(and I yet see no reason to alter my opinion) I supposed those different complaints had their origin from the same cause, and that their different appearance arose from accidental causes, such as difference of constitution, or the manner of living. Our physician, who for nearly two months attended the Spanish soldiers, informed me that medicines had but little or no effect upon those labouring under the dysentery, and which I was afterwards informed by some intelligent Spanish gentlemen, was thought to be owing to a profuse use of stimulants, such as Cayenne pepper, by their soldiers in that country, which, by its inordinate use, destroyed the tone of the intestines, and rendered them insensible to the most active medicines.

"Various theories have been devised by physicians to account for those malignant fevers which are the scourge of the human race, but the most natural appears to be that of supposing a portion of the system, by some cause or other, to be rendered unfit for animal life, and, therefore, obnoxious to the healthy part, which, from a natural impulse, is constantly endeavouring to expel the morbid matter, and which is probably thrown off by both the external and internal surfaces. If this theory be just, the best means of prevention appear to be gentle cathartics, and frequent cleansing the outward surface, by bathing and changing of the clothes, particularly such as come in contact with the skin. To this practice I attributed my escaping the fever during the time of its general prevalence. If the offensive matter is thrown out of the system as fast as it is generated, and removed from the surfaces, I am of the opinion that but little danger is to be apprehended; but if, on the contrary, it is suffered to remain in the intestines, and on the external surface, and become entangled in foul clothes, the danger will be much increased.

"The variety of diseases in our southern country is not so great as in the middle and northern States. The degree of cold in the southern States, and the Floridas, is not sufficient to make a complete change in the appearance of the prevailing diseases, or to generate those which may be considered endemic in cold countries. But it is different in the middle and some of the northern States, which have not only a sufficient degree of heat, but such a continuance of it, in some seasons, as to produce the malignant fevers of the southern States and West-Indies. The degree of cold, with its continuance, is also sufficient, in some winters, to produce those diseases which prevail most in cold countries, and hence a greater variety of diseases may naturally be expected.

"It has been doubted by some, whether the climate of the middle, and some of the northern States, is capable of producing the malignant fevers of our southern States and the WestIndia islands; but these doubts would, in my opinion, be removed from the mind of any person who should reside a few years in the latter, unless he was previously wedded to a preconceived hypothesis, or supposed facts, and his mind entrammelled by prejudice.

"A reluctance to admit truth is little less injurious than the propagation of falsehoods; and the longer we contend that the climate of the middle, and some of the northern States, is incapable of generating the malignant fevers of the southern States and West-Indies, the longer we shall be in danger of suffering by these scourges; for while our measures are only taken to oppose a foreign enemy, a domestic one may begin its ravages. Experience teaches us that there are generally three things necessary to the production of the malignant southern fevers-first, heat-secondly, water, swamps, or marshes-and, thirdly, a collection of persons. And whenever we have a long continuation of heat, aided by the miasmata from impure water, and marshes partially dry, loaded with putrid vegetables, added to a large collection of persons, each of whom, by respiration, is constantly rendering one gallon of air per minute unfit for the functions of animal life, we are in danger of being attacked by a malignant fever.

"From the locality of those fevers in the United States, may not a conclusion be fairly drawn, that the cause, or causes, is, or are, in some degree, local also? for if this were not the case, those fevers would not be confined to our large towns on the water, but extend generally over the face of the country; which is contradicted by experience. And again, if the fever had its origin from importation, why is it confined to particular places? The answer, it is presumed, would be, that in those places there is a greater predisposition, from some exciting cause, whatever it may be, to receive the infection. Now let us see to what point this answer would conduct us. If in those places there is a greater predisposition to receive the infection, it follows that this predisposition in some degree depends upon local causes; and if the causes which produce this predisposition to receive the infection can, from concurring circumstances, be increased, may not a just and logical conclusion be drawn, that they may be so heightened as to produce that species of fever which, in a milder form, they prepare the system to receive?

1

"As those fevers appear evidently to depend, in part, upon local causes, the means of prevention will, in an equal degree, depend upon removing or correcting those causes.

"It is the opinion of many persons, that our large commercial cities would be materially injured if they were thought capable of producing the malignant fevers of our southern country and the West-Indies. This opinion, however plausible, certainly rests upon a slender foundation, because this opinion alone cannot prevent the recurrence of those fevers; and it must be the recurrence, whatever may be the origin, that will eventually be found injurious.

"If those fevers can possibly be generated in our large commercial cities, in the middle and southern States, we may, as has already been observed, be attacked by a domestic enemy, while our measures are only taken to avoid a foreign one. And if it should be discovered that those fevers are not of domestic origin, it must be granted that, from some cause or other, there is a greater predisposition to receive the infection in our large towns and villages, situated on our rivers, than in other places: an investigation of this cause would, therefore, be a subject of the highest importance; for, in all probability, the removing the cause would secure us against this scourge, so injurious to the interests, population, and happiness of our country.

"On this part of the subject I should have been silent, had it not been to correct an opinion which I entertained some years ago, that the climate of the middle States could not generate that species of the bilious fever commonly called the yellow fever; but from a residence of several years to the southward, where those malignant fevers frequently appear, I feel a strong conviction, that in the middle, and some of the northern States, there is both a sufficient degree of heat, and continuance of it some seasons, to generate those fevers in places situated in the neighbourhood of swamps, ponds of stagnant water, and in the midst of such filth as will too frequently be found about large cities and towns,"

To this part of the work are added instructive maps of the Floridas.

It would be improper for us to dismiss Mr. E.'s work, without giving our opinion that he has made very important additions to our geography, furnished valuable facts to medicine and geology, and collected good materials for our civil history and we trust his readers will agree with us, that these important and instructive parts of his book will much more than compensate for the prolixity and dryness of some of his details. VOL. I. 2 M

ART. II. Dissertatio Medica Inauguralis: Sistens Observa tiones ad Abscessum Bursalem pertinentes, apud Interro gationem publicam, prelocutas et sustentatas, Die Julii 11, A.D. 1801, habitam: Quam, annuente summo Numine, ex auctoritate Reverendi Josephi Willard, S. T.D. LL. D. Universitatis Harvardianæ Præsidis, et Honora→ torum et Reverendorum Curatorum et etiam Senatus Academici consensu; nec non Institutionis Medic decreto, pro gradu Doctoratus, Eruditorum examini subjicit Gulielmus Ingalls, Massachusettensis. 8vo. pp. 17. Bos toni. Fleet. 1803.

So

rare has it become for graduates in physic to compose their inaugural essays in the Latin language, that, as far as our recollection serves us, this Harvard candidate is the only one who, since the commencement of our labours as reviewers, has made use of it, in an American college, to convey his opinions. Although attempts have been made in these latter days to discountenance the study of the ancient classics, and bring them into disuse, we have ever lamented the success of such endeavours to favour the indolence and supineness natural to man. Readily, therefore, do we seize the opportunity which now presents of expressing our pleasure on beholding this dissertation, written, not in the vernacular tongue, but in imitation of the Roman idiom. However imperfect the execution, the attempt is entitled to some degree of praise. There is a dignity and an excellence in this kind of literature which we respect and admire, notwithstanding all the fashionable clamour against it. And we do not hesitate to pronounce, that a taste for the writings of ancient Greece and Italy, though it may not make an individual or a nation great, is one of the most agreeable and ornamental accompaniments of greatness. But to proceed with the dissertation.

Mr. Ingalls has chosen to exercise his talents in describing that kind of imposthumation or abscess which occurs in those membranous sacs, called burse mucose, that are situated in the vicinity of such muscles as are subject to considerable motion. The principal matter of the dissertation is a case of bursal abscess, with a comment thereon. The history of this curious disease we shall extract in the author's words, and exhibit it to our readers without translation, that they may at once form a judgment for themselves of Mr. I.'s proficiency as a scholar and a medical student.

"In autumnitate* homo, annos 22 circiter natus, corpore bene constituto præditus, cujusque modus vivendi liberalis fuit, ad meum consilium de acerba femoris affectione petendum, advenit. Ob femoris amplificationem, et calorem præternaturalem per totum membrum circumfusum; atque permansionem doloris, et facultatem ægri ad res usitatas laboriosasque peragendas; considerandum, eventum inali, quod quidem evenit, formationem abscessus alte siti, esse futurum. Ea ratio medendi, quæ progressum morbi maxime interrumpere spectaret, est designata. Ut hæc res consequeretur, diætam rigide antiphlogisticam observari, et vesicatoria frequentur admoveri, necesse fuit. Sic, emplastro epispastico applicato, vis inflammationis, dolorisque severitas, tum remissa tum mitigata est. Hic non silentio prætereundum, me raro ægrum videre; eumque non omnibus meis normis obsequi. Nihilominus paulo post, admotu vesicatorii singuli facto, morbus, omnibus ejus symptomatibus magna ex parte imminutis, genu solum occqpavit. Dolor in hoc articulo, et ejus amplitudo, morbum hydarthrum fuisse rheumaticum indicavissent; vero tumor, inter femoris ossis condylum internum et patellam, paulatim accrescens, et pus in eo, digitis palpatum, cedens, sensumque liquidi subtus moventis præbens, rem fuisse abscessum plane demonstraverunt. Qui, usque ad ver, dolore incomitatus, neque ulla repentina corporis commotione stipatus, augescere non cessabat; tunc temporis quidem aspectum formidulosum assumpserat.

"Cum ver aliquatenus consumptum sit, medicorum convocatorum consultationem de morbo tanti momenti, eventusque tam incerti, libertatem habendi postulavi. Medici, consultatione facta, omnes consenserunt, ut quicquid in tumore contentum evacuareter. Igitur, ab suo consilio, tumor lanceola pro abscessu in directione obliqua fuit ita incidendus, ut plaga cum parte pendula fieret; per cujus os quæcunque puris quantitas, nullo aëre ambiente in ejus cavum interim admisso, emitti posset.

"Propter modum inæqualem, quo pus, eo agitato, nunc huc nunc istuc fluxit, perspicuum fuit, ut in cystidibus sit inclusam; autem postea non solum tumorem, eo aperto, esse bursalem, licuit; sed etiam eum de quibusdam sacculis componi, qui duntaxat ad semetipsos mutuo adjunxerunt. Nam tantum unum iter, inter sacculum internum et externum per aperturam parvulam femoris ossi anteriorem, est repertum. Situs

A. D. 1798.