Medical inquiries and observations. By Benjamin Rush, M.D. professor of the institutes of medicine, and of clinical practice in the University of Pennsylvania. ; Volume II.

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Medical inquiries and observations. By Benjamin Rush, M.D. professor of the institutes of medicine, and of clinical practice in the University of Pennsylvania. ; Volume II.
Author
Rush, Benjamin, 1746-1813.
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Philadelphia: :: Printed by T. Dobson, at the stone-house, no. 41, South Second-Street.,
M,DCC,XCIII. [1793]
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http://name.umdl.umich.edu/N19953.0001.001
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"Medical inquiries and observations. By Benjamin Rush, M.D. professor of the institutes of medicine, and of clinical practice in the University of Pennsylvania. ; Volume II." In the digital collection Evans Early American Imprint Collection. https://name.umdl.umich.edu/N19953.0001.001. University of Michigan Library Digital Collections. Accessed June 16, 2024.

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An ACCOUNT, &c.

MOST of the facts which I shall deliver upon this subject, are the result of observations made during the last five years, upon persons of both sexes, who had passed the 80th year of their lives. I intended to have given a detail of the names—manner of life—occupations—and other circumstances of each of them; but, upon a review of my notes, I found so great a sameness in the history of most of them, that I despaired, by de|tailing them, of answering the intention which I have purposed in the following essay. I shall, therefore, only deliver the facts and principles which are the result of the inquiries and observa|tions I have made upon this subject.

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I. I SHALL Mention the circumstances which favour the attainment of longevity.

II. I SHALL mention the phaenomena of bo|dy and mind which attend it: and,

III. I SHALL enumerate its peculiar diseases, and the remedies which are most proper to remove, or moderate them.

I. THE circumstances which favour longevity, are,

1. Descent from long-lived Ancestors. I have not found a single instance of a person, who has lived to be 80 years old, in whom this was not the case. In some instances I found the descent was only from one, but in general, it was from both parents. The knowledge of this fast may serve, not only to assist in calculating what are called the chances of lives, but it may be made useful to a physician. He may learn from it to cherish hopes of his patients in chronic, and in some acute dis|eases, in proportion to the capacity of life they have derived from their ancestors.* 1.1

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2. Temperance in Eating and Drinking. To this remark I found several exceptions. I met with one man of 84 years of age, who had been intem|perate in eating; and four or five persons who had been intemperate in drinking ardent spirits. They had all been day-labourers, or had deferred drink|ing until they began to feel the languor of old age. I did not meet with a single person who had not, for the last forty or fifty years of their lives, used tea, coffee, and bread and butter twice a day as part of their diet. I am disposed to believe that those articles of diet do not materially affect the duration of human life, although they evidently impair the strength of the system. The duration of life does not appear to depend so much upon the strength of the body, or upon the quantity of its excitability, as upon an exact accommodation of stimuli to each of them. A watch spring will last as long as an anchor, provided the forces which

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are capable of destroying both, are always in an exact ratio to their strength. The use of tea and coffee in diet seems to be happily suited to the change which has taken place in the human body, by sedentary occupations, by which means less nou|rishment and stimulus are required than formerly, to support animal life.

3. THE Moderate exercise of the Understanding. It has long been an established truth, that literary men (other circumstances being equal) are longer lived than other people. But it is not necessary that the understanding should be employed upon philosophical subjects to produce this influence upon human life. Business, politics, and religion, which are the objects of attention of men of all classes, impart a vigour to the understanding, which, by being conveyed to every part of the body, tends to produce health and long life.

4. Equanimity of temper. The violent and ir|regular action of the passions tends to wear away the springs of life.

PERSONS who live upon annuities in Europe have been observed to be longer lived, in equal circumstances, than other people. This is pro|bably occasioned by their being exempted, by the certainty of their subsistence from those fears of

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want which so frequently distract the minds, and thereby weaken the bodies of old people. Life-rents have been supposed to have the same i••••••••+ence in prolonging life. Perhaps the desire of life, in order to enjoy for as long a time as possi|ble, that property which cannot be enjoyed a se|cond time by a child or relation, may be another cause of the longevity of persons who live upon certain incomes. It is a fact, that the desire of life is a very powerful stimulus in prolonging it, especially when that desire is supported by hope. This is obvious to physicians every day. Despair of recovery, is the beginning of death in all dis|eases.

BUT obvious and reasonable as the effects of equanimity of temper are upon human life, there are some exceptions in favor of passionate men and women having attained to a great age. The morbid stimulus of anger, in these cases, was pro|bably obviated by less degrees, or less active exer|cises of the understanding, or by the defect, or weakness of some of the other stimuli which keep up the motions of life.

5. Matrimony. In the course of my inquiries, I met with only one person beyond eighty years of age who had never been married.—I met with several women who had borne from 10

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to 20 children, and suckled them all. I met with one woman, a native of Herefordshire in England, who is now in the 100th year of her age, who bore a child at 60, menstruated till 80, and fre|quently suckled two of her children (though born in succession to each other) at the same time. She had passed the greatest part of her life over a washing-tub.

6. I HAVE not found Sedentary Employments to prevent long life, where they are not ac|companied by intemperance in eating or drink|ing. This observation is not confined to literary men, nor to women only, in whom longevity with|out much exercise of body has been frequently ob|served. I met with one instance of a weaver; a second of a silver-smith; and a third of a shoe|maker, among the number of old people, whose histories have suggested these observations.

7. I HAVE not found that acute, nor that all chronic diseases shorten human life. Dr. Franklin had two successive vomicas in his lungs before he was 40 years old. I met with one man beyond 80, who had survived a most violent attack of the yellow fever; a second who had had several of his bones fractured by falls, and in frays: and many who had been frequently affected by intermittents. I

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met with one man of 86, who had all his life been subject to syncope; another who had for 50 years been occasionally affected by a cough;* 1.2 and two instances of men who had been afflicted for forty years with obstinate head-achs.† 1.3 I met with only one person beyond 80, who had ever been affect|ed by a disorder in the stomach; and in him, it arose from an occasional rupture. Mr. John Strangeways Hutton, of this city, who died last year, in the 109th year of his age, informed me, that he had never puked in his life. This circum|stance is the more remarkable as he passed several years at sea when a young man.‡ 1.4 These facts may serve to extend our ideas of the importance

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of a healthy state of the stomach in the animal oeco|nomy; and thereby to add to our knowledge in the prognosis of diseases, and in the choices of human life.

8. I HAVE not found the loss of teeth to affect the duration of human life, so much as might be ex|pected. Edward Drinker, who lived to be 103 years old, lost his teeth thirty years before he di|ed from drawing the hot smoke of tobacco into his mouth through a short pipe.

DR. SAYRE, of New-Jersey, to whom I am in|debted for several very valuable histories of old persons, mentions one man aged 81, whose teeth began to decay at 16, and another of 90, who lost his teeth thirty years before he saw him. The

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gums, by becoming hard, perform, in part, the office of teeth: But may not the gastric juice of the stomach, like the tears and urine, become acrid by age, and thereby supply, by a more dissolving power, the defect of mastication from the loss of teeth? Analogies might easily be adduced from several operations of nature, which go forward in the animal oeconomy, which render this supposi|tion highly probable.

9. I HAVE not observed Baldness, or Grey Hairs, occurring in early or middle life, to prevent old age. In one of the histories furnished me by Dr. Sayre, I find an account of a man of 81, whose hair began to assume a silver colour when he was only one and twenty years of age.

I SHALL conclude this head by the following remark—

NOTWITHSTANDING there appears in the human body a certain capacity of long life, which seems to dispose it to preserve its existence in every situ|ation; yet this capacity does not always protect it from premature destruction; for among the old peo|ple whom I examined, I scarcely met with one who had not lost brothers or sisters, in early and middle

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life, who were born under circumstances equally favourable to longevity with themselves.

II. I COME now to mention some of the phae|nomena of the body and mind which occur in old age.

1. THERE is a great sensibility to cold in all old people. I met with an old woman of 84, who slept constantly under three blankets and a coverlit du|ring the hottest summer months. The servant of prince de Beaufremont, who came from Mount Jura to Paris at the age of 121, to pay his respects to the first national assembly of France, shivered with cold in the middle of the dog days, when he was not near a good fire. The national assembly directed him to sit with his hat on, in order to de|fend his head from the cold.

2. IMPRESSIONS made upon the ears of old people, excite sensation and reflexion much quicker than when they are made upon their eyes. Mr. Hutton informed me, that he had frequently met his sons in the street without knowing them until they had spoken to him. Dr. Franklin informed me that he rcognized his friends, after a long ab|sence from them, first by their voices. This fact

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does not contradict the common opinion, upon the subject of memory, for the recollection in these instances, is the effect of what is called reminiscence, which differs from memory in being excited only by the renewal of the impression which at first pro|duced the idea which is revived.

2. THE appetite for food is generally increased in old age. The famous Parr, who died at 152, ate heartily in the last week of his life. The kindness of nature, in providing this last portion of earthly enjoyments for old people, deserves to be noticed. It is remarkable, that they have, like children, a frequent recurrence of appetite, and sustain with great uneasiness the intervals of regular meals. The observation, therefore, made by Hippocrates, that middle-aged people are more affected by ab|stinence than those who are old, is not true. This might easily be proved by many appeals to the re|cords of medicine; but old people differ from children, in preferring solid to liquid aliment. From inattention to this fact, Dr. Mead has done great mischief by advising old people, as their teeth decayed or perished, to lessen the quantity of their solid, and to increase the quantity of their liquid food. This advice is contrary to nature, and experience, and I have heard of two old per|sons who destroyed themselves by following it. The circulation of the blood is supported in old

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people chiefly by the stimulus of aliment. The action of liquids of all kinds upon the system is weak, and of short continuance, compared with the durable stimulus of solid food. There is a gradation in the action of this food upon the body. Animal matters are preferred to vegetable; the fat of meat, to the lean, and salted meat to fresh, by most old people. I have met with but few old people who retained an appetite for milk. It is remarkable, that a less quantity of strong drink produces intoxication in old people than in persons in the middle of life. This depends upon the re|currence of the same state of the system, with re|spect to excitability, which takes place in childhood. Many old people, from an ignorance of this fact, have made shipwreck of characters which have commanded respect in every previous stage of their lives. From the same recurrence of the excitability of childhood in their systems, they commonly drink their tea and coffee much weaker than in early or middle life.

3. THE pulse is generally full, and frequently affected by pauses in its pulsations when felt in the wrists of old people. A regular pulse in such per|sons indicates a disease, as it shews the system to be under the impression of a preternatural stimulus of some kind. This observation was suggested to me

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above twenty years ago by Morgagni, and I have often profited by it in attending old people. The pulse in such patients is an uncertain mark of the na|ture or degree of an acute disease. It seldom partakes of the quickness or convulsive action of the arterial system, which attends fever in young or middle-aged people. I once attended a man of 77 in a fever of the bilious kind, which confined him for eight days to his bed, in whom I could not per|ceive the least quickness or morbid action in his pulse until four and twenty hours before he died.

4. THE marks of old age appear earlier, and are more numerous in persons who have combined with hard labour, a vegetable or scanty diet, than in persons who have lived under opposite circum|stances. I think I have observed these marks of old age to occur sooner, and to be more numerous in the German, than in the English or Irish citi|zens of Pennsylvania. They are likewise more common among the inhabitants of country places, than of cities, and still more so among the Indians of North America, than among the inhabitants of civilized countries.

5. OLD men tread upon the whole base of their feet at once in walking. This is perhaps one reason why they wear out fewer shoes, under the same cir|cumstances

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of constant use, than young people, who by treading on the posterior, and rising on the an|terior part of their feet, expose their shoes to more unequal pressure and friction. The advantage de|rived to old people from this mode of walking is very obvious. It lessens that disposition to totter which is always connected with weakness:—hence we find the same mode of walking is adopted by habitual drunkards, and is sometimes from habit practised by them, when they are not under the influence of strong drink.

6. THE memory is the first faculty of the mind which fails in the decline of life. While recent events pass through the mind without leaving an impression upon it, it is remarkable that the long forgotten events of childhood and youth are re|called and distinctly remembered.

I MET with a singular instance of a German wo|man, who had learned to speak the language of our country after she was forty years of age, who had forgotten every word of it after she had passed her 80th year, but spoke the German language as flu|ently as ever she had done. The memory decays soonest in hard drinkers. I have observed some studious men to suffer a decay of their memories, but never of their understandings. Among these,

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was the late Anthony Benezet of this city. But even this infirmity did not abate the chearfulness, or lessen the happiness of this pious philosopher, for he once told me, when I was a young man, that he had a consolation in the decay of his me|mory, which gave him a great advantage over me. "You can read a good book (said he) with plea|sure but once, but when I read a good book, I so soon forget the contents of it, that I have the plea|sure of reading it over and over; and every time I read it, it is alike new and delightful to me."— The celebrated Dr. Swift was one of those few stu|dious men, who have exhibited marks of a decay of understanding in old age; but it is judiciously a|scribed by Dr. Johnson to two causes which rescue books, and the exercise of the thinking powers, from having had any share in inducing that disease upon his mind. These causes were, a rash vow which he made when a young man, never to use spectacles, and a sordid seclusion of himself from company, by which means he was cut off from the use of books, and the benefits of conversation, the absence of which left his mind without its usual stimulus—hence it collapsed into a state of fatuity. It is probably owing to the constant exercise of the understanding, that literary men possess that faculty of the mind in a vigorous state in extreme old age. The same cause accounts for old people preserving

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their intellects longer in cities, than in country places. They enjoy society upon such easy terms in the former situation, that their minds are kept more constantly in an excited state by the acquisition of new, or the renovation of old ideas, by means of conversation.

7. I DID not meet with a single instance in which the moral or religious faculties were impaired in old people. I do not believe, that these faculties of the mind are preserved, by any supernatural power, but wholly by the constant and increasing exercise of them in the evening of life. In the course of my inquiries, I heard of a man of 101 years of age, who declared that he had forgotten every thing he had ever known, except his GOD. I found the moral faculty, or a disposition to do kind offices, to be exquisitely sensible in several old peo|ple, in whom there was scarcely a trace left of me|mory or understanding.

8. DREAMING is universal among old people. It appears to be brought on by their imperfect sleep, of which I shall say more hereafter.

9. I MENTIONED formerly the sign of a second childhood in the state of the appetite in old people. It appears further,—1. In the marks which slight

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contusions or impressions leave upon their skins. 2. In their being soon fatigued by walking or exer|cise, and in being as soon refreshed by rest. 3. In their disposition, like children, to detail immediately every thing they see and hear. And, 4. In their aptitude to shed tears; hence they are unable to tell a story that is in any degree distressing without weeping. Dr. Moore takes notice of this pecu|liarity in Voltaire, after he had passed his 80th year. He wept constantly at the recital of his own tragedies. This feature in old age did not escape Homer. Old Menelaus wept ten years af|ter he returned from the destruction of Troy, when he spoke of the death of the heroes who perished before that city.

10. IT would be sufficiently humbling to human nature, if our bodies exhibited in old age the marks only of a second childhood; but human weakness descends still lower. I met with an instance of a wo|man between 80 and 90, who exhibited the marks of a second infancy, by such a total decay of her mental faculties as to lose all consciousness in dis|charging her alvine and urinary excretions. In this state of the body, a disposition to sleep, suc|ceeds the wakefulness of the first stages of old age. Dr. Haller mentions an instance of a very old man

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who slept twenty, out of every twenty-four hours during the few last years of his life.

11. THE disposition in the system to renew cer|tain parts in extreme old age, has been mentioned by several authors. Many instances are to be met with in the records of medicine of the sight* 1.5 and hearing having been restored, and even of the teeth having been renewed in old people a few years be|fore death. These phenomena have led me to suspect,

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that the antediluvian age was attained by the fre|quent renovation of different parts of the body, and that when they occur, they are an effort of the causes which support animal life, to produce antediluvian longevity, by acting upon the revived excitability of the system.

12. THE fear of death appears to be much less in old age, than in early, or middle life. I met with many old people who spoke of their dissolu|tion with composure, and with some who expressed earnest desires to lie down in the grave. This in|difference to life, and desire for death (whether they arise from satiety in worldly pursuits and plea|sures, or from a desire of being relieved from pain) appear to be a wise law in the animal oeconomy, and worthy of being classed with those laws which accommodate the body and mind of man to all the natural evils, to which, in the common order of things, they are necessarily exposed.

III. I COME now briefly to enumerate the dis|eases of old age, and the remedies which are most proper to remove, or to mitigate them.

THE diseases are chronic and acute. The CHRONIC are,

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1. WEAKNESS of the knees and ankles, a les|sened ability to walk, and tremors in the head and limbs.

2. PAINS in the bones, known among nosologi|cal writers by the name of rheumitalgia.

3. INVOLUNTARY flow of tears, and of mucus from the nose.

4. DIFFICULTY of breathing, and a short cough, with copious expectoration. A weak, or hoarse voice generally attends this cough.

5. COSTIVENESS.

6. AN inability to retain the urine as long as in early or middle life. Few persons beyond 60 pass a whole night without being obliged to discharge their urine* 1.6. Perhaps the stimulus of this liquor in the bladder may be one cause of the universality of dreaming among old people. It is certainly a frequent cause of dreaming in persons in early and

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middle life: this I infer, from its occurring chiefly in the morning when the bladder is most distended with urine. There is likewise an inability in old people to discharge their urine as quickly as in early life. I think I have observed this to be a|mong the first symptoms of the declension of the strength of the body by age.

7th. WAKEFULNESS. This is probably produ|ced in part by the action of the urine upon the bladder; but such is the excitability of the system in the first stages of old age, that there is no pain so light, no anxiety so trifling, and no sound so small, as not to produce wakefulness in old people. It is owing to their imperfect sleep, that they are sometimes as unconscious of the moment of their passing from a sleeping to a waking state, as young and middle aged people are of the moment in which they pass from the waking to a sleeping state. Hence we so often hear them complain of passing sleepless nights. This is no doubt fre|quently the case, but I am satisfied, from the result of an inquiry made upon this subject, that they often sleep without knowing it, and that their com|plaints in the morning, of the want of sleep, arise from ignorance, without the least intention to de|ceive.

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8. Giddiness.

9. Deafness.

10. Imperfect vision.

THE ACUTE diseases most common among old people, are

1. Imflammation of the eyes.

2. THE pnuemonia notha, or bastard peripneu|mony.

3. THE colic.

4. Palsy and apoplexy.

5. THE piles.

6. A difficulty in making water.

7. Quartan fever.

ALL the diseases of old people, both chronic and acute, originate in debility. The remedies for the former, where no morbid action takes place in the system, are stimulants. The first of these is,

I. HEAT. The ancient Romans prolonged life by retiring to Naples, as soon as they felt the infirmities of age coming upon them. The aged Portuguese imitate them, by approaching the mild sun of Brazil, in South America. But

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heat may be applied to the torpid bodies of old people artificially—1st. By means of the warm bath. Dr. Franklin owed much of the cheerful|ness and general vigor of body and mind which characterized his old age, to his regular use of this remedy. It disposed him to sleep, and even produced a respite from the pain of the stone, with which he was afflicted during the last years of his life.

2. HEAT may be applied to the bodies of old people by means of stove rooms. The late Dr. De|wit of Germantown, who lived to be near an 100 years of age, seldom breathed an air below 72°, after he became an old man. He lived constantly in a stove room.

3. Warm cloathing, more especially warm bed-clothes, are proper to preserve or increase the heat of old people. From the neglect of the lat|ter, they are often found dead in their beds in the morning, after a cold night, in all cold countries. The late Dr. Chovet, of this city, who lived to be 85 slept in a baize night gown, under eight blank|ets, and a coverlet, in a stove room, many years before he died. The head should be defended in old people by means of woollen, or fur caps, in the night, and by wigs and hats during the day, in

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cold weather. These artificial coverings will be the more necessary, where the head has been de|prived of its natural covering. Great pains should be taken likewise to keep the feet dry and warm, by means of thick shoes.* 1.7 To these modes of ap|plying and confining heat to the bodies of old people, a young bed-fellow has been added; but I conceive the three artificial modes which have been recommended, will be sufficient without the use of one, which cannot be successfully employed without a breach of delicacy or humanity.

II. TO keep up the action of the system, gene|rous diet and drinks should be given to old people.

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For a reason mentioned formerly, they should be indulged in eating between the ordinary meals of families. Wine should be given to them in mo|deration. It has been emphatically called the milk of old age.

III. YOUNG COMPANY should be preferred by old people to the company of persons of their own age. I think I have observed old people to enjoy better health and spirits, when they have passed the evening of their lives in the families of their children, where they have been surrounded by grand children, than when they lived by them|selves. Even the solicitude they feel for the wel|fare of their descendants contributes to invigorate the circulation of the blood, and thereby to add fuel to the lamp of life.

IV. GENTLE EXERCISE. This is of great consequence in promoting the health of old peo|ple. It should be moderate, regular, and always in fair weather.

V. CLEANLINESS. This should by no means be neglected. The dress of old people should not on|ly be clean, but more elegant than in youth or middle life. It serves to divert the eye of specta|tors from observing the decay and deformity of

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the body, to view and admire that which is always agreeable to it.

VI. TO abate the pains of the chronic rheuma|tism, and the uneasiness of the old man's cough (as it is called); also to remove wakefulness, and to restrain, during the night, a troublesome inclina|tion to make water, OPIUM may be given with great advantage. Chardin informs us, that this medicine is frequently used in the eastern countries to abate the pains and weaknesses of old age, by those people who are debarred the use wine by the religion of Mahomet.

I HAVE nothing to say upon the acute diseases of old people, but what is to be found in most of our books of medicine, except to recommend BLEEDING in those of them which are attended with plethora, and an inflammatory action in the pulse. The degrees of appetite which belong to old age, the quality of the food taken, and the seden|tary life which is generally connected with it, all concur to produce that state of the system, which requires the above evacuation. I am sure that I have seen many of the chronic complaints of old peo|ple mitigated by it, and I have more than once seen it used with obvious advantage in their inflamma|tory diseases. These affections I have observ|ed

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to be more fatal among old people than is ge|nerally supposed. An inflammation of the lungs, which terminated in an abscess, deprived the world of Dr. Franklin. Dr. Chovet died of an inflam|mation in his liver. The blood drawn from him a few days before his death was sizy, and such was the heat of his body, produced by his fever, that he could not bear more covering, (notwithstanding his former habits of warm cloathing) than a sheet in the month of January.

DEATH from old age is the effect of a gradual palsy. It shews itself first in the eyes and ears in the decay of sight and hearing—it appears next in the urinary bladder, in the limbs and trunk of the body, then in the sphincters of the bladder and rectum, and finally in the nerves and brain, de|stroying in the last, the exercise of all the faculties of the mind.

FEW persons appear to die of old age. Some one of the diseases which have been mentioned, generally cuts the last thread of life.

THE END.

Notes

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