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 address 
 
 Charles E. Johnson 
 
 
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 Howell Collection 
 
 OF HISTORICAL 
 MATERIALS 
 
 Presented by Kay Kyser 
 
 And his Mother 
 
 Emily Royster Howell Kyser 
 
 As a Memorial 
 
 To her Brother 
 
 Edward Vernon Howell 
 
 Dean School of Pharmacy 
 
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 THE UNIVERSITY 
 
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 NORTH CAROLINA 
 
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 AN ADDRESS 
 
 BEFORE TKE 
 
 MEDICAL SOCIETY OF NORTH CAROLINA, 
 
 
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 ITS SECOND ANNUAL MEETING, 
 
 IS RALEIGH, MAY 1851, 
 
 BY CHARLES E. JOHNSON, M. D, 
 
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 Cum nil sine ordine et lege fiat, ita vitae nostrae integritas naturali lege constat, et 
 nobis hanc investigare legem; sed prinsqnam ad nos spectat cognosoere ignorentiam. 
 
 RALEIGH i 
 
 SEATOff GALES, PUBLISHER, REGISTER OFFICE. 
 
 1851. 
 
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A N -A D I) E E S S 
 
 BEFORE THE 
 
 MEDICAL SOCIETY OF NORTH CAROLINA, 
 
 ITS SECOND ANNUAL MEETING, 
 
 IN RALEIGH, MAY 1851, 
 
 BY CHARLES E, JOHNSON, M, D, 
 
 Cum nil sine ordino et lege fiat, ita vitae nostrae integritas naturali lege constat, et 
 nobis banc investigate legem ; sed priusquam ad nos spectat cognoscere ignorentiam. 
 
 RALEIGH: 
 
 SEATON GALES, PUBLISHER, REGISTER OFFICE. 
 1851. 
 
Digitized by the Internet Archive 
 
 in 2012 with funding from 
 
 University of North Carolina at Chapel Hill 
 
 http://archive.org/details/addressbeforemedOOjohn 
 
ADDRESS. 
 
 Mr. President and Gentlemen 
 
 of the Medical Society of the State: 
 
 It is with no ordinary feelings of embarrassment and with a 
 profound distrust of my ability to contribute any thing of import- 
 ance to your deliberations, that I appear before you on this interest- 
 ing occasion, in the novel character of a Public Speaker. Although 
 I consider myself one of the very humblest of the gallant lew, who 
 have stepped forward in the good work of Medical Reform in North 
 Carolina, "to perform the tasks of hope in the midst of despair,'' 
 yet I have not felt at liberty, from any considerations, however 
 gratifying to me personally, to shrink from the discharge of the re- 
 sponsible duty which your partiality has assigned me. 
 
 Here I might be permitted to say many very civil, pleasant, 
 and truthful things of the Medical Profession, nor would it be 
 what the Lawyers call a '-departure,'' since it is as clearly within 
 the object of our Society to say a kind word of our professional 
 brethren, as it is to inveigh against follies, vulgarities and vices, 
 qualities which the pretenders in medicine have in common with 
 some men of other pursuits. Whilst, therefore, I am compelled to 
 admit that there are some practitioners of Medicine, who are pur- 
 suing in a most unworthy manner, our highly honorable and truly 
 useful profession, I wish to be distinctly understood to assert, that 
 neither the causes which originate or aggravate their vices are ne- 
 cessarily incident to the profession itself. That such an objection- 
 able state of things should exist is, perhaps, mainly our own fault, 
 but partly owing, I believe, to the lack of a general diffusion of 
 useful knowledge, and to the existence on our statute book, of a 
 very pernicious law. By reference to our Revised Statutes, it will 
 
be found, that all sorts and degrees of Doctors, from thePcoot and 
 Cancer and Thompsonian Doctors, up to the regularly educated 
 and highly polished gentleman and physician, stand upon the 
 same footing, and enjoy, under the law, the same privileges and im- 
 munities as to the Doctorate. 
 
 It is astonishing how soon one of these pretenders will learn 
 to cheat the public. He takes all advantages and seems to have 
 no idea of any other principle. Cunningly mysterious and secret 
 as to the sources of his knowledge and the means which he employs 
 in the treatment of disease, he soon becomes a trading sycophant 
 and flatterer, pandering to the pride and pleasures of tne few, and 
 ministering to the prejudices and ignorance of the many, whilst his 
 own mind is impenetrable to a single my of liberal knowledge, is 
 
 "Xot pierceable by power of ahy star." 
 
 However, I shall not discuss here the legal privileges, nor the 
 cherished errors oi these charlatans, who are so well versed in the 
 "gospel of enlightened selfishness" as to deny the importance of 
 every consideration, the value of which they cannot estimate in dol- 
 lars and cents. Nothing is to be made by an argument with or a- 
 bout them. That sort of gratuitous advertisement would only en- 
 able them the more readily to climb up into public view, confident, 
 in their own minds, that the application of the old adage, "who 
 shall decide when Doctors disagree," could not result to their dis- 
 advantage. It will not be expected of me, therefore, to occupy 
 your time wlthany farther allusion to them particularly, as I de- 
 sire to make a few remarks, before I pass on to the consideration of 
 the proper subject of this essay, in defence of the profession of 
 medicine, the peculiar advantages we possess for prosecuting the 
 study of it successfully, and in praise of those noble spirits who 
 bring to the practice of their art, learning, humanity, discretion and 
 integrity, the four cardinal virtues of a really deserving physician. 
 
 It is as true now, as ever, that the services of a learned and 
 skilful physician are of such vital importance to mankind, that if 
 medical men will take care to be distinguished, as a body, for their 
 humanity and integrity, their knowledge and acquirements, and 
 their high-toned gentlemanly bearing and kind offices toward each 
 other, they will soon ensure the perfect confidence and entire respect 
 of their fellow men ; whilst the blunders, ignorance and miscon- 
 duct of unqualified pretenders, would attach to each undeserving 
 one of them, agreeably to his worthlessness, rather than to the pro- 
 
fession itself. Then, there would be more hope of a moral regene- 
 ration of the profession than croakers will allow is possible, because 
 the sordid and selfish even will begin to discover that a thorough 
 devotion to professional science and duty is the surest, if not the 
 shortest, way to wealth and importance ; and wisdom once acquir 
 ed, no matter what the motives were which prompted the acquisi- 
 tion, will be faithfully cherished afterwards, not only for the advan- 
 tages it can confer, but for its loveliness and virtue. The wise 
 man, in describing the advantages of the love of wisdom and virtue, 
 says: "Length of days is in her right hand, and in her left hand, 
 riches and honor." But in my humble judgment, the members of 
 the profession, who undertake the study and practice of medicine 
 with a full knowledge of its relations with the various wants, pur- 
 suits and purposes of life, and with a determination to be prepared 
 to meet these exigencies, are more deserving of praise for merit of 
 every kind than the world is in the habit of according to them. 
 
 " A Physician skilled, our •wounds to heal, 
 Is more than armies to the public weal," 
 
 is the testimony of him, who, nearly a thousand years before the 
 beginning of our era, sang of Troy and her fall; and shall it be 
 said in this so justly called age of progress, when invention is 
 every day discovering new and unappropriated objects of interest, 
 and opening, by experiment and the inductive method of reasoning, 
 new fields of enquiry in which every man may take an even start, 
 that the humble, but earnest and truthful disciple of vEsculapius 
 is a less useful, important, and respectable member of society than 
 he was in those ruder times? No; it cannot be. I will not be- 
 lieve it. The love of useful knowledge not only still exists, but 
 even burns with a more ardent glow than at any former period of 
 the world's history. Many circumstances conspire to produce this 
 condition of things. It is not owing to any change in man's na- 
 ture, peculiar to this age, for human nature, without doubt, has been 
 the same in every enlightened age and nation, but results in part 
 from the higher incentives to cultivation and the greater rewards 
 offered to industry. Wherever these are liberally provided, there 
 every faculty of mind and body will be exerted to the utmost, and 
 man will furnish the most numerous and shining examples of hu- 
 man perfection. Besides, along with these inducements for the ar- 
 dent pursuit of useful knowledge, we are the fortunate heirs of time, 
 who have acquired by inheritance all the advantages of the expe- 
 
rience and wisdom which history teaches. Mounted, as it were, 
 upon the shoulders of those who have preceded us in the pathway 
 of human progress, we enjoy a more extended horizon than met 
 their view. No narrow limits contract the sphere of our intellect- 
 ual vision, but the whole boundless world is ours. Much, too, is 
 clue to Protestantism, which has achieved wonders in philosophy 
 as well as religion, and is one of the distinguishing peculiarities 
 and most valuable characteristics of the present age. In our day, 
 the inquirer after Catholic truth, in all the departments of knowl- 
 edge, in the exact sciences and speculative philosophy, as in reli- 
 gion, can pursue his object with a Protestant spirit. No longer the 
 Schools are connected with the Vatican, producing a degree of men- 
 tal vassalage and subserviency, destructive of the spirit of free in- 
 quiry. No longer the word of a Priest or Master, or a dogma of 
 the schools, is the test of truth, but the immortal mind, whose ca- 
 pacity for knowledge and wisdom is increased the more it is stored 
 with useful treasures, is left that full liberty to combat error or pur- 
 sue truth, which is so characteristic of the age we live in. And if 
 it be the honor, as I believe it is, as well as the character of this 
 age, that genius and learning, not less than christian benevolence, 
 are chiefly busy in the habitations of men, and around the walks 
 of daily life, and that the greatest men, as well as the best, find their 
 themes of study, and their sources of inspiration in the moral and 
 physical wants of mankind, then, in such an age, and especially in 
 a country like ours, where we have in our governmental policy 
 avoided the cherished prejudices and tolerated errors of long estab- 
 lished despotism, on the one hand, and escaped from the greater 
 evils of fanaticism, unrestrained by law, on the other, " he who will 
 not reason is a bigot, he who cannot reason is a fool, and he who 
 dares not reason is a slave." God has given man the peculiar fac- 
 ulty of reason to guide him wisely, and therefore safely, in the 
 pursuits of life, and he who will not exercise it vigorously and 
 healthfully in the progress of events, will presently find himself 
 trodden down and crushed beneath the feet of the rushing multi- 
 tude whose onward course he obstructs. Let not this be the lot 
 of any one of us. 9n the contrary, let each of us, not only in his indi- 
 vidual character andposition,butlikewisein his associated character, 
 press on to the attainment of the objects and purposes of his high 
 calling, emulating the lives and conduct of the masters in our pro- 
 fession, who have taken their stand, shoulder to shoulder, in the 
 
foremost ranks with those philosophers who have inscribed their 
 names high in the temple oi fame. 
 
 In the anticipation of a glorious future, the youthful and am- 
 bitious student finds the highest incentive diligently to prepare 
 himself for the active and honorable course he means to run ; and 
 the older ones find it necessary to labor faithfully in their several 
 callings, that they may wear the honors of experience gracefully 
 and not be outstripped by their more youthful and equally well in- 
 formed competitors. So, as there is no privileged road to knowl- 
 edge and usefulness, every competitor, whatever his age and condi- 
 tion in life, who struggles to win and wear a distinction worth pre- 
 serving, must undergo the same painful discipline of mind and la- 
 borious exertion. But let him who runs take heed lest he fall, mis- 
 taking the feverish excitement and fitful energy of a sanguine tem- 
 perament for a true and noble ambition, and a momentary popular- 
 ity for lasting renown. All this is true of the study and practice of 
 medicine, and I am persuaded that the former, if carried on with a 
 full knowledge of its important duties and relationships with the 
 well being of society, is ennobling in its very nature ; and that the 
 latter is honorable and will be remunerative, when conducted un- 
 der the influence of that preparation, hopefulness, and patience, 
 which enable us to be contented with small beginnings, but keep us 
 always ready for the gradually widening sphere of useful labors 
 that certainly awaits us. We must remember though, if we hope to 
 succeed, always to have some good objector useful purpose in view ; 
 and even in our moments of relaxation from the severer studies and 
 arduous labors of our profession, not to turn exactly into the "prim- 
 rose path of dalliance," but endeavor to cultivate an acquaintance with 
 thsse kindred sciences, which develop the mental faculties, and a taste 
 for polite literature wh ich gives them harmony, and to acquire a chris- 
 tian spirit, that we may have it in our power to contribute to the refine 
 ments, as well as happiness of the social circle. This course of men- 
 tal gymnastics will not only enable us to investigate wtth facility 
 and scrutiny the advantages and disadvantages of all the facts and 
 theories, which are continually coming out of the prolific laborato- 
 ries of medical Philosophers, but likewise to discharge the onerous 
 duties of our profession more as a pleasure than as a task. 
 
 •'Tis not for mortals to command success 
 
 But we'll do more, Sempronius, we'll deserve it." 
 
 Lord Bacon regarded the science of medicine with the great- 
 
est interest. He aimed at the relief of "man's estate," and this he 
 believed was to be accomplished as well by mitigating human suf- 
 fering as by multiplying human enjoyment. The study, therefore, 
 of the to kalon and to eidolon of the old philosophers, however 
 well calculated it may have been to sharpen the wit or refine the 
 rhetoric of the schoolmen, contributed but little, according to the 
 views of this great man, to alleviate the pains, or lessen the burdens 
 of suffering humanity. Considered in relation to these great ob- 
 jects, he regarded the science of medicine as the most important de- 
 partment of knowledge, because it was capable of conferring the 
 most desirable benefits on mankind. 
 
 In this connection, too, it will not be improper to elevate our 
 thoughts and recollect that "the great physician of the soul did not 
 disdain to be also the physician of the body." How gratifying to 
 the mere philanthropist and physician are the views and opinions of 
 Bacon! How cheering and sustaining to the enlightened, laboring 
 physician, who is at the same time a christian man, to know, that 
 in some degree, at least, he is following the example of his Divine 
 Master ! Again ; the dangers the medical man encounters, and en- 
 counters alone, unsupported by the emulous spirit and confidence 
 of numbers, 
 
 "All the while 
 
 Sonorous metal blowing martial sounds," 
 
 are as much greater than those of the soldier in the battle field, as 
 the calm deliberation of high purposes and conscious rectitude is 
 superior to the mere enthusiasm of excited courage. Aye, and if 
 he falls, as he oftentimes does, fighting with deadly disease, in his 
 lonely walks amidst pestilence and famine, no funeral honors at- 
 tend upon him, no public provisions await his family. His is the 
 honor only to have acted well the things that belong to the sad re- 
 alities and pressing necessities of human life — h'"s the honor to have 
 been a co-worker with those great and good men, by whose con- 
 stant toils, and energetic labors and self-sacrificing spirits, mankind 
 have been ever blessed. Hence it is with some assurance, although 
 with an humble spirit, I assert, that the diligent and enlightened pur- 
 suit of so honorable a calling as ours, for honest purposes, is faith- 
 fully to serve God. 
 
 But I must turn from this agreeable theme, and the further e- 
 lucidation of it, inviting as it is, and direct your attention to the 
 proper subject of this essay, in which I propose to discuss the doc- 
 trine of the miasmatic origin of disease. 
 
9 
 
 The acquisition of as complete and perfect a knowledge of the 
 causes of diseaae, as may be attainable, is so obviously useful to 
 the general practitioner, that it will not be necessary for me to in- 
 sist upon it here ; for although the nature and seat of the malady 
 be equally well known, and the method of treatment thorough/ un- 
 derstood, it is nevertheless of great importance to be able to refer to 
 its cause, which, indeed, after giving rise to the disease, may still 
 continue to operate injuriously by its presence. Now, as this is 
 especially true of that class of disorders, commonly denominated 
 malarious or miasmatic diseases ; and as these diseases and their 
 causes should be particularly objects of study and inquiry with ma- 
 ny, if not most of the physicians of North Carolina, I shall assign 
 no other reason, because I believe I can adduce no higher one, for 
 making their Etiology the subject of this communication. On the 
 other hand, I do not mean to be prevented from expressing my o- 
 pinion in the premises, because it is too commonly the case, that 
 he, who undertakes to direct the professional or public mind to ob- 
 jects of etiological reform, is more apt to be considered a visionary 
 theorist, than a zealous and intelligent advocate of sanatary im- 
 provements. Nor shall I bring forward, just now, any other theory 
 to explain these phenomena, as an excuse or apology for what I have 
 to say in opposition to the received notions upon this subject. En- 
 tertaining, as I do, the firm conviction, that the first important step in 
 a practical investigation is the removal of any error with which it 
 may be encumbered, it is sufficient for my present purpose, whatever 
 my ultimate intention may be, to show that marsh miasm, in the 
 sense of an exhalation from putrescent vegetable matter, cannot be 
 the cause of disease. And, indeed, it would not be a difficult mat- 
 ter to bring forward evidence to prove that if, instead of sitting down 
 quietly under the persuasion of the existence of this thing, marsh 
 miasm, an inappreciable essence, about which they cannot agree, 
 medical men and the civil authorities would earnestly and wisely 
 exert themselves to discover the real nature and sources of morbific 
 agents, the result would be an astonishing diminution of the 
 liabilities to disease and the rates of morality. It is apparent, 
 therefore, in regard to this question, that I consider it one of some 
 little importance, at least, to the skilful physician of the South- 
 ern States, involving as it does, the every day application almost 
 of the principles of practical etiology, which I understand to be 
 the establishment of the invariable relationship, as cause and ef- 
 2 
 
to 
 
 feet, of those agents or influences that are capable of producing dis- 
 eases and the diseases themselves. This, I believe, the sequel will 
 show is not the case with miasm and the so-called miasmatic dis- 
 eases. 
 
 I know that in advancing this opinion, I am impinging upon 
 the current prejudices and dogmas of the schools, andj perhaps, upon 
 the opinions of most, if not all, of the medical gentlemen here as- 
 sembled. But, let me ask you, in all sincerity, have you not adop- 
 ted, as a portion of your early professional education, your belief 
 in the miasmatic origin of disease ? Have you faithfully and phil- 
 osophically investigated its claims to validity and truth, and after 
 due inquiry, yielded it your full credence because you could not re- 
 sist the overwhelming evidence in its favor? Or, have you hot 
 unpardonably cherished an error, because it was a popular one, or 
 because it furnished you with an easy, if not satisfactory solution, 
 of a difficult question 1 Or, have you not preferred to rest on a 
 foregone conclusion, not, at bottom, really embracing any well 
 tried fact, or established principle, rather than be troubled or dis- 
 turbed about that on which you have already made up your minds ? 
 Or, acting still more culpably, and upon the well known maxim of 
 Bolingbroke, "that whilst plain truth may influence half a score of 
 men, mystery will lead millions by the nose, '' have not medical 
 men, from the days of Lancisi down to the present time, used the 
 term miasm or malaria, as a sort of convenient cloak for covering 
 up their real want of information upon this subject, and thus hid- 
 ing their ignorance from the public gaze? And is this the prop- 
 er method, think you, of conducting an investigation after truth, 
 reasonable truth, especially by those who seek it for the ennobling 
 purpose of remedying the "ills that flesh is heir to ?" Surely not. 
 For, after all, the expression, marsh miasm, as denoting the cause 
 of disease, is notliing more than a mere theoretical way of announc- 
 ing the fact that something exists, of the nature and source of which 
 we are ignorant, for the production of these diseases, since it can 
 neither be appreciated by our senses in their natural state, nor aided 
 by all the artificial contrivances which ingenuity can suggest, nor 
 traced even by the presence of those agencies which are said to be 
 capable of generating it. 
 
 Educated to believe, with entire confidence, in the theory of 
 the miasmatic origin of disease, it was not long after I commenced 
 the practice of my profession in one of the paludial districts of this 
 
11 
 
 State, before I began to doubt the sufficiency of the facts and ar- 
 guments upon which the doctrine rested. Subsequent observations,, 
 and a more enlarged and matured experience have ripened those 
 doubts into convictions and I now regard the doctrine as a ground- 
 less assumption or pure hypothesis. Let me not, however, be mis- 
 understood on these points. I do not mean to deny the fact, 
 well known to every observing man, whether he be a physician 
 or not, that a low marshy country is, generally speaking, more 
 sickly than a higher, drier, and better ventilated one. Indeed, 
 I may observe in this connection, that so far from denying the 
 effect of climate and position upon organic life, I am inclined 
 to think there is some truth in the remark of a distinguished nat-. 
 uralist, made at a meeting of Savans in Charleston, South Car- 
 olina, a year or two ago, that he was so well acquainted with 
 the geological and meteorological conditions of the State in which 
 he resided, and the influences they produced, even upon man, as to 
 be able to decide in a given number of individuals by their peculiar 
 characteristics, in what sections of the State a majority of them 
 were reared. Nor do I mean to assert, what every educated person 
 will deny, that hypotheses are altogether valueless in every scien- 
 tific inquiry. The views I wish to present, and hope to maintain, 
 are simply these : That the greater sickliness of the low lands is 
 not owing to miasm, an exhalation from decaying vegetable matter, 
 under certain circumstances of heat and moisture, the sense in 
 which it is used by the schoolmen ; and that hypotheses, to be of 
 any importance in philosophical investigations, must have such a 
 fixed and determinate value as will always render them applicable 
 under like circumstances, and inapplicable under dissimilar ones. 
 Locke says, "Hypotheses, if they are well made, are at least great 
 helps to the memory, and often direct us to new discoveries."' But 
 at the same time, he gives us the wholesome caution, "that the 
 names of principles deceive us not, nor impose on us, by making us 
 receive that for an unquestionable truth, which is really at best but 
 a very doubtful conjecture." 
 
 Sir Isaac Newton says, " For the best and safest method of phi' 
 losophizing seems to be, first, to inquire diligently into the proper- 
 ties of things, and establish those properties by experiments, and 
 then to proceed more slowly to hypothesis for the explanation of 
 them." But, lest it may be said that Newton had reference to the 
 exact science of mathematics, listen to the language of Sir H. Davy, 
 
12 
 
 to whose particular department of philosophical knowledge, chem- 
 istry, this subject of miasmata properly belongs. He says, "I trust 
 that our philosophers will attach no importance to hypotheses, ex- 
 cept as leading to the research after facts, so as to be able to discard 
 or adopt them at pleasure, treating them rather as parts of the 
 scaffolding of the building of science, than as belonging to its foun- 
 dation, materials or ornaments." It is not my purpose then, alto- 
 gether, to condemn hypotheses, but to keep them in their proper 
 places, to render them subordinate to the laws which should regu- 
 late all inquiries in the physical sciences. For example, to assume 
 that miasm was the cause of disease, the existence of which is only 
 inferred from the fact that disease prevails under circumstances to- 
 tally inexplicable, unless upon the assumption of the existence of 
 such a cause, would not be, I apprehend, an improper method of 
 philosophizing, provided, on the one hand, we always had the cir- 
 cumstances present which were claimed as being capable of gene- 
 rating the cause itself, and, on the other hand, the disease invaria- 
 bly following as a matter of consequence. Under different circum- 
 stances, that is, in the absence of either the disease or the miasm, we 
 should have a cause without its corresponding effect, or, what 
 would be a much worse state of things in physics, because fatal to 
 any theory of causation, an effect without a cause. 
 
 Now, the course of nature, so far as it has been observed, and 
 is cognizable by our senses directly or indirectly, where we have 
 been able by the aid of artificial contrivances, carefully to observe 
 her laws and operations, is so uniform in respect to causes and ef- 
 fects, and so specific in the character of her laws, that we are bound 
 by a correct philosophy to refer the phenomena of disease to some 
 one or more of the appreciable states of the surrounding media, 
 which are in any way brought into relationship with our bodies, 
 or to intelligible internal agencies, or systemic influences, rather 
 than to some unknown fanciful and inappreciable condition of the 
 atmosphere. It is my purpose, therefore, in the course of my re- 
 marks, to show that the doctrine of the miasmatic origin of disease 
 does not rest on the evidence of our senses, aided or unaided, or 
 indeed, upon reliable evidence of any kind ; but that it falls under 
 the absurdity alluded to above, namely, of a cause without a conse- 
 quence, or a consequence without a cause. Hence, the conclusion 
 to which I have come, with others, that this theory is a groundless 
 assumption, unsupported by such facts and principles as should 
 
13 
 
 constitute the basis of every philosophical inquiry. 
 
 In mathematics, you cannot rightfully seek, much less con> 
 mand, a demonstration without a suitable basis of established facts 
 or admitted axioms. So, every legitimate argument and philosoph- 
 ical investigation should rest upon facts and principles that are ca- 
 pable of application under like circumstances in every process of 
 reasoning by which the inquiring mind desires to establish truth. 
 But tor the very reason that like circumstances are absolutely nec- 
 essary for the proper display of these prerogative facts and princi- 
 ples, it is obviously the case, that they are inapplicable in any rea- 
 soning or argument by which it may be attempted to account for 
 the same phenomena under dissimilar ones. 
 
 This statement comprises the theory of induction, and if medi- 
 cine be entitled to a place among the inductive sciences, then is the 
 principle here laid down of importance to our inquiry ; for, as every 
 investigation of natural phenomena necessarily becomes an inquiry 
 into causes and their effects, and unavoidably leads to a series of 
 physical laws, so every well-grounded theory of causation must 
 have an intimate connection with the theory of induction, as prac- 
 tised in the natural sciences. Induction, then, gives us the right 
 to expect that the same result will always happen from the same 
 cause, operating under like circumstances ; but it is of the very es- 
 sence of this inference that the similarity be first shown. Without 
 it, no process of induction can be brought to a lawful conclusion, 
 and reason, right reason, cannot be the ground of our belief. More- 
 over, upon what does our idea of causation rest? Unquestionably, 
 the uniform observance of two facts or sequences of external 
 nature furnishes us the only evidence, a priori, of causes in that 
 sphere. The conjunction, therefore, of any two successive events 
 may very properly become the ground ot our belief in their relation- 
 ship as cause and effect, provided, the second event has always been 
 found not only to follow the first, but the second must never have 
 been observed without the first preceding it. 
 
 Mill, in his admirable treatise on causation, defines " the 
 cause of a phenomenon to be the antecedent or concurrence of an- 
 tecedents upon which it is invariably and unconditionally conse- 
 quent." And again ; " Invariable sequence, therefore, is not sy- 
 nonymous with causation, unless the sequence, besides being invari- 
 able, is unconditional." 
 
 Inconsiderately viewed, this absolute law of causation, whose 
 
14 
 
 property and requirements are not only invariable uniformity, but 
 unconditional consequence, might appear to shackle our experimen- 
 tal inquiries by narrowing down the proof too rigidly ; but a mo- 
 ment's reflection will satisfy us that such is not the case, as the con- 
 stituent elements of a law in the science of physical etiology, the 
 subject under inquiry, ought not to differ from those of a law in the 
 physical sciences generally — that is, so far as the analysis has ref- 
 erence to the constancy of a phenomenon, or the invariableness of a 
 relationship. For, let it be remembered that we are investigating 
 natural phenomena and that every such inquiry is a search after 
 causes and effects, and not a study of the calculus of probabilities, 
 whose loose and too hasty system of generalization, attempting to 
 define the complex before the simple is faithfully learned, has led 
 medical minds, loaded with hypotheses, into endless vagaries and 
 absurdities in their speculations upon the subjects of practical eti- 
 ology. Recollect, too, that nature in her course is always uniform 
 and certain, and that her order and economy are such as never to 
 employ the wasteful expenditure of two separate and distinct caus- 
 es to accomplish one and the same object, although in a series of 
 events some one leading phenomenon may be the chief cause of 
 many consequences, and it will be clearly seen that these princi- 
 ples are not too rigid for a correct philosophy. 
 
 Now let us apply this Baconian process of inductive reason- 
 ing, this well established method of conducting philosophical in- 
 vestigations, to our belief in the miasmatic origin of malarious dis- 
 eases, and see if it is well founded. Or whether, in the first place, 
 we have not assumed a fact, which is not proved, and then built 
 upon it a theory, which, in the next place, we are prone to apply when 
 no induction or proper plan of philosophizing shows that it is ap- 
 plicable; thus making the whole operation not a process of infer- 
 ence or induction, but one of interpretation or deduction, which is, 
 after all, the old Syllogistic method of teaching by authority, rather 
 than according to the rules of modern philosophy, which has dis- 
 covered the only true method of scientific investigation, by making 
 facts the basis of inductions. To take these constructive formulas 
 or syllogysms for the realities of experience and observation was 
 the grand folly of the ancients. To employ them without due ex- 
 amination as to their real value and scientific applicability is the be- 
 setting pedantry of many moderns, especially wrangling theologi- 
 ans, who attempt to make the wisdom and laws of Omnipotence 
 
15 
 
 quadrate with their finite notions and preconceived opinions. Care- 
 fully investigated then, I think it will be clearly seen that medical 
 men have been reasoning backwards, as it were, upon this subject 
 of miasm, and that too without sufficient data to conduct them to 
 a legitimate conclusion, whilst the rules of a just and well grounded 
 philosophy require of them not only to prove, first, the existence 
 of the facts of the case, and their invariable relationships, but sec- 
 ondly, that they shall not reason from such facts, in an explanation 
 of any phenonmena, excepting under like circumstances 
 
 It might be well worth my while to dwell longer upon this 
 important principle, if I had the time, instead of apologising for the 
 length of this preliminary discussion, as the neglect of it is an error 
 very generally prevailing with medical men, as well as others, and 
 one which leads to an exceedingly loose and careless kind of inqui- 
 ry; but I must pass on to the consideration of my subject more in 
 detail, trusting that the array of facts and lawful inferences, which 
 I shall adduce in support of my position, will, at least, awaken the 
 spirit of inquiry in your minds, if they do not satisfy you of its en- 
 tire correctness. 
 
 But for the purpose of doing this in a somewhat systematic 
 manner, it will be necessary for me to state clearly, first, what is 
 understood by the word miasm or miasmata in the sense in which 
 it is used by those who invoke its aid in the causation of diseases ; 
 and secondly, to demonstrate the fallacy of the doctrine, by show- 
 ing ice have no satisfactory 'proof that the morbific cause of what 
 are called miasmatic diseases, arises from vegetable putrefaction. 
 
 Under the first head, I shall make a few pertinent extracts 
 from different authors, to show the sense in which the word miasm 
 or miasmata is used, and what is understood by them to be the 
 source of this febrific agent. These might be multiplied without 
 number, but as there does not prevail much difference of opinion 
 among the miasmatists upon this subject, it is quite unnecessary. 
 
 Bancroft informs us that a humid soil abounding in vegeta- 
 ble remains, and acted on by heat, the range of which is from 45 
 to 100 Fahrenheit, is the most favorable for the extrication of mias- 
 mata. 
 
 Dr. Charles Caldwell, of Transylvania University, in a 
 prize essay upon the subject of miasm, expresses the following opin- 
 ion as to the disease producing properties of decomposing vegetable 
 matter: "Is the city commercial, and situated on navigable water 1 
 
16 
 
 Let not the wharves be built entirely of wood. Their facing, at least, 
 should consist of stone or brick, else they will become, in time, 
 masses of dissolving vegetable matter, and abundant sources of 
 febrile miasm. That the cities in the United States suffer in 
 their health from this cause, cannot be doubted. Piles of decaying 
 timber, alternately wet and dry, and exposed to the ardor of an 
 American summer sun, must produce malaria as certainly and as 
 naturally as the influence of spring promotes vegetation, and the 
 rigors of winter suspend it." 
 
 Dr. Eberle, article miasmata, assures us that "Wherever vegeta 
 ble matter meets with sufficient heat and moisture to cause it to enter 
 into humid decomposition, there miasmata will be evolved, &c. 
 
 Clymer, in his "treatise on fevers," declares "Whatever its 
 constitution or essence maybe, it at any rate appears evident, that 
 in order to its production, there must be present a certain quantity 
 of moisture, vegetable matter in a state of decomposition, and a 
 warm temperature." 
 
 Professor Wood, of the University of Pennsylvania, in his 
 work on the practice of medicine, article miasma, observes that, "So 
 strong indeed, is the evidence of this fact, that the great mass of ob- 
 servers, ever since the time of Lancisi, have agreed and still agree, 
 in ascribing the miasmatic influence, whatever may be its nature, 
 to organic and especially vegetable decomposition." 
 
 Agreeably to Elliotston, a distinguished practitioner of London, 
 "The exciting cause of ague, the true indispensable cause of it, I be- 
 lieve to be an exhalation from decaying vegetable matter," and that 
 "a certain degree of moisture is necessary for the fermentation and 
 putrefaction of vegetable matter,which fermentation and putrefaction 
 give rise to the exhalations which produce ague." Whilst Mc- 
 Cullock, who stands at the head of the miasmatists, in his 
 treatise on malaria, arrives at the opinion, "That the presence 
 of vegetables or vegetable matter in some mode or form, is necessa- 
 ry to the extrication of malaria; while the conclusion has some- 
 times been, that it is a production formed between the living veget- 
 able and water ; more generally that it is generated between that 
 and the latter, in some stage intermediate between life and absolute 
 decomposition, or lastly, that it is the eonsequence of absolute pu- 
 trefaction." 
 
 From the above extracts, which have been selected without 
 much care, it will be seen that miasm consists mainly, if not entire- 
 
17 
 
 Iy, of an exhalation from decomposing vegetable matter, under such 
 circumstances of heat and moisture as are capable of producing 
 putrefaction. 
 
 Now, as it is not necessary for the object of this investigation 
 that I should stop here to inquire into the slight differences in opin- 
 ion amongst the miasmatists, as to the specific amount of heat, 
 moisture, and vegetable, or organic matter, which it is necessary to 
 have for the purpose of evolving this subtile poison, since we may 
 very naturally conclude, we shall have the greater product, the 
 more material we have out of which to form it, I shall proceed at 
 once to show, under the second head, by extracts from the most 
 reliable authors, and by adducing instances of undoubted truth, 
 that we have miasmatic diseases prevaling in situations so totally 
 different from each other, it is impossible, under the rules of a cor- 
 rect philosophy, to ascribe them to effluvia from decaying vegetable 
 matter. In other words, that we are sometimes exempt from them 
 where vegetation and decaying vegetable matter, together with heat 
 and moisture, sufficient to produce putrefaction are abundant, and 
 then again, have them committing fearful ravages, where there is 
 no vegetable matter to decay, and where there is no moisture to aid 
 putrefaction. 
 
 Dr. Drake, in his work on the principle diseases of the valley 
 of North America, speaking of the Miami valley, says : " The up- 
 per portions of this basin abound in wet and marshy prairies, wood- 
 land swamps, and ponds, or small lakes of pure water. The Sou- 
 thern portions offer but little of either on the uplands ; but in the 
 wide valleys of both the miamies and along all their larger tributa- 
 ries every variety of wet surface was found in spring and early 
 summer, when settlements were first made : by clearing, cultiva- 
 tion and draining, however, a much drier condition has been pro- 
 duced. At the same time, mill-ponds have greatly multiplied, and 
 two canals, one from Cincinnati to Dayton, and thence to Lake 
 Erie, and the other from the former city to Brookville, and Gam- 
 bridge, in the State of Indiana, have been excavated. In the month 
 of June, they are annually emptied of water, and the mud accumu- 
 lated in their bottoms, is scraped out upon their banks." * * * 
 
 " Through the whole distance, it (the canal to Dayton,) traver- 
 ses a fertile valley from one to three miles in width, abounding in 
 diluvial terraces and low alluvial bottoms, to which the present dim- 
 inutive stream bears in the volume of its waters no assignable pro- 
 
is 
 
 portions. This valley is, in fact, the obsolete bed of one of those 
 vast river currents which once flowed from the north into the trough 
 of the Ohio river." 
 
 Here we unquestionably have an abundance of the materials, 
 heat, moisture and vegetable matter, for the generation of miasm ; 
 and yet the same writer who has furnished us with the above de- 
 scription, declares, "It does not appear that the inhabitants of the re- 
 gion through which the canals were dug were injured by the process, 
 or by letting in the water when they were finished ; nor have I been 
 able to collect any reliable evidence, that the annual emptyings and 
 •cleanings out, have been productive of fever." 
 
 Again, on the authority of Dr. Hentos, he assures us, there is 
 on Paint Creek, in Ohio, a mill pond covering over sixty acres oi 
 bottom land, near the village of Washington, which is generally 
 drained off about the first of June, after having been submerged all 
 the previous autumn, winter, and spring, and yet it was never 
 known to cause sickness in the neighborhood. 
 
 Pensacola bay is several miles in extent, and bounded On the 
 west side, from the Gulf coast up to its head, with sand beach of lim- 
 ited extent, in the midst of which are found marshes of fresh Water 
 covered with cypress, magnolia, subaquatic plants and shrubs, yet 
 it is quite healthy, excepting near the head of the bay, where the 
 Escambia river, coming down from Alabama, empties. Here it 
 has been notoriously sickly always, notwithstanding the tempera- 
 ture and moisture are the same, as they are lower down the bay and 
 the extent of marsh only a trifle greater. 
 
 My present object does not make it necessary for me to de- 
 scribe particularly the topography of the Delta of the Mississippi^ 
 further than to state, what every one knows, that it consist of allu- 
 vial deposits, with an abundant and luxuriant vegetable growth. — - 
 Such a condition of things, in so hot a climate, might, dpriori, be 
 claimed by the miasmatist as the very focus of miasms ; but let us 
 see what are the opinions of some distinguished medical gentlemen, 
 themselves believers in the doctrine of the miasmatic origin of dis- 
 ease, upon this subject. 
 
 The inhabitants of the Balize, writes Dr. Drake, suffer 
 much less from miasmatic diseases than those who reside along 
 the rivers of the interior of Louisiana, notwithstanding vegetation, 
 heat, and moisture, are as abundant at the Balize as more inland. — 
 ThiSj he and others attempt to explain, by supposing that the salt 
 
19 
 
 water of the Gulf waves prevents the extrication of miasmata at the 
 Balize. The same reason is given for the comparative healthful- 
 nessof Key West ; and also to explain, why Port Pike is less liablo 
 to malarious diseases than Fort Wood; but it will be seen present- 
 ly from the statements of Marci-ietti, that whatever sanatary prop- 
 erties salt water may have in this country, under such circumstan- 
 ces, it has no such virtues in Italy. As to the influence of salt water 
 in preserving the health of marshy places, Marchettj, in his med- 
 ical topography and statistics of the Tuscan Maremma, speaking of 
 the cause of the fever, is decidedly of opinion, that "the mixture of 
 salt with fresh water greatly increases the intensity of the miasms, 
 because pestiferous marshes have become innocuous as soon as the 
 ingress of salt water has been prevented." He gives instances of 
 this fact, one in particular. Near Viareggeo, a nice and pleasant 
 little town has sprung up and is used as a retreat, or watering place, 
 in those very months when it was formerly, or before the salt wa- 
 ter was shut off from its marshes, almost pestilential, In a word 
 he insists that the cause of fever in. the Maremma is an emanation 
 from decomposing animal matter in the marshes, and that the "hu- 
 midity of the atmosphere, vegetable decomposition, and changes of 
 temperaturej are only auxilliaries, as these conditions are to be found 
 in districts not subject to intermittant and remittant fevers." 
 
 Dr. E?erle, one of our standard writers upon such subject s, 
 confirms this statement of Marcpettj, upon the opinion of Mon- 
 falcon, a.nd his own observations. He says, "A mixture of fresh, 
 and sa,lt water in marshes appears to enhance the copiousness and 
 virulence of miasmata to a very obvious degree. "It is a singular 
 fact," says, the Doctor, ''that tne water of the sea is much more apt 
 $o enter into putrefactive decomposition than freshwater j and this, 
 no doubt, depends on the great quantity of organic matter which it 
 contains." 
 
 But to return to, the delta of the Mississippi. Fort Pike is, 
 thirty five miles north-east from New Orleans, and situated on the 
 Island of Petites Coquilles. This Island, elevated about two feet 
 above the Gulf, enjoys a rich productive soil,, composed of shells,, 
 argillacious and vegetable matter. It is washed on one side by the 
 waters of Pearl river, and intersected with numerous bayous and 
 marshes, and has pools of stagnant water, but notwithstanding these- 
 inviting circumstances, it has never been visited by yellow fever,, 
 and autumnal fevers even, are very scarce.* 
 
 *Army Statistical Reports 
 
20 
 
 Port Wood is seven miles from Fort Pike, and situated on the 
 south side of the channel, Chef Mentieur, one of the connecting 
 Straits, between Lake Ponchartrain and Lake Borgne. In its rear 
 there are some cypress and fresh water swamps of limited extent, 
 which are annually replenished by rains with fresh water, like the 
 same character of swamp and marsh in the rear of the " coasts," 
 from New Orleans to Bayous La Fourche and Plaquemine. This 
 situation is decidedly insalubrious, according to the same authority, 
 A. S. Reports, which makes Fort Pike comparatively healthy ; and 
 Dr. Drake and others endeavor to account for the difference, by 
 the presence of salt water in the swamps of the last mentioned 
 place. The insufficiency of this explanation, I have already denied 
 upon competent authority, but even if it were true, the difficulty 
 would still remain of accounting for the healthiness of the " coasts," 
 as they are called, or banks of the Mississippi, from New Orleans to 
 the outlets of Bayous La Fourche and Plaquemine, which the 
 swamps and marshes about Fort Wood closely resemble, and 
 which Dr. Drake assures us, are peculiarly exempt from autumn- 
 al diseases. 
 
 Dr. Cartwright, a gentleman of great distinction, in an ar- 
 ticle in the Western Journal ot Medicine and Surgery, Vol. 1., is 
 reduced to the necessity of attributing health preserving properties 
 to the water lily, (Jussieua Grandiflora,) to save himself from the 
 confession that there is no truth in the miasmatic hypothesis. He 
 says : " The country immediately north of the line bounding the 
 growth of the floating plant, (which is about the 30 deg. north lat- 
 itude,) like that south of the 30 deg., is alluvial, contains lakes, 
 swamps, and stagnant water, is covered with nearly the same veg- 
 etable productions ; but its atmosphere is evidently insalubrious, 
 it stagnant waters impure, its inhabitants sickly, and human life of 
 short duration, while the country of the aquatic plant, immediately 
 south of it, contains a wholesome atmosphere, pure water, healthy 
 and long lived inhabitants." In some situations, within the region 
 of the floating plant, where the Doctor thought if the country con- 
 tained sickly spots anywhere, they richly deserved to be so consid- 
 ered, he found the inhabitants altogether exempt from autumnal 
 diseases. 
 
 In regard to the value, however, of this theory of Dr. Cart- 
 wright, Dr. Drake remarks, that "it is at least an open question, as 
 the "coasts," or banks of the Mississippi, from New Orleans to the 
 
21 
 
 outlets of Bayou Plaquemine and Bayou La Fourclie, lying nearly 
 north of the region of Jussieua Grandiflora, are equally free from 
 autumnal diseases and contains as many aged inhabitants." 
 
 Here, then, we have, confessedly an ample supply of all the materials 
 required by themiasmatists for the manufacture of malaria ; but, in- 
 deed, the country seems to be so singularly and unexpectedly ex- 
 empt from miasmatic diseases, that every one is looking out for 
 some countervailing agency, some means of neutralizing the marsh 
 poison, which each believes must be generated under circumstances 
 so favorable for its evolution. Each learned Doctor has lus own 
 peculiar views upon the subject, whilst the common people gen- 
 erally say it is owing- to the prevalence of sea breezes ; but why do 
 not the sea breezes, felt with equal force and constancy at the head 
 of Pensacola bay, where the Escambia river empties, and where 
 there is one little marsh of some one or two miles in extent, instead 
 of a whole region of marshes, preserve that locality from the repu- 
 tation of being one of the most insalubrious spots on the face of the 
 earth.* 
 
 So, likewise, in our own State, we have extensive tracts of 
 swamp land, in which a great number of laborers are engaged ev- 
 ery year in getting shingles. These laborers, not only work dur- 
 ing the day in these swamps, and drink swamp water, which is 
 greatly discolored by decaying vegetable matter, but sleep in them 
 at night, in open huts or rudely constructed shantees ; yet they are 
 decidedly the healthiest portion of the laboring classes in those 
 parts of the State. Now, this cannot be owing, as some pretend 10 
 believe, to the iact, that as the swamps are not entirely cleared and 
 drained, vegetable decomposition does not take place, because that 
 is palpably an error. Our own senses teach us such is not the case, 
 and that vegetable decomposition does take place to an enormous 
 extent. The whole superstratum, which is oftentimes many feet in 
 thickness, consists of the debris of vegetable and animal matter ; 
 for these swamps are scarcely more noted for their luxuriant vege- 
 tation, than they are for their abundance of insects and reptiles. 
 Besides, I am informed by Mr. Redding L. Myers, a respectable 
 gentleman of the town of Washington, who, as assistant engineer, 
 had charge, in part, of theworkmen employed upon the public lands 
 about PungoLake, that they were remarkably healthy Here, an ex- 
 tensive and systematic plan of drainage, by canaling and ditching, 
 exposed the laborers 10 the exhalations from the soil, under a variety 
 
 * Lind and others. 
 
22 
 
 of circumstances, as well upon the prairie marshes, as in the open 
 swamps and close jungles; and yet ihey scarcely had any fever 
 amongst them, or required the attentions of a physician, during the 
 two or three years they were engaged in this service. 
 
 The Antilles, Brazil, East Indias, Europe, and other parts of 
 the earth, furnish us examples of the same kind. British Guiana, 
 with its wet and dry seasons, and extensive alluvial marshes, which 
 have been reclaimed from the sea by a most expensive and perma- 
 nent system of diking, together with its culture of Sugar. Rice, In- 
 digo, &c, is represented by a writer in the British and Foreign 
 Medico-chh'urgical Review for 1850, as "among the most healthy 
 of the West Indian Colonies, and capable of being healthfully ten- 
 anted by European residents/' notwithstanding "its wide alluvial, 
 tiaets." 
 
 Furgerson says °"The town of New Amsterdam, Berbice, is 
 situated within short musljet shot to leeward of a most offensive 
 swamp, in the direct tract of a strong tradewind that bjows night 
 and day, and frequently pollutes even the sleeping apartments of 
 the inhabitants, with the stench of the swamps ; yet it had produced 
 no endemic fever worthy ot notice, even among the newly arrived, 
 for a period of years previously to my visiting that colony." 
 
 The town of Kingston, in the Island of St. Vincent, is so situ- 
 ated, says Report Armstrong, "as to have all the elements necessary 
 for the production of this vegeto-animal poison, heat, moisture, de- 
 cayed and decaying vegetable matter, with as large a proportion of; 
 reptiles, insects and other animal matter as is found in other tropical 
 countries ; yet strange to say, the town of Kingston is one of thj 
 most healthy spots in the West Indias. I was informed by the 
 staff surgeon to the forces, who had long resided there, that it ivqs. 
 as healthy as the most favorable spot in England. 
 
 Brazil, too, is said to be entirely exempt from endemics, al- 
 though it has an extremely fertile soil, a sultry atmosphere, and a 
 most magnificent profusion of vegetation of almost endless variety. 
 This vast empire is intersected everywhere with navigable streams, 
 which pour their waters through a common mouth into the Ocean, 
 and indented along its sea coast, of more than two thousand miles. 
 in extent, with numerous beautiful and safe harbors. The Delta 
 of the Amazon alone spreads along the Atlantic shore, on either side 
 of the equator, to the breadth of one hundred and fifty miles, and its 
 length from the ocean to the fartherest point where the ebbing and 
 
flowing of the regular tides are felt, and where the innumerable 
 Islands and labyrinth of channels begin, is over six hundred miles. 
 The intelligent American travellers. Kidder and Edwards, spent 
 several years in this country, and concur m representing every por- 
 tion of it, even the entire valley of the Amazon, embracing nearly 
 one half of this vast territory, as salubrious in a remarkable degree. 
 The latter, Edwards, says he never saw but one case of Intermit- 
 tent during the three years he remained in the country, and that, 
 he cured with a single dose of medicine. 
 
 Dr. Horner, of the U. S. Navy, in describing the topography 
 of the city of Rio Janeiro, says : u The proximity of the Oceanj the 
 great size of the harbor, the great height of the land about it^ the 
 many hills, narrow streets, and high temperature, keep Rio almost 
 without cessation immersed in a heavy, sultry atmosphere, render- 
 ed nib re disagreeable by want of cleanliness and the exhalations 
 from the ravines and marshy grounds in its rear" — yet Rio, not- 
 withstanding, is considered by travellers generally, who have spent 
 some time there, as well as in other parts of Brazil, to be healthy. 
 And Walsh informs us that for many weeks at a time, during the 
 rainy season, there were several hours in each day when his clothes 
 would be wet on hiim and that he oftentimes put oh wet clothes in 
 the morning, which had remained wet all night ; and that whenever 
 the sun shone out, it was so intensely hot, that he went smoking 
 along in his wet clothes, the water from which was exhaling by 
 heat and dissolving into vapor. " Such weather," to use his own 
 language, "in Africa, under the same latitude, no human being 
 could bear ; but not so in Brazil ; no one is affected by those states 
 of the atmosphere which are so fatal elsewhere. It lias with some 
 reason, therefore, grown into a proveb, that it is a country where a 
 physician cannot live, and yet where he never dies/' 
 
 New South Wales, including South Australia, and Australia Felix r 
 has a wet and dry season, an abundance of streams, bays, estuaries, 
 swamps and ponds of stagnant water, and in some places, particu- 
 larly about its towns, a rich and highly productive soil. It is like- 
 wise subject to inundations from the rivers, and its alluvial swamps 
 to overflows from the sea ; yet notwithstanding all these indica- 
 tions of a sickly climate. New South Wales is exceedingly healthy 
 and free from endemics.* 
 
 "The Island of Java" says, Sir Stanford Raffles, one oi 
 the lieutenant Governors of that Island and its dependencies; "stands 
 
 s Malte Brun and Byrne. 
 
24 
 
 on a level, in point of salubrity, with the very healthiest parts of 
 British India, or any tropical country in the world, although it a- 
 bouuds in a most luxuriant vegetation, and in numberless streams 
 cataracts and rivulets, which are tamed to the peasants will. In 
 the hottest and driest season, they are made to retain some of their 
 water, which the farmer directs into endless conduits and canals to 
 irrigate! the lands, which he has laid in terraces for its reception. 
 It thence descends to the plains and spreads over them shedding 
 fertility whereever it flows, till at last, by innumerable outlets it 
 discharges itself into the sea." 
 
 This same system of artificial irrigation, which is so innocuous 
 in Java, is beleived by Dr. Wilson, in his medical notes on China, 
 to be the cause of the unheal fhiness of the Islands of Chusan and 
 Hong Kong : for he says, "The meteoric influences and the aspect 
 of the country appear highly favorable to health — what is detrimen- 
 tal is believed to be chiefly the wilful work of man's hands, or of 
 perverse ignorance." 
 
 Mr. Peale, the Geologist to the exploring expedition, under 
 Capt. Wilkes, in a letter to Dr. Dungleson, published in the Med- 
 ical Examiner for 1843, states, that they visited situations in the 
 course of their travels amongst the Friendly, Society, Fegee, Sam- 
 oan and Sandwich Islands, where the inhabitants subsisted, in part, 
 upon the root of the Tarro plant, which requires to be cultivated, 
 like our rice, in shallow fresh water ponds and marshes, and where 
 natural marshes do not occur, they are artificially constructed by 
 the natives. He states further, that they often found their towns 
 situated in the midst of these "Tarro patches," which plentifully 
 supplied the residences with musquitoes and other inseets, and the 
 stench of the marshes; yet neither the officers, nor men, nor the 
 scientic corps, suffered in consequence of their exposure although 
 they were in the midst of the exhalations from these marshes day 
 and night, living and sleeping, owing to "the shore duties of the 
 service, in the midst of marsh stenches and musquitoes, when the 
 days were hot, and the huts open and exposed." 
 
 Capt. Wilkes mentions that these Islands are hot, moist, fertile, 
 and remarkably healthy. 
 
 On the other hand, Mr. Peale observes that almost every one of 
 the expedition, suffered more or less from endemic diseases, after their 
 arrival on our north-west coast, and had encamped upon the Wal- 
 lametle river, in Oregon, where there were no marshy gronnds, ex- 
 
25 
 
 cessive moisture, stagnant ponds, or other sources of miasm, as both 
 the earth and the atmosphere were remarkably dry. 
 
 Dr. Hope, of Princeton, in a letter to Prof. J. K. Mitchell, 
 of Philadelphia, describes the Island of Singapore, which lies with- 
 in the tropics, and abounds in streams, marshes, ponds and pools of 
 stagnant water, with its jungles and a most luxuriant vegetation in 
 many places, of astonishingly rapid growth, and equally rapid decay, 
 as being very rarely visited by fevers of any kind, and when they 
 did occur, were from "imprudent exposure to fatigue or the sun." 
 "Singapore," says the Doctor, "is considered a kind of Sanatarium. 
 for the oriental invalids, who go thither, from every quarter of the 
 eastern world, to escape from malaria or to recover from chronic 
 diseases." 
 
 In Ireland, emphatically a country of swamps, bogs and ponds, 
 the inhabitants in the linen manufacturing districts rot their flax 
 in dead water ponds and ditches, thus filling the whole atmosphere 
 with the effluvia from this mass of decomposing vegetable matter; 
 yet, Ireland, even under such favorable circumstances for the pro- 
 duction of miasmata, is not subject to endemics of intermittent 
 and remittent fevers. 
 
 Dr. Bell, in an article " On miasm as an alleged cause of fe- 
 vers," in the llth vol. of the Philadelphia Medical Journal, says: 
 " The inhabitants of every Dutch house, ought, from the above 
 creed, to be attacked annually with intermittent fevers, since to 
 each is attached a summer house, situated immediately over a small 
 stagnant canal, covered with vegetable remains, and exposed to the 
 sun's rays. Here, hours, especially in the evening, are spent by 
 the family, without the members of it being afflicted with disease." 
 
 Siou, or what is called the " Jews' Quarter" in Rome, is rep- 
 resented by Dr. James Johnson, in his work on change of air, as 
 the dirtiest, filthiest, dampest, " and the healthiest spot in that 
 famous city.'''' Being down upon the shores of the Tiber, and 
 more exposed to the vapors from the river, and wet river banks, 
 than any other portion of the Roman Capital, it ought to be sickly 
 according to the views of the miasmatists, but " it is quite free from 
 the fatal malaria.'' 
 
 So, Lisbon, one of the filthiest towns in all Europe, cannot 
 
 carry on gardening, which, in so dry a country, is of the utmost 
 
 importance to every family, without artificial irrigation, and that 
 
 the inhabitants may be able to accomplish this desirable purpose, 
 
 4 
 
26 
 
 the Water is collected during the rainy season in the cisterns in 
 their gardens, and under their houses. The water, says Fergu- 
 son, being of utmost importance, is husbanded carefully, for sever- 
 al months in the dry season. Diminishing daily by drainage and 
 evaporation, it, of course, gets into a most concentrated state of 
 foulness and putridity, with a thick green vegetable scum upon it ; 
 yet, no one- ever dreamed of its producing fever, although the most 
 ignorant native is well aware, that were he to cross the river, and 
 sleep on the shores of the Alentejo, where a particle of water, at 
 that season, had not been seen for months, and where water, being 
 absorbed into the sand as soon as it fell, was never known to be pu- 
 trid, he would run the greatest risk of being seized with remittent 
 fever."* The same author gives us another example of a somewhat 
 similar nature. " In the West India Sugar Ships," he observes, 
 " the drainage of the Sugar, mixed with the bilge water of the hold, 
 creates a stench that is absolutely suffocating to those unaccustomed 
 to it, yet it is denied that malaria or malarious diseases are genera- 
 ted even from this combination." 
 
 So the water of the Thames, according to Dr. Dun&lison, 
 loaded with all the filth and soluble materials, animal and vegeta- 
 ble, which it acquires in its course to the sea, is nevertheless the 
 best water to take on a long voyage ; for having undergone a pro- 
 cess of fermentation, or self purification, it keeps sweet and potable 
 a great while. Accordingly, merchantmen and ships of war fill 
 with it their water tanks, which are situated immediately under 
 the hammocks and berths of the men. Now, during the fermenta- 
 tion of the water, which takes place after a little while, the sleep- 
 ing apartments, and, indeed, all portions of the ship, are filled with 
 an almost intolerable stench ; yet it never produces disease. 
 
 I shall now call your attention to another class of facts. In 
 Guinea, according to Lind and other writers, during the entire 
 period of continued heat and drought, which sometimes lasts for six 
 or eight months, when every thing is parched up, and the earth is 
 literally baked and cracked open in great fissures, and the rivers 
 dried up, or restricted to very narrow channels, leaving a large 
 portion of their alluvial beds and slimy mud banks exposed to the 
 rays of a burning sun, there is no disease. But when the rains 
 have set in, and the parched earth is soaked with water, and the 
 rivers begin to fill up, diseases become rife and the mortality is 
 
 great, 
 
 'Article on Marsh Poison. &.c« 
 
27 
 
 Egypt, too, which is inundated or partially covered by the o- 
 verflowing waters of the Nile for nearly three-fourths of the year, 
 and which has its atmosphere filled with the exhalations from 
 stagnant lakes, canals and pools, and the drying up of its deep al- 
 luvial soil by the action of a powerful sun, producing an excessive 
 evaporation, enjoys freedom from endemics of intermittent and remit- 
 tent diseases ; and, indeed, since the days of the celebrated Yolney, 
 travellers generally have agreed that its climate was salubrious — ■ 
 much more so than Cypress and other parts of the Levant, less a- 
 bundantly furnished with the supposed sources of miasm. Let us 
 Cake a single example of this fact. Menouf, the capital of one of the 
 provinces of lower Egypt, although its south and west walls are 
 situated on the banks of a very shallow canal, and near to another 
 still shallower, neither being navigable, and the latter consisting 
 .chiefly of stagnant pools, is, notwithstanding, a remarkably healthy 
 place. Besides these canals, there are, in the immediate neighbor- 
 hood of the town, ponds of dead water in which the inhabitants rot 
 •their fax, with here and there a burying ground, which is over- 
 flowed by the high waters from the Nile ; but as the waters do 
 not remain on the lands about Menouf as long as they do over most 
 other parts of the delta, Surgeon Carrie thinks this may be the 
 reason of its extreme healthiness. So, in our own State, on the 
 lower Roanoke, where the bottom lands are guarded from the river 
 inundations by diking, in August last, owing to a very unusual rise 
 in the river, the levees gave way in many places, and large farms 
 and extensive tracts of land, heretofore protected against such inun- 
 dations, were overflowed. When this disastrous rise in the river 
 occurred, the farms were covered with luxuriant growing crops, 
 and an abundance of vegetable matter, in a succulent state, occu- 
 pied the bottom lands and marshes. In many places, all this mass 
 of vegetable matter was destroyed entirely, and left, by the subsi- 
 dence of the flood., to putrefy upon the land, filling the whole air 
 with its stench, whilst the earth's surface, by excessive evaporation, 
 during an unusually warm and long autumn, became perfectly 
 dry and even baked, cracking open in many places with long and 
 deep fissures. Such was particularly the case with regard to the 
 bottom lands and marshes in the counties of Northampton, Halifax 
 and Bertie; and, yet, I am informed by gentlemen of high intelli- 
 gence and standing, part owners of these lands, that contrary to all 
 expectation, it was an unusually healthy season. 
 
28 
 
 .Such a state of dryness, t must admit, perhaps, according to 
 Bancroft, ought not to have evolved miasm; but it is precisely 
 under such a condition ot the atmosphere and earth's surface, that 
 diseases are often violent, and the mortality greatest, agreeably to 
 Brown, Pringle, Fordyce. Ferguson, and others ; and I now 
 propose to examine the subject in that point of view. The last 
 named writer, a standard authority, insists, " that putrefaction and 
 the matter of disease are altogether distinct and independent ; that 
 the one travels beyond the other without producing the smallest 
 bad effects ; and that however frequently they may be found in 
 company, they have no necessary connection ;" and that the cause 
 of disease " cannot emanate from vegetable putrefaction, but is 
 found most virulent and abundant on the driest surfaces ; often, 
 where vegetation never existed nor could exist, &c."* He also says 
 " A year of stunted vegetation, through dry seasons and uncommon 
 drought, is infallibly a year of pestilence to the greater part of the 
 West India Islands ;" and that " The most ignorant peasant of Lin- 
 colnshire knows that there is nothing to be apprehended from the 
 ditches of his farm, till they have been dried up by the summer 
 heat." Much autumnal disease was likewise observed by him in 
 South Holland, in 1794, after a hot dry summer, at the encamp- 
 ments of the British forces, at Rosendaal and Oosterhout, where the 
 surface was a level plain of dry sand, without vegetation, and 
 where no vegetation could exist, except the stunted heath plant, 
 and where all the wells of the camps were plentifully supplied with 
 sweet and potable water. 
 
 Pringle also bears testimony to the insalubrity of the dry, 
 unproductive sandy plains of Dutch Brabant, whilst Fordyce in- 
 forms us that the British Armies, when encamped upon the pure 
 sandy plains of Flanders in 1810 and 1811, were greatly troubled 
 with intermittents and remittents ; and, also, that there is a region 
 in Peru, barren from want of water and vegetation, and yet nearly 
 uninhabitable from the prevalence of virulent fevers. 
 
 The result of Ferguson's observations on the medical topo- 
 graphy of Spain, is, " that in the most unhealthy parts of Spain, we 
 may, in vain, towards the close of summer, look for lakes, marshes, 
 ditches, pools, or even vegetation ; and that Spain, generally speak- 
 ing, though as prolific of endemic fevers as Walcheren, is, beyond 
 all doubt, one of the driest countries in Europe, and it is not till it 
 has again been made one of the wettest, by the periodical rains, with 
 
 ^Article on Marsh Poison, &c. 
 
29 
 
 its vegetation and aquatic weeds restored, that it can be called heal- 
 thy, or even habitable, with any degree of safety." 
 
 Dr. Brown, a decided miasraatist, confirms this statement, and 
 adds: " He has repeatedly observed that cases of fever and ague 
 abounded in parts of Estremadura, so remote from the Gandiana or 
 any stream, that no influence from visible water or dampness could 
 be supposed to have a share in their production."* 
 
 Bishop Heb^r, in his account of India, according to Mitch- 
 ell, says, the wood tracts of Nepanl and Malwa, having neither 
 swamps nor perceptible moisture, in summer and autumn are aban- 
 doned, not only by man, but even by the birds and beasts, in conse- 
 quence of their pestilential character. In regard to the insalubrity 
 of woodlands, Marchetti, before quoted, observes that, "The pre- 
 sence of crowded and extended woods, according to some, and on 
 the contrary, their destruction, according to others, cause malaria. 
 Targioni, on the authority of Doni and others, considered woods 
 injurious, not only for being liable to retain and imprison the prin- 
 ciple constituting malaria, but also from being, as he believed, ca- 
 pable of producing them. Such a disparity of opinion proves, in 
 my judgment, that there are circumstances in which a too extensive 
 and general clearing of woods may be equally injurious, as allow- 
 ing trtes and shrubs to increase and multiply without the regulation 
 of man. We find certain districts and houses with a perfectly 
 healthy atmosphere, in the midst of extended woods, while others 
 in similar situations, suffer from malaria." 
 
 Malta is a barren rocky Island, considerably elevated above 
 the sea, in some places as much as twelve hundred feet. Its sub- 
 stratum consists of calcarious sandstone, scantily covered witli soil, 
 most of which has been carried thither. It has no marshes, sta^-- 
 nant pools, swampy grounds, lakes or rivers, yet Maj. Tullock 
 asserts that it is quite sickly. The same is true of the town of 
 Gibraltar, which is built on a bed of dry red sand, at the foot of the 
 rock of that name, and has no ponds or marshes to furnish decompo- 
 sing vegetable matter to generate disease. So, too, with one of the Isles 
 de Loss, near Sierra Leone, about a mile in diameter, and at its centre 
 as much as three hundred feet above the level of the sea. It has no 
 marsh, no swamp, very little soil, and only one small peice of ara- 
 ble land, but it is represented by Boyle as one of the most insalu- 
 brious spots on the African coast. 
 
 ^Cyclopedia of Practical Medicine. 
 
30 
 
 Here I might be satisfied to rest the discussion of this question, 
 Laving already subjected it to the test of the experimentum cruris: 
 but I prefer to examine it still further, and under another point of 
 view, lest the miasmatists may think I have not furnished them 
 difficulties enough to solve. 
 
 In a great many parts of Kentucky, Tennessee. North Alaba- 
 ma, North Carolina and Virginia, where the country is dry and 
 ridgy, and in many places quite eievated, autumnal fevers occur up- 
 on the highest lands, where there is comparatively no moisture, 
 and where vegetable decomposition, to the extent of poisoning the 
 atmosphere, is never suspected. Professor Wood attributes the pre- 
 valence of intermittent and remittent feveis, under such circumstan- 
 ces, to an unaccountable epidemic influence, and not alone to the 
 presence of marsh poison ; for, he says, speaking of the effects of 
 epidemic influences: "Hence, probably, the late prevalence of inter- 
 mittent and remittent fevers, during the summer and autumn, in 
 portions of the middle and eastern States, in which these diseases 
 were formerly almost unknown; while the circumstances of these 
 regions, in relation to the production of miasmata, remained, so far 
 as could be discovered, the same as in preceding years." The learn- 
 ed professor does not exactly acknowledge here the agency of two 
 separate and distinct causes for the production of one and the same 
 effect, for he seems to be fully aware how apparently inconsistent 
 this statement is with his previously expressed opinion of the spe- 
 cific febrile character of miasmata in these diseases, and therefore 
 endeavors to reconcile them, by supposing that there is always, and 
 in every place, even in the healthiest situations, where there is no 
 unusual amount of moisture, heatand vegetation, and where intermit- 
 tent and remittent fevers have been hitherto unknown, a sufficiency 
 of exhalation from decomposing vegetable matter to produce these 
 diseases, if there was only present a little epidemic yeast to enliven 
 the mass. Now this view of the matter, in my humble judgment, 
 necessarily leads to one of two conclusions — either to the employ- 
 ment of two causes for one effect, which I have elsewhere stated to 
 be at variance with the order and economy of nature, or amounts 
 to a begging of the question. But let that pass. 
 
 Dr. Robert Jackson, in his work on the diseases of the 
 West Indies, informs us, that the same fevers occur in those Islands 
 amongst the series of mountain ridges, not exposed to the exhala- 
 tions from swampy and low grounds, and at an elevation of six or 
 
31 
 
 seven hundred feet above the level of the sea ; and Dr. Jas. John- 
 son, in his work on tropical climates, asserts, that these diseases 
 prevail in the high hills and thickly wooded parts of the mountain 
 ridges of the Island of Ceylon, and on the secondary mountains and 
 primitive ridges in Sicily ; while Dr. Heyne attempts to account 
 for their occurrence amongst the rocky, wooded hills, in the Madras 
 Presidency, distant from any acknowledged sources oi miasms, 
 by supposing them to be owing to some magnetic influence, depend- 
 ant upon the ferruginous character of the rocks. In the same man- 
 ner, other distinguished observers have insisted that these diseases 
 have been known to originate and prevail extensively in argilla- 
 ceous soil, where no vegetable putrefaction was going on, or at all 
 suspected.* The celebrated Linnaeus contended in his inaugural 
 essay, that periodical fevers originated in all those places where the 
 soil abounds in clay, and only in such places ; and Yon Aenvank, a 
 Netherlander, endeavors to explain their prevalence in argillaceous 
 soils, by supposing that clay possessed the property of absorbing 
 oxygen from the atmospheric air and thus impairing its purity. 
 
 From Dr. Dunglison, we learn that in the summer and au- 
 tumn of 1828, the high, ridgy, and beautiful shores of Long Island, 
 known as the Narrows, received a fearful visitation from intermit- 
 tent and remittent fevers, without any assignable cause for it, and 
 when scarcely a single case of either had been known there for for- 
 ty years previously ; nor does it appear, says the Doctor, to have 
 prevailed there since. The same thing has occurred upon the Is- 
 land of Portsea, on which Plymouth, in England, is situated. Many 
 years ago, it was believed to be entirely freed from malarious dis- 
 eases by drainage ; but they have recently returned again, not only 
 to the best drained portions of the Island, but even to parts of it 
 which were never beiore subject to them. 
 
 So, in our own State, in 1846 and 1847, districts of country 
 hitherto exempt from autumnal fevers, were terribly scourged by 
 them, notwithstanding there was no apparent difference in the 
 amount of moisture, heat and growth of vegetable matter, from 
 what was usual in such places. The tract of country dividing the 
 waters of Roanoke and Tar Rivers, and extending from the neigh- 
 borhood of Weldon on the former river, through portions of the 
 counties of Halifax, Warren, Franklin, Granville and Person, hav- 
 ing an argillaceous and gravelly soil, with white and red quartz 
 and granitic formation, the purest and finest springs and wells of 
 
 ■Chisholmn, Brown., and olheis. 
 
 to 
 
32 * 
 
 water, and with a growlh chiefly of oak, hickory and dogwood, 
 was, during these years, visited by autumnal diseases, and in many 
 places through this region, old men, heads of large families, who 
 had never taken a dose of medicine or seen a case of ague and fe- 
 ver, or bill .us fever, in their lives, became as familiar with these dis- 
 orders and their treatment, as with household words. Other por- 
 tions of our State, extending even into the gorges of the mountains, 
 heretofore unfrequented by these maladies, suffered in a like unac- 
 countable manner. 
 
 These are some of the facts and circumstances which have in- 
 duced me to abandon the miasmatic hypothesis ; for, whatever this 
 febrific agent may be, if different from' the appreciable states of the 
 atmosphere and the earth's surface, it cannot be traced, as I think 
 I have conclusively shown, by the presence of those conditions of 
 moisture, heat, and vegetation, which are claimed as indispensable 
 for its production. Nor has any chemical analysis, so far, been able 
 to detect it ; nor microscopic investigation, although conducted 
 with all the diligence and zeal incident to a fashionable pursuit, as 
 yet revealed it. M. Julia, a writer of considerable distinction on 
 marsh miasm, assures us that, after sixty trials to detect the chem- 
 ical and physical properties of this poison in the air of several very 
 insalubrious marshes, by the most searching analysis, in each in- 
 stance he found only such constituent principles as are contained 
 in th^ purest atmospheric air. 
 
 Moschati and Broschi also examined analytically the air 
 of rice fields, and some notoriously unhealthy spots in the papal 
 States, with nearly like results; while "M. Deseye obtained in 
 the most confined and unhealthy marshes, as on the most exposed 
 hills, seventy-eight parts of Nitrogen, twenty-one of Oxygen, and 
 one of Carbonic acid." 
 
 Such is the view of this subject which I have thought propel 
 to present for your consideration ; and these the facts which the 
 brief space allotted to an address of this kind has permitted me to 
 bring forward in support of my position. Nevertheless, I be- 
 lieve they will, under the operation of the rule which I have laid 
 down for our government in the study of all questions in physical 
 etiology, the scientific value and applicability of which no one can 
 deny, furnish sufficient evidence to convince us that there is no 
 truth in the doctrine of the miasmatic origin of disease. 
 
 
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