Download the full version and explore a variety of ebooks

or text books at https://ebookball.com

AACN Essentials of Progressive Care Nursing 3rd

Edition by Suzanne Burns 0071822925 9780071822923

_____ Follow the link below to get your download now _____

https://ebookball.com/product/aacn-essentials-of-
progressive-care-nursing-3rd-edition-by-suzanne-
burns-0071822925-9780071822923-1526/

Access ebookball.com now to download high-quality

ebooks or textbooks
Here are some recommended products for you. Click the link to
download, or explore more at ebookball.com

AACN Essentials of Progressive Care Nursing 4th edition by

Suzannne Burns, Sarah Delagado ISBN 1260116735
978-1260116731
https://ebookball.com/product/aacn-essentials-of-progressive-care-
nursing-4th-edition-by-suzannne-burns-sarah-delagado-
isbn-1260116735-978-1260116731-6336/

AACN Essentials of Critical Care Nursing 1st Edition by

Marianne Chulay, Suzanne Burns ISBN B01FIXVDAE
9780071104975
https://ebookball.com/product/aacn-essentials-of-critical-care-
nursing-1st-edition-by-marianne-chulay-suzanne-burns-
isbn-b01fixvdae-9780071104975-578/

AACN Essentials of Critical Care Nursing 4th Edition by

Suzanne Burns, Sarah Delgado ISBN 126011676X 9781260116762

https://ebookball.com/product/aacn-essentials-of-critical-care-
nursing-4th-edition-by-suzanne-burns-sarah-delgado-
isbn-126011676x-9781260116762-6344/

Practical Leadership in Nursing and Health Care A Multi

Professional Approach 1st Edition by Suzanne Henwood ISBN
9781482229813 1482229811
https://ebookball.com/product/practical-leadership-in-nursing-and-
health-care-a-multi-professional-approach-1st-edition-by-suzanne-
henwood-isbn-9781482229813-1482229811-676/
Essentials of Anatomy and Physiology 1st Edition by Elaine
Marieb, Suzanne Keller ISBN 1292216115 9781292216119

https://ebookball.com/product/essentials-of-anatomy-and-
physiology-1st-edition-by-elaine-marieb-suzanne-keller-
isbn-1292216115-9781292216119-3066/

Essentials of Psychiatric Mental Health Nursing Concepts

of Care in Evidence Based Practice 4th edition by Mary
Townsend 9780803616110 0803616112
https://ebookball.com/product/essentials-of-psychiatric-mental-health-
nursing-concepts-of-care-in-evidence-based-practice-4th-edition-by-
mary-townsend-9780803616110-0803616112-958/

Essentials of Psychiatric Mental Health Nursing Concepts

of Care in Evidence Based Practice 5th edition by Mary
Townsend 0803623380 9780803623385
https://ebookball.com/product/essentials-of-psychiatric-mental-health-
nursing-concepts-of-care-in-evidence-based-practice-5th-edition-by-
mary-townsend-0803623380-9780803623385-888/

Essentials of Human Anatomy and Physiology 12th Edition by

Suzanne Keller Elaine Marieb ISBN 1292216115 9781292216119

https://ebookball.com/product/essentials-of-human-anatomy-and-
physiology-12th-edition-by-suzanne-keller-elaine-marieb-
isbn-1292216115-9781292216119-3204/

Essentials of Human Anatomy and Physiology 12th Edition by

Elaine Marieb, Suzanne Keller ISBN 0134593642
9780134593647
https://ebookball.com/product/essentials-of-human-anatomy-and-
physiology-12th-edition-by-elaine-marieb-suzanne-keller-
isbn-0134593642-9780134593647-3304/
Also from McGraw-Hill Medical:

978-0-07-182292-3

Available everywhere
medical books are sold
AACN Essentials of Progressive Care Nursing
Third Edition

Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP

Professor Emeritus, School of Nursing
University of Virginia
Consultant, Critical and Progressive Care and Clinical Nursing Research
Charlottesville, Virginia

New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Copyright © 2014, 2010, 2006 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be
reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

ISBN: 978-0-07-182294-7

MHID: 0-07-182294-1

The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-182292-3,
MHID: 0-07-182292-5.

eBook conversion by codeMantra

Version 1.0

All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only,
and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps.

McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To contact a
representative, please visit the Contact Us page at www.mhprofessional.com.

NOTICE

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the
publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted
at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for
any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other
sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is
of particular importance in connection with new or infrequently used drugs.

TERMS OF USE

This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under
the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works
based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your own
noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.

THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,
ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED
THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or
guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors
shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no
responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect,
incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such
damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
 To my progressive care nursing colleagues around the world
whose wonderful work and efforts ensure the safe passage of patients
through the progressive care environment. Special thanks to Marianne Chulay, RN, PhD, FAAN, my dear friend and colleague,
for her many contributions and mentoring during the development of the first two editions of the Essentials of Critical Care
Nursing and the Essentials of Progressive Care Nursing books. Her inspiration, drive, and thoughtful approach to the books
continue to be an inspiration to me and the authors with whom she worked.
This page intentionally left blank
 Contents

Contributors..........................................................................................................................................................................................................................................................xvii
Reviewers............................................................................................................................................................................................................................................................. xix
Preface................................................................................................................................................................................................................................................................. xxi

Section I.╇ The Essentials........................................................................................................................................................................................... 1

1. Assessment of Progressive Care Patients and Their Families.............................................................................................................. 3
Mary Fran Tracy
2. Planning Care for Progressive Care Patients and Their Families...................................................................................................... 17
Mary Fran Tracy
3. Interpretation and Management of Basic Cardiac Rhythms.......................................................................................................... 33
Carol Jacobson
4. Hemodynamic Monitoring................................................................................................................................................................. 67
Leanna R. Miller
5. Airway and Ventilatory Management................................................................................................................................................ 93
Robert E. St. John and Maureen A. Seckel
6. Pain and Sedation Management....................................................................................................................................................... 133
Yvonne D’Arcy and Suzanne M. Burns
7. Pharmacology..................................................................................................................................................................................... 151
Earnest Alexander
8. Ethical and Legal Considerations..................................................................................................................................................... 181
Sarah Delgado

Section II.╇ Pathologic Conditions............................................................................................................................................................................ 197

9. Cardiovascular System....................................................................................................................................................................... 199
Barbara Leeper
10. Respiratory System............................................................................................................................................................................ 231
Maureen A. Seckel
11. Multisystem Problems...................................................................................................................................................................... 261
Ruth M. Kleinpell
12. Neurologic System.............................................................................................................................................................................. 279
Dea Mahanes

v
vi CONTENTS

13. Hematologic and Immune Systems................................................................................................................................................. 303

Diane K. Dressler
14. Gastrointestinal System..................................................................................................................................................................... 317
Deborah A. Andris, Elizabeth Krzywda, Carol Rees Parrish, and Joe Krenitsky
15. Renal System....................................................................................................................................................................................... 349
Carol Hinkle
16. Endocrine System............................................................................................................................................................................... 365
Christine Kessler
17. Trauma................................................................................................................................................................................................. 381
Allen C. Wolfe and Benjamin C. Hughes

Section III. Advanced Concepts in Caring for the Critically Ill Patient................................................................................................................................. 397
18. Advanced ECG Concepts.................................................................................................................................................................. 399
Carol Jacobson
19. Advanced Cardiovascular Concepts.............................................................................................................................................. 441
Barbara Leeper
20. Advanced Neurologic Concepts....................................................................................................................................................... 469
Dea Mahanes

Section IV. Key Reference Information............................................................................................................................................................................................................. 493

21. Normal Values Table.......................................................................................................................................................................... 495
Suzanne M. Burns
22. Pharmacology Tables......................................................................................................................................................................... 497
Earnest Alexander
23. Advanced Cardiac Life Support Algorithms................................................................................................................................... 511
Suzanne M. Burns
24. Cardiac Rhythms, ECG Characteristics, and Treatment Guide................................................................................................... 515
Carol Jacobson
Index ............................................................................................................................................................................................................... 523
 Contents in Detail

Contributors.............................................................................................................................................................................................................................................................xvii
Reviewers................................................................................................................................................................................................................................................................. xix
Preface................................................................................................................................................................................................................ xxi

Section I.╇ The Essentials........................................................................................................................................................................................... 1

1. Assessment of Progressive Care Patients and Their Families.............................................................................................................. 3
Mary Fran Tracy
Assessment Frameworkâ•… 3
Prearrival Assessment 4 / Arrival Quick Check 4 / Comprehensive Initial Assessment 4 / Ongoing
Assessment 4 / Patient Safety Considerations in Admission Assessments 4
Prearrival Assessment: Before the Action Beginsâ•… 5
Arrival Quick Check Assessmentâ•… 5
Airway and Breathing 6 / Circulation and Cerebral Perfusion 7 / Chief Complaint 7 / Drugs and
Diagnostic Tests 7 / Equipment 7
Comprehensive Initial Assessmentâ•… 8
Past Medical History 9 / Social History 9 / Physical Assessment by Body System 10 / Transition/
Discharge Planning / 15
Ongoing Assessmentâ•… 15
Selected Bibliographyâ•… 16
Progressive Care Assessment 16 / Evidence-Based Practice 16
2. Planning Care for Progressive Care Patients and Their Families...................................................................................................... 17
Mary Fran Tracy
Multidisciplinary Plan of Care â•… 18
Planning Care Through Staffing Considerationsâ•… 18
Patient Safety Considerations in Planning Careâ•… 19
Prevention of Common Complicationsâ•… 20
Physiologic Instability 20 / Deep Venous Thrombosis 20 / Hospital-Acquired Infections 20 /
Skin Breakdown 21 / Sleep Pattern Disturbance 22 / Psychosocial Impact 22
Patient and Family Educationâ•… 24
Assessment of Learning Readiness 24 / Strategies to Address Patient and Family Education 24 /
Outcome Measurement 25
Family-Focused Careâ•… 25
Transporting the Progressive Care Patientâ•… 27
Assessment of Risk for Complications 27 / Level of Care Required During Transport 28 /
Preparation 29 / Transport 30 / Interfacility Transfers 31
Transitioning to the Next Stage of Careâ•… 31
Supporting Patients and Their Families During the Dying Processâ•… 31

vii
viii CONTENTS IN DETAIL

Selected Bibliography 31
Family Interventions/Visitation 31/ Infection Control 32 / Patient and Family Education 32 /
Psychological Problems 32 / Sleep Deprivation 32 / Transport of Critically Ill Patients 32 /
Evidence-Based Practice 32

3. Interpretation and Management of Basic Cardiac Rhythms.......................................................................................................... 33

Carol Jacobson
Basic Electrophysiology 33
ECG Waveforms, Complexes, and Intervals 34
P Wave 34 / QRS Complex 35 / T Wave 35 / U Wave 35 / PR Interval 35 / ST Segment 35 /
QT Interval 35
Basic Electrocardiography 35
Cardiac Monitoring 35
Determination of the Heart Rate 38
Determination of Cardiac Rhythm 38
Common Arrhythmias 39
Rhythms Originating in the Sinus Node 39
Normal Sinus Rhythm 39 / Sinus Bradycardia 39 / Sinus Tachycardia 40 / Sinus Arrhythmia 40 /
Sinus Arrest 40
Arrhythmias Originating in the Atria 41
Premature Atrial Complexes 41 / Wandering Atrial Pacemaker 42 / Atrial Tachycardia 42 / Atrial
Flutter 43 / Atrial Fibrillation 45 / Supraventricular Tachycardia 49
Arrhythmias Originating in the Atrioventricular Junction 50
Premature Junctional Complexes 50 / Junctional Rhythm, Accelerated Junctional Rhythm, and
Junctional Tachycardia 51
Arrhythmias Originating in the Ventricles 51
Premature Ventricular Complexes 51 / Ventricular Rhythm and Accelerated Ventricular Rhythm 52 /
Ventricular Tachycardia 53 / Ventricular Fibrillation 54 / Ventricular Asystole 54
Atrioventricular Blocks 55
First-Degree Atrioventricular Block 55 / Second-Degree Atrioventricular Block 55 / High-Grade
Atrioventricular Block 56 / Third-Degree Atrioventricular Block (Complete Block) 57
Temporary Pacing 58
Indications 58 / Transvenous Pacing 59 / Epicardial Pacing 60 / Components of a Pacing
System 60 / Basics of Pacemaker Operation 60 / Initiating Transvenous Ventricular Pacing 62 /
Initiating Epicardial Pacing 62 / External (Transcutaneous) Pacemakers 62
Defibrillation and Cardioversion 62
Defibrillation 62 / Automatic External Defibrillators 63 / Cardioversion 63
Selected Bibliography 64
Evidence-Based Practice 65

4. Hemodynamic Monitoring................................................................................................................................................................. 67
Leanna R. Miller
Hemodynamic Parameters 67
Cardiac Output 67 / Components of Cardiac Output/Cardiac Index 69 / Stroke Volume and Stroke
Volume Index 70 / Ejection Fraction 70 / Factors Affecting Stroke Volume/Stroke Volume Index 70
Basic Components of Hemodynamic Monitoring Systems 74
Pulmonary Artery Catheter 74 / Arterial Catheter 74 / Pressure Tubing 74 / Pressure Transducer 74 /
Pressure Amplifier 74 / Pressure Bag and Flush Device 74 / Alarms 76
Obtaining Accurate CVP and Arterial Values 76
Zeroing the Transducer 76 / Leveling the Transducer to the Catheter Tip 76 / Calibration of the
Transducer/Amplifier System 77 / Ensuring Accurate Waveform Transmission 77
Insertion and Removal of Catheters 78
Central Venous Catheters 78 / Arterial Catheters 80
Obtaining and Interpreting Hemodynamic Waveforms 81
Patient Positioning 81 / Interpretation 81 / Artifacts in Hemodynamic Waveforms: Respiratory
Influence 85
Continuous Mixed and Central Venous Oxygen Monitoring (Svo2/Scvo2) 86
Svo2/Scvo2 Monitoring Principles 86
Minimally Invasive Hemodynamic Monitoring 87
 CONTENTS IN DETAIL ix

Thoracic Bioimpedance 87 / Pulse Contour Measurement 88

Selected Bibliography 88
Hemodynamic Monitoring 88 / Minimally Invasive Hemodynamic Monitoring 89 /
Therapeutics 90 / Evidence-Based Practice Guidelines 92
5. Airway and Ventilatory Management................................................................................................................................................ 93
Robert E. St. John and Maureen A. Seckel
Tests, Monitoring Systems and Respiratory Assessment Techniques 93
Arterial Blood Gas Monitoring 93 / Venous Blood Gas Monitoring 98 / Pulse Oximetry 98 /
Assessing Pulmonary Function 100
Airway Management 101
Oropharyngeal Airway 101 / Nasopharyngeal Airway 102 / Laryngeal Mask Airway 102 /
Esophageal Tracheal Airway 102 / Artificial Airways 102 / Endotracheal Suctioning 105
Oxygen Therapy 107
Complications 107 / Oxygen Delivery / 107
Basic Ventilatory Management 110
Indications 110 / General Principles 110 / Patient-Ventilator System 111 / Modes 114 /
Complications of Mechanical Ventilation 115 / Weaning From Short-Term Mechanical
Ventilation 117 / Weaning From Long-Term Mechanical Ventilation 119 / Respiratory Fatigue, Rest,
and ­Conditioning 120 / Wean Trial Protocols 121 / Other Protocols for Use 122 / Critical Pathways
122 / Systematic Institutional Initiatives for the Management of the LTMV Patient Population 123 /
Troubleshooting Ventilators 124 / Oral Feedings 124 / Communication 125 / Principles of
­Management 128
Selected Bibliography 129
General Critical Care 129 / Ventilator Management 130 / Weaning From Mechanical Ventilation 130 /
Communication 131 / Evidence-Based Resources 131
6. Pain and Sedation Management....................................................................................................................................................... 133
Yvonne D’Arcy and Suzanne M. Burns
Physiologic Mechanisms of Pain 133
Peripheral Mechanisms 133 / Spinal Cord Integration 134 / Central Processing 134
Responses to Pain 135
Pain Assessment 136
A Multimodal Approach to Pain Management 136
Nonsteroidal Anti-Inflammatory Drugs 136
Side Effects 138
Opioids 138
Side Effects 138 / Intravenous Opioids 139 / Patient-Controlled Analgesia 139 / Switching From IV
to Oral Opioid Analgesia 140
Epidural Analgesia 141
Epidural Opioids 142 / Epidural Local Anesthetics 142
Cutaneous Stimulation 143
Distraction 143
Imagery 143
Relaxation Techniques 144
Deep Breathing and Progressive Relaxation 144 / Presence 145
Special Considerations for Pain Management in the Elderly 145
Assessment 145 / Interventions 145
Sedation 145
Reasons for Sedation 146 / Drugs for Sedation 147 / Drugs for Delirium 147 / Goals of Sedation,
Monitoring, and Management 147
Selected Bibliography 149
Pain Management 149 / Sedation 150 / Evidence-Based Practice Guidelines 150
7. Pharmacology..................................................................................................................................................................................... 151
Earnest Alexander
Medication Safety 151
Medication Administration Methods 152
Intravenous 152/ Intramuscular or Subcutaneous 152 / Oral 152 / Sublingual 153 / Intranasal 153 /
Transdermal 153
Central Nervous System Pharmacology 153
x CONTENTS IN DETAIL

Sedatives 153 / Analgesics 156 / Anticonvulsants 158

Cardiovascular System Pharmacology 161
Miscellaneous Agents 161 / Parenteral Vasodilators 161 / Antiarrhythmics 164 /
Vasodilators and Remodeling Agents 166 / Vasopressor Agents 166 / Inotropic Agents 167
Antibiotic Pharmacology 167
Aminoglycosides 168 / Vancomycin 168
Pulmonary Pharmacology 169
Theophylline 169 / Albuterol 170 / Levalbuterol 170
Gastrointestinal Pharmacology 170
Stress Ulcer Prophylaxis 170 / Acute Peptic Ulcer Bleeding 171 / Variceal Hemorrhage 171
Renal Pharmacology 172
Diuretics 172
Hematologic Pharmacology 173
Anticoagulants 173 / Factor Xa Inhibitors 175 / Direct Thrombin Inhibitors 175 / Glycoprotein IIb/
IIIa Inhibitor 175 / Thrombolytic Agents 176
Immunosuppressive Agents 177
Cyclosporine 177 / Tacrolimus (FK506) 177 / Sirolimus (Rapamycin) 177
Special Dosing Considerations 178
Drug Disposition in the Elderly 178 / Therapeutic Drug Monitoring   178
Selected Bibliography 179
General 179 / Evidence-Based Practice Guidelines 179
8. Ethical and Legal Considerations..................................................................................................................................................... 181
Sarah Delgado
The Foundation for Ethical Decision Making 181
Professional Codes and Standards 181 / Position Statements and Guidelines 182 / Institutional
Policies 182 / Legal Standards 183 / Principles of Ethics 183 / The Ethics of Care 186 / Paternalism 186 /
Patient Advocacy 187
The Process of Ethical Analysis 188
Assessment 188 / Plan 188 / Implementation 188 / Evaluation 188
Contemporary Ethical Issues 188
Informed Consent 188 / Determining Capacity 189 / Advance Directives 189 / End-of-Life
Issues 190 / Resuscitation Decisions 192
Building an Ethical Environment 193
Values Clarification 193 / Provide Information and Clarify Issues 193 / Recognize Moral Distress 194 /
Engage in Collaborative Decision Making 194
Selected Bibliography 194
Professional Codes, Standards, and Position Statements 195 / Evidence-Based Guidelines 195 /
On-line References of Interest: Related to Legal and Ethical Considerations 195

Section II. Pathologic Conditions............................................................................................................................................................................ 197

9. Cardiovascular System....................................................................................................................................................................... 199
Barbara Leeper
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems 199
Assessment of Chest Pain 199 / Coronary Angiography 199 / Percutaneous Coronary Interventions 202 /
Other Percutaneous Coronary Interventions 202
Pathologic Conditions 203
Acute Ischemic Heart Disease 203 / Electrophysiology Studies 214 / Heart Failure 214 / Shock 221 /
Hypertension 225
Selected Bibliography 228
General Cardiovascular 228 / Coronary Revascularization 228 / Acute Ischemic Heart Disease 228 /
Heart Failure 228 / Shock 228 / Hypertension 229 / Evidence-Based Practice Guidelines 229
10. Respiratory System............................................................................................................................................................................. 231
Maureen A. Seckel
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems 231
Chest X-Rays 231 / Computed Tomography and Magnetic Resonance Imaging 236 / Pulmonary
Angiograms/CTPA and V/Q Scans 236 / Chest Tubes 237 / Thoracic Surgery and Procedures 237
Pathologic Conditions 238
 CONTENTS IN DETAIL xi

Acute Respiratory Failure 238 / Acute Respiratory Distress Syndrome (ARDS) 243 /
Acute Respiratory Failure in the Patient with Chronic Obstructive Pulmonary Disease 244 /
Acute Respiratory Failure in the Patient with Asthma 247 / Interstitial Lung Disease 250 /
Pulmonary Hypertension 250 / Pneumonia 251 / Pulmonary Embolism 255
Selected Bibliographyâ•… 258
Critical Care Management of Respiratory Problems 258 / Chest X-Ray Interpretation 258 /
Miscellaneous 258 / Evidence-Based Practice Guidelines 258
11. Multisystem Problems....................................................................................................................................................................... 261
Ruth M. Kleinpell
Pathologic Conditionsâ•… 261
Sepsis and Multiple Organ Dysfunction Syndrome 261
Overdosesâ•… 268
Etiology, Risk Factors, and Pathophysiology 268
Complex Wounds and Pressure Ulcersâ•… 273
Pressure Ulcer Stages 273
Healthcare Acquired Infectionsâ•… 274
Selected Infectious Diseasesâ•… 276
Selected Bibliographyâ•… 276
SIRS, Sepsis, and MODS 276 / Overdose 277 / Complex Wounds and Pressure Ulcers 277 /
Healthcare Acquired Infections 278 / Selected Infectious Diseases 278
12. Neurologic System.............................................................................................................................................................................. 279
Dea Mahanes
Special Assessment Techniques and Diagnostic Testsâ•… 279
Level of Consciousness 279 / Glasgow Coma Scale 280 / Full Outline of UnResponsiveness (FOUR)
Score 281 / Mental Status 281 / Motor Assessment 282 / Sensation 283 / Cranial Nerve Assessment
and Assessment of Brain Stem Function 283 / Vital Sign Alterations in Neurologic Dysfunction 285
Diagnostic Testingâ•… 285
Lumbar Puncture 285 / Computed Tomography 287 / Magnetic Resonance Imaging 287 / Cerebral
(Catheter) Angiography 288 / Transcranial Doppler Ultrasound 288 / Electroencephalography 288 /
Electromyography/Nerve Conduction Studies 289
Intracranial Pressure â•… 289
Cerebral Blood Flow 289 / Causes of Increased Intracranial Pressure 289 / Clinical Presentation 291 /
Principles of Management of Increased ICP 291
Acute Ischemic Strokeâ•… 292
Etiology, Risk Factors, and Pathophysiology 292 / Clinical Presentation 293 / Diagnostic Tests 294 /
Principles of Management of Acute Ischemic Stroke 294
Hemorrhagic Strokeâ•… 296
Etiology, Risk Factors, and Pathophysiology 296 / Clinical Presentation 296 / Diagnostic Tests 296 /
Principles of Management of Intracerebral Hemorrhage 296
Seizuresâ•… 297
Etiology, Risk Factors, and Pathophysiology 297 / Clinical Presentation 297 / Diagnostic Testing 298 /
Principles of Management of Seizures 298
Infections of the Central Nervous Systemâ•… 298
Meningitis 298 / Encephalitis 299 / Intracranial Abscess 299
Neuromuscular Diseasesâ•… 299
Myasthenia Gravis 299 / Guillain-Barré Syndrome 299 / Amyotrophic Lateral Sclerosis 299
Selected Bibliographyâ•… 300
Assessment and Diagnostic Testing 300 / Intracranial Pressure 300 / Acute Ischemic Stroke and
Hemorrhagic Stroke 300 / Seizures 300 / Infections of the Central Nervous System 301 /
Neuromuscular Diseases 301 / Evidence-Based Practice 301
13. Hematologic and Immune Systems................................................................................................................................................. 303
Diane K. Dressler
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systemsâ•… 303
Complete Blood Count 303 / Red Blood Cell Count 303 / Hemoglobin 304 / Hematocrit 304 /
Red Blood Cell Indices 304 / Total White Blood Cell Count 304 / White Blood Cell
Differential 305 / Platelet Count 305 / Coagulation Studies 305 / Additional Tests and Procedures 306
Pathologic Conditionsâ•… 306
xii CONTENTS IN DETAIL

Anemia 306 / Immunocompromise 308 / Coagulopathies 310

Selected Bibliographyâ•… 314
Anemia 314 / Immunocompromised Patient 315 / Coagulopathy 315
14. Gastrointestinal System..................................................................................................................................................................... 317
Deborah A. Andris, Elizabeth Krzywda, Carol Rees Parrish, and Joe Krenitsky
Pathologic Conditionsâ•… 317
Acute Upper Gastrointestinal Bleeding 317 / Liver Failure 325 / Acute Pancreatitis 330 / Intestinal
Ischemia 332 / Bowel Obstruction 333 / Bariatric (Weight Loss) Surgery 335 / Surgical Procedures 335
Nutritional Support for Acutely Ill Patientsâ•… 337
Nutrition Requirements 337 / Nutritional Case: Special Populations 337 / Postgastrectomy
Syndromes 338 / Gastric Residual Volume 339 / Aspiration 340 / Bowel Sounds 341 / Nausea and
Vomiting 341 / Osmolality or Hypertonicity of Formula 341 / Diarrhea 342 / Flow Rates and Hours
of Infusion 342 / Formula Selection 343
Selected Bibliographyâ•… 343
Upper GI Bleeding 343 / Liver Failure 344 / Acute Pancreatitis 344 / Intestinal Ischemia/Bowel
Obstruction 344 / Nutrition 345 / On-line References of Interest 347 / Bariatric (Gastric Bypass)
Surgery 347
15. Renal System....................................................................................................................................................................................... 349
Carol Hinkle
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systemsâ•… 349
Pathologic Conditionsâ•… 349
Acute Renal Failure 349 / Life-Threatening Electrolyte Imbalances 354
Renal Replacement Therapyâ•… 358
Access 359 / Dialyzer/Hemofilters/Dialysate 360 / Procedures 360 / Indications for and Efficacy of
Renal Replacement Therapy Modes 362 / General Renal Replacement Therapy Interventions 362
Selected Bibliographyâ•… 363
General Renal and Electrolyte 363 / Renal Failure 363 / Renal Replacement Therapy 363 / Online References 363
16. Endocrine System............................................................................................................................................................................... 365
Christine Kessler
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systemsâ•… 365
Blood Glucose Monitoring 365
Pathologic Conditionsâ•… 367
Hyperglycemic States 367 / Hyperglycemic Emergencies 368 / Acute Hypoglycemia 374 / Syndrome
of Inappropriate Antidiuretic Hormone Secretion 375 / Diabetes Insipidus 377
Selected Bibliographyâ•… 379
Blood Glucose Monitoring 379 / Hyperglycemia, DKA, and HHS 379 / SIADH and Diabetes Insipidus 379
17. Trauma................................................................................................................................................................................................. 381
Allen C. Wolfe and BenjaminW. Hughes
Specialized Assessment Techniques, Diagnostic Tests, and Monitoring Systemsâ•… 381
Primary and Secondary Trauma Survey Assessment 381 / Diagnostic Studies 383 / Mechanism of
Injury 384 / Physiologic Consequences of Trauma 386
Common Injuries in the Trauma Patientâ•… 387
Thoracic Trauma 387 / Abdominal Trauma 390 / Musculoskeletal Trauma 391
Complications of Traumatic Injury in Severe Multisystem
� Trauma╅ 393
Acute Respiratory Distress Syndrome 394 / Infection/Sepsis 394 / Systemic Inflammatory Response
Syndrome 395
Psychological Consequences of Traumaâ•… 395
Selected Bibliographyâ•… 396
General Trauma 396 / Selected Online References 396 / Evidence-Based Practice 396

Section III.╇ Advanced Concepts in Caring for the Critically Ill Patient................................................................................................................................. 397
18. Advanced ECG Concepts.................................................................................................................................................................. 399
Carol Jacobson
The 12-Lead Electrocardiogramâ•… 399
Axis Determination 403 / Bundle Branch Block 404 / Acute Coronary Syndrome 408 / Preexcitation
Syndromes 414
Advanced Arrhythmia Interpretationâ•… 418
 CONTENTS IN DETAIL xiii

Supraventricular Tachycardias 418 / Polymorphic Ventricular Tachycardias 422 / Differentiating

Wide QRS Beats and Rhythms 424
ST-Segment Monitoringâ•… 427
Measuring the ST Segment 427 / Choosing the Best Leads for ST-Segment Monitoring 427
Cardiac Pacemakersâ•… 429
Evaluating Pacemaker Function 431 / VVI Pacemaker Evaluation 431 / DDD Pacemaker Evaluation 434
Selected Bibliographyâ•… 438
Evidence-Based Practice 439
19. Advanced Cardiovascular Concepts................................................................................................................................................ 441
Barbara Leeper
Pathologic Conditionsâ•… 441
Cardiomyopathy 441 / Valvular Heart Disease 446 / Pericarditis 452 / Aortic Aneurysm 454 /
Cardiac Transplantation 458 / Ventricular Assist Devices 463
Selected Bibliographyâ•… 466
General Cardiovascular 466 / Cardiomyopathy 466 / Heart Transplantation 467 / Valvular
Disorders 467 / Pericarditis 467 / Thoraco-Abdominal Aneurysms 467 / Ventricular Assist
Devices 467 / Intraaortic Balloon Pump 468 / Evidence-Based Practice Guidelines 468
20. Advanced Neurologic Concepts....................................................................................................................................................... 469
Dea Mahanes
Subarachnoid Hemorrhageâ•… 469
Etiology, Risk Factors, and Pathophysiology 469 / Clinical Presentation 469 / Diagnostic Tests 470 /
Principles of Management of Aneurysmal Subarachnoid Hemorrhage 471
Traumatic Brain Injuryâ•… 474
Etiology, Risk Factors, and Pathophysiology 474 / Clinical Presentation 476 / Diagnostic Tests 477 /
Principles of Management of Traumatic Brain Injury 477
Traumatic Spinal Cord Injuryâ•… 479
Etiology, Risk Factors, and Pathophysiology 479 / Clinical Presentation 479 / Diagnostic Tests 481 /
Principles of Management of Acute Spinal Cord Injury 481 / Future Spinal Cord Injury Treatment 486
Brain Tumorsâ•… 487
Etiology, Risk Factors, and Pathophysiology 487 / Clinical Presentation 487 / Diagnostic Tests 487 /
Principles of Management of Intracranial Tumors 488 / Special Considerations: Transsphenoidal
Resection of Pituitary Tumors 489
Special Procedures: Invasive Monitoring of Intracranial Pressure â•… 489
Intracranial Pressure Waveforms 490
Special Procedures: Management of a Patient With a Lumbar Drainâ•… 491
Selected Bibliographyâ•… 491
Subarachnoid Hemorrhage 491 / Traumatic Brain Injury 492 / Spinal Cord Injury 492 / Brain
Tumors 492 / Intracranial Pressure Monitoring 492 / Evidence-Based Guidelines 492

Section IV.╇ Key Reference Information............................................................................................................................................................................................................. 493

21. Normal Values Table.......................................................................................................................................................................... 495
Suzanne M. Burns
22. Pharmacology Tables......................................................................................................................................................................... 497
Earnest Alexander
23. Advanced Cardiac Life Support Algorithms................................................................................................................................... 511
Suzanne M. Burns
24. Cardiac Rhythms, ECG Characteristics, and Treatment Guide................................................................................................... 515
Carol Jacobson

Index .................................................................................................................................................................................................................................................................... 523

Other documents randomly have
different content
be driven to say nothing at all.” Mr. Williams expressing his confidence that he
should never say it, Mr. Hooker proceeded: “If it be unlawful to call an
unregenerate person to pray, since it is an action of God’s worship, then it is
unlawful for your unregenerate child to pray for a blessing upon his own meat. If it
be unlawful for him to pray for a blessing upon his meat, it is unlawful for him to
eat it, for it is sanctified by prayer, and without prayer unsanctified. (1 Tim. iv. 4,
5.) If it be unlawful for him to eat it, it is unlawful for you to call upon him to eat
it, for it is unlawful for you to call upon him to sin.” Our fathers were adepts in
logic. Mr. Hooker’s syllogisms do not now seem very convincing, but they must
have puzzled Mr. Williams, if he held the notions ascribed to him. Accordingly,
Cotton Mather adds, that “Mr. Williams chose to hold his peace, rather than to
make any answer.” We may wonder, nevertheless, that Mr. Williams has not been
accused of starving his children, to the horror of succeeding generations!

80. The Court, in March, 1634–5, passed an act, “entreating of the brethren
and elders of every church within their jurisdiction, that they will consult and
advise of one uniform order of discipline in the churches, agreeable to the
Scriptures, and then to consider how far the magistrates are bound to interpose
for the preservation of that uniformity and the peace of the churches.”

81. Ecclesiastes, vii. 7.

82. Winthrop, vol. i. p. 167, note.

83. Winthrop places the banishment under the date of October, but the
Colonial Records, (I. 163) state, that it took place, November 3, 1635.

84. See Appendix C.

85. Backus, vol. i. p. 516. He called this daughter Freeborn. This was in the
taste of the times. The first three children christened in Boston church were
named Joy, Recompense and Pity. It is worthy of remark, that the name Freeborn
was given, while the father was the object of what he doubtless thought
oppression. It shows his indomitable spirit.

86. MSS. Letter.

87. This is the ground on which Mr. Cotton himself justified the punishment of
heretics. See the “Bloody Tenet.”

88. About the same time that Bossuet, the most illustrious champion of the
Church of Rome, was engaged in maintaining, with all the force of his
overwhelming eloquence, and inexhaustible ingenuity, that the sovereign was
bound to use his authority in extirpating false religions from the state, the Scotch
Commissioners in London were remonstrating, in the name of their national
Church, against the introduction of a ‘sinful and ungodly toleration in matters of
religion;’ whilst the whole body of the English Presbyterian Clergy, in their official
papers, protested against the schemes of Cromwell’s party, and solemnly declared,
‘that they detested and abhorred toleration.’ ‘My judgment,’ said Baxter, a man
noted in his day for moderation, ‘I have always freely made known. I abhor
unlimited liberty or toleration of all.’—‘Toleration,’ said Edwards, another
distinguished divine, ‘will make the kingdom a chaos, a Babel, another
Amsterdam, a Sodom, an Egypt, a Babylon. Toleration is the grand work of the
Devil, his master-piece, and chief engine to uphold his tottering kingdom. It is the
most compendious, ready, sure way to destroy all religion, lay all waste and bring
in all evil. It is a most transcendent, catholic and fundamental evil. As original sin
is the fundamental sin, having the seed and spawn of all sins in it, so toleration
hath all errors in it, and all evils.’ Verplank’s Discourses, pp. 23, 24. Similar
language was used in this country. The Rev. Mr. Ward, in his Simple Cobler of
Agawam, written in 1647, utters his detestation of toleration, and says: “He that is
willing to tolerate any religion, or decrepit way of religion, besides his own, unless
it be in matters merely indifferent, either doubts of his own, or is not sincere in it.”

89. 1 His. Col. vi. p. 248.

90. Mr. Haynes was preceded by Mr. Dudley, who was a stern man, and
particularly opposed to toleration. He died soon after, with a copy of verses in his
pocket, written with his own hand. The two following lines made a part of it:

“Let men of God in court and churches watch

“O’er such as do a toleration hatch.”

Mr. Haynes also accused Governor Winthrop as too mild. Winthrop, vol. i. p.
178.

91. Mr. Cotton denied, in his Reply to the Bloody Tenet, that he had any
agency in the banishment of Mr. Williams, but avowed that he approved of it. Mr.
Williams asserts, “Some gentlemen who consented to the sentence against me,
solemnly testified with tears, that they did it by the advice and counsel of Mr.
Cotton.” These two assertions may be reconciled, perhaps, by the remark of Mr.
Cotton, that “if he did counsel one or two, it would not argue the act of the
government.”

92. In the Bloody Tenet such phrases as these are repeatedly applied to Mr.
Cotton: “I speak with honorable respect for the answerer”—“the worthy
answerer”—“a man incomparably too worthy for such a service.”

93. Baylies’ History of Plymouth, vol. i. chap. 4.

 94. 2 His. Col. vol. ix. pp. 235, 236.

95. Key, Introduction.

96. Key, ch. 21.

97. The remark of Tacitus, respecting the German tribes, is true of the
Indians: “Reges̄ ex nobilitate, Duces ex virtute sumunt. Nec Regibus infinita aut
libera potestas, et Duces exemplo potius quam imperio; si prompti, si conspicui, si
ante aciem agant, admiratione præsunt.” De Mor. Ger. c. vii.

98. Key, ch. 22.

99. Encyclopædia Americana, art. Indians.

100. Hutchinson, vol. i. p. 411.

101. Roger Williams says, “I have known many of them run between
fourscore or an hundred miles in a summer’s day, and back in two days.” Key, ch.
11.

102. Key, ch. 2.

103. When boiled whole it was called msickquatash, and it is still eaten in
New-England, under the name of suckatash. The ground corn, when boiled, was
called Nasaump. “From this,” says Roger Williams, “the English call their samp,
which is the Indian corn, beaten and boiled, and eaten hot or cold with milk or
butter, which are mercies beyond the natives’ plain water, and which is a dish
exceeding wholesome for the English bodies.” Key, ch. 2.

104. This shell fish is now called quahawg. The blue part of the shell seems to
have been broken off, drilled, ground to a round, smooth surface, and polished. It
appears that the white parts of the quahawg shell were in like manner made into
wampum. Morton’s Memorial, Appendix, p. 388.

105. Hutchinson, vol. i. p. 406.

106. The remark of Lord Bacon is applicable to the native tribes of our land.
“It is certain, that sedentary and within door arts, and delicate manufactures (that
require rather the finger than the arm) have in their nature a contrariety to a
warlike disposition; and generally all warlike people are a little idle, and love
danger better than travail.” Essay 29.

107. They supposed that their elysium was situated in the southwest, because
the wind from that quarter is always the attendant or precursor of fine weather. It
was not unnatural for an ignorant savage to imagine, that the balmy and delightful
breezes from the southwest were “airs from heaven.”

108. Key, ch. 21.

109. The Rev. John Eliot, called the Indian apostle, was settled as the teacher
of the church in Roxbury, in 1632. He learned the Indian language, and
commenced preaching to the natives. In 1651, an Indian town was built, on a
pleasant spot on Charles river, about 16 miles from Boston, and called Natick. A
house of worship was erected, and a church of converted Indians was formed, in
1660. In 1661, he published the New Testament, in the Indian language, and in a
few years after, the whole Bible, and several other books. His labors for the
welfare of the natives were very great, and his success was gratifying. In 1670,
there were between 60 and 70 praying communicants. The example of Eliot was
followed by others, especially by the Mayhews, who labored among the Indians on
Nantucket and Martha’s Vineyard. Many churches were formed in various places
besides Natick, schools established, books printed, and other efforts made for the
welfare of the natives. The aggregate number of praying Indians, in 1674, has
been estimated as follows:

In Massachusetts, principally under Mr. Eliot’s care, 1100

In Plymouth, under Mr. Bourne, 530
In Plymouth, under Mr. Cotton, 170
On the island of Nantucket, 300
On Martha’s Vineyard and Chappequiddick, under the Mayhews, 1500

3600

See Morton’s Memorial, note U, p. 407, and Qu. Register of the Am. Ed. Soc.
for Feb. 1832. Adams’ Bio. Dic. art. Eliot and Mayhew.

110. The illustrious Professors Adelung and Vater, and Baron Humboldt,
deserve a special mention. They are the authors of that astonishing work, the
Mithridates.

111. The Cherokee language exceeds even the Greek in its power to express,
by the inflection of a single word, delicate modifications of thought. An example is
given in the Appendix to the 6th volume of the Encyclopædia Americana. It is also
a specimen of the length to which the words in the Indian languages are often
extended. The word is, Winitaw´tigeginaliskawlungtanawneli´tisesti, which may be
rendered, “They will by that time have nearly done granting [favors] from a
distance to thee and to me.” This word is understood to be regularly inflected,
according to fixed rules. If so, the Cherokee language must have an arrangement
of modes, tenses and numbers, which few if any other languages on earth can
equal.

112. 2 His. Col. ix. 227.

113. The number assigned, in the same work, to Europe, is 587; to Africa,
276; to Asia, 987. Total, in the world, 3064.

114. 2 His. Col. ix. 233, 234.

115. Heckewelder and Edwards assert this fact.

116. Key, introduction.

117. Vattel’s Law of Nations, book i. sections 81 and 209.

118. “And God blessed them, and God said unto them, Be fruitful and multiply
and replenish the earth, and subdue it.” Genesis, i. 28.

119. The patents which they brought with them were, in theory, unjust; for
they implied, in terms, the absolute control of the English monarch over the ceded
territory, and contained no recognition of the rights of the natives. But the
Christian integrity of the Pilgrims corrected, in practice, the error or defect of the
patents. An able writer says: “It is beyond all question, that the early settlers at
Plymouth, at Saybrook, and, as a general rule, all along the Atlantic coast,
purchased the lands upon which they settled, and proceeded in their settlements
with the consent of the natives. Nineteen twentieths of the land in the Atlantic
States, and nearly all the land settled by the whites in the western States, came
into our possession as the result of amicable treaties.” “The settlers usually gave
as much for land as it was then worth, according to any fair and judicious
estimate. An Indian would sell a square mile of land for a blanket and a jack-knife;
and this would appear to many to be a fraudulent bargain. It would, however, by
no means deserve such an appellation. The knife alone would add more to the
comfort of an Indian, and more to his wealth, than forty square miles of land, in
the actual circumstances of the case.” See a very judicious article in the North
American Review, for October, 1830. We may add, that, at this day, a square mile
of land might be bought in some parts of the United States, for less than the first
settlers paid the Indians for their lands. Indeed, as the writer just quoted says,
“There are millions of acres of land in the Carolinas, which would not, at this
moment, be accepted as a gift, and yet much of this land will produce, with very
little labor, one hundred and fifty bushels of sweet potatoes to the acre.” Vattel
says, (book i. § 209) “We cannot help praising the moderation of the English
puritans, who first settled in New-England, who, notwithstanding their being
furnished with a charter from their sovereign, purchased of the Indians the land
they resolved to cultivate. This laudable example was followed by Mr. William
Penn, who planted the colony of Quakers in Pennsylvania.”

120. The consternation which the war with Black Hawk spread over the
western country the last year, may give some faint idea of the horrors of an Indian
warfare in the early days of the colonies.

121. See Opinion of the Supreme Court of the United States, at January term,
1832, in the Cherokee case.

122. There is a strange confusion in the statements of different authors

respecting the time of Mr. Williams’ banishment, and of the settlement of
Providence. The above date is unquestionably correct, for reasons which will
hereafter be presented.

123. Letter to Major Mason.

124. Letter of Roger Williams.

125. Letter to Major Mason.

126. Key, chap. ii.

127. The venerable Moses Brown assures me, that he has ascertained this
fact, to his own satisfaction.

128. William Harris, John Smith (miller), Joshua Verin, Thomas Angell and
Francis Wickes. R. I. Register, 1828, article written by Moses Brown.

129. Equivalent to the modern How do you do?

130. The lands adjacent to this spot were called Whatcheer, in memory of the
occurrence.

131. “Tradition has uniformly stated the place where they landed, to be at the
spring southwest of the Episcopal church, at which a house has recently been built
by Mr. Nehemiah Dodge.” Moses Brown.

132. Mrs. Hemans’ noble ode, “The Landing of the Pilgrim Fathers.” This
beautiful stanza applies with more literal truth to Roger Williams and his
companions, than to all the Pilgrim fathers.
 133. Published in the Providence Gazette, from January to March, 1765, and
republished in the 2 Mass. His. Col. ix.

134. Mass. Rec. vol. i. p. 163.

135. Backus, vol. i. 74.

136. The Plymouth settlers, in 1623, began to plant their corn the middle of
April. Prince, p. 216.

137. Winthrop, vol. i. p. 190.

138. In a letter to the author, from John Howland, Esq. of Providence, one of
the most intelligent and active members of the Rhode-Island Historical Society, he
says, “When our Society was first formed, it was proposed to fix on the day of his
arrival here, as the day of the annual meetings of the Society; and till that day
could be ascertained, we decided on the day of the date of the charter of Charles
II.”

139. Backus, vol. i. p. 89.

140. Rhode-Island Register, 1828.

141. “Under the general name of Narraganset, were included Narraganset

proper, and Coweset. Narraganset proper extended south from what is now called
Warwick to the ocean; Coweset, from Narraganset northerly to the Nipmuck
country, which now forms Oxford, (Mass.) and some other adjoining towns. The
western boundaries of Narraganset and Coweset cannot be definitely ascertained.
Gookin says, the Narraganset jurisdiction extended thirty or forty miles from
Seekonk river and Narraganset Bay, including the islands, southwesterly to a place
called Wekapage, four or five miles to the eastward of Pawcatuck river; that it
included a part of Long-Island, Block-Island, Coweset and Niantick, and received
tribute from some of the Nipmucks. After some research, I am induced to believe,
that the Nianticks occupied the territory now called Westerly. If so, then the
jurisdiction of the Narragansets extended to the Pawcatuck, and perhaps beyond
it.”—Whatcheer, Notes, p. 176.

142. This is transcribed from a copy furnished by John Howland, Esq. It

differs a little from that contained in Backus, vol. i. p. 89. The orthography is
conformed to modern usage.

143. “The great hill, Notaquoncanot, mentioned as a bound, is three miles

west from Weybosset bridge. Mashapaug is about two miles south of the hill.—J.
H.”
 144. Mr. Backus (vol. i. p. 90) has this reading: “He acknowledged this his act
and hand; up the streams,” &c. But the reading in the text is retained, according
to Mr. Howland’s copy. The deed was written by Roger Williams, but the
memorandum by some other person.

145. Backus, vol. i. p. 94.

146. Backus, vol. i. p. 290.

147. See above. He adds, “It hath been told me, that I labored for a licentious
and contentious people; that I have foolishly parted with town and colony
advantages, by which I might have preserved both town and colony in as good
order as any in the country about us.” The following letter from his son may be
properly quoted here, as confirming the preceding statements:
“To all them that deem themselves purchasers in the town of Providence, if
they be real purchasers, I would have them make it appear.
“Gentlemen,

“I thought good in short to present you with these few lines, concerning the
bounds of Providence, &c. I have put forth several queries to several men in the
township, to be answered; but have not any answer from any of them; and, as I
judge, doth not care to have any discourse about it. Therefore, now I speak to you
all, desiring your honors will be pleased to consider of the matter, and to answer
me to one or two queries; that is, whether you have any thing under my father’s
hand to prove the bounds of this town afore those twelve men were concerned; or
whether my father disposed of any of the township to any other persons since the
twelve men were first in power, &c. If my father had disposed or sold his whole
township, and they he sold it to, or have it under his hand, prove the sale,
although it was but for one penny, God forbid that ever I should open my mouth
about it, &c. It is evident, that this township was my father’s, and it is held in his
name against all unjust clamors, &c. Can you find such another now alive, or in
this age? He gave away his lands and other estate, to them that he thought were
most in want, until he gave away all, so that he had nothing to help himself, so
that he being not in a way to get for his supply, and being ancient, it must needs
pinch somewhere. I do not desire to say what I have done for both father and
mother. I judge they wanted nothing that was convenient for ancient people, &c.
What my father gave, I believe he had a good intent in it, and thought God would
provide for his family. He never gave me but about three acres of land, and but a
little afore he deceased. It looked hard, that out of so much at his disposing, that I
should have so little, and he so little. For the rest, &c. I did not think to be so
large; so referring your honors to those queries you have among you,
 “Your friend and neighbor,
“DANIEL WILLIAMS.

“Providence, Aug. 24, 1710.

“If a covetous man had that opportunity as he had, most of this town would
have been his tenants, I believe.
D. W.”

148. The first deed was “written in a strait of time and haste,” as he alleged,
and contained only the initials of the names of the grantees. He was censured for
this by some of them, as if he had done it for some sinister design! They urged
him to give them another deed, which he finally did, on the 22d of December,
1666, when the document in the text was written, retaining the original date.

149. The name, New Providence, appears in a few documents written by Mr.
Williams himself, and by others, but it was soon discontinued. The origin of the
epithet New may have been, a desire to distinguish the town from the island of
Providence, one of the Bahama islands, on which a plantation was begun in 1629.
Holmes’ Annals, vol. i. p. 201. This island has since received the name of New
Providence. The town of Roger Williams was entitled to the precedence.

150. Backus, vol. i. p. 92.

151. This seems to be loosely expressed. Mr. Williams could not mean that he
delivered the deed to the grantees in 1637, for several of the persons named, did
not arrive in Providence till after April, 1638. (Backus, vol. i. p. 92.) His own deed
of cession is dated Oct. 8, 1638. He probably meant, that he delivered the deed,
signed by the sachems in 1637, to the purchasers. This deed was dated March 24,
the last day of 1637, old style.

152. An anchor, reclining.

153. We are surprised at the form of this signature. That Mrs. Williams could
not write, would be incredible, if it were not rendered certain that she could write,
by a reference to her letters, in a public document at Providence. It is probable,
that she wrote the initials, believing them to be sufficient; and some person added
the words, the mark of, and wrote the name at length.

154. Mr. Backus so understood it. Vol. i. p. 93.

155. He found “Indian gifts” very costly. He was under the necessity of
making frequent presents. He says, that he let the Indians have his shallop and
pinnace at command, transporting fifty at a time, and lodging fifty at his house;
that he never denied them any thing lawful; that when he established a trading
house at Narraganset, Canonicus had freely what he desired; and when the old
chief was about to die, he sent for Mr. Williams, and “desired to be buried in my
cloth, of free gift.”

156. Throckmorton, Olney and Westcott, three of the first proprietors, were
members of the Salem church. Hutchinson, vol. i. p. 371.

157. Hubbard repeatedly alludes, in a somewhat taunting tone, to the poverty

of Roger Williams.—pp. 205, 350.

158. The author of Whatcheer, (p. 163) has accommodated his hero with the
dwelling of a deceased Indian powaw. Poets have a license to build castles in the
air, or on the land. I fear that Roger Williams was not so easily furnished with a
habitation. It was, however, we may suppose, sufficiently humble.

159. Among these, were Chad Brown, William Field, Thomas Harris, William
Wickenden, Robert Williams (brother of Roger), Richard Scott, William Reynolds,
John Warner, Benedict Arnold, Joshua Winsor and Thomas Hopkins. Backus, vol. i.
p. 93.

160. Gov. Hopkins, History of Providence, 2 Mass. His. Col. ix. p. 183.

161. Vol. i. p. 293.

162. John Howland, Esq. in a letter to the author.

163. Moses Brown says (Rhode-Island Register, 1828) “Roger Williams’ lot
was No. 38, northward from Mile End Cove, at the south end of the town; William
Harris’ was No. 36; John Smith’s, No. 41; Joshua Verins’, No. 39, adjoining on the
north of Roger Williams’ lot; Francis Wickes’, No. 35. The Court House appears to
be standing on No. 34. These first six settlers all became proprietors, though
Francis Wickes and Thomas Angell did not receive full shares till they became of
age.”

164. Copied from 3 His. Col. i. 165.

165. Journal, vol. ii. p. 360.

166. Winthrop, vol. i. 147, 149. The Pequods agreed to deliver up the
individuals who were engaged in the murder, and to pay four hundred fathoms of
wampumpeag, forty beaver skins, and thirty otter skins. While the Pequod
ambassadors were at Boston, a party of the Narragansets came as far as
Naponset, and it was rumored that their object was to murder the Pequod
ambassadors. The magistrates had a conference at Roxbury, with the
Narragansets, (among whom were two sachems) and persuaded them to make
peace with the Pequods, to which the sachems agreed, the magistrates having
secretly promised them, as a condition, a part of the wampumpeag, which the
Pequods had stipulated to pay. The note of Mr. Savage, on this affair, deserves to
be repeated:
“If any doubt has ever been entertained, in Europe or America, of the
equitable and pacific principles of the founders of New-England, in their relations
with the Indians, the secret history, in the foregoing paragraph, of this negotiation,
should dissipate it. By the unholy maxims of vulgar policy, the discord of these
unfriendly nations would have been encouraged, and our European fathers should
have employed the passions of the aborigines for their mutual destruction. On the
contrary, an honest artifice was resorted to for their reconciliation, and the tribute
received by us from one offending party was, by a Christian deception, divided
with their enemies, to procure mutual peace. Such mediation is more useful than
victory, and more honorable than conquest.”
It may be added, here, as an illustration of the temper of the times, that Mr.
Eliot, the Indian apostle, expressed, in a sermon, some disapprobation of this
treaty with the Pequods, for this reason, among others, that the magistrates and
ministers acted without authority from the people. He was called to account, and
Mr. Cotton and two other ministers were appointed to convince him of his error.
The good man appeared to be convinced, and agreed to make a public retraction.
It is stated by Dr. Bentley, that Mr. Williams, then at Salem, expressed his
disapprobation of the treaty, doubtless on the same ground, of the combination of
civil and clerical agency in the transaction. But Mr. Williams would not retract, after
the example of Eliot.

167. Winthrop, vol. i. p. 192.

168. Winthrop, vol. i. p. 199. Hutchinson, vol. i. p. 61. The last article of the
treaty provided, that it should continue to the posterity of both parties. Our fathers
thus treated with the Indians as independent tribes. They did not then dream of
the doctrine, that the Indians are mere tenants of the soil, and are under the
jurisdiction of the whites.

169. 3 His. Col. i. p. 159.

170. Letter to Major Mason.

171. The principal force from Massachusetts, under General Stoughton, did
not arrive till some time after the action. The Plymouth troops did not march,
though fifty men were got in readiness, but not till the war was nearly finished.
The friendly Indians did very little service, except to intercept some fugitives. The
battle was fought by the whites.

172. “It was judged,” says Dr. Holmes, (Annals, vol. i. p. 241) “that, during
the summer, seven hundred Pequods were destroyed, among whom were thirteen
sachems. About two hundred, besides women and children, survived the swamp
fight. Of this number, the English gave eighty to Miantinomo, and twenty to
Ninigret, two sachems of Narraganset, and the other hundred to Uncas, sachem of
the Mohegans, to be received and treated as their men. A number of the male
children were sent to Bermuda. However just the occasion of this war, humanity
demands a tear on the extinction of a valiant tribe, which preferred death to what
it might naturally anticipate from the progress of English settlements—
dependence, or extirpation.

‘Indulge, my native land! indulge the tear,

That steals, impassion’d, o’er a nation’s doom;
To me each twig from Adam’s stock, is dear,
And sorrows fell upon an Indian’s tomb.’”
Dwight’s Greenfield Hill.

173. Backus, vol. i. p. 95. None might have a voice in government in this new
plantation, who would not allow this liberty. Hence, about this time, I found the
following town act, viz. “It was agreed, that Joshua Verin, upon breach of
covenant, for restraining liberty of conscience, shall be withheld from liberty of
voting, till he shall declare the contrary.” Verin left the town, and his absence
seems to have been considered as a forfeiture of his land, for in 1650, he wrote
the following letter to the town, claiming his property. The town replied, that if he
would come and prove his title, he should receive the land.
“Gentlemen and countrymen of the town of Providence:
“This is to certify you, that I look upon my purchase of the town of Providence
to be my lawful right. In my travel, I have inquired, and do find it is recoverable
according to law; for my coming away could not disinherit me. Some of you
cannot but recollect, that we six which came first should have the first
convenience, as it was put in practice by our house lots, and 2d by the meadow in
Wanasquatucket river, and then those that were admitted by us unto the purchase
to have the next which were about; but it is contrary to law, reason and equity, for
to dispose of my part without my consent. Therefore deal not worse with me than
we dealt with the Indians, for we made conscience of purchasing of it of them,
and hazarded our lives. Therefore we need not, nor any one of us ought to be
denied of our purchase. So hoping you will take it into serious consideration, and
to give me reasonable satisfaction, I rest,
 “Yours in the way of right and equity,
“JOSHUA VERIN.

“From Salem, the 21st Nov. 1650.

“This be delivered to the deputies of the town of Providence, to be presented
to the whole town.”
Winthrop’s account of this affair (vol. i. p. 282) under the date of December
13, 1638, is a good specimen of the manner in which that great and good man
was biased by his feelings, when he spoke of Rhode-Island. The account must
have been founded on reports, perhaps on mere gossip:
“At Providence, also, the devil was not idle. For whereas, at their first coming
thither, Mr. Williams and the rest did make an order, that no man should be
molested for his conscience, now men’s wives, and children, and servants, claimed
liberty hereby to go to all religious meetings, though never so often, or though
private, upon the week days; and because one Verin refused to let his wife go to
Mr. Williams so oft as she was called for, they required to have him censured. But
there stood up one Arnold, a witty man of their own company, and withstood it,
telling them, that when he consented to that order, he never intended it should
extend to the breach of any ordinance of God, such as the subjection of wives to
their husbands, &c. and gave divers solid reasons against it. Then one Greene,
(who hath married the wife of one Beggerly, whose husband is living, and no
divorce, &c. but only, it was said, that he had lived in adultery and had confessed
it,) he replied, that if they should restrain their wives, &c. all the women in the
country would cry out of them, &c. Arnold answered him thus: Did you pretend to
leave Massachusetts because you would not offend God to please men, and would
you now break an ordinance and commandment of God, to please women? Some
were of opinion, that if Verin would not suffer his wife to have her liberty, the
church should dispose her to some other man who would use her better. Arnold
told them, it was not the woman’s desire, to go so oft from home, but only Mr.
Williams’ and others. In conclusion, when they would have censured Verin, Arnold
told them, that it was against their own order, for Verin did that he did out of
conscience; and their order was, that no man should be censured for his
conscience.”

174. “Every man and woman, who had brains enough to form some imperfect
conception of them, inferred and maintained some other point, such as these: a
man is justified before he believes; faith is no cause of justification; and if faith be
before justification, it is only passive faith, an empty vessel, &c. and assurance is
by immediate revelation only. The fear of God and love of our neighbor seemed to
be laid by, and out of the question.” Hutchinson, vol. i. p. 59.
 175. One of these decisions of the synod will be approved by the good sense
of Christians in this age. “That though women might meet (some few together) to
pray and edify one another, yet such a set assembly, (as was then in practice in
Boston) where sixty or more did meet every week, and one woman (in a
prophetical way, by resolving questions of doctrine and expounding Scripture) took
upon her the whole exercise, was agreed to be disorderly, and without rule.”
Winthrop, vol. i. p. 240.

176. Backus, vol. i. 86.

177. Vol. i. p. 247.

178. This word is spelled by different writers, in various ways. The island was
afterwards (in 1644, according to Callender,) called the Isle of Rhodes, and by an
easy declension, Rhode-Island. (Holmes, vol. i. p. 246.) In a letter of Roger
Williams, already quoted, written before May, 1637, the name Rode-Island is
applied to it. The reason does not appear. A fancied resemblance to the Isle of
Rhodes is supposed to have been the origin.

179. This deed is as follows: (Backus, vol. i. pp. 180–1.)

“The 24th of the first month, called March, in the year (so commonly called)
1637–8, Memorandum, that we, Canonicus and Miantinomo, the two chief
sachems of the Narraganset, by virtue of our general command of this bay, as also
the particular subjecting of the dead sachems of Aquetneck and Kitackamuckqut,
themselves and lands unto us, have sold to Mr. Coddington and his friends united
unto him, the great island of Aquetneck, lying hence eastward in this bay, as also
the marsh or grass upon Canonicut, and the rest of the islands in this bay
(excepting Chibachuwesa [Prudence] formerly sold to Mr. Winthrop, the now
Governor of the Massachusetts, and Mr. Williams, of Providence) also the grass
upon the rivers and bounds about Kitackamackqut, and from thence to
Paupusquatch, for the full payment of forty fathoms of white beads, to be equally
divided between us; in witness whereof, we have here subscribed. Item, that by
giving, by Miantinomo’s hands, ten coats and twenty hoes to the present
inhabitants, they shall remove themselves from off the island before next winter.
“Witness our hands,
“The mark (†) of CANONICUS.
“The mark (‡) of MIANTINOMO.
“In presence of

“The mark (X) of Yotaash,

“Roger Williams,
“Randall Holden,

“The mark (‡) of Assotemuit,

“The mark (∥) of Mihammoh, Canonicus his son.

“Memorandum, that Ousamequin freely consents, that Mr. William Coddington

and his friends united unto him, shall make use of any grass or trees on the main
land on Pawakasick side, and all my men, to the said Mr. Coddington, and English,
his friends united to him, having received of Mr. Coddington five fathoms of
wampum, as gratuity for himself and the rest.
“The mark (X) of OUSAMEQUIN.

Witness, { Roger Williams,

{ Randall Holden.

“Dated the 6th of the fifth month, 1638.”

180. Mr. Callender says, (His. Dis. p. 32,) “The English inhabited between two
powerful nations, the Wampancags to the north and east, who had formerly
possessed some part of their grants, before they had surrendered it to the
Narragansets, and though they freely owned the submission, yet it was thought
best by Mr. Williams to make them easy by gratuities to the sachem, his
counsellors and followers. On the other side, the Narragansets were very
numerous, and the natives inhabiting any spot the English sat down upon, or
improved, were all to be bought off to their content, and oftentimes were to be
paid over and over again.”

181. Messrs. Nicholas Easton, John Coggeshall and William Brenton.

182. Holmes, vol. i. p. 246.

183. “While the General Court sat, there came a letter directed to the Court
from John Greene, of Providence, who, not long before, had been imprisoned and
fined for saying, that the magistrates had usurped upon the power of Christ in his
church, and had persecuted Mr. Williams and another, whom they had banished for
disturbing the peace, by divulging their opinions against the authority of the
magistrates, &c.; but upon his submission, &c. his fine was remitted; and now, by
his letter, he retracted his former submission, and charged the Court as he had
done before. Now, because the Court knew, that divers others of Providence were
of the same ill-affection to the Court, and were, probably, suspected to be
confederate in the same letter, the Court ordered, that if any of that plantation
were found within our jurisdiction, he should be brought before one of the
magistrates, and if he would not disclaim the charge in the said letter, he should
be sent home, and charged to come no more into this jurisdiction, upon pain of
imprisonment and further censure.” Winthrop, vol. i. p. 256.

184. Letter to Major Mason.

185. 3 His. Col. i. p. 166.

186. Winthrop, vol. i. p. 267. In the Journal, there are repeated allusions to
information received from Mr. Williams, respecting the Indians, and services
rendered by him. See vol. i. pp. 225, 226. &c.

187. 3 His. Col. i. p. 170–3.

188. 3 His. Col. i. 173–7. The letter was written about Sept. 1638.

189. righteousness?

190. .sp 1
“Nescia mens hominum fati sortisque futuræ.
Turno tempus erit, magno cum optaverit emptum
Intactum Pallanta.” Æneis, x. 501–4.

191. Vol. i. p. 283, already quoted.

192. Governor Hopkins thinks, that there was a church formed on

Congregational principles, before Mr. Williams’ baptism.—History of Providence, in
2 Mass. His. Col. ix. p. 196. This is not probable, for nothing is said by the writers
in Massachusetts, of such a church, and the members of the church in Salem, who
removed to Providence, were not excluded from that church, till after their
baptism. Hutchinson, vol. i. p. 371.

193. The first church in Boston, several of whose members were wealthy,
existed two years before they began to build a meeting-house. Winthrop, vol. i. p.
87.

194. Morton’s Memorial, p. 151.

195. Peirce’s History of Harvard University, pp. 10, 18.

 196. Dr. Woods, on Infant Baptism, Lecture I.—He adds, “the proof then, that
infant baptism is a divine institution, must be made out in another way.”

197. Winthrop, vol. i. p. 293. Under date of March, 1638–9, he says: “At
Providence, things grew still worse; for a sister of Mrs. Hutchinson, the wife of one
Scott, being infected with anabaptistry, and going last year to live at Providence,
Mr. Williams was taken (or rather emboldened) by her to make open profession
thereof, and accordingly was re-baptized by one Holliman, a poor man, late of
Salem. Then Mr. Williams re-baptized him and some ten more. They also denied
the baptizing of infants, and would have no magistrates.”

198. Governor Winthrop (vol. i. p. 293) calls Mr. Holliman “a poor man,” which
Hubbard, (338) in copying, alters to a “mean fellow.” But Mr. Benedict says, that
he was a man of “gifts and piety,” and that he was chosen an assistant to Mr.
Williams. Backus says, “after the year 1650, I find him more than once a Deputy
from the town of Warwick in the General Court.”—Vol. i. p. 106.

199. The first twelve members are named by Benedict, (vol. i. p. 473.) Roger
Williams, Ezekiel Holliman, William Arnold, William Harris, Stukely Westcott, John
Green, Richard Waterman, Thomas James, Robert Cole, William Carpenter, Francis
Weston, and Thomas Olney.

200. Backus, vol. i. 106, note. “There had been many of them [Baptists]
intermixed with other societies from their first coming out of Popery; but their first
distinct church in our nation was formed out of the Independent Church in
London, whereof Mr. Henry Jacob was pastor, from 1616 to 1624, when he went to
Virginia, and Mr. John Lathrop was chosen in his room. But nine years after,
several persons in the society, finding that the congregation kept not to their first
principles of separation, and being also convinced, that baptism was not to be
administered to infants, but such only as professed faith in Christ, desired and
obtained liberty, and formed themselves into a distinct church, Sept. 12, 1633,
having Mr. John Spisbury for their minister.”—Crosby, vol. i. pp. 148, 149. In the
year 1639, another Baptist church was formed in London, but probably not so
early as the church at Providence.

201. Mosheim, b. 1, c. 1, p. 2, ch. 4, s. 8. See Campbell’s Lectures on

Ecclesiastical History, lecture iv. for proof, that laymen, in the early times of the
Christian era, often baptized. He quotes Hilary, who, in his Exposition of the Epistle
to the Ephesians, 4: 11, 12, says, “Postquam omnibus locis ecclesiæ sunt
constitutæ, et officia ordinata, aliter composita res est, quam cœperat; primum
enim omnes docebant, et omnes baptizabant, quibuscunque diebus vel temporibus
fuisset occasio.” That is, when churches were every where constituted, and official
duties prescribed, things were otherwise regulated, than at first, when all taught,
and all baptized, whenever occasion required.
 202. Lib. de baptismo, cap. xvii. Laicis etiam jus est (baptizandi.) Sufficiat in
necessitatibus utaris, sicubi aut loci, aut temporis, aut personæ conditio compellit.

203. S. Ambrosius in Eph. iv.

204. S. Augustinus contra Padmenian, lib. ii. cap. xiii.

205. Hieronymus, adv. Lucifexianas, cap. v.—See Potter on Church

Government, p. 231, &c. Phil. ed. for other authorities.

206. Concil, Elib. Can. xxxviii.—Peregre navigantes, aut si Ecclesia in proximo

non fuerit, posse fidelem, qui lavacrum suum integrum habet, nec sit bigamus,
baptizare in necessitate, ita ut, si supervixerit, ad Episcopum suum perducat, ut
per manus impositionem perfici possit.—Quoted by Potter, p. 232.

207. Mr. Holliman, who baptized Mr. Williams, became a preacher.

208. Neal, vol. iii. p. 233.

209. The excellent John Robinson, the father of the Plymouth colony, had a
controversy with the Rev. Mr. Bernard, an Episcopal minister. Mr. Robinson wrote a
book, entitled “A Justification of Separation from the Church of England.”—In this
book, he uses the same argument as that in the text: “Zanchy, upon the fifth to
the Ephesians, treating of baptism, propounds a question of a Turk, coming to the
knowledge of Christ and to faith by reading the New Testament, and withal
teaching his family and converting it and others to Christ, and being in a country
whence he cannot easily come to Christian countries, whether he may baptize
them, whom he hath converted to Christ, he himself being unbaptized? He
answers, I doubt not of it, but that he may, and withal provide that he himself be
baptized of one of the three converted by him. The reason he gives is, because he
is a minister of the word, extraordinarily stirred up by Christ; and so as such a
minister may, with the consent of that small church, appoint one of the
communicants, and provide that he be baptized by him.” Backus, vol. i. p. 106.

210. The question, which has been asked, with some emphasis, as if it vitally
affected the Baptist churches in this country: “By whom was Roger Williams
baptized?” has no practical importance. All whom he immersed were, as
Pedobaptists must admit, baptized. The great family of Baptists in this country did
not spring from the First Church in Providence. Many Baptist ministers and
members came, at an early period, from Europe, and thus churches were formed
in different parts of the country, which have since multiplied over the land. The
first Baptist church formed in the present State of Massachusetts, is the church at
Swansea. Its origin is dated in 1663, when the Rev. John Miles came from Wales,
with a number of the members of a Baptist church, who brought with them its
records. It was, in fact, an emigration of a church. Of the 400,000 Baptist
communicants now in the United States, a small fraction only have had any
connection, either immediate or remote, with the venerable church at Providence,
though her members are numerous, and she has been honored as the mother of
many ministers. The question, discussed in the preceding pages, disturbed, for a
while, the first English Baptists. They had no clerical administrator, who had
himself, in their view, been baptized. Some of them went to Holland, and were
baptized by Baptist ministers there. “But,” says Crosby, (vol. i. p. 103,) “the
greatest number of the English Baptists, and the more judicious, looked upon all
this as needless trouble, and what proceeded from the old Popish doctrine of right
to administer sacraments by an uninterrupted succession, which neither the
Church of Rome, nor the Church of England, much less the modern dissenters,
could prove to be with them. They affirmed, therefore, and practised accordingly,
that after a general corruption of baptism, an unbaptized person might
warrantably baptize, and so begin a reformation.” These examples, however,
cannot justify a departure from the usual practice of our churches at the present
day, when the ministry is regularly established.

211. Vol. i. p. 450.

212. New-England Firebrand Quenched. 2d part, p. 247.

213. Benedict, vol. i. p. 477.

214. John Howland, Esq., in a letter to the author, says: “The college was built
in 1770. On the question among the founders of it, on what lot to place the
building, they decided on the present site of the old college, because it was the
home lot of Chad Brown, the first minister of the Baptist church. Other land could
have been obtained, but the reason given prevailed in fixing the site. Had the
impression been prevalent, that Roger Williams was the first minister or principal
founder of the society, his home lot could have been purchased, which was a
situation fully as eligible for the purpose. If any doubts rested in the minds of the
gentlemen at that time, as to the validity of the claim of Chad Brown to this
preference, perhaps the circumstance of Mr. Williams’ deserting the order, and
protesting against it, might have produced the determination in favor of Brown.”

215. This house was built on the west side of North Main street, near its
junction with Smith street, and a short distance north of Roger Williams’ spring. It
was probably a small and rather rude building. Tradition states, that it was “in the
shape of a hay cap, with a fireplace in the middle, the smoke escaping from a hole
in the roof.” It was taken down, and a larger building erected in 1718. In 1774–5,
the spacious and elegant house now occupied by the First Baptist Church, was
erected.
 216. Magnalia, b. vii. sec. 7. Gov. Hopkins, (a member of the Society of
Friends) says, in his history of Providence, written in 1765, “This church hath, from
its beginning, kept itself in repute, and maintained its discipline, so as to avoid
scandal or schism, to this day. It hath always been, and still is, a numerous
congregation, and in which I have with pleasure observed, very lately, sundry
descendants from each of the founders of the colony, except Holliman.” 2 His. Col.
ix. 197.

217. The letter, announcing their exclusion, to the church at Dorchester, may
properly be quoted here, as an illustration of the customs of those times:
“Salem, 1st 5th mo. 39.

“Reverend and dearly beloved in the Lord,

“We thought it our bounden duty to acquaint you with the names of such
persons as have had the great censure passed upon them in this our church, with
the reasons thereof, beseeching you in the Lord, not only to read their names in
public to yours, but also to give us the like notice of any dealt with in like manner
by you, that so we may walk towards them accordingly; for some of us, here, have
had communion ignorantly with some of other churches. 2 Thess. iii. 14. We can
do no less than have such noted as disobey the truth.
“Roger Williams and his wife, John Throgmorton and his wife, Thomas Olney and
his wife, Stukely Westcott and his wife, Mary Holliman, Widow Reeves.
“These wholly refused to hear the church, denying it, and all the churches in
the Bay, to be true churches, and (except two) are all re-baptized.
“John Elford, for obstinacy, after divers sins he stood guilty of, and proved by
witness. William James, for pride, and divers other evils, in which he remained
obstinate. John Tabby, for much pride, and unnaturalness to his wife, who was
lately executed for murdering her child. William Walcot, for refusing to bring his
children to the ordinance, neglecting willingly family duties, &c.
“Thus, wishing the continued enjoyment of both the staves, beauty and
bands, and that your souls may flourish as watered gardens, rest,
“Yours in the Lord Jesus,
“HUGH PETERS,
“By the Church’s order, and in their name.

“For the Church of Christ in Dorchester.”

218. Winthrop, vol. i. p. 297. Mr. Savage remarks, in a note: “Those members
of Boston church, who had been driven by intolerance to the new region, if they
gathered a church at all, must do it in a disordered way, for they might well
apprehend, that an application for dismission would be rejected, and perhaps
punished by excommunication.”

219. Horace (Ep. lib. ii. Ep. i. 244) has a pungent sarcasm, ending thus:

“Bœotum in crasso jurares aera natum.”

220. John, i. 46.

221. Vol. ii. p. 8.

222. Williams’ Key, p. 22, Providence ed.

223. See Appendix D.

224. See R. I. State Papers, 2 Mass. His. Col. viii. p. 78.

225. Hutchinson, vol. i. p. 113. Allen’s Bio. Dic. article Gorton.

226. Hutchinson, vol. i. p. 113. Winthrop, vol. ii. p. 59. Lechford, an author
quoted by Mr. Savage, in a note, says: “There (Newport) lately they whipped Mr.
Gorton, a grave man, for denying their power, and abusing some of their
magistrates with uncivil terms, the Governor, Master Coddington, saying in Court,
You that are for the King, lay hold on Gorton, and he, again, on the other side,
called forth, All you that are for the King, lay hold on Coddington; whereupon
Gorton was banished the island; so, with his wife, he went to Providence. They
began about a small trespass of swine, but it is thought some other matter was
ingredient.” Lechford’s tract, called Plain Dealing, or News from New-England, is
published in the Mass. His. Col. 3d series, 3d vol. Lechford’s preface is dated
January 17, 1641, after his return from America. He says that there were two
hundred families on Rhode-Island. This must be a mistake.

227. Reply to Mr. Cotton, p. 113.

228. In 3 Mass. His. Col. vol. i. p. 2. is their letter, signed by William Field,
William Harris, William Carpenter, William Wickenden, William Reinolds, Thomas
Harris, Thomas Hopkins, Hugh Bewitt, Joshua Winsor, Benedict Arnold, William
Man, William W. Hunkinges, and Robert R. West. The letter was written by
Benedict Arnold. Roger Williams, also, wrote a letter to the government of
Massachusetts, in which he said, “Mr. Gorton, having foully abused high and low,
at Aquetneck, is now bewitching and bemadding poor Providence.” General Court’s
Vindication, May 30, 1665. It has been said, that Mr. Williams requested the
government of Massachusetts to interfere; but we have seen no evidence of this,
and it is in itself highly improbable. The utmost which we can suppose him to ask,
in such a case, would be temporary aid in suppressing a tumult. We may be sure
that he would oppose the usurpation of jurisdiction by Massachusetts. His letters
show that he disapproved it.

229. Vol. ii. p. 59.

230. Winthrop introduces this account, by the remark, that “those of

Providence, being all anabaptists, were divided in judgment; some were only
against baptizing of infants, others denied all magistracy and churches, &c. of
which Gorton, who had lately been whipped at Aquetneck, [Newport] was their
instructer and captain.” This observation is worthy of notice, as it shows how
loosely this fearful word anabaptist was applied, and as it discriminates between
those who merely rejected the baptism of infants, and those who denied all
magistracy and churches. It is certain, that all the inhabitants were not Baptists;
and it is doubtful whether the allegation against Mr. Gorton, that he was opposed
either to churches or magistracy, could be sustained. A letter from the Hon.
Samuel Eddy, inserted in a note to Winthrop’s Journal, vol. ii. p. 58, after
mentioning that Gorton was in office almost constantly, after the establishment of
a government, says: “It would be a remarkable fact, that a man should be an
enemy to magistracy, to religion, in short, a bad man, and yet constantly enjoy the
confidence of his fellow townsmen, and receive from them the highest honors in
their gift.”

231. Hutchinson, vol. i. p. 113.

232. Backus, vol. i. p. 120. These persons were Samuel Gorton, Randal
Holden, Robert Potter, John Wickes, John Warner, Richard Waterman, William
Woodale, John Greene, Francis Weston, Richard Carder, Nicholas Power, and
Sampson Shatton.

233. This sum, at 5s. 8d. per fathom, was 40l. 10s. The deed was dated
January 12, 1642–3. Backus, vol. i. p. 120.

234. Miantinomo was summoned to Boston, where he asserted his claim, but
his arguments were not satisfactory to the Court. It was not convenient to admit
his pretensions; and the Court were, we may suppose, scrupulous in examining his
proofs.

235. “Gorton,” says Hutchinson, (vol. i. p. 117) “published an account of his

sufferings. Mr. Winslow, the agent for Massachusetts, answered him. In 1665, he
preferred his petition to the commissioners sent over by King Charles the Second,
for recompense for the wrongs done him by Massachusetts, alleging, that besides
his other sufferings, he and his friends had eighty head of cattle taken and sold.
Massachusetts, in their answer, charge him with heretical tenets, both in religion
and civil government, and with an unjust possession of the Indian lands in the
vicinity of the colonies, for the sake of disturbing their peace; and add, that the
goods which they seized did not amount to the charge of their prosecution; but
they do not sufficiently vindicate their seizing their persons or goods, without the
limits of their jurisdiction, and conclude with hoping that his Majesty will excuse
any circumstantial error in their proceedings.” In the appendix of Hutchinson’s first
volume, is a Defence by Gorton, dated Warwick, June 30, 1669, and addressed to
Nathaniel Morton, in which the charges in the Memorial are discussed with an
ability, which shows that Gorton could write, when he chose, clearly and forcibly.

236. Winthrop, vol. ii. p. 58, note.

237. A gentleman of Providence, William R. Staples, Esq. has been engaged,

for some time, in preparing a revised edition of Gorton’s work, entitled “Simplicity’s
Defence against Seven Headed Policy,” with extensive notes and appendices. This
book, it is hoped, will soon be published, and will furnish the means of forming a
correct opinion concerning Gorton, and the transactions in which he was a party
and a sufferer.

238. Winthrop, vol. ii. p. 101.

239. Mr. Williams was absent, having sailed for England in June or July
preceding. Had he been in the country, he would certainly have used his influence
in favor of Miantinomo.

240. Winthrop, vol. ii. p. 131.

241. Gov. Hopkins’ History of Providence, 2 His. Col. ix. 202. See note to
Winthrop, vol. ii. 133, where Mr. Savage says: “With profound regret, I am
compelled to express a suspicion, that means of sufficient influence would easily
have been found for the security of themselves, the pacifying of Uncas, and the
preservation of Miantinomo, had he not encouraged the sale of Shawomet and
Pawtuxet to Gorton and his heterodox associates.”

242. In his letter to Major Mason, Mr. Williams says: “Upon frequent
exceptions against Providence men, that we had no authority for civil government,
I went purposely to England, and, upon my report and petition, the Parliament
granted us a charter of government for these parts, so judged vacant on all hands.
And upon this, the country about was more friendly, and wrote to us, and treated
us as an authorized colony, only the differences of our consciences much
obstructed.”
 243. Backus, vol. i. p. 148. Winthrop places Lady Moody’s removal from Salem
after Mr. Williams’ mediation with the Long-Island Indians. He speaks respectfully
of her character before her lapse into the heresy of denying infant baptism: “The
Lady Moody, a wise and anciently religious woman, being taken with the error of
denying baptism to infants, was dealt withal by many of the elders and others,
and admonished by the church of Salem, (whereof she was a member) but
persisting still, and to avoid further trouble, she removed to the Dutch, against the
advice of all her friends. Many others, infected with anabaptism, removed thither
also. She was after excommunicated.” Winthrop, vol. ii. pp. 123–4.

244. Key, p. 17.

245. Byron’s Giaour.

246. Holmes’ Annals, vol, i. p. 273.

247. For a copy of the charter, see Appendix E.

248. The Westminster Assembly of Divines, who were then in session, might
have learned from this book, if they had read it, lessons which they greatly
needed.

249. Bloody Tenet, p. 64.

250. Massachusetts was the more disinclined to show favor to Mr. Williams
and his colony, because the Baptists began to multiply. A Baptist church was
formed about this time, in Newport, by Dr. John Clarke and a few others, and in
Massachusetts itself the new doctrine spread. The General Court was aroused,
therefore, to an effort to crush the growing sect; and no method seemed to
promise more success, than to wield against it a legislative denunciation, edged by
an appeal to the popular dread of anabaptism:

“Immortale odium, et nunquam sanabile vulnus.”

They accordingly passed the following act, in November, 1644:

“Forasmuch as experience hath plentifully and often proved, that since the
first rising of the Anabaptists, about one hundred years since, they have been the
incendiaries of the commonwealth, and the infectors of persons in main matters of
religion, and the troublers of churches in all places where they have been, and
that they who have held the baptizing of infants unlawful, have usually held other
errors or heresies therewith, though they have (as other heretics use to do)
concealed the same till they spied out a fit advantage and opportunity to vent
them, by way of question or scruple; and whereas divers of this kind have, since
our coming into New-England, appeared amongst ourselves, some whereof (as
others before them) denied the ordinance of magistracy, and the lawfulness of
making war, and others the lawfulness of magistrates, and their inspection into
any breach of the first table; which opinions, if they should be connived at by us,
are like to be increased amongst us, and so must necessarily bring guilt upon us,
infection and trouble to the churches, and hazard to the whole commonwealth; it
is ordered and agreed, that, if any person or persons, within this jurisdiction, shall
either openly condemn or oppose the baptizing of infants, or go about secretly to
seduce others from the approbation or use thereof, or shall purposely depart the
congregation at the ministration of the ordinance, or shall deny the ordinance of
magistracy, or their lawful right and authority to make war, or to punish the
outward breaches of the first table, and shall appear to the Court wilfully and
obstinately to continue therein, after due time and means of conviction, every
such person or persons shall be sentenced to banishment.” Backus, vol. i. p. 150.

251. This incident is related by Richard Scott, in his letter, inserted at the
close of the “New-England Firebrand Quenched.” Mr. Scott disliked Mr. Williams,
and his comment on the transaction referred to is an instance of the effect of a
man’s feelings on his judgment respecting the conduct of others. “The man,” he
says, “being hemmed in, in the middle of the canoes, was so elevated and
transported out of himself, that I was condemned in myself, that amongst the rest,
I had been an instrument to set him up in his pride and folly.”

252. From Massachusetts, 190; Plymouth, 40; Connecticut, 40; New-Haven,

30.

253. He was a brother of Miantinomo, and succeeded him.

254. The following note, in Hutchinson, vol. i. p. 134, may be properly quoted
here:
“Uncas, the sachem of the Mohegans, was hated and envied by the
Narragansets, for his attachment to the English, and the distinguishing favors
shown him in return. In 1638, having entertained some of the Pequods, after the
war with them, and fearing he had given offence, he came to the Governor at
Boston, and brought a present, which was at first refused, but afterwards, the
Governor being satisfied that he had no designs against the English, it was
accepted, and he promised to submit to such orders as he should receive from the
English, concerning the Pequods, and also concerning the Narragansets, and his
behavior towards them, and concluded his speech with these words: ‘This heart
(laying his hand upon his breast) is not mine, but yours. Command me any
difficult service, and I will do it; I have no men, but they are all yours. I will never
believe any Indian against the English any more.’ He was dismissed, with a
present, went home joyful, carrying a letter of protection for himself and men
through the English plantations, and never was engaged in hostilities against any
of the colonies, although he survived Philip’s war, and died a very old man, after
the year 1680.
“The Narragansets failed in the payment of the wampum, and in 1646,
messengers were sent to them from the commissioners, but Passacus, their chief
sachem, not attending, in 1647 the message was repeated, and he then pretended
sickness, and sent Ninigret, a sachem of the Nianticks, to act in his behalf, and
told the messenger, that it was true he had not kept his covenant, but added, that
he entered into it for fear of the army which he saw, and that he was told, that if
he did not set his hand to such and such things, the army should go against the
Narragansets. When Ninigret appeared, he asked how the Narragansets became
indebted to the English in so large a sum, and being told that it was for the
expense the Narragansets had put them to by their breach of covenant, he then
pleaded poverty, but the commissioners insisting on the demand, he sent some of
his people back to procure what he could, but brought two hundred fathoms only.
They gave him leave to go home, and allowed him further time. The whole was
not paid until 1650, when Capt. Atherton, with twenty men, was sent to demand
the arrears, which was then about three hundred fathoms. Passacus put him off
some time with dilatory answers, not suffering him to come into his presence. In
the mean while his people were gathering together, but the Captain, carrying his
twenty soldiers to the door of the wigwam, entered himself, with his pistol in his
hand, leaving his men without, and seizing Passacus by the hair of his head, drew
him from the midst of a great number of his attendants, threatening that if one of
them offered to stir, he would despatch him. Passacus presently paid down what
was demanded, and the English returned in safety. Ninigret, after this, began to
stir up new troubles from the Nianticks, but upon sending Capt. Davis, with a
troop of horse, into the Indian country, he was struck with a panic, and would not
be seen by the English until he had assurance of his life, and then he readily
complied with their demands, and they and the other Indians continued quiet
many years, until by familiar intercourse, and the use of fire-arms, they became
more emboldened, and engaged in the war in 1675, which issued in their total
destruction. Records of United Colonies.”
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookball.com