exceed every other remedy in the difcafe in queftion, when accompanied with the characteristic fymptoms of putridity; and this conviction, together with a defire of contributing to the flock of medical facts (which I confider as the fureft foundation of rational and certain practice) has prevaled with me to make my opinion public.

Obfervations on the cause and cure of the tetanus.-By Benjamin Rush, M.D. profeffor. of chemistry in university of Pennsylvania. DURING my attendance upon the military hofpitals of the united Aates, in the courfe of the late war, I met with feveral cafes of the tetanus. I had frequently met with this diforder in private practice, and am forry to fay, that I never fucceeded with the ordinary remedy of opium, in any one cafe that came under my care. I found it equally ineffectual in the army. Baffled in my expectations from a remedy that had been fo much celebrated, I began to inveftigate more particularly the nature of the diforder. I found it to be a diforder of warm climates, and warm feafons. This led me to afcribe it to relaxation. I refolved to attempt the cure of it by a fet of medicines in fome measure the oppofites of most of the medicines that had been employed in that diforder. Soon after I adopted this refolution, I was called to vifit col. John Stone, who was wounded through the foot, at the battle of Germantown on the 4th of October, 1777. He was in the third day of a tetanus. His fpafms were violent, and his pains fo exquifite, that his cries were heard near a hundred yards from his quarters. His head was thrown a little backwards, and his jaw had become ftiff and contracted. He was under the care of a skilful regimental fur

geon, who was pouring down opium in large quantities without effect.

Duty and friendship both led me to do my utmost to fave the life of this valuable officer. I immediately dif miffed the opium, and gave him large quantities of wine and bark, to the amount of two or three ounces of the latter, and from a bottle to three pints of the former, in the day. In a few hours, I was delighted with their effects. His fpafms and pains were lefs frequent and violent, and he had not done for feveral days and flept for feveral hours, which he nights before.

With the fame indication in view, I applied a blifter between his fhoulders, and rubbed in two or three ounces of mercurial ointment upon the outfide of his throat. He continued to mend gradually under the operation of thefe medicines, fo that in ten days he was out of danger, although the fpafm continued in his wounded foot for several weeks afterwards.

In the fummer of the year 1782, I was called to vifit a fervant girl of mr. Alexander Todd, merchant, of this city, who had brought on a tetanus by fleeping in the evening on a damp brick pavement, after a day in which the mercury in Farenheit's thermometer had flood at near go The cafe was nearly as violent and alarming as the one I have defcribed. I treated her in the fame manner, and with the fame fuccefs. To the above named medicines, I added only the oil of amber, which he took in large dofes, after I fufpected the tonic powers of the bark and wine began to lofe their effects. The good effects of the oil were very obvious. She recovered gradually, and has continued ever fince in good health.

In the fummer of the fame year, I was called to Alexander Leflie, a joiner, who had run a rail in his foot. I found him the day afterwards, in extreme pain, with fmall

convulfions, and now and then a winge in his jaw. The wound in his foot was without fwelling or inflammation. I dilated the wound, and filled it with lint moftened with fpirit of turpentine. This in a little while produced a good deal of pain and a great inflammation in his foot. While I was preparing to treat him in the manner I had treated the two former cafes, the pains and fpafms in his body fuddently left him; and in twenty hours after I faw him, he complained of nothing but of the pain and fwelling in his foot, which continued for feveral weeks, and did not leave him till it ended in a fuppuration. From the hiftory of these three cafes, I beg leave to make the following remarks. 1. That the predifpofition to the tetanus depends upon relaxation. This relaxation is generally produced by heat; but exceffive labour, watchings, marches, or fatigue from any caufe, all produce it likewife; and hence we find it more frequent from wounds received in battles, than from fimilar wounds received in any other way. These wounds more certainly produce the tetanus, if they have been preceded for fome time with warm weather. Dr. Shoepft, the phyfician general of the Anfpach troops, that ferved at the fiege of York, in the year 1781, informed me of a fingular fact upon this fubject. Upon converfing with the French furgeons, after the capitulation, he was informed by them, that the troops who arrived just before the fiege, from the West Indies, with count de Graffe, were the only troops belonging to their nation that fuffered from the tetanus. There was not a fingle inftance of that diforder among the troops who had fpent a winter in Rhode Island.

2. As the tetanus feems to be occafioned by relaxation, the medicines indicated to cure it, are fuch only as are calculated to remove this relaxa

tion, and to reflore a tone to the fyllem. The bark and wine appear to act in this way. The operation of the blifters is of a more complica ted nature. That they are fedative and antifpafmodic in fevers, is univerfally acknowledged; but in the flate of irritability, which occurs in the tetanus, perhaps their effects are nore fimply ftimulating. But I will go one itep further. In order to cure this diforder, it is necessary not only to produce an ordinary tone in the fyllem, but fomething like the inflammatory diathefis. The ablence of this diathesis is taken notice of by all authors, particularly by dr. Cullen*.

Mercury appears to ad only by promoting this diathefis. Hence it never does any fervice, unless it be given time enough to produce a fali vation. The irritation and inflammation produced in the mouth and throat, feldom fail to produce the inflammatory diathesis, as blood drawn in a falivation has repeatedly fhown.

I apprehend that the oil of amber acts as a ftimulant chiefly in this diforder. I have heard of a tetanus be ing cured in the island of Grenada by large dofes of muflard. Dr. Wright, lately of the island of Jamaica, relates, in the 6th volume of the London medical ellays, feveral remarkable cafes of the tetanus being cured by the cold bath. Both these remedies certain ly aft as ftimulants and tonics. By reafoning a priori, I com ceive that electricity would be found to be an equally powerful remedy in this diforder.

As a general inflammatory diathe fis difpofes to topical inflammati on, fo topical inflammation difpofes to general inflammatory diathefit. Wounds upon this account are lef

NOTE.

* First lines, vol. III.

apt to inflame in fummer than in winter. In the tetanus, I have uniformly obferved an abfence of all inflammation in the wounds or injuries that produced it. A fplinter under the nail produces no convulfions, if pain, inflammation, and fuppuration follow the accident. It is by exciting pain and inflammation, I apprehend, that the fpirit of turpentine acts in all wounds and punctures of nervous and tendinous parts. I have never known a fingle inftance of a tetanus from a wound, where this remedy had been applied in time. It was to excite an inflammation in the foot of mr. Leflie, that I dilated the wound, and filled it with the fpirit of turpentine. I was not furprifed at its good effects in this cafe, for I was prepared to expect them.

I find a remarkable cafe related in dr. W. Monroe's thefis, published in Edinburgh in the year 1783, of a black girl, who had a tetanus from unning a nail in her foot, being perfectly cured by deep and extenfive ncifions being made in the wounded art by dr. John Bell, of the ifland of Grenada.

It is by producing inflammation na particular part, and tone in the whole fyltem, I apprehend, that the imputation of a wounded limb fomeimes cures a tetanus; and it is beaufe the degrees of both are too inconfiderable to oppofe the violence of the fpafins in the advanced tages f the tetanus, that amputation often ails of fuccefs.

I have been informed by a phyfiian who refided fometime at St. Croix, that the negroes on that ifland Iways apply a plafter made of equal arts of falt and tallow to their fresh ounds, in order to prevent a locked aw. The falt always produces fome egree of inflammation.

If the fatts that have been flated re true, and the inferences that have een drawn from them are juff, how hall we account for the action of

opium in curing this disorder? I do not deny its good effects in many cafes; but I believe it has failed in four cafes out of five in the hands of moft practitioners. It is remarkable, that it fucceeds only where it is given in very large dofes. In thefe cafes I would fuppofe that its fedative powers are loft in its ftimulating. It is upon a footing, therefore, in one refpeći, with the flimulating medicines that have been mentioned; but from its being combined with a fedative quality, it is probably inferior to molt of them. I am the more inclined to adopt this opinion, from an account I once received from dr. Robert of the island of Dominique, who informed me, that after having cured a negro man, of a tetanus with large doses of opium, he was afterwards feized with a diforder in his ftomack, of which he died in a few days. Upon opening him, he found his ftomach inflamed and mortified. I do not forbid the ufe of opium altogether in this diforder. I think small dofes of it may be given to ease pain, as in other fpafmodic diforders; but as its qualities are complicated, and its efficacy doubtful, I think it ought to yield to more fimple and more powerful remedics.

To the cafes that have been mentioned, I could add many others, in which I have reafon to believe that the excitement of a topical inflammation by artificial means, has effectually prevented a tetanus.

To this account of the tetanus, I beg leave to fubjoin a few words upon a diforder commonly called the jaw-fall in infants, or the trifinus nafcentium of dr. Cullen, which is nothing but a fpecies of tetanus.

I have met with three cafes of it in this city, all of which proved fa tal. The flage of the diforder in which I was confulted, and the age and weakness of the infants, forbad me to attempt any thing for their relief, I have introduced the fubject

of this diforder in children, only for the fake of mentioning a fact communicated to me by the late dr. Cadwallader Evans, of this city. This gentleman practifed phyfic for feveral years in Jamaica, where he had frequent opportunities of feeing the tetanus in the black children. He found it in every cafe to be incurable. He fuppofed it to be occafioned by the retention of the meconium in the bowels. This led him invariably to purge every child that was born upon the eftates committed to his care. After he adopted this practice, he ne

ver met with a fingle inftance of the

tetanus among children.

Perhaps it may tend to enlarge our ideas of the tetanus, and to promote a spirit of enquiry and experiment, to add, that this diforder is not confined to the human fpecies, I have known feveral inftances of it in horfes, from nails running in their feet, and other accidents. It is attended with a rigidity of the mufcles of the neck, a ftiffness in the limbs, and fuch a contraction of the jaw as to prevent their eating. It is generally fatal. In two cafes I had the pleasure of feeing the difeafe perfettly cured by applying a potential cauftic to the neck under the mane, by large doses of oil of amber, and by plunging one of them into the river, and throwing buckets of cold water upon the other.

How far the reafonings contained in this paper may apply to the hydrophobia, I cannot determine, having had no opportunity of feeing the difeafe, fince I adopted thefe principles; but from the fpafmodic nature of the diforder, from the feafon in which it generally occurs, and above all, from the cafe related by dr. Fothergill, of a young woman having efcaped the effects of the bite of a mad cat by means of the wound being kept open, (which from its feverity was probably connected with fome degrees of inflammation) is it not probable that

the fame remedies, which have been ufed with fuccefs in the tetanus, may be ufed with advantage in the bydrophobia? In a difeafe fo deplorable, and hitherto fo unfuccesfully treated, even a conjecture may lead to useful experiments and enquiries.

Letter from dr. Thomas Bond to dr. Fothergill, on the use of tho barh in fcrophulous cafes.

Philadelphia, 08. 2, 1769 Dear fir,

WHEN I read your effay on the

use of bark in fcrophulous difeafes, I confefs it a little furprifed me. However, I determined to give it a fair trial, and have found that it much exceeds what you gave us reason to expect: but to anfwer any effectu al purpofe, it requires the fleady uf of large dofes, repeated for a combderable space of time; to comply with which, there is no difficulty in preval ing with the patients, because they daily obferve its good effects. The two following cafes appear to 12 worthy of notice, which I commun cate to you in acknowledgment for the obligation I think myself under, for this improvement in the medical art.

The lady of an officer of diffic tion in the American army, about four years ago, was affected with fe veral cluflers of fcrophulous tumors in the neck, for the cure of whitt, the underwent many tedious and fe vere courses of medicine, witho the lealt advantage. In February lat, the came to Philadelphia to conft me. She was then fo reduced by a lofs of appetite, and flow fevers, that he could fcarcely walk acros the chamber. Her neck and throat were full of indurated tumount many of which were at least two inches in diameter: feveral of thes had undergone a partial fuppuration, and difcharged an ichorous maser

1

From fiftulous ulcers. The tumours were fo numerous, large, and hard, and her conftitution in general fo hattered, I could no flatter myself with any rational profpect of fuccefs rom medicine. However, that I night not be wanting in doing for o diftreffed an object all in my powr, I ordered a difcutient fotus to he affected parts; covered the wellings with the emp. e fapon. ; nd directed three fcruples of the

again yielded to the bark and feel, I am, fir, &c. THOMAS BOND.

Relation of a cure performed by elec tricity. Communicated to the medical fociety in London, by dr. Cadwallader Evans.

rice a day; by which method, I ad the unexpected pleasure of feeing er much relieved in a month. Her ppetite was reftored; her fever ured; and the tumour leffened at aft one-third. She continued the me courfe, under my infpection, etween two and three months loner: and being then nearly well, Dok one hundred dofes of the bark with her, and returned to her husand's ellate in the country, where he now enjoys perfect health, with ut the least remains of the disease.

The other inftance is not fo exraordinary as the above; but is as lear a proof of the efficacy of the ark, and of the necellity of contiuing the use of it without intermiflion, until the cure is completed.

A young girl, of a good family, was brought to me from the country, with a large number of scrophuous tumours, which had gradually ncreased for many years. I first directed a flight falivation to be kept up for feveral weeks, which the bore well, but rather increased than lefened her tumours. I then directed a courfe of the bark in powder, with a ew grains of feel. After he had aken one hundred and fifty dofes, The was brought to me again, when I obferved the tumours to be alınoft diffolved. A misfortune in the family foon after, caufed the child to be neglected fome months, during which time, the. fwellings increafed to near their former fize; but have Vol. II. No. V. j

about the fourteenth year of her age, was feized with convulfion fits, which fucceeded each other fo fall, that the bad near forty in twen ty four hours after the first attack. She ftruggled with fuch violence 'in the fits, that three frong people could fcarcely keep her in bed: but, after bleeding, blifters, with the ufe of anodyne and nervous medicines, they now abated in feverity, and did not return above once or twice a day. It was thought to be occafioned obftruction of the menfes, by an from imprudently expofing herself to cold at the time of their appearance; therefore he was put upon a courfe of gums, fleel, bitters, &c. which fucceeded in procuring that difcharge in a pretty regular manner.

Notwithstanding this, her diforder continued in one fhape or other, or returned after an intermiffion of a month or two at fartheft. Sometimes the was tortured almoit to madness with a cramp in different parts of the body; then with more generat convulfions of the extremities, and a choaking deliquium; and, at times, with almoft the whole train of hyfteric fymptoms. Thefe continued, and harraffed her alternately for ten years, though fhe had the beft advice the place afforded, and took a greac number of medicines.

In September, 1752, the determined to try what electricity could do for her; which, together with its effect, the relates as follows, in two letters-the first dated five month