh and woods at sunset, and remained for some time after sunrise. During this month, intermittent fever, acute rheumatism, and typhous fever were the prevailing com- plaints. The intermittent'3 were very irregular and obstinate. Arsenic, which was the sovereign remedy the last year, on this frontier, had now very little effect j while the bark, which theu CAMPAIGN OF 1814. lOfc failed, was now gpnerally Buccessrwl. Some obstinate cnsos, in which every thin Ise had failed, were cured by the sulphate of copper. Three patients, Who had tried moat of the remedies with which we were supplied, without effect, cured themselves at once, by taking a pint of brandy undiluted, in which was mix- ed a large quantity of ground black pepper, on the accession of the cold stage. This was not followed by inebriation nor any appearance of undue excitement. It led me to use oi»iiim in much larger quantities than I had been accustomed. It was be- gun with four or live grains at a dose, and increased until some stimulating effects were produced, or the disease cured. The success of this prescri|)tion was very great during the whole sea- son. In fine, of the remedies used this season, emetics had but little effect, even at first; and the mineral solution scarcely any — bark succeeded in the majority of cases ; and opium very seldom failed. A few obstinate cases were checked for several periods, by the application of tourniquets to one leg and one arm; the disease however recurred; the tourniquets then had no effect; but remedies, which had before failed, now succeed- ed, after the interruption thus produced in the morbid associa- tions. " Rheumatism, during the whole war, generally put on a re- mitting form; this was particularly obvious whenever intermit- tent fever prevailed, and more especially this season. Bleeding was but seldom necessary ; after a brisk cathartic, bark was giv- en in the quantity of from 4 to 8 drachms during the remission, and a large dose of opium on the accession of the fever; and al- ways in sufficient quantity to relieve the pain. This treatment was very generally successful. I was induced to try it, in many cases, where the remissions were very slight, and generally ef- fected a cure. In these, however, bleeding or purging were premised, which produced more perfect remissions. In short, I considered the bark and opium the remedies for rheumatism, par- ticularly when intermittents prevailed, and for the most part succeeded. ■ " Many of the cases of typhus, about the end of May, were remarkably severe. The most prominent symptoms were great t m n I 162 MEDICAL SKETCHES. '■i m'^ prostration of strength, and delirium ; of tlie species not attend* ed with symptoms of great arterial action in the head, local ap- plications as usual having no effect upon it. Symptoms of re- covery were not ol)8erved in these cases, until the end of the third week. The treatment adopted was strictly that of Fo^ dyce, and recovery took place in every instance. " On the first of August, a general hospital was established at Williamsville, eleven miles eust from Buffalo. The number of sick, during the remainder of the season, a:t this place, varied from 3 to 400 ; the number of wounded being somewhat greater. " The troops suffered much during the siege of Fort Erie ;; and soon after it was raised, the rainy season commenced^ Dysentery and diarrhoea were the principal diseases. I be- came fully convinced after a fair trial of every medicine to be obtained at this place, of the decided advantage of ipecacuanha in various forms and doses, to any other remedy. The remark- able effects of lliis medicine, which Fordyce considers as acting specificail}' in typhus fever, led to the conclusion, that the febrile symloms attending the latter stages of diarrhoea were in fact a true typhus, supervening upon the former complHint. Hasty in his treatise on dysentery, he speaks of several complaints, which are often combined with typhus fever ; and are then generally contagious ; and 1 had observed that the nurses of the wards, where diarrhoea prevailed, were often attacked with typhus, ac- oompanied with diarrhoea, or a great tendency to it. Decided benefit had often been observed from small doses of ipecacuanha, with mucilaginous drinks, in an irritable state of the stomach and bowels, which appeared to be owing to a degree of inflamma- tion extending through the mucus coats; and not attended with febrile symptoms ; and it is probable that the good effects of the remedy, in the cases now referred to, were in some measure to be attributed to this mode of operation. Intermittent fevers and rheumatism prevailed during the whole season, and varied but little from the cases in May and June. The cases of typhus a- mong the regular troops were generally mild. " AlHJut the end of September, a large detachment of militia crossed the Niagara, under General P. B. FgftxER. Diarrhoea; CAMPAIGN OP 1814. 163 typhus ftnd idiopathic dysentery very soon made their appear- ance among them ; the two latter were extremely severe. As these patients were not sent to the general hospital, until they had been sick for some time, I saw only the latter stages ot these complaints. The dysentery was at this period very obstinate; the bloody discharges and tenesmus incessant, and the prostra- tion of strength as usual most dangerous. In this state, relief was very generally obtained from injections of a decoction of ip- ecacuanha, sometimes combined with laudanum ; at others, the irritability was first reduced by an injection of laudanum alone. The decoction was often rejected immediately ; it had however some efiect even then, so that by repeating it several tim<3s, it would finally remain, and give relief. Blisters to the abdomen often had a very good effect ; but no application to the part ap- peared generally to prove so beneficial, as a poultice of slippcry- elm-bark to the whole abdomen, often repeated. It relieved the tenesmus, and produced a gentle diaphoresis, which was promot- ed by warm mucilaginous drinks, a mixture of tine. opii. and tine, ipecac. This was the only treatment found beneficial in the latter stages of this complaint, and it very generally succeeded. Typhus, among the militia, was very severe. Patients were seldom sent to the general hospital, until the third week of the fever ; and the treatment had been as different, as the whims of the attending surgeons. The most usual practice, however, a- niong them, was to blister the patient almost from the crown of his bead to the soles of his feet ; so that the chief difficulty was to remove the irritative fever induced by this empirical, slovenly practice. In some, calomel had been employed, but generally without any obvious effect, except increasing the danger of the patient. At this stage of the complaint, and under these circum.- stances, no general method of treatment could be adopted, ex- cept remedying the mischief which had been done. The cure was principally attempted by removing every cause of irritation, as appeared most urgent, and trusting to nursing and nourish- ment. IJnder this plan many appeared to be in a fair way of re- covery ; but in the course of the 4th week, a small circumscrib- ed spot of iaflammation shewed itself in the face, generally, near ''Hi 1 t r i- o- 164 MEDICAL SKETCHES. the angle of (lie mouth. In a Tew days, the whole side oT tlie faee swelled; this tumour was hard ami pale, resemliliiiji; the colour of a while swelling of the joints. It was not in the seat of the parotid ^land, hut anterior to the branch or the lower jaw, and was attended with a most profuse and fttiil salivation, ap- parently from irritation communicated along the salivary duct, as the liver and gall-bladder are excited by the chyme. In a few days more, the red spot began to assume a livid afipearance, and symptoms of incipient mortification. In a short time, the nioulh was liternlly extended from ear to ear, exposing the back- most grinders on holh sides. All the remedies usually em|)loy- ed in this species of disease, were em|»loyed without visible ben- efit. The only article which appeared to produce any good ef^ feet was charcoal, which, however, seemed only to prolong the sufferings of the patients. Three attacked with this affeclioa had severally so far recovered, as to have a good appetite, and sit up a great part of the day. Their strength and appetite held out surprisingly after mortification had taken place. I have since seen two instances among citizens ; one in Boston, on a young boy. He had so far recovered as to sit up, he took nour- ishment with a good appetite, and every symptom of fever had disa(i|teared ; when about the middle of the fourth week, the swelling, salivation and mortification took place, and shortly sunk. It should be added, that in the majority of these cases, I jt a particle of mercury had been used in any form." Ji The follmving cases of a siinilar disease as the last noticed by Doctor LovELL, were reported In/ Doctor Purcell, with his observations, at Burlington Hospital, in the Autumn of 1814. CASE FIRST. " Thomas Burns, a soldier, 16th infantry, was admitted into the hospital 7th September, with an enlargement of the parotid, and submaxillary glands, and soreness of the tonsils, accompan- ied with a large flow of saliva. The tumefaction extended from the glands down the neck. The tumefied parts were so great and tender, that the mouth could not be opened sufficiently wide, lo admit of the inspection of the fauces. No food could br CAMPAIGN OF ir.M. 165 rrccived cxrrpl in a li(|iii(1 form. DIsc.isrs, at Hiis llmo, were. tlisposrd to niti iiilo 1} phiis. This circumstance, and csprcially as no foviMS acconii)an.j(l tlie complain!, determined ns to dlg- pnisc willi c'vnciiationn ; and, vicwini; it as a local disease, not dejfcndent, and unconnected with a {general alTection, to depend on the empl(»ymcnt of local applications. " The tumid parts were embrocated uilli volatilt; liniment ev- ery four or five hours ; after whi<;h a flannel !)andai:5C was applied over tlie jaws. By tills manat^ement, the swellings in a few d;iy8 were reduced, while the profuse siilivation and soreness of (lie fauces continued. At first it was lielicved. that the com- plaint was |)roduced by mercury ; but having; been ./ssured by the patient, he had not taken any medicine along time |)reviou« to his admittance into the hospital, and this assurance liavins; been imaccompanied with that peculiar smell of his breath, which denotes mercurial excitement in the system, convinced us that our first conjecture was incorrect. " A fiargle of borax dissolved in water was directed, and the liniment continued. These applications were employed ten or fifteen days, but w ith very little benefit. By this time the sore- ness in the glands and tumefiiclion were so much reduced, as to admit the opening; of the mouth, so as to inspect the fauces. The first appearance which attracted the attention was a lar^c ulcer, commencing half an inch from the lip, on the left side of the iongue, and extending half way to its base. U[)on pressing the tongue down with a'spatula, ulcers appeared on each side of the cheek, and over the anterior surfiice of the tonsils, the dcntes molares were incrusted wilh a hard substance of some thickness. The breath was intolerably fetid. The surface of these ulcers appeared white, and adhered to the sound parts as if they had been a component part, but now an inorganic substance, which was with dilTiculty removed. *' At this time the patient was directed to the use of a gargle composed of sulphate of zinc, vinegar, and w ater, and to contin^ ue the volatile liniment. Having continued the above applica- tions twelve days, and no benefit having been experienced. « gargle of alum and kino was substituted. No better effrcfH 22 ■.il i il'K lit 111 ! ! ii 106 MEDICAL SKETCtlEri. were cxperieuccd frum ilie last ineiiicinc. A solution of mtiriai liydrarriiyri, one grain to an ounce of water, was next prescrilicd as n gargle to he used several times in a day. After continuini^ the Inst medicine three weeks, w itiiout any henetit, recourse wag had (o Fowler's mineral solution, five drops of which were di- rected in half a gill of water, three times in twenty-four hourH. There was an apfiarent change for the better in the ulcer, on the second day. The inorganic substance had detached itself; the condition of the ulcers appeared healthy and the breath less fe- tid. By the continued employment uf the last prescription, the sores in a few days were healed. " It should be observetl, that the pn.ient laboured under no other disease at the time he was admitted into the hospital, l)ut was muscular and strong : his complaints had been of three raonllis duration, previous to the use of the arsenic preparation. It was employed only six days until every vestige of the disease disappeared." !• ; ii r II -* 1 ;i * t 1! CASE SECOND. The follow ing symptoms of a second case were given by one of the surgeons, who attended in the early stage of the disease. " The patient was seized with pain a little above the inferior portion of the nose which extended to the adjacent parts. It was light at first, but in eight or ten hours became very severe. In its incipient stage, an efflorescence appeared, which gradually assumed a deeper colour, and was accompanied with a little tum- efaction, which enlarged until the parts became disorganized. This process was rapidly performed in three days. " The ulcer was formed when I first saw the case; (says Doc- tor Purcelij) then an ichorous corrodin ; matter issued from the sore, vvliich destroyed the surrounding teguments, and the ossa naris became carious in a few days. The disorganized muscles assumed a black and flabby appearance ; the edges of the ulcer w ere indented, and the circumjacent parts slightly swelled. The disease progressed until it reached the eye, when that organ be came much enlarged, so that the ball protrud(jd from its socket. The pain, at this stage of the disease, was insupportable. fill •^W»»^W^ CAMPAIGN OF 1814. 101 '• Thfi nppellte was not impaired iinlil the eye was afTectcd A ileliriiim then supprvened, the patient liecnme ravinj; when the appetite failed, and death soon closed tlie scene. " Two other soldiers were attacked after a similar manner. Upon hoth, the disease commenced and pros^ressed with all the dreadful appearances, as described in ttie first case, and terminat- ed fatally in a few days. *' The several stages of the disease followed each other in rap- id succession. The practice however cannot be particularly detailed. TJie general remedies, in the first stage, prescrib- ed, were to counteract inflammation ; after the ulners were form- ed, a carrot poultice was applied ; all without any benefit." ( CASE TIITRD. " A sohlier was attacked soon after the above fatal cases, with symptoms so similar, that an unfavourable termination was prog^ nosticated. It was suggested to the attending surgeon, to ad- minister the Fowler's solution. The plan was adopted, as in the first recited case. To our great satisfaction every unpleasant symptom disappeared, and the man was reported for duty with- in one week. " Quere, did the arsenic, in the above cases, act as a stimulus and tonic ? The three last patients had been reduced by previ- ous diseases. This circumstance induces a belief, that as the swelling was not truly phlegmonous, these were diseases of de- bility ; and that, in the fortunate cases, the cures were eflected by the stimulant and tonic powers of arsenic." DISSECTIONS. " Upon dissection, the diseased parts through their whole ex- tent, were found completely disorganized. The nasal bones, and molar teeth on the side affected, were either carious or en- tirely destroyed ; the periosteum of the adjoining bones was re- njoved, even where the superincumbent teguments appeared sound; between which, and the bone, of a dark colouf, was lod^ ged a dark ichorous matter." .i i< il#|!'ll ^ ICC MliUIt'AL SKETCIIE?^. :r, liAKi: CIIAMI'LAIX, AM» UJM'lt ST. LAWUK.N tf:. THOMTERS. lii'RLiNRToN is oilualfd oil Ihi^ onsl. sitit* of liUke ClKiiiiplniii, distiiiil from While Hall 70 miles nurtii; tlic first village lice 164 milca north from AllKiiiy. From a wildt'rnrss, (hi!) most hcniiliful vilhi,i!:« hue, in (wen- tyfive years, become a phice (»f eoiisidcrjiMc importance. From llie lake shore it rises hy uii easy and regular ascent one mile, to the summit of the lukc-hill. Upon the extreme height of land bordering (he lake, is erected u handsome eollege edifice, Avhich overlooks (he vi!la<;(! Ixlow, rej^iilarly built on strreli* which intersect each other at ri;^lit anules. From this eminence tlie prospect is extensive und picliire3(|iie, possessing an exten- sive view of the lake, in whicli, are in sight some small islanib. Tliid prospect is terminateil i)y the mountains, which range oii (lie west border of (he lake, from south to north, the whole ex- tent of tlie viaible liovi/.on. On the east, (he view is interrupted Ly forests, but which will be more extensive as the country im- proves. Ueyond tlie iiiterveniMi;' woodlands, rise appiring ridg( r of mountains, ^,hich divide the state of Vermont from ftouth Id north its whole extent, known l)y the nameof (Jreen MounlaiiiN from which (he utate derives \l^ n;ime. From the baacs of ilx mountains to the lake, which i.s the west boundary of Verinoiif the distance is twenty miles. This tract is under good cultiva- tion; the B(til rich, anil very productive in grass, every sjiecic? of grain, and fruits. The whole of this district is in an improv ing state. From the tioulhern extremity to Canada line, are seen farms in a good »tale of cultivation, and at distances of six and ten mileii Croni each other, pi' -^ant village?; interspersed with ycats built in the modern style of architecture, wliich iu' dicatcis Ihul the [losscssurs arc v.cullliy aud ai!!i:eat. CAMPAIGN OF 1811. lod Tli^ MilUary Uosititul iit Hiirlin};;toii in ^ituntcd on the hi){h bank of Uu; lako fiiiorc, olovnUnl (>() foct abovo itx \vi)U>r»; thu •uil of which is (;rnvi;l, wliicli iininediutcly drinks up (ho wnter as soon as it falls in rain ; so tli:it during; the wet seasons o( tlie year Ihr (ground in the vicinily of the ho«|dlat is free from nutd and even moisture. The Eiluation of (his (losition in lieultiiy ; much iireferuhle to any wliicli I saw on eitlier the northern or westerti rrnntiers. Pi.ATTBDiKoii is situatcd on a bay the weet side of Cliam- plain fiakc, iiO miU's nortii of its southern extremity. It is U.'i miles south of Montreal. The village, handsomely laid out, forms a crescent on the high lake bank. The country in its vi- cinity is level, lint rises gradually to the west, some distance; then abruptly to lofty mountains. Thevilla;;e is intersected by the Haranac, which empties into the bay from the S. W. Its course is, for two or Ihiee miles, nearly parallel with the lake shore, from half to one mile distant from it. On the tongue of land comprised between the lake and river, are the United States' fortificatior.a, extending from the lake bank to (he river; 80 situated that they reciprocally defend each other's llanks. This post is three fourths of a mile above the lower bridge over the Saranac, near its outlet, and one mile and half below the npper bridge. The forests arc cut to the distance of one mile south ; beyond which to Peru, distant nine miles, few settle- ments are seen on t!ie lake shore ; on the Saranac none short of Union village, distant six miles. General Pikf/s cantonment, during the winters 1312-13, was about half the distance betweeu the fortifications and the last village. The woods had been cut at (his place ; on this account this point was selected by the British army to cross the river. After it had gained the eastern bank, and entered the adjacent forest, it was attacked by the New- York militia, under General Mookrs, who retired to Un- ion village, where they were joined by the Vermont volunteers under the command of General Strong, when the action be- came warm. The British retired and recrossed (he Saranac at the same point they first forded the river. m >> v If; Ijltl 11 ^ ' ' r * 170 MEDICAL SKi'^TCHES. ■' II m ■)i' 1 '-'■! %\ 1 ! t ^^ bA-^ ill: The left of the British army rested on Platlshurgh hay, oue mile north of the Saranac ; its ri<2;lit v\ ing extending to a point on tlie Saranac near the upper bridge, one and half mile above the fortifications. Between these two extreme points, the dis- tance is three miles. Advanced of their line, the British, be- tween the 6th and 11th, erected seven batteries. The village of Plattsl)urgh, comprising 70 houses, is pleasant- ly situated on the high hank of the lake. It is a place of con- •idcrahle trade ; mostly in lumber, which is rafted over the lake, and down the Sorel and St. Lawrence to Quebec. The courla for the county are held here. The county-house with a number of private dwellings were burnt at the time the post was invest- ed by Sir George Prevost. Tlie soil of this district is good for grazing, but inferior to that west of Utica. Alter leaving the settJ^mc its of Plattaburgh, tlie route to Malone, distant 52 miles, is dreary, through forests of hard and soft woods intermixed, with a log hut once in four, six and eight miles, until we arrive at Chateaugay four corners, where is a small village of eight or ten houses. From this we pass a forest and few settlements, at a distance of twelve miles, when suddenly opens the pleasant village of Malone. From this to French Mills is a distance of 16 miles; near the point where the 43th degree of north latitude intersects the river St. Lawrence, being the line of demarkation between the United States and Canada. Up this river' to Sackett's Harbour, 160 miles, are thinly scattered vill^iges. The most of the road is through a wilderness. The villages are pleasant, particularly Ogdensburgh, ninety miles from Malone, and 70 N. E. from Sackett's Harbour. The brigades of Generals Chandler and Pike endured a severe storm of snow on this route in the month of March, 1813 ; where they found snow three feet deep on an average, until they arrived in tl.e vicinity of Lake Ontario. The snow never falls the same depth on the holders of the large lakes, rwCi ..welve miles back, as it does beyond this dis- fance. All tho mountainous parts of New-England and state of New- York, duijug winter, are pregnant with storms of snow, when. CAMPAIGN OP 1814. 171 aL the same lime on the Atlantic shores, it generally rains. On the herders of the great lakes, I \vas always disappointed in my prognostications of weather from the appearance of the skj'. Even the first settlers acknowledged their ignorance, being unable to predict in the morning what the weather would be, or in the evening what the morning would bring forth. At Lewisto.vn on the Niagara, storms of rain and snow were experienced, with winds from every quarter of the compass. On the Atlantic, storms of any duration are from the E. and N. E. On the 29th May, 1813, the enemy seized the opportunity when Sackett's Harbour was left almost defenceless, under the Cf^mmand of Major General Brown, with 300 United States' troops -ind a small body of militia, to attack the post with all his force from Kingston ; but after he made good his landing, and advanced as fur as the barracks near the harbour, was repulsed with considerable loss. In this action fell Colonel Backus of the army, and Colonel Mii^ls of the New- York volunteers. This first action in which General Brown was engaged, and which terminf'ted with much honor to the small detachment of regulars commanded by Major Aspinwall, after the death of his superior olficers, was honourably noticed by Government ; particularly by the appointment of General Brown, then of the Militia, to the r nk of Brigadier General in the United States' army. At Oswego, in 1814, 60 miles south west of the harbour, Col- onel MiTCHEL defended himself against a body vastly superior, in which action the enemy sulTered great loss. In a subsequent action at Sandy Creek, 200 of the enemy were made prisoners by an inferior body of riflemen under Major Applen. The route from Plattsburgh to Lake George, south a distance of one hundred miles, the jrreatest part of the way, is through a wild, mountainoi:s, •'ock^ ''.strict, whose sceneries are continu- ally varying as we progress, all of which are truly majestic. Be- tween mountains towering to the sky, are small vales, in some of which, very remote from each other, are situated pleasant villages. Essex, is one of these beautiful spots, surrounded by mountains, nhich, by tlieir vicinity, exclude every other distant object, ■M 172 ]\rEDICAL SKETCHES. iliil iim except tlu'ir aspiring summits. These sublime sceneries arc loo circumscribed to plenae more t'nrin a few sess these (ioramanding pot>: ' «ns, at the time he invested Plattg. burgh. This would have given him the command of the whole state of Vermont and the northern district of New York ; from which districts resources for the maintenance of 120,000 men might be obtained. The water communication from this to Que- bec being free, would have enabled the enemy with a powerful army to have threatened not only the interior of the country eouth, but the Atlantic shoKs ; and aided by a fleet with a strong party i:i New-England, as he anticipated, might have prolonged the war ; but which would have terminated not in the subjuga- tion of the nation, nor division of its territories. The expedition against Plattsburgh, with a view to the con- 'quest of the country, would have been an act of madness, even with an army of 50,000 men, had not a diversion of some of the states been expected by -the government of Great Britain in its favor. Without strong assurances of such co-operation, would so im- portant an object have been attempted with only 15,000 men ? Future historians, it is to be hoped, will be prepared to unfold xt train of transactions veiled in mystery ; the secret springs of which the public documents of individual states had commenced •a development:; and when fully exposed to the discerning eye t)f the people, the delusive, insidious charm, which bound their liands, would have been dissolved; their native spirits of inde- pendence would have kindled anew in their breasts ; they would have burst from their mental inthralment ; and while the inter- nal foe sheltered his guilty head in coverts from public indigna- tion, the enemy without wouM have felt the overwhelming power of tbp'- arms. ij ^1 I'St t 1 r Pf'lf -■ 'M, -U' CONCLUDING OBSERVATIONS. Many casualties concur to enfeeble a soldier in the field ; lome of which have, in the course of these sketches, been notic- ed. When a ntan is animated Mrith the object which duty urges him to accomplish, if his health is firm, and not rendered inac- tive by old age, he will endure extreme fatigues, and severe colds, when time is given him to take his common rations at seasonable hours. Long abstinence, watchings, and unremitted hardships, soon break down not only the spirits, but strength of an army. But when well fed, they cheerfully endure fatigues, colds, and expose themselves to the most threatening dangers, regardless of consequences. Familiar with death, the soldier floon forgets that the feeling of horror was once attached to its name. The love of country, honour, the pride of conquest, incite him to acts of heroism. When duty calls to confront the enemy, he obey» the summons with the same alacrity, as when invited by the alluring voice of pleasure to his amuse- knents. Under these strong excitements, with a due proportion of nutriment, disease seldom assails the body. During long inter- vals of inactivity, the system becomes enervated. Then it is that the deleterious agents exhibit their influences upon animal life. Then it is that an army sickens from cause» connected with their local positions. The soldiers are attacked with disea- ses in the field, which originate from their own filth and impru- dence. In city cantonments, additional causes co-operate to en- feeble not only the body, but mind ; productive of sickness and military apathy. During periods of active service, intervals ot* repose are necessary ; but they should be short, and, during rest, unexposed to rain or snow. Profound sleep is increased by fa- tigue ; during this state, tlie powers of life are either weakened or suspended. The cutaneous secretions are diminished in pro- portion to the waste or evaporation of caloric upon tlie surface.. II' '. 'fr«»» ■SH« \l 176 MEDICAL SKETCHES. .J il^R fH 'l! The circumambient moist atmosphere favours the process, whife diseased sensibility assumes the place of health. The sensa- tions of cold and rigors succeed with obstructions of the capilla- ry vessels upon the surface ; which derangement, by a syra|)a- thetic association of parts remote from each other, disorders the more immediate organs of life. Hence arise fevers, rheuma- tisms, dysenteries and diarrhoeas ; — diseases, the forms of which arc governed by the incidents of positions, or local eauies, and seasons. • : .; ' ', ,•., ;• , ■ . ,■■'■ 'V.' .1', It is therefore favourable to the soldier's health, after a hard march, to be obliged to seek or cut his wood, to make a fire, and cook his provisions. By this gentle exercise a suitable action is preserved upon the several organs, while the |)erspiration oo the surface is gradually evaporated, without the too sudden waste of heat ; the powers of life do not sink, and are further supported by his soup, and a short period of rest. He rises re» freshed, and is prepared to obey commands. There are two principles which are necessary to form the effi- cient soldier. The first is a rigid military discipline, which op- erates on the mind of man with a force superior to the strong- est apprehension of dangers. It is this which constitutes the courage and bravery of European armies, who have no object in view but to obey the commands of their superior officers. They fight the battles of a Prince without knowing whether the cause, in which he is engaged, is founded upon principles of justice ; or ^vhether he is actuated merely by capricious motives. Their soldiers, no ways incited by objects which they can appropriate to themselves, are but machines, while the courage which they possess is wholly artificial. But there is a second principle which renders a man brave ; a knowledge that he possesses a native property — liberty, inde- pendence, and a right of soil. These he will support and de- fend without compulsion. In defence of these, he instinctively assumes his arms and becomes a soldier. Added to this last principle the discipline of Europe, the armies and fleets of the United States have rendered themselves irresistible. And thus Vt CAMPAIGN OF 1814. 177 they will continue to be, while the principles of our government remain unimpaired ; and the pillars of our federated constitutioa stand firm. What besides this innate bravery has given superiority to our armies and fleets, over those of the enemy ? The unexampled heroic achievements of our fleets on the ocean; the attack on Little York, under General Pike; and on Fort George, where Generals Boyd and Scott's intrepidity and consummate bravery were conspicuous ; the defence of Sack* ett's harbour, under the command of Maj. Gen. Brown ; the sev- eral battles on the Niagara, at Chippawa, and Bridgewuter; the defence of Fort Erie, and the subsequent sortie from that fort, by the army under the command of Migor General Brown ; in which actions Brigadier Generals Scwtt, Riplev, Gaines, Porter and Miller severally, and the oiBcf rs and soldiers of the army, generally, highly distinguished tbomselves, are ample testimo- flies of the above position. To add to the climax of brilliant victories, we record with peculiar pride the battles of New Or- leans, and Plattsburgh, under Generals Jackson and Mc'Coomb; and particularly the capture of two of the enemy's fleets on Lakes Erie and ChampUiin, by Commodores Perry and Mac-^ DONOuoH. These demonstrate with what high toned courage, our soldiers and seamen defend and protect the rights and privi- leges of the nation ; and evince that their superior valor is the effect of the principles of liberty and independence, associated with our forms of government — principles imbibed in infancy, a knowledge of which increases with growth, and becomes mature ed in adult age. END OF CAMPAIGN 1814. ill m m f m M I ! •rT? ■■CP ■ J*. /; . > it\i> . j)i" I :' '1 ilU'.u >■»■ .■*>» ». *•» I ■!■> 'Wr. ,; '*lvl 1 >• .J ' •t J • 'r.'(.j '1.1- (I t;-. •■»< '.. ->• I' i ...•)«j u 'U V 1 /» i', .» 'M li 1 i vt I m . ., . J' « NOTES; NOTE A. GiRCENiUBii is a township on the east bank of the Hudson, •lireolly opposite Albany. The town, which . occupies eight miies square, has a diversity of soil and surface. Alluvial fluts border the river. Hills present themselves in the rear, distant from the bank of the river trom one quarter to one mile, gradu- ally rising until they gain an elevation of 200 feet or more. The country exhibits an unequal surface, diversified with hills and Tallies. The soil, in some parts, is clay ; in others, a mixture «f clay, loam and sand. The cantonment is on an elevated plane, one mile east of the Hudson. It overlooks the city of Albany on the opposite bank of the river, and the adjacent country, five or six miles. From this position are seen, indistinctly, the beautiful villages of Troy, Lansingburgh and Waterford so contiguous to each other, that they ap[)ear as one. Here are barracks for the troops of the United States' army, sufficiently capacious to accommodate -loop men, with adequate quarters for their officers. On an em- inence 60 feet higher, is the hospital, which may accommodate one hundred patients. Attached to the hospital department, are quarters for the surgeons, offices and kitchens- for the subor- dinates of the hospital. The wards of this hospital are too small in thehr dimensions, both for health and convenience ; being oi^- ly 20 feet by 1 6, and nine feet in height. The elevation of the hospital is so great above the surface of (he river, that the fogs, which, during the hot season, are sus- pended over the fiats and villages on the banks, seldom rise to 't9 summit. ill ' 180 NOTE A. Upon the alluvial flat opposite Albany, williin six years hat been laid out a village upon regular streets, which intersect each other at right angles; whose population hay rapidly increased. At this time it contains about 70 houses. A sulphurated spring, about 100 rods Trom the landing at Grecnbush, has attracted much attention. During the summer months, some resort here for the benefit of its waters; which, to my knowledge, have cur- ed cutaneous diseases by ablutions and frequent potations. Those waters would have more frequent visitors, if suitable baths were erected for the accommodation of invalids. Another beau- tiful village of 35 houses, called Bath, is romantically situated on the bank of Hudson, one mile above Greenbush. The temperature of the climate on the Hudson is more regu- lar than in the same latitudes on the Atlantic shores ; where are experienced greater and more sudden transitions of weather than here. The cantonment, at Greenbush, has the reputation of be- ing healthful; and the country in its vicinity salubrious. The city of Albany, the capital of the state of New York, ift situated one mile in length on the west bank of the Hudson. It rises from the river by a gradual ascent nearly 200 feet to the elevated plain. The width of this city is from one quarter to one half a mile. This city, with the diversified country in its vicinity^ and the chain of the distant Catskill mountains, view- ed from the elevated lands of Greenbush, forms a variegated, beautiful prospecl. On the margin of the river, the lands are alluvial and rich ; while those more elevated and uneven, are a mixture of clay and sand, and barren. That part of the city, on the alluvial flats, has the reputation of being less salubrious than that on the hill. The want of a rigid health police is manifest- ed by the dlthiness of some of the streets ; more especially of the back yards connected with stables and kitchens. In a growing city, an apology f«r dirt may be offered, on account of unavoid- able lodgments on the streets of materials for hou88 building. As the increase of population introduces weallii and opulence; so these afford the best means to remedy the evils complained of. It is too frequent that people neglect their most important tem- poral concerns — those conducive to health ; till, by repeated ep- I NOTE A. IPJ idcmlc (liseatK 8 and mortnlity, they are roused to adopt mensure<: to obvintc them. To an opinion that inreclioiis distempers are of foreign, rather than domestic orij;in, tbe inhabitants of cities are mostly disposed to give credit ; while it leads them into fat- al security. Under this impression, at the moment when they view a formidable disease at a distance, it meets them unex- pectedly at the threshold of their doors; the direfu' onsequence of surrounding filth. With a good health police, Albany, from its local situation, may be considered one of the most healthful cities in the United States. With its natural advantages, it has, in a short period, increased in its population beyond examfile ; and [ircvious to the lapse of many years, will be classed as a commercial city among the first in the union. Agreeably to the census of 1810, the whole population of AHiany was 9,350. Al. this time (1810) it may be not less than 13,060; who occupy more than 1,800 houses and stores, a Iar2;e proportion of which are bride There are also 10 houses for public worship; the capital or state house, built in a style truly elegant and highly fmished, a new jail, three banks, with two banking houses, au alms house, a mechanic hall, a powtler house for the state, and one also for the city, an elegant state arsenal, two market houses, a theatre, &c. [See SpatTord's Gazetteer of the State of New York.] The majestic Hudson, famous on the historic page, has often borne on its swelling tide, armies to defend its romantic banks, and the fertile territories through which it flows. The luxuri- ant fields, on its borders, from its mouth to its source, have been often crimsoned with the blood of freemen, in defence of their rights and privileges. The enemy has known, and still knows full well, the importance of this river to the possessors. The invading foe has always directed his march by this route ; and has^improved those advantages, w hlch its waters give, to aid hb movements both from New York and Canada. On the banks of the Hudson, Burcoyn surrendered an army of veterans, to the undiscipl .led yeomanry of the country. On the borders of lake Champlain, moving with an army to gain the source of thiaxiv- 24 *i • M I't. ti' ^, *f*t IMAGE EVALUATION TEST TARGET (MT-3) .«^% ■4?^ 1.0 1.1 ■>!! liitM |2.5 125 III 1.4 i I 1.6 **- P /2 /2 /: /A ''W '/ Photographic Sdences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 ^ 782 NOTE B. cr, Prevost witnessed llie defeat of his armed doliUa, aad r»» treated with discomfiture aud disgrace. v « . No section of the United States can bear testimony to more hard fought battles, than the waters which intersect their most uorUiern territories. Time only will disclose, whether this dis* trict will become the seat of future wars — and whether a divi- sion of the states will again be attempted by this route. The yeomanry of this district is a barrier, which is continually strengthened by a rapid increase of population r and while di- rected by a Tompkins, will defy a foreign invasion. The state of New York alone can bring with facility, more than one hun- dred thousand men to its defence ; which forbids a belief that an attempt to subjugate the nation by a division of its territo* lies, at this point, will be again contemplated. NOTE B. mi |i-U i > iU ' C/AiiOMEii and opium were found beneficial in chronic rheu< matism ; also Dover's powders. Blisters gave a temporary re- lief — their effects, however, were not permanent. When the patient was kept in a gently diaphoresis between blankets 24 or 36 hours, there was always a mitigation of pain. Later experi- ence has demonstrated, that the Vapour Bath of Doctor Jex- MNGS is superior to any mode of removing rheumatism. Without detailing that train of reasoning, by which he sup- ports a theory, somewhat peculiar to himself, of the causes of diseases, aud their most appropriate mode of treatment, especial- ly when supervening with most morbid symptoms, we shall mere- ly select from his communication, the effects which have beeo ex[)erienced by its employment. Diseases attended with general coldness of the body, local, or more universal pain through the system, torpor, and mental de- rangement ; the patient, if not immediately relieved, expires in two or three days, often milna the first twentyfour hours. The NOTE E. tsb: IhmiperabTe coTdness, and torpor, Avhich exi8t9> has led the sci- entific physician to restore heat to the body by the application of artificial means. For this purpose, the ^varm ^vater bath, bil- lets of >vooil heated, hot ashes, bladders filled Avith hot water, have, according to the fancy of the prescribing physician, beea- applied in various ways to the body. In some instances, these warm and hot applications have been fbllew«d with success ; while in others, they have failed ; not because the intention of the application was incorrect ; but because the intention was not com' pletely fulfilled. The moisture which is attached to the body, and the surrounding clotheS) frequently counteract all the bene- fit derived from the heat communicated, by favoring its speedy evaporation from the body ; whereby the patient, in a short pe- riod, is found as cold and as torpid as he was previous to the em- ployment of those heated' applicat'ons. In these cases, internal stimulants^ such as ardent spirits, have been resorted to, with ef- fects more frequently dangerous than salutary, by inducing high- er degrees of excitement upon the larger internal vessels, and some important viscus, already in a gorged state, without beings capable of extending their influence to the extreme vessels of the skin. The substitution of Doctor Jennhjgs' Spirituous Vapour Bath remedies the evils, which are necessarily con- nected with the usual application of heat; a&its effects are more general, and as it diffuses throughout the system a more equal excitement, without the hazard of an exhaustion, which follows the employment of the water-batU heat, by itfr sudden evapora- tion. The following extracts from Doctor Jennings' communica- tions will give a partial idea in what cases the application of his Spirituous Vapour Bath is most suitable. A full knowledge of his treatment cannot be obtained except by reading the whole work, which is scientific and incomparable. " Heat (says Dr. Jennings) is a very powerful medical agent, and admits of a more universal application than any other yet . discovered. It is derived in certain seasons and countries, in part from the sun, but its principal source is from the lungs, iit whioh it appears to be generated by the decomposition of pure f^ I [^ •, '.rrr 184 NOTE B. il »'3l vM \ air, and from whence it is conveyed by me^gis of the circulation to every part of the body. But if the whole eystem ia prostrat- ed, the volume of heat, decomposed in (he lungs, must be less than natural. In conseijuence of the feebleness of the excite- ment, it cannot be properly conveyed to the remote points of the system. It must, therefore, necessarily follow, that an exter- nal application of an appropriate portion wiK afford the most natural aid in this situutiun. In proof of this, it is always agree- able to the patient. *• Having tried the experiment an hundred times over, with- out meeting with ofiie exception, I assert, that in every ease of fever with exhausted energy, and in ail cases of direct debility, artificial heat, in an appropriate degree, brings pleasurable sen- sation to the patient, and may be so managed a& to produce cor- dial eifects. In all cases of debility, whether directly or indi- rectly induced, there is a prevailing inclination to an introver- sion of excitement. Heat, applied to (he skin, most eflectualiy counteracts this tendency, and promotes a centrifugal determi- nation. " When the surface is abandoned through want of excitement, the skin collapses, and seems to lose its natural elasticity. Heat, artificially applied, corrects this inconvenience. In some in* stances it may seem at the tirst to produce a transient effect on- ly; but by careful and well timed repetitions, it will at length become durable. The system artificially replenished with this principle, is presently enabled to generate a more competent supply for itself. But as an excessive portion of wine, or any other cordial, stimulates too much, and induces a morbid degree of indirect debility ; so also an excessive application of heat Avill produce similar effects. In all such cases, therefore, spec- ial regard should be had to (he feelings of the patient. ^ " There are some remarkable and important advantages at- tending the use of this cordial, which no other can possibly claim, f n every case, where properly used, it produces a full effect, with- out imposing any improper stress upon the central vessels. So that in securing the-most pleasant diffusion of excitement, it of- fers no injury to any of the organs of life j ordinary cordials, on NOTE B. IBS. the contrary, are depend&nt upon the struggle vrliich they may excite in the heart and central vessels, for any and every centri- fugal effect which they may produce. " Again, iit the same time that heat, by its stimulant power, invites excitement to the surface, it softens and expands the skin, in a wiiy preparatory to receive the returning blooil. Or- dinary cordials must accomplish the effect, by corapelling the feeble system, if indeed it can be done, to assume an action suf- ficient not only to resume all those branches which it had aban« doned because it was not able to maintain them, but also to overcome all the resistance of an almost lifeless collapse of the vessels on the surface, v.' * . i . " It is true, that hitherto insuperable difficulties attended the use of this agent in many cases. But, by the aid of my porta- ble apparatus, every difficulty is now perfectly corrected, and the application o^ heat can be made with such precision, as fitly to meet the most accurate intention. " By raising an intense degree of excitement on the surface, every necessary effect can be produced with the utmost safety. " Other powerful remedies, when once administered, arc gone beyond the leach of control, and must have their full effect, whether judiciously or injudiciously administered. But if too mu6h heat has been employed, it is perfectly within our reach to check its influence, by an immediate application of cold. " In cases of gout, rheumatism, spasm, cholic, &c. when there is a morbid determination, or location of excitement, heat affords a safe agent by which to correct the dsi rraination of power, and maintain a sufficient degree of excitement on the surface, till the system can recover a balance. *• After debility has long prevailed in the system, by whatev- er cause it may have been induced, the collapse of the vessels of the surface becomes obstinately fixed. The skin, therefore, looses its elastic feeling — becomes habitually and obstinately pale, and through its privation of <;irculating blood, is disarmed of its power to resist the cold. Heat promises much in such a case. "It ni^y perhaps be feared, that a frequent use of heat may induce debility. My experience warrants the assertion, that the contrary is true. J 11 Ilia!' |9 1 ' l| : nja 'if )'■ t i^ ■ P 15 1if|i '.: 'I- ■'W , m f. I na NOTE C. ** The bath produces no loss or vital fluid, and therefore any moderate degree of debility is quickly recovered. A pleasant expansion is given to the vessels of the surface, and by heat they arc stimulated into increased action. The circulating blood is invited from the centre to the skin. The intestines, therefore, by being partially deprived of excitement, are, for a time, relaxed — But when the bathing is ended, the blood returns 1o its natural equilibrium, without any subsequent inconven- ience, '•i ' 'i ' ■-:;•■■ " ■ :..!'-, I • ''■■:, " It is worthy of remark, that there is no danger of taking roUl, especially in recent cases. The gass which is used, is as much freed from moisture as atmospheric air, insomuch, that it will dry a damp sheet.'* Dr. JENNiNGb is a respectable physician : he holds the use of his jfortable warm and liot bath by patent right. It is not to be placed among the ephemeral pretensions of those who deal in qanck remedies. This new mode of applying heat, like all oth- er useful remedies, should be employed under the direction of a ecientiBc physician ; more especially, as its usefulness is circum- scribed to states of morbid action, which require a knowledge of the animal economy, under all states of disease and health, to direct with precision. f', (^ .' '; :'(^ " -Kt ' .: ^. i; ; •:'>:;* ■ il.: »:■■ I, NOTE C. v^^'J. !•.•.: -'n ., . Vasci of ilisftcclions reported by hospital Surgeon's matCt March^ cxhibilins: the appearances of the diseased orgatis of those who died with the pneun.unia notha of the winter 1812-13, connect- ed with the sj/mptoms and general treaitncnt of the disease, r«» fi-*- , . . (■ .'...,..- TASE FIRST* ,fii..'v»ni > • ;V. tiJ .•}1 //'a. " Jamp.!^ Casren, Gth regiment infantry, was admitted into fhe hospital September 1st, 1812, sick with intejmittent fever. ft NOTE C. I8f Irom which lie recovered by the ordinary treatment ; but contin- ued weak, having eome cough and diarrhoea until 1st November, when one eye was diseased, accompanied with pain, and a loss ef clear and distinct vision, which terminated in eight days with a loss of sight. The pupil was white and opake, assuming the appearance of a cataract. " November 10th, he was seized with violent pain in the breast and side, with common symptoms of pneumonia ; fur which he was bled, and treated with medicines commonly employed in pneumonic fevers. He died on the 13th. DIBSECTIOX. " Upon laying open the abdomen, the splceu was found un- commonly large, much resembling t'le kidney of an ox, and of a similar texture, and weighed 2 Jfe 2 oz. avoirdupoise. — The lungs were tumid, hard and inflamed ; adhering to the plcur<'i costalis, in many places. A membrane of coagulated lymph lined the cavity of the thorax. A considerable quantity of effus- ed lymph was found in its cavity." .'^; ' , . REMARK. The indurated spleen was probably the cause of his cunlinucil debility^ after the intermittent fever was subdued. The state of lungs was such as were their appearance where the patient did not survive the first stage of pneumonia. In the above case, death took place previous to the suppurative stage, and the in- spection evinced, that bleeding was not carried to tlm oxteiiij which the state of the disease demanded. M' CASE SECOND. *•' Sullivan of the corps of artificers, 34 years old, ro- bust, muscular, intemperate, and in a state of intoxication, took a large quantity of opium ; soon after, was seized with violent spasms, cramp in the stomach and breast, with vomiting. After recovering from the severe effects of the opium, was seized witU pain in the side, for which a blister and diaphoretic powders were prescribed. 1 ii 188 NOTE C. " I was called five or six days after his first illness to vnit him, when he was found groaning at every breath, his hands al. tcrnately pressed upon his breast and head, and delirious. The whole of the symptoms indicated agonizing pains in the head, breast, and si(le. It was said he had been in the above condi* tion three hours, and previously complained of a very severe pain in his head. With much difficulty eight ounces of blood was taken from the arm, and a blister applied. He continued in this distressed situation twelve hours, and died. - DISSECTION. " The bowels on dissection appeared perfectly healthy, also the liver. The spleen was enlarged, darker, and of a softer tex- ture than natural. When the sternum was raised, the lungs ap* peared in a high state of disease. The right lobe (the side affect* «d) was much inflamed, adhering to the pleura, swollen so as completely to fill the cavity of the thorax. The left lobe was slightly inflamed — a fleshy substance similar to a gland was found detached from every part, in the abdomen* — This sub* «tauce is now entire, preserved in spirits of winew" '' .■•■ ■ '■ REMARKS. »''■..■ . • .. ... -■/, : This robust patient, it is highly probable, was, in addition to the disease, in a state of intoxication. The state of the lungs required a full bleeding. Had thirty ounces or more been takea away, he might have been saved. • i . - • CASE THTRD. " William Murray, private of the light artillery, was admit* ted into the general hospital Ist December, 1812, with a pneumo' iiic fever. The pain in the breast and side was very severe. He was of a robust and plethoric habit. The treatment was hieeding, cathartic, blisters, submuriate of quicksilver, and opium. He lived only four days. m f.y KOTE C. 18» DISSECTION. <^Upofi exafhination, the abdominal vise^ >rere sound ; (he lungs highly inflamed and surcharged with blood. A pint of jrellowish, or whey-coloured lymph was effused int6 the cavity of the thorat. The inside oT the thorax was lined with a thick membrane of coagulated lymph. The pericardium contained eight ounces of whev->eoloured lynlph, in which were floating co- agulated lymph resembling cheese curds.^ MfcliAKKS^ The quantity of blood taken away is not stated, yet It is most oertain, from the robust habit of the patient, and appearance of the lungs after death, that a sufficient quantity was not taken away in this case. At the commencement of this pneumonic disease, the lancet was employed with too great timidity in most cases. CASE FOURTH. ** William Moork, 16th regiment InfEintry, was admitted a pfr> tient into the general hospital atGreenbush, October 17th, 1812, in a debilitated state of health, having pain in the breast, with a lore throat and cough—>was bled once, took a Cathartic, which relieved his throat. The cough continued ; a diarrhoea sooa wpervened, which continued until death, which took place on the Ist December. Gentle cathartics were occasionally admin- istered. His cough was generally attended with expectoratloa of muco-purulent matter, which denoted an ulceration of the lungs. An emetic of ipecacuanha was once or twictf given to promote expectoration, and to determine the circulation to the iarface. Paragoric was given to allay a dry tickling cough* The diet was rice, chocolate, milk, wi.e occasionally as a stim- ulus. . DISSECTION. " Upon inspecting the chest, the lungs appeared large and hard^ both cavities, and firmly adhered in several places to the 25 )9a NOTE c;. pleura. Both lobes, excepting a small part of the left, were oT t •dark purple colour. After making an incision into the substance of the lungs, and squeezing them, thick pus was forced by the compression out of the air cells. There were found also several hard lumps or tubercles. *' Upon examining the abdomen, ihe rectum, and sigmoid flex- ure of the colon were found of a livid hue, very much thickened in their coats. Those parts of the intestines which rested on the back or psoas muscles, assumed a dark and gangrenous ap- pearance. In the cfficum, or caput coli, were found some hard lumps of hardened faeces, over which had passed the watery •tools. These scybala are believed to be frequently the cause of cur obstinate diarrhwas, especially where the stomach and intes- tines have lost their tone, so as not to perform their offices of digestion. The more solid parts are retained and keep up irri' tation, while the fluids pass on and produce a troublesome diar- rhoca, which frequently continue a great length of time. CASE FIFTH. " Thomas Settlers, private in the 2d regiment artillery, was admitted into the general hospital at Watertown, N. Y. (12 miles from Sackett's Harbour) about 1st April, 1813, v^itii pneumonia. The pain in the breast and side was incessant aad severe several days. Respiration was laborious, so that tlie pa- tient was under necessity of sHtingup in his bed most of the time, catching and gasping for breath — unable to make a long and full inspiration. Repeatedly bled and ^.Istered without effect. He died the 12th day after his Qrst indisposition. , ~ , DtSSECTION. ** On exposing the tliorax, the lungs were found contracted, tough, compact, almost destitute of air vessels. The right cavi- ty of the thorax was completely filled with serum, three pints in quantity ; the lobe being so diminished as not to occupy but a very small space. In this case, the inflammatory symptoms had subsided, the patient died hectic, produced by absorption of pus, and from a hydrothorax. The latter was probably the chief agent of accelerating death." KOTE a lot >id flex- ickened sated on BOUB a|c Die hard I watery cause o( nd iDtes- offices of p up irri" ome diat' OABE SIXTH. *' Reuben Smith, a private in tlie Otii regiment, 27 years of age, admitted into the general hospital at Watertown, Ist April, 1813, with the following symptoms : troublesome cough, difficul- ty of breathing, little appetite, and declining in strength, effects of a previous attack of the epidemic pneumonia. The lungs ap- peared the principal seat of disease. Small doses of calomel and opium were administered night and morning to promote ex- pectoration, which had the desired effect. Intermediately was given a mixture of elixir, paregoric and antimonini wine ; a blister was applied on the breast to remove a dull heavy pain. Three days previous to death, the patient was attacked with hemo-phthisis ; and at the same time he expectorated a piece of the lobe of the lungs, a little hardened in texture, and partly ul- cerated, which weighed over two ounces. The raising of blood' continued, and he died while he was coughing blood." DISSECTIOITk " The cellular texture of the lungs, upon opening the chest, was yellowish ; the left cavity of the thorax was filled with yellow water. The lobe was large, hard, and adhered to the upper part of the cavity. The lobe on the other side adhered strongly and uniformly to the pleura covering the riba ; it was large and ap- peared like the liver ; tender and easily lacerated with the fin- gers, entirely destitute of the spongy texture peculiar to healthy lungs ; in its superior part adjoining the clavicle and near the trachea, there was a large sphacelus. It was evident from its ap- pearance, that a portion of this rotten part had l)een removed ; and undoubtedly was that which was raised by coughing. Pus was by compression squeezed out of the air cells. The 8ub> stance of the lobe was easily broken and torn to pieces. The eavity of the abdomen contained at least two quarts of water similar to that in the thorax ; the stomach and liver appear- ed healthy; the gall bladder was larger thaa usual, and_ filled with thinish biie,'* ||t >1 \\\ Ji' M WM U ^9•l NOTE C. CXaZ NEVBNTU. " George Whkrliv, or th« lecond regiment of artillery, was Btlmitted into the hospital at Watertown 10th of March, 1813, in the last stage of the epidemic pneumonia ; with short breath* ing and rattling in his trachea, which continued five or six ^eeks; troublesome cough, attended with expectoration of puru< lent natter; disturbed sleep, accompanied with delirious reveritts upon being awoke. When first admitted, the patient coughed thick purulent matter in large quantities ; became very feeble^ emaciated and sweated profusely. Immediately previous to his being sent to the hospital, he was bled ; after admittance, was Iriiatered repeatedly on his breast, and took submuriate of quick< f ilver and ipecac, combined, in small doses with favourable ef' fect^. Other medicines were occasionally -administered as symptoms demanded. About the seventh week be expectorated freely and largely, the calomel was discontinued, and caraphora< ted tine, of opium and wine of antimony were directed to ease the cough ; sweating now began to abate, pain in the throat and breast bad left him, breathing was more free, appetite better, cough was less frequent and expectoration less. The purulent inatter which hail been generated was thrown off, and less ffeem- f;d to have been formed. The general symptoms were favoura* ble* and a speedy recovery was eipected. ., .,iiv v*i -u :. >' " A severe dysentery at thi^ lime supervened from some cause ipnknown, which precipitated the patient in three days to the l^rave. The stools were very frequent, attended with severe gripes, tenesmus, rapM prostration of strength, sudden eraacia- lion, sinking of the eyes and contraction of the features of the &ce. At the moment of dissolution, purple spota and streaks appeared over the body, particularly on the abdooien, which in* dicated morti&catiop." . ," BISSECTION. ..\. , , _., ** The rectum and part of the colon, upon inspectiBg the co» tents of the abdomen, shewed strong marks of iniammatioo, be* ing thickened in their coats, dark red, or nearly purple. The NOTE C. 193 Ntrer wai found. The lung« were full and appeared in a healthf condition, excepting one lobe, which had a imall adhesion, and the other had depressed s[K>ts of a da^-ker colour than the rest of the lungs ; which evinced that these Kpots were once the seat of little ulcers or abscesses, but now healed and apparentlj sound •i the other parts of the lungs.*' , CASE EIGHTH. ^ Landon C. Bruce, sergeant \n the 6th regiment of infantry, acting clerk to Doctor Bloob, hospiral surgeon, vis seized with a fever about the first of November, 1813, of intermittent, in* flammatory and pneumonic symptoms, with pain and soreness in the breast, and cough. Of these complaints he so far recov- ered as to perform the writing in the hospital, which occupied three or four hours in a day. During his convalescence he was in habits of intemperance. He still was troubled with some pain in his breast, and more or less cough, and often a diarrhtca accompanied the other complaints. These had increased by the first of March, 1814, to a considerable degree. About the mid- dle of this month he became so emaciated and debilitated as to be unable to write in the hospital office. As cough and diarrhoea, were aggravated, appetite failed. The c. .)ectore.tion at this time was mucus tinged with blood ; pain in the breast, not severe. Little was taken by him except opium to check diarrhoea and al- leviate cough. ' '" ■ .1' '1 " April loth, a large blister was applied over his breast. The blister had little or no effect. Some calomel bad been taken, but how long time it was continued, or much in quantity sufficient to produce a sensible effect, is to me uuknown. 13tb. He was so weak as to be unable to sit up, and at times a little delirious. 16th. H« expired. UI8SGCTTON. *' The next day I opened the jdy. The ab ti /ii f\ V ; (3 ■J r' iii V i n 'ir' j i \ k mi >.. 104 NOTE C. lobe of the langs entirelj filled its cavity, and adhered tothe pleura costalis, diaphram, aternum, and pericardium, wherever St came in contact with these organs. Many specks of pus were discovered on cutting into the substance of the lobe ; but no ab> scess. The right lobe had formed no adhesions ; but some schir- rons lumps were found in its srhstance. The heart and pericar> dium were sound." CASK NINTH. •Uii^t lii'* ^^.f^* ,,•.."! r: f* 7f." -f • I " James Kinney, 0th regiment infantry, was admitted into the general hospital 20th March, 1&14, latrauring under pneumonio symptoms in its advanced stage. On the 28th of the same month, he was placed under my charge, then complaining of pain in the breast, short and difficult breathing, scarcely able to articulate ; with the above symptoms, and a diarrhoea, with which he was attended, had become emaciated aud debilitated. A blister was applied, which relieved the pain in the breast ; at the same time aubmuriate of quicksilver, opium, and tartrite of antimony com- bined, were administered in small pills night and morning; each pill containing one grain of the submuriate, one grain of opium, and one fourth grain of tartrite of antimony ; occasionally a pill of opium, per «r, when too great determination to the bowels was perceived. Camphorated tincture of opium was also given, when the cough was troublesome, to take off the irritation from (he lungs. This treatment was pursuet. one fortnight. The pills produced a free expectoration, which was aided by soft di- luents. About this time one gill of wine was allowed a day^^ i " The laborious respiration still continued. Small pains now and t'ien returned, but confined to the left side. His general iiealth failed, and he became more emaciated. Suspecting that there might be an effusion of lymph mixed with pus in the tho- rax, on the 20th of April an examination was made as to those symptoms wliich indicate an hydrothorax or an empyema. He had cold sliiverings ; no anlematous swellings of the lowc** ex- tremities; nor had he dreamed of drowning; all of which occa- sionally occur. The symptoms which might lead to a suspW rion of empyema were, he had a pneumonia ; the left side of the NOTE C. W» ibonx was visibly larger than the other; the spaces between the ribs on that side were more tense and distended than tii^ other ; in the left side there had been more pain than the other. The most unequivocal symptom of a fluid in the cavity was the fluctuation lieard, when a sudden shake was given by turning him on the opposiie side. The noise was not much unlike the agitation of buttermilk in a churn. " By the advice of Hospital Surgeon Blood, I tried the effects of a large blister; the result was what was expected. It ans^ wered bo good purpose. The effusion being the termination of a severe pneumonia, and the collection of long standing, and great in quantity, blistering was believed to be a very inefficient remedy in such a case. The inflammatory stage had subsided more than a fortnight. The operation of paracentesis appeared to be the last resort. ** On the 24th April, an opening was made between the sixth and seventh ribs, near where the external oblique muscle of the abdomen indigitates with the serratus major anticus ; or, (which brings it to about the same point) at an equal distance between the ensiform cartilage of the sternum, and the spine. I made the incision through the skin and muscles with a common «scaN pel, and punctured the pleura with a lancet) a quart t of an inch long. The pus flowed in an uninterrupted stream. About one quart was taken away, at this time, when the patient began to grow faint, and I closed the orifice. This first discharge of mat- ter procured him much relief in his breathing. He couglied less, slept better the ensuing night than he had done for three weeks previous. The orifice was opened again the next day, [25tb] from which was discharged more than one pint of matter. Al- though his breathing was considerably relieved, yet his pulse became more hectic, and bis strength failed. [26th.] Being weak and exhausted, and respiration not \evy laborious, no dis- charge was attem[)ted. On the 27th, the orifice was again op- ened, and a pint and half matter taken away. The last dis- charge was of the fluid consistence of buttermilk, and of a green- ish colour, very offensive, so as to contaminate the whole room viiih a nauseous smell. Pulse now, small, hard, frequent ; he *t|ifi ■•1 i i' I) II ■ ■ ' i ' t : : ! w^ 100 KOTE C. wu restless, and had little or no appetite. At this period ho took wine and soft nourishing diet, as much as h)s stoaiach coaM bear, with a pill of opium at night. From this time there waa but little discharge, except when raised up. His breath became Tery offensive, and his pulse smaUer and more frequent, nntil May 4tb, whea he expiredv" ' ' jj < ■; CA8£ TENTHk ** Thomas FAMtiNo, 11 th regiment, was placed nnder Wf oarei the last of April, 1814. Upon examination, be was found la- bouring under a chronic complaint of the lungs, consequent to pneumonia. At this time, his complaints were some pain in the left breast, hoarseness, troublesome cough, difficulty of breathing, little appetite. Previous to his present indisposition, he had an hemophthisis. He was bled moderately ; a blister wa\i applied to the affebted breast ; a pill of one grain of submuriate of quicksil- ver, one grain of opium, and one fourth grain of tailrite of anti- mony was administered every night, and was continued one week with some good effect, by promoting an expectoration ; but his breathing was no better. Profuse night sweats super- vened, with loss of speech, delirium and anasarcoua swellings. He died ten days after I made my first prescriptions. DISSEfTION. " May 6th. ITpon opening the abdomen, it was found to contain about one and half pint of \tater. The intestines were much thickened and corrugated, bearing strong marks of inflammation. The caput coli and ascending part of the colon appeared to be free from inflammation, but much distended with wind. The stomach and spleen appeared sound. The liver, as in health and natural, except the ligamentum teres running along a fissure on the under side, passing through a foramen in the same place where the fissure should be. The foramen was free and open, and sufiiciently large to admit my little finger by the side of the round ligament. Upon raising the sternum, the lungs were found exceeding farge in either cavity. The right lobe had some slight adhe- NOTE C. lOT MOM at the back and upper part of the cavity of the thorax. A small portion of the lobe immediately under the clavicle, and near the fli)ine, had lost its natural spongy texture, and resemt- bled that of the liver. Upon cutting into this part, a small quantity of pus was found in the cells. — The left lobe was very- large, and distinctly divided by a fissure running longitudinally, dividing the front from the back part.— This fissure, or which was more like an incision made with a knife, was aboist an inch and half deep, 'the front division . this lobe appeared healthy and natural, without any adhesions ; the back portion, (whicb was rather larger than th6 front, and by itself almost as large as a common lobe) adhered to the pleura in every part. It exhib- ited strong marks of inflammation, being of a dark purple colour, and considerably hardened. Upon cutting into every portion, particularly the upper and back part, every cell discharged thick pus in abundance. Indeed, wherever an incision was made, the wound appeared like a mass of thick pus, connected only by the thin membranous textui of the iDngs ; not much dissimilaf to a hOney-comb if filleil with thick pus." ",.•:.'"? ►>!.. ■ tABG ELEVENTH. " DaKiel Cathburt, 23d regiment infantry, was adntitted into the hospital at Brownville, 10th March, 1814, with a pulmonic complaint. The greatest part of the preceding winter, he had been sick at Sackett's harbour, previous to his removal to Brown* ville. This patient had a bad cough, with slight pains in his breast, and difficulty of breathing, some diarrhoea, edematous swellings of the legs, which were reduced by the spiral bandage. With the above symptoms he was much emaciated. Blisters were applied upon his breast; was ordered at night a pill of sub- muriate of quicksilver and opium; after taking the above medi^ cine a few days, an expectoration took place ; to assist this and quiet an irritating cough, camphorated tine, of opium was admin* i«tered with soft mucilaginous drinks. The diet was principal- ly milk ; and the patient was indulged with wine every day tilf his death, which was on th6 10th of May. '1 1 ri I 1 < ' n ' 1 i ; 1 II ^i il iil 11;. ii isv :;:li !i! \i (' ^■ii,IJ w^i,g)|iHU|Ui^iip^M)||H^ii ion NOTE C- ».'ii* OtSSECTIOK. .('>■, " On opening the abdomen, the coats of the intestines were found very much thickened and corrugated, and appeared to have been highly inflaaied. The stomach was contracted, the Uver was whitish with a yellowish cast. The vcsicula fellis contained but a small quantity of bile ; its coats were much thickened, contracted, and appeared to have been inflamed. Having sufisred from diabetes a considerable time, I was induc> ed to examine the I idneys. To the upper part of that on the left side, there was an appendage, nearly as large as a midling sized auricle of the heart, and in resemblance somewhat lilce it, but in texture soft and tender as the liver or spleen. It was ea- sily torn with my fingers. The right kidney appeared natural excepting the ventricle which empties itaelf by the ureter, was larger than usual. , . , _,...,,.,. , .,.a,w< . ■. «i - *' Each cavity of the thorax contained three pints of water, rather serum, limpid and glutinous, resembling whey in colour. The right lobe was contracted to half its natural size, the upper part consolidated and hardened, feeling and appearing like a piece of heart boiled. ^hesions had formed to the spine, ribs, clavicle and pericardium. The lobe was so much drawn to the spine, that no adhesion existed between it and the ribs of the au- terior part of the thorax. In the upper part of the lobe immedi- ately under the clavicle, there was an abscess as large as a goose egg. The substance of this part was destroyed. There was found adhering to the pleura and lungs, a membrane of coagulat- ed lymph, and some similar thick pieces resembling what is com- monly called mother of vinegar. The left lobe appeared little diseased ; but, on cutting into the substance, drops of pus were squeezed out of its cells. There were slight adhesions, nothing more, it is presumed, than many have for years, who ei^oy good health. The pericardium contained a fluid similar to that in the thorax, but more glutinous. This man was 25 years of age, light complexion, of a delicate constitution.'* ,^ ."J^ if ■■?T, r^-..-',i4'-..t- (199) Ld 1 Jl w I l\i\ ll i'3i.; ill »f 1 i 1 , 1; ii W^l m'i\ ^ 2flii NOTE U. V ease.'* It being true " that it appeared among the troop* two or tliree weeks earlier than among the citizens," ^vho eventually sutTcred with no less severity troin it, but in some instances much greater. Id the month of February, the numlier of deaths agree- ably td the offici'al report of Doctor LovcMi, did not exceed three in a hospital, which contained more than one liundrcd patients through the whole time; when during the same mouth, th»re were seventy three deaths of citizens in the small village of Burlington. This last fact was communicated to Doctor Lov- eiAj^ by a highly respectable clergyman of the town. The re- mark in a medical view is especially important, that while the soldiers were under an antiphlogistic practice, the citizens were treated by stimulants. *' A depression of mind from a repulse immediately before, un- der General Disarborn, in an attempt to invade Canada," (as conjectured by Doctor Gallup) could not have existed ; when there had been no repulse which this division experienced. Neither did General Dearborn immediately command the ar- my on the lines of Canada; which had an invasion been intend- ed, he would have headed in person. After General Van Ren- seleer's disastrous battle at Queenstown, and failure of General Smttb's expedition, no hostile movement against the enemy was contemplated at that late season of the year. The officers of the army well understood that General Bloomfield's move- m^it towards the lines of Canada was only a feint to draw the attention of the enemy from Upper Canada, to aid General. ^MTTH in his expedition. No person can more respect the opinions of Doctor Gallup than myself; especially as to the nature and treatment of epi- demic diseases, particularly the pneumonia notha of 1812 — 18. A similar treatment had been pursued by the surgeons of the ar- my, in O|iposition to the sentiments of very respectable physi- cians in that part of the country. A concise view of which was published, at that period, in the Arous at Albany, and with some additions may be seen in the Medical Repository for 1813 jkOd 1814, printed at New^York. > « - ^201 ) llllll KOTE E. In a hie Amencan eaition of GoIdamith^B History of Eng* land, by the Reverer;] Manlt Wood of Exeter College, Oxon. ig a summary of events to the year 1815, published by a profes< 8or of Harvard University at Cambridge, (who has aclcnowledg- ed himself the author,) from which the following abusive state- ment is extracted. *' The border war against his mjyesty's North American Col- onies, produced no important results } but was incalculably dis- tressing to the inhabitants of both frontiers. In the course of the season, several considerable battles were fought. Little York, the capital of Upper Canada, was taken, sackedy and the fublic IndUkngs manionly destroyed^ in the former part of the campaign, by troops under General DEARBoax; but the Amer- icans were soon forced to abandon it with considerable loss." What base pusillanimity is represented in the above para- graph ! ^^ forced to abandon the placCy* when an enemy was not within the distance of 90 miles t A more astonishing and impu- dent mistatement never was befoire published, directly in the face of correct official documents. It is much to be lamented that any one, but more especially a member of the Massachusetts Historical Society, holding a highly respectable place in an important public institution, es- tablished for the advancement of science, morality and religion, ihould be so lost to a just sense of his situation, as to have giv- en vent to such virulent party feelings— as to betray a disregaid of facts, as well as common decency. i«v'.l/ - ;!, . . . , i4 i ,' km Ift! 1!! ' •■ . 1'^ 1' !l ir f^ ( 20^ y % i \ NOTE F. In justification of measures pursued by General Boyd, while he commanded the army at Port George, we state, that the gal- lantry of no one, on that memorable day, when Fort Geor^o surrendered, was more honorably mentioned than his was, arter the action ; in which he not only led his brigade up the banli, defended by a line of the enemy eligibly posted for defence ; but by his animating address to his troops while in the heat of bat- lie. It is in my power to state, being on the battle ground im- mediately after the action, near four hundred men, including those of both armies, either killed or wounded, extended on the high bank, intermixed, a length of 200, and breadth of 15 yards. This alone demonstrates the ground was disputed nearly at the point of the bayonet, until the enemy's line broke. ^ '^ = From information given by oflicers, some sections of our army actually engaged the enemy at the point of the bayonet. The following extracts of letters from Officers of high grade, express Hie sentiments of the offi^iers^ generally ^ of the army, respecting the conduct of General Boyd on that occasion. Extract of Major General Lewis' letter to the Secretary of War. •' Of General Boyd, I feel it a duty to do justice to his intrep- vl conduct at the landing of our troops on the Canada shore, at Niagara. His brigade made the landing under a heavy fire of musquetry. It was instantly formed, and he led it up the baok with great gallantry, and was the first himself to gain it." '<' Extract of General P. B. Porter's letter to the PresidaU of the United States. " At the taking of Fort George, on tte 27th May, the Amer- ican troops landed in succession — 1st, the advance on the righ*/ NOTE P. sofa anAer (he command or Lieutcnanl Colonel ScoTt — 2d, Botd's brigade— 3d, Winder's, and lastly, Chandlbh's. The landing or General Boyd's brigade, was eflected (as well as that of Scott's command) under a heavy shower of miisquctry from the enemy, who lay on the margin of the lako. But such was (he promptitude and order with which the troops were formed and led into action, that the enemy was beaten by the time Winder's brigade began to debark. i " General Boyd and his brigade porticipated largely In the well earned honors of the day ; and the expedition and order with which his brigade landed and formed, and the personal gal- lantry, were s|)okea of Ihrouglioul the army io terms of the high- est commendation.** . .' >u, > .1 • 1, " ! / .c '! >......,...< »..,••. .'..I •.,.•.>■ . ,.,, ».......?,,.. ■■ r » Exlracl cf General Miller's htter to a General in Boston, " I served in his brigade (General Boyd's) at the capture of Fort George on the Niagara. Lieutenant Colonel SCott led the advance and struck the shore first, followed immediately by our brigade, which landed in succession from right to left, and formed under a most destructive fire from the enemy who lined the bank for some hundred yards. The contest was principal- ly, or all over, before any other brigade landed. " General Boyd was the senior officer on shore. I have ever considered his conduct on that occasion brave, animating, in' trepid, and officer like." General .Miller, speaking of the capture of Fort GeorgC;, says— • *'» "'' —'■■ -■-■ki " General Boyd inspired the whole by his zealous rnd animat- ing conduct. He rushed up the steep bank at the head of his k-igade, when after about fifteen minutes sharp fighting, the charge was given, and the enemy fled. General Boyd Avas sen- ior officer in the battle, and proclaimed the victory by three cheers— to him and Scott, the army acknowledged a preemi- nent claim to the honors achieved. « u;., M . '. " This conquest I have ever considered one of the most bril- liant achievementg during the war, the sortie at Fort Erie ex- cepted." II 11 i I ■■If'; ' m r i i ■ TT^ S04 NOTE P. il^ 1:1^ m ... i I The foITowIiiff cfocument exhibits the orden hf which OtMf> al Boyd wa« governed lubsequent to that period, when General Drarboen wai ordered from the command oT the army at Fort George. .; , „ . **War DrpartmerU, My 7, 1813. " Sin, — General Dearborn being about to withdraw Trom the command oT the army, until his health shall be re-established, this trust will devolve upon you, as the senior officer, until tite arrival of some person fo whom it will be specially assigned. * During this period, you will pay the utmost attention to the in* Btruction and disciplining of the troops, and engage in no aflair with the enemy that can be avoided. The orders of Generals Hampton and Lewis you will obieyk jo;j " I am, with great respect, your most obedient servant, JOHN ARMSTRONG.'* •|Vj ,fj f.ilj T^ The above documents have been already published, and com* ing from officers of most respectable standing, when more gene^ ally Icnown, will remove every aspersion which has been cast upon Gene)ral Boys by the public^ while he commanded at Fort George. The aggregate of the at*my at Fort George and its dependen* ties was about 5000. From an estimation of numbers sick in general and regimental hospitals, it was my persuasion^ but lito tie more than one half of the army were capable of duty, at one period during the summer months. The officers equally suffer* ed with the ranlc and file. This has been already expressed in page 66. It was repeatedly stated to myself by officers, that they were on duty every other day. ; i,« ■ Wherein the comparative strength of the two armies, as to aggregate numbers, is noticed, page 91, it is not designed to im* pute to General BoYb a want of courage; no officer was ever heard to suggest that he would not have attacked the enemy in their lines, if he had been at liberty to have acted offensively. If he was unfortunately placed under circumstances by superior authority, which operated to his injury in the public mind, a full exposition of which, prudence, at the time, forbade ; the in- 1'. > t ; NOTE F. 20d justice is to be attributed to those ordcra, which restrained hia native energies, and prevented bini the acquisition oT those high military honours, for which, in early life, he assumed the profes- sion of arms ; for which he always thirsted, and for vihWa he has, at all times, displayed the highest ambition to expose his life. While enumerating the several causes of disease, to which the army was subjected at Fort George, the sinl&s were noticed ia pages 66 and 70 as one. No neglect on the part of General fioTD is here intend.'d. The officers of the amy, la all things connected with cleanliness, were governed by their perceptions. To the c^e the enoampnMut appeared in fine order, and very «lean. Nevertheless, offensive effluvia from the sinlcs, (whea the wind was from that quarter, from which it blows four-fifths of the time during the summer months) were noticed by myself and others, who accasionally visited the encampment from a posi- tion surrounded by a purer atmosphere. A report of tlie exbtent (act, however, is not intended as a censure on any one. The observation ia made, not in a military, but a physical point oC view, to show more generally, what every physician knows, and all the world should know, that persons may be surrounded with poisonous gasses, without being conscious of them through the medium of any of the senses. Had I been placed two weeks un- der similar circumstances, it is presumed the unpleasant efBuvia would not have been noticed by myself, more than by thoaa whose sensitive organs, from habit, were not annoyed by theDU ??'>•»,' ..t "«(*?■;;! /: " V-'. i.(.;..Jj : TJ '■ ':<■'■ ^,iv;;; • . ir ,-i';-i; '* \vy>\ w > > I f ;..:.' \. i.^f' - •> ;.' r* N i 1 i; I .'V. I»l!^.,, ■ ' -^:. •/ .(■ >♦.« I i|!i!l I !• , i. ! ^.. f f!*:*! ••• X •I i 1 . ,'1 V i ..■( ■ ' • '- ' ■ '. . • ; ■1.1 •'•• ■ . ';. ' ' 1 , ,ft»'t'» J »l •» ^».,' •;.'» •• ., ,. I. i ,1 i I,, . .-»•■ SURGERY. .• I'll r.t' n h M »;* i'l »i. AMPUTATIONS, AND CASES OF WOUNDS. The opinion! of Labrcy, chier«nrgeon of llie imperial guardijf ftod inspector general of the niodical itaff of tlie French armieB, respecting amputations and gun-shot wounds, are well deserving the attention of surgeons. It is generally believed, they are Correct, and with some exceptions, should be adopted. He ob* serves, " when a limb is so much ii\jured by a gunshot wound* that it cannot be saved, it should be amputated immediately. In the army, many circumstances enforce the necessity of primi* tive amputation." i:7*:>,j i .'■■(. .t:'.*m -■ ** 1st. The inconvenience which attends the transportation of the wounded from the field of battle^o the military hospitals on bad constructed carriages. 2d. " The danger of remaining long iuliospital. This riaqm is much diminished amputation ; it converts a gun-shot wound 5nto one w '^ich is capable of being speedily healed, and obviates the causes that produce the hospital fever and gangrene. *' 3dly. In cases the wounded are of necessity left on the field of battle ; it is then important that amputation should have been performed, because when it is completed, they may remain sev- eral days without being dressed, and the subsequent dressings ajre more easily accomplished. : . . • '^ • ■ ** The necessity of primitive amputation is enforced by state* meats of a number of cases illustrated by examples. X. ii n ! fiURGERT. cot CASE riEST. ** Whea B limb if carried away by a ball, by the bufBtihg of a* grenade or a bomb, the moat prompt amputation is necessary. The least delay endangers the life oT the wounded.** After the battle of Lake Champlain, two cases or this discrip- tion fell under my observation. A simple dressing was applied to the ragged stump. In this situation they were brought to the hospital. The wounds, having the appearance oTbeing dressed, did not call 'i\ir first attention, when many presented, which re- quired an imrkJdiate operation ; and not being painAil, were neglected on the day or the action. The follow ing morning one was round dead, and the second having been exhausted by loss of bk)od, survired amputation only a few houiv, although he did not loose half a gin of blood during the operation. The abive cases might have been saved by an immediate amputation.. CASE SECOND. * *' When a body is projected '-^m a cannon, and strikes a limb 10 that the bones are fractured, and the soft parts violently con- tused, extensively torn and broken up, amputation should be in- itantly performed.** I am persuaded that several of the above description lost their lives in consequence of wounds received by the explosion of the magazine at Little York, who might have been saved by immediate amputation.. ••' -l \4\\\ -i^ CASE THIflD. " When a targe portion of the soft parts and the principal ves- sels of a limb are carried away by a ball, and the bone is frac- tured, amputation should be immediately performed." CASE FOURTH. ** When a large ball strikes the thick part of a Hrob, breaks the bone, cuts and tears the muscles, destroys tiie great nerves, and yet leaves the principal artery entire, immediate amputation Should be resorted to. It is rendered necessary by the destruc- tion that has taken place in the limb, and by the coucussibiL tbt^t has been given to the whole eubstauce.*' 1 ) i ii 1 ; 1 ' '[ 1. ! ■ ' 5 I I ^ T7^ w SURGERY. II r r At the engagement or Plattsburgh, Lieutenant Dunean or the navy, yiM wounded by a eaanoQ baU, which passed in a direc- tion of the acapulo-buraeral articulation. The •uperincuiBl>ent muBcles of the shoulder with part of the Hibjacent were destroy- ed, leaving a amaU portion in the axilla connected with the principal artery, which received no iryury. The acromeon pro- cess and clavicle were fractured. The bead of the humerus vrat broken, and fonr inches of its substance forced away by the trail, leaving an inch of its extreme head attached to its socket. In similar cases, Larrey recommends immediate an^)utatioB. From the destruction of the parts, my opinion was that to save life amputation was absolutely necessary. I had previously read Iiarrey*8 statement of similar wounds cured only by the opera- tion ; of which he triumphantly says, " the truly intelligent, bold and ''xpeiieoced Kun can alone know and appreciate the wonderful effects.** Lieutenant Duncan objected to amputation, saying he bad rather lose his life than his arm ; the loss of which lie did not wish to survive, via jm . ._ The fractured pieces of the bones, and ragged portions of the muscles were removed by th^ attending surgeons, Doctors Brown and Walker, after fae was removed to Burlington, distant twenty five miles ; by attentive and careful attentioa to his wound big arm was saved, and in addition to appearance, is of some use. Two >Younds of a similar description were received from can* uon balls by two seamen of Commodore Macdonough's fleet, on the eleventh September, 1814, in Plattsburgh bay Upon both I applied the first dressings. Fragments of the humerus, clavicle and acromion process adhering to the lacerated muscles were removed, as well as such puitions of the muscles as appeared to be deadened by the ball ; the end of the fractured humerus which presented itself through the wound, was removed as low as pos- sible with the saw ; the superior extremity of the humerus which remained in the socked was detached by dividing itit ligaatents. The sound muscles which remained with the skin were secured by straps of adhesive plaster in as close contact as possible, with- out giving pain ; the arm was permittett to retract to favour this contact. I^arge sloughings succeeded for some considerable SUROERr. SM time ; the patientf were supported nvith a soft generoof diet* wine in moderate quantity and bark ; and eventually recovered. A maimed arm is preferable to no arm, if only for its appear- ance. Where the loss of skin is as extensive as the wound, and little or none can be had for flaps, the cure, in the above in- stance was nearly as soon effected as it would have been had amputation been performed. Larrey exults, that by the operation nine cases out of ten will succeed. — But it will be understood, a loss of a limb and consequent deformity succeeds. Whereas I am convi. ^d that ten out of ten may be cured, where the pa- tients have good health ; the limb saved, with the small deform- ity of a too sudden sloping of the shoulder, f ,, , - ,. %, r- ^ .1 i , V . CASE FIFTH. " If a spent or a rebounding ball strikes a limb obliquely, with- out causing a solution of continuity in the skin, as often happens, the parts which resist its action, such as the bones, the muscles, tendons, the aponeuroses, and the vessels may be broken and torn. The extent of the internal injury must be ascertained, and if the bones be fractured under the soft parts, and if there be grounds to suspect the vessels are lacerated (which may be known by the enlargement, and a kind of fluctuation) araputar tion should be performed without delay. But sometimes the ves- sels and the bones have been spared, and the muscles alone have been totally disorganized. Then an incision should be made in the skin ; by this means the thick, black blood may be permit^ ted to escape, and the consequences may be predicted.** 1 t • tempting a cure, compared with the certain loss of the limb. A patient is willing to submit to extrer ^ distress for the sake of a limb, if there is a distant prospect of saving it. CASE SEVENTH. " * ' ' '' ** Has a ball or the fragment of a bomb passed through a limb, and denuded a large portion of its bone without fracturing it? In this case, although the soft parts nay appear as if they might be' saved, yet amputation is not less indicated. Yet, before a decision be made, all t ' symptoms should be attentively con^ sidered." "e ,'H}';:'"*! 5 5* * i«'a .ij4^*e>« :K"-3ia04«i-^>t'-iJ W4 It is believed the above case seldom requires amputation in the first instance, especially where the ball is no larger than one projected from a musket. It is more advisable to wait, and be governed by consequences; and d.pend upon consecutive am« putation if necessary. -^ - -. „ _, , CASE EIGHTH. ■n:,h. Larrey " adds another case in which primitive amputation is requisite ; that is, when a great ginglymoid articulation, such as the elbow, and especially the knee is opened by a cutting instru- ment to a great extent, and a sanguineous effusion takes place in the joint. In these wounds the synovial membrane, th6 liga- ments, and the aponeuroses inflame from the injury received and the contact of the air. '''}&^mymmy. m>i^m^> iHAUs^mm^^mM ** Tumefaction and erethismus of the parts soon ensue, and acute pain, abscesses, deep fistulas, caries, fever from absorption, and death follow. I have seen a great number perish from this spe- .! 1 ■^ SURGERY. 211 tiies of wound*, beeauie the operation has been postponed from a hope that the limb might be preserved." Doctor Hall, the translator, does not admit as conclusive eV' idence, the necessity of amputating when large joints are wound- ed, or the cases adduced by Larrey, " one was brought to the hospital two days after he was wounded ; and in the second, the soldier walked two miles after having the knee opened by a sa- bre. Is it then surprising," adds Doctor Hall, *' that fatal in- flammation should ensue, where p' ' os, every necessary cause is combined to produce it ? What d have been the result in these cases, if their wounds had received immediate surgical at- tention in the comfortable and temperate wards of a hospital ?" ^ A soldier of the 33.d regiment was admitted into the hospital at Burliqgton, having received a wound through the knee. The ball entered at the external condyle of the femur, just under the qpper edge of the patella, and passing obliquely downwards and backwards, made its exit where the inner condyle meets the tibia. Amputation was pro;5osed. This was olyected to by the patient. Six weeks after, this case came under my observation. The integuments of the knee joint were extremely swollen, the swellii^ extending'up to the trunk. The leg and foot were en- larged and sedematous ; pus mixed with synova issued from the wound. Upon examination, a sinus extended from the external Qtpening up under the muscles of the thigh, also between the muscles and femur on the internal and posterior parts. The capsular ligament appeared to be thickened and distended with matter. The patient, extremely emaciated, had suffered ex- ceedingly from pain. Amputation was again proposed, buthis first, resolution was still adhered to. The sinuses were laid open up from the external, and from the internal wounds ; and a more depending opening was made on the back part between the two openings. A spiral bandage was applied upon the limb from the foot to the trunk. . Afler ten days, the discharges from the sinu- ses lessened ; the swellings throughout the thigh and leg had much abated ; the wounds assumed a belter appearance. Final- ly, they healed and the limb was saved, but with a stiff joint. . f The above wound not made . by a cutting io8trumeM> was . Ill i i if I r •i hi Mm n i\\ I n "T 1-^ It ip^ 212 SURGERY. more hszardoin. The ease demomtrates that La&rcy tvas too' precipitate in making up his opinion. The following case b similar to the fast position, tvliereiB Larrey recommends immediate amputation. A soldier receiv* ed a sabre«wound on the knee, vrhich divided the common ten- don of the extensors of the leg, near its union iivith the patella, obliquely downwards. The patient was immediately put into bed, his leg extended, was largely bled, purged, and put on a Tegetable diet. The lips of the wound were immediately brought into apposition by straps of adhesive plaster. This wound was cured by the first intention without suppuration* In many cases it is diflScult to determine, most correctly, whether it is best to amputate immediately, or defer it, to see if the limb may be saved— ^and if it oannot be saved, to operate at a future period. When an opinion is formed that the chance of saving a limb is greater than the risque of losing life by defe^ ring an amputation until an experiment is made to save it — to defer the operation is proper. While taking this into consideration, due weight should be given to all the circumstances which may tend to promote, re- tard, or prevent a cure. '• ' When a case is of such a nature as would render a cure dubi- ous under the best attendance, and most eligible situation— t symptoms were passed, were followed \\,ith success. Three were made by myself between five and seven weeks after their wounds were received, all of whom recovered. The amputa- tion of these was delayed in the first instance, in expectation of saving the limb ; but unavoidable exjiosures. On board transports^ to wet, and motion of the vessels during a storm of several days, rendered am|)utation necessary after the wounded were landed on the Niagara. I also performed an amputation at Lewistown» uiK>n a Canadian volunteer, belonging to the corps of Colonel WiiiCox, twenty-one days after the wound was received, with success. rri'/. ■','/ *■::■■ ,{ \ ; ', ■■■■■. . . A musket ball shattered the femur about five inches below the great trocanter. This man remained with his corps and was attended by its surgeon, until the rlay previous to the operation;, when hfe was received into the hospital at Lewistown, extreme- ly emaciated and debilitated^, with total loss of appetite. Sinu- ses were formed down the thigh its whole length ; the leg waa also extremely swollen and «ederaatous. In order to avoid a »i- 28 i i T i': 1 1 il iji 1 : li|i i, h 11 1 4\ M: II '1 ';7 V 214 SURGERY. n nus running up, the amputation was made as near the trunk as possible. The first six days his case was doubtful. In conse* t]uemce of great distention of the lymphatics, large discharges from their open mouths, followed the operation a number of days. " ^ter which his appetite was restored ; the wound was entirely jaled in five weeks. I performed an amputation in a similar case, at Plattsburgh, upon Williams, a soldier of the 10th regiment from Virginia. This man was admitted into the hospital twenty- three days after the wound was received. The ball fractured the femur half way between its articulation with the tibia and the great trocanter. The thigh and leg were much enlarged ; an edematous swelling extended to the groin. Sinuses were formed through the muscles of the thigh in all directions — so that it was necessary to make the amputation as near the trunk as possible ; and then it was discovered that a sinus continued up above the place of incision. This man's ivound healed com- pletely, and he was on his crutches in sixteen days after the op- eration. When a wound is of such a nature, that, from the first, no cure mny be calculated upon, no delay for the first symptoms to pass off should be admitted ; an amputation should be immediately performed. It is acceded to by all, that the primary symptoms of a wound, which'requires amputation, are more severe than those which succeed primitive amputation. Wherefore nothing is gained by waiting until the primary symptoms are over, but much is hazarded. The patient, convinced that amputation is necessary to preserve his lil^, has less hesitancy to the immedi- ate operation, than the consecutive when it becomes necessary. I have seen cases, where an amputation, performed immedi- ately after the wound was received, might have saved life ; and where the same limb might have been preserved by suitable means ; and life eventually lost by neglect of proper manage- ment. Instances like these should not be brought as examples to demonstrate that delay was improper ; they show the neces- sity of applying the means of cure most assiduously ; and where these means are not at command, no delay of amputation should be permitted. m SURGERY, 215 Larrey mentions four caset where consecutive amputatitu it> required. " ^^,, :.rV:"„.'> .'•3.:> ;■..- >■; ';M'i '■... CA8E riRST. '^ ^ -■,{.'■( .1 ;„. :% •' When there is mortification on a limb ; " if gangrene be trau^ matic, no time should be lost in removing it above the sphace- lated part The amputation will succeed, when the deleteri- ous principle has not been copiously absorbed. There are ma* ny facts to support the doctrine." , , ., . ., .. ,, , . EXAMPLE. •V ihia Report of a Case of Amputation, by J. B. JfHJTRIDGEy M. D. Hospital Surgeon's Mate, non a resident in Clmrleston, Souths Carolina. *' Sir — Permit me to offer you the following report of the case of James Parker, of the 13th regiment United States' In- fantry^ belonging to Captain Paige's company ; who was wound- ed at Sandy Creek, and received into the general hospital at Sackett's harbor, on the 11th of June, 1814. ,y , ;,'. . ,.; " This patient was wounded about six days previous to his be- ing sent to the hospital, and received little or no treatment dur- ing that time, not even the common attention of nursing ; of consequence his case was a very,unfortunate one. " I feel peculiarly interested in this case, as it is the only fatal case of simple amputation, which has occurred to me in the course of an extensive surgical practice, during the present war. " A common musket bull, of nearly one ounce weight, and three buck shot, entered upon the inside of his right leg, near the edge, and at the superior portion of the gastrocnemius muscle. They passed in a direction obliquely upward, through a portion, both of the tibia and &bula ; the ball and two shot made their exit at the articulation of those two bones ; extending the frac- ture into the articulation of the kaee joint. , <{ " The fracture was very extensive, and several large portions completely detached, while a large mass of the bones were re- duced to very small fragments, approaching even to powder. " When this patient was received into the general hospital, from Sandy Creek, transported by land, a distance of eighteen 1 I I , I- 'I ;l) i i i ■^'1: IN I l; / ', 210 SURGERY. ! l^ ^ miles, his leg wns in a state oT comiilete sphace]at!oD, na high ai the wound. • ", > " From a history of llie case, It appeared that there had been mnch hemorrhagy from the vroiind in the first instance, and dur- ing the first day of the acciiiont ; from this circuinatancr, and from the course of the ball, it is probable the peroneal artery, or perhaps the tibialis postica, was wounded ; which, however, was not particularly demonstrated after tlie operation. " On the first day after his reception, carbonic acid gas, was applied, in the form of a fermenting cataplasm to tlie whole limb. Baric, (cine, ofls.) wine, and opium were given him. The eve- ning following, a tinct. meloes vesicat. was applied to the gan- grenous |)art, and the fermenting cataplasm re-applied over the whole, with the hope of restoring the heat and circulation ; but In vain ! — The barlt, wine, and opium, and the fermenting poul- tices, were continued until 4 o'clock the day following ; when a consultation was called. Four hosnitul surgeons, and a number of other medical gentlemen, both of the army and navy, being present, (from the declension of his health,'^ and urgency of the symptoms,) an immediate amputation was agreed on, though under circumstances, not the most favorable. ** The inHammation and swelling about the knee, and along the muscles of the thigh, having measurably abated, and the progress of the mortification being checked— circumstances, which ^vere thought to warrant the operation ;> the lim'i was amputa- ted about five inches above the knee joint ; the skin below the place of operation, having a somewhat Hvid appearance. ** The whole thigh still considerably swollen,^ and the integu- ments and muscles very rigid. After the integuments were di- vided, and the flap dissected up with a scalpel, the swelling and rigidity were such, that it was with much difficulty reflected. " It is remarkable in this case, that the muscles when first dit yided, shew very Httle disposition to retract. * See Dorset's Surg. Vol. 2d. p. ?46. .:»,.. ,- • * YMe Mr. C. Bbil's Oper^t. Surg. Vol, 1 at. p. 2T0, 1 SURGERY. 217 *' I performed this operation hj tlie triple incision, (something in the style of the celebrated M. Loui8,t a French surgeon,) in the manner mentioned l>y Mr. S. Cooper^ and recommended bj Doctor Warren, jun. of Boston. " Very little, however, was gained by (his complicated mode of operation in this particular case. The superficial muscles, though first divided, retracted so li'Me, that perhaps not more than a quarter, or three eights of an inch was gained by this sec- ond incision : by the third incision the dee[) seated muscles were divided, and (he retractor applied without much effect, in conse< quence uf the inflammation and swelling of the muscles, at the place of operation. .,;..,,. " The bone was sawed as high as possible, with the ordinary retraction ; this, however, was very little above the division of the deep seated muscles. ** After the ligatures were made upon the bloo<1 vessels, the edg- es of the wound were placed in contact, which fit very neatly to- gether, so as to form only a longitudinal line ; and secured in that situation by adhesive plaster. The stump was then dressed, and the patient placed in bed. He rested very well the night follow- ing, and appeared to be very much relieved by the operation. " The local arterial action for the first two or three days after the operation, was inconsiderable ; but the general action some- thing above the healthy standard ; so that he would bear no stimulus above his ordinary food, and for that he had not much appetite. ; " On the fourth day, in consequence of the bandages becom- ing foul, it was thought advisable to dress it. On removing the dressings, it was observed, although the lips of the wound were perfectly in contact, no union of any consequence had taken place. As soon as the adhesive straps were removed, the lips of the wound fell immediately asunder : no granulations had formed ; suppuration had not taken place ; the muscles were shrunk and contracted, and had assumed a pale and almost col* I 1 m'l. . t 1 ' 1 . ji, 1 1 t i 1 1 t For his method consult Mem. de I'Acad. de Chirnrgic. I Sec Cooper's First-Lines, p. 426. ! ■' h i £18 SURGERY. y HJU) . J ,. t • ' r ! i. L. .ourless appearance; but which was pre-eminently thecaieat the subsequent dressings. There seemed to be a want of action in the par'** ; as it afterwards ap^teared, there was not action sufficient to excite adhesive inflammation.* .mri./tvT'<*(7 m^jim *' By the medical gentlenion present, this first dressing wan thought premature : had it not been dressed so soon, perhaps ad- hesion might have talcen place. The parts were then placed in contact, and the dressings applied as before. Cine. ofi*. was administered in as large quantities as the stomach would bear. As much wine was given as the patient could be made to take» and occasionally a few draps of the tinct. opti. " By the advice of the faculty, the dressings were not again re- moved until the Aiird f day following ; at which time it had be- come very foul. On remov' ^g the adhesive straps, it appeared no union had taken place ; the lips of the wound fell immediate- ly apart as before : no granulations had taken place from the bot- tom, and very little suppuration. The muscles had contracted still more, ai>d left the bone quite bare;| they were shrunk and pale, and indicated a total waqt of action. The stump was thor- oughly washed with a strong solution of soap. Bark in powder was then introduced in large quantities, into every part of the wound, to endeavour, by its co-operation with the stimulus of the soap, to excite it into action. The parts were then place - io contact, and the wound dressed as before. *' At this time diarrhoea supervened, which occasioned the use of an additional quantity of the tine. opii. " The anorexia and debility increased. Nourishing food was given him — such as rich soup, milk porridge, panada, &c. in such quantities ^,s he could be made to take. Bark, wine, and lauda- num were also continued in large quantities. )->r.vffo» ui\'.U)^'.'vi *' Tuesday, the 21 st. It was dressed as before: medicines continued — had the patient sponged all over with St. Croix ram, and the stump frequently wet with it — substik "ted milk- puncb, instead of wine for common drink. The patitat now be- » See Bell's Operat. Surg. vol. 1st, p. 246. ;,v.: • ,,- , . . •„; 1 ' t See Dorsey's Surg. vol. 2il. p. 251. : t/n. X Vide Bell's Operat. Surg. vol. 1st. p. 290, Amer. E& . , T^ SURGERY. 21d came lomeii^hat lethargic and ttupid, with a slight diieccea. Though restUss and uneasy, from the time of the operation, com- plained of It.) |>ain t:i his leg, but pain in his Iwcic and hips Trom fatigue of lying, and would frequently roll from side to side, re- gardless of the stump ; instead of resting it on the pillow upon which it was placeil, would suffer it to hang without any support^ or lie any way he happened to turn. •'' i- -nl' . 'icmKli' •• '* Wednesday, 22d. Though the integuments covered the bone handsomely, the muscles had retracted so much that it was evi- dent a cure could not be effected without a removal* of a portion of the bone, either by a natural or artificial process. The pro* cess of exfoliation is so tedious, that it was thought advisable, to remove it by means of the saw. The crurcus muscle was re i i ^'SackctCs Harbour, June 2%ih,\Z\A.'* :'.)■! The following cases of gun-shot wounds, where the opeAition was delayed to preserve the limbs, and a consecutive amputa- tion became necessary, is here detailed at full, as reported by hospital surgeon's mate, March, to show, that in similar cases, immediate amputation should be made ; as well us to describ-j the feelings of a young surgeon, when performing his first am|>u< tion. "Jacob Blutit, a private inCapt. Van Vechten's company, 23d regiment, 24 years old, in the action at Sackett's Harbour, 29th May, 1813, received a grape-shot in his leg, which shatter- ed the tibia and fibula. It soon inflamed and became much swollen. Clolhs wet with diluted spirits were continually ap- plied. By thv; fourth day the limb was so much swollen as to induce Doctor Trowbrid^c to make several incisions through the integuments, from just below the knee to the ancle. Af this time mortification had considerably progressed. The leg assumed a mixed colour of yellow and purple ; the cnticiila >Ya!« SURGERT. 221 t&UcA In smnil blisters. The Irt; and IhiKit vrcre contlnualljr wet with told rum nnd watrr, until the tenth oT June, when the mortincntion hnd censfd. Innairtmation hud disappeared from both le;; and thiKh so munh, that an amputation was determined U|>on. U|K)n the lllh of June I performed the operntion in the following; rannner just above the knee. I gave the patient, 30 minutes before the operation was commenced, two j^rains of opi- um, when he was placed on a hi^h table. After the a|);dica- tion of the tourniquet, Docttor Trowbridoe, my operative as- sistant, grasped the thigh with l)oth hands, and kept the integ- uments steady, while the first incision was m;ide down to the fascia { ofter which he retracted the integuments as much an possible, while 1 dissected tiiem up from the muscles with a scal- pel. Having dissected the skin with the cellular substance about an inch and half up, and turned them back on the thigh, at this point, I made a second incision with a steady and firm stroke of the knife around the thigh down to the bone. [Note. It re- quires considernble strength and firmness to carry the knife through the thick musclos and firm tendons^ at one stroke. If we are not aware of this, we shall fail in our first attempt. At the moment the incision is made, the vl..jus and arterial blood gushes out in such torrents, as to alarm the young surgeon, per- forming his first amputation, fearful that the tourniquet waa not sufficiently secur?. But soon I found the blood t8sue ' m 1 \'l i hesive straps had not adhered with sufficient Torce ; the lips of the integuments had separated to the distance of an inch ot more. New strips were applied, and the lips brought together as near as possible without using force. This man was after- wards dressed by others, and confined in a room with many, both wounded and sick with typhus. He, in a few days, was also seized with the fever, and died in about thirty-nix days after the amputation. -■ f^'J- s-'-'^rf^^^^- ■- >■ '■■■".>■■!: . .:, :vi *: '^ - " Had this patient been removed from a foul, crowded hospital, as soon as the limb had been taken off, and received that atten- tion his case required, there is little doubt but he would have re- covered in a reasonable time. But, without charging the sur- geons and nurses with negligence, it is not to be expected that 160 wounded men could receive every necessary attention which their sufferings deow-aded." .,V-'vi ■■...".a -J- J.. V r^-, ,■ :■.;„ REMARKS. ,,..'■ This case was attended at Sacketfs Harbour, where the au- thor was not at the time. He has heretofore observed, that no infectious disease was generated at those points where he per- formed duty. The above patient, agreeably to the statement, ?ost his life in consequence of being placed in a foul hospital. If an hospital is foul, no persor. but the director can be censured. When patients die in foul hospitals, the surgeons are as culpa- ble for their deaths, as if they had been improperly treated by medicine or wholly neglected. A foul hospital is no excuse for want of success in practice. The following case reported hy hospital surgemi's mate March. Upon the 6th July, 1813, Simeon Grant, of Castine, Dis- trict of Maine, a sailor belonging to the schooner Scourge, on Lake Ontario, comjianded by sailing-master Osgood, being in a saw-mill, his hand was caught by the saw, and was separated at the wrist joint, the carpal bones were torn asunder by a stroke of the saw ; no hemorrhage succeeded. An immediate amputa- SURGERY. G2fJ lion ivas performed about half way between the wrist and elbow, by semicircular and angular incisions ; their angles meeting on the outside of the ulna and radius. The dressings were remov- ed th« fourth day ; it was not fcKind necessary to remove the ad« hesive straps until the day follow ing, when the lips of the wound were nearly in contact, and the integuments united by the first intention. After the 6th day the ligatures were solicited, but were not removed until the 12lh and 15th. In four weeks th9 cure was finished. ^V'^rt7 REMARK. ' , t Union of the integuments, over the stump of an amputation, succeeds immediate amputation more frequently than consecu- tive. • yj,, (^(f/ft^, >ffr.;»t^ r\«f;vf,r( ^■'■i^^j ".^''♦'»'^v*)^!*v»w-»7 /^jf^ ',^*ifti CASE SECOND, .tftlf^ff^^ti ■■■iitnf'--f'^i. . tr,\i When there is a convulsive spasm in the wounded limb. " If a limb be amputated as soon as tetanus appears, all communication between the origin of the disease, and the general system is cut off. This division removes the nervous pain, by separating the local irritation from the rest of the body ; if this is performed before the general system partakes of the diseased mobility of the muscles, caused by their sympathising with this wounded part, tetanus will be obviated, iu^t if tetanus has become general, it is doubtful whether amputation will succeed to remove the spasm. The momentary pain produced by the operation, cannot aug- ment the enlisting irritation. The pains of tetanus, over-balanc- ing those which arise from the operation, make it more support- able, and diminish the intensity of pain, especially when the nerves of the limb are strongly compressed." . i^r^ During the campaigns, no instance c tetanus, either from wou ids or any other cause came within my observation. CASE TUIRD. "^ViHaled suppuration. — It often happens in gun-shot wounds^ complicated with fracture, that ip opposition to the best directed care, suppuration becomes putrid, and the bony fragments are '1 1; i 1 ; \\ I 11. I i; lii' I 1 : \ ^?i \ < 1'! ■> -v, 224 «URGERY. If 1' » li enveloped in pus, ant) have no dispoeUion to unite. Hectic fever and colliquative diarrlioea weaken tlie patient, and in this extre- mity amputation has saved his life, and by removing the source of matter absorbe/d, the above evils are obviated." The wound, from being complicated, becomes simple. The system recovers froi.i its languid state, as soon as causes opposed to healthy ac- tion are removed." I have witnessed cases of the above descrip- tion, where cures progressed astonishingly quick after amputa- tion was performed. ■^' -inii i-.^j: . i . Gun-shot wounds of the thigh, complicated with a fracture of the femur, may, in most instances, be cured by the immediate application of Desault's splints, constructed for extension and counter-extension of the limb. Doctor Physick of Philadel- phia, has improved Desaui.t's plan. Some within my knowl- edge have had their limbs saved by them ; while many have not only lost limbs, but Uves for want of their seasonable cm ployment. - ■ ■■"■■'■■ . ..; •»n H« .'Mr'nfc •^i !•). Cm orn:' •.;! i'r:;i * CASE KOURTU. " • Bad state cf the stump. — The cure of stumps is arrested by fevers, and exposures to cold. Subsequent to the battle of Little York, the wounded were exposed in tents, on the Niagara, in the rtionth of May, wanting warmer accommodations. The integu- ments preserved to cover the surface of the stump, did not unite for want of adhesive inflammation ; large vitiated suppurations, a retraction of the muscles round the bone, which left it project- ing beyond the surface of the wound, from one to two inches, supervened. These projecting ends of the bones were amputa- ted. The cures of several were retartled by exposures to cold and unhealthy situations. After the sick were removed to Lew- istown, the weather became more pleasant ; the wounds assumed a better appearance and finally were healed. We coincide with Larrey in opinion, that " under any cir- cumstance, amputation should be the last resort. But when there is a decided necessity for performing it, there should be no hesitation nor delay. The operation should be performed be- fore the iiivasioo of the primitive syroptonis. If they have tak- 1 1- I nil SURGERY. 225 ea place when the sargeon is called to the assistance of the wounded, he should wait until the (irst inflammation is removed.** Larkey establishes it as a principle, where a ball has fractured the femur at the condyles, to perform the amputation immedi- ately. Wounds of the thigh with fractures, are always danger* ous, and if not immediately secured in a state of extension by Dbbault's or Physick's method, the limb cannot be saved. Where the radius is shattered, and ulna fractured near the eN bow, Larrey divides the ai>oneurosis, removes the splinters, and dresses the wound with a view to preserve the limb. All sphacelated limbs in consequence of gun- shot wounds, as well as extensive lacerations, require immediate amputation. Gun-shot wounds through the trunk, are not always necessari- ly moKal. Men frequently survive wounds through the lungs, by musket balls and the bayonet, also through the abdomen. It cannot be always ascertained to what extent a viscus is injured ; whether an intestine or an important blood-vessel is lacerated. When either of these last have taken place, the event will soon determine. But in cases where the membranous coverings of the viscera are only wounded, and the extreme danger arises from consecutive inflammation, the intention is to obviate its excess by liberal blood-letting. A ball passeu through the left lobe of the lungs, the man fell on his face, and fainted from loss of blood. His position on the ground favored the egress of blood from the wounded chest. After two hours, he was found with scarcely the symptoms of life, was taken to the hospital and eventually recovered. In this case, there is no doubt, the ex- cessive loss of blood was a cause of recovery, by obviating high inflammation. Repeated instances of similar cases may be re- lated, where wounds from the same cause had a favorable termi- tion. The more blood exitended the better, in wounds of the viscera, provided life is not exhausted, when hemorrhage is stopped. lit' ' n^.rt t tj*! ,<..-.) , i'-. ■ ,. \ }i t):j ^xi ;.-■ . A soldier at Greenbnsh was wounded by a bayonet, which entered the left of the spine, i)assed through the trunk below the diaphragm. This man was attacked with puking, and sufiered extreme pain. He was bled immediately j the operation was ii 1 Ir ( r i'J.! !, ^!| 1 ■ 1 ' 5 '11 :i t ■■! ; i: n u/ f i'.\ .M(eia:iilm' 'I I If I .1 I ^ u .i I; hi i; % V iit 228 SURGERY. I' » 'm H not obviated by emollients. The swelling commences vihctf. the bone is fractured. When the swelling is not remedied by permanent extension and spiral bandages, extensive sinuses are formed between the muscles ; which demand amputation of the limb to preserve life. Physick's improvement on Desault's method of extension Und counter-extension in compound fractures by gun-shots, obvi- ates many unpleasant symptoms. By this support, the fractured extremities of the bones are preserved in their natural position ; irritation, a cause of inflammation, extensive suppuration and deep-seated sinuses are obviated. Extension and counter-exten* sion obviate the contraction of the muscles, which shorten the limb, when a portion of the bone is destroyed and removed. Where there is no loss of bone, with a diagonal fracture, by means of Puysick's splints, the limb may be retained at its full length; while pain is mitigated, as irritation from the sharp ends of the bones is prevented. Too many attempts were made to preserve a limb, in cases of compound fractures, without the use of Physick's splints. It was urged by those opposed to the method, that extension could not be endured by the patients. To my knowledge, their conditions were infinitely more tolera- ble with Physick's splints than without them. At the com- mencement of the war, only a few surgeons of the army had witnessed their benefit. Time and experience were necessary to remove prejudices. Physick's improvement is to be prefer- red to Desault's ; the extension being completely under the command of the patient. A surgeon may operate well, still he may not be a proficient in his art. After an operation, if he is not well acquainted wMh the animal economy, he cannot cure the wound. A clean wound upon a healthy person will readily heal by retaining it? sides in contact ; yet a different practice is necessary, or more is required, where the constitution is impaired ; a knowledge oC which is only acquired by inspection, and practice of dressing. Scientific sui^ery is so intimately connected with a medical ed- ucation, that to be a proficient in the healing art, he should be a practical surgeon. By practical surgery — an attendance on 1; ! SURGERY. 220 Iresring* of ivouncis am) ukersy the nature of the living body ii mora thoroughly investigated, and habits and temperaments more correctly acquired. Extpmal inflaramations, with their most suitable treatments, lead to a knowledge of internal aflbc- tiooa of a similar nature. As much information may be gained of the tnternal states o£ the human body by the appearance oS ulcers, as by feeling the skin and pulse. The effects of extern nal applicaitionB are allied ta internal. Practical surgery famil«' iarizes us with the active principles of life in all temperaments. More attention is often paid to o()erative surgery than to scien^ tific Some ulcers require stimulant applications, ^hile otherv demand emoUients. This knowledge is only acquired by prac- tice. An amputation may be wcil pciformed by one little skif- led in medicine ; while to cure a wound and preserve a limb re> 4|iure the talents of the most experienced practitioners. To become a good surgeon a man must be a good physician. These professions are inseparably connected: The aspect of a wound frequently points out the state of the body, and indicates thei most suitable remedies. A correct method of practice is found- ed on practical facts and observations, not on speculative opin" ionSk Tlie first are stal)le, the last fluctuating. Experience di- rects our reason, and impresses on the mind flicts, in a mannei! which language cannot. Curative indications are founded upon an acquaintance with the laws of animal life both in health andk disease. In cases of wounds, to form an (^linion how they will terminate, more depends on the habit of the body and part in- jured, than on the application of a dressing. Upon a robust patient, an inflammation will supervene proportionate to the in- jury done, or other concomitant casualties ; upon one weak anA feeble, a wound may be succeeded by spasms and convulsions. These morbid dispositions are to be obviated by different and^ opposite remedies, known only to the practical, scientific sur- geon. In incised wounds where the skin, cellular membrane and muscles are divided, it only requires to bring the divided parts in contact, and secure them in that position by straps of stick- ing plaster, with a pledget of any mild soft ointment to exclude the air ; when, if the patient is of a healthy habit, u re-union of 30 I 'I 1 ! i| J 7 JW^ 2^0 eURGERY. r -t ii •I? Ihe divided parts will follow, and in a Tew days he will be cured by the firat intention. Here inflammation only sufficient to eF- feet adhesion takes place between the sides of the wound. But a bad habit of body, or irregularities of life will prevent this ha|i> py and speedy termination of the wound, and will require such medical treatment as ap[)earances may indicate. Where there is much inflammation, bleeding and emollient applications are demanded ; perhaps cathartics, as neutral salts, or castor oil, as well as antimonials. Where there is debility, tonics and stimu- lants are necessary. An incorrect practice of securing the sides of divided muscles by stitches or sutures should be avoided^ when a few strips of adhesive plaster of linen will better fulfil the intention, without causing irritation and inducing inflam- mation and pain. A suitable application of plasters and ban- dages will generally secure divided muscles in apposition ; and even where wounds are contused and lacerated by blunt instru- ments, a retention of their sides in as close union as possible by straps of adhesive plasters, obviates great suppuration, and ex- pedites their filling up with new granulations, and accelerates cicatrization. ' > It has been already noticed in the preceding sketches, that many soldiers, after their passage down lake Ontario and river St. Lawrence, were afllicted with edematose swelled legs. In many instances, the swellings were accompanied with both fun- gous and callous ulcers ; the consequence of long exposures to cold, wet and inclement weather ; also, a want of exercise of the lower extremities while on their passage down in open boats, confined on their seats ; supported with coarse, and in some in- stances damaged rations, irregularly administered, or after long -iods of abstinence. Under these circumstances a small scratch soon enlarged, and by frequent exposures in water, deteriorated to a most formidable ulcer, in extent from six to twelve inches up and down the legs. it' . ' The following treatment was adopted ; — after the ulcers v/ere washed clean with water, in which a little soap was dissolved, adhesive straps were ajoplied across them so as to support the pendent muscles on tJie side opposite, as well as the integuments \'A SURGERY. 231 at tite iimi^in or the ulcers. Over the straps was applied dry lint, instead or pledgets armed with ointment. To remove Tun^ gosities, the nitrate of silver was applied ; and when the ulcers shewed little, or no disposition to granulate, the surface was oc>- easionally stimulated with mere, precip. rub. Over the whole dressing was applied a s|)iral bandage, commencing at the toes and extending above the knee ; and where the swelling had ht- tacked the thigh, the spiral bandage ;vas continued up to the trunk of the body. Cathartics were occasionally administered^ When the ulcers continued ill-conditioned after the above means were eniydoyed, the chinchona was directed to give tone, but seldom with any benefit excepting in cases of sphacelus. A laudable digestion and healthy granulation was better promoted by calomel in small doses. When the patients were restrained from ardent spirits, and confined to a milk and vegetable diet with light soups, their recovery was astonishingly rapid. Dur* ing the winter 1813 — 14, there were in the hospital at Burling* ton more than one hundred of the above described cases. The following case o( anthrax admitted into the hospital at Malone, is worthy of being recorded in detail. A small swel- ling appeared immediately over the vertebrse of the neck, equi* distant from the occi|>ut and the first dorsal vertebre, not unlike^ at first, a small phlegmon, but as it progressed it was character- ized with marks essentially different. It commenced with shoot- ing pains through the tumor, whicb at first was red, and after a few days livid ; when were noticed upon its surface small vesi- cles filled with a thin yellowish matter. The tumefaction con- tinued to extend from its centre to the circumference in every direction. When the vesicles burst, the subjacent (I rrotn ita epQ. Ire to 4b« eircumference. This patient when admitted into tiie hospital at MalAiie «nt extremely enaoiated and detiilKnted. The «ynBputbetic fever, which ufually accornpaates pbief^aonotn iufliimmation did not exist ; the tongue vrna dry and of a dirty yeliuw. A soft iiutri« liout diet with wine was preacrilied during the first etate of the diaeaae. A* emollient |M)uUice of the hark of slippery elm was Upplied over the swelling. On tlie fourth day Ofifienred the 0OiaU vesicles.; on tlie ftfth tlie chinchona with an increased quantity of wine was directed ; on the eightli day the twnor was iphacelalee procesees of tlie verlebre of the neck. The dreesings of bark were continued a few days, until new granulations were seen rising from the surface of the wound ; -when the usual dressings of lint and a pledget spread over with cerate were applied. As the wound filled up from its base, it contracted in its dimensions, and in a few weeks wae red jced from a deep, ei;ten8ive, fetid, gangrenous, to a healthy, saperfi* cial ulcer, the size of half a doUar ; and was, a short period after, eompletbely eieatrieed. A sokUer, Brown, was admitted into tli« hospital at Lewislown in July, 18)3, who had previously been reduced by fever and diarrhoea. When admitted, his extremities and face irere extremely emaciated, and his abdomen UMjch swollen and tense. It was, on first inspection, apprehended that the swelling was dropsical. From his general emaciated appearance and ex- treme debility, it was believed he could survive but a few days ; and not being a subject for active medicine, the only indication, jvhich bis miserable condition pointed out, was such support as SURGERY. 233 foft nutriment and wine, with opium to procure case, miglit ar> ford. After tliree weelcs tlie attending sui^'eon, to my nstonisli- ment, reported liim still living ; when he proposed to perform the operation of paracentesia on the abdomen. At this period being confined to my tent, and not having seen this patient af- ter the first examination of the case, the operation was perform- ed in the presence of no surgeon. The following day upon en- quiry, it was learnt that the opening was made in the region of the liver ; and that a discharge of pus followed the o|)eration. The patient still lived ; at the expiration of three weelts tho case waa examined by myself, when it was very evident that the trochar not only penetrated the parietes of the abdomen, but in- to the cist of an abscess ia the liver ; the discbarges from the opening had gradually enlarged the external puncture to the size of an inch and quarter in diameter. Notwithstanding all the unfavourable circumstances of the case, the general health of the body was improved ; the appetite was better, the stomach waa capable of receiving more nourishment than at first ; milk being the principal diet. Now bark and wine were administered with good effect. His health continued to improve, so tliat he waa able to leave that frontier. The winter following he was seen either at Greenbush or Burlington hospital in a good state of health ; the 0[>ening into the liver having entirely healed. l!» •I rwf •'. t OF HOSPITALS. The eocial affections have enlarged their sphere or operation, B8 the arts and sciences have progressed. No longer confined to a small circle, they embrace not only nations, but the human race as one family. Dissentions and their bitter consequences arc nevertheless excited between nations. As in the small fam- ily contested interests engender strife ; so in the large, conten- tions more extensive and permanent are productive of destruc- tive warfare, merciless devastations and a miserable waste of hu- man life. In proportion to the value, a people estimate their property and privileges, the defence of them will be sanguinary. The most valuable of all possessions are liberty and independence. In support of these, the lives of thousands are sacrificed. To maintain these, wars the most vindictive have existed. Still under the highest excitements of inflicted injuries and violated rights, the soothing influences of civilization ameliorate the evils attendant on these national calamities. They render the con- lion of the conquered less severe, as they soften the ferocious temper and disposition of man. Uncivilized man inflicts upon his captive tlye most dreadful tortures, or death. If, in any instance, life is preserved, it is to aabject him to ignominious slavery. The sick and wounded prisoner never excites a feeling of compassion in the breast of his savage conquerors, but is generally doomed to sufiier. The wars of civilized nations to the conquered are less dread- ful than of savage. To become a prisoner to the first is not the Wor ' \ evils. The captive soldier is uo longer viewed 9» an HOSPITALS. 335 tjhpmy. He recclveB from the victor every uttention which hu- manity (lictAtei, nnd circumBtances allow. The healing halm \» a|>|tliutl to his wouiuIb, and his diBpirited heart is revived by the cordial draught. Instancea, however, there have l)een, where the conqueror, diveating himseir of the fine feelings which char- acterize the human heart in civil society, has satiated his thirst for revenge, by inflicting misery and distress when the fortune of war has placed his enemy in his iKiRsession. Crimsoneit with tlie blood of a defenceless prifoner, the victor, although «>dut ated in civil life, is but a savage. • '■ In ancient wars pestilence and disease were more destructive to armies than the sword of the enemy. Ignorant of their caus- es, the Gods were believed by the multitude the immediate, or secret agents of pestilential calamities. To avert their mortali- ty, prayers and incantations were resorted to, instead of more appropriate measures — cleanliness and ablutions. Prophylactic means were neglected ; putrid gasses, mofitic airs, and marsh miasmata hud do place in ancient nomenclatures ; while urmies were wasted by diseases, generated by them and their own tilth. In proportion as superstition has yielded its influence upon the mind to general science, so have philanthropy and benevolence Iirevailed, and human calamities been overcome, or their causpi obviated. Medical philosophy investigates the disease, and points out its preventive and curative means ; while ingenuity is called into action in war, to furnish the instruments of human de- struction. In modern times, systems of military operations, plans of at- tacks, and methods of slaughter, are not the only preparatory measures for warfare. Accommodations for the sick and wound- ed of an army, are among the first considerations of military ex- peditions. Hospitals are established, to which a medical staff is assigned, distinct from that immediately attached to the line of army. The medical department is not its least important appendage, and when well appointed, may, by its efforts, ensure strength, and give energy to its movements ; not merely by attention t© i| III I' I? :)l ': I - 1! ,ii ■'4' hi l^ ^ 1 I, 'ill t)0 HOSPITALS. the sick and ii'ooBded, but by recommeiiding prccautionarf meMure», to seciwe to the soldierj* health, and obviate diteaaesy to which, in the teoted field, men are aubjectedi. The good of aervice requtreft tliat the medical staff of an army be not only well a|;H>o^"t®(l> ^ respected by the effieen of the line. Without due respect* advice, given by surgeons however correct, will not be regarded, especially by young inexperienced officers. Invested as they are witii authority* they often affect to despise counsel offered by surgeons; who, under the present establishment,, have no rank nor command in the army. The « ledical department will uever command that degree of confidbtM^e and respectability from officers of the line, necessary to promote its greatest usefulness, until it ia more immediately protected by government. It was frequently the case, during the war, that commissnoned officers, of inferior grades, intruded themselves into the hospitals, without consulting the attending aui^eons, and without their knowledge ordered out of the wards the convalescent men ; and when detected in such anmititary conduct, justified themselves by claims of superior rank. Offi- cers commanding regiments, who had been long in service, were guilty of similar misdemeanours. Interferences of this descrip^ tion, at the commencement of the war, were extremely vexatious to the surgeons. In one instance, a Colonel ordered lv» Quar- te^master to take possession of barracks already occupied by the sick, who, weak and infirm as they were, left their beds, and preferred to expose themselves without doors, on the ground, to being crowded and overrun by healthy rude men. At another time, a sergeant regularly appointed to perform the duty of Stew' «rd in a hospital, was, at the moment ef making issue of stores to the sick, taken from his duty by a file of men under anns, by an order from tlie Commandant of bis regiment, for tite allied crime of neglecting to join his regiment, upon his order. Irregularities like these were remedied only by a special order of the Commanding General. Whereas, had the surgeons been invested with explicit and distinct powers, in their own de- partment, and these inserted among the rules and regulations of the army, troublefome^ collisions w^d have been Avoided. f ^^ f ill- !'■* t' HOSPITALS. 231 That the medical staff of the army was not respected in pro- portion to its importance, was evinced by facts whicii are Bof justifled upon any principle, civil or military. They were en< gaged in more unpleasant rencounters with officers of the line, than those otficeiti were with each other. As many of the sur- geons of the army s!«cri(iced their lives in support of what was falsely called their honour, as of commiseieoed officers of the line. These fatal evils occurred at periods when medical assist- ance was most in demand. >, ' ' ♦ >*<•■■>' ' . ii*»< V The first transition to which a recruit is exposed, when hf quits domestic employment for a camp, is a change of diet. Vegetables, excepting bread, are not a part of hi? ration. The meat allowance is more than he requires were vegeti*bles made a part of his ration ; and where it might be ccavenient to com* mute a part of the meat for beans and peas, U would conduce to Ms health. But, in active services, the proposed conmiutation would be impossible, as the transportation jf animal food, being less bulky, is le.s expensive. The beef ration of an army^reo quently travels with the troops. A change of lodgings from dry houses to tents, exposed to at- nospheric damps, and evaporations from the ground, predispose men to disease, by obstructing perspiration. This, in some de- gree, may be obviated by woolen shirts, at all seasons, on the north-western frontiers. ,• - •. ,;, ^ . ^ The sick and wounded of an army, wlieu suffered to continue with their corps, impede military operations. It has, on this ac- count, been found expedient, in modern wars, to select some convenient post for the establishment of hos[Htals. Positions not too remote from the scenes of action, nor where they may be exposed to depredations of an enemy, should be chosen. A cultivated country, where m'^'\ could be procured, as well as vegetables, is preferable to towns, or thick settled villages. The situation of hospitals should be at such p ints, which least inter- fere with extensive military movements of an enemy, and his opposing army. Although, agreeably to modern warfare, hospi- tals are respected by an enemy ; yet, established within the com- pass of active movements of armies, they are exposed to be de*- 31 I m la i'l «// ■>pr* ^ HOSPITALS, -prived of such necessary supplies, as are furnished by the viN 'Cumjacent country. Elevated lands, which command a free circulation of air, and «n abundance of good water, are preferable to plains, for the site of hospitals. They should be erected at a distance from exten- tive woods, inhere it is possible ; in an open country, remote from marshes, or swampy lands ; and beyond the influences of winds, whose currents of air are infected with miasmata generat- ed on sunken lands ; and are known to convey with them the seeds of disease. A military hospital wliich is considered temporary, built oC rough materials, should never be but one story in height. The attendants of a second story have additional duty to pe^ form; the sick in the wards beneath are incommoded by the ne- cessary noise of walking on the floors over their heads. In the upper wards the observance of cleanliness is with difficulty en- forced. Attendants, rather than give themselves the labour of descending a flight of stairs to execute their duty, take liberties of throwing filth from windows above, to the annoyance of pa- tients below, without possibility of detection. The wards of a military hospital should have an east and west aspect, with windows on each side. On the west, a closed pas- sage should extend the length of the hospitail 12 feet wide, into which the doors of the several wards open. The passage should be furnished with windows, which correspond with those of the wards. Thb passage will be commodious for the patients able to walk, where they will be secure from cold and wet. In front of this should be an open piazza projecting ten feet, where the patients may walk unexposed to the rays of the sun in hot weath- er. By means of two walls and the roof of a piazza, heat will be excluded the rooms, which is at its highest in hot seasons, after the sun has passed the meridian. These walls \i\\\ also secure the wards from cold, during the severe frosts of winter. Wards of an extensive hospital «hould be thirty feet by twen- ty four in dimenision, and not less than eleven feet in height; which may accommodate twenty patients, if not sick with con- tagious diseases. This number in a ward reqjuires only two J»V HOSPITALS. saa nnnea, when their diet is prepared in kitchens. The wards of Burlington hospital, (which had the reputation of being under the best regulations of any in the northern district) are twenty four feet by twenty, and nine feet high. These rooms were found by experience to be too low. The windows of the wards should be constructed so that the upper sash may fall, and the under rise at pleasure ; that when ventilating them, the air may hahre free access to the rooms, without passing in currents imme- diately over the beds of the sick. Convenient rooms should be appropriated for offices. One to contain hospital stores under the charge of the steward of the Iiospital ; one for the use of the ward master, under whose care is placed the furniture and bedding ; one to be improved as a dispensary ; one room for a kitchen, and one for washing. The hospital department should be furnished with spare cloth> ing as well as bedding, for men who are frequently admitted des- titute. During the war it was frequent that the wounded lost their clothing in battle. Many, after the action at Little York, were received without an article except what they had on their backs, who, in consequence, were not only dirty, but covered "with tribes of lice. As soon as their circumstances were report- ed, the commander in chief ordered cloth for shirts, but they could not be furnished before the men suffered for want of a change of garments. Each patient should be provided with a separate bed in a moveable bunk. When bunks are attached to the walls of a room, as has been sometimes the mode, they are not easily cleansed. The proper dimensions of a bunk are 6 feet 8 inches in length, and 2 feet 8 inches in breadths. Various methods have been proposed to ventilate the wards of A. hospital. A hospital having east and west aspects, with sin- gle rooms, is easily ventilated ; especially where the windows are made with double sashes, which rise and fall. Chimnies are of themselves good ventilators ; no dwelling house should be destitute of them, even in climates where fires are unnecessary to warm them. A wind-sail suspended over the tpp of a chinmey by two posts and a cross piece, and its funael ' :: ri Uii It . n 'I i* 'U. ) 240 HOSPITALS. let down fiotn the top as low as the fire ptace, will throw a eol- umn of fresh air into a room, which will expel the impure air through the open doors and windows. These can be employeit only during the warm seasons. Doctor TiiiToiT, Sui^on General of the army, with a raind possessing correct principles of philosophy, desirous of introduc- ing a system of economy creditable (o himself, suggested hospi- tals ui)on a novel plan. They are built one story in height with round logs, having a fire place or hearth in the centre, without a chimney, the smoke ventilated through an inverted wooeriment to demoHstrate their usefulness was but partial, at French Mills, where the army remained only a short time. No other attempts were made within my knowledge to prove them, excepting at Brownville, under the direction of Hospital Sur- geon Blood, who, it whs said, reported favourably of them. The nature of infection and the means of obviating it were so little known by Sir John Pringlij:, that he viewed large milita> ry hospitals us the graves of an army. The same opiniou con- tinued in Europe and America, until the philanthropic and hu- mane Howard explored the hospitals in many of the kingdoms on the eastern continent, " penetrated the dark cells of despair, the wretched prisons of man, where the seeds of disease long matured, diffused their pestilential effects ; and with a success unrivalled, divested them of their deadly powers.'^ The soldiers of the army, at the commencement of the war» possessing all the prevailing prejudices, reluctantly consented to be removed into the military hos{)itals ; from which, after recov- ery, they as reluctantly departed, having once experienced then* as comfortable asylums. This was noticed at Lewistown, on the Niagara, where it was known deceptive arts were often ' esorted to by the soldiers, to induce the sui^eons to permit liiem to remain in the hospital, after restoration from sickness, and able to perform their duty in the field. Similar decefrtions were more frequently practised by the men at Burlington hospital ; which, in point of cleanliness, had claims to be ranked among the best established hospitals in the United States. The following regulations were adopted in the General Hos- pital at Burlington ; where in no instance from its first estab- lishment, even when the monthly reports counted from six to nine hundred men, was an infectious disease generated, or propa- gated. i.^ii i t 11 :: 1 ■•• ill l! \ A I ii lii ■ ! :^\ < pr^ 242 HOSPITALS. v\v- The trashing of the floors and walls with soap and water^ ty lime water, was of the first importance. This was frequently repeated, especially during hot weather. In <:old weather, when the wards were occupied by the sick, washing them was not on* 1y inconvenient, but hazarded the healtifi of the patients. A coat of sand half an inch thick or more, renewed on the floors every day, was never attended with ill consequences, but was refreshing to the sick, while it superseded the necessity of wash^ ing. White-washing the walls V "h lime and water never in- commoded the sick ; it sweetened the rooms and corrected voit fectious principles. By daily sanding the floors they were pre- served not only clean but perfectly white. The opportunity of washing them was improved, when the number of sick was re- duced so as to aiimit their removal from one ward to others. The wards were thus alternately washed and thoroughly repair- ed. Bunks, as soon as they were unoccupied, were removed from the wanls, and after cleansing, returned. The straw of the sacks was burnt as soon as the bed was vacated. The sacks were washed once in two weeks and the straw changed. Blanks c'ts were always clean, and frequently changed. During hot seasons the windows and doors of the wards were continually open. In cold seasons the windows were opened, for a short time, repeatedly in the day ; care being taken that the sick in th( ir beds were not exposed to the direct currents of air. No person was i)ermitted to spit on the floors of the wan'^. Spit- boxes were furnished every bed, and filled with fresh sand twice n day, sometimes oftener where the patients expectorated large- ly. Close-stools, bed pans and urinaries were removed as soon as employed. No culinary process was performed at the hearths of the sick wards. Attached to each ward was a closet, where the table furniture, after washing, was deposited in neat order. Each ward was furnished with a large table, constantly covered with a clean cloth of linen, the better to ensure its cleanliness ; on which was placed a box with a number of little apartments, wherein were set in order the vials and medicine for the pa- tients, each vial and parcel labelled with directions, so as to obviate mistakes. i' HOSPITALS. 243 Attention wag paid to the distribution of the sick. The wards appropriated to infectious, or contagious diseases, were less crowd- ed than those occupied by patients with less important com- plaints. Surgical cases had rooms separate from the febrile. Venereal and itch patients were assigned to their separate wards, and not intermixed with men of different diseases. To guard against infection, or obviate its generation, was of the highefl imiiortance. An infected ward was not seen at these points, where my observations were made ; but it required unremitted application of the means which were experienced most etlicient to prevent infection — such were the daily sanding the floors — ventilating the wards — and frequently washing the walls with lime and water. Personal cleanliness was also a mean which promoted health, and obviated the generation of new diseases. At Burlington hospital, the sick, previous to admittance, «vere washed in tepid water, in an apartment appropriated to this use ; then placed in a clean bed with a clean shirt. Daily ablutions of the hands and face were ordered. The sick with febrile diseases under the immediate direction of a surgeon, were occasionally washed er spunged with vinegar and water, at some seasons. The pa- tients in the hospital were shaved every other day, and shirted twice in a week. The beds throughout the hospital were always in order wheth- er occupied or not. If a patient left his bed ever so frequently^ m the day, if only for five minutes, it was immediately put in or- der ; so that the wards were always in a condition to be visited or inspected by officers of the army. The inspectors, generally, gave a few hours notice of their reg- ular inspections. This was done more with a wish that the sur- geons might be present at the time, than to give opportunity for preparatory arrangements. For the hospital department was not ignorant that domiciliary visits, or private inspections were fre- quently made without the knowledge of the surgeons ; also, con- fidential reports to government by inspectors, as a part of a sys- tem of espionage instituted at the war department. This was told in my hearing by an officer, when reproving one for n^ ' t. I frr:* 244 HOSPITALS. gleet of duly. With (his Byetem we were not dissatisfied, and no officer will object to it when carried into effect without prcju- vhen returned to duty, and death. This regulation was adopted at Burlington in the winter 1813-14; previous to which, no sick records were found at that hospital. The hospi. tal records on the Niagara, were under no order. The pressure of duty was so heavy and unremitted, that all our time was em- ployed among the sick. Besides, in many instances, they were sent from their regiments, in an irregular manner, unaccompa- nied with their description rolls; and this neglect of duty con- tinued in some cases, even until the close of war. It is necessary that surgeons should preserve a record of their prescriptions, as well as a correct history of disenses which fall under their immediate observation. These assist memory, im- prove practice, and establish method and order; which are highly important in an extensive hospital. At Burlington and some other posts, this regulation was adopted. An abstract of im|>ortant cases is equally important ; but was only very partial- ly attended to by the surgeons of our army. The above regula- tions will not be carried into practice, until the surgeons feel that a neglect is an abandonment of duty. During the winter 1813-14, at Burlington hospital, Vermont, there were, at one period, betwt^en 7 and 800 patients, distribu- ted in 40 wards, nearly equally «!!ivided among eight hospital surgeons and mates. These young gentlemen felt themselves highly resfionsible for the state of their respective wards, and condition of the sick ; who were not a little benefited by a com- petition excited to excel each other in their duty ; which was manifested by daily improvements, in respect to cleanliness aoU liccommodations of their patients. During four months, my own task was unremitted; every ward was daily visited, and an equal share of the prescribing du- ty was performed by myself; not a day was granted for relaxa- tion ; every hour in the twenty-four, except when taking refresh- ment and natural rest, found me at the hospital. "* '^' ".'" " ■• The location of this military hospital is most eligible, situated on the highest bank, elevated sixty or seventy feet above the I ' H0SPITAL8. 243 water. The toil of this spot ii taad mixed with gravel, dry and hard at all ■eaiuni of the year. During the campaign 1814, a convenient garden was laid out, under the direction of Doctor Hunt, hospital surgeon. Tor the benefit of the convalescents and invalids, which by thdr labour was kept neat and in gooil order , The interior of this hospital has been already noticed, the ex- terior was not less attended to. In an a(\joining house, the sur- geons were accommoilated with comfortable rooms, where one or more always remained. The wa 'Is of this hospital were regularly swept and put in or* der by sun-rise through the year. The wards were visited by their several surgeons in the summer months, at eight o'clock in the morning, in the winter at nine. Previous to these hours, the patients had breakfasted. The rooms were not only in per- fect order, but every patient was found in his own lodging. While the surgeons were making their prescriptions, silence was preserved. The prescriptions were taken by the attendants to the dispensary, where they were immediately made up by the apothecaries. During the winter 1813-14, four apothecaries were constantly employed in their appropriate duty. . , FLYING HOSPITALS. It has been found necessary, during active operations of au army, to attach to it flying hospitals, so denominated, because they are subject to repeated removals during a campaign. As, at all times they should be in preparation to receive and accom- modate the sick and wor.aded, so they have or should have an- nexed to them a complete corps of the hospital stafiT, with an ade- quate numl)er of attendants, enlisted solely for that employment. Instead of which, on the Niagara, we were under the necessity of selecting stewards and ward-masters from the line ; and wece I j 11; 1'1 ■i'' ■ 7i 1 248 1I08PITALK. ilopondent, in tlio lirat instnnco, upon detnitx Trom t1i<» nrtny for our nttenilanis, who, unfi»fluMftl<'ly, wen* mi'n of incom ct hiibils, ami bad (ItBitosilions. It wns uiulrrHlcxNl, wlinn (he dt'tailfl wrre made, such were desif^nedly pelecled Tor this (wliinh was couHid- erod) permanrnt duty, ns were ohalinate and ungovernable; men upon Avhom no «lepender.(;e could be placed. Soilly dFx- posed were they to perTorm, aiid totally uncpialified to execute the duty assigned, they were immediately ordered to rejoin I heir several corps. Thus disappointed, no further requisitioufi were made on the adjutant general of the army for attendants during the war ; but they were selected from the convalescents, who were retained for this service. From among these we were al- ways able to obtain men of happy disjiositions, who were kind to the sick, and whose unremitted attention was a constant pledge of their fidelity. Large tents were improved as field hos[titals during cam- paigns, each of which was sufliciently capacious to accommodate 16 or 18 patients. From the Ist of June to the last of Se|)lpm- ber, hospital ttiits v/ere comfortable accommodations for the sick, in the northern district; far preferable to common dwell- ing-houses. Tents require but little care and attention, to pre- serve them in a state of cleanliness. It is of importance that a suitable position be chosen for au hospital encampment. The ground should be grnvell}', hard and dry. Such were the lands on which the hospital was estab- lished in 1813, at Lewistown. Drains or ditches should be cut to take off the rain water; and the tents should be removed i\» often as two weeks from the old ground to fresh. Frequent changes prevent the generation of infection. Ground floors should be daily scraped and swept. On the Niagara, these dn- ties were rigidly enforced. The flying hospital at Lewistown, was continually preserved in so healthy and pure condition, that, where the monthly reports exceeded, at one period, 600 men, no new disease supervened. Among some hundreds of convales- cents, who were discharged the hospital for light duty ; only three were returned to the hospital from the first of July until the last of September. Such were the state of the hospital awl healthy situation of that encampment HOSPITALS. ^4tt Arter seleclinii; luitalile ground and pitching tentt, the firat care U to dis; linka, nt n |iro|i«r dietHnCR from the iMiaiiital, munt npc inry r«c<>|ititclr8 Tor all kiuUs of (ilth, and which ihould he daily covrrrtl u it li earth. • • -i '-i ,' . Kilchcns are moat necessary app«nda);es to a field hospital. They are fxpeditioiiely ronstriicled with stones or sods of earth, in shajie of the fire-place of a chimney. The o|ieniiii; in front nnd s'lJes is defended from wind hy a barrier composed of pliant bnuiches interwoven witli stakes fixed in the ground, and roofed over with houghs or bark of trees to |)rotect the cooks from the rain and the sun's rays. Ovens arc also conveniently constructed with stones, If at !inn«l, or Carih supported by round tim!>er in a square form of suitable (iimenHions, locked into each other at the corners. Tim floors of the ovens are of flat stones, or clay, which arc shaped by «mall dry wooitals from the rough tim- ber of the forrests in the vicinity of Lewistown, or occupy the barracks built at Williamsville (eleven mile Creek) by General Smyth's division. The first required too much time to com- plete, at this advanced season of autumn ; the last was consider- ed 'the most eligible, as the men would have less ha. aips to en- dure by a remove to houses already erected, than by necessary exposure, while new huts were building. The barracks at Wil- liamsville wanted considerable repairs ; but in a short period were rendered comfortable. During this remove Doctor Wiht- BiDGE was my only assistant. The February following, in most severe weather, the removal of 450 sick, from French Mills and Malone to Burlington, dis- tances of 75 and 93 miles, through a dreary wilderness, with few improved spots, was a scene much to be deplored. To establish an hospital, and render it a comfortable asylum for the sick and wounded, is a work whicli requires considerable time ; and while in preparation, their sufferings, frequently, are extreme. To support it in good order, requires unremitted du- ' ly and rigid attention. It often happens as soon as an establish- ment is completed, it is ordered to be broken u;), tlie sick remov- ed to a distant position, where the business of forming a new es- tablishment is repeated. Such was a part of our duty from the commencement of the first campaign to the close of tlie war. It were unreasonable to expect that such temporary infirmaries could be made to assume, in a few days, that order and regulari- ty which are seen in old established hospitals. It is much less difficult to frame a system in the closet for the well ordering of a department, than put it into execution in the field ; especially in a country where materials for its organiza- tion are with difficulty obtJ»'""d ; where ingenuity and industry, as well as science, aie called into requisition to give their aid. Sui^eons and physicians may write admirably well upon wounds t I, 'I ' h I r ' 'i I 7^ ^62 HOSPITALS. II ami diseases, and describe correctly modes of treatment and methods of practice, who are unable to perform the simplest op- eration, or prescril)e with judgment at the bed side. Men who have never witnessed an action, nor seen an encampment, can with adroitness manoeuvre an army on paper, beat his enemy and cluim all the honours of war. Take a man educated in a city, and locate him in a wilderness, he would starve. As ex- amples make stronger impressions on the mind than precepts ; so the manner in which a thing has been executed, is more durable on the memory, than systematic rules and regulations; which, under all circumstances and at all times, cannot be followed. The Physician and Surgeon General to the army directed, that in all instances where the hospital department was not sup- plied with a sufficient number of the hospital staCT to execute its requisite duties, the directors of hospitals should require a detail from the regimental surgeons for assistants. The above regula- tion was made witl'out reflecting th^t the increased duty in hos- pitals immediately attached to the army, did not lessen that of regimental surgeons in their respective regiments. There were times when the hospital mates were ordered to perform regiment- al duty, while at the same period the hospital department was deficient of medical aid. From Lcwistown, two hospital mates were ordered to Fort George by the commanding general, which reduced the number of mates attached to myself to two, at a pe- riod when the hospital returns of sick and wounded counted be- tween six and seven hundred. Remonstrances against t ..e im- propriety of the order had no influence to countervail ito execu- tion. It was assigned by the Commander in Chief as a reason for this procedure, as the army expected an immediate action, it Avas important the destitute regiments should be furnished with surgeons. At another F)t:fiou, \>ItOe characteristic marks of ei- ther the masculine or feminine gender ; therefore I was under the necessity of considering him as one of the few of the animal creation, as belonging to the neuter. An hermaphrodite is an animal, which, agreeably to its import, unites both sexes — thia person had not the characteristic marks of either. The testes and penis were wanting ; in place of the scrotum there was a fleshy excressence which was not pendant, but appeared similar to the scrotum of a child ; in place of the penis there was a fleshy elongation similar to the teat of a cow, about two and half inches in length, destitute of a urethra ; immediately under which was the urethra of the bladder. There was no such part lo l>e found as a vagina. When I conversed with him respect- ing venereal passions and sexual intercourse ; of the first, he said he had none, of the last, he had no knowledge except what be HOSPITALS. 861* had occasinally " ^arnt from those belter experienced than him- self. Upon examining his countenance more particularly, (al- though he had a thinly scattered beard, being over the age ol thirty) it exhibited neither the expression of masculine nor fern- nine. It wanted the hold front of the man, and the soft features of the woman ; the spirit and animation of Iwth. There appear- ed about him nothing revengeful, but every thing inotfensive ; something of low cunning and deceit. This being was filthy ia his ;reneral appearance, and to me extremely disgusting ; more especially after his character was known. — A being abhorrent to hura.in nature ; having nothing about him which could ex- cite the passions of eitlier sex. He had, however, sufficient address to impose upon the officer who enlisted him ; wil- ling to receive a premium, but as willing, after having obtained Ills bounty, to exhibit pretensions, whereby he might be dis- charged the service. With his physical defects, a moral turpi- tude, as want of honour and rectitude, was very conspicuous. The distresses incident -to an army, however bad, and fre- quently as great as can be endured, are always exaggerated at a distance from the scenes of action. High coloured representa- tions produce on the public mind sensations as varient, as are political views respecting measures pursued. Those, who have not the means of obtaining a correct knowledge of facts, are among the first to censure ; while one sincerely lanoents, another rejoices at every disaster. Could all become eye-witnesses how much with spare means is executed, the tongue of slander and detraction would be converted to vehicles of praise and admira- tion. For the reputation of the establishments where orders have called me, it is my duty to state, that visitors from remote parts always expressed astonishment, on finding the condition of the sick far more comfortable than was expected from represen- tations received; while it gave me much satisfaction to improve every opportunity to undeceive all, who were prejudiced by mis- representations. It is with peculiar pleasure that I call to mind the gentlemen;, with whom I had the honour to serve, at various points, on the Irontiers during the war. Particularly, the names of VVheaton^ I: I I ■! i 1 I I I'i i t i\^ > ^U'^Ciiir..^ -..v. J.' ■ Y rrw:^ 25a HOSPITALS. ') » M ^ m Hunt and Lovell, of the hi^jiheat grade of surgeons ; the first et^ whom, my predecessor at Burlington, directed lliat estaltlishmeni very creditable to himself; from whom the hoapitul came under my charge in high order. To Doctor Hunt, who succeeded me at that post, the most liberal encomiums are due. My acquaint- ance with the last gentleman being more extensive, gave me au opportunity more fully to appreciate his merits as director oT that establishment; which, from its infancy to tho close of tlie campaigns, had h claim to pre-eminence. I have had frequent occasion to respectfully mention Doctoc Lovell in the course of these sketches. His frequent reports, one of which is conjmunicated at large, bespeak an accurate and discriminating mind. As au operative surgeon, be is inferior to none. In a particular manner, my acknowledgments are here expres- sed to the medical gentlemen of the second and subordinate grades, with whom I was associated at various periods. Among the Qrst are Surgeons Day and Wilson ; by whose exact system of police, the hospital establishment at Burlington was, in the first instance, reduced to order. Surgeon's Mates Wuitribge, Van-Hovenbur6h, PuacELL, March, Walker, Wallice,Van- Hov, RussEL, Trevet and Russel, severally claim my high regards. To all these gentlemen I shall ever feci attached by the strong ties of friendship. To their aid and assistance, in- dustry and economy, close application and unremitted duty, tlie hospitals, at every point, where orders called my attention, owe their celebrity, 1 recognize with pleasure the urbanity of Doctor Buli/, Hos- pital Surgeon ; although not immediately associated with him iu duty, yet his acienti&c knowledge entitles him to jny high res- pect. It is with peculiar satisfaction, I recollect the good state of some of the regimental hospitals, particularly that under the charge of Doctor Brunough, now Hospital Surgeon ; and those of Doctors Dlnham, of the light artillery, and Lawson, of tht 8lh regiment, at Plalt^^inirgh. HOSPITALS. 659 There are many meritorious gentlemen of the medical staff, both of the ho8|)ital department and line of the army, whose names have not been recognized in these sketches. These gentlemen have not been particularly noticed, because my cir< cumscribed observations, embracing only those associated with me in their duty, at different periods, precluded me from that critical knowledge so necessary to appreciate their superior claims. Of their services, the army has reaped the benefits; of their merits, the nation will long have a recollection. Injustice to Doctor Le Barron, Apothecary General of the army, whose civilities will always be preserved in grateful recol- lection, it is with pleasure we acknowledge, he execuiicd his du- ty with promptitude and fidelity. I have the fullest (vidence, that the defect of supplies for the hospital department on the Ni- agara iu 1813, was not occasioned by his neglect; as they were diverted on their route, from the Niagara frontier to Sackett*s Harbour, by superior authority. For the deficiency, at French Mills, he was not censurable; no person could have antici- pated the unaccountable waste of property on the St. Lawrence. To Doctor Low, Assistant to the Apothecary General, who was attached to the division of the army, where orders called my services, many encomiums are due. In addition to his appro- priate duty of issuing stores, he, at all times, volunteered his ser- vices in the hospital ; and was considered, in point of abilities, among the most efficient surgeons of the army. u i5 H :n !| I- 'T/^^ /7^ ■■i . * ! * ■- » 1,7 OFFICIAL LETTERS, WHICH ARE ILLUSTRATIVE OF ORSKRVATIONS, ADDU. CED IN THE PRECEDING WORK. NUMBER I. 1 1 General Hospital Malonc, Januan/ 31, 1814. To Doctor Le Barron, Apothecary General of the Army. Sir — Your letter of the 20th instant was this day received. In answer to which I have to state, that your assistant, surgeon Low, upon reporting himself to the Commander in Chief, with his instructions from you, was directed to perform duty under my 'orders at this place. As the hospital stores addressed to him had not arrived, and having but one mate doing duty with me at this post, his services were necessary in the hospital. Since which, having been advised the hos|)itaI stores had arrived at French Wills, Doctor Low was released from duty here, and ordered to take charge of the stores and medicines, in conformity to your instructions ; and is now at the Mills issuing stores and medi- cine to the several regiraenls. As soon as the regiments have received their supplies, more especially, as soon as the sick at the Mills can be accommodated at Malone, Doctor Low will be ordered to this post, where he will have an opportunity to do hospital duty. This is agreeable to his wishes, as well as mine ; as he is very attentive to his dut}"", and a young gentleman of pleasing manners. OFFICIAL LETTERS. 259 The Commnnder in Chief Ivis selected thii» place as hcing tho most eligible situation fur a general hospital ; especially hi the army may not e^main a long time in their firesent cantonment at the Mills; and U|ion retiring From that post, the sick must he transported to a more secure position, remote from the excursions of the enemy. . i- . • , In consequence of my frequent removals at (he close of the last year, the reports of sick, and estimation of su|>{>lies for the present year, were to have been forwarded to the surgeon gen- eral of the army, by Doctor Ross from the Mills, and by Doctor Pkntegrass from Platts')urgh. From some cause, the hospital stores, which accompanied the expedition down the river St. Lawrence, were not properly se- cured. They were either consumed by the troops, damaged, or lost. Many articles were not to be found, which were put on board the flotilla, and were not accounted for, when the army arrived at French Mills. It is now ascertatned, that no |)er> son was charged with the care of them ; it appears they were promiscuously placetV- ', li HBO OFFICIAL LETTERS. NUMBER II. General Hospital Malone, February 1, 1814* To Major General Broavn, at French MiiiLs. Rr.HPECTED Sir — It is my duty to state to you, the lick, sent to this [ilacr yestehliiy, were not all accorapanie«l with the reg- ular r<>p<>rt8 required by the rules of the hospital department. Consequently, the surgeons, annexed to ■ regiments, are reported as having neglected their duty. Similar neglects and Inattentions have been often overlooked. The service requires a more punctual attention to duty. Being unacquainted with the names of the surgeons attached to those regiments, I am ua* able to point out, at this distance, the delinquents. Those gen* tiemen are undoubtedly known to you. It is important that the surgeons of the army strictly obey the rules and regulations pointed out by the Surgeon General; and, during his absence, those which may be enjoined by the senior hospital surgeon present. Yesterday, I had the honor to state to you, no provisions have been made Tor a larger number of sick than we have at present. The A. Q. M. General will not take upon himself the respon* sibiity of quartering them upon the inhabitants. All the sick now here, are not as yet made cortifortable. It is my duty further to state, that out of the number sent here yesterday, four literally died with colJ ; having not a suflficient quantity of cloathing and blankets, to render them, in their debilitated con- dition, comfortably warm. Many of vhem are destitute of ap- parel. The reputation of either our government, or the offi- cers, who have the immediate command of the troops, is daily suQering among the citizens, in consequence of the distresses to which the soldiers are subjected. Humanity shudders at the appearance of these unfortunate men. Cannot the officers of the line be stimulated to pay some attention to their mck? OFFICIAL LETTERS. 261 t)o turgeonit or ro(:;imcnt8 exercise all their tnlcnts to nlleviato the wretched condition uf thoBc intnistrd to their care? It aeeinn m if their only nnxiely wa» to pnHB theni o(T their own hnndff, indilTerent to the m:tnner, rct;ardlero of ill consecpien^ cn«, provided Ihey do not make theinBelves, immediately, ac- countable for the deaths which follow. Doctors LovEi.i. and Wooubi'ry are the only sur^com of re^- iments, who have sent with their sick regular reports. It is ex- pected VvAt all the sick sent to the hospital be furnished with (hitir deb".riptive lists ; noticing their diseases, time wliea taken down, and the j^eneral method of treatment. • i With sentiments of high respect, I am, Sir, . i your most obedient and very hura!)le servant, . JAiMES MANN, Hospital Surgeoh', NUMBER IIL I 1 i dcncral Hospital, Malone, Fcbruaty 4, 18149 To Major General Brown. Respected Sir — The regimental sirgeons have neglected to send with their sick their bed-sacks. AH wc Can procure here have been already issued to the sick in the hospitals. Des- titute of bed-sacks, the men must suffer extremely during the severe weather. Information has been received, that there are no sacks in the Quarter Master OeneraPs store. Blankets are also wanted. One hundred and fifty received front Chateauguy Four Corners have been long since issued. Less than three Mankets will not render a man sick in hospital comfortable. With sentiments of high respect, I am, your most obedient and very humble servant, JAMES MANN, Hospital Surgeon. P. S. Eighty sick have this day been received, consequent-' ly, as many sacks and one hundred and sixty blankets are wvir ted for these men. J. M«, 34 t i U'll 1 r ( t ! r i h 212 OFFICIAL LETTERS* NUMBER IV. General UospilaU Malone, February 5, 1814. To THE COMMANCKR IN ChIKF. Rebpi.ctf.d Gknkral — During the month of January, ac- comuioilations were provided Tur ahout two hundred and Hft^ sick. This number was received, and comrurtably lodged. The second of this month, the A. I). Q. M. General at this post vihk directed to make additional provisions for the sick ordered here from the Mills. A house capable of receiving one hundred men was procured. Upon the evening of the 4th, two hundred men, in addition to those already in the general hospital, were sent on. It is impossible to render tlieir situation comfortable, Avith the means in our possession. Every house in this vlliagc, which can be procured at this time, is ap|)ropriated to the use of the sick. They may possibly receive four hundred. It is not possible to do justice to these unfortunate men, destitute of bed-sacks, and wanting a(hlitional blankets. These men were sent on without attendants or nurses, without kettles, pans, and cups ; destitute of even an axe to cut their own wood. These evils are accumulating ; while writing this, several loads of sick have arrived in a deplorable condition. It is now understood, the sick of the army are all on their way to this place. And if information be correct, and it is presumed some opinion may be formed, from returns already received, the number ordered here, exceed one thousand. In what manner these invalids are to be covered from the weather is not known. And if secured from the inclemency of the season, how are they to receive medical aid ? This is not the first time since the war, the hospkal department has been nooded with numbers. In the mouth of July last, when the general hospital was e»tabliahed OFFICIAL LETTERS. 2oa at Lewiitown, on the Niagara frontier, Ave hundred and forty Biclt were received at on« time, from Fort Grorge, when there were only three of the ho«|>itu! detiartinem present at that post. It viM impoBsilile then to do justice to the sick. There are now here more than can be attended hy the hospital surj^eons pres> ent. When it is found necessary to rrmove all the sick of tha army to the (general hospital, (the hospital stiitTIteing too few to give lliem necessary attendance,) would it not conduce to tho benefit of (lie Eiervico, that regimental surgeons he directed to perform hospital duty ? For while surgeons of hospitals are |>er- forming severe duty, surgeons of regiments have little or noth- ing to attend to. Many of the sick want not only sacks and blankets, but common clothing. It miiy be alledged, these men have received nil their clothing due. Admitting this as a truth, shall men be left tosufTor? Cannot some measures be adopted to remedy evils resulting from loss of their apparel, whether their wants arc the consequence of unavoidable casualties, care- lessness, knavery or folly ? Of the means of cleansing euch ar- ticles of clothing as we have on hand, we are destitute ; not hav- ing a sufHcient number of men in health to perform the labor of washing. Women in this part of the country will not do this duty for others, although they may for themselves. Humanity shudders at the appearance of distress, whatever may be the causes. Bensible as I am, that high degrees of responsibility are attach* ed to my otlice, I am unwilling to suffer the evils above mea- tioned to rest concealed within my own breast. To you Gen- eral, as Commander in Chief of tlie most respectable, as well as important division of the army of the United States, I am in du- ty bound thus to state them; persuaded that nothing will be wanting on your part, thst the appropriate temedies be admin- istered. At present we have at command a supply of stores and medi- cines. With more extensive accommodations, more medical assistance, an additional number of nurses, more bedding, and a shift of clothing to enable the men to be cleaned ; the gentlemen, of the hospital department attached to mcj would be ambitious 1 1 1 ! 1 1 1 i .1 M I •T^/",^"' '" ze4 OFFICIAL LETTERS. to give a high character to their several ward? ; and while he^ stowing the balm of life to the distressed, would acqtrire addi-< tional honours and a well deserved praise. That they poasest the talents and disposition to execute (if they hud the means) all which may be required of tliem, I have the fullest evidence to believe. With the highest respect, &c. ^ JAMES. MANN, Hospital Surgeon. .' ( f! .„;!.., .„ .,!u.7, i ,.,, NUMBER V; ,., . ,,.,,,...,,^ utiy illii rv V t;! , ' 1 i.i i- •■■ ^•■ . v.- .rn ■ Respected Sir — Inclosed you will receive a proposed system for the re-org<\nization of the medical department of the aimy. How far ?t will meet with your approbation we do not know. With me it is doubtful whether it will comport with the views of government, even if it should be approved by the committee to whom it is addressed. If, however, you should think it worthy their attention, it is our request it may be laid before them. This is a fact, and a serious one too, that tlie surgeons and mates of regiments, under existing encouragements, have no in- ducements to continue long in service. Curiosity alone will induce them to sflcrifice the term of one year in service. This being gratified, its exciting powers lose their efifects. The pay and emoluments of Surgeons and mates of regiments do not give them a support, especially on the frontiers of Canada, where the articles of life are procured at the most extravagant prices. With the highest respect, .^c. • JAMES MANN, Hospital Surgeon. REMARK. During this session of Congress, the pay and emoluments or ^e regimental SurgQons were increased. OFFICIAL LETTERS. 205 1.?' -vi'-' i. •• 1 (1 '- NUMBER VL General Hospital, Burlingtony April, 1814* To General. Smith, Burlington. Respected Sir — There are a number of men in the Gen- eral Hospital at thia post, wlio are fit subjects for discharge. It is necesi ':iry the hospital surgeon be possessed of their descrip^ five lists, to enable him to make correct certificates. The regu- lations of the General Hospitals are, that every man admitted be furnished with his description roll upon his admittance ; these are put on file, to be used if necessary. In many instances, these rolls have not been forwarded ; in some, refused by officers of companies. To remedy the evils arising from these irregulari- ties, the interference of the commanding general is necessary. With high respect, &;c. JAMES MANN, Hospital Surgeon, I '? ! i! NUMBER VIL , General Hospital, Burlington, April 21, 1814. To Colonel Smith, 29th Regiment, at Plattsburgh. Sir — Inclosed you w. \ receive the written orders directed to two men of your regiment in ray hospital, to join their regiment immediately, or be considered as deserters and treated as such. No man regularly admitted into the general hospital can be con- sidered as a deserter while in the hos|)ital. No officer has au- thority to order a map 'ui of the general hospital, until he is re- I \,i ( l\' If Pi,-' u 26^1 •PPICIAL LETTERS. ported fit for duty, or by an explicit order from the Commanding General. In either case, it is expected that so much respect, at least, be shewn to the hospital department, the application Tor discharge from the hospital be made to the senior surgeon pres- ent, not directly to the man himself. This last procedure is calculated to induce irregularities in the hospital. Men must not leave the hospital without the knowlc Ige of its otficera. Evils too much abound in our department, without measures to create more. In addition, I have to state, lh;it general orders were in force, which prohibited men from joining tlieir regiments at PInttsburgh, even if capable of duty. The men demanded by liieutenant H were, however, not fit for duty. I am, with much respect, &c. • > JAMES MANN, Hospital Surgeon. ' NUMBER Vlll. M it' ■ if General Hosjjital, Burlington, April 28, 18l4» To Brigadier GENEiiAii Smith. Sir — It 16 with pain, I am obliged to state to you, that three men of regiment, have since the 23th instant^ found their way, or been brought into the general hospital in an irregular manner. It has been reported, these men have had no medi- cal aid, previous to admittance. Had it not been for tb call of humanity, they would not have been so received ; but their con- dition was deplorable. One, brought last evening in a dying fltate, lived a few hours only. The sick are not so numerous, at this time, but that ihey may be faithfully attended by the sur- geons of regiments. If the last man had been seasonably re- portetl, Jiis life might have been spared. The last part was the duty of the surgeon to attend to ; and where there is no surgeon, it becomes the duty of the immediate commanding officer of company. Of what ise can it be to send a dying man to the / ii'liii OFFICIAL LETTERS. t267 bMpital, except to give the hospital department the credit cX kilUr^, and trouble of burying him ! U men are aent, in caaeg where they cannot be attended or cured by their own regimen- tal Burgeon, it is desirable to have them reported before they are in a moribund state. Very respectfully, &c. JAMES MANN, Hosyitcl Surgcotii i NUMBER IX. General Hospital^ Pittsburgh, August 17, 1814. To Colonel Cummi!n8, Adjutant General. SiR-^There are in the general hospital at this cantonment, more than one hundred men, who require medical aid. These are under my sole care. In addition. Doctor Whbaton takes charge *" the hospital in the village, in which are thirty pa- tients. The several surgeons in this cantonment have eftch ia their respective bos[)ital3 from fifty to ninety sick. Doctor Wheaton and myself are the only surgeons of the hospital de- partment present, capable of duly; hospital surgeon's mate Pur- cell being confined with an intermittent fever. In addition to my duty of prescribing, of making up my prescriptions, attend- ing to the police of the hospitals, I have yet to provide for the accommodation of one hundred more recently sent up from th& lines of the army at Chazy, without any ho8i)ital assistants ; having no Steward, no Ward-Master, no Orderly, capable of making out provision returns, (Steward and Ward-Master being sick) nor even an attendant capable of preparing the diet in a suitable manner. This statement however, is not made with a view to censurdr any officer ; but that you will order hospital surgeon's mate Rus- ai^LL, who has lately reported himself at your office, to perform duty at this po^t. I have no doubt the Commander in Chief, in '■ » if i* fi NW m^^'J. TTTT?" 26ft OFFICIAL LETTERS* all his transactionf , will consult the good of tbe service ; yd duty compels me to state, that with every exertion, full justice cannot be done the sick. Very re!»r 'ctfully, . JAMES MANN, Hospital Surgem. • ' \' • NOTE. On the Ist September following, the hospital returns counted^ more than seven hundred, with one assistant only. 1 NUMBER X. ■Extract of a Letter addressed to Doctor Tilton, Surgeon General of the Army, dated Plattsburgh, Hospital DepartmeiUy Septem- ber 2, 1814. Respected Sir — You will atone view perceive this division of the army, is not sufficiently furnished with medical aid. I have only one assistant, on whom much dependence can be placed, this is surgeon's mate Russell ; Purcell is out of health. General Izard, when he left this post with his army, ordered with his division, hospital surgeons Hayes and Brunough ; and mates Wallace and Walker. The sick of the division, were placed under my charge. Hospital surgeon Wheaton, had previously obtained leave of absence, on account of bad health. Hospital surgeon Hunt is at Burlington, with Tre- VETT, as his assistant. You will perceive there is placed on me, more duty batants are out of danger. This however is not always the case. During the investment of Plattsburgh by the enemy, the sur- geons were constantly passing from fort to fort, or block-houses, to dress the wounded, exposed to a cross fire of round anrHICH OBTAINBD THE BOYLSTON PRIZE MEDAL FOR 1800. . To Ward Nicholas BoylstoNj Esf. >IR, The first honours of your benevolent institution for the pf«V motion of medicine, and the sciences connected with the healino- art, were conferred in 1803. The fortunate dissertation on Cholera Infantum was impressed with a token of your appro^- bation, l)y permitting its author to dedicate it to yourself. This dissertation on dysentery is so intimately connected with the former, that the author was induced to become a competitor for the prize, which was a(\judged him in 1806. Various circura* stances have conspired to prevent its publication until noww Among the most potent was, that in reviewing the dissertation, it was found to embrace no new principle in theory, nor im- provement in practice. A determination was adopted, not to expose it to the eye of the world. But, since the adjudication was publicly announced, repeated applications have bsen made by friends for a copy, excited probably more by curiosity thaa an expectation of acquiring any new ideas on the subject. Ta gratify a curiosity thus excited is one reason now offered, why the author assents to its appearance in print. If the dissertation ' 1 I'. ' . ' n^ ' Mji i u i ;^^) IjI jf^r-^fr^.fffmfi*j,*>»9.rj *>, |ii^J?p^w* i^M I ■•■rj, ,.!*«, ■^^U '■ ',,'Jl«JWt« WT"Jff IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 1.25 rM 121 2,2 miuu ^ IIIIII& ^ 7. V 7^ y^ Photographic Sciences Corporation ^' m !\ V [v ^ ^ ;\ 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 873-4503 7^^ 27(J APPENDIX. i. i has any claims to merit, it will appear as comprising in a com' pciuUous form, the most approved practice in the United States. Diseases of the bowels are among the most formidable disor- ders to which armies in the tented field are exposed ; produced by hardships, bad provisions, insalubrious climates and unhealthy positions. As these, on the northern frontiers, appeared under forms different from those in domestic practice ; the additional observations respecting the disease among soldiers will, not be unacceptable. In proportion as the usefulness of this disserta- tion is more enlarged, so the object of your benevolence is pro- moted. Your views, similar to your good and great prototype, the immortal Howard, are not circumscribed within narrow limits ; they embrace not only states and kingdoms, but the whole human race. No further apology is believed necessary, for the publication of this dissertation, connected with the diseases of the army. The author deprecates wars, as well as the causes which ex- cite nations to arms against each other. From a state of barbar- ism, by the instrumentality of a few, the horrors of a field of battle have been progressively ameliorated ; penal laws are rendered less severe, and our prisons converted to comforta- ble asylums for the wietched ; wherein penitentiary hours for reflection and reformation are granted ; and while under the sal- utary discipline of retributive justice for evils inflicted on socie- ty, criminals may, by solitary labour, make a partial atonement for their sins. These improvements are the glorious and happy ef- fects of that spirit of divine love, imbibed from the doctrines of Christianity. These doctrines, in proportion to their diffusion, have, in some degree, softened the calamities of war, and avert- ed its attendant evils. While philanthropy invites to her aid the benign arts and sci- ences, which improve the state of society, and meliorate the con- dition of man ; she causes to be inscribed upon the historic page — a monument morq durable than marble or brass^ — the names of those philanthropists, the worthies of every age and country, who have devoted their lives, fortunes, or time to her cause. ArPENDIX. «T7 ITnrvard University with pride enrols (he name of Botl3ton am . .; her m «st lilieral benof ictors. The medical college of ili.it iMiu'«>r8ity will lons^ remember him among its principal pat- rons; vvlMJe the rapid improvements in the healing art in New- H ;<:,! md Dear testimony, that to his munificence they are highly iniieited, lor their increasing extension and wide diffusion. May he long survive his establishment, to enjoy the sublime snt sfiict'on of witnessing the multi|>lied benefits resulting from liis? rility, is the sincere wish of his most obedient, and very huinjie servant, THE AUTHOR. ADJUDICATION. It a mMing of the C&mmiUecupon the Boi/lston prise question (as pnOliihed the ]3th March last) at Boston, December 31 *f, 180&. PiiESENT, ISA \C RAND, M. D. LEMUEL HA YWARD, M. D. JOHN BROOKS, M. D. BENJ. WATERHOUSE, M. D. AARON DEXTER, M. D. JOSIAU BARTLETT, M. D. WILLIAM SPOONER, M. D. * A dissertation on the first question, relati\ - (o mortification, and one on the seccnd question, relative to dysentery, having been read and duly considered, the question was taken whether Ihey were resj)ectively entitled to the premiums offered, and it ■was determined in the affirmative, on condition, that neither of them should be published, unless revised aitd abridged by the authors. " On opening the papers accompanying the dissertation, it ap- peared that the one on mortitication was written by George Cheene Shaituck of Templeton, in the county of Worcester; »-d the other on dysentery, by James Mak« of Wrentham, m ttie county of I^orfolk. 30 ■: I I (■ m- :l\ It ')!Mm^ »v«iMM«a«a««t<~ - y^ 27a APPENDIX, " Votett, That the chairmun be requested to write to Doclof SuATTccK and Doctor MA^N, and also to the President of Har- vard College, inrorming them respectively of the doings of the Committee, and (h>tt the adjudication be published ia the Ce> lumbiun Centinel, aud Independent Chronicle." |i ADVERTISEMENT. AeRCGABLY to the recommendations of the adjudicating cora* mittev, the following dissertation has been revised and abridged. No alterations have been made in respect to the causes and the general treatment of the disease, excepting some ot)8erva- tions have been added, which were made on the northern front- iers, on the disease as it appeared in the army. In conse(j»ence of an objection adduced to the author's hy- pothesis, that materials under the form of gass are one cause of dysentery, the consideration of that subject is more fully attend- ed to, aud for the sake of elucidation, some observations are ad" ded. It has been urged, the author empleys inefficient cathartics. This objection will be removed, when the reader understands, that liberal evacuations frotn the intestinal tube are strenuously enjoined in all cases of dysentery. Will it be a question, by what kind of cathartic medicine this is efTected, if the intention is fully accomplished ? May not the less irritating cathartics, in large doses, fulfil the intention, as well as the more drastic, with less hazard of an hypercatharsis ? During the last war there •were experienced a few cases only, compared with the num- ber attacked, which required very active medicine. Drastic purges are sometimes retjuired for patients of robust bab'its. The practice in this dissertation is applicable to dysentery as it ap- pears under every circvmstance of age, habit, temperament, and climate. rr — 3 A DISSERTATION tJPON THE CAUSES OF THE VARIETIES OBSERVED IN DYS* ENTERY, AND THE METHODS OF TREATMENT ADAP- TED TO THE CURE OF THESE VARIETJES. PATHOGNOMONIC OBSERVATIONS. It may not be improper to observe, that the appellation, dys- •Dtery, is derive*:! from the Greek Unvunge, denoting a bad state of the intestines. Hippocrates, the father of medicine, gives the following definition : " When the body is heated and there are acrimonious purgings, with bloody stools, corrosion and ulcera- tion of the intestines, the disease is called dysentery." His co- temporaries and more immediate sitccessore adopted an opinion that ulceration and corrosion were necessarily connected with the other symptoms ; but physicians of the present age consider these morbid affections within the intestines the consequence of the disease, not the immediate cause of the symptoms constitu- ting the several phenomena. The various nosological descriptions of dysentery, as being little applicable to practice, we decline to notice; but shall pro- ceed to point out its most prominent symptoms, as described by physicians of the present day. Dysentery should be distinguished from diarrhoea and other diseases of the same organs; which, aithi>utom3 of dyseiitrry. In Ihr liifti onset ol inidaiiit ;b .- »- gravated hy fecal congestions; l)ut it is c^rl;un Ihui lh«- Un.^s- mus which exists after the disease is of some er8tt laion, have in their praetice prc9c.ri!)rd intdieine to obviate ganirrene, rallier than the real state of tlie diae ise. Hence we lind sliinu- lants [(rescrilied, insU.id of the more approjiriate anlipfdogislic Tegiinen, at the first altacU of the disease. Pus has been noticed in tlie evacuations in the last stnce of dysentery. Hence arises tlie |)reposteroii8 and inert practice of administering tranmatics to the exclusion of more elTicieut remedies at tlie commencement of the diaease.f Tlie fecal materials voided are, at times, iirown or Idack; upon which has been established an erroneous palholo;;y, that l»ile, or its vitiated state, is the formidable cause of all the evils attendant on the dysentery, us well as oilier dist-oisca.^' In some states of disease there is a copious evacuation of blooiy the quiuitity voided. Ilmce it wag inferred, thia astontghin^ flood of hlood could have no auurcc but the liv- er ; from thence the blood is nipposed to pass through the due** tiis cbohdociiB into the duodenum. The state of this important orjran so necessary to di^restion and healthy action of the intes- tines, when in thit condition which permits its vital fluid to pass ofl" in torrents, will be hereafter explained. Whenever in the course of the tom0. Severe gripes and tenesmus some- times abate while the evacuations assume the form of diarrliiua, or H lienteria, wherein the nutriment is voided in the same state as when taken into the stomach, and slides through tlie intes- tines 81) quickly, that it appears indii^estetl or unchanged. Thise various apfiearances, formiTly distinguished by ditfer- ent appellations, as being diiV^rent diseases, are inlluenceil by climate, season and constitution upon the disease in its ditlereut stages and degrees of existing disorder. The danger is always estimated from states of severe pain and debility induced by mor!>id effects of the disease. Unremitted gripes with most frequent and inetfectual elforls to evacuate the contents of the intestines; swollen, tense abdomen, cold ex- tremities, indicate death, or imminent danger. CAUSES. Previous to n consideration of the causes which wc believe active in producing dysentery, we think it exj)edient to concise* ]y notice the o|)inion3 of writers upon this sulyect ; and shall, at the same time, take the freedom to controvert such as appear objectionable; and with much deference to high and distinguish- ed authorities, otfer reasons for our disseolioa which to us appear im|)orlant. Sydenham supposes that dysentery is the fever of the season turned in upon the bowels. This sentiment has been often re- ferred to by writers upon this subject. As this disease most generally prevails iu those seasons when autnmnai fevers are f i ; 1! Il 284 APPENDIX. M 1 epidemic, it is inferred by that acciir ile obaerver of the nature of disensea, and their chanj^es depending; on trnnsitinns or sea- sons and weather, that dysentery and these fevers have one com* inoii cause. Among others who have adopted the al>ov(> opin- ion is MosELEY ; who has adduced an additional oltservution to support the sentiment, " the stools are more frequent, and every symptom of the disease np^gravatcd at those hours when these fevers are in their exacerbation." " This fever of the intestines like most other fevers,^" adds Mobeley, " is caused by obstruct- ed perspiration, not confined to cold, wet or dry seasons, partic- ular food, water, or fruit, chiefly depending on some influence of the atmosphere, or sudden transitions of the air, and such other causes as expose people to have their perspiration stopped.'' In order, however, to assign a reason why one part of the body be- comes affected at one time, and a ditferent [lart at another, from . the same cause ; Moseley finds it necessiiry to have recourse to a conjunct cause, otherwise "obstructed perspiration," to use his own language, " the parent of so many diseases, would al- ways produce the same." Mobelby further remarks, " as he has practised in the opinion that this fever of the intestines is caused by obstructed pers{)iration, so he universally found it re- lieved by turning back the discharges to their natural channels." If obstructed perspiration be the principal cause of dysentery, it may be aslted, why does not the application of cold, or a sud- den transition from heat to cold, by abstracting heat (caloric) from the body, whereby the pores are closed or contracted by spasm, produce this disease, at every season of tiie year, as well as the autumnal ? From the accuracy of Moseley's observations upon most sub- jects, one would suppose several circumstances as productive causes of dysentery would not have escaped his notice ; viz. heat, moisture, filth, and vitiated food ; except for the purpose of supporting a favorite doctrine. Perhaps we all are disposed to give too much weight to a simple agent, when it is discover- ed to be deleterioub; and lose sight of a combination of causes most productive of violent epidemics ; sometimes aa elfeet is as- signed a caose of disease. -j-m APPENDIX. 28S • HeHt and motiture, fillh and vitiated Tood conjoinetl, or even fieveraliy, rniiy he demonstrated to have heen more active in thR i^enertttioii of violent rormsordiaeaBe, than any agent, whicii is unly capiihle of obstructing per8|>iration. It is among soldiers in the field and quarters, thotfiltb and bad provisions abound. It is among that class of men, that dysentery afipears with all its hideous Turms ; and it v/ai among these that Mosely collected the most of his facts upon which his observations are founded. Cullen says, that*^ dysentery often arises from the application of cold, and, oflen contagious ; that by propagation of such con- tagion, independent of cold, or other exciting causes, it becomes epidemic in camjis and other places," and adds, " that sjtecitie contagion is the remote cause of dysentery." That '♦ dysentery" is a contagious disease, passing from one to another in camps, and from soldiers to the inhabitants of the neighboring villages,** is also an opinion of Sir John Pringle, who further observes, " this disease, aeteris paribus, prevails mostly among such, as are of a scorbutic, that is, of a putrid habit; or among the poorer people, ■who, from foul air, bad diet, and nastiness, are most liable to pa- trid diseases." If it can be made evident, that this disease may be produced hy causes independent of contagion, where is the consistency or rationality of having recourse to the supposed contagious nature of the disease, to account for its prevalence in those seasons, even when it is epidemic ? A supposition more philosophical is, that the same causes, which produce an epidemic disease, and give its form to a single patient, may continue active in produc- ing a similar state on others. Formerly epidemic diseases were apprehended to have been propagated mostly by contagion : the doctrine had become so general, that even common coughs were called by some contagious. But in cases, where a disease orig* in.tted without a concurrence of known communication with aa inlK'ted person, to account for its existence physicians resorted to cold, heat, nastiness, putrid effluvia, marsh miasmata, obstruct- ed fiersjMration, or some secret agent ef darkness ; but the dis- ease h.ving been fairly introduced into community, all the as- signed causes of its first existence arc forgotten^ aad no loDger •37 J^-.> r ' il fitO APPENDIX. mentioned. The multitude hope to escape diienie, by avoids iniK the lick ; while at the lame tinae they cherish altout them* •elvei many of the active cautei, and hug to the last the most lataK *' - >f ■ • k. . a, " The doctrines of contagion and infection^ and the scientific distinction between them were not formerly, it is apprehended, ■o well understooil as at the present dny. This interesting sub- ject has been recently treated with so much clearness and per- spicuity, in that valuable collection of communications, the Medical RKPesiTORV, and is therein exhibited in so luminous a point of view, that we deem it necessary only to refer the read- er to the definitions of those terms, therein found, " which," says the author, " although they have been used in a synonimous tense, apiiear to a mind, in the habit of noticing nature, in her diversitied forms, to convey very different and distinct ideas.' Diseases, known to be contagious, as small pox and measles, are propagated t.t all seasons of the year, without regard to tern* perature ; whereas, diseases, which depend on an infected air from putrefofction of substances in a state of decay, or on local position for their existence, are endemic only at one season. Dysentery prevails durkig the summer months, and does not be- come endemic until the heat of the weather is so high in degree, as to generate putrefaction on animal and vegetable substances, in a state of decay ; this disease abates or disappears, as soon as the heat of the season decreases to the line of frost. Dysentery may also exist during winter, in crowded prisons and hospitals, where a putrefactive process is generated from hith and animal excretions. [Note. The last observation is added since the author was conversant with the disease during the winter months, in the military hospitals. Under these circumstances, the disease was considered consecutive, not ideopathic. It was the consequence of habitual diarrhoea, continued from its first ap* pearance by the agency of those causes which produced it, until the rectum became excoriated and ulcerated. If dysentery is generated during the winter months, it is where the patient is surrounded with animal filth, and in a confined state.] '•Jsl■'1^* II IX APPENDIX. 28f DiMftSci are eaniiderMi epidemic, when they spread over a 0oiiiid»>rible extent of country. They hnve common fymptoms, which constitute their pathognomoaic chiiractert. Similar caua- ea, under similar circumatances, are' proituctive of the same ef- fecta. Diflerent additional causps may, and do often coojierate to diveraify the forma, under which diseaaea may ap|tear. ' * From conaiderationa to he adduced, we presume to say, that one immediiite cause of an epidemic dysentery is the proiiuctton of putrefaction in a i ubtile form, or gasseous state actinti; imme- diately upon the alimentary tu(>e. tihould it be c introverted, that invisible passes are active agents, when in contact with ir« ritable fibres, we enquire, what form ** that vitiated product of living Vflscular action" assumes, which excites, through the Boeilium of the air, a diseai^ like that by which itself was pro- duced, but gasseous ? What is the material, expired from the lungs of a {lerson under the measles, which in capable of commU' bicating to a person in health a similar disease, except gas ? What is that agent which abounds in nnventilated prisons, la dirty hospitals, in foul ships, in large towns and populous cities, filled with filth, in houses stored with fish, beef, and corruptible articles, which havo been known to have been active in the generation of disease, but the oroduction of either putrefaction, or arifmal decomposition, or animal excretions in the forms of gas ? Do the emanations from substances in a state of putrefac- tion assume the form of gas ? Are offensive productions of an- imal excretions gasseous ? The olfactory nerves of f.very one will determine the question. To convince ourselves, that more active agents cannot be found to generate diseiases, than the pro- duction of putrefaction and animal excretions, it is unnecessary to review the history of diseases further back than the late sum- mer and autum>aal epidemics in cities and in the field. In 9»11 cases where critical examinations have been made, it has been dem''^'*trated by clear elucidations, that the prevalent dis- eases had their sour from gasseous materials, eliminated from either the animal k^. gdom, or vegetable substances in a state of decaj* HM^/i^.t -f «<*,«'.. ,t"*v. A. fj t' ' >•/« ''.i^iv^i-n i». .rvja^' ^f^r «efl APPENDIX. i m [r'ii- CoUI and sudden tran»Uion8 or weather from a ho( to- a colder ttate of atmosphere, are considered as exciting causes of dysente* ry, co-operatiag with the more etlicient, which give the form of the disease. Great variations of weather co-operate with all the hurtful agents, during every season of the year. But the cold seasons do not generate epidemic dysentery, inde- pendent of other causes. Is it remarkable, that dysentery suc- ceeds sudden variations of weather, without the co-operation of other active agents? It has been observed, that this di:»ease is mostly epidemic in that season, and those years, when there is the least variation ; when the hot season continues during a long period, with little variation. Heat may be considered an immediate exciting cause of dys- entery, as well as mediate. An imnudiate exciting cause^ by in- creasing the irritability of the body, or rendering it more sus- ceptible of active <«timulants, and thus co-operating with delete- rioui! agents. An over proportion of caloric induces morbid ex- citability ; to support the health of the body, due degrees of that powerful agent are necessary, r. js** , -^j^fa* aw, w»t. ;s ijiiiR :m. ; k\- It is to be observed, that heat, also, is a mediate^ or more re- mote cause of this disease, by a combination with moisture, act- ing upon vegetable and anima! substances in a state of decay, favourable to a putrefactive process. ?i«mr»-^*smj t'^p ■rrfvw . During the hot seasons of the year, an extensive section of a country may abound witli deleterious agents, productions of pu- trefaction, so as to generate dysentery ; which, from its general prevalence, may be denominated endemic. From the records of endemic diseases, evidence of the above position may be drawn. A diseased action of the organs of digestion, effects of intemperance, may induce in the alimentary canal morbid agents liberated by the process of putrefaction, and produce inflamma- tion and ail the symptoms of dysentery. Provisions in a taint- ed state, " replete with the poison of putrefaction,'' may be eat- en by numbers, and who, at the same time, may be attacked xiith this disease. These last conditions will be denominated sporadic. The disease may originate from a combination of the above causes, infected air, impaired digestion, human ex- 1: > APPENDIX. 2ftd oretfoiii, and comipted provisions taken as nutriment ; nvi pre* vail under forms the most mortal. Thus geuerated, it frequent- ly appears in camps, in besieged cities, in prisons and hospitals. A question may be usked, in what manner gasseous poisons introduce themselves into the body from the atmosphere ? The Air impregnated with these volatile materials may be conveyed to the stomach with the" saliva and nutriment in the act of deglu- tition ; thence into the intestines. It is most evidentsthat these organs are firimarily diseased, as if some poison had been swal- lowed. All the symptoms of morbid action, nausea, vomitings and gripes demonstrate it ; more particularly inflammation and ulceration of the intestines, when the disease is not cured in its early stage. The increased heat upon the surface, and obstruct- ed pers|nration, which are among the first symptoms, are the ef- fects of association, not the causes of the disease. Such is the connexion between the internal viscera and the skin, that the dis- eased actions of the last are intimately connected with the mor* bid condition of the former. If, as has been adduced, epidemics are all caused by the same exciting agents, it becomes a subject for enquiry, how the same cause, at one time is productive of fevers A another time dt^seri' fCT^, and at a third, cKorr^a. »-»» *-"■ *»Hii«*t'rt*i. :r •* «j We reply, that when the hurtful agents are absorbed into the pulmonic vessels, through the thin membranes of the lungs with the oxygen, and there united with the blood, thence conveyed to tlie heart, they become a direct stimulus to that organ and the arterial system ; when a fever will he the effect. When the poisonous cause of diseased action is conveyed to the stomnch and intestines, by deglutition, or in the act of swallowing our sa- liva, a dysentery may he the consequence ; while a fever which accompanies it will be a secondary effect. But when the dis- ease-generating-principles in their progress through the intes- tines, stimulate the gall duct, a flow of bile is thereby produced, and meeting the offending cause, a salutary diarrkcea may fol- low, which in its progress may wash from the canal tlie foul ma- terials ; when a natural cure may be effected.""^ It is further to ■ • Medical »epolitor^ ^m.^.^----' ?X.t.^;^ .;■.,>;/ ■.•,-.^,.>^;-v^:f ■.. ' 1 7^7^ eta APPENDIX. ' I i be unckntood, these hurtful agent*, under some* circumstances* find access ta the important organs of life, through all the ave- xuies of the animal system. Dissection* have given us a clearer view of the diseased conditions of the intestines. In some cases they have been found ulcerated, or in high states of inflammation ; in others, in, a state of gangrene and mortification, n^nio «n/# \ifiit m(^^.^m^^*i* These morbid states, connected with the several forms and symptoms of the disease, direct us to the nature of the offending causes, which are lodged within the alimentary canal. From the morbid effects produced, they are believed to be of a caus> tie, or irritating quality. That their irritating property depends on acidity, is presumed from the well known beneficial effects of neutralisers of acids in this disease ; and for a curative indica- tion it is immaterial whether the offending principle, denomi* nated acidities, is cause or effect. From the diseased state of the alimentary organs in dyseutery, and the combination of morbid actions, as symtomi associated Xiith it> our indications of cure are obvious. .-r*: i*^ .•(V'Hjvv,. .v>w TREATMENT. v^,,f * Having delineated the several forms under which dysentery appears, and concisely stated, what are believed to be the cau- ses of the varieties, under which this disease commences ; also, what are supposed the general causes ; and as it is apprehended, these varieties are principally " influenced by climate, seasons and constitution, upon the disease, in different stages and degrees of it ;" there will, in the curative indications, be considered two general states, or conditions of the disease ; and under each be comprehended such varieties, as require particular methods of treatment. I. When the disease is accompanied with heat, and a strong action of the arterial system of vessels, denoting a a^nochal state. II. When the dise^ise assumes a weak action of the heart and. arteries, with languor and coldness, indicating a tjfphoid state. A. When this disease is accompanied with high degrees of heat^ strong action of the arterial system, severe gripes and tenesmus ; it APPENDIX. 2tfl ; , ! 61eediHK is indicated. From much experieiioe we are convioi cedf that this is a remedy of too much importance to be omitted. By immediately abstracting Trom the body a quantity of stimu- lus, by blood-letting, heat is reduced, and pain mitigated. Bleed- ing is a well known mean of subduing inflammation, which con- stitutes the disease. It is not always the case that inflamma> tion of the intestines exhibits itself by a rtrong and full pulse. Inflammation of the stomach as well as bowels, is usually ac- companied wii mall action of the arteries, or rather contracted and hard pulse, at the same time, with no remarkable increased heat on the skin. This circumstance seems to contra-indicate the use of the lancet. Its employment, notwithstanding these appearances, is often as necessary in dysentery with the last de- scribed symptoms, as in pneumonia, with pain and great heat. Severe dysenteric symptoms, at their commencement, have been known to have been removed by one copious bleeding ; and we have the practice of most celebrated authors upun the subject to justify its recommendation. B. Remedies employed after venesection, are such as operate directly upon the diseased organs, by exyelling or counteracting the causes of derangement. They are cathartics and emetics. Tlie most violent forms of dysentery require the most prompt evacuations by the bowels, at the first attack of disease. Ca- thartics should be administered in full dosea, so as to promote quick and thorough operations. From that class of medicine^ which accelerates the peristaltic motion of the intestines, we se- lect those articles, which purge effectually, with the least irrita- tion, and occasion little or no gripings, viz. sulphate of soda, (glaubers salts ;) sulphate of potash, (vitriolated tartar;) oil of castor. Submuriate of quicksilver, (calomel) is also employed m full doses for a cathartic. Jalap and calomel combined, is a favorite cathartic with some physicians on robust patients. . Ca- thartics are to be employed, until the urgent symptoms of in- flammation are. abated. In idiopathic dysentery, little besides cathartics is necessary ; for the disease is overcome in robust habits, as soon as the bowels are evacuated ; when the appetite returns without any excitements. But after full (tvacuationst r"f "■t ^Y^ 202 APPENDIX. If i M ?i ) ' UM-. m. the disease eontiouing, calomel, with or without opium, as sym{» toms demnnd, are admioistered ; and in obstinate Cases, are con* tinued until a sore mouth, or gentle ptyalism is induced. It has been frequently noticed, that as soon as the last effect has heeu produced, the disease removes, or is mitigated. Ulcerations of abrasions having sujiervened, experience has proved, that calo^ mel is a doubtful medicine. Our practice in the army, demon- strated the correctness of the preceding observation. ' • c. Emetics are indicated, in cases where nausea and vomiting exist, dunng the commencement of this disease. Tartrlte of antimony, (tartris antimon.) and ipecacuanha are severally or jointly administered. The first of these emetics, in cases where the patient is robust ; the last, where delicate. Emetics not only evacuate offending materials from the stomach, but promote the secretions in general, particularly those of the liver and skin. It has not escaped the observations of physicians, whenever a full flow of bile follows the use of emetics or cathartics, the vio- lent symptoms of this disease abate. A gentle perspiration suc- ceeding any means employed, is considered a salutary symptom. D. In cases where there is deficiency of bile, evidenced by the absence > vellownes in the evacuations, by cardialgia, acid eructations, and sensations of heat in the stomach ; the follow- ing neutralizers of acids, magnesia, chalk, and lime-water, have been employed, and not without benefit ; but it has been expe- rienced, that he weaker correctors of acidities are ineffectual in all cases ; and physicians of late are more in the use of alka- lies, soda and potassa. Alkalies, it is to be observed, should be employed in very diluted states, because when unneutralized, they aggravate, by their stimulating properties, the inflammation and pain in the bowels, when administered in quantity, greater than necessary to neutralize the existent acidities. Doses are to be regulated by effects produced. ' ■-«> '"' • * • > •> i-i*. i E. Gripes and tenesmus, the most urgent symptoms of the dis- ease, seem to demand the employment of anodynes, in the use of these, much cautior is to be exercised ; and we should be under some restriction^ in their administration. Although the violence of the above symptoms, is, for a time, mitigated hj fl! 1 dis- the liould )ugh [dby APf*ENDtX* -..Pi 1293 i!"!f «ftitini, yet, evacuations or the aHmentary canal previous to their employment, are enjoined. By experieb«'.e, yie are con- vinced, that as soon as the pacific etfecis of opium cease, (aiio» dynes having been employed, previous to suitable evacuations,) the gripes and tenesmus occur, and often with increased force, from the retention and consequent accumulation of the offend- ing agents within the alimentary tube. The intestines, how- ever, having been well evacuated, or the vitiating materials therein corrected, by the several means above recommended, opium becomes an indispensable remedy. The beneficial effects of opium, in the synochal state of dys- entery, are sometimes increased by calomel in small doses. By their joint operation, a Icind of neutral effect is produced. The cathartic property of one obviates the restriction occasioned by the other ; so as while pain and tenesmus are mitigated by the anodyne effects of opium, the peristaltic action of the intestines fe preserved by the calomel. ' ^'IJ -•' » > .»* ' If. When the disease assumes a weak action of the heart and arteries with languor and coldness, indicating a typhoid state. A. In this state, bleeding, either at the commencement, or ia a more advanced stage of the disease, is unnecessary. Injuri- •us consequences may follow its employment. • B. Cathartics, however, are indicated, for the same intentions as in the synochal, especially, where previous evacuations have- not been made. Those cathartics already enumerated, as prop- er in the synochal state of the disease, may be employed here* where the vigour of the system, and strength of the stomach will admit of their use. But here, as no specific directions eaa be pointed out for every case, the judgment of the prescribing physician must dictate. As this state however is often accon»> panied with extreme debility and irritability of the stomach, in- asmuch as it frequently rejects every article received ; no pre* scription fulfils the intention of an evacuant so kindly, as a so- lution of manna, and cream of tartar, (super tartrite of potash,) or soluble tartar, (tartrite of potash,) administered at short inter- vals, i Ofies which will not excite vomiting, until the propo8»> ed end is effected. No cathartic, in oases of nausea or vomi^ 3S II 1 1 !,, .1 I i! ii 29'4 APPENDIX. 'n iag, is leas alTensivc to the stomach ; wliile it may vrith safety be received in quantity sutAcient to prove operative, even in ca> ses of extreme debility. , ; c. Emetics of ipecacuanha are occasionally employed in this state, as well as in the synoclial ; the doses should be regulated, 80 as to produce one or two ejections pt a time ; and if necessa- ry, may lie repealed every day, or every second day. We choose the morning for their administration, while the patient is in bed. A smaller dose will answer the intention of an emetic, at that time, in consequence of increase of sensci'ial power dur- ing sleep. (See Darwin.) Emetics \ivove more diaphoretic, and determine the mnterial of perspiration to the skin most ef- fectually, while the patient is in bed. D. Alkalies in diluted states are employed in this state of dysentery. To render them more agreeable to the palate, and accommodating to the nauseated stomach, (for nausea, gen- erally, accompanies the typhoid slate of dysentery,) they are Joined to weak aromatics and bitters in decoction, or infusion ; viz. serp. virgin, (aristolochia serpentarin ;) Colombo. By these raeans, we artificially furnish the intestines with the soda and the bitter of bile. E. Blisters are found beneficial in the typlioid state of dys- entery. In the synoclial, they are seldom necessary. In cases of most obstinate pain, by making a derivation from tlie diseased viscera, or by their counter-stimulus, they remove spasm, and Rvert danger. When applied in cases of debility upon the epi- gastric^ or umbilical regions, they not only mitigate pain, but check nausea and vomiting. In states of languor, and where coldness has supervened, their afiplication upon the extremities are important ; while the daily repetition of one is beneficial to excite the torpid system, and support the powers of life, sinking under the weight of disease. F. Opium has been, and is, at this time, on account of its re- strictive powers, employed as the principal remedy for the cure of dysentery by some physicians. It is our opinion, we should be under restrictions even in a typhoid state of the disease, as to its employment. Previous to which, evacucilions are nece?-- 1: APPENDIX, 20$ «aiy; while «ometimes after it» anodyne efTects are over, a rcii- etition oT eccoprotics is demanded, l.i many cases opium be>- comes im|H>rtant, by procuring ease and sleep ; and seemn to invigorate the body worn out by tenesmus. 0. The tepid bath has been advnntngeoui ly employed ia some •tates or dysentery. 3t admirably co-operatos with opium to re- move spasm and pain. The bath relaxes the vessels upon th' aurt'ace, which, by association with the int^^stines, mitigates griping pains within them. It also equalises, by its diffusive ef« fects, the excitement throughout the animal system. H. Mucilageki, prepared from the farioaeea, the gums and woods, are auxiliaries m the cure of every condition of dysen' tery. In severe cases, at the commencement of the disease, these soft articles may be taken in large quantities. Frcm a vast variety at conHn:md, the judicious physician has an oppor- tunity to make bis selection. 1. Enemas, prepared with the mucilages, are often employed ivith much advantage, in cases of extreme irritability of the in- testines. Where tenesmus is a very diatrcsstng symptom, we add laudanum to these mucilaginous enemas. ^ K. After evacuations have been employed, and pain and in- IBammation overcome by the various means above mention- ed ; and where the dyspeptic symptoms shew the inactive condition of the stomach and other organs, subservient to diges- tion ; physicians have employed the cortex peruvianus, (chin- chona,) astringents and bitters* We are not however convin- ced from experience, a preference is to be given to any one of these classes of medicine ; which^ by authors, have been sup- posed specific remedies in dysentery. Astringents and bitter? may be of use under some circumstances. In whatever manner these medicines act, to give tone to the stomach and intestines, when in a condition to receive them ; they should be cautiously employed, on account of the increased irritabiHty of the alimen- tary canal in this disease. Where stimulants are demanded to support the action of the system of vessels, in the last and sink- ing stage of this disease, we administer wine in small doses, but frequently and with moderation ; adapting the cia«uuty to th< state of debility, and excitability. II T^ 260 APPENDIX. I « i t' 'llil I 1 Ij. Diarrhosa and lienteria sotnelimefl auume the place of dysentery.* In these cases, more depeadeace ia to be placed U|)Oii opium and ipecacuanha combined, than upon astriiiKenta and bitters. Small and repeated dosev of Ipecacuanha, so as to excite vomiting, are found useful : a small efrietic every twen- ty-four hours, for a few days. Anoilynes, fre(|uently repeated in small doses, are preferable to full doses, at long intervals. M. In the apthoua state of dysentery, we recommend the trial of blood-root, (sanguinaria canadense ;) also, raarsh rosemary, (Statice Limonium.) From the above medieiue we have expe- rienced benefit. They are generally employed in decoction, or infusion. In one case, where from soreness of the mouth, fau- ces and throat, swallowing was difficult ; and from extreme irri- tability of the stomach, it rejected most articles; a tea-spoonful of olive oil was admi(ustered every Qfteen minujtes for twenty- four houni, and after, at intervals somewhat longer, in larger quantity ; and was thus continued several days. This, with some soft nutriment, was supposed to be a mean of preserving life, and Bnally of restoring the patient to health. N. In cal^s, where blood unmixed is evacuated in profusion, opium, bark and wine are among the principal remedies. This state of disease is not accompanied wiM) pain ; wherefore, abra- sions are not here suspected. The livef is believed the source from which the blood flows. In these cases of active intestinal hemorrhages, the mineral astringents have been employed with much success ; acetite of lead, (acetas plumbi ;) vitriol of zinc, (sulphas zinci.) As it is highly probable, that these discharges of blood are from the liver, would a blister upon the region of this viacus be of service, to remove its torpidity ? DIETETIC MANAGEMENT. In dysentery, the diet is to be regulated by the state of the disease. In all cases, the nutriment sliould consist principally of the firinaceous preparations; viz. rice, sago, salep, gruels prepar- ed from the flour of the various species of corn, &c. So dispos- * In the practice of the army, we experienced dyEcateric symptcms, ^ torn^cnting gripes, and tenesmui to succeed diarrlift*. ' ^■vi'r.-- - -;. i Bg'.-U. f k ti., _. ■, . APPENDiat aQ7 ed U the alimcDtar^ eanal to favor the putrefactive process with- in it, on account of the defiriency of bile and gastric liquors, as well M excessive inflammation ; animal nutriment is to be prohibited the patient. After the disease is mitigated or re-, moved, and appetite restored, c vegetable diet with inilk should be continued during a statfe of convalescenry. Relapses have been known t« succeed an indulgence of animal nutriment, even in a liquid form.*,^^,^ .^ fv,,^, ...jiyfj vr.'Tf^tvr ir^-^^ ,;fjrf"* Where stimulants higher in degree than simple vegetable nu- triment are demanded to support the powers of life, wine is the most appropriate. In all sta,■• <»./«>«.' «,4f'> .t.: vm its.r^inaiK' 9 Army patients, with chronic diarrboda, were supported a long time, with diluted brandy, and opium occasionally; u addition to the above soft jvatrimeol. • •; " I yr" f ► H: '!li 3Bi APPENDIX thartlet, should examine the ttooli to satisfy thenuelvet, iwheth- er a cathartic has performed its office. 3d. The most drastic purges are not best adapted to the in- flamed state of the inner coals of the intestines in dysentery. Irritating purges are not retained upon the stomach in mauy cases ; and if they are retained, the effects of their stimulating properties continue a greater length of time upon the intestiues, 4han neutral purging salts, or oil of castor ; wrhich operate quick and with little pain. In divrrhoea and lienteria, rhubarb, (rheum) in small doses, combined with magnesia, or chalk, has been ad- ministered by physicians, upon supposition that in addition to its cathartic property, it irossesses considerable restrictive pow- ers, noticed by the costive state which succeeds its cathartic- operation. 4th. Antiraonial emetics should be con(\ne ease, most generally, by bleeding and ipecacuanha. Tisson says, that tartrite of antimony will sometimes cure ; but that an emetic of ipecacuanha is not less efficacious ; and has been es* teemed a certain specific in dysentery. Beocklesbt, on diseases of the army, says, " a combination of two grains of opium, with three of ipecacuanha, made into a pill, was highly beneficiaL^ Prinolg also attests to the efficacy of this medicine administer^ eti, so as to operate as a cathartic ; for which intention, he ad* .ministered five grains every hour to his patients, until the d«» sired operation was produced.^ •r* . * No article of the materia mbdica proved equally beneficial and lafe, in cbronic dysentery, and diarrhoea, as they appeared in our annici on thf I i. 300 APPENDIX. i r ) I 0tTi. Aidfugents have been employed In dfieiifHrjr, npon «q erroneous opinion, that the frequent inclination to itool is the conieqaencf of immoderate action of the intestines, the efTerts of debility ; and that they required tonics and astringents to tt- strain profuse discharges. Premature administrations of this class of medicine, we are confident, have been productive of dan* ger ; as the fecal materia'is are thereby confined, and inflamma- tion increased, inducing an increased tendency to gangrene and morf^fication.* In the convalescent state succeeding dys< entcry, and where tonics may with safety be employed, we have not succeeded as well with chinchona, as other articles of this class of medicine. -•«-""'.■.- -— . ..h^.^.m. Physicians in the United States, we are warranted to notice, have not experienced the same efficacy from the bark, which British writers have ascribed to it ; and have been disappointed in it, when admini!>tered agreeably to their practice, in appar« ently similar states of disease. Can this be accounted for upon any principle, but the known fact, that the poorer inhabitapts of Europe, among whom diseases are most prevalent when they are epidemic, are generally supported with food less nutritious, than the Americans ? The first, with their lax fibres, assume, when attacked with febrile diseases, that typhoid form, which requires tonics and stimulants ; which experience proves to be inadmissible, in states of disease, apparently similar, among t^e well fed inhabitants of the United States. And where astrin- gents and bitters are required, the indigenous proiluctions of our own soil being fresh, are not less efficacious than exotics^ •^AKhern rrontiera, as a combination of ipecacuanha and opium, in the form of Dovaa's powder. Tbio has been before noticed, in the preceding Sketch- es, to which the reader is referred. * ff * The fatal effects of astringents during the war were often demonstra- ted ; especially, when evacuations were suddenly checlced by thur use, When men were exposed to cold and moisture. These effects were most con- spicuous, after the employment of acetite of lead. Cases in the foregoing Sketches are evidence convincing, without retorting to argumentath'c cJu- eidatioD, to shew the manner, by which the injurious effects were proiJuceJ. I I APPENDIX. 30 r Ibund in the itorei of druggists, lut^jf^ct to dnmage and comip- tion, by which their virtues are either destroyed or impaired. 7ih. J)illusiv« stimulants perhaps, are in more general use among the iiihubitants, than any article of the materia medica, fvhcn Ihey are first seized with (iiese complaints of the bowels. In all complaints o( this description, ardent spiritr bre first re- sorted to oy the- ignorant ; these itotent stimulants are also di- rected by those who prorets to be wibe. We cannot deny, a disease caused by an extremely high degree of morbid exciting powers, may be subdued by active stimulants. But this favora- ble event is too sehlom, to warrant our indiscriminate recom- mendation of them. The Ingenious speculations of Brown, in some measure, introduced the high stimulant plan of ol/etiiffiii^ la cure diseases, to the notice of physicians. His bold un(|uali- fied assertion, that ninety-eight out of an hundred cases, requir- ed stimulHuts, is not only imposing and pletising to us, circum- srriDed as our knowledge of the states of diseases is, but is a subterfuge for ignorance ; because if stimulants were prescribed in every case, were the position true, the prescribing physiciaa could not err bui twice, in one hundred cases. It had been be- lieved, the stimulant plan recommended by BaowN, was goin^ out of practice.* .ti • ;• , r Sydenham, however, has left on record, he cured at one pe- riod, dysentery by opium. In this instance, the disease appear- ed probably, more under the form of diarrhoQa or lienteria, thaa when the disease was considered by him, as the fever of the sea- son, turned in upon the bowels ; in which he urged the necessi- ty of evacuating the alimentary canal, previous to the employ- ment of slimulaiits or anodynes. In chronic complaints of the bowels, in arn^y practice, opium was indispensable, as well as ardent spirits diluted, but in moderate quantity. * It has lately been revived in the New-England States, to a degree which i^ aitonishing. TIjo glass doses of Brown, in con8e4uence of want of suc- cess, have been by the wi«e Mieulapeana, increased to pint doiea. Still with all this improvement, death closed the scene. The physicians, although fairly beaten, acquired high degrees of honor, by th«ir perseverance, and courageously fighting their foe, to the last breath. '; ». . /iR 39 Tf' , ,w^ . 062 APPENDIX. I; I 8th. MosBLET believed, the mtitter or perspiration, throim Uiion the intestines, in consequence of oltstruction on the sur- face of the hiidy, is the cause of dysentery ; and conceived by returning it bacic to the skin, its natural channel, the disease is readily removed. After bleeding, and evacuations by emetics and cathartics, he depended on sudorifics to complete the cure. With this intention "laudanum and antimonial wine'' were re- commended, " as a pleasant, and certain diaphoretic." Jamrs^ powder, he says, is admirably calculated to answer the above intention. If the disease continues obstinate, repeated vomits of ipecacuanha are given, to divert the blood from the intestines, and force it to the surface of the body. Let \t be here observ- ed, that however correct Moseley's practice might be, yet it does not follow, that obstructed perspiration is the cause of dys- entery. And inasmuch as an evacuation from one part will re- move inflammation from one remote by revulsion, or by ab- sorption ; such evacuation should be promoted, not however from a belief that obstructed perspiration is the cause, but an effect, which should be obviated, to expedite the cure of this disease. Dysenteric patients therefore, should not be exposed to currents of air, or cold, but coniined in situations favorable to promote perspiration. -. / ' ■ 9th. " In chronic dysentery, and |>erverse diarrhea, which may occur in practice ; from errors, want of skillful advice and con- veniences," MoBELEY gives a formula, composed of sulphate of zinc and alum, which may be found in his treatise on tropical diseases. The quantities of the vitriol and alum, are varied in ;he prescription, as their restrictive or evacuating properties ar*? required.* lOlh. Dysenteric patients, where their diseases are chronic, and obstinately resist common remedies, have been benefitted, if not cured by flannel waistcoats next the skin ; and they be- come more important, when the disease continues into winter ; * 'Ihi« vitriolic preparatiun, was re])eatedly tried in army and hospital practice, on the northern fro' icrs, without apparcjit benefit ; still we have 'cason to believe, ander some circumstances, it is a valuable medicine in these chronic diseases of the bowels. " '■■' - > v>^« .„.j,^j ,„.„..,^^^^;.,: 1:1 APPENDIX. C03 fvhen every mean should be employed, to supnort the action of the extreme vessels, by retaining (he caloric of the body, and obviating its evaporation upon the surfHce. 11th. A change of climate becomes necessary sometimes, to cure chronic dysenteries aud diarrhoeas. Invalids in the West* Indies, have been frequently advised to remove to the enstern states of America, to re-establish health. It has been observed, when these convalescents do not arrive, until the setting in of frost in autumn, their complaints deteriorate, or continue through the cold of winter, until the warmth of summer commences. As our cold latitudes prevent the necessary action u|ion the skin, and a general healthy excitement, warmer latitudes are to be preferred. 12th. When diarrhoeas become chronic in our climate, and obstinately resist remedies, until autumn commences ; the pap tients have been benefitted by a change, either to southern lat- itudes of the United States, or the West-Indies. 13th. Too much attention <'.annot be paid to cleanliness in all diseases, more especially in this, which, from its nature, is pe- culiarly offensive. Excrementitious materials, should be imme- diately removed from the sick room. When it is apprehended that a prevalent disease might have originated, or been aggra- vated by materials in a state of putrefaction,^ the offensive articles should be immediately removed from the vicinity of d\vellings, or covered with earth ; and if from neglect of domestic ablutions and purifications, '^ recourse should be had to means well known to every wash-woman, but too little practised by a large propor^ tiou of mankind ; viz. a liberal ut>e of water, soap and lime." CONCLUSION. ^ From the earliest ages of antiquity, physicians liave beeu searching after specifics to cure all diseases. Some have flatter- ed themb. 'ves, every disease, to which the human body is lia- ble, has either upon the surface of the globe, or concealed with- in its bowels, an antidote ; while others have believed, there existed under some form, an universal medicine; which, as with a charm, possessed the wonderful power, not only of removiuo; '!• ! T^ 1 , U 004 APPENDIX. infirmities accompanying diseaBes, but the imbeGilities peculiar to old age. '^ ' ' That medical enthasiasts, and pretenders or the healing art, should have frequently imposed upon the credulous their specif- ics, for the cure of diseases, which experience proves to be a de^ ception, is not a passing strange event ; but, that mankind, not satisfied with having paid one tax on account of their credulity, should, at this more enlightened period of the arts and sciences, suffer many to be extorted by artful impostors, is truly won- derful. The name of a disease, by the scientinc physician, is less at- tended to, while making his prescriptions, than the state ; while experience evinces, that a specific does scarcely exist ; and a medicine, possessing the powers to cure aU diseases, is a mere fancy of an extravagant imagination. The various states of excitability^ to which the human system is subjected, in consequence of the variableness in the season?, of age and temperament, evince this incontrovertible truth, that the same exciting powers, are not adapted to every existing state of distise. A general knowledge of the above physiolog- ical fact, may prevent imi)Ositions from those, who deal in spe> eifics and catholicons ; as well as ensure a more judicious praor tice, from the honestly disposed physician. '^li. .('* >i - - 5.: i'^;..!' i>- ,'" '. ••> ,) . ,1.,;;, i . ■■ • .'. >v,tw,-,^; ni, jf- ,,, !,„^,;:, ''.».^ "' iv-U .- : 'u- /: i.'HU-i.'rie.i^ ^m- WINTER EPIDEMIC OF 1815-16. '*-. •■» ^-Ti V , ivi>imii \iht"-> J.ff »/>■■'■". *'■■>.;? V An epidemic peripneumonia notha prevailed during part of the month of February, March, and into April, in the town of Sharon, County of Norfolk, twenty miles southerly from Boston ; "where in the course of ten days, eighteen persons out of the first twenty-four cases of the disease died. In consequence of the alarm given by this uncommon mortality, I was invited to attend the sick. During my stay of sixteen days in the town, I visited between sixty and seventy patients, who were attacked with this malady ; of whom three died, one of eighty-two, one of sev- enty-two, and one of sixty-two years of age. The following ex- tract of a letter which appeared in the Boston Pateiot, and Dailt Advertiser, is expressive of the opinion, which the inhabitants of the town of Sharon possessed, respecting the prac- tice which was adopted by myself, in that complaint. . , " Through the medium of your paper, we wish to express our full satisfaction of Doctor Mann's practice ; believing as we do, that he is as well qualified to combat the mortal effects of this disease, as any physician within the circle of our knowledge." *' It is our wish, he would lay before the public, the nature of this disease, which has appeared to confound and distract many ; while his method of practice, different in many respects from what had been pursued, might be a mean of saving many valua- ble lives." (Signed) ENOCH HEWInS, Jun. JOHN MORSB, BENJAMIN RAYNOLDS, •i ,,»v " JOHN SAVELS, OLIVER WILLIAMS, JONATHAN COBB, " • RANSLE JONES, J'iim WTTEE. . } Selectmen ef Sharon LEWIS MORSE, AARON FISHER, JOSEPH MORSE, ELIJAH HEWWS, Jo). TP 306 WINTER EPIDEMIC OP 1815-16. I i l( f Mi m V In the same paper, notice was given, that in compliance with (he request of the gentlemen or the town of Sharon, it was my intention to give to the public, a statement of the prevalent epi- demic, ay it appeared at that place, under its various forms, with the most successful method of practice pursued. After exhibit* ing my general practice, it was observed, I had never seen the peripmumonia notha, as an epidemic in this section of New-Eng- land, until 1 saw the disease at Sharon ; that sporadic cases of this disease sometimes occur on the aged and infirm, during pe- riods of pneumonic disorders ; that about fifty years ago, a simi- lar disease, which proved very mortal, appeared in the upper towns of Norfolk, and adjacent towns in the county of Bristol j and that many physicians have seemed (orun wild, with appear- ances of new diseases. Hence, we find diseases at the present day, descril)ed under new names; which are calculated to seduce the young practi- tioner, from a correct and established practice. It is true, that im[)rovemeul3 have been made in the science of medicine ; but it requires a discriminating mind, and an extensive knowledge of ancient as well as modern authors, so to apply these improve- ments, OS to be able to meet diseases, in all their varying shapes, ^hich they assume in the routine of years. 'Mf' ? • 'V«? A student of the present day, may mdke himself well acquaint- ed with the prevailing diseases of his time, by a little reading, and an extensive practice under a judicious physician; but vrithout an extensive knowledge of books, can lie be prepared to prescribe with the best effects, to a disease, the form of which he has never seen, and of Avhich he has little or no knowledge, by the aid of medical books ? For instance, the spotted fever, when it first appeared, was considered a novel disease. It is not a new disease under the sun. Various remedies were prescribed, by the most judicious, before a permanent efficient practice was adopted. After the spot- ted fever had its mortal race a few years, at its heel, appeared the peripneumonia notha, no less formidable in various places on the northern frontiers, during the winters of 1812-13-14, not only among the troops, but with equal morlaJHtf over an extensive l.i^t ti * .-•-!».• WINTER EPIDEMIC OP 1815-10. 307 district of country among the citizens, in ttie states or Ncw-Tork, Connecticut, Massachusetts, Vermont and Ne\?-Hain|)shire ; and where these two formidable disorders were frequently con- founded with each other. — From the sudden deaths which oc- curred, and the general fatal tendency of the last disease, physi- cians conceived it wac typhoid, or a disease of debility ; whence ardent spirits and wine were resorted to as remedies. Indeed, when ihe peripneumonia notha first appeared at Burlington, Ver- mont, and its vicinty, in 18 1 2-13, it was viewed and treated by some, as that form of disease called spotted fever had been. By the last name, the pneumonic epidemic of the last winter, in somo parts of the counties of Norfolk and Bristol, has been called; especially where it has proved mortal; for every mortal disease, whether necessarily mortal from its nature, or bad management, must have attached to it some terrijic name ; and since spotted fever has become a fashionable frightful disease, the old and more common terrifc term mah snant is laid u|) for future use ; but how soon it may again be ordered into service, time, which changes the fashion of names, as well as things, will only disclose. This a&me peripneumonia notha, has also attached to it in some places, the additional terrible name cold plague ; in consequence of a torpor and coldness, which accompanies its first attack. Thus this disease commenced its first onset, in Attkborough, Matutfield, Wrentham, Sharon, &c. ■ * ' ■» / -i"- • s '• *" v Thus we perceive, a formidable name, in many instance!?, instrumental of introducing an incorrect practice, to the no smalt discredit of the medical profession ; and this will ever be the case, while physicians administer to natnes, rather than the symp- toms and states of disease. "- ■ In some places, profuse sweatings have been resorted to, in the first attack of this disease. If any have been so fortunate as to pass through this mode of practice, in addition to the wei;r|]t of disease, they have abundant reason to bless their strength of constitution, net their prescribing physicians. I have the fullest evidence to convince myself, that many have succumbed under this absurd practice. Some probably have survived tliis violent process, as well as the more stimulating practice of ardent spir^ T^ SOS WINTER EPIDEMIC OP 1815-16. i ll VI I \ I I its, by pints and quarts ; their number however, hre too few to induce a belief, that these irregular means, are the most eligible remedies. ititui^i i.i'ix muiU .•»; ^^Lir Im<> As this disease is nearly allied to the more common disease, denominated pleurisy ; bleeding, was, in some instances, india- criminately resorted tp, at Wa first attack, in connection with stimulants ; but as death too frequently followed this irregular practice, it was rejected as a deadly practice, in toto. Almost every potent remedy has had its day of trial, in this epidemic ; and in their turn, have been indiscriminately condemned. Whereas, many of those, excepting profuse sweatings, and ar- dent spirits, may be not only suitable, but necessary, in some of the forms of this disease ; while the success of their different ad- ministrations, depends altogether upon the ages, constitutions, temperaments, and habits of the patients. "• - " -f" At Sharony the peripneumonia nolha made its first attack, with symptoms of uncommon coldne^.d and torpor, which pervaded the whole system, without those strong rigors observed in pleu- risy, and intermittent fever; the heat of the body at the same time, to the touch, much below the standard of health. During the state of torpor, an oppressed respiration supervened, accom- panied with i>ain in one side, which increased, as the paroxism of fever came on. The heat of the botly during the febrile stage, was never much above the standard of health; sometimes the heat did not appear to be higher in degree than natural. The pulse during the cold stage, was very small ; and somewhat ful>- ler than natural, during the hot stage ; but not what might be denomiuatod a hard full pulse, except in two or three instances, in very robust constitutions. There was a remarkable pale pink coloured suii'usion over the ^vhole face, distinct from the usual i'ehrile blush in the cheeks ; the appearance was similar to the sudden flush colour, produced by silting before a fire, after hav- ing been exposed to cold. This appearance was most conspic- uous on persons having ,fair and light complexions. This was accompanied with a bloated countenance, which gave to the spare and (lale-faced patient, additional beauty to the general features. This roiige>like appearance, was less conspicuous oa WINTER EPIDEMIC OP 1315-10. 309 Ihe body, Ihan the face. A cough supervened, after the first twenty-four hours, in some instances ; and when it was iiccom- panied with an expecluratioM, the pain in the side abated; but if no expectoration accompanied the couj^h, all the dangerous aymptoms were aggravated. The expectoration was dilTerent, according to tlie degrees of danger. The matter expectorated, did not appear like common mucus ; but more similar to lympli, intimately tinged or tinctured with blood, varying its hue in ditTerent subjects. Sometimes the expectoration was ash-col- •ured, or dark brown ; in a few cases, it was a simple plilegm. The tongue, the first twenty-four hours, assumed a very foul ap- pearance, from a thick yellow fur, to a dark brown colour. The dark coloured tongues, wore dry, hard, and rough ; and on tho second day, appeared lilce the dark furred tongues of those, who have been sick with typhous fever a fortnight ; when, after the fur separated, or sloughed off, the tongue appeared of strawberry, or cranberry red, as did the fauces. It is to be noticed, that during the cold stage, the patients suffered from pain throughout; the muscles of the body, in one case similar to rheumatism. la four or five instances, this epidemic made its assault upon the head ; which bleeding immediately relieved ; upon enquiry, E found there was here no complaint whatever within the chest. It was then prognosticated, that in twenty-four houra, more or less disease would exhibit itself on the lungs. This prediction, which was presumed upon former experience, on the northera frontiers, was fulfilled in every instance where made ; while the pneumonic symptoms which followed, were not eventually less severe, than in those cases, where the first symptoms of disease shewed themselves, within the breast. ' . . There were three among seventy or more sick, not marked with characteristic symptoms of the epidemic, which assumed the form of genuine erysipelas ; where the iofiammation, in one instance, pervaded successively every part of the body. These forms of disease, were unaccompanied with any pneumonic af- fection ; but required the general remedies employed in that oomplaiat. This disease was not coDtiaed to any age j upoa those over 40 ▼ ' V II dio WINTER EPIDEMIC OP 181 5-1 ft i II r iir fifty yeV .1 *f -^ :»-.>« Vj-'r iritf'r.-.(tl/.1;t While the animal creation is fortified by nature, against the Varying seasons, and more sudden transitions of weather ; man is endowed with reason to direct him, how to avoid their dele- terious effects. This first gift of heaven will not be improved to -secure his health, while he erroneoraly believes, that occult agents are the sole causes of disease. Natural evil is so inti- mately connected with moral, to obviate the first, man should shim ihe lasL No species of irregularity, predisposes the body to tlisease, in so high degrees, as an intemperate \ite of ardent spirits ; while, during periods of epidemic diseasss, these exciting liquors are swallowed by those ignorant of their dangerous ten- dency, in still greater profusion, as a mean to obviate those very ;; eases, which ihey often generate, or excite to states of excessive danger. .Cne of the most effectual means, to secar« WINTER EPIDEMIC OP 1815-1§. 91t Hie body against all our vrioter epidemic*, is warm clothing ; and could the inhabitants or New-England, but he made sensi- ble, that ardent «i)irits do not protect the body Trom diseases of any kind; and would they adopt a firm resolution, to drink none of these stimulating liquors, and place the value usually con- •umed, in woollen or flannel garments upon their iKMltes, they would, when they settle their annual accounts, find themselves not only richer *n the means to render themselves happy, hut abounding in health; the greatest blessing which man can po6» sess on earth. Vicious habits once confirmed, are with difficulty overcome; but however bad, they may be conquered by persevering reso* lulion. Those, who have been in the intemperate use of ardent spirits, experience a sinking sensation at the stomach, when they abstain from these liquors; which discourages them in their first attempts to reform. The stimulating eflecis of ardent spir- its, are of short duration ; while the debility induced, renders the subjects of intemperance nut less, but more susceptive of oold. To cure intemperance, the patient may advantageously drink sweetened water, charged with ginger or red pep|)er ; in the pro|)ortion of a table-spoonful of the first, or a tea-spoonful of the last, to a pint of water. When the above liquor is drank to re- sist cold, it should be taken into the stomach milk warm ; and where it is advised to old inebriates, the water should be as high* ly impregnated with the pepper, as can be borne on the stomach. Much experience has convinced me, that nothing fortifies the body to endure severe cold so long, as strong coSee, with a small quantity of animal food. The writer of this, has repeatedly rode on horse'flick fifty miles, in a cold Avinter's day, without taking into his stomach any stimulating article, except hot cof- f«e, and a piece of bread and meat. With this stimulus alone, be was rendered capable of enduring the severest cold of a northern climate, three hours, with little inconvenience. Where circumstances do not admit of the benefit of coffee beverage, the ginger and pepper drink may be equally beneficial, taken witli some animal nutriment ; and pe.'haps more useful than cof^eOfi^jf ^osb' habituated U) tbe stimulut of ardeat spirits. 312 WINTER EPIDEMIC OP 1816-16. ^liihi Amon;; llie means BiMt effccfivc, to secure Iho Imdy frord at- taekf of inrentiout diaeaseB, nre clennlinens, chrerralnrnfl, mid rt Hoft nufritioiis diet. Pear, drnpondrnry, fatipie, and long watch- Jr»js, co-operate with hiirlful agents, to pr«)diicc diseiine. When n violent disease nRsails one menil»er of a family, and otiiers in the same dwelling .ire taken down, ,1 is often apprehended the iliseaae is contagious. The sick are shunned by friends, and nssistancc is with difliculty procured. Hence, during; opidemicr. Ihe diseased, who might have been preserved by suitable meanf . ]icrish ; while the general and local causes of the disease, as pu- trid effluvia, transitions of weather, &c. co-opernte with the fac- titious, to induce on each individual, a similar disease. I oner predicted, that n family would be invaded by disease. The precaution was aug^ested, to induce a removal of filth, which incommoded their habitation, during the hot season. PrcviouF to the expiration of four weeka, my prognostication was verified, l)y the appearance of a typhous fever, tvhich seized succeBsivelr the whole family. In this instance, as in similar occurrences, a belief existed, that the fever was contagious, and communica- ted from one to others. Tlie truth was, as all were subjected 1o the ger^rating cause of the disease, the surrounding filth, so all were infected. •*>^ ■">.**•:■ *,'^ ^. v ■■i.t-;,; .><■ During periods of epidemic disorders, every irregularity, ca- pable of exciting disorder in the system, will produce a disease, correspondent with that form of fever most prevalent. This of itself is evidence, that during these states, more or less predis- position to disease, exists within the human system, even when n person appears in perfect health. A transition from high states of health, to severe disease, is not unfrequent, sometimes vry sudden; and a disease which might have been light, pro- duced by mere atmospheric influence, may become, by addi- tional exciting causes, extremely dangerous. The scourge of epidemics may, in some degree, be prevented, by protecting the body from cold, by woollen garments next t le skin ; by a rigid temperance in eating and drinking; by avoiding excessive fa- tigues and watchings, and contaminated air, generated in small close rooms, by an assemblage of people ; and after respiring "^ .,.- WINTER EPIDEMIC OF 181 5-1 tt. 318 tho impare nir of such confined roomi, by guardinf^ the bodjr ngainst nocturnal exposures to culd. Severe attacki of epidem- ic discasrs may as certainly lie obviated, as the above condi> lions mny be avoided. At liochester, county or Plymouth, there were eases where (he disease was not confined to the lungs ; but the inflammation ap- peared under the form of cynanche trachealis, pharyngaa and pa- rotidaa, as the trachea, tonsils, and parotid glans were succes- sively or simultaneously afTected. Erratic pains, or a dry cough were noticed, as precursors of the local affection. These wand' ering symptoms did not alarm thn patients. Tor their appetites were not impaired, nor were their strength and spirits depressed. The appetite indeed was not much impaired during the course of the disease. No permanent relief was obtained, until a free expectoration supervened ; and where there was no expectora- tion under severe attacks, the patients always died. i- • > This disease was highly inflammatory from its commence- ment to its final resolution. It was as idle to administer stimu* laats for its cure, as it appeared at Sharon and Rochester, as it would have been to have poured oil on fire, to extinguish the flame. A man thirty years of afje, convalescing, relapsed, in consequence of taking into his stomach one glass of brandy, with symptoms more severe than the first attack ; from which, by mcnns of bleeding, blistering and cathartics, he eventually recovered. A woman forty years old, was indulged in half a glass of wine after a resolution of fever. The day succeeding a renewed attack of pain in the side, laborious respiration and dry cough supervened ; when, by the employment of expecto- rants, calomel, tartrite of antimony, and an emetic of ipecacuan- ha, expectoration was reproduced, and restoration to health. A woman past sixty, while in a convalescent state, drank some braady diluted ; in a few hours, expectoration stopped, succeed- ed by pain in the breast, and difficult respiration. This case was thought extremely dangerous. By the employment of cal- omel, ipecacuanha, blisters on the chest, an expectoration of bloody mucus returned ; and from this state, a slow recovery of health followed. i ,v U' T^ su VINTER EPIDEMIC OP 1815-lflt* i 1 1'. V The ntture of thh iliscaie wai well koown to me, baring pfrnf' ■cribed for it, during; the winters 1812-13-14, on the northern froBtien. Many diiiectiont also had coafirmrd me, the diteaa* was inflammatory in the highest degrees ; notwithstanding all which has been a