A Systematic Treatise, Historical, Etiological and Practical, on
the Principal Diseases of the Interior Valley of North America,
as they appear in the Caucasian, African, Indian, and Esqui-
maux Varieties of its Population. By Daniel Drake, M. D.
Cincinnati, Winthrop B. Smith & Co. Philadelphia, Grigg,
Elliott & Co. New York, Mason & Law. 1850. pp. 878.
8vo. With Hydrographical Map and Diagrams, and numerous
Topographical Maps and Plans of Cities.
How different from what it now is, and how greatly improved
would be medical literature and the practice of medicine at the
present day, if the precepts of Hippocrates had been carried out by
his successors, after the example which that eminent philosopher
and teacher himself gave, in his treatise “ On Airs, Waters, and
Places.”* Whoever, he says, wishes to investigate medicine pro-
perly, should in the first place consider the seasons of the year,
and what effects each of them produces ; then the prevalence and
temperature of the winds, distinguishing those of perennial direc-
tion from those which are peculiar to each locality, and the quali-
ties of the waters. In the same manner, when one comes into a
city or district in which he is a stranger, he ought to consider its
situation, its exposure to the winds and to the sun, the waters
which the inhabitants use, the nature of the ground, whether naked
and dry, or wooded and well watered, the situation, hollow and
confined, or elevated and cold. Next the new comer is to inquire
into the mode of living of the inhabitants, and their pursuits, as to
whether they are fond of drinking and eating to excess, and given
to indolence, or are fond of exercise and labor and not given to
excess in eating and drinking.
* The Genuine Works of Hippocrates—Translated from the Greek—with
a Preliminary Discourse and Annotations. By Francis Adams, LL. D. In
two volumes. London. Published by the Sydenham Society.
Informed of these things, a physician “ cannot miss knowing,
when he comes into a strange city, either the diseases peculiar to
the place, or the particular nature of common diseases, so that he
will not be in doubt as to the treatment of the diseases, or commit
mistakes, as is likely to be the case, provided one bad not pre-
viously considered these matters. And in particular, as the season
advances, he can tell what epidemic diseases will attack the city,
either in summer or in winter, and what each individual will be in
danger of experiencing from the change of regimen.”
A physician, who has thus investigated the circumstances in
which he is placed, “ must succeed in the preservation of health,
and be by no means unsuccessful in the practice of his art.”
Just in proportion as the recommendations and example of Hip-
pocrates, in this celebrated treatise, have been followed, has been
the permanent reputation of medical writers. To the worthy
followers of the Coan sage, we are proud to add the name of
Drake, whose labors in the same field of observation will insure
him enduring fame, as the faithful and observant historian of the
climatic peculiarities, and the medical topography and diseases of so
important a portion of the earth as the interior valley of North
America, and of the regimen and pathological tendencies and diseases
of the different races by which it is inhabited. The physiological
and hygienic comparisons instituted by Hippocrates between the
people of Asia and Europe,—families of the same race,—are made
on a scale of greater geographical extent, and on various races by
the American writer, with greater precision and accuracy of de-
tail, obtained by the aid of scientific investigations and appliances
which were unknown to the great master of Greek medicine.
We cannot, in advance of any critical or even analytic view of
Dr. Drake’s treatise, give a better idea of our appreciation of its
great and distinctive merits than in thus connecting it with the
treatise of Hippocrates 11 on Airs, Waters, and Places.”
Having once entered on the field of investigation which he had
proposed to himself, Dr. Drake continued to prosecute his inquiries
and observations for a term of years, with perseverance, and a sin-
cere desire to arrive at a knowledge of the facts and without any pre-
conceived theory or bias.
The volume before us consists of two Books, the first of which
contains three parts ; of these latter, the first has sixteen chapters,
the second five, and the third four chapters. Book second includes
eleven chapters.
Book first treats of General Etiology, which is discussed under
the heads or parts of 1. Topographical and Hydrographical
Etiology ; and 2. Climatic Etiology. The second, which is the
most attractive theme, cannot, however, be either studied or under-
stood to any extent without the aid of the first; and the two jointly
are of paramount value, we might say necessity, for a clear know-
ledge of the diseases described in a subsequent part of the work.
It would be a grave mistake in the reader and injustice to the
author, not to see a unity of plan and purpose in its numerous divi-
sions. Many of these, which, at first sight, would seem to be matters
of allowable philosophical curiosity merely, or at most collateral
or even introductory, are, truly, an integral and indispensible part
of the treatise ; and they could not be detached from it without
marring its proportions, if not actually destroying its characteristic
and attractive features.
The common constituents of climate, in temperature, atmos-
pheric pressure, and dryness and moisture, force and direction of
the winds, and electricity, are greatly modified, independently of
latitude and the succession of seasons, by the localities, whose
peculiarities are included under the head of Topographical and
Hydrographical Etiology. This is first exhibited in general
analysis,” and then in connection with successive portions of the
“ southern hydrographical basin,” which includes the Gulf of
Mexico and the different towns and harbours and inlets from Vera
Cruz to Mobile, and the Delta of the Mississippi. Thence, in
one direction, we follow along the bottoms and bluffs of this river on
to the Upper Mississippi, and, in another line, the regions “West of
the Gulf and of the Mississippi River.” In fine, the entire regions on
each side of the father of waters, up to the Ohio Basin and the coun-
tries north of this latter, are spread before us by the author, who
has thus collected and concentrated an amount of medical hydro-
graphy and topography of the great valley of the Mississippi,
hitherto either unknown, or to most of us unattainable.
Next we are taken over the “Eastern or St. Lawrence Basin,”
including the regions of the lakes and of the river itself; and the
first part is concluded by a sketch of the “Hudson and Arctic Hy-
drographical Basins.”
Part second is devoted to “ Climatic Etiology” under its appropri-
ate divisions. Part third furnishes us with “ Physiological and
Social Etiology,” especially of the Caucasian portion of the people
of the Great Valley, in their physiological characteristics, diet and use
of stimulating and narcotic substances; also in their clothing, lodging,
bathing and habitations, and in their occupations, pursuits, exercise
and recreations. The Hippocratic advice given at the beginning of
this notice, has been fully followed out by Dr. Drake; and no phy-
sician can henceforward pretend to practice medicine in the great
valley of North America, without having first possessed himself of
the Systematic Treatise and studied carefully its contents, that so
he may prepare himself for a suitable treatment of the diseases in
his town or district, and for filling up from his own observation
the great outlines furnished in this work.
Book second exhibits the application of all that preceded it to a
review of the geographical and topographical, in fine, the climatic
causes of Febrile Diseases; beginning with Autumnal Fever, being
that which has the widest range, and attacks the greatest number
of people. The divisions of this latter described by Dr. Drake, are first,
Intermittent Fever, with its varieties of simple, inflammatory and
malignant,and then Remittent Fever, considered as simple and malig-
nant. The last two chapters are given to a consideration of the
“ Pathological Jinatomy and Consequences of Autumnal Fever.”
From the preceding outline our readers may acquire some idea
of the abundance and variety of the topics examined in the present
volume. Of their richness and intrinsic worth, they can only obtain
accurate notions by reference to its pages. Even if more space
were allotted to us than is possible within the assigned limits of this
journal, we should still fail to do justice to the multiplied and pains-
taking researches, statistical and other tabular estimates, as of tem-
perature, barometrical changes and seasons, interspersed with ju-
dicious summaries and apposite statements of the material facts, with
which this volume abounds.
Adequate apology, if any be needed, for the want, on the part of
the author, of more abundant literary reference and comparisons
between the American and other climates, is given in the following
passage of his Preface, in which he says :
“ Long journeys of observation, repeated through a large part of
several years, with elementary teaching in winter, have much
abridged the time for bibliothecal research, and, perhaps, even
diminished the taste for that mode of inquiry.” After admitting
that, notwithstanding his extensive explorations, large regions of
country remain unvisited, he adds that, “ as his personal examina-
tions were carried through eighteen degrees of latitude and as many
of longitude, he trusts that facts which may, in some degree, stand
as representatives of the whole, Aowe been collected; and, therefore,
that no general conclusion will be found radically wrong.”
While prosecuting his researches, the author “visited the larger
part of the military and naval posts of the Interior Valley, both
American and British, bearing a letter explanatory of his object
from Major General Scott, and received, from each, such facilities
as were practicable.” We can readily understand the value of
these visits, from the fact that at the American posts, for many years
past, meteorological registers have been carefully kept, agreeably to
rules and instructions laid down for the purpose when Mr. Calhoun
was Secretary of War.
The engravings, for the illustration of medical topography, in-
clude those of the Bay of Pensacola, Mobile Bay and City, the
Delta of the Mississippi, New Orleans, Transverse Section of the
Trough of the Mississippi, Memphis, with a Section of the Trough
of the Mississippi, St. Louis, Louisville, Harroldsburg Springs,
Pittsburg, Cincinnati, Mackinac, Buffalo, Island of Montreal and
Quebec. Not only are there engravings of the cities just named,
but, also, of the environs of each. Accompanying them are brief
but lucid descriptions of the soil and of the geological formation of
the adjacent region, either maritime or alluvial, together with their
peculiar climatic features.
Not the least attractive subject, of those which come under a
consideration of the influences of climate, is that of “ Climatic Dis-
tribution of Plants and Animals,” treated of in Chapter V. of Part
Second.
We should like much to be able to present a summary, with
illustrative extracts, of the Physiological and Social Etiology, con-
tained in Part third of Dr. Drake’s volume; but our limits forbid.
The reader will find a pleasant notice of the different national
origins of the people of the great valley and of the late and present
emigrants from Europe, coming from no less than seven different
countries; the first enumerated being the Irish, and the last the
Poles. The oldest great family of all, that of the Jews, is also men-
tioned.
In the chapter on Physiological Characteristics, under the head of
Intermarriage, our attention was arrested by the following para-
graphs:
“ 1. Our frontiers, from Quebec, round by the Lakes and Hudson
Bay, to the Gulf of Mexico, beyond the Rio del Norte, present a
mixed race of whites and Indians ; which is gradually lost, in the
population residing immediately within that boundary. Thus In-
dian blood is, as it were, absorbed by the surface of the new nation.
The readiest amalgamation with the people of that race, is by the
northern French, and the southern Spanish Creoles; but the Anglo-
American immigrants from the Atlantic States, and their descend-
ants have, at all times, when war did not prevent it, shown a pro-
pensity of the same kind.
“2. Wherever there is a negro population, bond or free, the
same coalescence is displayed; so that in all our towns, from Mo-
bile to Montreal, and from Pittsburg to St. Louis, the streets are
more or less thronged with mulattoes, quadroons, and other mixed
breeds, all pressing upward, that is, ambitious of intermarriage with
those whiter than themselves; and thus our Caucasian blood is con-
stantly, though slowly, acquiring an African element. In the wil-
lingness for this commingling, the Spanish Creoles of Florida, Lou-
isiana and Mexico, stand first; next come the French Creoles of the
Lower Mississippi; then some of the classes of the modern emi-
grants from Great Britain, Ireland and Germany; lastly, the native
Anglo-Americans.”
Apposite remarks, respecting the changes being wrought on the
inhabitants of the great valley, of which intermarriage is one, are
made under the additional heads of changes of climate, of food, and
of political, moral and social condition.
The section on statistical physiology communicates some precise
returns respecting the stature, weight and strength of the different
people who inhabit the valley. Towards the illustration of this sub-
ject the materials are as yet few.
Instructive matter is given in the chapter on the modes of living
of the people of the great valley, including a consideration of the
solid and liquid food and table drinks. The varieties of water are
considered, both natural for drink, mineral for medicinal uses, and
artificial for both purposes.
When speaking of alcoholic drinks, the author tells us that “the
successful cultivation of the vine in different parts of the valley,
above all in the country around Cincinnati, has originated the manu-
facture of wine—not from various ingredients—but from the una-
dulterated juice of the grape.”
“ Bar Room Drinking.—While family and hospitable drinking
have thus declined, bar room drinking, in many parts of the valley,
has held its own.”
Large quantities of beer “ are drunk in the beer houses with
which all our towns and cities abound. It is the cherished beverage
of our German and English immigrant population. Cider, formerly
manufactured and consumed in large quantities by the people of the
State of Ohio, is now in less general use.
Dr. Drake discusses the question of the “ Necessity and Effects
of Alcoholic Drinks.” He shows from a priori reasoning and from
the evidence of facts on a large scale, that there exists no such ne-
cessity as that claimed for their use by some physiological writers.
He admits that there is a desire for stimulants as well as a desire
for food implanted in the physical system of man. These are
common salt, an element of the blood, not less than a stimulus; the
various aromatic and acrid substances, which man has sought out
and instinctively mingled with his food and drinks, under the name
of condiments; and, lastly, tea and coffee. These are all the physi-
cal stimulants which his system demands for its full perfection—
all that are necessary to satisfy his desires, when kept unperverted.
Adapted by infinite wisdom, to man’s wants, not less than to his
instincts and appetites, he seldom uses them to excess; and when he
does, their injurious effects bear no assignable proportion to those
of the artificial substitutes, which his ingenuity has manufactured
out of sugar, now known to be the only source of alcohol.” In
these conclusions we heartily concur.
Tobacco is largely used in the great valley, as, unfortunately, it
is everywhere else. The author thinks that “ nothing in the pre-
sent state of society justifies the expectation that tobacco will go
out of use.”
When speaking of £C Clothing,” the author tells us that the male
population of the Valley are generally well clothed, as far as relates
to protection from cold. The same cannot be said of the dress of
the females, in which, cotton and silk too often exclude woollen
textures. An improvement, however, is going on in this respect,
especially in the more general use of muslin or flannel drawers.
Proper strictures are made on the dress of the children, in their
being often inadequately clothed—not from deficiency of means on
the part of their parents, but to meet the requirements of absurd
fashions. Specification is made of the pernicious fashion of exposing
the arms and upper parts of the chest during youth.
Bathing, we regret to learn, is far from being general in any part
of the Valley. “X)ur large cities, from New Orleans and Mobile to
Pittsburg and Montreal, ought to have public cistern-baths, for the
gratuitous accommodation of the poorer laboring classes, so many
of whom, when sick, are supported at the public expense in our alms-
houses and hospitals.” It would be easy, as Dr. Bell has shown
in his late work on Baths and the Watery Regimen, &c., to pro-
cure warm baths on a large scale, at a low cost, -wherever steam
power is used.
Judicious remarks follow on Lodgings, Habitations and Shade
Trees; and,in successive chapters, on Agricultural Labor, Commercial
Pursuits, Mining and Smelting, Salt Making, Mechanical and Che-
mical Arts and Manufactures, in reference to the health and ten-
dency to disease of those engaged in them.
Under the head of Exercises, Recreation and Amusement, Dr.
Drake lays merited stress on the necessity of a portion of time being
allotted to these purposes, in the interests of a healthful state of
both body and mind. He regrets that the utility of systematic ex-
ercise is so little appreciated in the Great Valley, and he shows its
importance on physiological grounds. On the subject of Dancing,
the author asserts, too truly, that, “ As a mode of exercise in child-
hood and youth, it is insufficient; and as a method of amusement
in after years, it is neglected by those who, physiologically speaking,
most require it.”
At the conclusion of Book first, the author indulges in some re-
marks on the probable future, as regards the physiological traits,
and the diseases of the people who shall then inhabit the Great
Valley.
“ The physicians of a future day will see, what we cannot now,
a prevailing temperament, a stature, form, complexion and physi-
ognomy, characteristic of an indigenous, but greatly compounded
race; with its own physical, intellectual and moral constitution ; its
special liabilities and exemptions from disease; its national idio-
syncrasies, and the required peculiarities of hygienic regimen and
therapeutic treatment. In the course of this development, what
hereditary diatheses may disappear, and what new ones take their
places; what new maladies may arise, or old ones cease or become
greatly modified, under the joint influence of mingled blood, of cli-
mate, water, occupations, modes of living, customs, and moral,
social and political influences, cannot be specified ; but a few pre-
dictions may be hazarded :
“ 1. Autumnal fever will decrease, and typhus and typhoid fevers
become more prevalent.
“ 2. Gout will occur oftener than at present.
“3. The diseases produced by the intemperate use of ardent
spirits will diminish.
“ 4. Consumption and scrofula will increase.
“5. Apoplexy, palsy and epilepsy will become more frequent.
“6. Diseases of the liver will become less, and those of the
mucous membrane of the bowels more prevalent.
“7. Lastly, mental alienation will be more frequent.”
Book Second will be devoted, as we learn at p. 702, “to febrile
diseases, under the five following heads: First, Autumnal Fever—
second, Yellow Fever—third, Typhous Fevers—-fourth, Eruptive
Fevers—-fifth, Phlogistic Fevers, or the Phlegmasia:.”
The first part of the second Book on Autumnal Fever, with its
varieties already designated, is contained in the present ample
volume. The article on Yellow Fever, will, as the author informs
us in his Preface, make the first part of the second volume, “the
materials for which have been chiefly collected, and considerable
portions of it written, so that the author hopes it may be committed
to press in about a year”—from December, 1849.
We cannot pretend to review the part on Autumnal Fever; but
we are safe in recommending it for the ample views which it pre-
sents of the etiology and special pathology of the varieties and com-
plications of periodical fever,—although on some points we might
express our dissent from the opinions of the author, as, for instance,
on the subject of Malaria.
We close reluctantly our notice of this valuable work, of which
not only the people of the Great Valley, but also of the United
States, may be justly proud, as an enduring contribution, of the
highest order, to our national medical literature. Its estimable
author may send it to Europe as a rich equivalent for medical pro-
ductions obtained from that quarter and largely current among us.
A word to our readers. The volume now issued, although but
a part of the great work, is so full and complete in its divisions,
and these have such connection and co-ordination one with another,
that it may be read and studied as an entire production, susceptible
of connection with that which is to come, but not dependent on it
for harmonious proportions and general fitness and adaptation.