THE
ELEMENTS OF MEDICINE;
OR,
A TRANSLATION
OF THE
ELEMENTA MEDICINÆ BRUNONIS.
WITH LARGE
NOTES, ILLUSTRATIONS, AND COMMENTS.
BY THE AUTHOR OF THE ORIGINAL WORK.
TWO VOLUMES IN ONE.
VOL I.
PHILADELPHIA,
PRINTED BY THOMAS DOBSON,
AT THE STONE-HOUSE, N° 41, SOUTH SECOND-STREET.
M.DCC.XCV.



PREFACE
TO THE
ORIGINAL WORK.
BY the Author of this work more than twenty years
were wasted in learning, teaching, and diligently scruti-
nizing every part of medicine. The first five passed away in
hearing others, studying what he had heard, implicitly be-
lieving it, and entering upon the possession as a rich and va-
luable inheritance. His mode of employment the next five
years, was to explain more clearly the several particulars,
to refine and give them a nicer polish. During the next
equal space of time, because no part of it had succeeded to
his mind, he became cold upon the subject, and with ma-
ny eminent men, even with the vulgar themselves, to de-
plore the healing art as altogether uncertain and incompre-
hensible. All this time passed away without the acquisition of
any advantage, and of that, which of all things is the most
agreeable to the mind, the light of truth; and so great, so
precious, a portion of the fading and short-lived age of man
was lost. It was only betwixt the fifteenth and twentieth
year of his studies, that, like a traveller in an unknown
country, wandering in the shade of night, after losing eve-
ry trace of his road, a very obscure gleam of light, like
that of the first break of day, dawned upon him.
A2 Thirteen

iv PREFACE TO THE
Thirteen years ago (a), when he was going in the thirty
sixth year of his age, he fell into his first fit of the gout.
For many years before he had lived well, with the excep-
tion of having confined himself to a diet more sparing than
usual a few months before the arrival of the disease (b). In
about six weeks the disease finished its course, and did not
return till six years after, and not even then, but in conse-
quence of unusual low living for several months (d). He
was in the vigour of his age, and, excepting the taint of the
gout, and some debility, brought on by his unusual absti-
nence, his habit was good. The disease, according to an
old theory among physicians, was said to depend upon ple-
thora and excessive vigour; vegetable aliment was enjoin-
ed, wine was forbidden, and the careful execution of that
plan of cure was promised to be rewarded with no return of
the disease. A whole year past in a strict adherence to this
regimen. In the course of that space of time, instead of
never having a return of the disease, he experienced no less
than four fits, most violent, most painful, and of a very
great duration: In short, the whole year, except fourteen
days, was divided between limping and excruciating pain.
If an over-proportion of blood and excess of vigour was
the cause of the disease, according to the general theory just
now mentioned, it became next with him a subject of enquiry,
how such distressing symptoms were to be explained; his
reflections were, why the disease had not made its first ap-
pearance
(a) Four years must be added now, it being that time since the second
volume of the Elementa was published, that is, seventeen years since the
author's first fit of the gout. At this very time from hard walking in
very hot weather, to inspect the beauties and majesty of Hampton-Court
he had a slight attack, which gave him no sort of trouble, never hinder-
ed him from business, and which he repelled in less than thirty-six
hours.
(b) It was about six months. 
(d) Between five and six. 


v ORIGINAL WORK.
pearance twelve or fifteen years before, at a time when there
was in reality more blood and vigour in the system (e), and
why it only came on after an abatement of diet both consi-
derable in degree and duration; why so great an interval
of time, during which he had returned to his usual full di-
et, had intervened betwixt the first fit and these recent ones;
and, why the disease had twice, almost instantaneously,
come on after the change of full nourishing diet into a spa-
ring one. At last the solution of this question was made
out by the interposition of one of greater magnitude, in the
following interrogatories: What is the effect of food, drink,
and similar supports of life? They produce strength.
What is their effect afterwards? Always less and less.
What is it towards the end of life? They are so far from
giving any more strength, that they evidently prove weak-
ening. Nay, the very same powers, by which life was at
first supported, at last put an end to it, commonly through
the intervention of disease.
As diseases first, and death after, in general happen in
the way that has been just now explained, not from want,
but an over-abundance of the supports of life, he found,
however, that the cause was debility, and saw that it was
not debilitating (f) but strengthening powers that were
to be thought upon as remedies. To this sort of debility
he thought proper to give the name of indirect. Such for
two
(e) The blood is made from the food, and is in proportion to the
quantity, quality, and completeness of its digestion. Now before each
of his last fits for the time specified in the text, as well as during the
whole course of the attacks of the second year, his food had been almost
solely vegetable, and, therefore, was not suited to produce enough, much
less an excessive quantity, of blood, and the digestion was also more
imperfect.
(f) according to the common practice of evacuation and starving.


vi PREFACE TO THE
two years was the success of his invigorating plan (g),
that at the end of that space of time he only underwent a
very slight fit, which did not amount to a fourth part of
any of the former ones (h). Now, no physician will deny,
that the recurrence of such a disease as the gout, which had
made four attacks in one year, would have been more fre-
quent than in that proportion the next two years, had the
same method of cure been continued; nor will any one
think the addition of two fits every year too much. The
mild fit was four times less in degree than the more violent
ones. Multiply, therefore, twelve by four, and, accord-
ing to that computation, the proportion of alleviation of
the disease will amount to a reduction of eight and forty to
one. As, during the first year, he had made use of vegetable
food alone, so, during these two years, his only food was
of the land animal kind, and of the most nutrient quality.
Of the latter, his choice was directed to the best in kind,
without any other precaution than being sparing in the quan-
tity he used (i). A young gentleman, who lived with him
and had laboured under a very severe asthma, in conse-
quence of submitting to the same treatment, suffered only
one fit at the end of the same two years, instead of experien-
cing one every day, as he had done upon the common treatment.
Afterwards to remove an opinion, that had been often
insisted on, of the gout not depending upon debility, be-
cause inflammation accompanied it; little doubting that
the
(g) which he immediately after the last mentioned reflections and
queries carried into execution;
(h) the fit that happened at the thirty-sixth year of his age, and the
four severe ones, that attacked him about six years after, all within the
course of the same year.
(i) He found most kinds of fish, whether from the sea or fresh-water,
nearly as debilitating as vegetable matter, when solely or chiefly relied
upon for a meal. 


vii ORIGINAL WORK.
the inflammation itself depended on debility, he subjected
the question to experiment. He invited some friends to
dinner, and by the use of certain stimulants used in their
presence (k), recovered the most perfect use of that foot,
with which, before dinner, he could not touch the floor
for pain. By this fact he saw, that not only the gout itself,
but the inflammation accompanying it, was asthenic (l).
And he found, afterwards, such inflammations affecting
the throat in the putrid, in the gangrenous sore throat,
and the joints in rheumatalgia, or that rheumatism which
depends upon debility, and is improperly denominated
chronic rheumatism (m), and supposed, if there be any
truth in that supposition to attack the brain in the end of
typhus, to be also asthenic.
As the gout affects the alimentary canal, and especially
the stomach, and proceeds in its course with distressing cir- 
cumstances similar to those that happen in dyspepsia (n);
being desirous to know if there was any affinity betwixt it
and them, he observed that they, as well as it, depended
on debility, and yielded to stimulant remedies. Nay, he
afterwards found for certain, that all the spasmodic, all
the convulsive, diseases of the same canal (o), and nearly
all the diseases of children, were of the same stamp.
Continuing his investigation of the same spasmodic and
convulsive diseases, when they occupy the organs of vo-
luntary motion; he discovered that their nature was al-
so
(k) These are mentioned in Dr. Jones's Enquiry.
(l) that is, depending on debility.
(m) The word rheumatism, as implying a similarity of the disease to
the true acute rheumatism, should be rejected, and this term, taken from
Sauvage, substituted in its place.
(n) or indigestion;
(o) or, first passages, comprehending the passage to the stomach, that
organ itself, and the intestines below it;


viii PREFACE TO THE
so the same in kind, but only greater in degree; as they
are exemplified in the spasms and pains, that occur in
various parts of the external surface of the body, and
in epilepsy (p), and in tetanus themselves. And by
that means he discerned, that a vast number of affections,
in which, upon the supposition of their being inflammatory,
no limits had been set to the use of the lancet, instead of ari-
sing from an over-proportion of blood and excessive vigour, or any
other such cause, depended upon an under-proportion of that
fluid, and other causes of debility, and were to be cured,
not by bleeding, nor any other evacuations (q), but by fill-
ing the vessels, and restoring the strength of the whole system.
At first, for the purpose of removing fits of the gout, he
went no farther than the use of wine, and other strong
drink of a similar operation, and nourishing food, that is
seasoned meat, and kept the use of the more powerful re-
medies in reserve. But, of late (r), his surprising success
in the use of the latter, has enabled him to find in opium,
and certain other stimuli, the secret of repelling the fits of
the gout as often as they returned, and at the same time,
re-establishing the sound healthy state, a secret that has hi-
therto been so much wanted and despaired of. This he
has often effected both in himself and in other persons.
It is now going the third year, and near the end of it (s),
since he has always been able to prevent all return of the
disease.
Taught by similar instances of actual practice, he found
for certain that bleeding discharges, which are called he-
morrhages, do not depend on plethora and vigour, but
upon penury of blood and debility arising from any other
source,
(p) or the falling sickness,
(q) such as vomiting, purging, sweating, blisterirg, glystering, &c.
(r) that is, now, for many years past.
(s) now the seventh, 


xi ORIGINAL WORK.
source, and therefore did he reject them from the number
of sthenic diseases (t) among which they had been arran-
ged in the first edition of the text book, reserving a place
for them among the asthenic diseases in the second volume
of that work. For he saw, that bleeding, various other
evacuations, abstinence, cold, and sedatives, as they are
called, proved hurtful; and that the stimulant plan of cure
alone, was salutary. Even wine and brandy, which had
been thought so hurtful in those diseases, he found the most
powerful of all other remedies in removing them. Upon
finding that a certain fact; he learned, that in all the dis-
eases, in which others had thought there was abundance
of blood, there was a deficiency of it, and that from the
defect of that and of other stimulants the real cause of the
diseases was debility; and stimulants, given in proportion
to the degree of the cause, the proper remedies.
In consequence of the light that thus beamed in from the
practice, he found, that the cause and cure of fevers, both
intermittent and continued, was the same as those already
mentioned.
Gradually led, as it were by the hand of nature, around
the whole circle of asthenic diseases (u) he thoroughly
perceived, that they all depended upon the same cause, that
is, debility, that they were all to be removed by the same
kind of remedies, to wit, stimulants (x), and that neither
their cause nor their cure differed but in degree.
With
(t) Sthenic diseases, as will be afterwards explained, are such as de-
pend upon an excessive application of the several powers that otherwise
produce health.
(u) diseases of debility.
(x) Wherever the word stimulant is used without a particular quali-
fication of its degree, the degree is understood to be greater than that
required in the healthy state, as will afterwards more fully be ex-
plained.


x PREFACE TO THE
With respect to sthenic diseases, the nature of either
the cause or cure of which nobody had observed; he had
long ago understood that inflammation in them, as well
as the other symptoms, were not, as had been universally
believed by Systematics, the cause, but the effect: and that
the inflammation arose from the cause, i. e. the diathesis
(y), and not even from it, unless very violent. In fine,
he experienced in his own person, that catarrh was not
produced by cold according to the common opinion, but
by heat, and the other known stimuli, and was removed
by cold and other debilitating powers. By which discove-
ry he was led to form a proper judgment of the catarrhal
symptoms in the measles: In which he found, that a very
great man who had improved the cure of sthenic diseases,
but never attained to any knowledge of the asthenic, had
been misled, by the alexipharmic physicians. And, as these
symptoms are the most dangerous part of the disease, he
was right in supposing, that the proper cure of them very
much interested that of the whole disease. The conse-
quence of which was that it came out a demonstrated fact,
that the refrigerating antiphlogistic plan of cure was of e-
qual service in the measles and small-pox.
In sthenic diseases he illustrated the cause, enlarged the
plan of cure, enriched the knowledge of both, explained
and reduced the whole to a certain principle; he distributed
all general diseases into two forms, a sthenic and an asthenic
one (z). He demonstrated that the former depended upon
excess, the latter upon deficiency of exciting power; that
the former were to be removed by debilitating, the latter
by stimulant, remedies; that the hurtful powers which
excited either were the remedies of the other, and the con-
trary;
(y) or habit.
(z) Sthenic signifies excess, asthenic a defect, of invigorating power.
 

xi ORIGINAL WORK. 
trary; and that they acted by the same operation with the
powers which produce the most perfect health, differing
from them only in degree. He extended the same doctrine
to plants. He laid down a principle which is illustrated and
confirmed by all the parts of the detail, and itself reflects
illustration and confirmation upon every one of them.
Lastly, he put the question, whether the medical art, hi-
therto conjectural, incoherent, and in the great body of it
false, was not at last, reduced to a demonstrated science,
which might be called the science of life (a).
(a) That question has been answered in the affirmative by every one
who had been at due pains to understand the doctrine.
PRE- 


 



PREFACE
TO
THE TRANSLATION.
A PRESSING, and very general, demand for an En-
glish translation of the Elementa Medicinæ, made seve-
ral years before the publication of the second edition of
that work, and successively repeated with an encreasing
importunity ever since; a desire of spreading the know-
ledge of a doctrine, which had exhibited so many indubi-
table proofs of its importance and utility to mankind: an
ambition, not quite extinguished by advancing years, do-
mestic cares, and a declining state of health, to get the
better of the keenest, and most universal persecution
that ever was raised against an useful and extensive disco-
very; the necessity for a translation in the present decaying
state of the knowledge of the Latin language; the dan-
ger of the doctrine coming before the public from adventu-
rers unequal to the talk; and some other circumstances,
partly of a private, partly of a domestic, nature, with
which it would be impertinent to trouble the reader; all
these at last prevailed with the author to submit, for once,
to a task, otherwise not desirable, that of translating his
own work. Such a talk seemed more naturally calcula-
ted to lay the foundation of the commencing same of an in-
genious pupil. But, as no one of many, whose literature
4 and

xiv PREFACE TO THE
and knowledge of the subject completely qualified them
for the undertaking, wished to supersede the occasion for
his engaging in it himself; and as the courage of several
persons of a different description keeped not peace with
their affectation or interestedness; it is to be hoped the
public will not be displeased to receive the work from the
author himself. This performance is intended for the use
of three sets of readers; those who do not readily enter
into a thought conveyed in pure Latin, and who, there-
fore, might wish to be possessed of a translation for the
sake of comparing it with the original, and, thereby, of
acquiring, renewing, or improving their knowledge of
the latter; those, who are only acquainted with such
Latin, as has prevailed in modern times; and, lastly,
those who either cannot, or will not be subjected to the
trouble of reading Latin at all, and who, surely, may
often be better employed.
Both this and the original work, are intended not for
the exclusive use of medical readers, but also for that
of the public at large, it being evident, that without
even the exception of the professional knowledge of each
individual, that of his own health is preferable to all
others. And such an acquisition becomes valuable in pro-
portion to its justness and solidity. The public are pre-
sented with a work, that claims the merit of having redu-
ced the doctrine and practice of medicine to scientific cer-
tainty and exactness. With respect to the form in which
it is delivered, it is stripped of that jargon of numerous,
unmeaning or misleading terms, and all that mystery ei-
ther in style or matter, that has hitherto rendered the pre-
tended healing art impenetrable to the most intelligent and
discerning, and locked it fast up in the schools. No
terms are admitted but the few that necessity imposed, and
these are every where defined. The style is simple, and
suited 


xv TRANSLATION. 
suited to the simplicity of the subject. In the language and
composition, as far as the thoughts, which are new
throughout, and that restraint, which is inseparable from
exactness of translation, permit, clearness is every where
preferred to elegance, and diffusion to brevity.
The author, in prefixing his name to both forms of his
work, has thrown the gauntlet to its numerous, but anony-
mous, opposers. They are, therefore, called upon, now
or never, to disprove it, and the judicious and candid
part of mankind to judge between the parties.
THE 



OBSERVATIONS
ON THE
CHARACTER AND WRITINGS
OF
JOHN BROWN, M. D.
VOL. I. C





OBSERVATIONS
ON THE
CHARACTER AND WRITINGS
OF
JOHN BROWN, M. D.
AT the time I undertook to superintend this
republication of the Brunonian System of Me-
dicine, I was pleased with the prospect of re-
cording the life of its extraordinary author. Of
the vicissitudes he experienced I had former-
ly heard enough to be persuaded that they would
furnish a narrative sufficiently amusing. I was,
moreover, aware of circumstances in his histo-
ry, which it would be impossible to relate with-
out adverting to the condition of medicine—a
subject concerning which, unfortunately for ma-
ny who have occasion to seek assistance from
that art, gross misconceptions prevail through-
out society.
I find myself, however, obliged to relinquish
the office of biographer, such as I had conceiv-
ed it. Of late I have had few opportunities of
personal inquiry; and very little of the infor-
mation, I had reason to expect, has reached me.
Never- 


xx ON THE CHARACTER
Nevertheless, I may succeed in delineating the
moral portrait of my hero, for his character
was exceedingly open to observation; and in his
productions the temper and understanding of the
man are most faithfully exhibited.
A person, who was his school-fellow, and af-
terwards his pupil at school, informs me that his
parents were mean, but honest. What was the
particular occupation of his father I have not
heard. Had his condition been superior to that
of a petty village artificer, I suppose the origi-
nal destination of the son would have been high-
er, for this is an affair in which parents seldom
err by excess of humility.
Mr. WAIT, the late respectable rector of
Dumfries school, supposes that John Brown was
born in 1735 or 1736. He was a native of the
parish of Buncle, in the county of Berwick. He
himself, in order to associate his name with that
of John Duns Scotus, commemorates the place
of his education rather than of his birth.—
From expressions he sometimes dropped in his
lectures, I conclude that he was endowed with
that quickness of sympathy and that sensibility
to the charms of nature, which characterize the
infancy of genius. This warmth of heart, I
believe, he never lost.
I am sorry I cannot minutely trace the steps,
by which he advanced towards intellectual emi-
nence. Mr. WAIT, without whose communi-
cations


xxi OF JOHN BROWN, M. D. 
cations mine would have been a meagre narra-
tive, states that " he early discovered un-
" common talents. His aptitude for improve-
" ment," continues this gentleman, "induced
" his parents, after having fruitlessly bound
" him apprentice to a weaver, to change his de-
" stination. He was, accordingly, sent to the
" grammar-school of Dunse, where, under Mr.
" Cruickshank, an able teacher, he studied with
" great ardour and success. Indeed, he was, at
" that time, regarded as a prodigy. I went
" the same road to school with him; and his ap-
" plication, I well remember, was so intense
" that he was seldom without a book in his hand."
It is a singular coincidence, that the two indivi-
duals, who in these times have been principally
celebrated for their attempts to extend the
knowledge of animal nature, should have been
both natives of Scotland, and that each should
have been put to a coarse mechanical employ-
ment—John Brown to the trade of a weaver,
and John Hunter (according to common same
and the report of one of his biographers) to
that of a carpenter or wheelright.
By an anonymous writer, who seems well-in-
formed, it is asserted that Brown " submitted in
" his youth to be a reaper of corn to procure for
" himself the means of improvement. With
" the price of such labour he put himself to
" school, where his abilities and ardour attract-
ed 


xxii ON THE CHARACTER
" ed the notice of his master, and procured him
" the place of assistant to the school (a)." His
revolt from the loom, according to this account,
must have been attended with highly honourable
circumstances: and the reader will desire fuller
information concerning both his motives and
conduct than has been transmitted to me.—From
the custom of the country, we may presume that
he had received much more instruction, before
he was put apprentice, than commonly falls to
the lot of boys of his condition in England.—
Considering the energy of his mind, we cannot
be surprised that a little cultivation should have
rendered the gloomy and uniform labour of a
weaver distateful. But this, though true, is per-
haps not the whole truth. As he was repelled on
the one hand, so he might, on the other, have
had some peculiar attraction towards literature.
The supposition is, at least, conformable to analo-
gy; since in the history of eminent men, when we
are fully acquainted with it, we never fail to dis-
cover some incident, which has determined each
individual towards the pursuit in which he has
excelled. Now I imagine Brown may have ap-
plied himself with such unusual assiduity to
school, learning from a persuasion that it would
qualify him to propagate more effectually the te-
nets of his sect. My conjecture is founded on
(a) Analytical Review for August, 1789. p. 450.
the 


xxiii OF JOHN BROWN, M. D.
the following expressions of Mr. Wait: " he
" had at this time"—the time of his entrance at
Dunse school,—" sober habits: he was exceed-
" ingly religious, and so attached to the sect of
" Seceders or Whigs, as they are called in Scot-
" land, that I really believe he would have
" thought his salvation hazarded, if he had heard
" or read the profane discourses of the Scotch
" establishment. He aspired to be the minister
" of a purer church, of which it was expected
" he would prove a chosen vessel." Nor is this
force of religious sentiment unusual in youthful
minds. Samuel Johnson was early struck with
superstitious terror: Haller had scarcely emer-
ged from his infancy, when he began to preach
to his father's domestics: and in families, where
the hatred of sect against sect is cherished, one
may generally perceive its most virulent tokens
in the boys. The most humanized of my read-
ers may remember the time when he glowed with
zeal against persons who had been taught a differ-
ent creed: and where reflection, softening the
heart into universal charity, has not introduced
perfect indifference as to the religion or irreligi-
on of others, the pious flame must be still alive.
The years of Brown's grammar education ap-
pear to have been, in no common degree, well-
spent and happy. He had vigour of body with
vigour of mind, and exerted both. He him-
self, with much complacency, relates proofs of
that 


xxiv ON THE CHARACTER
that strength, which his appearance indicated.
When a boy, he says he valued himself on being
a stout walker. At fifteen, on a summer's day,
he peformed a march of fifty miles between
Berwick upon Tweed and Morpeth in Northum-
berland. Some years afterwards, he travelled
on foot, resting but one hour and making but
one "hearty" meal, from four o'clock in the
evening of one day till two in the evening of the
day following—two-and-twenty hours—with so
short an intermission! During this excursion,
he traversed "all sorts of ground, in roads and
"out, over smooth and plain, mountain and
"heath." We have seen, however, that he
could make a more rational use of his strength
than merely to stake it against time and space.
While he was thriving in godliness and know-
ledge, but at what precise period I am not in-
formed, there occurred an incident which finally
diverted him from the path he had hitherto with
so much alacrity pursued. At a meeting of the
provincial synod of the Merse and Teviotdale,
a party of his school-fellows urged him to ac-
company them to the parish church of Dunse.—
He manifested reluctance, but yielded to their
importunity, and remained to hear the sermon.
The scandal did not pass unnoticed. He was
summoned before the session of the seceding
congregation; but not choosing either to atone
by an apology for his sin in mixing with profane
worshippers 


xxv OF JOHN BROWN, M. D.
worshippers, or to wait for a formal sentence of
excommunication, he abdicated his principles,
and professed himself a member of the establish-
ment. Thus, bigotry is often but the masque
of avarice, pride, or ambition; and here though
the nature of his present zeal was a secret to the
zealot himself, we see it fully disclosed by this
instructive anecdote. Encouragement at first, and
afterwards flattery, from his brethren, seems to
have formed a strong connection between the pe-
culiar articles of his faith and a sense of his per-
sonal importance; the moment this connection
was dissolved, an alteration of sentiment suc-
ceeded, not very much unlike that produced in
Luther's mind by the offensive measure of the
pope: the opinions he had so warmly cherished
lost all their value in his estimation; or rather,
perhaps, became odious from the disgrace with
which they threatened him. Religious enthusi-
asm, however, survived this sacrifice to pride;
and his friends still recollect the vehement indig-
nation he expressed on account of the dangerous
tendency of Mr. HUME's speculative writings;
which, some time after this event, he found
much the subject of conversation at Edinburgh.
Those who regard the Scottish establishment
as the true apostolical church may have cause to
rejoice, that so ardent a seceder did not persevere
in his original zeal. For complaints are some-
times heard in Scotland, as well as in England,
D of 


xxvi ON THE CHARACTER
of the increase of sectaries; and he might have
become formidable as a propagator of schisma-
tic doctrines. Among the divines of his nation
he would have been unrivalled in classical learn-
ing; and I see not what should have hindered a
man endowed with so acute and comprehensive a
genius from attaining equal pre-eminence in po-
lemical divinity. He would have marched with al-
acrity into the field of controversy, and confident-
ly assailed the stoutest champion of the adverse
host. His vehement eloquence must have been
deeply felt by audiences, to whom his dialect
was intelligible and inoffensive: and, as little
regard will be paid to style, when the thoughts
are intent on the high concerns of grace, faith,
good works, election, and reprobation, he might
have seconded, with his pen, the effect of his
personal labours. Had the incredulity of the
age induced him to undertake a general treatise
on christianity, he was capable of rendering
Grotius obsolete by language of superior purity
and more skilful management of his arguments.
If he had borne the cross as a seceding minister,
he must have led a life of the strictest tempe-
rance; since in Scotland the clergy, even of
the established church, cannot safely indulge in
open dissipation. I need not therefore explain
how much leisure he would have had for his
classical and theological pursuits. Nor would
he have enjoyed fewer or less lively sensations of
pleasure 


xxvii OF JOHN BROWN. M. D. 
pleasure than a different course procured him;
for to a person of his temperament, same and
fanaticism may well supply the place of wine.
He continued at the grammar school till he
had nearly attained the age of twenty. In the
summer of 1755, his reputation, as a scholar,
procured him the appointment of tutor in a
family of some distinction in the neighbourhood
of Dunse. But here, it seems, he did not long
continue to be an agreeable inmate. It is likely
enough that he had added the stiffness of pedan-
try to the sourness of bigotry. But I have no in-
formation concerning his deportment; and
should any of his disciples think a fuller narra-
tive due to their master's memory, some notices
may, I conceive, still be collected from the sur-
viving members of the family.
When deprived of this employment, he re-
paired to the university of Edinburgh. In this
busy seat of science, after going through the usu-
al course of philosophy, he regularly entered
upon his theological studies: he attended the
lectures, diligently applied to the perusal of the
authors recommended by the professor, and pro-
ceeded so far as to deliver in the public hall a
discourse upon a prescribed portion of scripture:
which is an academical exercise previous to or-
dination as a clergyman of the Scotch establish-
ment. At this point he stopped, and relin-
quished the profession of divinity altogether.—
The


xxviii ON THE CHARACTER
The sequel will sufficiently explain his motives
for this change. Its immediate consequence was
his retreat from Edinburgh to Dunse. Here, to
gain time, as may be supposed, for arranging the
plan of his future life, he engaged himself as
usher to the school which he had lately quitted.
In this capacity he officiated from Martinmas
1758 to Martinmas 1759. Mr. WAIT, who
professes himself to have benefited by the new
usher's instructions, mentions, as a proof of the
accuracy of his memory, that after once reading
ever the lesson, consisting of two octavo pages
in Latin, he would lay aside the book and pre-
lect the whole over, without mistaking a single
word. In the course of this year, one of the
classes in the high school at Edinburgh becom-
ing vacant, Brown appeared as a candidate, but,
"on a comparative trial, proved unsuccessful."
While he remained at Dunse, it was remark-
ed that the strictness of his religious principles
was relaxed. He even began to be accounted
licentious both in his principles and conduct.—
At a later period he was open enough in his a-
vowal of irreligion. Whatever scope the fact
may afford to the eloquence of persons, accu-
stomed to decry Edinburgh as a school where the
reason of young men is exercised more than
their faith, it seems too evident to be denied,
that this revolution of opinion in our student of
theology took place during his residence there.
The


xxix OF JOHN BROWN, M. D. 
The distinguishing portion of his heriditary
creed he had abjured from pique; nor can he
be supposed to have had any rational conviction
of the remaining articles; if rational convicti-
on can only originate in sincere doubt and per-
fect carelessness in regard to the conclusion to
which examination may lead. Under such cir-
cumstances it is easy to conceive by what a pre-
carious tenure a speculative student, placed in a
situation where information is at hand and inqui-
ry not only free but fashionable, holds the bene- 
fit derived from the religious lessons of his pa-
rents and preceptors. Some unlucky suggestion
may start a perplexing scruple, the serious inves-
tigation of this scruple may raise a host of diffi-
culties, and deliberation terminate in unbelief.
At the time he renounced divinity, the scene
before him must have directed his thoughts to
the study of medicine. The only difficulty lay
in the expence: but his observations might have
suggested the means of overcoming this difficul-
ty, independently of the encouraging circum-
stance which I shall immediately relate. He
must have been aware that students of physic are,
in general, by no means such proficients in clas-
sical acquirements as to speak Latin with tolera-
ble fluency. Hence, before the examinations
for a doctor's degree, which are carried on in
Latin, it is common to have recourse to a pri-
vate instructor, who converses with the candi-
date 


xxx ON THE CHARACTER
date in that language. This preparation is fami-
liarly called grinding, as a similar process at Cam-
bridge is, I think, called cramming. The trans-
lation of inaugural dissertations into Latin, which
the students, in most instances, compose for
themselves in English, is another occupation
from which a good scholar may derive emolu-
ment at Edinburgh; the ordinary gratuity for a
translation being five, and for an original com-
position, where that is required, ten guineas.
Of his qualifications for these employments,
accident, shortly after his unsuccessful competi-
tion for the vacancy in the High school, furnish-
ed him with an agreeable proof. Application
being made to one of his friends to recommend
a person to turn a thesis into Latin, Mr. Brown
was mentioned. He performed the task in a
manner that exceeded the expectations both of
the friend and the candidate. When it was ob-
served how much he had excelled the ordinary
style of such composition, he said he had now dis-
covered his strength, and was ambitious of riding in
his own carriage as a physician.—Towards the
close of 1759, therefore, he settled at Edinburgh
in the double capacity of teacher and student.—
At the opening of the session, he addressed a La-
tin letter to each of the medical professors. They
were perhaps already apprized of his merit as a
classical scholar; and they were all induced by 
his application to present him with a ticket of
admission 


xxxi OF JOHN BROWN, M. D 
admission to their lectures. After so auspicious
a beginning, he soon became famous as a teach-
er of Latin; and I believe he never afterwards
refused to exercise his pen in the translation of
thesis. He was also at all times ready to furnish
an original dissertation according to the system
his employer preferred.
I have obtained no particular information con-
cerning the first four years of his medical stu-
dies. His circumstances were probably more
flourishing than at any former period. From
the beginning of the masterly preface to his Ele-
ments it appears that he prosecuted his studies
with his characteristic ardour. In 1763, an old
acquaintance found him in as high repute among
his fellow-students as he had formerly been
among his school-fellows—a distinction which
has never been obtained without the conjunction
of ability with industry. He seems, however,
during the intervals of his application, to have
given into the most dangerous of vices; " for
" the langour of his appearance seemed to shew
" that he had taken liberties with a constitution
" originally firm and vigorous."
In certain universities, destitute of foundati-
ons or yearly stipends for scholars, the students
live dispersed in ordinary dwelling-houses: and
this dispersion, according to my observation, is
not less favourable to diligence and regularity
than residence in colleges. In mixed company
the 


xxxii ON THE CHARACTER
the vicious propensities, peculiar to any class of
individuals, will never be countenanced; or,
in the language of Dr. Adam Smith, a whole
company can never sympathize in those unbeco-
ming practices, to which a few only feel them-
selves inclined. By this mutual correction, the
association of persons of different ages and sexes
becomes the great preservative of good manners
and good morals. Colleges, which, after the
example of monasteries, seem instituted on pur-
pose to prevent this salutary variety, doubtless
give frequent occasions to emulation in those ex-
cesses, to which young men are particularly
prone. A nice observer, too, may perhaps dis-
cover that their monastic discipline irritates full
as much as it restrains. At Edinburgh the keepers
of lodging and boarding houses have generally
sober habits; and the observance of early hours
is enforced with as much effect, though with less
form, than by the porter's list, the fine, and im-
position. As far as discipline regards learning,
every man must estimate its value by his opinion
of the effect to be produced by setting grown
gentlemen tasks. Where there have existed
none of those restraints, which always give more
or less disgust, I have seen a large majority of
students pursuing knowledge with as great eager-
ness as any of their equals in age where else-
where pursuing the pleasures of the chace; and
from the same motive—the immediate satisfacti-
on 


xxxiii OF JOHN BROWN, M. D. 
on it affords. Nor do I believe that the acquisi-
tion of knowledge can be otherwise than agreea-
ble, except from the fault of the tutor or the in-
stitution.—If examinations are considered as
powerful incentives to diligence, none can equal
in severity those which are carried on at the vo-
luntary meetings, which it has long been the
custom to hold at the great school of medicine in
Scotland, and which have since been established
among the students at the inns of court in Lon-
don, with the approbation of the most distin-
guished professors of the law. 
Brown, who now seems to have supported
himself in affluence as a single man, perceived
in the establishment of a boarding-house for stu-
dents, a resource which would enable him to
maintain a family. His reputation for various at-
tainments was, he thought, likely to draw round
him a number sufficient to fill a large house.
With this prospect he married in 1765; and
his success answered his expectations. His house
was soon filled with respectable boarders. But
he lived too splendidly for his means, and " ma-
" naged so ill that in two or three years he became
" bankrupt. Towards the end of 1770, though
" reduced in his circumstances, he maintained
" the independence of his character, proving
" himself to be, in the language of his favour-
" site Horace,
E 


xxxiv ON THE CHARACTER
—Satis inter vilia fortis.
" He seems to be happy in his family, and, as
" far as I could ever observe, acquitted himself
" affectionately as an husband and a parent.—
" He still frequented the medical classes," (or
lectures); " and I heard him say he had now
"attended them ten or eleven years."
[Mr. WAIT].
We have seen how liberally Brown was treat-
ed on his entrance upon the study of medicine.
From the celebrated Cullen he early received
the most flattering marks of attention. This
speculatist, like Boerhaave and other men of ge-
nius in the same station, was accustomed to
watch the fluctuating body of students with a
vigilant eye, and to seek the acquaintance of the
most promising. There was a period when he
made the greatest exertions to gain proselytes to
his opinions; and his mind was doubtless alive
to that pleasure which the encouragement of me-
rit affords to all who are capable of discerning
it, when no dread of rivalship interferes with the
gratification. But Brown's power over the La-
tin language served him as a peculiar recom-
mendation; and his circumstances might induce
Cullen to believe that he could render this talent
permanently useful to himself. Taking there-
fore its professor " under his immediate patron-
" age," he gave him employment as a private
instructor 



xxxv OF JOHN BROWN, M. D. 
instructor in his own family, and spared no pains
in recommending him to others. A very strict
and confidential intimacy ensued. The favour-
ite pupil was at length permittad to give an e-
vening lecture, in which he repeated, and per-
haps illustrated, the morning lecture of the pro-
fessor; for which purpose he was intrusted with
Cullen's own notes. Though Mr. Wait had
not recollected the profuse encomiums of his old
school-fellow, his warmth of attachment would
be fully testified by subsisting tokens; to his eld-
est son, for instance (WILLIAM CULLEN
BROWN) were given both the christian-name
and sirname of his patron. Other proofs of
mutual confidence and esteem might be collected:
but friendships originating in protection are very
prone to terminate in enmity, unless difference
of rank and pursuits totally preclude competiti-
on; and it is well known that the friendship in
question was far from permanent. My materi-
als do not furnish distinct information concern-
ing the cause or pretext of an alienation, which
was certainly injurious to the dependant party,
and perhaps detrimental to society. In a com-
munication from Dr. S—, likewise an old and
intimate acquaintance of Brown, it is said, that
after the failure of his boarding-house, he " be-
" came impatient, and unfortunately quarrelled
" with Dr. Cullen, from a supposition that the
"doctor had it in his power to extricate him
from 


xxxvi ON THE CHARACTER
" from embarrassment by placing him in a more
" liberal and lucrative situation in the medical
" line." A report I remember to have heard at
Edinburgh coincides with intimation; but I re-
late it only on the authority of rumour. When
the theoretical chair of medicine became vacant
either on the death of Dr. Alexander Monro
Drummond, or the refusal of this promising
young physician to fill it, Brown gave in his
name as a candidate. On a former occasion of
a nature somewhat similar, he had disdained to
avail himself of recommendation, which he
might have obtained with ease; and though, ac-
cording to the friend whose words I have just
quoted, he acquitted himself in a manner far su-
perior to the other candidates, private interest
then prevailed over the juster pretentions of me-
rit. At the present competition he was also
without recommendation; and, I suppose, could
have obtained none. Such was his simplicity,
that he seems to have conceived nothing beyond
pre-eminent qualifications necessary to success;
nor did he harbour any suspicion of that debasing
system of influence, which has infected the land
so thoroughly, that the post of a scavenger, were
it held by appointment, would hardly be procu-
red without cabal, or retained without servility.
The magistrates of Edinburgh appoints profess-
ors to the college, as well as masters to the
school. They are reported deridingly to have
inquired 


xxxvii OF JOHN BROWN, M. D. 
inquired who this unknown and unfriended candi-
date was; and Cullen, on being shewn the name,
after some real or affected hesitation, is said to
have exclaimed in the vulgar dialect of the coun-
try—Why, sure, this can never be our Jock! With
this sneer the application of a man was set aside,
whose equal the patrons of the Edinburgh pro-
fessorships will probably not soon have an op-
portunity of rejecting. Though this account
should come near the truth, it does not follow
that the municipal board deserves much censure.
In the execution of their trust they are indeed
bound to examine the pretentions of the compe-
titors, or rather to cast their eyes round where-
ever the English language is spoken, and select
the person best qualified for the office, even if
he should not enter the lists of competition.—
But they had not our means of deciding; and
although he, who enjoyed so high a reputation
among his fellows, and to whom Cullen partly
committed the credit of his system, could not well
be deemed a contemptible candidate, there did
not perhap exists reasons to warrant them in rais-
ing him to the vacant chair. Public same seems
the surest guide for such electors; and the repu-
tation, so long enjoyed by the University of
Edinburgh, proves that it is a guide sufficiently
sure. The danger is, lest its patrons, relying
upon the established credit of the seminary,
should at any time suffer intrigue to interfere
with 
 

xxxviii ON THE CHARACTER
with their choice. In this case a splendid col-
lege may indeed be erected, but students from
different regions of the globe will soon cease to
crowd its halls.
Whether such a sarcasm was uttered or not,
Cullen (b) completely estranged the mind of his
Latin secretary on a subsequent occasion. As I
am not sufficiently acquainted with the particu-
lars, I cannot venture to appreciate his conduct;
but the mortal affront was given, when Brown
attempted to gain admission into that philosophi-
cal society which published the Edinburgh Es-
says. After this transaction, an open rupture
took place; but, however it arose, the account
furnished, if not written, by Brown, evinces
that both parties had before conceived a secret
jealousy of each other: the account is as fol-
lows: " There is a junto of men in Edinburgh
"who at all times, from fear of his"
(Brown's) " learning and abilities, have been
" his determined enemies; and by all arts, but
" good ones, have uniformly sought his ruin,
" and that of a large and innocent family de-
" pending upon him. This conduct, first of
" all, was the return they made him for great
" services done to them as a body, and to cer-
(b) Jones's Enquiry into the State of Medicine,
1781, p. 358.
tain

xxxix OF JOHN BROWN, M. D. 
" tain individuals of them as friends. Their
" open conduct to him was friendly; their se-
" cret a plot, a dark Catalinian conspiracy.—
" Accordingly, his suspicion of it was late, the
" full detection later....He chose to tear
" off the mask of their pretended friendship.
" His first step was to make application for be-
" ing made a member of a certain literary soci-
" ety, to which no man's petition had ever been
" rejected before, or since: foreseeing that he
" would be rejected. This accordingly hap-
" pened. But he was previously advised by one
" of themselves, as a friend, to withdraw his
" letter of application. A frivolous and false
" cause was assigned for the opposition. The
" friendly monitor who had perceived that our
" author had a new doctrine of medicine in me-
" ditation, began, as it would appear, to fear
" that it might terminate in the extinction of
" one which he assumes as his own. He was
" therefore the prime mover of the plot.—The
" answer was, in a tone of firmness, that the ap-
" plication would not be withdrawn..and that
"the applier" was resolved to make the pre-
sent conduct of the adviser and his friends " the
"criterion of his judgment of their intentions
"towards him." The body must mean the col-
lege of physicians; the services I presume to
have been the translation of their Pharmaco-
pœia into Latin, and the plotter unquestionably
was 


xl ON THE CHARACTER
Cullen. After the failure of this bold experi-
ment upon the strength of his credit, the pro-
jector had evidently no time to lose in seeking
some fresh resource for the support of his family.
The following notice from Dr. S—applies to
this part of his history.
" Being estranged from Dr. Cullen's family,
" he gradually became his greatest enemy, and
" shortly afterwards found out the new theory of
" physic, which gave occasion to his publishing
" the Elementa Medicinæ, in the preface to which
" work he gives an account of the accident that
" led to this discovery. The approbation his work
" met with among friends encouraged him to give
" lectures upon his system. Though his lectures
" were not very numerously attended by the stu-
" dents, on account of their dependence upon the
" professors, still it was always remarked that the
" cleverest among them were all, as they were
" now called by way of nick-name, BRUNO-
" NIANS. Hence arose that persecution which
" was carried on with such rancour that it at
"length obliged him to leave Edinburgh.—"
This account of the origin of the Brunonian
system, as we may conclude from the preceding
quotation, is not exact; and in other particulars
the statement, from evidence I shall afterwards
produce, will appear overcharged. Meanwhile,
if it be undeniable that, as the Cullenian hypo-
theses were sinking into disrepute, many of the
ablest 


lii OF JOHN BROWN, M. D. 
students resorted to the standard of Brown, it
ought not to be forgotten that it was joined also
by the most idle and dissolute. Their miscon-
duct and their master's imprudence in private
life, together with the offensive manner in
which he spoke of himself and of others, kept
the system and the author in constant discredit.
He was soon in a state of open hostility with
all the medical teachers at Edinburgh; and it
required nicer management than he could ob-
serve to keep on fair terms with other practition-
ers of medicine. To a disciple, who was desi-
rous that he should meet one of the professors in
consultation, he remarked, " that he (the disci-
ple) " was unacquainted with the interested arts
" of those men; that all their ideas in medi-
" cine, and particularly in its practical part,
" were so diametrically opposite to his, that they
" never could be brought to any sort of recon-
" ciliation."—Like other reformers, who have
had to wrestle with powerful opposition, he
committed and sustained injustice. Like them
too, where his system was concerned, he gradual-
ly lost his sense of equity. If we judge by his lan-
guage the only way he had to show his disposition,
his countryman Knox could scarcely have exceed-
ed him in ferocity. Thus, having remarked that
the doctrine of spasm, suggested by Van Hel-
mot, and clumsily wrought up into a system by
Hoffmann, was banished by Boerhaave from
F the 


liii ON THE CHARACTER 
the country which gave it birth, " it found at
" last," he adds, " amidst a new persecution
" raised against it by the pupils of Boerhaave——
" then in possession of the medical chairs at Edin-
" burgh—a friend and protector in Dr. Cullen,
" who had lately become one of the number of
" those professors.
" This brat," he proceeds, "the feeble,
" half-vital, semi-production of phrenzy, the
" starveling of strained systematic dullness, the
" forlorn outcast of the fostering care to which
" it owed its infect vitality, was now to be
" pampered by a crude and indigestible nutri-
" ture, collected from all the materials which
" had composed the several fabrications of for-
" mer erroneous systems, was to be decorated
" with every foreign plumage, and in this its
" totally borrowed and heterogeneous form,
" instead of the hideous caricatura, which it
" was, contrived to excite the derision of man-
" kind, it was to be ostentatiously obtruded up-
" on the world as a new, and respectable doc-
" trine, and held up, forsooth, as the formida-
" ble rival of a splendid system (c)."
Such is the torrent of metaphors that rushes
upon his imagination when he thinks of the sys-
tem of his ancient friend and master. Of the
(c) Observations on the old Systems of Physic,
1787, p. xxxi.
past 

liv OF JOHN BROWN. M. D.
past and present condition of the healing art he
speaks with greater coolness, but with equal
contempt:
" The accomplishments of the regulars have
" been learning and ingenuity in a few, not di-
" rected to improvement in their own professi-
" on: a mere shadow of learning, or the study
" of a bad kind of it, as botany and the other
" branches of natural history, in the greatest
" number; sly attention to reputation for skill;
" intriguing with their brethren for countenance;
" opposition to improvement; persecution of
" discovery; narrowness of mind under the
" thin veil of a false pretension to liberality;
" affectation of decency; all for the purposes
" of trade; silence, from a consciousness of in-
" ability to speak so as to gain by it; formality,
" pomp, stateliness, gravity, all making a
" motley group of absurdities; invincible at-
" tachment to the errors of their education;
" aversion to improvement; ready upon every
" slight occasion to break out into rage and
" transport; invincible bigotry and prejudice;
" an over value of what learning they have any
" pretensions to; and under value of all they
" are conscious they want.
" As every country, in proportion as it is dis-
" tinguished by riches, and openness of man-
" ners, for that very reason, becomes the em-
" porium, the scene of action, for high-way-
men,


lv ON THE CHARACTER
" men, footpads, pickpockets, swindlers, sharp-
" ers, gipsies, regular practitioners in law and
" physic, quacks in both professions, so England
" has long held and still holds the pre-eminence
" over all her neighbour countries, in being,
" for the reason assigned, the place of common
" resort, in which a comfortable subsistence is
" afforded to all those different denominations
" of purse-takers.
" Exilis domus est, ubi non et multa supersunt Et
" fallunt dominos, et prosunt furibus." (c)
During the heat of the contention betwen the
opposers and defenders of the new system, an
event happened which I wish I could fairly pass
over in silence. But as it has already been the
subject of more than one publication (d), there
can be no pretence for the omission.
Mr. Isaacson, a student of medicine, had been
seized with a fever, which in its progress exhi-
bited the most alarming symptoms. Dr. Duncan
was first called in, and afterwards Dr. Monro.
Dr. Robert Jones, a new graduate, and a friend
to Mr. Isaacson, tampered with the nurse to in-
(c) Observations, pp. lxxxi—111.
(d) See Jones's Enquiry, p. p. 134—150.—Letter
to Dr. R. Jones, by Andrew Duncan, M. D. Cadell,
1782.—Letter from Philalethes to Andrew Dr. Dun-
can, without date or title, announcing a reply to the
former publication, which, I believe, never appeared.
duce 


lvi OF JOHN BROWN, M. D.
duce her secretly to administer strong stimulant
medicines: they were given, as he asserts, for
about twenty-four hours, with such effect that, on
their next visit, the physicians " declared the pa-
" tient free of fever," though before he had all
the symptoms of approaching death. In the af-
ternoon, however, of the same day, he was seized
with a raging delirium. Jones in his alarm ap-
plied to his preceptor; the preceptor being told
that the nurse desired to see him, ordered "her
"to be brought before him." When she was
brought before him, he complimented her by a
solemn appeal to her understanding concerning
the great principles of his system. " He en-
" deavoured to assure her that there was either
" no inflamation in the case at all, or that it was
" a very different affection from the inflamati-
" on that physicians were acquainted with; that
" instead of requiring bleeding and other eva-
" cuant antiphlogistic means, it is required the
" very same treatment which had been last em-
" ployed; and he asserted with confidence that
" the intermission of the stimulant powers
" through the day was the cause of all that had
" happened; that, in short, the present affec-
" tation was a disease of debility of the whole
" system, predominant in the brain, in conse-
" quence of the great sinking of strength which
" constantly follows a total cessation of the use
" of such highly stimulant powers. He beg-
ged 


lvii ON THE CHARACTER
" ged therefore as the life of a fellow-creature
" was at stake, and as she had been so late a
" witness of the good effects resulting from the
" method of cure, the continuance of which
" he still recommended that she would not al-
" low prejudice and impressions from the false
" theories of physicians, among whom she had
" been conversant, to prevail over the high
" probability of success from this mode of cure.
" He dismissed her, after obtaining a promise
" that she would continue the plan of cure in
" question (e)."
Brown, for a comic figure, was not inferior
to Sancho Panza; nor indeed much unlike that
entertaining personage; and this clandestine
conference, if it had been delineated by Cer-
vantes, would have made a good companion for
the nocturnal interview between Don Quixote
and the venerable duenna, Donna Rodriguez.
The patient, thanks be to fortune, skill, or
virtue! recovered. The Brunonians placed the
cure to the credit of their practice, which they
reported to have been successful after Dr. Dun-
can and Dr. Monro had given the patient over;
they published the case; they asserted that the
cure " gave great vexation to the attendant phy-
" sicians and all their partizans;" and with the
policy usual among agressors, they complain-
(e) Jones, p. 136.
ed that
 

lviii OF JOHN BROWN, M. D. 
ed that Dr. Brown was ill-treated, because he
was blamed in " the numerous circles of physi-
" cians friends and his enemies, while no oppor-
" tunity was offered him of vindicating him-
" self from these charges."
The nurse had threatened, if the secret pro-
ceedings should transpire, to deny the perform-
ance of her part of what in the Enquiry is term-
ed the paction. Dr. Duncan, roused by these
rumours, applied for information to the nurse
and her assistant, to Mr. Isaacson himself, to the
mistress of the house where he lodged, to Mr.
Edmund Goodwin, and Dr. Monro. In his let-
ter he has published their respective attestations
and depositions upon oath; it appears that the
clandestine proposals were rejected, and that only
one unsuccessful attempt was made by the negoci-
ator himself to administer a dose of his diffusible
stimulants. According to the nurse's testimony,
Mr. Jones on her first refusal declared, if she
" would do as he desired her, Mr. Isaacson 
" would give her a handsome reward when he
" recovered—that the medicine he wished her
" to administer was a bottle of double rum, of
" which she was to give him a glassful, with
" fifty drops of laudanum in it, the first night;
" and another glassful, with one hundred drops
" of laudanum in it, the second night, if the
" first dose should have a good effect. To this
" proposal she answered, that if such medicines
were 


lix ON THE CHARACTER
" were administered to Mr. Isaacson in the state
" in which he then was, he would not recover
" to reward either her or Mr. Jones. To
" which he replied, that she was a damned fool
" for refusing, and that he would give her two
" guineas out of his own pocket if she would
" do it. She said, that if the best graduate in
" Edinburgh would give her her apron full of
" gold, she would not." This woman depo-
sed moreover that one evening, while she was
employed apart, she heard Mr. Isaacson suddenly
cry out, " Good God, what is this? It is laud-
" anum! I am poisoned!" She then observed
Mr. Jones by the bedside with a tea-cup, con-
taining some liquor, in his hand, which he set
down on the table, requesting the landlady to
give it to Mr. Isaacson at a proper opportunity.
The landlady asserts, that, late one evening,
she saw Mr. Jones drop one hundred drops of
laudanum into a tea-cup, and add some wine,
which he immediately carried into Mr. Isaacson's
room. She followed him: he endeavoured to
make Mr. Isaacson, who was so far delirious that
he did not appear to know Mr. Jones, swallow
the contents; " on tasting the medicine, he spit
" it out of his mouth; cried out that it was
" laudanum, and that he was poisoned; but to
" the best of her observation, he did not swal-
" low any of the medicine;" which, soon af-
ter, was thrown into the fire.
The 


lx OF JOHN BROWN, M. D. 
Dr. Duncan's indignation urged him to an
immediate prosecution, which, as he was assu-
red by some eminent advocates, would have
terminated in the infliction of a severe punish-
ment on the negociator. Dr. Monro discoura-
ged, by this idea for reasons which it would be
injurious not to quote; they are thus assigned
in the letter to Dr. Jones: " He was principal-
" ly averse to it on your account, because he
" considered you in the light of an imprudent
" young man—he imagined that the mal-prac-
" tices might be sufficiently proved of you, al-
" though they could not be brought home to
" Dr. Brown, whom he considered as the ori-
" ginal aggressor. He was averse to it on ac-
" count of Dr. Brown's wife and infant chil-
" dren, who might have suffered more severely
" by it than we could easily foresee. And be-
" sides this, he thought there was but little
" danger that Dr. Brown should repeat such
" practices, and still less chance that he would
" again find any student to be his assistant in the
" manner you had been." In these reasons Dr.
Duncan acquiesced.
By this intrigue Dr. Brown's " character was
" very near ruined as a physician, and as a man
" (Enquiry, p. 139)." All chance of lucrative
employment in his profession, if he ever had
any, was destroyed. His character among his
countrymen suffered irretrievably; nor have I
G courage 


lxi ON THE CHARACTER
courage without better documents to undertake
his vindication. Dr. Duncan assures me, that
he knows of no reply to his letter; and little
satisfaction I apprehend will be found in the pleas
offered by the Enquirer and Philalethes. If the
means of erasing this blot remain, I hope they
will be employed without delay. I shall be glad
to have solicited, where I could not ascertain
the truth. But " the desire of rescuing a fellow-
" creature," will never be admitted by the pub-
lic as a justification of the clandestine interfe-
rence of any man, much less of a physician,
in the treatment of the sick. Such motives may
be chiefly feigned; and, when real, they may
occasion endless mischief.
Things and persons are generally estimated in
the gross; and this unwelcome portion of my
narrative, I fear, will raise in many minds a
prejudice fatal to the credit of the following sys-
tem. Just and judicious readers will, however,
discriminate. And if, in the case of Bacon,
the baseness of the magistrate detracts not from
the wisdom of the philosopher, why should the
imprudent or unjustifiable means which Brown
adopted to carry his principles into practice, in-
fluence our opinion concerning the justness of
those principles?
He sometimes discovered the propensity, so
common among the framers of systems, in a
less offensive way.
A student 


lxii OF JOHN BROWN, M. D.
A student of medicine died of a low fever
in spite of the full and avowed use of diffusible
stimulants. The body was opened; several
persons were present; among others the gen-
tleman that informed me of the occurrence.—
During the examination of the appearances,
Brown with an air of great sagacity remarked
that the body was unusually fresh. The dissect-
ing surgeon, whom perhaps kindred devotion to
Bacchus had inspired with tenderness for the
Doctor, replied that, considering the circum-
stance, he had scarce seen an instance where pu-
trefaction had made such little progress. "Then,
"gentlemen," rejoined the doctor, "I appeal
"to you if we may not consider this as a clear
"proof of the propriety of our practice."
Brown was elected President of the Medical
Society in 1776 and again in 1780. In what
years he became a lecturer and graduate in me-
dicine, I must leave to some future biographer
to settle. Though he had attended the medi-
cal classes at Edinburgh ten or eleven sessions
[Mr. WAIT], he resorted to St. Andrews for
a Doctor's degree. His pupils, I believe, fol-
lowing in his train, strove to give to his passage
the air of a triumphal progress; he was certain-
ly accustomed to relate with infinite satisfaction
the circumstances attending his graduation. He
described the professors beyond the Firth as
overawed by his same and presence; it is likely
enough 


lxiii ON THE CHARACTER
enough that they wished to exchange their di-
ploma for his money with as much expedition
as possible.
For several years after 1780, and perhaps
before, the professors, the physicians to the in-
firmary, and the societies were unceasingly an-
noyed by the adherents of Brown; the students'
debates were carried to the highest pitch of vi-
olence; by the Medical Society a law was pas-
sed, and, I think, put in force, that if any
member should challenge another for any thing
said in debate, he should incur the penalty of
expulsion.
The efforts of the Brunonians to expose
those practitioners, who followed a different
system, are fully exemplified in a Letter on the
management of patients in the Royal Infirmary (g).
This letter was occasioned by a restriction an-
nexed to the allowance of a very thin beef-stake
to a patient in that hospital. It was expressly
ordered that the stake should not exceed one
inch and five sixteenths in length, nor seven
eighths of an inch in breadth. This, at least,
is the measure of the pattern (h). The tone,
assumed in the commentary upon this text, is
that of vehement invective: on the authority,
(g). Edinburgh, 1782, pp. 32 Signed Veri
Amicus
(h). Letter, p. 9.
as 


lxiv OF JOHN BROWN, M. D.
as the writer says, " of one of your own stu-
"dents" he gives the following statement of
the hospital diet:
" The Common Fare.
" Soldiers pay 2s. 4d. per week.
" Breakfast—One roll of bread and a measure of milk
" or beer.
" Dinner—One ditto, and a choppin of weak broth.
" Supper—The same as breakfast.
Common Patients.
" Breakfast—Half a roll, and a measure of milk or
" beer.
" Dinner—One roll, and a choppin of weak broth.
" Supper—The same as breakfast.
" In a few particular cases, a little meat is al-
" lowed and other necessaries, as may appear
" proper to the physicians."
He then notices the roast beef and porter of
St. George's hospital in London, and subjoins
this appeal: " Let me figure the case that you,
" Doctor, were plunged at once into disease
" and beggary; I put this plain question, whether
" would you choose to be lodged and nursed in
" St. George's hospial, or to be deposited and
" starved in the Royal Infirmary, under such
" medical treatment as your own? Your victu-
" als," he proceeds, " are not only scanty but
" bad. Your porridge is sometimes boiled
" almost into water-gruel; your broth is
commonly 


lxv ON THE CHARACTER
" commonly much better qualified to operate as
" an emetic than to nourish the system—of your
" milk we need only say that it resembles the
" rest which is sold in the streets of Edinburgh.
" Your beer is not always tolerable even to the
" palate of an ale house scullion."
None undoubtedly but members of the me-
dical profession, can have an adequate concep-
tion of the wide-wasting misery that daily arises
from the want of food, fuel and cloathing. Oc-
casionally, in distressful seasons, the gnawing
pains of hunger are assuaged by private chari-
ty; and impending death or madness is prevent-
ed. But no effort is made to improve the pre-
dominant condition of the poor, though it is
alike destitute of comfort and of hope. Expe-
rience teaches how little they have to expect
from those POLITICAL SWINDLERS, who, un-
der false pretences, acquire the power of sport-
ing with the wealth and blood of nations. The
wretchedness of imprisoned criminals remained
unredressed only because it was indistinctly
known; the wretchedness of the indigent is not
more clearly understood; to expose it fully to the
eyes of the community is a work of extensive
beneficence reserved for some future HOWARD.
When it is atchieved we shall be astonished at
the proportion of human beings that languish in
misery or perish prematurely; the universal
feelings of mankind will rise in behalf of these
victims 
 

lxvi OF JOHN BROWN, M. D.
victims of penury; and their flesh will no long-
er be devoured by the luxurious creatures of cor-
ruption. But our Brunonian "friend of truth,"
seems to work upon the passion of his reader,
merely for the purpose of degrading a few pro-
fessors in the opinion of a set of students. If
his letter contains material exaggerations, it
could only serve to bring the cause of humanity
into disrepute.
In 1782 I remember to have spent an evening
in company with Dr. Brown. He assumed the
sovereignty of the circle, which consisted prin-
cipally of his disciples; and nobody thought of
disputing his title; he displayed uncommon vi-
gour of imagination, but to me the figures he
called up were so little agreeable, that I never
desired his conversation a second time. Others
received entertainment; and by those who knew
him well, he is remembered as " the best com-
" panion in the world." His Doric dialect had
nothing prepossessing to an English ear. It
was so broad as to leave me often uncertain of
what he said even in his lectures. And yet be-
fore he undertook the charge of a private tutor,
he had attended an English master at Edinburgh,
" for the purpose of acquiring a proper pro-
" nunciation and method of teaching that lan-
" guage, which he had not before had an op-
" portunity of being improved in" [D. S.].
But the vestigia ruris were not to be effaced, or
else he had voluntarily resumed his original notes. 


lxvii ON THE CHARACTER
Unprofitable adherence to the house of STU-
ART, had been relinquished at Oxford before my
entrance: and Brown was the first person I ever
saw absurd enough to profess himself a Jacobite.
He had several years since embraced political sen-
timents thus repugnant to those he once held,
and which had now become almost universally
extinct. In 1770, " I was surprised," says a
gentleman who had known him long, "to find
" the Doctor a warm admirer of the Scottish
" aristocracy: the lairds of Clanronald, Kep-
" poch, and Gengary, were the theme of his
" eulogy; and prints of some of the chieftains
" who had joined the late Pretender were pla-
" ced among the divinities of his household.".
No cause for such a revolution of opinion is as-
signed. It did not arise by analogy from his
hostility to the professors, for it took place be-
fore his rupture with Dr. Cullen. This species
of superstition easily fastens upon the mind of
the antiquary; and Brown had paid attention to
the antiquities of his country. He was elected
assistant Latin secretary to the Antiquarian Soci-
ety of Edinburgh, without his solicitation or
knowledge, and from the sole consideration of
his literature, according to the Enquiry; but
this assertion is contradicted by Dr. Duncan.—
His contradiction is founded on Mr. Cummyng's
declaration when he proposed Brown, that " he
" knew him to be very desirous of obtaining
" the appointment." 


lvii OF JOHN BROWN, M. D.
His conversation was full of contempt for
the literature, talents, and doctrines of the me-
dical professors, one great natural philosopher
excepted. He continually criminated them as
his persecutors, and as unjust towards those stu-
dents who adopted his principles. This inju-
stice is said to have appeared in unusual severity
on the examinations previous to graduation. In
the Enquiry these complaints are repeated; and
to shew how much the right of private judg-
ment was infringed in the article of inaugural
dissertations, the following correspondence is
produced: the candidate, it should be premi-
sed, was desirous of quoting the sixty-ninth,
seventieth, and seventy-first paragraphs from
the Elementa Medicinæ in a thesis on epilepsy.
" Sir,
" A former experience of your civility pre-
" vents my apologizing for troubling you on
" the following occasion, viz.
" From a strict perusal and attention to my
" dissertation, I find it necessary to solicit your
" approbation of inserting the quotation I made
" from Dr. Brown's printed book, to which
" you formerly objected.
" Amongst many other reasons, I will submit
" the two following to your consideration.
" 1. That without it I am prevented from
" saying what I really believe, to the manifest
" injury of my dissertation.
H " 2. That 


lviii ON THE CHARACTER
" 2. That I am deprived of the liberty other
" candidates have always enjoyed in making
" quotations from any author; a privilege too,
" which was promised me by Dr. Gregory.
" As I wish to have my dissertation printed
" immediately, your answer as soon as conveni-
" ent, would oblige
" Your humble Servant,
" J. WAINMAN."
The answer was as follows:
" Sir,
" I objected to your quotation, as I have of-
" ten done to quotations made by other candi-
" dates, not that it contained the opinion of
" this doctor, or of that professor; but that it
" contained such jargon, as could not fail to
" disgrace the candidate, and of course the
" university, which gave sanction to its publi-
" cation. As to the liberty you say, ' candidates
" always enjoyed of making quotations from
" any author, right or wrong,' I never heard
" of it before, and am determined to give it no
" quarter, neither now nor hereafter."
(Signed.) ALEXANDER MONRO.
I must profess myself incapable of entering
into these sentiments: and I suppose many rea-
ders will concur with me in regarding with con-
tempt the patch-work of education; whether
it consist of a specimen of penmanship, retouch-
ed by 


lix OF JOHN BROWN, M. D
ed by the master for the honour of the school,
or an inaugural specimen, garbled by the profess-
ors for the honour of the University.
Observing the students of medicine frequently
to seek initiation into the mysteries of free ma-
sonry, the author of the New Doctrine thought
their youthful curiosity afforded him a chance
of proselytes. In 1784 he instituted a meeting
of that fraternity, and entitled it, The Lodge of
the Roman Eagle. The business was conducted
in the Latin language, " which he spoke with
" the same fluency and animation as he spoke
" Scotch. I was much diverted," adds Dr.
Macdonald, " by his ingenuity in turning into
" Latin all the terms used in masonry."
In unfolding his system it was his practice first
to translate the text book, sentence by sentence;
and then to expatiate upon the passage. For
most of his pupils the translation was a prelimi-
nary highly necessary; and he must have consi-
dered it as politic to combine literary with sci-
entific instruction. The prospect of this dou-
ble advantage, might perhaps, from time to
time, bring him a few additional hearers; but
whatever was the absolute or comparative merit
of the theory he taught, his seats, I fear, were
seldom crowded.
The introductory lecture, if my memory is
accurate, was intended to impress upon his au-
dience a sense of the importance of the lectu-
rer's 


lx ON THE CHARACTER
rer's discoveries; its effect was rather to render
him ridiculous. The dread of pain and death
easily persuade us that improvements in medi-
cine are more beneficial than any other art; but
when a man asserts the superior utility of his
discoveries to those of Newton, he will with
difficulty avoid the appearance of asserting the
superiority of his talents. The lecturer, in his
cooler moments, would have been sensible that
lofty claims produce only laughter or resistance.
But his imagination easily kindled; he was
thrown off his guard, and he strongly ex-
pressed what he fervently believed. He usually
proceeded to open his system with animation;
but he did not always persevere with the same
spirit. He was apt, as he advanced, to fail in
punctuality of attendance. As the master's ar-
dour abated, slackness stole upon the pupils; so
that his courses not very unfrequently, I believe,
shared the fate of Butler's story of the bear and
fiddle. The numerous inaccuracies with which,
in spite of the remonstrances of his well-wish-
ers, he suffered both editions of his Elements
to pass through the press, evince his negligence
in those concerns which might be supposed to
lie nearest his heart.
His voice was in general hoarse and almost
croaking, but " when he became animated, he
" had fine cadences and pleasing tones, which
" took off all the uncouthness of his accent and
" his manner."


lxi OF JOHN BROWN, M. D. 
One of his pupils informs me that when he
found himself languid, he sometimes placed a
bottle of whisky in one hand, and a phial of
laudanum on the other; and that, before he be-
gan his lecture, he would take forty or fifty
drops of laudanum in a glass of whisky; re-
peating the dose four or five times during the
lecture. Between the effects of these stimulants
and voluntary exertion, he soon waxed warm,
and by degrees his imagination was exalted into
phrenzy.
The subjoined quotation shews that he some-
times endeavoured to enforce his tenets in a man-
ner not very usual; conceiving it lay in his
power to remove certain objections deducible
" from the real or imagined inflammation of the
" brain at the end of Typhus," and " from
" the inflammatory part of the gout," he call-
ed together a party of his confidential pupils.
" He had brought on a slight fit of the gout
" by unusual exercise in walking. This was an
" opportunity for making an experiment which
" was to decide the whole controversy. A per-
" son called for him before dinner, who was in
" a way of business that led him to drink in the
" morning; he expected a glass from him and
" was gratified. The Doctor for a reason that
" the reader must perceive, collected half a
" dozen of his principal pupils to dinner, and
" drank then till he only, in consequence of
" what 


lxii ON THE CHARACTER
" what he had taken before, was considerably
" affected. He told them he had planned some
" degree of intoxication in order to explain ma-
" ny inflammations, which were universally un-
" derstood to be accompanied with, or to de-
" pend upon, phlogistic diathesis. Before the
" application of the stimulus we speak of, he
" had not been able to put his inflamed foot to
" the ground, but had supported himself in any
" little motion that he chose to make through
" the house, by his sound extremity, assisted
" by the use of his staff; but before he dismis-
" sed his company, he recovered the perfect
" use of his affected leg (k)."
A few words will describe the tenor of this
unfortunate man's life, till his removal from
Scotland. He was so reduced in his circum-
stances as to be committed to prison for debt,
where his pupils attended his lectures. In the
abuse of intoxicating liquors he observed no mo-
deration. In 1775 Mr. Wait found him drink-
ing water only. His situation, about that time,
would have roused almost any man to a struggle
with this destructive habit. His preface dis-
closes the reason of his sobriety. Finding the
gout return with severity, after some perseve-
rance in this experiment of abstemiousness, he
returned to the bottle, and never afterwards
relinquished it.
(k) Enquiry, p. 134.
His 


lxiii OF JOHN BROWN, M. D. 
His prospect of maintaining himself by teach-
ing medicine at Edinburgh becoming every year
worse; he at length carried into execution a de-
sign which he had long meditated, and to which
he had received some encouragement. In 1786,
therefore, he embarked for London, bearing in
mind most probably, if he did not utter, Sci-
pio's exclamation against the ingratitude of his
country. Immediately on his arrival, an incident
befel him which I have heard Mr. Murray, the
bookseller of Fleet-street, relate in proof of
his simplicity. The peculiarity of his appear-
ance, as he moved along—a short square figure
with an air of dignity, in a black suit which
heightened the scarlet of his cheeks and nose—
fixed the attention of some gentlemen in the street.
They addressed him in the dialect of his coun-
try; his heart, heavy as it must have been from
the precariousness of his situation, and distance
from his accustomed haunts, expanded at these
agreeable sounds. A conversation ensued, and
the parties, by common consent, adjourned to a
tavern. Here the stranger was kindly welcomed
to town; and after the glass had circulated for a
time, something was proposed by way of sober
amusement-a game at cards or whatever the Doc-
tor might prefer. The Doctor had been too civil-
ly treated to demur, but his purse was scantily fur-
nished, and it was necessary to quit his new
friends in search of a supply. Mr. Murray was
the 


lxiv ON THE CHARACTER
the person to whom he had recourse; the read-
er will not wonder that his interference should
have spoiled the adventure.
A London sharper of another denomination
afterwards tried to make advantage by the Doc-
tor. This was an ingenuous speculator in public
medicines. He thought a composition of the
most powerful stimulants might have a run, un-
der the title of Dr. Brown's exciting pill; and
for the privilege of his name offered him a sum
in hand by no means contemptible, as well as a
share of the contingent profits. Poor Brown,
needy as he was, spurned at the proposal.
It is easy to anticipate the remainder of my
tale. Change of residence wrought no change
of conduct. Some of his friends were disgust-
ed by those habits which repetition had unalter-
ably fixed. In dictating Brown's resolutions,
pride had always its share: Cullen, who never
mentioned his abilities without praise, used to
add, that his temper rendered it difficult to
deal with him. At the present period I have
been told, and I can easily believe, that he was
more impracticable than ever. He spoke in
sanguine terms of the probability that his system
would become at length triumphant; but what-
ever he said or imagined, he effected little. He
attempted to open, but never, I understand,
completed a course of lectures in London. In
1787 he published, without his name, those
" Observations," 


lxv OF JOHN BROWN. M. D.
" Observations," from which I have already
borrowed a passage. He could not in reason
expect to find a cordial welcome among his bre-
thren in England. Public opinion can alone
awe the body of established physicians in any
country into toleration of innovators; and know-
ledge on this subject was too little diffused for
public opinion to operate with effect in his fa-
vour. These "Observations" were therefore
properly intended for general perusal; but the
author was extremely defective in the talent of
rendering science popular. Nor was he patient
or rich enough to wait for the beneficial con-
sequences that might have resulted, if he could
have rendered his doctrine a subject of univer-
sal curiosity.
He persisted in his old irregularities for some
time, meditating great designs, with expecta-
tions not less ardent than if the spring of life,
in all its bloom of hope, had been opening be-
fore him. At length, on the seventh of Octo-
ber, 1788, when he was about fifty-two years
of age, he was seized with a fatal fit of apo-
plexy. He died, if I am not misinformed, in
the night, having swallowed as he went to bed
a very large dose of laudanum; a species of
dram to which he had, indeed, been long ad-
dicted. He was at this time about to begin a
course of lectures. I am assured by one who
had seen him the evening preceding his death,
I that 


lxvi ON THE CHARACTER
that his appearance did not betray any tokens of
distress; nor was it apparent that his constituti-
on had run much into decay since his departure
from Scotland.
When Cullen, two years afterwads, died in
embarrassed circumstances, his friends obtained
public aid for his family. Brown's destitute
widow and children were saved from distress by
private benificence; but it cannot be expected
that the contributions, raised for that purpose,
should have proved sufficient for their perma-
nent support.
Dr. Brown's family has been already mention-
ed as numerous: he left two sons and four
daughters. His eldest son is now studying me-
dicine at Edinburgh, where he has experienced
great liberality from the professors and the soci-
eties of students. His talents will, I hope, meet
with a more adequate compensation than those
of his unfortunate father.
In the recital of this scanty information, my
own sentiments have fluctuated so much that I
am doubtful whether I have preserved imparti-
ality, or shall appear consistent in the distributi-
on of pity, ridicule, censure, and applause,
among the incidents of Brown's life. Yet the
peculiarities by which he was distinguished, ap-
pear obvious enough. He was endowed with
uncommon susceptibility to impressions. By
whatever object they were touched, the springs
of his 


lxvii OF JOHN BROWN, M. D. 
of his nature bent deeply inwards; but they im-
mediately rebounded with equal energy. This
quality is the foundation of all moral and intel-
lectual superiority; but, unhappily, the strong
feelings and bold resolutions of Brown were not
improved into steady principles. He never
seems to have taken pains to form a system of
conduct advantageous to himself, and just to-
wards others. As soon as he lost the controul of
superstition, his high spirits hurried him into
the most intemperate excesses; and, at a later
period, his actions can only be regarded as the
plunges of despair. The tenderness with which
his cordiality inspired those who knew him
formerly, I could demonstrate by a varie-
ty of testimonies. By a writer already quo-
ted, he is styled " a man of infinite good-
" ness of heart (n)." Dr. S—con-
cludes his communication with these expres-
sions: " He was possessed of a great mind that
" supported him in the midst of all his distresses.
" He despised riches; detested every thing base,
" and possessed such openness of heart as to be
" liable to be taken in by every knave." He
undoubtedly committed an error, which has of-
ten been productive of fatal consequences to
persons accustomed to scientific speculation.—
He gave man kind credit for a more sincere re-
(n) Analyt. Rev. See above.
gard 


lxviii ON THE CHARACTER
gard for truth, and an higher sense of its impor-
tance, than they have entertained in any age.—
He imagined, perhaps, that Plato's sally con-
cerning Virtue was applicable to Science. He
therefore utterly neglected those arts by which
the imagination is captivated; and trusting to
their intrinsic value, bluntly challenged accep-
tance for his opinions.
Cicero and Bacon were his favourite authors;
in his elaborate compositions he imitated the
Roman orator with affectation; and it must be
confessed, that by taking advantage of the pe-
nury and want of precision, which Lucretius
and Cicero so loudly lament, he has succeeded
to his utmost wishes in constructing a style of
classical obscurity. He could, however, write
otherwise, and unite at will perspicuity with
purity. This may be ascertained by examining
the dissertations, which he furnished, at least,
with their Latin garb. Several are preserved in
a well-known collection (o); but for an obvi-
ous reason I must leave it to the curious reader
to discover, by private enquiry, which were
composed by Brown.
Bacon he admired not only for his masterly
survey of universal science, but likewise, as Dr.
Macdonnel acutely conjectures, because that
great author appeared to countenance him in the
(o) See Thesaurus Medicus, iii. and iv. Edin-
burgh, 1785-
disrespect 


lxix OF JOHN BROWN, M. D. 
disrespect with which he treated his predecessors.
He had little medical erudition. At first he
probably read more than ordinary students; but
after he had constructed his theory, he seldom
perused or consulted any medical author. He
was impatient when any difficulty was started
which he did not see clearly how to solve (p):
nor would he ever acknowledge any exception
to his principles. An argument against his fun-
damental propositions, which I had mentioned
in conversation to a favourite pupil, was com-
municated one evening, to the master in my
presence, a little before the hour of lecture.—
He said little in reply at the moment. But it ap-
peared that the objection worked upon his mind;
in the course of his lecture he waxed unexpect-
edly warm; and at last, addressed himself parti-
cularly to the pupil who had stated the objection.
He did not attempt to expose its futility, as
might easily have been done; but, exhorting
him to suffer no insinuations to divert his atten-
tion from the doctrine, he proceeded to deliver
against the exercise of the understanding, a dis-
suasive that might have done credit to the pul-
pit.
The Observations, and the Elements of Me-
dicine, are all the productions which he avow-
ed. But there prevailed a suspicion, and it has
(p) Dr. Macdonnel.
been 


lxx ON THE CHARACTER
been publicly mentioned (q), that he was the
author of the Enquiry, published in the name
of Dr. Jones. By his most confidential disciples
I have been assured, that they never heard him
drop an hint of having assisted in its compositi-
on. In manner it certainly bears a strong re-
semblance to the "Observations;" there are,
besides, as the reader may observe in my quo-
tations, forms of expression peculiar to Scot-
land; but the professed author may be said to
have derived the one from his preceptor, and
the other from the country in which he resided.
This book, we are told, was composed as spee-
dily as it could have been transcribed by an or-
dinary hand. It is unquestionably ill arranged,
tedious, uncouth, arrogant, and illiberal; yet
it contains passages presenting juster views of
medicine than I remember to have elsewhere
seen, and conceived in the genuine spirit of Ba-
con.
He designed a Latin elementary treaties of
morality on philosophical principles (r)—Elemen-
ta Morum; but he never, perhaps, committed
any portion of such a work to paper. We may
fairly presume that it would have been original,
luminous, and profound.—And since no man,
not deeply skilled in such knowledge, as phy-
(q) Dr. Duncan's Letter, p. 25.
(r) Dr. Macdonnel.
ever 


lxxi OF JOHN BROWN, M. D.
sicians should possess, will ever trace back human
actions and passions, along their winding course,
to the fountain head, the failure of Brown's de-
sign may be regretted as an heavy loss to literature.
Having received a little additional informati-
on, too late for insertion in the proper place, I
annex it here. To Mr. Wait's account of his
quickness in mastering languages; it may be
added, " that Brown displayed a genius for li-
" terature far superior to any scholar that had
" ever been under the care of Mr. Cruikshanks.
" In the course of two years, he could read all
" the Latin classics with the utmost facility; in
" the Greek language, he made the same re-
" markable proficiency." This intelligence
comes from Dr. S—, who likewise mentions
the astonishing power of his memory, and adds,
that he first went to Dunse school in 1751, when
he must have been above fourteen years of age.
The fact is remarkable, as he does not appear
to have been before instructed in the rudiments
of the learned languages. The same gentleman
confirms my account of the motives of his stre-
nuous application. " The leading members of
" the seceding congregation at Dunse, to which
" his parents belonged, were struck with the
" proofs of capacity he manifested at the coun-
" try-school, where he learned reading and
" writing; they encouraged him to go to the
" grammar- 


lxxii ON THE CHARACTER
" grammar-school, that he might be afterwards
" educated as one of their ministers, expect-
" ing he would greatly contribute to the promo-
" tion of their particular interest,"—
I have pleasure in recording that, by advice
of the friend who brought him the first thesis to
translate, he addressed a Latin letter, to the late
excellent Alexander Monro, then professor of
anatomy at Edinburgh, requesting gratuitous
admission to his lectures. Having succeeded in
this instance, he applied in the same manner to
the other medical professors.—
His intercourse with Cullen forms the most
curious part of Brown's history. The following
memorandum includes his reasons for dissatis-
faction with his patron, as they were assigned
soon after the separation to a person how ac-
knowledged his talents, without being a partizan
in his disputes, or a follower of his doctrines.
" They lived upon the strictest intimacy for ma-
" ny years; and Brown could call for a bottle
" of wine in Cullen's house, when he pleased.
" During all that time no man in Brown's com-
" pany could contradict any of Cullen's opini-
" ons without danger of offending him. After
" the quarrel, he said Cullen had promised him
" his interest for the first vacant chair in the
" college; but when the late Dr. Gregory died,
" instead of using his interest in Brown's fa-
" vour, he did the reverse—that, to try him
further 
 

lxxiii OF JOHN BROWN, M. D. 
" further, Brown petitioned for admission in-
" to the philosophical society, but was re-
" jected through Cullen's means." Here only
one side of the question is shewn: and the re-
presentation comes from a man of impetuous
passions, who, to obtain our full confidence,
should either have been less violent in defend-
ing or in opposing Cullen.—Complaints of dis-
appointed expectations are still more common
in the intercourse of patronage, than of faith-
less vows in that of gallantry: this happens, I
suppose, because offers and promises are extract-
ed from harmless expressions, by which persons
who amuse themselves with gallantry and pa-
tronage, do not intend to convey any particular
meaning.
K OF

(lxxiv)
OF Dr. BROWN'S PRIVATE
PRACTICE.
TO some readers it may appear strange that
I should have finished the life of a physician,
who caused so great an uproar in the medical
world, without more particular notice of his
private practice. I enquired with some solici-
tude, but in vain, whether during the long pe-
riod of his studies he was peculiarly observant
of diseases. One circumstance I have lately
learned; and it will surprise those who believe
him to have inculcated contempt for the sciences
auxiliary to medicine: my authority however is
unquestionable. The season before he became
an independent lecturer, he was industrious to
acquire more minute anatomical knowledge than
he had gained by attendance on the public lec-
tures; and for some time attended a private in-
structor at five o'clock in the morning, and con-
tinued with him for two hours; botanical infor-
mation was added, on these occasions, to the
anatomical. He had formerly been advised by
Cullen to qualify himself for giving demonstra-
tions in anotomy. Nothing could be imagined
so entirely repugnant to his turn of mind; no
wonder, therefore, the advice was not followed. 
 

lxxv PRIVATE PRACTICE. 
Brown somewhere condescends to speak of
his own " very large practice;" but this is a
compliment which every medical writer appa-
rently thinks that usage justifies him in paying to
himself.
I remember to have heard of an house at Edin-
burgh, which the Brunonians opened for the
reception of poor patients; probably they were
not able to procure funds for its permanent sup-
port. The founder of the sect was, I believe,
seldom consulted but in cases given up as hope-
less; and he was then apt to speak with impru-
dent confidence. According to Dr. S—,
" his wish to ride in his carriage would, in all
" probability, have been gratified, had it not
" been prevented by his sudden death afterwards
" in London." If this surmise is founded up-
on any real tokens of approaching prosperity,
I could wish they had been assigned. For Brown
went to London with no favourable omens; eve-
ry extraneous circumstance was against him, and
what else could avail him in a place, where it is
well known to men of observation, that success
has seldom been in proportion to merit? Dr.
JOHNSON, who must have witnessed physician
after physician carrying away the prize of public
favour from competitors, far superior in parti-
cular skill and general abilities, declares that
" in a great city medical reputation is, for the
" most part, totally casual." " By an acute
" observer," 


lxxvi OF DR. BROWNS, &C. 
" observer," he subjoins, " who had looked
" on the transactions of the medical world for
" half a century, a very curious book might
" be written on the fortune of physicians."—
The idea appears to me so happy that I shall
venture to prosecute it through a few pages.
Such a book, with a due extention of the
plan, would afford opportunities for displaying
professional science, to wit, knowledge of the
world, and benevolence. For if it be true that
many have been received in the name of the
goddess of health, who were, in reality, not
the least active among the ministers of death,
the mistake deserves to be cleared up; and a
proper explanation would be better than " cu-
" rious;" it would not only teach how some
members of the faculty have contrived to retain
a privilege which the priesthood has lost, but
furnish I know not how much useful instruction
besides.
OF REPUTATION IN PHYSIC.
On the most superficial enquiry, it would be
manifest that this man prospered because he had
been of a certain univesity; another, merely be-
cause he belonged to a particular sect; a third,
because he happened to be in the way of procu-
ring a recommendation to some leader in poli-
tics or fashion. A great number would be seen
to have succeeded in life for the same reason
precisely 


lxxvii OF REPUTATION IN PHYSIC 
precisely that Falstaff succeeds upon the stage.
Few analyse their sensations, and the first im-
pression made by these adventurers was pleasing.
As far as the dramatic personage is concerned,
the reason is unquestionable, but it by no means
applies so happily to the other case. The qua-
lities producing the happy impression, have, in
truth, frequently borne no nearer a relation to
professional merit, than Falstaff's pleasantry to
solid worth of character; in a variety of instan-
ces, they have been no other than symmetry of
features or softness of address.
It is calamitous enough for individuals, la-
bouring under disease, to fall into bad or indif-
ferent hands; but when the caprice of fortune
elevates her worthless favourites to the first emi-
nence in so important a profession as medicine,
a more extensive injury is done to society than
we should at first imagine. To calculate its
amount requires a great deal of thought. Be-
side the mischief they perpetrate with their own
hands, these intruders occupy the station due
(if the general welfare is to settle the prece-
dence), to physicians of enlarged views, who
would make a beneficial use of its advantages,
and impel the defective art on towards perfecti-
on. Is an example necessary to enable you to
conceive what might be effected by the power-
ful influence of medical men, enjoying the con-
fidence of the great? A number may be given,
but 


lxxviii OF REPUTATION IN PHYSIC.
but one will suffice: and it is the better for its
simplicity. We have no observations from
which we can certainly deduce the difference, in
point of efficacy, between certain warm medicinal
springs and common water, heated to the same
temperature. The problem, merely for its cu-
riosity, deserves to be solved; and it happens
to be peculiarly interesting to that order, from
which doctors in vogue receive their amplest
gratuities. They have shewn little anxiety for
the removal of this difficulty, either for their
own direction in practice, or by way of return
to their benefactors.
They will too often, I fear, be found to have
been worse than inattentive to the advancement
of their art; and to have discouraged useful in-
vestigations by insinuation, if not by direct op-
position. Pride and avarice will always combine
to render a prosperous adventurer in medicine,
whose views are narrow, jealous of improve-
ments and hostile to improvers. The internal
monitor whispers that it was not by knowledge
he rose, but by knowledge he may sink. It is
therefore the constant expedient of dullness to
persuade the world that men of genius are defi-
cient in judgement; though it be certain that
the very persons who have been most remark-
able for devising new means of relieving distress
and removing uncertainty, have also been the
most acute in discerning the real relations of
things. 


lxxix OF REPUTATION IN PHYSIC. 
things. Still, however, the old way is judged
the safest, and crafty mediocrity treasures up the
spoils of the credulous and the rich.
It is possible to measure the number of de-
grees by which medicine is more imperfect than
it would have been if the public was not so liable
to misplace its confidence, and had not actually
so often misplaced it. For this purpose, our
enquirer, I apprehend, will find in the progress
of a kindred art, a standard of easy application.
Let it be supposed that a succession of men of
specious carriage and mean talents had flourished
for a century past, in the place of our great im-
provers of surgery. Then good part of their
discoveries would have been lost, for we cannot
believe that, under discouragement, and with
inferior opportunities, Pott, Hunter, and their
predecessors could have rendered equal services
to humanity. Of these services a concise but
clear account should be given; the same scru-
tiny should then be extended to the labours of
the physicians that have flourished during the
same period; it may begin with Radcliffe, and
be carried down to our own times. Thus ordi-
nary readers would be put in a condition to judge
how far it betrays a spirit of wanton disparage-
ment, to affirm that a physician in a great city,
" is the mere plaything of fortune, they that
" employ him, not knowing his excellence,
" nor


lxxx OF REPUTATION IN PHYSIC.
nor they that reject him, his deficience (s);"
these assertions, if they be well-founded, ine-
vitably lead to a conclusion more important
than satisfactory, for however we may be start-
led, we must infer that the greatest repute in medi-
cine affords scarce the slightest presumption of superi-
or skilfulness.
Of the fortunate sons of Esculapius, several
have been wary enough not to expose themselves
to criticism; in most cases, however, we have
memorials sufficient to guide our judgement;
some have left written documents of their pow-
ers; here the proportion between reputation and
ability can be estimated with great precision.
Considering that his enquiry can be useful on-
ly by inculcating salutary circumspection, our 
author should not be deterred by the first senti-
ments of repugnance which the attack would ex-
cite in many minds, nor by the respect due to
his virtues, from examining the title of the cele-
brated Fothergill to present confidence, or post-
humous reputation. He should insist the more
on this decisive example, because Fothergill re-
ally appears to have done his best towards im-
proving the art that enriched him; and because
it would be difficult to prove that any among
his equals in popularity, have performed, or
could have performed greater things. How far
(s) Johnson's Life Akenside.
he excelled 


lxxxi OF REPUTATION IN PHYSIC. 
he excelled in sagacity of discrimination, or fer-
tility of resources, would be easily shewn by an
impartial survey of his works; and little doubt
would remain whether his patients would have
sustained much disadvantage, or our present
stock of information much diminution, if any
well-meaning man of plain sense had moved in
his sphere. If the smallest scruple should be
left, there exists a piece of evidence which it
may be the more difficult to resist, as it comes
from the mouth of the worthy Doctor himself.
Fothergill and others, have been heard by Dr.
G. Fordyce, " to state in a serious harrangue,
" their inspiration, not only in the knowledge of
" diseases without enquiring into their external
" appearances, but in making prescriptions to
" flow from their pen, without any previous
" composition in their mind; not in compli-
" ance with the prejudices of their patients, but
" from their own belief (t)."
From such a comparative estimate, the chief
reason why surgery has so far distanced medicine,
would appear. Should it be said that surgery
must, from its nature, have outstripped medi-
cine, as mechanical philosophy necessarily at-
tained some degree of perfection before chemis-
try, the justness of the observation may be ac-
knowledged. But after a liberal allowance for
(t) Fordyce on Fever, p. 160.
L this 


lxxxii OF REPUTATION IN PHYSIC.
this cause of inequality, the author of the In-
vestigation would find a far more powerful cause
necessary to account for the whole effect.—He
might corroborate his inference by an enumera-
tion of the improvements actually made in me-
dicine; from which it would be evident that
they have been principally owing to persons en-
joying moderate reputation in the country.
Objections will occur to hasty reasoners; and
these the author must take care to obviate. " A
" physician of great eminence may be too busy
" to write; he may, also, be highly useful in
" his generation without leaving any traces of
" his skill behind." He could not, however,
well be more busy than several of the most emi-
nent surgeons, who have found time to write
extensive treatises; moreover, his practice and
conversation, without the aid of his pen, would
so widely spread the knowledge of his discove-
ries, that the patients of every village apothe-
cary would have cause to bless the London lumi-
nary of physic.
The answer to these objections affords a cri-
terion, by which we shall be as little liable to be
deceived, as when we judge of the value of a
fruit-tree by its produce. If a physician has at-
tained to great eminence without having made some
assignable improvement in physic, if he has neither
executed nor promoted any designs, tending to this
end, he may be safely set down as the narrow-minded
creature 
 

lxxxiii OF REPUTATION IN PHYSIC.
creature of artifice, or the spoiled child of chance.—
In an age where every incident is brought within
reach of every eye, we may with perfect safety
apply to personages so conspicuous the maxim of
the schoolmen, that " what does not appear, is
" to be reputed not to exist."
The work in question doubtless requires cou-
rage as well as other valuable qualities; yet the
author, if I do not mistake, would incur less
danger at present than at any preceding period.
The professors of surreptitious or accidental same,
would infallibly join in crying or hunting him
down, and by signs of alarm bear witness to the
merit of the production. But I have reason to
believe that the combination would fail in bring-
ing it into total discredit. Some progress has
been made in arranging the peculiar properties
of animated nature, and in recommending to
mankind the knowledge of themselves. A se-
ries of propositions, expressed in intelligible
language, and capable of comparison with ap-
pearances, has been formed. These propositi-
ons, which occur principally in the writings of
Dr. Brown, Mr. Hunter, and the author of
Zoonomia, may be regarded as the foundation
of a new science, not less generally interesting
than any of the preceding: for it would be dif-
ficult to assign a reason why the celestial motions,
the working of machines, or chemical phæno-
mena, should be objects of liberal curiosity;
to the 


lxxxiv OF REPUTATION IN PHYSIC.
to the exclusion of the effects produced by the
principle of life. One reason, of which the
force will not be easily eluded, may be assigned
in behalf of the latter study. It directly tends
to promote the well-being, and prolong the ex-
istence, of the student. The time therefore
cannot be far distant, when instruction concern-
ing the causes of health and disease will be ac-
knowledged to form a necessary part of all rati-
onal education; and the nearer we approach to
this period, with less hazard may the analysis
proposed by Johnson, with the plan so enlarged,
and the purpose so ennobled, be executed.
There is, still, an addition which, in my
opinion, would contribute somewhat to precisi-
on, and somewhat to secure the sick against the
danger of medical slaughter. This appendix I
should call JATROLOGIA, a denomination from
which the learned reader may infer, that I have
in view some such application of the Linnæan
method to physicians, as Baron Born has exem-
plified in his classification of Monks.
If those assemblages of human animals, that
constitute political societies, were arranged ac-
cording to the nature of their occupations, one
class would consist of individuals, depending for
their support upon opinion. This class, being
provided with the name of Greek origin, might
be easily split into orders; of these orders the me-
dical tribe would make one. We have the or-
der broken 
 

lxxxv OF REPUTATION IN PHYSIC. 
der broken into genera ready to our hands: of
the distribution into species (which is more dif-
ficult) a specimen is subjoined.—Our writer's
present concern is only with the genus—Doctor
of Physic. This genus we may subdivide into
sections, or groups; as Linnæus sometimes ma-
nages with genera, comprehending a number of
species.
SECT. I.
DOCTORS as desirous, at least, of doing good and
extending knowledge, as of amassing wealth.
1. The philanthropic DOCTOR, D. equally sen-
sible of the importance and imperfection of me-
dicine; compares the phænomena of health and
disease with unwearied assiduity, that he may
form a just arrangement of the actions of life,
persuaded that this is the only sure guide in me-
dical practice; cautiously tries new remedies,
and abides by the best; beats the coverts of sci-
ence, that he may himself start something use-
ful; is humane in his conduct, not so much
from sudden impulses of the passion of pity,
as from a settled conviction of the misery pre-
vailing among mankind.
Var. α. The shy philanth. D. sick with dis-
gust at the manœuvres of his intriguing brethren,
runs into the opposite extreme, and keeps too
closely retired from public notice.
Var. β. The renegado phil. D. possessing ac-
tivity
 

lxxxvi JATROLOGIA.
tivity of mind and integrity of principles; re-
linquishes the practice of physic, partly for the
same reason as Var. α. and partly from dissatis-
faction with its helpless state; applies his talents
to literature or science.
Obs. 1. Several of the greatest accessions to hu-
man knowledge are owing to this second va-
riety.
Obs. 2. A careful examination and compari-
son of these two varieties, with some of the
succeeding species, will elucidate the nature of
those physicians, that have usually had great lo-
cal vogue.
More frequent than formerly—not apt to flou-
rish in great cities—otherwise not confined to any
particular situation. As self-love grows more
enlightened, the more common will this sp. of
D. become, till it supplants all the others: man
being an animal less liable to be duped as his ig-
norance decreases.
SECT. II.
D. Mere collectors of fees, regardless of medical
science, given to artifice and intrigue, each species
after its own manner.
3. The bullying DOCTOR, D.
—Inexorabilis, acer
looks big, struts, swaggers, swears.
Obs. Surgeons, in our times, more frequent-
ly bear these marks. According to a most
acute contemporary author, the famous RAD-
CLIFFE was a compleat specimen of the bullying 


lxxxvii JATROLOGIA.
D. " With small skill in physic, and hardly any
" learning, he got into practice by vile arts.—
" He would neglect a nobleman that gave exor-
" bitant fees;" and to heighten the insult by
contrast " at the same time carefully attend a
" servant or mean person for nothing—he was
" surly and morose; treated his patients like
" dogs—extended his insolence even to the
" Royal Family—scorned to consult with his bet-
" ters on what emergency soever; looked down
" with contempt on the most deserving of his
" profession, and never would confer with any
" physician who would not pay homage to his
" superior genius; creep to his humour, and
" never approach him but with the slavish obse-
" quiousness of a court flatterer."
3. The bachanalian DOCTOR. D. given to sot-
tishness, if not drunkenness—generally some-
what of the Bully.
4. The solemn DOCTOR. D. with garb, voice,
gestures, and equipage, contrived to overawe
weak imaginations, and hide the futility of his
art.
Obs. 1. D. of this remarkable species first
practised physic with pomp: they invented or
borrowed from the other professions those bar-
barous habiliments, of which ridicule has but
lately stripped physicians. In times, when an
huge wig, or a flowing gown, could more effec-
tually 


lxxxviii JATROLOGIA.
tually command respect than sound morality,
substantial justice, or useful skill, the stratagem
succeeded to admiration.
Obs. 2. D. of this species, when a pretext
offers, speaks ostentatiously of their experience
—never suspecting any of their hearers may
know that there are understandings which mul-
tiplicity of appearances serves but to confound.
5. The club-hunting DOCTOR. D. frequenting
the crowded haunts of men; pushing himself
forward, saluting all he knows, and all who will
know him; talking much and loud.
Obs. In England, D. of this species have of
late been frequently seen in paroxysms of frantic
loyalty, and of civisme in France.
6. The burr DOCTOR. D. fastening himself
upon you as tenaciously as the heads of the noi-
some weed (centaurea calcitrapa), from which
the trivial name of the sp. is taken, fix upon
your cloaths.
Obs. Nothing in art, but the juggler's ad-
dress in making you take what card he pleases
out of a pack, equals the dexterity with which
D. of this sp. force themselves on patients.
7. The wheedling DOCTOR. D. with an ever-
lasting smirk upon his countenance—frequent at
the polite end of large cities, and at places of
fashionable resort.
Var. α. The Adonis wheedling D. D. with an
handsome face, joined to the wily address, cha-
racteristic 


lxxxix JATROLOGIA.
racteristic of the sp.—flourishes at watering
places; sometimes joins to his profession the
trade of a fortune-hunter; and if he succeeds,
" gives physic to the dogs." 
Obs. 1. D. of this sp. when most moderate,
prescribe for every rich patient two draughts a
day, and one night draught, besides pills and
powders. Hence needlessly to swallow nauseous
drenches may be numbered among the curses of
wealth.
Obs. 2. The Adonis D. has sooner or later a
patient of note, ill of a fever or some disease,
that usually terminates favourably; in case of
recovery the female busy-bodies of the place,
exert their spirit of cabal in behalf of the won-
der-working youth, and his fortune is made.
8. The case-coining DOCTOR. D. publishing
forged or falsified cases.
Obs. " A very fertile source of false facts has
" been opened for some time past. This is, in
" some young physicians, the vanity of being
" the authors of observations which are often too
" hastily made, and sometimes, perhaps, very en-
" tirely dressed in the closet. We dare not at pre-
" sent be more particular; but the next age
" will discern many instances of perhaps the di-
" rect falshoods, and certainly the many mis-
" takes in fact, produced in the present age,
" concerning the virtues and powers of medi-
" cines." CULLEN. Mater. Med. I. 153.
M A-kin 


xc JATROLOGIA.
A-kin to this flagitious abuse is the practice of
purchasing false attestations, on oath, for adver-
tisements; and what is still worse in effect,
though not in intention; a custom beginning to
prevail among persons of distinction—who cannot
be supposed capable of discriminating diseases,
or deciding on the efficacy of drugs—but who,
nevertheless, permit Quacks to use their names
in testimony of cures, which they suppose them-
selves to have witnessed.
9. The good-sort-of-man DOCTOR. D. a good
sort of man, armed, by some mistake with a di-
ploma.
Var. α. The gossiping good-sort-of-man D.
fetches and carries scandal.
Obs. Varieties numerous as the hues of the ca-
mæleon.
10. The Sectarian DOCTOR. D. dwelling
among his own people at first; and by them of-
ten pushed on to spread devastation among the
rest of mankind.
Obs. Varieties manifold; each distinguishable
by the livery of its sect—one is too curious to
be omitted.
Var. α. The inspired Sect. DOCTOR. D. be-
lieving himself to be inspired with the know-
ledge of diseases and remedies.
In civilized countries not much more frequent
than witches. Among rude tribes, as among
the Tartar hordes, a kindred variety is univer-
sally 


xci JATROLOGIA.
sally found. See Gmelin's Travels. But these
seem rather to pretend to inspiration, than really
to believe that their deity serves them in the ca-
pacity of Prompter: and they conjoin the cha-
racters of priest and conjurer with that of phy-
sician. I have not been able to ascertain whe-
ther our variety receives the afflatus, except in
its medical capacity: and the miracles it has
wrought in this, are not so perfectly authentica-
ted, as to silence cavillers.
Obs. People are now-a-days delicate in giving
recommendations on some occasions; but the
best bred persons make no scruple of pressing a
favourite physician or apothecary upon their ac-
quaintance. Yet one would think that they are
nearly as competent to speak to the merit of a
footman, as of a prescriber or compounder of
drugs. Sects sometimes improve this propensi-
ty into a regular system of cabal. The deeper
the hypocrisy, or the wilder the enthusiasm of
the Sect. Doctor; the more eagerly will his bro-
ther-fanatics dash through thick and thin to serve
him. Now as belief or disbelief in certain points
of theology, has no apparent connection with
skill in the administration of antimony, mercu-
ry, opium, and bark, we may deduce from this
fact a rule which is probably as little liable to ex-
ception, as any that be laid down on the whole
subject. Never call in a physician, BECAUSE he is
recommended by a person of the same sect; the more
yo 


xcii JATROLOGIA.
you are urged, be the more on your guard against the
snare. This rule extends to all dæmoniacs pos-
sessed by the corporation-spirit, and to all sets of
persons remarkably gregarious.
Observation.
Concerning this decad of doctors, there re-
mains a caution to be laid down; and that it may
make the greater impression, I shall deliver it in
the style of my models, the naturalists. No-
tandum in toto hoc genere naturam mirabiles edere lu-
sus. It is indeed applicable to all the species;
individuals being apt, like hybrid plants, or
mule animals, to exhibit the marks of two spe-
cies, wholly or in part.
OF 

(xciii)
OF THE BRUNONIAN DOCTRINE.
A complete investigation of Dr. Brown's the-
ory of living nature, with its application to the
knowledge and treatment of diseases, would,
at least, equal the original work in size: besides,
if I had any inclination to write such a commen-
tary, I should not consider this as the proper
place for introducing it. I have, however, a
few words to say on the outlines and formation
of the system. I shall subjoin some reflections
to put medical students and readers, not profes-
sional, in the way of profiting by the true prin-
ciples he promulgated without being misled by
his doubtful or erroneous positions.
Of Dr. Brown's Fundamental Propositions.
The varied structure of organized beings it is
the business of anatomy to explain. Conscious-
ness, assisted by common observation, will dis-
tinguish animated from inanimate bodies with
precision more than sufficient for all the ends of
medicine. The cause of gravitation has been
left unexplored by all prudent philosophers; and
Brown, avoiding all useless disquisition concern-
ing the cause of vitality, confines himself to the
phænomena, which this great moving principle
in nature may be observed to produce. His most
general propositions are easy of comprehension.
I. To every animated being is allotted a cer-
tain portion only of the quality or principle, on
which 
 

xciv OF THE BRUNONIAN DOCTRINE.
which the phænomena of life depend. This
principle is denominated EXCITABILITY.
II. The excitability varies in different animals,
and in the same animal at different times. As it
is more intense, the animal is more vivacious or
more susceptible of the action of exciting powers.
III. Exciting powers may be referred to two
classes. 1. External, as heat, food, wine, poi-
sons, contagions, the blood, secreted fluids,
and air. 2. Internal, as the functions of the bo-
dy itself, mascular exertion, thinking, emotion
and passion.
IV. Life is a forced state; if the exciting
powers are withdrawn, death ensues as certainly
as when the excitability is gone.
V. The excitement may be too great, too
small, or in just measure.
VI. By too great excitement weakness is indu-
ced, because the excitability become defective;
this is indirect debility: when the exciting powers
or stimulants are withheld, weakness is induced;
and this is direct debility. Here the excitability
is in excess.
VII. Every power that acts on the living
frame, is stimulant, or produces excitement by
expending excitability. Thus, although a per-
son, accustomed to animal food, may grow weak
if he lives upon vegetables, still the vegetable
diet can only be considered as producing an ef-
fect, the same in kind with animals, though in-
ferior 
 

xcv OF THE BRUNONIAN SYSTEM. 
ferior in degree. Whatever powers therefore,
we imagine, and however they vary from such
as are habitually applied to produce due excite-
ment, they can only weaken the system by ur-
ging it into too much motion, or suffering it to
sink into langour.
VIII. Excitability is seated in the medullary
portion of the nerves, and in the muscles. As
soon as it is any where affected, it is immediate-
ly affected every where; nor is the excitement
ever increased in a part, while it is generally di-
minished in the system; in other words, differ-
ent parts can never be in opposite states of ex-
citement.
I have already spoken of an illustration, drawn
up by Mr. Christie from a familiar operation, to
facilitate the conception of Brown's fundament-
al positions. I introduce it here as more likely
to answer its purpose than if separately placed at
the end of my preliminary observations. " Sup-
" pose a fire to be made in a grate, filled with
" a kind of fuel not very combustible, and
" which could only be kept burning, by means
" of a machine containing several tubes, placed
" before it, and constantly pouring streams of
" air into it. Suppose also a pipe to be fixed in
" the back of the chimney, through which a
" constant supply of fresh fuel was gradually let
" down into the grate, to repair the waste occa-
" sioned by the flame, kept up by the air ma-
" chine." 


xcvi ON THE BRUNONIAN SYSTEM.
" The grate will represent the human frame;
" fuel in it, the matter of life, the excitability of the
" Dr. Brown and the sensorial power of Dr. Dar-
" win; the tube behind supplying fresh fuel, will
" denote the power of all living systems con-
" stantly to regenerate or reproduce excitabili-
" ty; while the air machine, of several tubes,
" denotes the various stimuli applied to the ex-
" citability of the body; and the flame drawn
" forth in consequence of that application re-
" presents life, the product of the exciting
" powers acting upon the excitability."
" As Dr. Brown has defined life to be 'a for-
" ced state,' it is fitly represented by a flame,
" forcibly drawn forth, from fuel little disposed
" to combustion, by the constant application of
" streams of air poured into it from the differ-
" ent tubes of a machine. If some of these
" tubes are supposed to convey pure or dephlo-
" gisticated air, they will denote the highest
" class of exciting powers, opium, musk, cam-
" phor, spirits, wine, tobacco, &c.—the dif-
" fusible stimuli of Dr. Brown, which bring
" forth for a time a greater quantity of life than
" usual, as the blowing in of pure air into a fire
" will temporarily draw forth an uncommon
" quantity of flame. If others of the tubes be
" supposed to convey common or atmospheric
" air, they will represent the ordinary exciting
" powers, or stimuli, applied to the human 
" frame, 


xcvii BRUNONIAN SYSTEM. 
" frame, such as heat, light, air, food, drink, &c.
" while such as convey impure and inflammable
" air may be used to denote what have formerly
" been termed sedative powers, such as poisons,
" contagious miasmata, foul air, &c."
" The reader will now probably be at no loss
" to understand the seeming paradox of the
" Brunonian system; that food, drink, and all
" the powers applied to the body, though they
" support life, yet consume it; for he will see,
" that the application of these powers, though
" it brings forth life, yet at the same time it
" wastes the excitability or matter of life, just as
" the air blown into the fire brings forth more
" flame, but wastes the fuel or matter of fire.—
" This is conformable to the common saying,
" ' the more a spark is blown, the brighter it
" burns, and the sooner it is spent.' A Roman
" poet has given us, without intending it, an
" excellent illustration of the Brunonian system,
" when he says,
" Balnea, Vina, Venus, consumunt corpora nostra,
" Sed Vitam faciunt Balnea Vina Venus."
" Wine, warmth, and love our vigour drain;
" Yet wine, warmth, love, our life sustain."
Or to translate it more literally,
" Baths, women, wine, exhaust our frame,
" But life itself is drawn from them."
" Equally
N 

xcviii ILLUSTRATION OF THE
" Equally easy will it be to illustrate the two
" kinds of debility, termed direct and indirect,
" which, according to Brown, are the cause of
" all diseases. If the quantity of stimulus, or
" exciting power, is proportioned to the quanti-
" ty of excitability, that is, if no more excite-
" ment is drawn forth than is equal to the quan-
" tity of excitability produced, the human frame
" will be in a state of health, just as the fire will
" be in a vigorous state, when no more air is
" blown in, than is sufficient to consume the
" fresh supply of fuel constantly poured down
" by the tube behind. If a sufficient quantity
" of stimulus is not applied, or air not blown
" in, the excitability in the man, and the fuel in
" the fire will accumulate, producing direct debi-
" lity, for the man will become weak, and the
" fire low. Carried to a certain degree they will
" occasion death to the first, and extinction to
" the last. If again, an over proportion of stimu-
" lus be applied, or too much air blown in, the
" excitability will soon be wasted, and the mat-
" ter of fuel almost spent. Hence will arise in-
" direct debility, producing the same weakness in
" the man, and lowness in the fire as before,
" and equally terminating, when carried to a
" certain degree, in death and extinction."
" As all the diseases of the body, according to
" Dr. Brown, are occasioned by direct or indi-
" rect debility, in consequence of too much or
" too little stimuli, so all the defects of the fire
" must 


xcix BRUNONIAN SYSTEM. 
" must arise from direct or indirect lowness, in
" consequence of too much or too little air
" blown into it. As Brown taught that one de-
" bility was never to be cured by another, but
" both by the more judicious application of sti-
" muli, so will be found the case in treating the
" defects of the fire. If the fire has become
" low, or the man weak by the want of the
" needful quantity of stimulus, more must be
" applied, but very gently at first, and increas-
" ed by degrees, left a strong stimulus applied
" to the accumulated excitability should produce
" death, as in the case of a limb benumbed by
" cold (that is weakened by the accumulation
" of its excitability in consequence of the ab-
" straction of the usual stimulus of heat), and
" suddenly held to the fire, which we know from
" experience is in danger of mortification, or
" as in the case of the fire become very low by
" the accumulation of the matter of fuel, when
" the feeble flame, assailed by a sudden and
" strong blast of air, would be overpowered and
" put out, instead of being nourished and increas-
" ed. Again, if the man or the fire have been
" rendered indirectly weak, by the application
" of too much stimulus, we are not suddenly to
" withdraw the whole, or even a great quantity
" of the exciting powers or air, for then the
" weakened life and diminished flame might
" sink entirely, but we are by little and little to
" diminish the overplus of stimulus, so as to
" enable 


c REPUTATION OF THE
" enable the excitability, or matter of fuel, gra-
" dually to recover its proper proportion.—
" Thus a man who has injured his constitution 
" by the abuse of spirituous liquors, is not sud-
" denly to be reduced to water alone, as is the
" practice of some physicians, but he is to be
" treated, as the judicious Dr. Pitcairn of Edin-
" burgh, is said to have treated a Highland
" chieftain, who applied to him for advice in
" this situation. The Doctor gave him no me-
" dicines, and only exacted a promise of him,
" that he would every day put in as much wax
" into the wooden queich out of which he drank
" his whisky, as would receive the impression
" of his arms. The wax thus gradually accu-
" mulating, diminished daily the quantity of
" the whisky, till the whole queich was filled with
" wax, and the chieftain was thus gradually,
" and without injury to his constitution, cured
" of the habit of drinking spirits."
" These analogies might be pursued farther;
" but my object is solely to furnish some general
" ideas, to prepare the reader for entering
" more easily into the Brunonian theory, which
" I think he will be enabled to do after perusing
" what I have said. The great excellence of
" that theory, as applied not only to the practice
" of physic, but to the general conduct of the
" health is, that it impresses on the mind a sense
" of the impropriety and danger of going from
" one extreme to another. The human frame
" is 


ci BRUNONIAN SYSTEM.
" is capable of enduring great varieties, if time
" be given it, to accommodate itself to different
" states. All the mischief is done in the transi-
" tion from one state to another. In a state of
" low excitement we are not rashly to induce a
" state of a high excitement, nor when elevated
" to the latter, are we suddenly to descend to
" the former, but step by step, and as one who
" from the top of a high tower descends to the
" ground. From hasty and violent changes the
" human frame always suffers, its particles are
" torn asunder, its organs injured, the vital prin-
" ciple impaired, and disease, often death, is
" the inevitable consequence."
" I have only to add that though in this illu-
" stration of the Brunonian System (written se-
" veral years ago), I have spoken of a tube
" constantly pouring in fresh fuel, because I
" could not otherwise convey to the reader a fa-
" miliar idea, of the power possessed by all li-
" ving systems, to renew their excitability when
" exhausted, yet it may be proper to inform the
" student, that Dr. Brown supposed every living
" system to have received at the beginning its
" determinate portion of excitability, and there-
" fore, although he spoke of the exhaustion,
" augmentation, and even renewal of excitabi-
" lity, I do not think it was his intention to in-
" duce his pupils to think of it, as a kind of
" fluid substance, existing in the animal and sub-
" ject 


cii REPUTATION OF THE
" ject to the law by which such substances are
" governed. According to him excitability was
" an unknown somewhat, subject to peculiar
" laws of its own, and whose different states we
" were obliged to describe (though inaccurately)
" by terms borrowed from the qualities of mate-
" rial substances."
T. C.
IT was not unusual for Brown's disciples to
disagree, when they were called upon for a strict
interpretation of his principal tenets. If they
be rigidly examined, they will be found, I think,
not quite consistent with his own important doc-
trine of the accumulation of excitability, du-
ring different states of inaction. It appears to
me, that according to his first chapters (xviii),
living beings ought to have proceeded through
langour to death in one unbroken tenour of wake-
fulness, and that all the images and lamentations
which sleep has suggested to the poets, would
have been lost. He who assumes that a certain
portion of excitability is originally assigned to
every living system, by his very assumption, de-
nies its continual production, subsequent diffusi-
on, and expenditure at a rate equal to the supply,
or greater or less. That the brain is an organ
destined to secrete the matter of life, he could
never have supposed, otherwise he would not
have expressed a doubt whether excitability be a
quality or a substance.
If we admit a successive supply of this princi- 


ciii BRUNONIAN SYSTEM. 
ple, we may solve in a very easy manner, seve-
ral difficulties, for the sake of which new epi-
cycles must be added to Brown's system. In the
cold bath we may imagine the generation of sen-
sorial power, to proceed with small diminution,
while the actions on the surface of the body are
considerably abated by local subduction of heat.
Thus the well-known glow will be the effect of
undiminished production within, while external
expenditure is diminished. But weak persons
frequently do not experience any glow. Here
the action on the skin affects the system univer-
sally; the production, therefore, is checked from
the torpor of the secerning organ, and this state
of the brain explains the head-ache and chilliness,
subsequent to the misuse of the cold bath. These
effects are not, in my apprehension, easy to be
reconciled to the hypothesis of a fixed original
stock of excitability; the same thing may be said
of seeds and eggs long preserved, without sensi-
ble change, in a state capable of germination and
growth. Sleep sometimes produces no refresh-
ment, and yet it seems not to be imperfect or
disturbed in proportion to the langour felt on
awaking. This I have attributed to a failure in
the supply of excitability (a.); and nervous fe-
ver is imputed by another physiologist, to this
cause of debility, of which Brown had no sus-
(a) Observations on Calculus, &c.
suspicions.—
 

civ REPUTATION OF THE
picion.—If an illustrative analogy be desired, his
excitability might be compared to a fluid lodged
in the body as a reservoir. According to the
statement which I think more consonant to the
phænomena, excitability would be like a fluid
issuing from the brain as water from a spring.—
These resemblances might be traced a little way,
but they soon fail, as always happens in matters
so essentially dissimilar.
The hypothesis of Brown is happily adapted
to the limited term of life; according to the
other supposition, we must conceive old age and
death to depend upon a limited power of secreti-
on in the brain. The difference is scarcely per-
ceptible here, but in terms; it is, however, plea-
sing to suppose that wiser ages will be employed
in the culture of the human species to which
prolongation of life is essential: and we can more
easily reconcile our thoughts to augmentation of
power in a secerning organ, than of the original
provision of excitability; so that the doctrine, in
other respects the more probable, seems more
conformable to the prospect of improvement.
Of Brown's Application of his Principles.
The most negligent observer might bring spe-
cious objections against that uniformity of opera-
tion in stimulus which is taught in the first propo-
sitions of the following elements: " heat and wine,
" it might be said, can never act in the same
" manner, for no person is intoxicated by heat."
In the progress of his work we find the author re- 


cv OF BROWN'S DOCTRINE.
laxing, in some degree, the rigour of his princi-
ples. When the excitability is wasted by one sti-
mulus, excitement, he says, may be produced
by another; nor does it seem necessary, accord-
ing to the examples quoted in the latter part of
the thirty-first paragraph, and the subjoined note,
that the second stimulus should be more pow-
erful than the first. The succession in the note
is, food, thought, wine, food, punch, opium, punch,
thought, and speech; and this is not conformable
to the ascending scale of stimuli, according to his
estimate in other passages.
He also admits some modification of stimulant
power, from the manner in which different stimu-
li are applied. Thus heat stimulates the surface
more than the subjacent parts; and stimuli re-
ceived into the stomach exert more action there
than on any other part.
It is extraordinary that he should not have ex-
tended this inequality of operation to the consti-
tuent, as well as the integrant parts of the sys-
tem. It was his principal fault, naturam tanquam
e præaltâ turri despicere; hence his explanation
of minute appearances, will often be found un-
satisfactory. The fourth and and sixth chapter
of Part II. afford several examples; I shall select
one: " Thirst and heat," he observes, (CLIX.)
" depend upon sthenic diathesis of the extreme
" vessels of the fauces and skin. These vessels
" become so much constricted as to prevent the
" discharge of the perspirable matter. Mean- 
O


cvi STRICTURES ON SOME
" while the blood, flowing near the extremi-
" ties of the exhalant vessels, lodges under the
" cuticle, the heat which is generated in the
" system, and which would be carried off, if the
" perspiration were free." He explains sthenic
thirst from a similar constriction of the vessels,
which secrete saliva and mucus; and in the small-
pox the pustules are said to be occasioned by a
similar constriction, which detains the contagious
matter under the cuticle. This permanent con-
striction, we are told, is not spasm; no distinction,
however, is attempted, except by referring con-
striction to excess, and spasm to defect, of ex-
citement.
Upon this reasoning, it may be remarked, 1.
That excessive excitement of vessels consists in
excessive oscillations—in the increase, not in
the suppression of their healthy functions; and
2. That to account for morbid alteration in
the ordinary state of any discharge, we ought to
look for an alteration in the action of those ves-
sels, by whose counteracting powers it is regula-
ted in health. The balance in the perspiration
depends on the cutaneous exhalants and absorb-
ents; but the properties of the lymphatic system
seem never to have struck the imagination of
Brown, though the investigation was carried on
with so much ardour during the period of his stu-
dies; attention to these anatomical discoveries
would have assisted him in the full explanation of
many diseases, which, though they pass under
the same denomination, he has most justly classed 
 

cvii OF BROWN'S DOCTRINES.
as of a nature entirely opposite; the one, sthenic,
the other asthenic; but to make out this explana-
tion, he must have acknowledged in these differ-
ent vascular systems, some degree of inequality
in the way in which they are affected by stimu-
lants that operate on both. Thus if the power
of absorption be sooner increased by the causes
inducing the sthenic diathesis than that of exhala-
tion, there is no occasion to imagine any con-
striction to account for the dryness of the
skin and fauces. The consequent more speedy
exhaustion of excitability in the absorbents,
would likewise have suggested the rationale of
that discharge that follows the state of dryness or
huskiness of the skin, fauces, or urethra, of the
trachea and its ramifications, when these parts
are affected by inflammation.
A great part of the symptoms of Brown's ast-
henic form of disease, depend upon imperfect ab-
sorption from indirect debility of the vessels
destined to that office; thus persons whose
lungs have been weakened by inflammation after
a meal expectorate mucus. In this case the food
excites the whole system; the activity of the
bronchial glands is increased, more mucus is se-
creted, and part becomes superfluous, on account
of the comparative inactivity of the absorbents.
Quibus post inflammationem superest urethræ debilitas
profluit mucus limpidus, postquam tensus fuerit penis.
The reason is the same.
Had it been once allowed by Brown that the
different 


cviii ORIGIN OF
different constituent parts of the body, bear a
different relation to the same agents, he must
have admitted the operation of specific stimulants
to an unlimited extent. This however, would
have destroyed the universality of his principles,
which he considered as the great beauty of his
system; but his own opportunities of observati-
on were probably too few, to force upon him a
conviction of their insufficiency; it is easy to ex-
ceed equity and prudence in refusing to hearken
to testimony, we may daily see speculative men
forgetting that philosophy does not more consist
in petulent rejection of information than in cre-
dulity.
Of the Formation of the Brunonian System.
It is believed that hints thrown out by Cullen,
were the seed from which Brown raised his doc-
trines.
The connexion between the two men, is
doubtless favourable to the supposition of a com-
munication of ideas, and it is confirmed by the
circumstantial evidence of a common term, from
which the other terms, employed by Brown,
might be constructed by an obvious analogy.
The hints suggested by Cullen occur in the
CXXXth, and some of the following paragraphs
of his Institutions of Medicine.
" It is," he says, " probable that the " nervous
" fluid in the brain, is truly capable of different
" states 

 

cix THE BRUNONIAN SYSTEM. 
" states or degrees of mobility, which we shall
" call its states of excitement and collapse." In his
youth, this author had imagined a mechanical
hypothesis respecting the nervous fluid, which he
regarded with fondness through life, and unfol-
ded with great prolixity in the decline of his pow-
ers (b). When he wrote the passage I have quo-
ted, his thoughts were turned from the living
body to an electrical machine; and he evidently
does no more than describe the common experi-
ment, in which a congeries of flexible fibres is
made to stand erect, and to diverge by electrici-
ty, and then shrinks together on the application
of a conducting substance. His idea of excite-
ment has therefore nothing in common with that
of Brown; and, on camparison, I am persuaded
it will appear that Brown was very little indebted
to the physiology of his master.
A material correction of the Brunonian theory
may be more safely ascribed to one of Mr. Hun-
ter's discoveries, than its origin to these obscure
opinions of Dr. Cullen. An intelligent writer
whose expressions bespeak personal observation,
gives the following account of the extent and oc-
casion of this correction. " In the first promul-
" gation of his doctrines, Dr. Brown did not suf-
" ficiently distinguish between the actions of
" the living body and its powers.—Excitement
" and strength were at first considered by him
(b). See his Materia Medica
" as 


cx IMPERFECTIONS
" as synonymous terms; and on the state of ex-
" citement, his distinction of diseases were en-
" tirely founded. To the last he had but two
" classes; diseases of increased and diminished
" excitement.
" After many discussions of his doctrine, in
" which the distinction between the powers and
" actions of the living body.....was pres-
" sed upon by him, he adopted the term excita-
" bility to express the disposition in action, and
" to replace the terms irritibility, sensibility, and
" inability, which he had discarded from his sys-
" tem (c)."
An alteration of some consequence respecting
discharges of blood, which was made in the inter-
val between two Latin editions of his elements,
is noticed by the author himself. What correc-
tions and enlargement are further required, the
curious reader may determine by a careful com-
parison of the following system with the kindred
systems of two contemporary authors; con-
stant reference being had to nature at the same
time.
Of Predisposition to Disease.
Among a number of individuals equally expo-
sed to any cause of disease, we constantly find
some affected, and others escaping. The cir-
cumstances on which exemption and aptitude de-
(c). English Review for Oct. 1794, p. 282.
pend 


cxi AND ERRORS.
pend have been anxiously investigated; and if
we were well acquainted with the powers that sa-
vour and resist morbific influences, we should be
able more effectually to accomplish one of the
two grand purposes of the medical art—the
preservation of health. But although facts have
been noted, the principle lies involved in total
obscurity. Brown does not purposely elude the
difficulty, but his principles lead him beside it;
and we may doubt whether the term predispositi-
on ought, in strict propriety, to have appeared in
his Elements; for predisposition is with him a
slight disease, differing only in degree from that
into which the person predisposed falls. (Chap-
ter VIII. Part I.).
Between those actions of our different organs,
and of the same organ which frequently occur to-
gether or in succession, a bond of union is formed
by habit, as in the case of our ideas. Of any
two movements, therefore, if the former tend to
introduce the succeeding, the second must take
place, unless it be prevented by some interposing
force. Hence it is manifest that robustness of
constitution, principally consists in the strength
of connexion between the several members of the
series, and proneness to disease in the facility
with which the series may be broken. On this
principle we may understand why brutes are
more robust than the human species. Their ac-
tions both of body and mind are less diversified
than ours; and being in consequence more fre-
quently 

cxii IMPERFECTIONS
quently repeated in the same order, they acquire
greater force of union, or, as it has been lately
termed, strength of catenation. It may deserve to
be considered whether the remarkable exemption
of negroes from the contagious fevers that have
lately raged in America and the West-Indies,
and the comparatively small mortality among
them depend on their uniform life (d).
Persons who have enjoyed uniformly good
health, are said to be in greater danger when they
become ill; and in cases where the opinion is
just, we may deduce an explanation of the ap-
parent paradox from the same principle; for the
disturbance of the functions betrays the interven-
tion of a powerful cause.
(d). " Although the contagion seemed to vary much in
" different descriptions of people, it is highly probable that
" the virus of the contagion itself was uniformly the same,
" only variously modified by peculiar constitutions, habits, or
" modes of living. Thus among sailors, perhaps a scorbu-
" tic taint, joined to extreme irregularity and imprudence,
" rendered the disease infinitely more fatal than among any
" other class of men. On the other hand, among field-ne-
" groes, who certainly possess an idio-syncracy peculiar to
" themselves, and whose mode of living is generally tempe-
" rate and regular in a remarkable degree, the virus of the
" contagion was so blunted as to act in the mildest form.—
" Why, however, it should operate with most violence on
" Europeans just arrived, and who had never entered the tor-
" rid zone before, is a singularity I do not pretend to ex-
" plain." Chisholm on the malignant pestilential fever which
raged at Grenada in 1793, p. 130-1, one of the most fatal
diseases on record.
Are 


AND ERRORS. cxiii
Are not the embryons of organized beings
placed in their peculiar receptacles, that they
may be secure against violent impressions, till
the movements of their organs, by repetition,
come to proceed with a steady pace, and the
animal machine is mounted?
Pregnant and puerperal women are among
the persons most liable to be affected by the
slighter causes of disease. In the former, from
the great change of the sanguiferous and glan-
dular systems, new irritative and sensitive mo-
tions are perpetually introducing themselves;
and at the time of parturition, there is a sud-
den dissolution of all the newly formed asso-
ciations; at this critical period they require to
be guarded with the nicest vigilance from all
sudden changes of temperature, irregularities
of diet, and exertions of body and mind.
In the transition from climate to climate, it
is obvious that our habitual movements, espe-
cially those of the cutaneous vessels of all deno-
minations, must be thrown into total confusion.
In this state of disordered action, there can be
no power of association or connection to protect
the system. It has also been universally ob-
served, that contagious fevers are liable to make
their attack after intoxication, when the whole
internal man is tumult.
In the account of the Grenada fever, there is
a scale to shew the gradation in which the na-
P tives 

cxiv IMPERFECTIONS.
tives of different countries, Africans, Ameri-
cans, Creoles, and Europeans, assembled in
that island, were liable to be infected and de-
stroyed. This scale will serve as an illustration
of the two last mentioned causes; a thousand
otheas are at hand.
" It is curious," says the writer, "and may
"be useful to observe the gradation of this fa-
"tal malady, with respect to the various de-
"scriptions of people exposed to its infection.
"Neither age nor sex were exempted from its
"attack, but some were more obnoxious to it
"than others, and the colour had evidently
"much influence in determining its violence.
" The scale of its violence, or the gradation it
"observed with respect to the different classes
"of the inhabitants, appeared to be the follow-
"ing:
"I. Sailors, more especially the robust and
"young, those least accustomed to the climate,
"and those most given to drinking new rum.
"II. Soldiers; more especially recruits, late-
"ly from Europe, and the most intemperate.
"III. White males, in general, lately arrived,
"more especially young men from Europe.
"All other white males, more especially the
"lower classes; and of them, the most intem-
"perate, those debilitated by recent sickness.
"V. White females, more especially those
"connected 


AND ERRORS. CXV
"connected with the shipping, and those late-
"ly from Europe.
"VI. People of colour, from Mustees to Ca-
"bres," (that is, I think inversely as the dark-
"ness of complexion.)
"VII. Negro men, more especially sailors and
"porters.
"VIII. Negro women, more especially house
"wenches.
"IX. Children, more especially those of co-
lour.
Infants, whose organic movements are not
yet regulated by habit, seem to afford an ex-
ception to the rule of predisposition. They are,
it is said, less liable to some contagious fevers;
and when infected, their chance of recovery is
much greater; the latter circumstance has been
noticed by various observers (e). If children
were only less liable to be infected, the differ-
ence might be fairly supposed to depend on their
not coming so often within the infecting dis-
tance; but after infection they are protected by
some unknown peculiarity. Is the contagion
weakened, when first swallowed by a diarrhoea,
as was the case with some persons who received
the dangerous infection at the Black assizes at
Oxford? Or has the gastric liquor of chil-
(e) See for instance, Campbell's Observations on Typhus,
1785, p. 55.
dren. 

cxvi IMPERFECTIONS.
dren, some power to render the poison inert?
This inferiority of power in one or two parti-
cular contagions, to enfect and destroy children,
deserves further enquiry.
Of the Depressing Passions.
There are several other opinions, which, in
a complete revisal of the Brunonian system,
would require particular examination; such are
his doctrine concerning hereditary diseases, the
peculiar seat of sthenic inflammation, and the
nature of the passions. This last subject is of
great importance, and if, in treating it, Brown
has failed, he has but shared the fate of other
writers. The mechanism of the passions, or the
state of our different organs, while we are un-
der their influence, has never been explained.
If any proof be required of the general want of
informationon this subject, it may easily be pro-
duced. Writers, educated in different systems,
and who cannot be supposed to have been mis-
led by the undistinguishing ardour of youth-
ful enthusiasm, have found no better resource
than to adopt Brown's theory (f).
In fear, grief, and anxiety, some parts man-
ifestly betray, by their paleness and coldness, di-
(f). See Dr. Rush on the fever of Philadelphia, p. 31.
"Fear debilitates only because it abstracts its antagonist pas-
"sion of courage."
minished 

AND ERRORS. cxvii
minished exertion. Now as no two parts, ac-
cording to our author, can be in opposite con-
ditions at the same time, what could he in con-
sistency do, but assert that the doctrine of heat
and cold is exactly applicable to the passions
(Part I. Chap. iii. n.)? In high spirits, there-
fore, we are to suppose ourselves animated by
something corresponding to the warmth of
summer; in tranquillity we are lowered by a
subtraction of this mental stimulus down to
temperate, and in grief we sink to the freezing
point; how far the common opinion varies
from this of Brown, I cannot exactly say, be-
cause I do not understand what particular
change the words depressing or sedative passions,
are designed to indicate. When I try to assist
my apprehension by some analogy, I find no-
thing in nature to help me out, but am obliged
to think of certain passages in books of ro-
mance, where the enchanter is described as in-
ducing a state of permanent torpor by the mo-
tion of his wand. To discover whether any of
the passions have a benumbing operation, does
not appear very difficult; let us take a tran-
sient look into the mind of a mother sorrow-
ing for the loss of her son, I ask whether her
ideas are more vivid than sual? whether she
does not exert herself to recollect all he said or
did between the cradle and the grave? whether
after 

cxviii IMPERFECTIONS.
after minutely considering what he has been,
she does not set herself with equal earnestness to
fancy what he would have been? and whether
every picture formerly drawn by hope, does
not pass again before her imagination, with the
figures more strongly illuminated, and more
distinctly imbodied?
"Grief fills the room up of my absent child;
"Lies in his bed; walks up and down with
"me;
"Puts on his pretty looks; repeats his words;
"Remembers me of all his gracious parts;
"Stuffs out his vacant garments with his form;
"Thus have I reason to be fond of grief."
CONSTANCE in the Play of king John.
If this expression of sorrow be not too strong,
while an happy meeting is still believed possi-
ble, it may be doubted whether the faculties
of Shakespeare or Schiller, strained to their ut-
most pitch, are equal to that intensity of
thought which takes place when this hope is
finally destroyed. Fear and anxiety excite ima-
ges of equal vivacity with grief, and on con-
sidering the subject, it will appear that for
these states of mind, perturbation, which occurs
in the writings of the ancient philosophers, is a
far more apt term than passion. Had it not
been for inaccurate language, which the au-
thor of the Enquiry into the State of medicine just- 
ly

AND ERRORS. cxix
ly calls the greatest of all plagues in science, the
opinions I am inviting the reader to compare
with nature, would probably never have exist-
ed. Neither should we perhaps have been
taught, that in grief the mind moves slowly—
an assertion as distant from the truth, as if it
should be said that animals in full chace of their
prey, move more slowly than when they are
not actuated by any appetite; for the eager-
ness, with which some train of ideas are pursu-
ed in pensive sorrow, admits of a comparison
with hunting.
The excitability, therefore, is exhausted by
any passion or perturbation, in the same man-
ner as by excessive excitement in other cases.
Whether temporary weariness, or irreparable
debility shall ensue, depends upon the intensity
and duration of the exertions, made by the or-
gans in action. The explanation of the differ-
ence between weeping and tearless grief, with
the means of curing either and changing the
latter (which is a much more dangerous dis-
ease) into the former, depends on principles,
not to be found in the following system. In
the present specimen of criticism, it is the less
necessary to enter upon these enquiries, as the
public may soon expect better instruction on the
pathological part of this subject than I am able
to give.
Conclusion. 

cxx IMPERFECTIONS.
Conclusion.
The Brunonian system has frequently been
charged with promoting intemperance; the
objection is serious, but the view already given
of its principles shews it to be groundless.
No writer had infilled so much upon the de-
pendence of life on external causes, or so strong-
ly stated the inevitable consequences of excess.
And there are no means of promoting morality
upon which we can rely, except the knowledge
of the true relations between man and other
beings or bodies. For by this knowledge we
are directly led to shun what is hurtful, and pur-
sue what is salutary; and in what else does mo-
ral conduct, as far as it regards the individual,
consist? It may be said that the author's life dis-
proves the justness of this representation; his
life, however, only shews the superior power of
other causes, and of bad habits in particular,
and I am ready to acknowledge the little effi-
cacy of instruction, when bad habits are form-
ed. Its great use consists in preventing their
formation, for which reason popular instruction
in medicine would contribute more to the hap-
piness of the human species, than the complete
knowledge of every thing which is attempted
to be taught in education, as it is conducted at
present. But though the principles of the sys-
tem in question did not correct the propensi-
ties 

CONCLUSION. cxxi
ties of its inventor, it does not follow that they
tend to produce the same propensities in others.
The distinguishing merit of Brown is obvi-
our; he avoided all false analogies, and con-
fined himself within the proper sphere of ob-
servation for a physician. Hence at a time
when I could not be suspected of that disposi-
tion to diminish the faults, and magnify the ex-
cellencies of his system, which my share in the
present publication may be supposed to pro-
duce; I was led to remark, that "if he has
"not always discovered the truth, he is seldom
"forsaken by the spirit of philosophy (g)." Be-
fore him investigations relative to medicine, had
been carried on just as rationally as if to dis-
cover the qualities of the horse, the naturalist
were to direct his attention to the movements
of a windmill. There existed no system which
was not either entirely, or in a great measure,
founded upon the observed or supposed pro-
perties of substances, destitute of life. Thus
Boerhaave taught that diseases depend upon
changes of the blood, similar to those which
certain oily, watery, or mucilaginous liquors
undergo; and I have already had occasion to
shew that Cullen referred the phænomena of
life to an imaginary fluid, endowed with the
same properties as the electric fluid; though
(g) Observations on Calculus, p. 159.
Q of 


cxxii CONCLUSION.
of this the very existence is still problematical (h).
His predecessors having in this manner left MAN
entirely out of their systems, or assigned him
an unimportant place, Brown atchieved the im-
portant service of restoring  him to his proper
(h). Mr. Hunter, who deserves so much praise for Ascer-
taining facts, has been led astray in some of his Attempts to
establish principles, by a different, but a very curious species of
delusion. In treating of that obscure subject, for instance, the
coagulation of the blood, he observes that it sometimes takes
place very quickly, as in mortification; but then "it is to an-
"swer some good purpose and arises from NECESSITY, which
"appears to act as a stimulus in disposing the blood to coagu-
late." He adds that by "actions taking place from necessity,
"effects are meant which arise from some unusual or unnatural
"change going on in the parts, and become a stimulus to action.
"The stimuli from this cause may vary exceedingly among
"themselves: but as we are unable to investigate them, I have
"included them under this general term, stimulus of necessity."
(On the blood, p. 24). It may be laid down as a rule in logic,
that general terms ought never to be employed, unless we can
substitute particular terms expressive of appearances in their
place. Mr. Hunter confesses his ignorance of those changes,
which he comprehends under the phrase, stimulus of necessity. 
It is manifest, therefore, that it refers to nothing cognizable by
sense; and his position amounts simply to this, the blood coagu-
lates because it must coagulate. This is not the only occasion on
which this ingenious anatomit has been betrayed into the my-
sticism of occult causes; and it would probably create some sur-
prise in an ancient poet to find allegorical beings like NECESSI-
TY and DEATH, figuring in a modern work among the prin-
ciples of physiology. It is easy to excuse Mr. Hunter for mis-
taking nominal for real essences; but the example deserves no-
tice as it so clearly shews the extensive utility of the philoso-
phy of words. 

CONCLUSION. cxxiii
station in the centre. We have other obligati-
ons to him; but as I have already had occasion
to point out some of them in the course of these
preliminary observations, and as the rest will be
discovered by an attentive perusal of the follow-
ing work, I shall leave the talk of singling them
out and appreciating them to the impartial rea-
der. In forming this estimate he should have
before him, 1. The difficulty of emancipating
the mind from the dominion of inveterate and
accredited error. 2. The much greater difficul-
ty of giving a new form to a complicated and
obscure science.
Three years ago I had occasion to observe that
the opinions of Brown had been so widely diffu-
sed by oral communication, as to affect the
whole practice of medicine in Great Britan. In
pamphlets recommending repeated doses of opi-
um to support excitement, and in other publica-
tions, it would be easy to detect attempts to pur-
loin his language and ideas; but it is unnecessa-
ry, for though literature has always been infest-
ed by a race of pilferers, original genius has
seldom been injured by their dishonest practices.
Brown cannot now be defrauded of his just re-
putation. His writings have lately been repub-
lished (k), and are gaining credit on the conti-
nent of Europe. In America his superiority to
(k). See Brunonis Elem. Med. cum Presatione Petri Moschati.
preceding 


cxxiv CONCLUSION.
preceding systematic authors, appears to be ac-
knowledged alike by students and professors (l).
To speak of the dangerous influence of his
System on practice, I think as useless now as to
detect plagiarisms. His disciples have sometimes
disgraced themselves by that rashiness, which
was too much the characteristc of his school.
But a cool perusal of his work will not pro-
duce the effect of his animated and sometimes
frantic prelections. What he has left can only in-
form or exercise the understanding: but he re-
tains no power to inflame the imagination
from the grave.
(l). See Rush on the yallow fever, and some inaugural dis-
sertations lately published at Philaadelphi.
Since the preceding pages were printed, I have received fur-
ther indubitable proofs of the ascendancy which the truths,
promulgated by Brown, are gaining over men's minds in dif-
ferent parts of Europe. A translation of his "OBSERVATI-
ONS under the title of Compendio delta nuovadottrina medico, di
G. Brown was published at Pavia in  1792. It has been since
republished at Venice, and so has Moscati's Edition of the E-
lementa. The translation is by Dr. Rasori, who has prefixed a
sensible introduction, and added many judicious notes. In a
letter accompanying a copy of his translation, Dr. Rasori says,
"In the University "of Pavia, undoubtedly one of the first
"in Europe, there is hardly a student, endowed with talents,
"who is not a Brunonian. The doctrine begins equally to
"spread in Germany. Many of the periodical publications
"of that country have noticed it, and the Elementa have late-
"ly been published there. A friend at Genoa assures me that
several
several 


CONCLUSION. CXXV
"several surgeons to French men of war have informed him,
"that Brown is known and much admired in France. In
"the University of Pavia, Brown is in high esteem even with
"some of the most respectable professors; and in other parts
"of Italy I can assert from my own knowledge that old phy-
"sicians have not refused their sanction to many of the Bruno-
"nian principles."
A late pamphlet intitled Jacobi Sacchi in principia Theoriae
Brunoniae animadversiones, but supposed to be written by pro-
fessor Carminati, affords ample confirmation of the account,
given by Dr. Rasori. The first sentence runs thus. Quaeren-
ti mihi causas incredibilis prope illius commotionis animorum, at-
que ingentis fere plausus, quibus nuperrime singularis illa hypothe-
sis, cui novum universae Medicinae systema celeberrimus Angliae
scriptor & medicus Bruno superstruxit, ab iis optimae spei adoles-
centibus excepta esset, quid in florentissimo Ticinensi Archigymnasio
salutaris artis studiis omnibus mecum incumbunt perarduum sane
non fuit eas..... invenire. After some pages of introductory
matter, the author objects strongly to Brown's definition of
life—quod ideam vitae non in proprietate seu incitabiliute, sed in
actione collocarit. He adduces various instances in which
organic bodies lose sense and motion, without losing their sus-
ceptibility of feeling and moving, when differently circumstan-
ced. professor Carminati, he says, having killed a cat by me-
phitic air, took out the stomach with the intestines, and expo-
sed them to the influence of a frosty air in his court yard.
They lost by degrees their peristaltic motion, and were frozen
stiff. Next day, they were put into warm water; and when they
were thawed, the peristaltic motion returned; and lasted for a
long time. This seems to be little else than a dispute about
terms. The objector next controverts Brown's grand discovery
-omnia quæ viventium partibus admovcnture, sive interna sivæ
externa sint, perpetuo incitantia esse. He produces the application
of cold bodies blood-letting, as examples of effects Produced
on the living body otherwise than by stimulating. He forgets
that it is the residuary heat and the residuary blood which
Brown 

cxxvi CONCLUSION.
Brown regards as stimulants, inferior indeed in efficacy but
still stimulants. The effect of alkaline substances on acid ge-
nerated in the stomach, and some other similar cases, are after-
wards specified, as not comprehended under the general propo-
rtion. The author however seems aware that no Brunonian can
want the wit to repel these objections. He mentions caustics
as exceptions to the rule; he however allows that they are part- 
ly benificial by stimulating, and omits to mention that part of
their operation which is not stimulating. During this skirmish-
ing, in which the adversary of Brown takes cares to retreat
nearly as much as he has advanced, he appears to gain cou-
rage, for he now attacks the new system in its strongest post.
Opium, he affirms, is a medicine which although it has some
stimulating power, removes irritation non eo, sed alio sibi pro-
pria principio. So are all sedatives. Under this head the power
of opium to allay excruciating pain and restrain irregular moti-
ons is copiously exemplified; the writer seems to suppose that
pain always implies excess of action, and convulsions excess of
general power. He ackowledges that volatile stimulants re-
move quasdam nervorum aegritudines fed eas quae vera debili-
tate procreantur. At the close of this article an argument oc-
curs, which I know not how the most determined Brunonian
will answer. It is this; if there were no difference but in energy
between opium and other drugs, it might be compensated by
increasing the dose of these, which is contrary to experience.—
An acute opponent would not, the reader may be sure, fail to
bring forward the specific action of quick-silver, cantharides
and other bodies; he even contends that universal stimulants
by no means tend to evince that the excitability is one and
indivisible, since they are compounds, and their several con-
stituent parts may act upon several portions of the system.
Brown was totally inattentive to the association of motions;
and our Italian critic does not omit to take advantage of this
imperfection. He quotes several instances of the sympathy of
similar parts (as the decay of corresponding teeth), and ar-
gues from them in the following manner: juxta diversas aut
similes


CONCLUSIONS. cxxvii
simies partes, sive sensilitas sive irritabilitas aut diversa aut si-
milis seu aequales est . . . Hinc ubi causa praedisiponens, aut idem
stimulus seu eadem causa occasionalis, quae in aliqus corporis sede
morbum intulit, ad aliam quoque similem deferatur, nascetur illico
causa proximo ejusque effectus, nempe morbus: quod quidem fieri
non posset in diversa parte, licet eam quoque idem stimulus pertin-
gat. Lastly, the author contends that Brown has improperly
given the common name of excitability, to irritability and sen-
sibility, properties essentially different.—The theory being
thus dismissed, the practice of the Brunonian school is brought
under examination. Frozen limbs, it is said, are to be warm-
ed gradually, but only left the vessels should be burst by the
sudden expansion of their contents. So also a small quantity of
food is to be given to persons who have been long fasting,
merely because the digestive powers are weak, and not to a-
void violent excitement from accumulation of excitability.
The writer protests equally against the use of small stimulants
in direct debility, and of a stimulus nearly equal to that which
has induced indirect debility, in cases of an opposite nature.
On the latter principle, he thinks, the most powerful stimu-
lants ought to be given in the most violent peripneumonies,
and blood-letting to be avoided. Under the former head, he
asks; Quis ubi siphylis faeirat atrociter ejus sanationem, validior-
ibus posthabit is mercurialibus, committet lenioribus?—To prove
the reality of contrary indications, the complication of true
peripneumony with malignant petechial fever and other disea-
ses, requiring the use of debilitating and strengthening
means at the same time are adduced. Several pages are em-
ployed to shew that a low temperature is not debilitating
and the converse. The Brunonians will easily shew by a few
obvious distinctions, to how little purpose the author has la-
boured here. In conclusion, he points out what he deems ab-
surdities in Brown's opinions concerning the itch, scurvy,
epilepsy, and some other disorders.
But whatever justness there may be in some of these remarks,
whatever errors Brown may have committed in the application
of 


cxxviii CONCLUSION.
of his principles, and however short his doctrines may fall of
a perfect system of medicine, I will venture to predict that his
credit on the continent will remain unshaken. The introducti-
on of his opinions will have a most beneficial influence upon
those by whom they are adopted as well as upon those by
whom they are rejected. Brunonians will not imitate the stu-
pidity of the disciples of certain antient philosophers, but ex-
ercise their reason in expunging, adding and correcting, as
experience mail dictate. With regard to Anti-Brunonians a
recent example will explain my meaning. When Lavoisier
first announced his system, the chemists who were most scan-
dalized by it, found themselves obliged to revise their whole
stock of facts and deductions; the immediate consequence was
an entire change in their opinions. Though they would not
go over to Lavoisier, they could not adhere to Stahl, but re-
luctantly abandoned half their errors. The dissemination of
the Brunonian doctrine will bring about the same thorough
lustration of opinions in medicine, and the most pernicious a-
mong the prevailing prejudices will be relinquished without
a contest.
The reader may estimate what it is to have put so many na-
tions into the right path of medical investigation. It is true,
indeed, that we in Great Britain, suppose ourselves to have
enjoyed the privilege of being purblind, while the eyes of fo-
reigners were sealed to the agency of those causes that actuate
animated nature; and would it not be a pity if we should lose
our distinction? But though we should be outstripped in medi-
cine by the awakened genius of France, or the enlightened
industry of Germany, we shall not be without consolation:
since in consequence of Brown's discoveries, our countrymen
labouring under disorders, such as we cannot cure, stand a
chance of profiting by the collective efforts of human ingenuity.
ERRATA.
Page 32 line 3 from bottom for where read were—p. 361. a after with
read this—p. 561. 20 dele is—p 581. 2 after of read the- p. 601.6 dele
by—p. 641. 19 for Hospial read Hospital—p. 701. 21 for Treaties read Trea-
tise—p. 721.17 for how who—p. 941.II for Mascular read Muscular. 

TABLE OF EXCITEMENT AND EXCITABILITY. 
DEATH. 
EXCITEMENT. EXCITABILITY.
0 80 
6 75
10 70 Extreme Sthenic. Indirect Debility. 
15 65 
20 60 High Sthenic. 
Predisposition to Sthenic Disease. 25 55
30 50 Mild Sthenic. Sthenic Diathesis. 
35 45 
Perfect Health. 
Predisposition to Asthenic Disease. 40 40 
45 35 
50 30 Good Health. 
55 25 
60 20 Mild Asthenic. 
65 15 
70 10 High Asthenic. 
75 5 
80 0 Extreme Asthenic Direct Debility. Asthenic Diathesis. 
DEATH. 
DISEASES. 
CAUSES. 
NOXIOUS IMMEDIATE 
CURE. 
Apoplexy.
Palsy. 
Plague. 
Malignant Fever. 
Gangrenous Cynanche. 
Confluent Small-pox. 
Hydrothorax. 
Phthisis. 
Contagious Dystentery,
&c. 
Excessive action of powerful stimuli ; as heat, 
exercise, food, abundance of blood, violent pas-
sions of the mind, contagion, and the like. 
Indirect debility. 
The indication of cure is to support the excitement. The reme-
dies are powerful stimuli, as electricity, opium, æther, spirituous, 
liquors, wine, musk, cinchona bark, snake root, camphor, rich soups, 
and the like. 
Synocha. 
Phrenitis. 
Inflammatory Cynanche. 
Mild Small-pox. 
Measles. 
Peripneumony. 
Dysentery. 
Mania, &c. 
The same as above, but not to that excess which 
induces indirect debility ; yet acting with greater 
force than in the next range of disease. 
Greatly increased excitement. 
The indication of cure is to diminish the excitement ; which is to 
be effected by avoiding powerful stimuli, and employing slight or 
defective stimuli, as lying cool in bed, tranquility of mind, bleed-
ing, purging, spare diet, and the like. 
Synochus. 
Rheumatism. 
Catarrh. 
Scarlet Pyrexia. 
Miliary Fever. 
Chicken-pox. 
Ophthalmia, &c. 
The same as above, but not acting with that 
force which induces high sthenic diathesis ; yet 
greater than in the state of health. 
Less increased excitement. 
The indication of cure is, as above, to diminish the excitement, 
but with more moderation. 
The range of good health is with propriety ranked from thirty to fifty degrees in the scale ; for perfect health, which consists in the middle point solely, or forty degrees, rarely occurs ; in consequence
of the variation of the stimuli to which man is continually exposed, as meat drink and the passions of the mind ; which sometimes act with more power, sometimes with less, so that the excitement com- 
monly fluctuates between thirty and fifty degrees. 
Intermittent Fevers 
Mild Colic. 
Dyspepsy. 
Hypochondriasis. 
Hysteria. 
Epistaxis. 
Menorrhœa. 
Amenorrhœa, &c. 
A deficiency of the stimuli necessary to the 
maintenance of good health ; and an improper ap-
plication of powers, which, though stimulant, do 
not stimulate in a sufficient degree.
Diminished excitement, 
or 
Direct debility. 
The indication of cure is to increase the excitement. The reme-
dies are powerful stimuli, such as are exhibited for the cure of indi- 
rect debility, but with this difference, that here it is necessary to be- 
gin with a small degree of stimulus, and increase it gradually. 
The indication of cure is here the same as above, but stimuli must 
be applied somewhat more cautiously.
Rheumatalgia. 
Cholera. 
Epilepsy. 
St. Vitus's Dance. 
Rickets. 
Hæmoptysis, 
Scrofula, &c. 
Defective stimuli alone ; as cold, diet sparing 
and not of good quality, fear, and the like. 
Typhus. 
Colica Pictonum. 
Gout. 
Tetanus. 
Scurvy. 
Diabetes. 
Dropsy. 
Jaundice, &c. 
Defective stimuli alone. 
The indication of cure is the same here also, but still greater cau- 
tion is necessary in the application of stimuli. 
TO 
JOHN BROWN, M. D. 
THIS TABLE IS DEDICATED, AS A TESTIMONY OF RESPECT, 
BY HIS FRIEND AND PUPIL, SAMUEL LYNCH. 



THE
ELEMENTS
OF
MEDICINE.
THE FIRST AND REASONING PART.
CHAP I.
I. MEDICINE is the science of preserving the
good and of preventing and curing the bad,
health of animals.
II. The application of the same profession to vegeta-
bles, should be named Agriculture.
III. Good health consists in a pleasant, easy, and ex-
act use of all the functions.
IV. Bad health consists in an uneasy, difficult, or dis-
turbed exercise of all or any of the functions. The latter
respects diseases.
V. Diseases are either extended over the whole system,
or confined to a part; the former merit the appellation of
Universal, the latter that of Local.
VI. The former are always universal from their first com-
mencement, the latter in their course, and that but sel-
dom. The former are always, the latter never, preceded
by predisposition. The originality of the former pro-
B ceeds 


2 THE ELEMENTS
ceeds from an affection of the principle of life, of the lat-
ter from local injury. The cure of those is applied to the
whole body, of these to the injured part.
VII. To the province of the Physician belong all the
universal, and as many of the local, as first affect a part,
and, in consequence of that, at last injure the rest of the
body with some resemblance to the universal ones.
VIII. Predisposition to disease is that state of the body,
that recedes from health, and approaches to disease in
such a manner, as to seem still within the boundaries of
the former, of which, however, it is only an insidious and
deceiving resemblance.
IX. These three states (a) constitute the life (b) of ani-
mals; to which that of vegetables is not dissimilar,
but more imperfect.
CHAP. II.
X. IN all the states of life, man and other animals
differ from themselves in their dead state, or from any o-
ther inanimate matter in this property alone; that they
can be affected by external agents, as well as by certain
functions peculiar to themselves, in such a manner, that
the phænomena peculiar to their living state, that is,
their own functions, can be produced. This proportion
comprehends every thing that is vital in nature, and there-
fore, at least, applies to vegetables.
XI. The external agents in general, are reducible to
heat, diet (a), other matters taken into the stomach, the 
blood, the fluids secreted from the blood, and air. How
poisons 
(a) Of health, disease, and predisposition,
(b) Or living state.
(a) Consisting of food, drink, and condiment. 

OF MEDICINE. 3
poisons and contagions come under the same view shall
afterwards be mentioned.
XII. The functions of the system itself, producing the
same effect, are muscular contraction, sense, and the ener-
gy of the brain in thinking, and exciting passion and
emotion. While these affect the system in the same
manner as the other agents; so, with respect to their ori-
gin, they arise both from the other and from them-
selves.
XIII. The result of withholding either the property
distinguishing living from dead matter, or the operation of
either of the two sets of powers, is the non-existence of
life. Nothing else is necessary to life.
XIV. The property, by which both sets of powers act,
should be named Excitability; and the powers themselves,
Exciting powers. By the word "body" is meant both
the body simply so called, and also as endued with an in-
tellectual part, a part appropriated to passion and emotion,
or to the soul; the appellation commonly given to it in
medical writings is system (b).
XV. The common effect, produced by the exciting
powers, is sense, motion, mental action, and the passions.
Which effect being one and the same, it must, therefore,
be granted, that the operation of all the powers is also
one and the same (c).
B 2 XVI.
(b) No disquisition is here meant to be entered into, as religion is no
where interfered with, but left to its proper guardians.
(c) That is, since sense, motion, mental functions, and the passions
are the only, and a constant, effect of the exciting powers, acting upon
the excitability; and since that happens, whether one, or more, or all
the powers, or which soever of them, act, the irresistible conclusion, that
arises in the mind, is, that the effect of the powers being the same, the
mode of operation of them all must be the same. This mode of reason-
ing, which is certainly as just as it is new in medicine, will often oc-
cur, and, we trust, will stand the test of the most scrupulous scrutiny. 


4 THE ELEMENTS
XVI. The effect of the exciting powers, acting upon
the excitability, is to be denominated Excitement.
XVII. Since, of the same exciting powers, some act
by evident impulses, and the identity of the effect of others
infers the same mode (h) of operation; and since they
have all a certain activity in them, they ought to be deno-
minated stimulant, or stimuli.
α. Stimuli are either universal or local.
☊. The universal stimuli are the exciting powers, so
acting upon the excitability, as always to produce some
excitement over the whole system. And their appellation
of universal is convenient to distinguish them from the
local.
ν. The local stimuli act only on the part to which they
are applied; and do not, without previously producing
an affection in it, affect the rest of the body.
CHAP. III.
XVIII. WE know not what excitability is, or in
what manner it is affected by the exciting powers. But,
whatever it be, either a certain quantity, or a certain ener-
gy of it, is assigned to every being upon the commence-
ment of its living state. The quantity, or energy, is dif-
ferent in different animals, and in the same animal at dif-
ferent times. It is partly owing to the uncertain nature
of the subject, partly to the poverty of common language,
and likewise to the novelty of this doctrine, that the phra-
ses of the excitability being abundant, encreased, accumu-
lated, superfluous; or weak, not well enough sustained,
not well enough exercised, or deficient in energy, when
enough
(h) Or ratio. 

OF MEDICINE. 5
enough of stimulus has not been applied; sometimes ti-
red, fatigued, worn out, languid, exhausted or consumed,
when the stimulus has operated in a violent degree; or be-
ing at other times in vigour, or reduced to one half, when
the stimulus has neither been applied in excess nor defect,
will be employed in different parts of this ensuing work.
Both upon this, and every other subject we must abide by
facts; and carefully avoid the slippery question about cau-
ses, as being in general incomprehensible, and as having
ever proved a venemous snake to philosophy.
XIX. As there is always some excitability, however
small, while life remains, and the action of the exciting
powers in one degree or another is never wanting; the
conclusion from that fact is, that they are all endowed
with more or less of stimulant power, and that this must
be either excessive, in due proportion, or deficient. A
great quantity of blood stimulates in excess, and there-
fore, produces the diseases that depend upon too much
stimulus; but an under proportion of blood, though de-
bilitating in its effect, and inducing the diseases that de-
pend upon debility as their cause, must still be understood
to be stimulant; but only so much more weakly stimulant,
as the penury is more considerable: The same conclusion
applies to all the other exciting powers, unless that poi-
sons, contagions, and some few other powers, might to
some seem exceptions. But,
XX Poisons either do not produce the universal dis-
eases, which make our present subject; or, if they do, by
operating the same effect as the ordinary exciting powers,
their mode of operation must also be allowed to be the
same (a).
XXI.
(a) This proposition of frequent occurrence in this work, that iden-
tity of known effect, always produces identity of cause though un-
known, will be found to be a mode of reasoning of equal service in
guarding 


6 THE ELEMENTS
XXI. Some contagions accompany diseases depending
on too much stimulus (b); others those that consist in de-
bility (c). If both these are the product, not of contagi-
on alone, but, by a conjoint operation, also of the hurtful
powers that usually depend upon stimulus, which is a
fact ascertained: the effect, therefore, in this case being
the same, the conclusion is unavoidable, that their cause
is also the same, and the mode of operation of both the
same. It must, therefore, be admitted that the operation
of contagions is stimulant (d). It makes for the same
conclusion, that no remedies, but those that cure diseases,
depending upon the operation of the usual hurtful powers,
remove those that have been supposed to be induced by
contagions. Finally, the great debilitating energy, obser-
vable in certain contagions, does not more prove a diver-
sity of action in them, than it does in the case of an equal or
greater degree of debility, arising from cold (e).
δ. It might appear to some, that a certain matter of
food, not sufficiently nourishing, and therefore, of hurtful
tendency; as also that emetics, and purgatives, and sedative
passions, as they are called, might be thought to belong to
the number of powers, the operation of which might
seem so many exceptions from the ordinary stimulant ope-
ration.
ε. In general all vegetable matter, when depended upon
alone for nourishment, is hurtful, at least, to those who
have
guarding our reader from the deceitfulness of abstract reasoning, and in
leading him into a proper mode of investigating solid and useful truth.
(b) As the small pox and measles.
(c) As the petechial typhus fever, the plague.
(d) This is all that is contended for at present; the degree of their sti-
mulus will be afterwards considered.
(e) At the freezing point, or below it, man, and similar animals of
warm blood, could not live a second in a dense medium, such as that of
water; but the animals of cold blood can. 


OF MEDICINE. 7
have been accustomed to better, and that by a debilitating
operation; and yet even it, since it supports life, however
incommodiously, longer than a total want of food, must, of
course, be stimulant. But, if asthenic diseases arise from
vegetable food, and not, to a certain degree, from want;
that circumstance must be owing to a certain change pro-
duced in the system, by which the sum total of stimuli is
rendered less fit to act upon the excitability. That such is
the case, is proved by the most stimulant matter of food
losing part of its stimulus by continued use, and requiring
the substitution of another in its place.
ξ. In the same manner is the operation of emetics and
purgatives to be explained, as diminishing the sum total of
excitement which depends partly on an agreeable relation
that the exciting power bears to the excitability, or on an
agreeable sensation. That it is sometimes the relation,
sometimes the sensation, that acts in this case, is evident
from the hurtful effect of things most grateful to the sense,
as in the examples of the legumina, and other articles of
vegetable food; and by the salutary effect of disagreeable
things, as the several forms and preparations of opium:
Both which produce their effect, the former by a debilita-
ting, that is, an insufficiently stimulant, the latter by a
considerably stimulant, operation (g)
The
(g) Suppose a certain power, as 40, to mark the degree, in which the
sum total of proper stimulant operation consists, and the excitement,
produced to that degree, to arise from different exciting powers, all of
them conducing to the same effect, by the operation of each bearing an
agreeable relation to the excitability, or producing an agreeable sensa-
tion on it; the inference to be drawn from that fact is, that a certain
suitableness in the mixture of the whole to the excitability, as well as
the degree of stimulus, produces the effect. Again, suppose certain in-
gredients, which cannot be denied to be stimulant, added to this given
mixture, the effect of the added article will be one of two: it will either
increase the excitement first produced, without altering the agreeable
state 


8 THE ELEMENTS
η. The sedative affections, as they are called, are only
a lesser degree of the exciting ones. Thus fear and grief
are only diminutions (h), or lower degrees, of confidence
and joy. The news of money gained produces joy, and
grief arises from the loss of it. Here then no operation of
a nature contrary to stimulant takes place; it is nothing
but a diminution, or inferior degree, of stimulant opera-
tion. The subject of the passions admits of the same rea-
soning in every respect as that of heat (i); and in the
same manner all the bodies in nature, that seem to be
sedative, are debilitating, that is, weakly stimulant; ow-
ing their debility to a degree of stimulus greatly inferior to
the proper one.
XXII. Since the general powers produce all the phae-
nomena of life, and the only operation, by which they
do
state which that had induced; or it will, still without any reason for
supposing it not stimulant, diminish the excitement that had arisen from
the combination of the agreeable articles. And this will happen merely
from the effect of a discordant combination of exciting powers, while
that, which diminishes the exciting effect of the others, as well as these
others, that constituted its given sum, are both stimulant; but the for-
mer in a higher, the latter in a lower degree, and therefore acting over
all as debilitating powers: Mustard taken with meat, or onions with
beef-stakes, are agreeable to most tastes: but they are, though still stimu-
lant, disagreeable to others, and debilitating. Peas-soup and peas-pud-
ding, though, independent of the animal juice infused into them, they
are far from being salutary, will be borne by many; while in others, es-
pecially those who have been accustomed to more stimulant meals, and
in persons who are gouty, and liable to complaints of the first passages,
they will produce morbid affection. The same thing is to be said of
beef-stakes with onions, which agree with the sound state, and disagree
with that of the first passages just: now mentioned. With regard to all
these enfeebling matters, there is no question about their being stimu-
lant; the whole effect is to be referred to their rendering a mixture,
stimulant in a certain degree, less so.
(h) Not passions different in kind.
(i) The doctrine of cold as an active power, and, opposite to heat, is
now universally rejected, and considered as only a diminution of heat. 


OF MEDICINE. 9
do so, is stimulant; it, therefore, follows, that the whole
phænomena of life, every state and degree of health and
disease, also consist in stimulus, and are owing to no
other cause.
XXIII. Excitement, the effect of the exciting power,
the true cause of life, is, within certain  boundaries
produced in a degree proportioned to the degree of stimu-
lus. The degree of stimulus, when moderate (i), produ-
ces health; in a higher degree it gives occasion to diseases
of excessive stimulus; in a lower degree, or ultimately
low, it induces those that depend upon a deficiency
of stimulus, or debility. And, as what has been men-
tioned, is the cause both of diseases and perfect health; so
that which restores the morbid to the healthy state, is a di-
minution of excitement in the case of diseases of excessive
stimulus, and an encrease of the same excitement for the re-
moval of diseases of debility. Both which intentions are
called Indications of Cure.
XXIV. This mutual relation obtains betwixt excitabi-
lity and excitement, that the more weakly the powers
have acted, or the less the stimulus has been, the more a-
bundant the excitability becomes; the more powerful the
stimulus of the agents has been, the excitability becomes
the more exhausted.
XXV. A mean stimulus, affecting also a mean or half
consumed excitability, produces the highest excitement.
And the excitement becomes less and less, in proportion
as either the stimulus is applied in a higher degree, or the
excitability more accumulated. Hence the vigour of youth,
and the weakness of childhood and old age. Hence with-
in a more moderate space of time, a middle diet gives
vigour, and debility is the effect of its being either too full
Of too sparing.
XXVI.
(i) Of a middle kind.
2 

10 THE ELEMENTS
XXVI. While that is the case, every age, every habit,
if the excitement be properly directed, has its due degree of
vigour accommodated to it. Childhood, and that weakness,
which an abundant excitability produces, admits of little
stimulus, but, upon less than the middle proportion becomes
languid, upon more is oppressed. Old age, and that frail-
ty, which is occasioned by a deficiency of excitability, re-
quires a great deal of stimulus, becomes enfeebled by less,
and overset by more. The reason for the latter is, that
the excitability, without which no vital action is produ-
ced, does not exist in that degree, by which vigour of the
functions is produced; while the former is to be explained
from the exciting or stimulant power, without which the
excitability is of no effect, not being applied in that degree,
which is requisite to the vigour that it should give. The
impotency of stimulus may rise to such a degree, as to pro-
duce death from its extreme under proportion. On the
contrary, the exhaustion of excitability may go so far, as
to extinguish life by the extreme excess of stimulus.
XXVII. The circumstances, under which excitement
is produced, have two confining boundaries.
XXVIII. The one of these circumstances is, ex-
haustion of the excitability from violence of stimulus.
For all the stimulant powers may carry their stimulant
energy to that degree, under which no excitement will a-
rise. The reason for which is, that the body becomes no
longer fit to receive the operation of stimulus another ex-
presson for which is, that the excitability is consumed.
XXIX. The termination (r) of excitement, from the
exhauftion of the excitability by stimulus, may be either
temporary or irreparable, and may arise either from a short
continuance of a high degree of stimulus, or a long applica-
tion of one the excess of which is more moderate. Both
circum-
(k) Or cessation, or extinction. 


OF MEDICINE. 11
circumstances come to the same thing; the high degree of
stimulus compensating for the shortness of its application,
and the shortness of its application for its greater modera-
tion in degree (l). The effect of the former is sudden
death; of the latter a more gradual death preceded by
diseases. And though a most exact measure of excitement
were kept up, yet death at last, however late, supervenes.
XXX. Ebriety, debauch in eating and drinking, sweat,
langour, heat, either operating alone, or overcoming the
effect of cold, dulness in mental exertion from excessive
thinking, or sinking of the spirits in consequence of vio-
lence of passion, finally, sleep; all these are the conse-
quences of a short application of a high degree of stimulus,
operating an exhaustion of excitability. The long conti-
nuance of a more moderate excess in the force of stimulus,
is followed by the frailty of old age, predisposition to dis-
eases of debility, as well as those diseases themselves. The
ultimate termination of both is death.
XXXI. When the excitability is washed by any one
stimulus, there is still a reserve of it, capable of being acted
upon by any other. Thus a person, who has dined fully;
or is either fatigued in body, or tired with intellectual exer-
tion, and therefore under a great disposition to sleep, will
be recruited by strong drink; and, when the last has pro-
duced the same sleepiness, the more diffusible stimulus of
opium will arouse him (m). Even after opium fails, and
leaves
(l) A force of stimulus as six, operating for a space of time as one;
and a force of stimulus as one, operating for a space of time as six, will
produce the same effect in wearing out the excitability,
(m) A gentleman, engaged in a literary composition, which required
an uninterrupted exertion of his mental faculties for more than forty
hours, was enabled to go through it with alacrity, by supporting him-
self in this manner. After dining well and letting to business, he took
a

12 THE ELEMENTS
leaves him heavy and oppressed by the same propensity, a
stimulus still higher and more diffusible, if there be any
such, will have the same effect. A person fatigued with
a journey will be roused by music to dance and skip; and
he will be enabled to run after a flying beauty, if her flight
encourages him with the hope of overtaking her.
XXXII. The waste of excitabilility, first exhausted by
stimuli, and then recruited by new ones, is most difficultly
repaired; because the more a stimulant operation has been
employed, that is the more the stimuli have been applied;
there remains the less access to fresh stimuli, by the opera-
tion of which the failure of excitement may be removed.
XXXIII. The reason of the difficulty is, that no
means of reproducing the healthy state, that is, the proper
degree of excitement, is left; but the very circumstance
that occasioned the waste, that is, already an excess of
stimulant operation, not admitting of more stimulus.
XXXIV. Such, in fine, is the nature of the same
loss of excitement, that it rushes to instant death, unless
proper measures be taken to preserve life by a great stimu-
lus, but less than that which occasioned it, and then by
a still less, till by means of the moderate stimulus, that
is suitable to nature, or a somewhat greater, life may at
last
a glass of wine every hour. Ten hours after he ate something nourish-
ing, but sparing in quantity, and for some hours kept himself up with
punch not too strong. And, when he found himself at laft like to be
overcome by an inclination to sleep, he changed all his stimuli for an o-
piate; and finished his business in forty hours. What he had wrote was
now to be put to the press. He had next to watch and correct the
proofs, which cost him between four or five hours further continuance of vi-
gilance and activity. To effect this he took a glass with the Master Prin-
ter, while his men were going on with their part of the work. The
succession of stimuli in this case was first food, next the stimulus of the
intellectual function, then wine, then the food varied, then punch, then
opium, then punch and conversation. 
         

OF MEDICINE. 13
last he preserved. The difficult cure of drunkards and
gluttons, already affected with diseases, sufficiently evin-
ces, that the same consideration applies to all the exciting
powers that stimulate in excess (a).
XXXV. The excitability, thus exhausted by stimulus
is debility, which should be denominated indirect, because
it does not arise from defect, but excess of stimulus (b).
XXXVI. Through the whole progress to indirect
debility, the second impression of every stimulus has less
effect than the first, the third less than the second, and so
forth to the last, which gives no more excitement; and
the effect takes place in proportion to the degree or du-
ration of the several impressions, though every one always
adds some excitement. The inference from this proposi-
tion is, that, before the establishment of indirect debility,
and, when it is now upon the eve of being established,
the stimulus which produces it, should be withdrawn;
a debilitating power should be applied, as in giving over
drinking wine at the end of an entertainment, and substi-
tuting water in its place, and applying refrigeration to a
person who has been exposed to an excessive degree of heat
(c).
XXXVII. The same progress to indirect debility
is
(a) This proposition applies to the most difficult part of the practice
for the cure of diseases, that is, those that depend upon a certain species
of debility, which in the very next paragraph will be denominated
indirect.
(b) Like another debility, by and by to be spoken of.
(c) A convalescent, from a disease of debility, was prescribed wine,
but not to carry it to excess. A hiccup was the signal, by which he was
to understand, that he had carried that stimulus too far. He desisted,
and ended his jollity with two or three tumbler glasses of water; which
prevented the establishment of the indirect debility into which he was
about to fall. 
 

14 THE ELEMENTS
is retarded by diminishing the excitement from time to
time, and proportionally encreasing the excitability, and
thereby giving more force to the action of the stimuli.
Take, for example, cold bathing from time to time,
lowering the diet from time to time, and a similar abate-
ment of all the other stimulant powers.
θ. If cold sometimes seems to stimulate, it produces
that effect, not as actual cold, but either by diminishing
excessive heat, and reducing it to its proper stimulant tem-
perature (d), or by rendering the body accessible to air, or
by accumulating the excitability diminished by excessive
stimulus, and communicating energy to the stimulus of
the exciting powers, now acting too languidly. An in-
stance of this operation of cold occurs in the Torrid Zone,
where actual cold is scarcely to be procured, in the use of
refrigerants, as they are called, in fevers, and in the con-
traction, by means of cold, of a scrotum previously re-
laxed by heat. Nay, the effect goes so far, that sthenic
diseases
(d) The principle upon which the operation of the cold bath depends
has never been understood, and therefore all reasoning, as well as prac-
tice, with respect to it, has been conducted in quite a vague and random
manner. Suppose a range of excitement, the middle and healthy point of
which is 40 degrees of excitement, the ultimate degree of its excess
70. It is, therefore, the intermediate degrees between these extremes
to which the practice of cold bathing is applicable. From 80 to 70, the
former of which is the head of the scale, and constitutes the range of in-
direct debility; and likewise through all the intermediate degrees from
40 down to 0, the cold bath, which is a weakening power, as well as
every other, is improper. It is a mistake prevalent among systematic
writers and lecturers, that cold is of service in the fevers and other dis-
eases of the Torrid Zone. The truth is, that, in that country, there is
no access to the use of actual cold. All, that can be done there, is, by
various means, to diminish the excess of heat, which is constantly rush-
ing from those degrees of it which stimulate and excite, to those, in
which its ultimate stimulant power destroys excitement, and leaves no
thing but indirect debility. 

OF MEDICINE. 15
diseases may arise more certainly from cold, alternating
with heat, and either preceding or following it, than from
pure heat.
XXXVIII. The other condition or circumstance, limi-
ting excitement, is, an energy of the exciting powers too
small, and therefore insufficient to produce excitement.
As this case arises from a deficiency of stimulus, and an
abundant excitability, it ought to be distinguished from the
other, which supposes an abundance of the former, and
deficiency of the latter. The same distinction is required
also for the purpose of practice. All the exciting powers
may fall so short of stimulant force, as to produce that ef-
fect. They all, therefore, equally serve to illustrate and
confirm this proposition.
XXXIX. In this case, the excitability is abundant, be-
cause, in consequence of the stimuli being withheld, it is
not exhausted. Thus, in the cold bath, the excitement is
diminished, because the stimulus of heat, and, therefore,
the sum of all the stimuli, is deficient; and the excita-
bility, as being less exhausted by stimulus, is encreased (e).
The
(e) This is altogether a negative circumstance. The accumulation,
encrease, or abundance of excitability, take any term you please, is not
oceasioned by any action or operation, but by the want of action, the
want of operation. To form an adequate idea of it, suppose a scale of
excitability of 80 degrees, as in the line here drawn.
EXCITING POWER.
0 10 20 30 40 50 60 70 20
EXCITABILITY.
80 70 60 50 40 30 20 10  0
At the commencement of life, the sum total assigned is understood to
be 80, because no part, as yet, is wasted by the action of stimuli. Next
it is wasted in proportion as these are applied from the beginning to the
end of the scale. Its wasting is, therefore, owing to action and opera-
tion, but its accumulation to the reverse, the want of the action or ope-
ration of the exciting powers, as is expressed by the numbers placed a-
bove 
  

16 THE ELEMENTS
The same conclusion applies to famished persons, to water
drinkers, to those who are in a state of refrigeration from
other causes, to those who have suffered evacuations of any
kind, to those who have neglected the stimulus of exercise,
and given themselves up to indolence, to those who have
neglected the use of that stimulus, which exercise of the
mind affords, and to persons in low spirits. The effect of
withdrawing any stimulus is the more liable to produce di-
rect debility, the more any person has been accustomed to
a higher operation of it (f). Take, for an example, the
gout, and many other diseases, under the same circum-
stances, affecting some, and sparing others (g).
XL.
bove those first mentioned. Thus one degree of exciting power applied
takes off one degree of excitability, and every subsequent degree im-
pairs the excitability in a proportion exactly equal to its degree of force.
Thus a degree of stimulant or exciting power equal to 10, reduces the
excitability to 70; 20 to 60; 30 to 50; 40 to 40; 30 to 30; 60 to 20;
70 to 10; 80 to 0. And, on the contrary, the subtraction of stimu-
lant power allows the excitability to accumulate. Thus, when the ex- 
citement is at 79, constituting only one degree of life, take off one de-
gree of exciting power, and 2 degrees of excitability will arise. As 80
degrees of exciting power leave no excitability, so 70 degrees of exciting
power leave 10; 60 20; 50 30; 40 40; 30 50; 20 60; 10 70; 0 80.
Hence death takes place from nothing positive, but from the negation of
the only means by which life is supported; which are the several exci-
ting or stimulant powers, now fully explained.
(f)  For instance, persons accustomed to drink wine, and eat well-
seasoned nourishing animal food, will be more hurt by a water and ve-
getable regimen, then those who have not lived so high in that respect.
The inhabitants of Britain could not live long upon the diet of the Gen-
toos. Persons in genteel life could never undergo the work of day la-
bourers upon their fare.
(g) Vegetable aliment, and fruits and cold roots, as cucumbers, me-
lons, acid drinks, and many other things not sufficiently stimulant, will
bring on a fit of the gout, all or any ens of them, at any time; while there
are other persons free from the taint which distinguishes that disease,
who

OF MEDICINE. 17
XL. As, during the encrease of excitability, the ex-
citement decreases, and in proportion to the encrease of
the former; so that that process may go all the way to
death, is a fact from which nature exhibits no exception.
It is confirmed by the effect of all the debilitating powers
mentioned above; every individual of which, as often as it
proves urgent, has a rapid tendency to death.
XLI. The defect of any one stimulus, and the pro-
portional abundance of excitability, is, for the time, com-
pensated by any other, and often with great advantage to
the system. So a person, who has dined insufficiently,
and therefore not well enough stimulated, is recruited by a
piece of good news. Or, if during the course of the day,
he has not been sufficiently invigorated by the stimulant
operation of corporal or mental exercise, and consequently
likely to pass a sleepless night, he will be laid asleep by a
dose of strong liquor. When the latter is not at hand,
opium will supply its place. The want of the venereal
gratification is relieved by wine, and the want of the latter
is made amends for by the use of the former, each banish-
ing languor occasioned by the want of the other. The
same conclusion applies to the use of stimuli, for which we
have an artificial, rather than a natural, craving. The
longing for snuff, when it cannot be got, is gratified by the
practice of chewing tobacco; and, when any one is lan-
guid for want of tobacco, smoaking supplies the place of
it. Nay, when the functions, as they often are, have un-
dergone a temporary lesion, and on account of that, there
is no access to the use of certain accustomary and natural
stimuli; the substitution of others, less accustomary, and
less natural, supports life, till the desire for the natural sti-
C muli
who can use them with impunity, or, at least, with much more freedom
and less harm. Something similar to this observation applies to most
diseases. 

l8 THE LEMENTS
muli is restored, and these are now in a condition to sup-
port the natural vigour as usual, and the health finally esta-
blished (u).
XLII. As, in this manner, the superabundance of ex-
citability, proportioned to the deficiency of stimulus, may
through all the degrees from its smallest to its greatest
quantity, be worn out to a certain extent, by one stimulus,
and then another, and the danger of its morbid accumulati-
on awarded, till the sum of it be brought down to that,
which is suitable to health; so, the more abundant the same
excitability is, that is the more stimuli are withdrawn, or
the greater the penury of the most powerful stimulids, the
less recourse can be had to that mediocrity of excitability
on which the vigour of life depends; and the weakness
may go to that pitch, the excitability arrive at that degree
of abundance, that the loss of excitement may at last be-
come irreparable. This proposition is both illustrated and
confirmed by the use of every debilitating power; as is ex-
emplified by cold, famine, thirst, and the progress of fe-
vers.
XLIII. This superabundant excitability proceeds with
such rapidity to death, that the only means of restoring
health, is first to encounter it with a very small dose of dif-
fusible stimulus, a dose scarcely exceeding the scanty (w) pro-
portion of stimulus, that occasioned it; then, after wasting
a part of the superabundance, to proceed to somewhat a
stronger dose of the stimulus; and in that manner to be con-
stantly taking off whatever superfluity still remains, till at
last
(u) This proposition is of the utmost importance, as holding out the
true principle, upon which so many actions and feelings of human life,
both in health and disease, are to be explained, and particularly as lay-
ing down an indication, which applies to 19/20ths of all the febrile diseases.
and include our artificial as well as our natural desires and appetites.
(w) Or under-proportioned. 

OF MEDICINE. 19
last the salutary mediocrity is regained. This state is the
converse of that debility, which arises from a worn out ex-
citabiiity (x), and the danger of death occasioned by it.
To give examples, a famished person is not immediately to be
gratified with a full meal; a person afflicted with a long du-
ration or high degree of thirst, is not immediately to be
indulged with a large draught: but the former should be
given bit by bit, the latter drop by drop, then both of
them gradually more plentifully. A person benumbed with
cold should gradually receive the cherishment of heat. Every
person, thoroughly penetrated with grief, sorrow, or any
high dejection of mind, should have good news gradually
communicated to him. The news of the safety of the Ro-
man soldier, who survived the disaster his countrymen
at Cannae, should have been communicated to the mother
in a round-about way, at first as having no better founda-
tion than doubtful report, then as being somewhat more
to be depended on, afterwards as having still a greater ap-
pearance of certainty, finally, as not admitting a shadow
of doubt: and last of all, before her son was introduced
to her, the woman should have been at the same time for-
tified (y) both by other stimuli, and a glass of Falerni-
an wine.
XLIV. Since all life consists in stimulus, and both the
over-abundance and deficiency of it is productive of diseases,
and in exalt proportion to the over-abundance or deficiency;
it follows, that the remedies of both these deviations from
the proper standard should be accommodated to their degree;
C 2 and
(x) An instance of worn-out Excitability is that debility which ari-
ses from intoxication; one of an accumulated excitability is that which
dram-drinkers experience the day after a debauch, in consequence of
which their hands shake till they are re-excited by their favorite cor-
dial.
(y) Had a part of her abundant excitability taken off, 


20 THE ELEMENTS
and that a high sum total of stimulus, through the course
of the disease, should be applied to a high degree of debi-
lity, or, what comes to the same thing, to a very abun-
dant excitability; but, that the quantity to be applied at
any particular time should be in the same proportion small
that the excitability is abundant.
XLV. The debility arising from defect of stimulus,
merits the appellation of DIRECT; because it happens in
consequence of no positive hurtful power, but from a sub-
duction of the necessary supports of life.
XLVI. Through the whole course of direct debility e-
very deficiency of stimulus is encreased by a second, the se-
cond by a third, the third by a fourth, till the effect at
last comes to be a cessation of any further excitement.
This last, therefore, is never to be lessened, and the debility
encreased, with the view, forsooth, that in consequence
of encreasing the excitability, the addition of a new sti-
mulus may act more strongly. For, as often as that is
put in practice, the morbid state is encreased; and, if the
debility should happen to be great, any further encrease of
it may induce death, but never encrease the strength. For,
while great debility, and, indeed, at pleasure, may, in
hat way, be produced; any excitement to be obtained
from a stimulus to come after, is confined within narrow
boundaries (z). Take for an example, cold bathing in
dropsy
(z) Suppose, that in place of an excitment of 40 degrees, the ex-
citement is gone down to XXX, and the excitability mounted up to L,
and a debilitating power, such as the cold bath, or any of those that
are just now to be mentioned in the text, has been superadded, reducing
the excitement to XXV, and accumulating the excitability to L.V.
Suppose also, that any stimulus is next employed, with a view to raise
he excitement, and sink or reduce the excitability; what will be the re-
sult? As an accumulated excitability admits of a very small degree of
stim- 


OF MEDICINE. 21
dropsy, in the gout, in fevers (a), in persons who, pre-
vious to this, have undergone refrigeration, and in every
sort of debility. And who would treat the cases of famine,
of deep sorrow, of weakness of the mental function, of
languor from inactivity, of penury of blood, which are all
cases of direct debility, who would treat them by superin-
ducing more direct debility, with a view to his gaining
some advantage from the very scanty stimulus, that can be
admitted? The accumulation of excitability, applies only
to the predisposition to indirect debility, or sthenic dia-
thesis.
XLVII. With respect to every sort of debility, it is to
be observed, from all that has been said upon both forms of de-
bility, that, as indirect debility is never to be cured by di-
rect, so neither the latter by the former, nor either by
the other,in the vain hope of obtaining benefit from the af-
ter employment of any stimulus (b).
CHAP.
stimulus at any given time, while the accumulation of excitability, and
sinking of excitement, even to death itself, can be effected in the short-
est space of time, and by any one of the debilitating powers; conse-
quently, the loss of vigour by the first practice, and the reparation of
it by the last, will bear no proportion to one another; there will be no
possibility of regaining the vigour thrown away, much less any hope of
procuring more than existed before it was lowered.
(a) By fevers here are meant those diseases so named, which depend
on evident debility, and not any of those, which, though most injudici-
ously so named, depend upon an opposite cause. Instances of the former
we have in all the fevers of the internment or remittent kind, in syno-
chus, typhus, and the plague itself, with others that have never been
considered as fevers. Examples of the latter occur in synocha, or the
common inflammatory fever in the several diseases of the same stamp
accompanied with inflammation in a part, as in the throat, lungs, and
various parts of the external surface.
(b) Indirect debility appears in the range of a scale from 70 up to 80;
the direct, in all the degrees below 40 to 0. The only cases, that ad-
mit of debilitating operation, are those of excessive excitement from 40
ap to 70. For the cure of diseases within this latter range, all the di-
rectly

22 THE ELEMENTS
CHAP. IV.
Of the Seat and Effects of Excitability.
XLVII. THE seat of excitability in the living body
(a), is medullary nervous matter, and muscular solid; to
which the application of nervous system may be given.
The excitability is inherent in it but not different in different
parts of its seat. This fact is proved by the production of
sense, motion, the mental function, and passion (b), im-
mediately, instantaneously, and not in a series of successive
operation (c).
7. Dif-
rectly debilitating powers are proper, and, for the most part, they only;
because there is no access to the use of the indirectly debilitating powers
till they have run their full course of stimulant operation from 40 to 70,
at whieh last only they become debilitating; and, though sometimes, and
under certain circumstances, they may be employed, the safest general
rule is to avoid them.
(a) Called system by medical writers.
(b) That is, all the functions which distinguish living animal sy-
stems.
(c) If a small quantity of an opiate, or a large one of any strong spirit
taken into the stomach, can instantly alleviate an excruciating pain in a
Part the most distant from that to which the remedy is applied, and, in
a short time after, remove it altogether, as is now well known, how is
that to be explained but by the above proposition: it being impossible to
pretend that it is carried in the vessels? Nor is any other of the many
hypothesis, that have been thought of for the solution of this fact, more
admissible. Should it be imagined, that it moves along the nerves ac-
cording to the last opinion, we demand proof of that affection; which
has not yet. and will not easily be produced; while the fact just now
assigned carries its own demonstration in its bosom. The question re-
solves itself wholely into the following solution; Why does opium at
ones relieve the gout in the stomach, on the internal surface, and in the
remotest extremity of that surface? Because the property in the living sy-
stem, upon which and by which it acts, is one and the same over all 


OF MEDICINE. 23
7. Different exciting powers are applied to different
parts of the nervous system, none at once to the them all; but
the mode of their application is such, that, wherever they are
applied, every one immediately affects the whole excitability.
XLIX. Every one of the same powers always affects
some part more than any other, in which respect one pow-
er affects one part more than any other, another another,
with the same inequality. The affected part is generally
that to which any of the powers is directly applied.
x. And besides that, the more excitability has been
assigned to any part from the beginning of the living state,
that is, the more vivid and sensible it is, the operation upon
it of each exciting power, whether acting with due force,
or in excess, or in defect, and through all the intermediate
degrees of its action, becomes more powerful (d). Thus
the brain and alimentary canal possesses more vivid exci-
tability, that is, more propensity to life, than other inter-
nal parts; and the parts below the nails, than other exter-
nal parts. Again, while the fact just now related is such,
as it has been stated, the affection of the part bears no pro-
portion to that diffused over the whole body.
L. An estimate may be formed of the degree of affecti-
on in the part more affected than any other, and of that
which is diffused over the whole body, by comparing the
affection of the former with as many lesser affections, ta-
ken together, as equal the number of parts in all the rest
of the body. Suppose the greater affection of a part (f)
to
(d) That is to say, if the exciting power acts with that force which
produces health, the degree of its action is greater upon the given than
any other part; as also when its action is either greater or less than that
of the middle salutary degree.
(f) As the inflammation of the lungs in peripneumony, the inflam-
mation of the foot in the gout, the effusion of water into a general or par-
ticular cavity in dropsy. 

24 THE ELEMENTS
to be as 6, and the lesser affection of every other part to
be 3, and the number of the parts less affected to amount
to 1000 (g); then it will follow, that the ratio of affection,
confined to the part, to the affection of all the rest of the
body, will be as 6 to 3000. This estimate, or something
very like to it, is proved by the effect of the exciting hurt-
ful powers, which always act upon the whole body (h);
and by that of the remedies, which always remove the
effect of the hurtful powers from the whole body (i), in
every general disease (k)
LI.
(g) Which is keeping greatly within the truth.
(h) The hurtful powers, which produce peripneumony, in common
English, the inflammation of the lungs, are excess in eating, drinking,
exposure to heat, or to the alternation of heat with cold, an over pro-
portion of blood from inactivity, or an encreased velocity of its motion
from violent labour, &c. the effect of any or all which must fail as much
upon every other part of the system as upon a small portion of extreme
vessels in the lungs, and therefore the morbid affection produced cannot
be confined to the latter, but must be extended to the former. The
whole body must partake of the morbid change; It must be one common
affection prevading the whole. If this is not probation, let any thing
left on record by authors, or any living physician, produce a single hurt-
ful power, that, without affecting the system over all, can penetrate in-
to the inmost recesses of the lungs, and there produce an inflamma-
tion. I shall be content with one such hurtful power, and in exchange
for it, when produced, give up my whole doctrine.
(i) Here too I throw the gauntlet. Find a single remedy which re-
ru oves the disease by an operation confined to the lungs. There is net one,
(k) A wound in the lungs, among other effects of it, may produce
an inflammation. But that is not a peripneumony, or a general disease
at all. It is, on the contrary, a local one, arising from a local cause, and
to be removed by local remedies, if access could be had to them. And
though nothing has been more common than blending such cases of local
and general disease, at the same time no error that has hitherto crept
into the art, needs more to be corrected. Such an accident is as much a
peripneumony, as an inflammation from a contusion in the foot is a gout,
or the swelled legs of women heavy with child is dropsy. But of all this
more hereafter. 


OF MEDICINE. 25
LI. In this way temperature affects the surface of the
body; diet the stomach, and the rest of the same canal;
the blood and other fluids their respective vessels; labour
and rest the vessels again, and fibres of the muscles:
passion and exertion in thinking, the brain; all these af-
fect the parts mentioned, each that upon which its action
is exerted, more than any other equal part.
LII. Instances of a greater excitement of a part than of
the rest of the body, are found in sweat in a person in health,
flowing first from the brow under exercise, in checked
perspiration, in inflammation or an affection analagous to
it in diseases, in head-ach and delirium. Proofs
of a lesser excitement in a part, are excessive perspira-
tion and sweat not occasioned by labour or heat, es-
pecially when it is cold and clammy, profusion of the
other excretions, spasm, convulsion, partial pally, weak-
ness or confusion of intellect, and again delirium.
LIII. As the operation of the general powers, whether
exciting in excess, in due proportion, or in defect, is di-
retted to some one part a little more than to any other
equal part; it is next to be observed, that it must be
of the same kind in that part as in the rest, and as well
as the general operation, be either in excess, or in just pro-
portion or deficient, but never of an opposite nature.
For as the exciting powers are the same, and the excitabi-
lity every where the same, it is impossible that the effect
should not be the same. The excitement, therefore, is
never encreased in a part, while it is diminished in the gene-
ral system—nor diminished, while the general excitement
is encreased. There is no difference here, but one of de-
gree; nor can different effects flow from one and the same
cause.
λ For though, on account of the great sensibility of
2 certain 


26 THE ELEMENTS
certain parts, (for instance, the stomach (l), and the for-
cible energy of the exciting powers, either in stimulating
or debilitating, exerted on them, these parts run sooner
than most others either into direct or indirect debility, or
into a great encrease of excitement; that however is only
a matter of short duration, and it is not long before the
rest of the functions are hurried into the same state. Thus,
nausea, vomiting, diarrhœa, and other similar symptoms,
produced by strong drink and opiates; as well as the same
affections apparently, and the gout, colic, gripes, and other
similar symptoms, occasioned by abstinence and water drin-
king; likewise good appetite, and the removal of the tur-
bulent symptoms of the stomach and intestines, which we
have mentioned, taking place in the convalescent state,
in consequence of a proper administration of food, drink,
and diffusible stimulants: all these are shortly followed by
a similar state of the rest of the body, and the establishment
of indirect debility is the consequence of the first case;
that of direct debility succeeds to the second, and health
over all is the termination of the last.
LIV. A part, therefore, is the seat of no general affecti-
on; the whole body is the seat of them all; because, with
the inequality above related, the whole excitability is affect-
ed in them all.
LV. Neither is the affection of the more suffering part
the first, and afterwards propagated over the system; for
this good reason, that, as soon as the excitability is affected
any where, it is also and immediately affected every where.
Both facts are confirmed by the operation of every exci-
ting power, affecting the whole body as quickly as any one
part; by general morbid affections appearing equally soon
over
(l) For the same reason, i.e. the sensibility of the genital system,
wine and other strong liquors, as well as opium, operate indirect debi-
lity sooner upon these parts than others, 

OF MEDICINE. 27
over all the system as in any part, and for the most part
sooner (m). Therefore,
LVI. Every affection of a part, however formidable,
ocurring in general diseases, is to be considered as only a
part of the affection inherent in the whole body, and the
remedies are not to be directed to a part, as if the whole
disease lurked there, and was thence to be taken off only,
but to the whole body, to all which it belongs (n).
CHAP. V.
Of Contraction and its Effects.
LVII. THE entire and vigorous contraction with
which muscular fibres are endowed, is in proportion to
the degree of excitement on which it depends (a). This
is proved by all the phænomena of health and disease, and
by the operations of all the exciting powers and of all the re-
medies. Force and propensity to motion are the same.
We must judge from facts, not from appearances. Con-
sequently
(m) The pain of the thorax in peripneumony, which is the sign of
the inflammation within, never appears so soon as the general affection,
and in more than in one-half of many hundred cases, where this fact
has been painfully scrutinized, it did not appear till one, two, or three
days after the commencement of the general affection. Likewise the
pain of the gout is not the first of the phenomena of that disease. But
all these, and many more particulars, will be brought in with more ad-
vantage in their proper places afterwards.
(n) When the affection of a part is external, and, therefore, accessi-
ble, the application of a remedy over it, in conjunction with the use of
the internal remedies, is of service, in consequence of their mutually
assisting each other. A rag drenched in a liquid opiate, helps the opera-
tion of that remedy taken internally; but that is still by operating upon
the excitability over all.
(a) It has already been proved, that all the functions depend upon
excitement and therefore contraction among the rest. 


28 THE ELEMENTS
sequently, tremor, convulsion, and every affection com-
prehended under it, are to be imputed to debility as their
cause. The hurtful exciting power is a stimulus uncom-
monly irritating to the part.
LVIII. The degree of contraction, that constitutes
spasm, is not an exception from this proposition. It is a
continued and deficient function, rather than a great and
exact one; and in so far as it is a great contraction, it
depends upon the local stimulus of distention, or of some-
thing resembling distention, it consists in diminished ex-
citement, is devoid of force, and removed by stimulant
remedies. The appearance of symptoms, which is ever
misleading, is never to be trusted in forming any judge-
ment. Take now both the fact and the explanation of
it.
LIX. As the degree of contraction, in so far as it is a
sound function, is connected with force; from that we
are to hold it as a certain and demonstrated fact, that the
density of muscular fibres considered as simple solids, is
proportioned to the degree of their contraction.
LX. It must therefore be admitted, that excitement is
the cause of density. And the density is rendered great-
er and greater by the excitement in proportion to the de-
gree of the latter: Which it is easy to perceive through
all the intermediate degrees of strength, from the highest, or
that which takes place in madness, and the density cor-
responding to it, to the lowest, or that debility which is
discerned in the article of death, in death itself, and after
death, with a laxity corresponding to it. That this is
the fact, is proved by the weakness of the same fibres in
their dead, and their strength in the living state; the
only cause of which difference, we know for certain, is
excitement (b).
LXI.
(b) Experiments have been made by Baron Haller and others, to as-
certain the comparative strength of muscular fibres, and the criterion 
of

OF MEDICINE. 29
LXI. Hence the cavities of the vessels, through their
whole tracts, over the whole body, are diminished in a state
of strength, and encreased in weakness. This is the true
cause of diminished prespiration (c).
CHAP VI.
The forms of Diseases and Predisposition.
LXII. EXCITEMENT, the effect of the exciting
powers, when of proper degree, constitutes health; when
either excessive or deficient, it proves the occasion of disease,
and, of predisposition previous to the arrival of disease.
The state both of the simple solids and fluids follows that
of health as constituted by the excitement, and a given
state (a).
µ. The first cause of the formation of simple solids,
and the sole one of their preservation after, is the excite-
ment. Under the direction of the excitement, the living
solids produce the blood from an external matter taken in-
to the system, keep it in motion, form its mixture, secrete
from it various fluids, excrete them; absorb others, and
circulate and expel them from the body. It is the excite-
ment alone, thro its varying degrees, that produces either
health, diseases, or the return of the sound state. It alone
governs both universal and local diseases. Neither of
which
of judgment was their greater or lesser disposition to break by appended
weights; but the power by which any body resists stretching, is the
density of that body. Those experiments show that the fibres in the li-
ving body are prodigiously stronger than the dead.
(c) and not any of the hypothetical ones, as constriction from cold,
or spasm, which are to be considered afterwards,
(d) This proposition overturns the principal systems that have ever
appeared in the profession of medicine. But more of it after, 


30 THE ELEMENTS
which ever arise from faults of the solids or fluids, but al-
ways either from encreased or diminished excitement.
The cure of neither is to be directed to the state of the
solids or fluids, and only to the diminution or the en-
crease of excitement. But.
LXIII. Affections peculiar to parts, or organic mala-
dies, being foreign from this place of the work, in which
the treatment of the general state of the body is only consi-
dered, must be passed over at present.
LXIV. That the excitement governs all life is proved
by the exciting powers, acting always by stimulating, and
thereby producing excitement; it is proved by the great-
er or smaller activity of the functions being proportion-
ed to the force of the exciting powers; it is proved by the
effect of the remedies, which always oppose deficient, to
excessive, and excessive, to deficient excitement, in ef-
fecting the cure of diseases,
LXV. The notion of health and disease being different
states, is disproved by the operation of the powers which
produce them, and those that remove them, being one and
the same.
LXVI. The general diseases, arising from excessive
excitement, are called sthenic (b); those that origi-
nate from a deficient excitement, asthenic. Hence
there are two forms of diseases, and both are always pre-
ceded by predisposition.
LXVII. That the origin of diseases, and predisposition
just now mentioned, is the only one and true, is pro-
ved by the same powers which produce any disease, or
pre-
(b) Their old name is phlogistic; but as that word is absurdly meta-
phorical from an old notion of that sort of diseases depending upon fire
or flame; and because it was not a proper contrast to the term here to
be opposed to it; as also because it is still more ridiculous when applied
to plant, which are comprehended in this doctrine; for these reason.
it has been thought proper to reject it, and substitute the other in its
place. 


OF MEDICINE. 31
predisposition, also producing the whole form of diseases
to which it belongs; and by the same remedies, which
cure any disease, or predisposition, also curing all the dis-
eases and predispositions of its respective form (c). Be-
twixt these opposite sets of disease and predisposition, per-
fect health is the mean, leaning to neither extreme.
LXVIII. The exciting powers, which produce pre-
disposition to diseases, or those diseases themselves, should
be denominated sthenic, or strictly stimulant. Those that
pave the way to asthenic diseases, or produce the latter,
should be called asthenic, or debilitating. The state of the
body producing the former or the predisposition to them,
is to be called Sthenic Diathesis, that which occasions the
latter, with the predisposition peculiar to it, receives the
new term of Asthenic Diathesis. Each of these diatheses
are a state of the body, the same with predisposition and
disease, varying only in degree. Distinguish the powers
that raise both the diathesis to the degree (d) of disease, by
the term exciting hurtful powers. The sthenic diseases, in
which the pulse is turbulently affected, should not be de-
I nominate
(c) The same hurtful powers produce, and the same remedies re-
move, both Catarrh and Peripneumony, only differing in degree. The
powers producing them are excess in the use of stimulants, and the re-
medies whatever moderates that excess. Evacuation, cold, and starving,
are the means. All the difference is, that more of the means are em-
ployed for the cure of Peripneumony than for that of Catarrh. The
hurtful powers producing indigestion and fevers, are also the same, to
wit, debilitating; and the remedies the same, to wit stimulant. Only a
small degree of the remedies, proportioned to the slightness of the de-
gree of the cause, is sufficient for the cure of indigestion; while the
most diffusible stimuli are required to effect the cure of sevors. Stimu-
lants, in one degree or other, make the cure of all asthenic diseases;
evacuants and other weakening means in different degrees, form the
whole cure of the sthenic form of diseases. Might not this have been
known long since?
(d) or full measure. 


32 THE ELEMENTS
nominated fevers or febrile diseases, but, for the sake of
distinguishing them from the asthenic diseases that disturb
the pulse, to which fever is a proper name, they should be
cold Pyrexies.
CHAP VII.
The Effect of both the Diathesis, and of the most perfect Health
itself.
LXIX. THE common effect of the sthenic hurtful
powers upon the functions, is, first to encrease the func-
tions, then partly to impair them, but never by a debilita-
ting operation (a). The effect, in common to the asthenic
hurtful powers, upon the same functions, is to diminish
them, in such a manner, as sometimes to exhibit an appea-
rance, but a false one (b), of encreasing them.
LXX. If the just degree of excitement could be con-
stantly kept up, mankind would enjoy eternal health.
But two circumstances prevent that. Such is the nature of
the sthenic diathesis, that it wastes the sum total of exci-
tability assigned to every being upon the commencement
of its living state, and, thereby shortening life often by the
interposition of diseases, sooner or later induces death.
Which is one cause of mortality.
LXXI. the asthenic diathesis is hurtful by not supply-
ing that degree of excitement, which is necessary to life,
and
(a) The inability to perform motion in peripneumony, arises not
iom debility, for two good reasons; first, no powers but those that pro-
duce all the other symptoms produce it; and the same remedies, that re-
move the other symptoms, are equally effectual for the removal of it,
(b) Spasm and convulsion, supposed to arise from encreased influx of
the nervous power, are both occasioned, and cured, by the same pow-
ers, all the other symptoms. 
               

OF MEDICINE. 33
and thereby allowing the state of life to approach more
nearly to that in which death consists. Which opens ano-
ther gate of death to mankind.
v. Further diseases and death are the consequences of
the change of either diathesis into the other. Either dia-
thesis, by means of the hurtful powers producing the other,
when these are employed as remedies (c), may, either from
accident, inadvertence, or design, be completely converted
into the other; and when that has been done, and oppo-
site remedies to those, that in this manner proved hurt-
ful, are employed; it may, by a contrary excess, be turned
back to the same state from which it set out (d). This
D observation
(c) Stimulants are the proper remedies for curing the gout; but they
may be carried so far as to produce so much sthenic diathesis as to border
upon indirect debility. A consequence of which is vomiting, purging,
a feeling of burning in the intestines, intermission of the pulse, and stran-
gury; which are only to be cured by substituting watery drink and low
diet in place of those opposite remedies: Nay, the stimulants may be
carried so far, as to effect the establishment of indirect debility. Hence,
will arise paralytic affection, anasarca, dropsy, &c. The evacuants and
other debilitating remedies, by which the diseases of sthenic deathesis
are removed, may, by being pushed to excess, produce the last mention-
ed diseases, as depending on direct debility.
(d) Pushing the remedies of sthenic diseases too far, may reduce the
patient to an incipient dropsy; and the remedies of the latter may be
urged to such excess, as to pass the range of sthenic diathesis, and ter-
minate in indirect debility. A is affected with a disease of debility,
where the excitement has gone down to 10, the excitability mounted
up to 70, degrees in the scale. What is to be done? By a proper
use of high stimulants the 30 degrees of lost excitement may be restored
and as many of superfluous excitability discharged, and the excitement
and excitability made to meet again at the middle point of 40. If the
remedies are carried up to any degree betwixt 40 and 55, they have
gone too far, and produced predisposition to sthenic diseases; if still far-
ther, but not exceeding 70, they will have produced one or other of,
these diseases. But carried beyond 70, the diseases, which their opera-
tion

34 THE ELEMENTS
observation will be found of the greatest consequence in
the cure of both predispositions and diseases (e). What
is wanting to a further illustration of it shall be given af-
terwards. An illustration of the change of sthenic diathe-
sis into asthenic is found in hydrothorax succeeding perip-
neumony. Again, the immoderate use of stimulants
may convert any asthenic affection into a sthenic one;
as when a violent cough, a catarrh, or an inflammatory
sore throat, are induced in consequence of the cure of the
gout, though proper in kind, being carried to excess in
degree.
ξ. Though excitement governs all the phenomena of
life; yet the symptoms of diseases, which either its excess
or deficiency produces, do not of themselves lead to any
proper judgment reflecting it; on the contrary, their
deceiving appearance has proved a source of infinite error.
LXXII. From all that has hitherto been said, it is a
certain and demonstrated fact, that, life is a (f) forced
state, that the tendency of animals every moment is to dis-
solution; that they are kept from it (g), by foreign pow-
ers,
tion produces, are those of indirect debility. Any disease of this sort,
when treated according to a rule lately delivered, will be cured. But
if the stimulants adapted to this purpose be urged further; the sthenic
diathesis will again be produced; and the debilitating power, suited to
the removal of it, may carry down the excitement below 40 into the
range of predisposition betwixt 40 and 45; and then, by a further abuse
of remedies, which should only be used in the range betwixt 40 and 70,
the excitement may return to the same point from which it set out, to
wit, the point of 10, and the excitability rise to its original point, that
of 70.
(e) It must never be forgot, that we are nothing in ourselves, but,
while we have any excitability remaining in proper capacity to be acted
upon, we entirely depend on the exciting powers acting on it,
(f) not a natural, but,
(g) not by any powers in themselves, but 

OF MEDICINE. 35
ers, and even by these with difficulty and only for a little;
and then,from the necessity of their fate, give way to death.
CHAP. VIII.
Of Predisposition.
LXXIII. Predisposition is a middle state betwixt per-
fect health and disease. The powers, producing it, are
the same with those which produce disease.
LXXIV. The period of predisposition will be shorter
or longer, according to the greater or lesser force of the
hurtful powers that have induced it; and the interval be-
tween health and actual disease will be more quickly or
slowly got over.
LXXV. That predisposition necessarily precedes disea-
ses, is evident from the fact of its arising from the same
exciting powers, acting upon the same excitability, from
which both health and disease arise, and of its being an in-
termediate state betwixt them both. And, as the excite-
ment of health differs much from that of disease; it is not,
herefore, to be supposed, that the former immediately
mounts up to the latter, and skips over the boundaries of
predisposition: nay, the contrary is certain and beyond
a doubt.
LXXVI. Contagious diseases are not an exception from
this observation; because, whether the matter of contagion
act by a stimulant or a debilitating operation, its operation
is the same with that of the ordinary powers, that is to say,
its cause is the same (a). If, as it sometimes happens, no
D 2 general
(a) The small-pox and measles are cured by the same means as perip-
neumony or any other sthenic disease; and, excepting the contagious
matter, arise from the same stimulant hurtful powers; they must, there-
fore

36 THE ELEMENTS
general affection follows the application of contagion, if
no undue excess or defect of excitement is the conse-
quence;
sore, with the same exception, be the same. The only difference is,
that,they are accompanied with a contagious matter, and the other
sthenic diseases are not. The amount of which is altogether unimport-
ant. For, if the ordinary powers have not operated, the affection does
not come under the definition of general disease, none of the functions
receding from their natural state, and the eruption amounting to no
more than a slight local complaint. It is, therefore, only of use to re-
gard the general circumstances of these diseases, making no more ac-
count of the local part, than to consider, arrange, and treat it as such.
It is well known, that, when by the means used for the cure of sthenic
disease without contagion and their sequel, eruption, the sthenic dia-
thesis is prevented or removed, the local part gives no trouble; and
that the disease is never dangerous but from the neglect of that manage-
ment. But the management is nothing else but the ordinary one in any
sthenic case. If it should be contended, that, all that being granted,
still the eruption may contribute a little: Be that so, and it can be but
very little; what is the effect? The cure shows it; which is exactly the
same as in sthenic diseases without eruption. The disease, therefore,
being the same (for its mere local part is out of the question, as only re-
quiring a peculiar exposure to cold, which is equally proper in every
sthenic disease); every part of reasoning respecting it, and, consequently
that affecting the question about predisposition, must also be the same.
If, therefore, other general diseases have their predisposition, so must
the small-pox, the measles, and the plague itself. If it should still be
said, that the eruptive diseases, though in other respects the same with
the non-eruptive, differ, in so far as predisposition is required as a com-
mon circumstance between them; the answer is, that that difference
only respects their local part, which, without the powers producing the
disease, is insignificant and a mere local complaint. As general sthe-
nic diseases, the small pox and measles, and as general asthenic ones, con-
tagious fever and the plague, to the full extent of their generality, have
their period of predisposition; we may have occasion afterward to esta-
blish the question about predisposition to them even as local diseases, but
this is not the place for it; all that was required here being to settle the
question about predisposition to them as general diseases. In the same
point of view all that has been said of contagious diseases, will apply to
diseases in which persons may have been concerned. 


OF MEDICINE. 37
quence; in that case, the affection is altogether local and
foreign from this place.
LXXVII. If poisons communicate any sort of morbid
affection without predisposition, such an affection, for that
very reason, is not to be considered as a general disease, as
also for this additional reason, that the affection is neither
removed nor relieved by the usual cure of general diseases;
and the diversity of the effect proves, that both the cause
and exciting hurtful power are different from the general
ones. In one word, since predisposition and disease are
the same, varying only in degree, the unavoidable con-
clusion is, that whatever, with a given force, produces the
latter, the same, with a lesser force, will produce the for-
mer. The only cure of most poisons is their early dis-
charge from the system. And if, as often happens, others,
by wounding an organ necessary to life, are not curable,
but fatal; the effect of both is foreign from our present
subject, and to be referred to local diseases.
LXXVIII. The only thing to be regarded in the
powers producing either predisposition to general diseases,
or those diseases in their full force, is the degree of the for-
mer (c) compared with that of the latter (d), or of the in-
dividual powers compared with one another; for the pur-
pose of discerning the degree of hurtful power that each
possesses, and the degree of curative means to be employ-
ed in order to remove the hurtful effect (e).
LXXIX.
(c) those that produce the predisposition,
(d) those that produce the disease,
(e) The distinctions of the powers producing predisposition, and of
those that excite disease, under the general appellation of predisponent
or occasional causes have been multiplied and refined upon without end.
But the whole system of remote causes, as they have been called, is
false in its first idea. The hurtful powers, whatever they be called, that
produce diseases, also produce the predisposition to them. Which be-
ing once admitted, as it henceforth must, the whole fabric of aitiology 
or

40 THE ELEMENTS
neral diseases (k); all these must be rejected from the num-
ber of general diseases: and that for the most solid reasons;
to wit, their differing from them in the hurtful powers
that produce them in their true cause (l), in their cure (m),
and in every essential respect, agreeing with them in no-
thing, but in a deceitful and deceiving superficial appear-
ance.
CHAP.
(k) Let it here be added, that the powers producing general diseases,
are those that act upon the excitability, and are, thereby, quickly commu-
nicated over the whole system; while those, that act upon the solid tex-
ture of a part, so as to cut, prick, bruise, or contuse it, &c. are the pow-
ers productive of local disease.
(l) The cause of the inflammation of the stomach has been mention-
ed. To concentrate it into a definition; it is a solution of the continui-
ty of a solid part in the stomach, by mechanical or acrid means, follow-
ed by inflammation and pain, and in consequence of the great sensibility
of the part, propagating symptoms of disorder over all the system. The
cause of the general diseases here alluded to is an encrease of excitement,
and the inflammation accompanying those diseases arises from that en-
crease.
(m) The cure of Gastritis, or the inflammation of the stomach, is to
contrive means to keep the hurtful, and all rude matters, from coming
into contact with the inflamed part, and leave that part to heal; taking
care, neither to encrease the local affection by too sthenic a diet, nor to
produce a tendency in the inflammation to run into gangrene, by the
abuse of evacuations and other debilitating powers; and if, than which
nothing is more likely, the acuteness or continuance of pain should at last
bring on a state of general debility, then to use the palliative means of
preventing that bad consequence. The cure of Peripneumony is to wea-
ken the system, from the very commencement of the disease, by diminish-
ing the energy of all the exciting powers; that of the abundance of the
blood by bleeding, that of the over-proportion of the other fluids by pur-
ging, starving; that arising from the stimulus of heat and other excessive
stimuli by cold, &c. 

38 THE ELEMENTS
LXXIX. The knowledge of predisposition is of great
importance; as enabling the physician to prevent disea-
ses (f), comprehend the true cause of them founded in pre-
disposition, and to distinguish them from local affections,
which are widely different from them (g).
LXXX. As the predisposition, to diseases, and the dis-
eases themselves, are the same state; a great criterion,
by which general diseases may be distinguished from local
ones, will be found in this single circumstance, that general
diseases are always, local never, preceded by predisposi-
tion (h).
LXXXI.
or of the doctrine of remote causes must fall to the ground: Consequent-
ly, simply remote causes, not divisible into predisponent and occasional;
relative remote causes, or such as are so divisible; internal and external
predisponent, internal and external occasional causes; approaching cau-
ses, or causæ propriores proximate causes, of which, not only one, but
often several, are assigned to every disease, must cease in medical language,
and the student's attention be turned away from the endless pursuit of
distinctions without a difference, to the study of the solid and useful facts
that nature holds up to his contemplation in great abundance, when once
his eyes are fairly opened to behold them,
(f) from his acquaintance with the powers that lead to them,
(g) Such is the simplicity to which medicine is now reduced, that
when a physician comes to the bed-side of a patient, he has only three
things to settle in his mind, First, whether the disease be general or lo-
cal; secondly, if general, whether it be sthenic or asthenic; thirdly, what
is its degree? When once he has satisfied himself in these points, all
that remains for him to do, is to form his indication or general view of
the plan of cure, and carry that into execution by the administration of
proper remedies.
(b) An inflammation in some part of the stomach, or as it has been
commonly called, "the Inflammation of the Stomach," as if it were
always of the same kind, produces many symptoms, that bear so great
a resemblance to general sthenic diseases, such as peripneumony, that by
systematics and nosologists, it, as well as many other inflammations of
internal cavities, have been united into an order of diseases, supposed all
to partake of one common nature. The Gastritis, however, which is 
its              

OF MEDICINE. 39
LXXXI. As the affection of a part is always the ori-
ginal source of local diseases, and as the distinctions, we
have related are established upon the solid basis of truth;
it follows, that the following disorders must be rejected
from the number of general diseases how great soever
their resemblance to them may be, and however much
they may conceal their own nature. Whatever affec-
tions, then, arise, from any state of a part, from stimuli,
from debilitating circumstances (neither of which last pro-
duce any commotion in the whole body, or only do so in
consequence of the force of the local cause), from com-
pression of a part, from obstruction, from other diseases
(i), and not from the exciting powers which produce ge-
neral
its nosological name, is essentially different, both from Peripneumony
and all the other general diseases of the order with which it is associated,
both in other respects, and in that of which we are speaking. As ari-
sing from certain local hurtful powers, it is not preceded by predisposi-
tion. So when I come to the bed-side of a patient under these circum-
stances, though I had no previous knowledge of the nature of his disor-
der; whenever I hear that he has swallowed ground glass, small fish-
bones, or, perhaps, a great quantity of Caien pepper, I can be at no
loss to discern the nautre of the disease, and to find, that it is altogether
local; and that for two of the best of all reasons; first, the person ha-
ving been in perfect health immediately before that accident; and se-
condly, that the substances which he had swallowed were such as would
naturally divide a sound part, or, in the language of our profession, pro-
duce a solution of continuity in it. From this, again, inflammation is
an inseparable consequence. And it is equally an universal fact in the
animal economy, that, when any part, whether internal or external,
which possesses great sensibility, is wounded or otherwise injured in its
substance, the pain arising from the inflammation superinduced, spreads
symptoms of disorder over the whole system, which are liable to mis-
lead those, who are not in possession of the criterion we here point out.
As such a case, then, is not preceded by predisposition, so peripneumo-
ny as well as every other sthenic, every asthenic, disease must, from the
proofs of the universality of the fact, be allowed to be, it must be local.
And here again we throw the gauntlet.
(i) whether general or local, 

OF MEDICINE. 41
CHAP. IX
The general diagnosis.
LXXXII. THE violence and danger of universal disea- 
ses is in proportion to the degree of excessive excitement (a)
or its indirect or direct deficiency (b); as is proved by
all that has been said above: consequently, their principal
variety turns upon this variation of the degree of excite-
ment.
LXXXIII. The only diagnosis (c) of any importance
is that, by which general diseases are distinguished from
local, or symptomatic affections, throwing the whole
system into disorder, with a certain resemblance to univer-
sal diseases. To execute which, the following marks are
to be understood to suffice for the detection of every gene-
ral disease; first, its  being preceded by a diathesis, and
this followed by one similar to it, and removed by an ope-
ration
(a) The excess is contained between 40, the point of health in the
table, and 70.
(b) The cases of indirect deficiency or debility are comprehended
betwixt 70 and 80. The direct are all the degrees below 40. Betwixt
40 and 55 consists predisposition to sthenic; betwixt 40 and 25 the pre-
disposition to asthenic diseases.
(c) Diagnosis is the doctrine of distinguishing diseases from one ano-
ther. It was naturally thought to be of the greatest importance, when
diseases were supposed very numerous, and as different from each other
as their names and the various appearances of their symptoms. That,
however, has been found to be altogether a mistake in this work, in
which the endless variety of general diseases is reduced to two forms, a
sthenic and asthenic one, without any ether difference but what con-
sists merely in degree. The huge volumes of diagnostics are then in this
chapter superseded; and much labour, not only irksome to the artist, but
worse than useless, often pernicious to patients, is proved to be super-
fluous,
2  


42 THE ELEMENTS
ration of the remedies of an opposite nature to that which
occasioned the disease: while on the contrary, local af-
fection is distinguished, first, by the affection of a
part, and the disorder of the system (d) being such
as may be traced back to that affection; and by the
absence of the diathesis of the disease which the local affecti-
ens resembles, or only its accidental presence.
LXXXIV. In order to attain to this useful knowledge
learn what is necessary from anatomy, waste no time in
superfluous study in it; peruse the works of the illustrious
Morgagni; dissect subjects; distinguish remaining effects
from causes that have passed away, examine diligently very
many bodies of persons who have been hanged, or have
died of wounds, and are otherwise sound: compare
these diligently with the bodies of those who have died by
lingering and often repeated disease; compare every par-
ticular with every other, the whole with the whole; guard
against the rashness of forming opinions, and, if you can,
you will be among a very few, who have ever been able
to do so; never expect to discover the cause of disease in
dead bodies; be circumspect in forming a judgment.
LXXXV. As internal local affections are often a cer-
tain taint that remains after general diseases have passed
away, it is therefore a matter of sound judgment to under-
stand, that there is less or more reason to suspect the for-
mer, in proportion as the latter have seldomer or oftener
preceded them.
CHAP. X.
The general Prognosis, or general Judgment of the Event.
LXXXVI. SINCE the powers producing sthenic and
asthenic diathesis, always act upon a part with more force
than any other equal part; it follows, therefore, that the
danger of disease during the predisposition, and of death
during
(d) not arising from any change in the excitement, but 
 

OF MEDICINE. 43
during the disease, arises in proportion to the degree of
diathesis, or to the importance of the part especially af-
fected. But, its degree being given, the more equal the
diathesis is, the more safe it is. Nor does it ever fall hea-
vy upon an organ necessary to life, without instant danger.
And hence it is, that peripneumony, apoplexy, phrenitis,
erysipelas, and the gout, when the two latter affect the head
with violence, are chiefly formidable.
LXXXVII. Local and symptomatic affections ought
to be distinguished from general diseases, and the remarks
made in the LXXXIII. LXXXV. transferred to this
place.
CHAP. XI.
LXXXVIII. THE indication for the cure of sthenic
diathesis is to diminish, that for the cure of the asthenic
diathesis, is to encrease the excitement, and to continue to
encrease it, till that degree of it, which constitutes the
mean betwixt its extremes, and which is suited to good
health, be replaced. This is the only indication of cure
that universal diseases admit of.
LXXXIX. As both diatheses arise from an operation
of the exciting powers, the same in kind but varying in
degree; so they are both prevented and removed by an ac-
tion of the remedies, also the same in hind, but opposite in
degree, to that which produced them. As their cause, so
is also their plan of cure, confirmed by an induction of
proof (a), drawn from the whole course of facts and phæ-
nomena (b). The same debilitating remedies, which re-
move
(a) not one or two, but
(b) Suppose the sthenic diathesis mounted up to 60 in the scale; to
reduce it to 40 it is evident, that the 20 degrees of superfluous excite-
ment 


44 THE ELEMENTS
move any one sthenic disease, remove that whole form of
diseases: and the same stimulant means, which cure any
one asthenic disease, remove all the rest (c). Are not pal-
sy, in fo far as it is curable (d), and dropsy, in so far as
it is a general affection (e), as well as the gout, and fevers,
both relieved and removed by the same remedies? And are
not peripneumony, the small-pox, the measles, rheuma-
tism,
ment must be taken off, and therefore, that remedies operating with
a stimulus, weak enough to produce that effect, must be employed:
they are still, however, stimulant, and of consequence, though they re-
move it, still the same in kind, as the powers that produced the diathe-
sis; it having been proved, that they are not to be supposed sedative,
both for the reasons already given, and for this additional one, that proof
has not been yet brought of a single sedative in nature. As their stimu-
lus, however, is less than that which is required to support the ordinary
state of health, they are understood to be debilitating, and, therefore,
proper remedies of sthenic diathesis.
(c) Suppose the asthenic diathesis to have sunk down to 20; to raise it
up to the standard of health, it is plain, from all the propositions hither-
to laid down, that the so degrees of deficient stimulus must be restored,
and, therefore, that remedies operating with a degree of stimulus ade-
quate to the production of that effect, must be used. All the difference
betwixt this force of stimulus and that of the other, is only a difference
of 40 degrees. As, therefore, the debilitating powers, though stimu-
lant, employed in the first, removed the morbid superfluity; so the sti-
mulant powers used in this case, called stimulant by way of eminence,
remove the morbid deficiency, and thereby, restore the degree of ex-
ciement, that constitutes the standard of health.
(d) When the prevalence of debility, and that to such a degree as to
destroy the connection that subsists betwixt the fibres of muscles, and that
function of the brain which we call will, takes place, in parts of the sy-
stem, not only remote from the center of activity, but beyond the cir-
culation, it must be of difficult cure; because the most powerful means
of effecting that operation, act most powerfully when taken internally,
and much more feebly when applied to the skin.
(e) What is called dropsy consists of a case which is a general disease,
and a number of others, which are only symptoms of local internal dis-
eases, and to be treated in the last part of this work: These arise from
ossifi- 
             

OF MEDICINE. 45
tism and catarrh, removed by the same remedies (f)? But
all these remedies in the asthenic case encrease, in the sthenic.
diminish, the energy of life. In both cases the operation
is a common one ever all, nor is there any diversity but in
degree.
XC. The remedies, therefore of sthenic diathesis are
powers, exciting by a weaker stimulus, than that which
is suited to health; and are in this work to be denomi-
nated, for the sake of brevity, Debilitating or Antisthenic
Remedies.
XCI. The remedies of asthenic diathesis are powers, ex-
citing with more force, than suits the best health; to be
named here in the practice stimulants or sthenic, for the
more convenient distinction of them from the other re-
medies.
XCII. These are to be employed with more or less free-
dom in proportion to the higher or lower degree of each di-
athesis, and of the local affection depending upon it. And
such a choice of each should be made in such a way as
that the most powerful may be adapted to the most violent
case. But the cure of any disease of considerable violence,
and scarce of any at all, is never to be entrusted to any
one remedy. The use of several remedies is preferable to
that of one; because, thereby, their direct energy is ap-
plied to the system to a greater extent, and the excitability
is
ossifications in the large vessels next the heart, from tumors, whether
schirrous or steatomatous, impeding by their pressure the return of the
blood by the veins to the heart. It is the general case that is here allu-
ded to, and the public may depend upon it, that it is to be cured, but not
by evacuant means, and, on the contrary, by the high diffusible stimuli,
necessary to the cure of diseases of high debility, such as the extremity
of typhus fever, and an expiring gout. All these are cured by high sti-
mulants.
(f) to wit, evacuants, old, and starving. 

46 THE ELEMENTS
is more completely and more equally affected. The per-
son, who means that his remedies should go to a parti-
cular part (h), is equally wise, as any one would be, who,
by cropping a twig, expects to eradicate a tree. What re-
medies are of general, what of local operation, shall next be
mentioned.
XCIII. General remedies are those, which, acting
upon the excitability, by an operation diffused over the
whole body, reproduce the state of health.
XCIV. Local remedies are those, which act by a simi-
lar operation on a part, and by an operation confined to
that, restore the sound state.
XCV. Since every universal disease, every predisposi-
tion, depends upon encreased or diminished excitement,
and is removed by the conversion of that into the degree
which constitutes the mean betwixt both; for that reason
in order both to prevent and cure diseases we must always
use the indication proposed, and stimulate or debilitate;
never lay by, nor trust to the supposed powers of nature,
which have no real existence.
XCVI. In the indication of cure, the only regard to be
had to morbific matter, is to allow time for its passing out
of the body. For whether it acts, like all other exciting
powers, sometimes by a stimulating (i), sometimes by a
debilitating operation (k), or whether its action consist in
only giving the peculiar form of its respective disease, and,
thereby, adding a local affection to a general one; in ei-
ther case there is no room for a new indication.
XCVII. For if the disease, as a general one, be pro-
perly managed, every eruption, aud its consequences,
every
(h) and there, from a local operation, and not by an affection of the
excitability, serve the purpose,
(i) as in the small pox and measles,
(k) as in contagious fevers and the plague, 


OF MEDICINE. 47
every species of inflammation, every species of ulceration,
give way to the happy effect of the general plan of cure.
And, when a contrary event takes place in consequence
of a bad method of cure, the local symptoms are propor-
tionally aggravated. This is proved in the small-pox long
ago, and in the measles lately (l), but, with equal certain-
ty; it is proved by the plague, at least, as often as it has
been treated with any judgment, and by remedies proper
in kind and administered in due proportion; it is proved by
the malignant, or gangrenous sore throat (m), and by
other
(l) After the discovery of the nature of the catarrh, the catarrhal
symptoms in the measles came naturally to be enquired into. A full trial
was given to the refrigerant debilitating plan, in the author's own fa-
mily, as well as among several patients, and lastly among near an hun-
dred patients in England, treated by the father of one of the author's
pupil's; who all did well, while others, who were kept warm, according
to a practice that Dr Sydenham had left as he found it among his
Alexipharmac cotemporaries, many died, and all had a bad recovery.
The Author's own son and name-son, a boy about six years of age, was
stript half naked and allowed to go out and play as he pleased. The only
check upon him was, his being allowed nothing but fluid vegetable mat-
ter, when he returned home with a keen appetite. This matter will be
further explained, and in a more proper place afterward. But, what
has been said, was in illustration of the hint in the text.
(m) This case of disease has been considered, as wholly and solely seat-
ed in the throat, and therefore conjoined with other disease, where
that local affection was understood to be the essential symptom, and a
symptom that connected all the cases. But the other cases are sthenic or
to be cured in the ordinary way of bleeding and evacuation; while such
a practice is certain death in it, as being not only an asthenic case, that
is a case of debility, but one of the highest; and, instead of depending
upon the affection of the threat, the affection of the throat depends on it.
Give stimulants to the patients labouring under the inflammatory sore
throat, and you kill them; bleed, purge, vomit, and starve, in the
gangrenous case, and you ensure the same fate. Such, however, are
the diseases, that systematics, nosologists, and other strangers in the
city of nature, have, from their ignorance of the place, in spite of their
natural 
 

48 THE ELEMENTS
other cases of typhus, with a similar affection of a part.
In the two last, the danger to life depends upon the degree
of the general affection, without which there is no occasion
for any apprehension from the local. And the same pro-
position is so true, with respect to the three former, that,
though the contagious matter has been applied, yet without
the general hurtful powers preceding, no true general
disease arises, the danger encreases in proportion to their
violence, and the whole cure depends upon the general
remedies. These are so many facts, that show, that no
matter, whether of a contagious nature or not, contri-
butes towards the cause of the general disease, which it
accompanies or distinguishes, or, if it contributes any thing,
that in that it differs not from the usual hurtful powers.
XCVIII. As, both in overabundant and deficient ex-
citement, the sound perspiration is diminished during the
predisposition, and suppressed in the course of the disease
(which has been already hinted, and will more fully be
demonstrated afterwards); it is, therefore, proper that it
should be carefully supported and kept up, for the purpose
of discharging every hurtful matter from the body. But
neither does that suggest a new indication of cure; since
the only means of effecting it are those, which otherwise
remove both the diathesis in proportion to their force, and
which are not serviceable as local, but as general reme-
dies (n).
XCIX.
natural distance, brought all together. (See Dr Cullen's Genera Mor-
borum, all the three editions, genus VII.) As soon will Mile end and
Knightsbridge meet; as soon will London place itself on the Calton-hill,
and become an elevatacd suburb of Edinburgh.
(n) The discovery of the support of perspiration upon a principle, which
extends to all the phenomena of the subject, was reserved for this work.
The heating remedies of the Alexipharmic physicians were intented to sup-
port the perspiration, and thereby, throw out a morbific matter; Which was
a very unlucky thought in the sthenic diseases,the principal of which were
pe-

OF MEDICINE. 49
XCIX. When any one, who, during the former part
of his life has lived luxuriously, has now, at an advanced
age, either from intention or compulsion, abated a good
deal of his usual indulgence, and yet preserves some appear-
ance of an abundance of fluids and of vigour; he must
not, therefore, as is commonly done, be supposed to labour
tinder plethora (o) and excessive vigour; but, on the con-
trary, unless there be arecent and evident cause for it,
which is possible, he must be held for one who labours
under indirect debility; and so much the more, if to
hurtful powers already too invigorating, in the number of
which are all those which fill the vessels, directly debili-
tating powers have succeeded: and it is not a debilitating
or asthenic plan of cure, which would increase the direct
debility, nor one too stenic (p), which would increase the
E indirect
peripneumony, of which we have already so often spoken; phrenitis, in
which the brain was supposed to be inflamed; and the small-pox and
measles; because the nature of those diseases, and the tendency of all the
powers producing them, was to check the perspiration, (see No. LXI.)
from the excess of their stimulus; consequently, the addition of more
stimuli, by way of cure, was to check it still more. But those diseases are
only three out of the hundred of general diseases: whereas the followers
of a great man who corrected that abuse through a fiery persecution,
ως δ α πυρος, against himself, went all into a much worse extreme.
Their imitation of their master transported them into a rage to carry the
plan of promoting perspiration, by the same means, through the remain-
ing 97 of the hundred. And they succeeded with a vengeance. For, as
it is here the nature of those diseases transmit too great a quantity of
fluids through the perspiratory pores, in consequence of the debility
which constitutes their cause; certainly the encrease of that debility,
that is to say,the encrease of the cause, should encrease the effect. Which
it most certainly did, through all the systems that have appeared for
more than a certainly past. This is intended only as a hint, to enable
our intelligent readers to understand the fuller explanation of perspira-
tion, which will soon follow.
(o) or an over proportion of blood,
(p) or stimulant, 

50 THE ELEMENTS
indirect debility, the principal part of the cause, and, con-
sequently, increase the force of the disease: But it is a
middle method, which is commonly called tonic, that
should be pursued (q).
C. Since to the degree of diseases (under which, to
make few words, let predisposition, also be comprehend-
ed, the degree of curative force should be accommodated;
in the indication, therefore, of cure, regard should be had
to age, sex, habit, constitution, climate, soil, in fine, to the
operations of all the exciting powers in general, of all the
hurtful ones in particular, of all the remedies, whether
they have previously been administered properly, or im-
properly.
CI. The subjects of direct debility are women, under
inanition
(q) The blood is made from the food, and elaborated by the powers of
digestion; that is, the more nourishing food is taken in, and the more
strength there is in the system to convert it into real blood, the more,
and also better, blood will be produced. The quantity of blood, so pro-
duced, may go to excess, as well as every other exciting power, the
principal of which is. But the question is, when, in whom, and under
what circumstances, is an over-proportion of blood generated? Com-
mon sense would say, not at the beginning or the end of life, when
the degree of nutriment used is far from being so considerable, as at the
middle and vigorous period of life. Again, which of the two sexes are
supposed most liable to generate this morbid redundancy of the vital
fluid? A simple creature aided by nothing but natural sagacity, would
be apt to say, the men; both because they eat more, and, from the
greater variety of the modes of promoting digestion to which they are
addicted, digest better. How medical systematics would laugh at such
simplicity? How contrary that would seem to mystery, their Lydian
stone under which they think all wisdom so safely lodged, as to sear it
would be dangerous to turn it up, and examine what was under it!
What sort of habits are most liable to it? Not those, who have the
greatest bulk of simple solids, whether they eat or not, much less those,
who are liable to bleeding discharges, who can neither eat nor digest;
but all those who eat and digest well. 
            

OF MEDICINE. 52
inanition (s), those who have had an insufficient share of
stimulus; those who have a delicate set of solids; those
who have been accustomed to moisture, whether from
the climate or soil; finally, all persons in a languid state,
without a preceding vigorous one, either from the powers
that produced their diseases, or from the mode of cure
employed to remove these.
CII. On the contrary, the persons in whom indirect
debility is prevalent are adult males; those who are full
and over stimulated, and so much the more, the longer
the latter has been the case; those who have formerly
had vigorous habits; those who have been overheated,
whether with moisture, without it, or from whatever
source; in one word, all whole former vigour, either
from the ordinary hurtful powers, or improper methods
of cure, is now converted into a state of languor.
CIII. In the cure of indirect debility, whatever be its
degree, from whatever sort of excessive stimulus it has
arisen; of the stimulus, which is to be employed as the
chief remedy, not much less than that, which produced
the disease, should at first be used; and then less and less,
till the disease is cured.
CIV. When the first part of the cure is completed, and
the convalescent now can use the more permanent and
natural stimuli, he should gradually be confined to them,
and drop the use of the more diffusible; with this dis-
tinction, that if he has been in the habit of using a consi-
derable deal of stimulus, he may be indulged in some-
thing extraordinary in that way for some time (t).
E 2 CV.
(f) or an empty state if the vessels,
(t) This indulgence is chiefly intended for those, who have gone to some
excess in the use of the stimulus of drink, and who still, without it al-
together, are not capable of taking enough of food and other durable
stimuli 

52 THE ELEMENTS
CV. The cure of the hurtful effect of any stimulus
should first be set about by changing it for a lesser one,
this for a still lesser; and the intention of cure should be
always to pass from the use of the more violent and dif-
fusible, which nature in her sound state rejects, to that of
the more durable, and more suitable to nature when un-
oppressed, till the healthy state can at last be upheld by
the usual supports (u).
CVI. In the case of indirect debility, when the view
is to restore vigour, a debilitating plan of cure should be
avoided; because no sort of debility is to be cured by an-
other, nor any degree of it by any degree of another. It
is
stimuli for their support. The aim, however, of all such persons (with
the exception only of those who are of an advanced age, or of those whose
debility threatens to run a certain course), should be to lay aside the daily
use of drink altogether, and to indulge in occasional approaches to
excess as seldom as possible. Some persons, even beyond the fiftieth
year of their age, when they found they could eat and perform all
their other functions with vigour, have had the resolution to abstain
from all sort of strong drink, not only with impunity, but with a most
wonderful improvement of their health and vigour. Another advantage,
arising from this management, is, that, whenever any disease, to which
a person may be liable, such as the gout, various affections of debility,
chiefly prevalent in the alimentary canal; in a word, the diseases of either
form of debility), either returns, or threatens to return; a return to
the use of wine and other strong drink will then become an excellent
remedy, and even supercede the use of the high diffusible ones. That
practice would he attended with this further advantage, that, when
the occasion that called for it was over, and the disease prevented or
removed, the person might again: lay aside the use of drink, with all the
good consequences he had formerly experienced from the practice, and
thereby both prolong his life, improve his health, and enjoy the proper
and vigorous use of all his functions.
(u) In many difseases of debility arising from a former excess, the sti-
mulant effects of which have passed away, the use of cold water, though
in gratification of the patients craving, and of other than potions, as well
as of vegetable aliment in a fluid form, and of evacuation of every kind,
is most hurtful.

OF MEDICINE. 53
is only in the progress to indirect debility (x), that direct-
ly debilitating powers are suitable for the purpose of sup-
porting the vigour, in that case, in danger of being worn
out (y); such as cold bathing, lowering the diet, weak
drink, and a similar abatement in the use of the other
stimuli.
CVII. For the cure of direct debility, we should begin
with the smallest degree of stimulus, and then rise to the
use of a greater and greater, till the morbid abundance of
exciteability be gradually worn off, and the health at last
restored.
CVIII. When the disease arises from the want of any
one stimulus, the return to its use should be gradual, and
facilitated by other stimulants more powerful than itself.
CIX. Also in this part of the general method of cure,
debilitating, either directly or indirectly should be abstain-
ed from; both for the reason formerly given, and also,
because the stimulant plan of cure, which is the only pro-
per one, when carried to excess, converts the sthenic dia-
thesis
(x) Betwixt 40 and 70,
(y) At 65 there are only 5 degrees of vigour left, which, either by
a continuance of the same excessive stimuli that produced them, or, by
the addition of a degree proportioned to that effect, would be worn out.
Remove some of the stimulant powers, the excess of excitement will be
diminished, suppose to 60; remove more of the former, and the excess
of the later will be further diminished, till the excitement is reduced to
its natural healthy standard of 40. The state of excitement, then, within
this range, that is, between 40 and 70, especially in proportion to the
approach of the excess to 70, is that, to which only directly debilitating
powers should be applied. In all cases above 70 where the excitement is
gone, and below 40 where it constantly decreases all the way, till it is
lost at 0, directly debilitating powers are pernicious. How bad then
must the only practice be, that we find in books and lectures, a practice
transmitted from the first accounts of our profession, and which deals in
the use of no other means but directly debilitating ones? Bad, indeed,
must it be!

54 THE ELEMENTS
thesis (x) into the asthenic (a), and the latter into death (b).
For which reason, while on the one hand, the debilitat-
ing powers, mentioned before, are to be avoided; it must
on the other, not be forgot, that the force employed in
the cure should be accommodated to the degree of morbid
state. The thirst, which is occasioned by debility, is in-
creased by draughts of cold water, is hurried on to (c)
nausea, and vomiting; is quenched by pine wine or spirit,
which prevent the troublesome symptoms that would
otherwise follow. Pure wine (d) encreases the thirst which
proceeds from a sthenic cause, and excites the same trou-
blesome symptoms, which cold water does in the other
case; cold water sates it, and prevents the future tumult.
CX. Since, therefore, the same powers excite all the
phænomena of life, and produce sometimes an excess,
sometimes a just proportion, sometimes a deficiency, of
life, according to the various degrees in which they are
applied; and since the same observation extends to the
same powers, when they are applied as remedies of dis-
eases; let it, therefore, be an universal rule, never un-
guardedly to convert either diathesis into the other. And
as every disease, that debilitating powers remove, is sthe-
nic, every one, that is cured by stimulant means, asthenis,
the knowledge of that may furnish the proper means of
caution against mistake.
THE
(x) that between 40 and 70,
(a) between 70 and 80,
(b) at 80.
(c) the higher symptoms of
(d) which is one of its principal causes, 

[55]
THE
SECOND PART.
CHAP. I.
Of the hurtful Powers, which produce either Diathesis,
Sthenic, and Asthenic.
CXI. THE powers producing the state of the body,
upon which the predispositions, to sthenic or asthenic dis-
eases or those diseases themselves, depend, that is, that
produce the sthenic or asthenic diathesis, are those which
were mentioned before (a).
The hurtful powers producing both Diathesis.
CXII. Heat, which is necessary to the production, the
growth, and the vigour of animals and vegetables, as
also to the form of the elements (a) from its action upon
the surface of the animal body, directly stimulates the
whole; an effect which it also exerts upon vegetables.
From this action of heat there is no exception when it
keeps within a certain range of scale; but when it is ei-
ther deficient, where it takes the name of cold, or exces-
sive,
(a) XI. XII.
(a) In a certain degree of diminished heat water freezes; but if such
a diminution of it could be found as to freeze air, the whole fabric of
the universe would rush into dissolution.
  

56 THE ELEMENTS
sive, its effect varies(b). This stimulus, in a moderate
degree, produces its effect in due proportion, in a degree
above that the excess of its action is such as to produce
more or less of sthenic diathesis.
CXIII. Because the action of heat is increased some-
what more upon the surface than in the internal parts,
where the temperature is nearly stationary, it, therefore
stimulates more in the former than in the latter. Hence,
in the phlegmasiae (c), the inflammation is always external.
The same agent encreases the tone of the muscular fibres
every where, and consequently their density (d). Hence,
as the diameters of all the vessels are diminished, so those
of the extreme vessels every where, and especially in the
skin, where a greater force of the cause is exerted, are of-
ten entirely effaced. But actual suppression of the per-
spiration is incompatible with predisposition, and arises
only from the diathesis, when it arises to the just mea-
sure of disease (e).
CXIV. Hence in the measles and small-pox, the irra-
tating matter, together with the perspirable, is detained.
And not only in these, but all other sthenic diseases, the
perspiration is suppressed, the excitement both upon the
surface and in the rest of the body is encreased, and ca-
tarrh particularly induced (f).
CXV.
(b) as shall be shown by and by,
(c) diseases with inflammation of a part.
(d) See Chap. V. Which produces a suppression of perspiration by some
imputed to constriction from cold, by others to constriction from spasms;
both erronously.
(e) The perspiration is diminished during the predisposition; but the
condensing power is not sufficient to suppress it, till it attains the degree
of producing the disease.
(f) Calefacients, or heating things were one of the means that the
Alexipharmic physicians employed to free perspiration; but the princi-
ple is now laid down, that shows they produce the opposite effect.
Hence

OF MEDICINE. 57
CXV. Heat, in extreme excess, whether it acts hurt-
fully by its duration or intensity, constantly debilitates by
diminishing the tone, and producing laxity instead of
density. Which effect is somewhat greater upon the
skin, to which the direct energy of heat is applied, than
in the interior part, in which there is little change of tem-
perature. Hence arises sweating as in the torrid zone;
hence the diameters of all the vessels, and particularly of
of the perspiratory vessels are enlarged. Hence proceed
the colliquative sweats in fevers, and a similar state of
the belly. Hence, also corruption of the fluids, and not
from a state of them directly produced by corrupting
powers (g).
CXVI. The same power in the violent measles, in the
confluent small-pox, in fevers, and in every kind of asthe-
nic (h) disease, in which the perspiration is deficient, does
not lessen the deficiency (i), though it expands and en-
larges the vessels, but on the contrary, encreases it(k).
CXVII.
Hence the merit of Dr. Sydenham in recommending cold both in the
small-pox and in peripneumony, in which disease he took his patients out
of bed, and placed them in an easy chair. Happy had it been for the
profession, and happier for the sick, had he extended his improvement to
the measles and catarrh, and all the rest of the few sthenic diseases, and
stopt there; but by extending his antiphlogistic and refrigerant doctrine
to the whole form of asthenic diseases, the harm and good he did were
in the proportion of 97 of the former to three of the latter.
(g) The idea of certain powers of a tendency to corrupt our fluids,
and or certain others to correct that effect, and take off the degeneracy
long prevailed in the minds of systematics, and is not among many of
their followers yet laid aside. Heat was one of the number; but that it
acts so, is disproved not only by the explanation here given, but by the
certainty of the fact, that the same effect is produced by cold, as well
as every other debilitating pow.
(h) or disease of debility,
(i) that is, does not encrease the perspiration,
(k) i.e. diminishes perspiration, 
  

58 THE ELEMENTS
CXVII. Cold, inimical to animals, vegetables, and
the elements, weakens the rest of the system, and still
more the surface, the temperature of which it almost
only diminishes, end it produces that effect always by a di-
rect operation, always in proportion to its degree. Cold
equally as excessive heat, produces atony and laxity of
the vessels, grangrene, and the other effects of excessive
heat (l).
CXVIII. That these effects of the extremes of tempe-
rature arise from debilitating not generating putrefaction,
from an affection of the excitement, not of the fluids,
plainly appears from this; that other exciting hurtful
powers, such as famine, an overbundance of blood, as
in the case of those who die of peripneumony, and similar
hurtful powers, which neither have been, nor can be, be-
lieved to affect the fluids by any direct operation upon
them(m), produce both the symptom of corruption, and
all the rest of the symptoms, and the same stimulants,
which remove the latter, remove the former. Nay, the
supposed antisceptics, such as wine, Peruvian bark, acids,
and
(l) In Siberia the phenomena of cold on the human body very much
resemble those of heat.
(m) Famine, acids, and cold, have all the same effects upon the fluids
that the putrefying substances were supposed to have; but surely acids
produce no putrefactive process; neither can want act as positive matter;
nor cold be supposed to produce any such effect. In a word, any cor-
ruption that it produced, arises only from the weakness by the heart and
arteries, predominant in their extremities. They cease to act; the fluids
within stagnate, and, under the heat of the body, degenerate. This is
the true cause of the corruption. And the remedies are not correctors
of the corrupted mass; but whatever invigorates the whole body, and
consequently the heart and arteries. Nothing can be more absurd than
to supppse that a glass or two of wine and water, a little bark, and so on,
after being blended in the whole mass of fluids, should go to a portion of
fluids in the extreme vessels, even without the circulation, and, by mix-
ing with it, change its qualities.

OF MEDICINE. 59
and other things of that kind, are either entirely destitute
of that operation, or they neither are given, nor can be
given, in that quantity, by which they can have any ten-
dency to effect the mixture of the fluids: In fine, the ef-
fects of inanimate matters upon one another are never,
with any propriety, transferred to living systems. Tho,'
then, the fluids are frequently corrupted, the corruption
is the effect of weak vessels not giving a sufficient mixture
or diffusion to them, but is never the cause.
CXIX. The disagreeable sensation both of cold and
of heat in extreme, is also hurtful, by diminishing the
sum total of stimulant operation, which, in so far as it is
agreeable, is serviceable by stimulating (n).
CXX. As cold is naturally so debilitating, and all de-
bilitating powers diminish excitement, it is therefore, ne-
ver of service but in sthenic diseases, that is, in those which
are in their progress towards indirect debility (o): because
the excitability, already too abundant, can never be ren-
dered more abundant, nor, when too much wasted, ren-
dered more accumulated, without an aggravation of the
disease(p); excitability admitting of less stimulus in pro-
portion as it is either more abundant, or more ultimately
wasted. When the debility is moderate, a mistake of
this kind is less evident: but in a high degree of debility
of either sort, a violent disease, or even death itself, may
be the consequence of the smallest encrease of debility (q).
CXXI.
(n) See note (r in par. XXI.
(o) See CVI.
(p) XLVI. XLVII.
(q) When the debility of the direct kind is very moderate, that is, the
excitement has not sunk much below XL. in the scale, the short suspen-
sion of a few degrees more would not do much mischief. Suppose the ex-
citement at 30 instead of 40, and a dip in cold water has brought it down
to 25, the effect even of that is not of a trifling nature; the debility by 
this

60 THE ELEMENTS
CXXI. As cold, as well as excessive heat relaxes, a fact
that is seen in the cure of the small-pox, and of every
sthenic disease, from that we are to understand, that the
property of cold in constricting (r) inanimate matter does
not extend to living matter (f). The diminution of the
bulk of the surface (t) arises from debility of the vessels,
not sufficently propelling the fluids, and filling the ves-
sels. In this way does cold produce asthenic diathesis.
CXXII. But, as always less and less excitement arises in
proportion as stimulant operation has been applied, till at
last no more at all is added; cold (u), as well as any
other directly debilitating power may, according to va-
rious degrees of it, produce health, and all the degrees
of sthenic diathesis (x); in the following way, however,
only. It stops the waste of excitability, makes the body
more susceptible of stimulant operation, checks the pro-
gress to indirect debility, and stems the latter. But it on-
ly
this means has passed the whole range of predisposition, and arrived at
the degree where disease commences. It is true the excitement will rise
the moment the person is taken out of the bath; but still something is
lost. The very accumulation implies a reduced disposition in it to be
acted upon by stimuli. A person, who has abstained from any one sti-
mulus for a given time, when it is again applied, will not bear near so
much of it as he did formerly. If he abstain longer, he will bear still
less, till, at last, he will be fit to bear none at all. If, on the other
hand, the excitement should have fallen to so, an addition of debilita-
ting power would be attended with the utmost danger, not only of en-
ereasing the disease, but of inducing death.
(r) or condensing,
(i) It has been alledged, that the diminution of the bulk of the body
by cold, furnished an argument in favour of its being an astringent to
it, as it certainly is a condensor of dead matter.
(t) or shrivelling of the skin,
(u) on that sooting of action,
(x) from the highest to the lowest, from that degree of it, which,
under the circumstances here mentioned, produces a moderate catarrh,
to that, where the modification of its action rises to the decree of being
adequate to the effect of producing a peripneumony.

OF MEDICINE. 61
ly effects that by checking the career of heat and other sti-
muli, which accelerate indirect debility, and by keeping
the excitement within the boundaries of vigour. And
hence vigour in cold countries, when the body is defended
by clothes, the shelter of a house, the warmth of a fire, as
well as by its own proper motion. Hence also the brace-
ing, by cold, of parts that have been relaxed by excessive
heat. Lastly, hence a remedy for the corruption of the
fluids, which consists in invigorating the vessels, not cor-
recting the degeneracy of their contents. This effect of
cold upon the surface, which is nearly the only part of the
system subject to refrigeration, is somewhat greater
than in the internal parts.
CXXIII. The debilitating effect of temperature, and
therefore also its hurtful tendency, is encreased by mois-
ture.
CXXIV. Of the articles of diet, the only food in dan-
ger of being too stimulant, is flesh and land-animal food,
used in great quantity. Meat too salt, and hardened, espe-
cially  when it has now begun to spoil, is an exception.
CXXV. The same thing is to be said of condiment; of
which a very small portion, upon account of its high de-
gree of stimulus, is sufficient.
CXXVI. Spirituous or vinous drink, in which the al-
kahol is always diluted, stimulates, more quickly, and
more readily, than seasoned food, and its stimulus is in
proportion to the quantity of alkahol that it contains.
But there are stimuli, which possess an operation as
much quicker, and more powerful (y), than these just now
mentioned, and which are the agreeable and proper ones
in health, as their operation is of shorter duration. To
these the name of diffusible is to be given. They rank
above strong drink in the following order:
π Next
(y) than that of the articles of diet.

62 THE ELEMENTS
π Next to strong drink, and immediately above it,
stands musk; above it volatile alkali; higher than this
æther; and the highest of all, as far as experiments have
yet reflected light on the subject, is opium (z).
ρ These according to their degree, possess the property
of converting the asthenic diathesis into a cessation of all
diathesis in health; this into sthenic diathesis, the sthenic
diathesis into indirect debility, and the last into death:
all which they accomplish with as much more ease and
prompitude, as they are more powerful than all the rest of
the stimuli (a).
CXXVII. The stimilus of the articles of diet, not ex-
clusive of the diffusible stimuli, should be denominated
direct, because it acts directly and immediately upon the
excitability of the part to which it is applied. The direct
stimulus, at least in so far as it regards the food, is assist-
ed by another, depending upon a distension of muscular
fibres, on which account, for the sake of distinction, the
latter should be called indirect. As the latter is afford-
ed by the bulk of animal and vegetable food, so the for-
mer is produced by a relation of the stimulus to exci-
tability.
(z) We are prety certain of the exactness of that place in the scale
which we have assigned to opium. Nor is our arrangement of the
others uncountenanced by the same kind of criterion; but having not
yet made all the trial necessary to establish the proposition, we defer any
final decision of this point to an after oportunity.
(a) In the use of the diffusible stimuli great care should be taken to
apply them only to the cases that require them: which are only the dis-
eases of the highest debility, or of which the intolerable pain, besides
tormenting the patent, threatens the worst consequences. All from the
end of CXXVI. is en addition in the MS. this most valuable part of
the exciting powers, whether considered as apart of diet, as the chief
of them are among the Turks, or as used for the prevention of diseases,
to which there may be a strong bias in the habit, or as remedies of these
diseases when they have come on, or as hurtful powers when improperly
employed, having been left out in both the editions of the Latin Work
that have yet been presented to the public.

OF MEDICINE. 63
tability. The indirect acts upon the living solids in so
far as they are to be considered as simple; the direct acts
upon them as living only. From a long and habitual
excess in food and drink, at last indirect debility arises
and the group of diseases depending upon it (b).
ς. All these stimuli have also a tendency to produce
asthenic diathesis.
CXXVIII. All the vegetable food (c), and too sparing
an use of animal, as also meat too salt, and deprived of its
native juices by keeping, when better nourishing matter is
withheld, constantly weaken, and thereby produce
asthenic diathesis through all its degrees. Hence arises
that remarkable imbecility both of body and mind, which
distinguishes the Gentoos, who follow the Brahminan
ceremonial of religion. Hence the diseases of the poor(d)
every
(b) When I make a meal of animal food, much less bulk is requisite to
give the same nourishment, than when the vegetable matter is the only one
made use of. What makes the difference is, that there is something in
the animal matter which affords a nourishing stimulus independent of its
bulk; and though the vegetable matter is not altogether devoid of that
kind of stimulus, it, however, possesses it in a much smaller degree.
Both stimuli are necessary, but chiefly the direct, by which animal food
chiefly acts; and therefore is the vegetable the worst and weakest sort
of aliment, because it chiefly acts by its bulk of matter. A small por-
tion of the indirect stimulus is necessary; hence the very general use of
bread. But our vigour of mind and body depends upon the direct.
(c) take in any quantity.
(d) The nourishment of animal food needs only a little support of ten-
sion from a moderate quantity of bread but the vegetable food, even
when supported by strong condiments, in no quantity whatever, ever
gives due support, appears plainly from the instance brought in the text.
Of the poor labouring people in Scotland, who chiefly live on vege-
table matter, it would take three to go through the work that one
Yorkshire man nourished by bolting fat pork, can easily execute. And
among the Gentoo servants a dozen is not able to perform as much work
as a single English servant. A year's experience of vegetable food, and
its pernicious consequences (vide the Preface) has now put the question,
about

64 THE ELEMENTS
every where; hence scrofula(e), fevers(f), epilepsy,
cough, with profuse expectoration and hemorrhage, and
the whole band of asthenic diseases. The direct debility
flowing from this hurtful power, affects the stomach
somewhat more than any other equal part (g); the conse-
quences of which affection are loss of appetite, stomach
sickness, vomiting, very loose belly, and similar dis-
turbances of the first passages.
τ But while improper aliment produces such effects, these 
will also be induced by an ultimate excess in the use of
food, consisting of the proper material; which must be in-
ferred from the universal effect of all the other stimulant
powers, when their operation has been pushed to the same
excess (h). The mean betwixt the extremes of the hurt-
ful powers, in so far as diet is concerned, is abstinence (i).
CXXIX.
about the supposed salutary effects of low living, and the pretended vir-
tue of a rigid observance of it, beyond all doubt, and brought irrefraga-
ble proof of its weakening effect.
(e) Scrofula, though supposed hereditary, produces its worst effects,
not from that circumstance, but the method of management, both for
the prevention and cure.
(f) Various particular, and sometimes specific causes, have been as-
signed for the production of fevers; but it shall be proved, that, what-
ever debilitates in a high degree, is adequate to that effect.
(g) Chap. IV.
(h) It will wow appear how far an assertion of the opposers of this doc-
trine is just or calumnious: low living and starving are condemned for
the facts and reasons assigned; but can it now be said, that the doctrine
is friendly to intemperance? On the contrary, it has reduced the fact to
its proper standard, reprobating the extremes, and establishing the mean
under which virtue takes her post. It is certainly as immoral or irre-
ligious, if you will, to hurt health, and hasten death by abstinence, as
by a luxurious excess. There is a gloomy luxury in superstition, a chear-
ful one in sensuality; both bad.
(i) At least it stands at the foot of the scale of directly debilitating
powers,
              

OF MEDICINE. 65
CXXIX. The witholding also of the use of condi-
ments, which, without animal food (k), are not suffici-
ent to give strength, gives an additional weakness.
CXXX. Strong drink, and the diffusible stimuli, are
never necessary to young and strong people, upon account
of their rapid tendency to indirect debility, from their
high stimulant power; nor are they even safe. But, in
persons who have been accustomed to them, in the case
of those who are advanced in age, and of those who are weak
from that or any other circumstance, cold, watery, acid,
or fermenting drink, has a great influence directly, and
excess in the life of strong drink indirectly, in producing
asthenic diathesis.
v. If the diffusible stimuli, after they have been employ-
ed, are too quickly withdrawn, they, in the same manner
as the more durable, allow the excitability to accumulate,
and indirect debility to come on, and consequently may
be said to produce asthenic diathesis. But asthenic dia-
thesis is never the consequence of withdrawing their ope-
ration at least worth speaking of, but when that has been
habitual. And all the hurtful effects which they have most
untruly, to the great detriment of mankind, been said ra-
ther, than are now said, to occasion, arise not from them-
selves, but from the want of knowledge how to manage
them. And as this operation of diffusible stimulus ought
to be supported by that of a durable; at the same time,
it must not be confounded with debilitating powers. What
disturbances, during the operation of opium, will not a
breath of cold air, affecting the body, create? And how
F easily,
powers, if they are to have the rank of standing uppermost, as being
most hurtful and to be followed by the enumeration of the indirectly
debilitating powers, as being next so, which by the way, is the rank
that nature seems to point out for both.
(k) as in the case of the Gentoos, who make use of a great deal of
condiment with their vegetable aliment. 

66 THE ELEMENTS
easily, as well as quickly, are they all removed, by care-
fully covering up the body? (l).
Φ. Both the other diffusible stimuli, as well as opium,
and the more durable one of strong drink, by an indirectly
debilitating operation, produce asthenic diathesis.
CXXXI. A further stimulus is an abundance of chyle
and blood; by this the excitement is encreased every where,
and particularly in the blood-vessels, and encreased in de-
grees proportioned to its degree of abundance. The quali-
ty of the blood, at least, as a cause, is of no effect, it is
the quantity only that is. The quantity, by its action of
distending the muscular fibres of the vessels, acts with a
constant impulse (m). The doctrine of plethora, so no-
ted
(l) As there are cases of indirect debility from an habitual abuse of
strong drink, there are also others from a mistaken or intemperate use
of the diffusible stimulus, particularly opium. Both of them require
nicety and skill in the management of them for their cure; for which
consult Chap. XI. from par, CIII. to CX. The management is out of
our present question; but what affects that is, that, from this obser-
vation, we can clearly find, as it was to be expected from the analogous
operation of the other exciting powers, that the diffusible stimuli, when
their operation is carried to excess, will also produce an asthenic diathesis
of the indirect kind.
(m) The blood by its quantity distends the muscular fibres of the ves-
sels; that distention stimulates the excitability in the fibres, and pro-
duces excitement, commonly called their irritability; thus excited, the
fibres contract; the contraction of each portion sends the wave onward
to another portion: when the wave has passed any given portion of ves-
sel, its fibres again relax, and make way for the next, which is pushed
along in the same manner. In this way the circulation goes on in all ca-
ses while life remains; contraction and relaxation constantly alternate;
the former propelling the wave before the latter opens to receive the next.
But the vessel may be in different states with respect to its power of ei-
ther contracting or relaxing. When it is weak, which every part of the
vascular system is as often as all the rest of the system is weak, both the
contraction and relaxation of each portion of vessel is imperfect. The
contraction from its smallness, and the relaxation from its being more
owing 
             

OF MEDICINE. 67
ted in the medical schools, is only applicable to sthenic
diathesis, and takes place in proportion to its degree (n).
CXXXII. The effect of distention (o) is encreased by
the velocity of the blood, both as arising from other sour-
ces, and especially from that motion of the body which
its own muscles perform, a motion, which, by compressing
the veins, carries the blood more quickly back to the
heart.
CXXXIII. Nothing is more effectual than these two
last mentioned stimuli, in producing sthenic diathesis, and
the diseases depending upon it. Those diseases are violent
in proportion to the over proportion of the blood, and the
rapidity of the force with which it flows; a fact, that is
proved by all the exciting powers, all the symptoms of
those diseases, and, especially, the pulse of the arteries;
F 2 it 
owing to the passive state of the simple, the active state of the living,
fibres, leave betwixt them a large diameter upon the whole. But, in a
vigorous, or sthenic, state of the whole system in general, and of that of
the vessels in particular, the contractions are strong and forcible, and
the relaxations active and in consent with the contractions. Hence the
diameter of each portion of vessel is diminished upon the whole, and while
the quantity of the blood is at the same time encreased, the action and
re-action are great; the blood distends with mechanical, the vessels re-
sist with vital energy; the mutual effect of both upon the excitability is
considerable; all is activity, all is force, and these are in exact proportion
to their cause over all the sthenic diathesis. This state of the vessel, in
so far as it respects the muscular fibres, is its tone; in so far as it re-
spects them as simple solids, its density. It is a sthenic state of the ves-
sel, opposed to the asthenic first described, which is distinguished by the
epithets of atony and laxity; which, however, opposed to tone and den-
sity are only relative terms, employed for convenience, not absolute:
like the term cold, used for diminished heat, they only signify a dimi-
nution of tone and density.
(n) It is a curious fact, that, while the truth of this proposition is
demonstrated, the plethora of the schools is only understood of a state
of the vessels diametrically opposite to a just idea of plethora.
(o) that we have been describing, 

68 THE ELEMENTS
it is also proved by the great efficacy of bleeding, purging,
abstinence from food, and rest, in the cure of the disease (p).
CXXXIV. While an over-proportion and velocity of
blood is a chief cause of sthenic diathesis; there is nothing
more powerful in producing the asthenic, than that penury
of blood which the greatest celerity of motion accompanies.
Hence, the smallness, weakness, and quickness of the
ulse: Hence the excitement is diminished every where,
and in preference to other equal parts, in the whole san-
guiferous system, and that in exact proportion to the pe-
nury.
χ. From this state of the vessels arises the discharge of
blood from the lungs, from the uterus, from the anus,
or around the anus, from the urinary passages, and through
the perspiratory pores. Hence arise disturbances of the
stomach, want of appetite, loathing of food, and, there-
fore, upon account of want of nourishment, and the lan-
gour of the digestive organs, always less and less blood
arises in the system. So great a penury of blood is the
principal origin of bleeding diseases; which never happen
but in the asthenic state. The same penury of blood acts in
such a manner, and chiefly affects its own vessels, because,
according to a law so often mentioned, its debilitating
energy chiefly falls upon them. In sthenic diseases, that
have advanced to their height, or a little beyond it, a few
drops of blood from the nose, or a dropping of blood from
the same or any other  part, demonstrate only a predis-
position to indirect debility, but not an establishment of
it,
(p) Relief from bleeding and other avacuations is certainly a good ar-
gument for the cause of the disease being so far owing to an over-pro-
portion of blood; and rest is as good for the proof of agitation of the ves-
sels being concerned in the cause: besides, exercise is otherwise a noted
cause of quickness of the pulse: and the hurtful powers and symptoms
are equally decisive, 

OF MEDICINE. 69
it, and that the matter still remains within the operation of
excessive stimulus (q).
†. Thus
(q) Who ever heard of a flood of blood coming from the lungs in a pe-
ripneumony? Or, who has not heard of it in consumptive cases; which
are the diseases depending upon the laxity of vessels of which we are
speaking. What vigorous woman, found in all her functions, as a wo-
man, ever fell into perpetual floodings? What had been the state of these
women before the disease? Did they eat and digest so completely, as
that there was any reason for supposing their vessels were filled with
blood? No; long before the arrival of the disease their eating was puny,
and considering the kind of matter they made use of, to wit, vegetable,
it was not to be supposed more beneficial from its quality than its quan-
tity. What was the idea to be gathered from their symptoms, and par-
ticularly the pulse? The pulse had all the marks of an asthenic one; be-
ing weak, small, and quick, like that of a new born infant. What was
the state of their habit? Was it vigorous and robust? It was the re-
verse; soft, delicate; the habit lax; a falling off in flesh, with weak-
ness over the whole system, and total loss of appetite. What were the
remedies employed to remove this supposed offspring of plethora? Bleed-
ings, repeated without end; other evacuations with the same freedom,
and vegetable food in a fluid form, and a horizontal posture, with their
head lower than their body and under-extremities. Miserable are the
resources of ignorance, and contemptible their execution? Fill a rigid
tube full of water, open at both ends, and the fluid, no doubt, will run
out at the end which is most below an exact horizontal position. But
that is not the case with the fluids in living vessels. The excitement,
distinguishing them from all rigid inanimate tubes, counteracts the ef-
fect of gravity, while its living state remains; In proportion to the de-
gree of which, the sides of the vessel will embrace their column of flu-
ids, and prevent the flowing out of the fluids, in proportion to the de-
gree of excitement; and before the gravity can act, the excitement must
be extinguished, and the living system reduced to a lumpish mass of
dead matter. It is the latter, that enables them to produce that effect.
And therefore, bleeding discharges can never happen, either in health
or sthenic diathesis, unless in that very high degree of it that approach-
es to indirect debility, and even then, only in the forced, scanty, man-
ner described in the text; whereas, after the establishment of indirect
debility, or in the case of direct, the great discharges only can happen,
and that without force, in great plenty, but still short of what would
happen if no excitement restrained it. 


70 THE ELEMENTS
†. Thus it is not an excess in the quantity of blood,
but laxity and atony from its deficiency, that upholds the
affair of bleeding discharges; which proceed in their course
not with any effort (r), but a dimunition of tone: They
are all asthenic, and the asthenic diathesis, as far as it de-
pends upon them, consists in direct debility.
ω. But, as every other exciting hurtful power may be
converted into indirect debility, so, also may an over-
proportion of blood. For the vessels, ultimately distended,
and beyond all bounds, may (s), by the excess of that sti-
mulus, exhaust their own excitability, and, thereby, put
an end to their excitement. Upon which the forcible con-
tractions are converted into languid ones, or such as could
scarce be called contractions at all; the diameters for-
merly effaced, are converted into an extremely patulous
state. The finer parts of the fluids flow through the patu-
lous extremeties of the arteries, wherever they find an outlet,
and carry with them, sometimes serum, sometimes red blood.
In the asthenic, diathesis as well as the sthenic, it is
not the quality of the blood, but its quantity, which is
to be found fault with, and the fault in quality here is de-
ficiency. The deficient quantity produces the symptoms
of the pulse, that have been mentioned above, by not suf-
siciently distending the vessels, and giving them sufficient
excitement. Plethora, which has been thought to be-
long to this form of diseases only, has absolutely no exist-
ence in it. The state of the vessels, with respect to the
quantity of blood in them, that is pleasant and suitable to
health, is the mean betwixt the extremes that have been
spoken of.
CXXXV. This state (u) is the chief origin of asthenic
diseases,
(r) or active impulse, (s) under the high sthenic diathesis,
(u) of the blood and vessels, that we have been describing, that is, pe-
nury of blood, and atony and laxity of the vessels, chiefly from direct,
sometimes from indirect debility; though the latter case is exceedingly
rare. 


OF MEDICINE. 71
diseases, of which the so very hurtful effects of evacuation,
especially bleeding, as well as vomiting, purging the belly,
and every other mode of diminishing the bulk and quantity of
fluids, give full proof. This proof has of late received a
further confirmation, in the singular success of the cure by
other stimulants first, and then by every mode of filling the
system (x).
CXXXVI The different fluids secreted from the blood
in different ways, are, by the distention which they give to
their respective vessels, also understood to stimulate. In
that respect the milk and seed, by the abundance of each
in its respective vessels, and likewise the perspirable fluid,
have the chief effect, the commotion of the secretory organ
(y), by means of excitability, which is one and the same
undivided property over all, is easily diffused over the
whole body, and, when it rises to excess, is capable,
with other powers that communicate an excess of excite-
ment, to produce sthenic diathesis.
CXXXVII. The same secreted fluids, when they do
not sufficiently distend their respective vessels, when they
do not communicate enough of excitement, make noinconsi-
derable
(x) Systematics allow that there are many diseases, which are a re-
proach to their art, from their never yielding to their method of cure,
but, on the contrary, becoming worse and worse in proportion to the
time and pains taken about it. Of these opprobria medicinæ (it would
be better, I believe, to call them opprobria medicorum) few are more
so than the bleeding diseases; which seem uniformly to have proceeded
from evil to worse under the evacuant debilitating plan; while it has
now been found, that the high stimulant plan removes them with the
greatest success.
(y) It has been said above, in chap. IV. that the excitability is one uni-
form undivided property over the whole living system; and that, where-
ever it is acted upon in any part of its seat, it is affected over all. This
fact, which is strictly true and universal over every part of living mat-
ter in nature, with the utmost ease explains many things, that were con-
fessedly inexplicable upon every other medical doctrine; and, among
the rest, the several affections of the secretory system. 
 

72 THE ELEMENTS
derablepart of the hurtful powers, that constitute asthenic
diathesis.
A. For which reason vomiting, purging, and every o-
ther evacuation, are powerful inducers of asthenic diathe-
sis, which they effect in proportion to the debility that at-
tends their operation. The same thing is to be said of
excess in venery, which is partly an indirect, partly a
direct, always a great, debilitating power (a).
B, Sometimes the secretory vessels seem so crammed
with a colluvies of fluids, that indirect debility may pos-
sibly arise from that source, as is exemplified in that over-
flowing of bile, which distinguishes the yellow fever (b).
Here too the debilitating effect, by means of the excitabi-
lity, tends to diffuse the diathesis over all.
From this source, arise, a languid action of the extreme
vessels (d), a slow, then no, motion of the fluids, a stag-
nation
(a) Nothing is more effectual in hastening of death than a love mar-
riage betwixt an old man of worn out excitability, and a young beauti-
ful virgin: I need not explain to any reader on which side, that of the
man or the wife, either the love or the danger lies.
(b) of the Torrid zone. I have been so often, and by persons of good
enough sense to make just observations, informed of the necessity of pur-
ging off the redundancy of that fluid, which not only fills the intestines,
but diffuses itself over the whole alimentary canal; and, then, of fol-
lowing out the cure of the disease by the use of wine, spirits, and the
diffusible stimuli, that I have, though at first with some reluctance, ad-
mitted the fact. The reason of the slowness of my assent to it was, that,
upon every other occasion of any accumulation of matter in the first pas-
sages, even in the colic itself, I had always found the pactice of invigo-
rating the peristaltic motion, by stimulants, sufficient to clear away all
such extraneous matter; while vomiting and purging, by their relaxing
effect upon the vessels, served to generate more, and increase the cause
of the disease, which is always debility. This I found not an exception
to that general principle, but an instance of a sort of local disease, from
an over-repletion of the exhalant mucous and biliary vessels.
(d) These are the exhalants that pour out the saline, watery part of
the 
               

OF MEDICINE. 73
nation and corruption of them. A diminution, or tempora-
ry destruction of excitement, over this large space in the sys-
tem (e), by means of the same excitability, communi-
cates debility to the rest of the body; and, in conjunc-
tion with other hurtful powers that give not enough of ex-
citement, produces asthenic diathesis.
r. The various sorts of gestation (f), and of exercise and
labour, by rousing the muscles into contraction, and
thereby accelerating the motion of the blood in the
veins towards the heart, while the valves prevent its taking
a contrary direction, greatly promote excitement in all the
vessels, and, therefore, over the whole system; and the
effect may go so far as to produce sthenic diathesis.
△. As nothing contributes more to health than moderate
and frequently repeated exercise, and its excess acts in the
manner that has just now been described; at the same time a
degree
the blood unchanged; the mucous glands that change, by their secretory
operation, the fluid they receive from the blood; the pori biliarii that
change the fluid that they receive from the extremities of the veins of
the gate, and of the hepatic artery, or artery of the liver; the little
ducts which these form by the union of numbers into single vessels; the
hepatic duct or great biliary vessel of the liver, which receives the bile
from all the ducts; and, lastly, the ductus communis choledochus, or
the duct that may be denominated in English, the general receiver of
all the bile, whether from the great duct of the liver, or that which
sends to the gall-bladder a part of the bile that returns in the same vessel
to the general receiver. These, and besides them, the inhalants or ab-
sorbents as they are called, to wit, the small vessels that take up from
the exhalants and other arterial terminations of vessels, the fluid, called
lymph, which is once more to be returned into the circulation; are the
vessels that suffer the concourse of symptoms described in the text.
(e) How great the space in the whole system is that these vessels oc-
cupy, maybe easily imagined, when it is considered, that every evane-
scent artery, over the whole body, terminates in one or more of these
colourless vessels that have been described.
(f) as riding on horseback, going in a carriage, using an hobby,
failing. 
 

74 THE ELEMENTS
degree of it, either greater or less, than the salutary degree,
by its weakening effect, the former in wasting the excitabi-
lity, the latter in with-holding a necessary stimulus; that
is the one by debilitating indirectly, the other directly,
produces asthenic diathesis.
CXXXVIII. Thinking, which acts more upon the
brain, to which it is immediately applied than upon any
other equal part of the system (h), encreases excitement o-
ver the whole body (i). Straining and thinking, whether
in a high degree for once, or often repeated in a lesser
degree, or habitual may alone prove hurtful; but, in con-
junction with other powers also hurtful from their excess
of stimulus, may become more so, and amount to a degree
equivalent to the production of sthenic diathesis.
CXXXIX. An evident cause of asthenic diathesis is
that state of the intellectual function, in which excess
in
(h) Vide Chap. IV. Part I.
(i) None of the exciting powers have more influence upon our activity
than the two which are just going to be mentioned, the exercise of our
intellectual function, and that of passion or emotion. With respect to
the former, Homer observes of the hero, whom he gives for a pattern
of eloquence, that upon his first address, that is while he was under
some agitation, and had not jet got into his train of thought, he was
awkward in every motion, and in his whole attitude; he looked down
to the ground, his hands hung strait along his sides as if powerless; his
whole appearance was torpid. But when he once entered upon his sub-
ject, his eyes were all fire, his limbs all motion, with force, grace and
energy. Upon commencing a lecture, the pupils have often observed
the same torpor in the lecturer, and a similar vivacity and life in a few
minutes, when he had now got fairly into his subject: the report which
a lecturers daughter, upon looking through the hole of a door, while
the lecture was going on, made to the family and some company then
present, was, that her father looked, in his lecture, as if he would look
through his hearers. A Mr. Donaldson is one of the few great masters,
in the art of painting, who never fail, with a most exact likeness, to
display the whole influence of the mind upon the features. A minia-
ture of me, done by him, as a present, is reckoned the greatest master-
piece in these respects, that ever came from the hands of a painter. 

OF MEDICINE. 75
in thinking, by wasting the excitability, ends in indirect
debility, or that deficient, weak, vacant state of mind,
uncapable of keeping up a train, which produces the
same hurtful effect by direct debility. This faulty state of
the mind contributes greatly to weaken the system (k).
CXL. Violent passions of mind, as great anger, keen
grief, unbridled joy, going to such a pitch as to destroy
excitability, have the same effect as excessive thinking,
and admit of all the same reasoning.
CXLI. A force of passion rising to the height of ex-
hausting the excitability, induces that asthenic diathesis,
which is occasioned by indirect debility, and diseases of
that stamp. Hence epilepsy (l), hence apoplexy, and that,
when the mind has been screwed up to the height of pas-
sion, often fatal.
CXLII. On the contrary, when there is a deficiency
of passion, as in melancholy, grief, fear, terror, despair,
which are only lower degrees of joy, assurance, and hope,
and imply no more than a diminution of exciting passions,
not emotions of a nature opposite to those, and positive;
their tendency is to produce the asthenic diathesis, which
depends upon direct debility. The immediate production
of this is loss of appetite, loathing of food, sickness at sto-
mach, vomiting, pain of the stomach (m), loose belly with-
out pain, the same with pain, indigestion (n), cholic, the
gout, and fevers.
CXLIII. The exercise of the senses, when it is agreea-
ble, has a very great effect in exciting the whole body, and
in
(k) It may often be remarked by physicians, that their patients, after
every other proper part of cure has been executed, are never completely
restored to their healthy state, till they are again engaged in their usual
occupations both of mind and body,
(l) or the falling sickness,
(m) called cardialgia by systematics (n) called dyspepsia, 
 

76 THE ELEMENTS
in producing emotions, which, together with the hurtful
powers mentioned above, may easily contribute to the pro-
duction of sthenic diathesis. Those emotions are exem-
plified in drinking, dancing, in agreeable entertainments
where the eye is dazzled with the splendour of the dishes,
of the company, and of all the objects around.
CXLIV. The energy of the same exercise of the senses,
when it is excessive, and carries the effects, just now men-
tioned, too far, produces indirect debility. On the con-
trary, when the senses are either in part destroyed, or in
part dulled, or disagreeably affected (o), the mind is de-
jected, and the whole body thrown into a state of languor
and direct debility. And, in both cases, especially when
there is a concurrence of other debilitating hurtful powers
the asthenic diathesis arises.
CXLV. The effect of the air (p), independent of its
qualities, as they are called, or its properties, and its use
in supporting respiration, is less obvious to observation (q);
at the same time it cannot be doubted, that its application
to the whole surface of the body is a stimulus not to be
dispensed with. The air is seldom applied in a pure state: it
is commonly blended with foreign matters that diminish
its force of stimulus; and, while its salutary stimulus depends
upon its purity, at the same time it is uncertain whether e-
ver its purity goes so far as to stimulate in excess, and there-
by produce sthenic diathesis. The balloons, lately invented, by
which men get above the clouds, would serve excellently to
throw light upon that matter, if it were not for the cold that
accompanies
(o) Nothing is more clearly disagreeable than an obscure light, as
when one reads with a small or unsnuffed candle. Hence the luxury of
more candles than one, or of wax or spermact candles. This is often
experienced at Ranelagh, and may be seen in children exquisitely
amused.
(p) upon the human body,
(q) than the other powers that have been spoken of, 

OF MEDICINE. 77 
accompanies this progress. Be that as it may; since we
never live in the purest air, and yet live commodiously e-
nough, it is, therefore, credible, that too pure an air has a
tendency to stimulate in excess, and therefore, produce
sthenic diathesis.
CXLVI. But, as nothing is more usual than impurity
of air, and every impurity diminishes its stimulus, a very
impure air, or air blended with impure matters, without
doubt debilitates, and produces asthenic diathesis. Ac-
cordingly, impure air is a frequent cause of typhus, as is
evident from the fate of those who died in the black hole of
Calcutta. Whether ever the air, from an excess of pu-
rity, produces asthenic diathesis, is the more doubtful,
that, as has been said, it is as yet undecided whether it
produces sthenic diathesis or not.
E. Contagious matter, in so far as it may have any ten-
dency to produce general diseases, in one form produces
sthenic, in another asthenic diseases, and, therefore, acts
like the ordinary hurtful powers of either sort, and admits
of all the same reasoning. But, in so far as it only occa-
sions the eruption, without making any change in the ex-
citement, it is to be referred to the local diseases.
z. To poisons, if they act as general stimulants, all
the reasoning that has been employed with respect to the
other hurtful powers, will apply. It is not, however,
likely that they are general stimulants.
CXLVII. It is seldom from the separate, almost al-
ways from the united operation of all the powers, that
both the diathesis, whether as remaining within the range
of predisposition, or rising to the degree of actual morbid
state are produced, and from no inherent power in the
system.
CHAP 

78 THE ELEMENTS
CHAP. II.
The Cause of each Diathesis.
CXLVIII. The cause of sthenic diathesis, produced
in the way that has now been explained, is, in conse-
quence of the operation of the powers that have been men-
tioned, too great an excitement of the living system every
where, with the effect of first encreasing all the functions,
then of producing a disturbance in some, and impairing
others, but never by a debilitating operation.
CXLIX. The cause of the asthenic diathesis arising
from the same source, is, in consequence of the debilita-
ting hurtful powers, too little excitement of the living sys-
tem every where, with the effect of impairing all the func-
tions, disturbing some, giving a false appearance of en-
creasing others, but always debilitating (a).
CHAP.
(a) It must now appear to the reader, to what simplicity the hitherto
conjectural, incoherent, erroneous, mysterious, and enigmatical art of
physic, is now reduced. It has been demonstrated, that there are only
two forms of diseases, that the deviation from the state of health, in
which the morbid state consists, is not either repletion or inanition, or
changes in the qualities of the fluids, whether of an acid or alkaline
nature, or the introduction of foreign matters into the system, or a
change of figure of the extreme particles, or a disproportion in the dis-
tribution of the blood, or an encrease or decrease of the power of the
heart and vessels as regulating the circulation, or a rational principle
governing the actions of the body, or an alteration in the extreme par-
ticles as being of too large or too small a size, or an alteration  of the
pores, as being too narrow or too capacious, or a constriction of the
superficial vessels from cold, or a spasm of them producing a reaction,
as it is called, of the heart and interior vessels, or any thing that any
person has yet thought of respecting the cause and nature or morbid state.
On the contrary, it has been proved that health and disease are the same
state depending upon the same cause, that is, excitement, varying only
in 
              

OF MEDICINE. 79
CHAP. III.
The sthenic Diathesis.
CLI. PREVIOUS to the disturbance (a) which
never happens till after the arrival of the disease (b), and
even then only in a violent attack of it, all the senses are
acute: the motions both voluntary and involuntary (c), are
vigorous,
in degree; and that the powers producing both are the same, some-
times acting with a proper degree of force, at other times either with
too much or too little; that the whole and sole province of a physician,
is not to look for morbid states and remedies which have no existence,
but to consider the deviation of excitement from the healthy standard, in
order to remove it by the proper means. The reasoning part of this doc-
trine, it is expected, the reader will find irreprehensible and unanswer-
able; and the practical part, from the astonishing cures that have upon
innumerable occasions been effected, will ever stand in support of the
truth and utility, as well as simplicity of the whole.
(a) of the functions, which, it has just now been said, the hurtful ef-
fects of both sets of powers produce,
(b) During the predisposition to peripneumony, as well as to every
other disease, neither the symptoms of disturbance, or any other symp-
toms at all appear. And in mild cases, such as catarrh, the symptoms
of disturbance occur not through the whole course of the disease: But,
when a disease is, like the peripneumony or the gout, of a violent na-
ture, then the system is commonly disturbed, and in a most conspicuous
degree. The affection of the lungs in the former, from the inflamma-
tion within, and of one of the feet, or some other part in the latter,
from an external inflammation, give extreme disturbance to the affected
parts, while there is a disease of the same nature as the gout, that is dy-
spepsia, or indigestion, in which the inflammation never appears.
(c) The voluntary motions are those that are performed under the in-
fluence of the will, such as the motion of the limbs in walking, or in any
sort of exercise. The organs, by which they are moved, consist of bun-
dles of moving fibres called muscles. The involuntary motions are those
of the interior parts of the system, such as those of the heart and ves-
sels 


80 THE ELEMENTS
vigorous, there is an acuteness of genius, and a great force
of sensibility as well as of passion and emotion. The se-
veral parts of the body are perceived to be in a state of vigour
from the following marks of it; the heart and arteries from
the pulse; the extreme vessels on the surface of the body
from the complexion; all the muscles from the strength
that they exert; the internal secretions from the great
quantity of milk and semen; the digestive organs from the
appetite, the digestion, the vigour of the body, and the
manifest abundance of blood.
CLII. How far the intellectual faculty, and the force
of passion, are encreased, will be learned from a comparison
of them in this diathesis, in good health, in the second
form of diseases and predisposition to it. In this way it
is that the functions are first encreased.
CHAP IV.
The Sthenic Diathesis illustrated by an explanation of its Symp-
toms.
CLIII. The encrease of the force of the senses, of the
motions, of the intellectual faculty, and of the passions,
depends upon the encrease of excitement in every one of
their organs, among other actions, quickening the moti-
on of the blood through them.
CLIV. The coming on of every sthenic disease is
announced by a shivering. It depends upon a diminished
perspiration, by means of the diathesis being exqnisitely
strong in the extreme vessels of the skin. The same is the
explana-
sels connected with it; the peristaltic motion in the first passages, which
are the passage to the stomach, the stomach itself, and the whole convo-
lution of the intestines; as also those of the womb, of the bladder, of
urine, and so forth. None of the latter are under the influence of the will.
3

OF MEDICINE. 81
explanation to be given of the sense of cold, which com-
monly accompanies the shivering; and the same is the ex-
planation of the dryness of the skin.
CLV. In the same diseases the pulse is stronger, harder,
and fuller, and somewhat more frequent, than in its sound
state. Its fulness and hardness is owing to taking animal
food plentifully during the predisposition. The force
and frequency is occasioned by the same and any other
stimulus, as that of strong drink; that of the diffusible
kind, and that of exercise, whether corporeal or mental:
Nay all the stimulant hurtful powers are participant of
the same effect.
CLVI. If, in the progress of the disease, the pulse some-
times becomes weaker, softer, emptier, and quicker, that
is a bad sign, and occasioned either by the debilitating plan
of cure being pushed beyond the proper bounds; or, in
consequence of a neglect of that sort of cure, it may be
owing to some debility induced by the excess of excite-
ment. The former of these is direct, the latter indirect
debility; both to be avoided.
CLVII. The complexion in the vessels, which is often
a consequence of a previous appearance of paleness, and
great quantity of secreted fluids, is occasioned by an over-
proportion of blood, in consequence of an excessive sthenic
diathesis obstructing the perspiration. The same is the
cause of the head-ach and pains in different parts. For,
as the head-ach so quickly and easily yields to bleeding, it
is, therefore, seldom to be suspected of being owing to in-
flammation within the head. And the reason for so think-
ing is strengthened by this further circumstance, that the
inflammation arising in general diseases always affects an
external part, as far as that fact has been enquired in-
to (a).
G CLVIII
(a) Vide above, CXIII. 

82 THE ELEMENTS
CLV7II. The delirium also, that sometimes arises in a
violent state of disease, is not to be imputed to inflamma-
tion, and for the same reason; for it yields so much to
bleeding and other evacuations, that there is no reason for
suspecting inflammation within the head. That abun-
dance of blood in the vessels, distending these to excess,
is the cause of the whole affair, is proved on the one hand
by the redness of the face, implying such abundance, and
on the other by bleeding, removing the disease at once.
CLIX. Thirst and heat, which are also remarkable
symptoms in sthenic diseases, depend upon the sthenic dia-
thesis in the extreme vessels of the fauces and skin; the
diathesis so obstructing the vessels as not to allow a re-
turn of perspiration, but to suffer, however, the blood to
pass into the very neighbourhood of the ends of the ves-
sels, and by means of the suppression of the perspiration,
to accumulate, under the cuticle, the heat generated in
the system. Thus, in the throat, from an affection of the
ends of the vessels, the saliva and other fluids, by the free
flow of which the throat is lubricated, and freed from
that sense of dryness, which is called thirst, are now con-
fined (b), and thereby produce thirst.
CLX. Hoarseness, cough, and expectoration, which
are sometimes observed in sthenic diseases, commonly pro-
ceed, and succeed to each other in the following order.
There is first often a hoarseness, then a dry cough, then a
cough with expectoration. The cause of the hoarseness
and dry cough is an obstruction of the exhalants and mu-
cous vessels, which terminate in the bronchia, still occa-
sioned by a violent sthenic diathesis, and prevented from
transmitting their contents to lubricate the air-vessels (c),
so
(b) and prevented to flow out,
(c) The bronchia arc the divisions of the wind-pipe running through
the substance of the lungs, and blended with the blood-vessels. In the
substance 


OF MEDICINE. 83
so as that hoarseness may be removed, and the expectora-
tion proceed with freedom. Again, the expectoration is
next freely made, because the diathesis, being now dimi-
nished, and allowing the ends of the vessels to be relaxed,
and the fluids to be poured out in abundance upon the
air-vessels, is the occasion of the fluids producing a com-
motion of the excitability over this whole organ, and by
the convulsive motion, which is called cough, of being
themselves thrown out.
CLXI. As the greater freedom of expectoration now
implies an abatement of the diathesis: so too great a flow,
and too long a continuance of it, shows, that the diathesis
is now rushing into the asthenic state, either from indirect
debility, or when the disease, in its progress, has much
exhausted the excitability; or from direct debility, as
when the plan of cure, proper in kind, has been pushed be-
yond the bounds.
CLXII. Those same symptoms (d), while they stop short
of the range of direct debility, or are not yet changed into
the indirect, are occasioned by heat, and whatever stimu-
lates in excess, and removed by cold and whatever acts as
a weakening power.
CLXIII. Paleness, shrivelling of the skin, clearness of
the urine, and bound belly, which chiefly happen
about the beginning of the disease, arise from a de-
gree of the diathesis, shutting up the ends of the
vessels in such a manner, that either nothing is excreted,
G 2 or
subtance of the lungs, besides these two sets of vessels, the air-vessels and
blood-vessels, there are likewise exhalants, small arteries, and mucous
glands, coming off from the extremities of the red arteries. The wind-
pipe is covered with the latter; and the great quantity of mucus thrown
up from the lungs, often in perfect health, and in innumerable cases,
both of sthenic and asthenic general disease, sufficiently proves the exist-
ennce of the source from which they flow.
(d) mentioned just now, 

84 THE ELEMENTS
or the thinner part, as in the urine, only escapes. The
cure of the affection of the urine, of the obstructed per-
spiration and costiveness, shows that the diathesis is now
gradually abating, the disease becoming mild, and now up-
on the eve of being thoroughly removed by emetics, pur-
gatives, and sudorifics, and the use of other debilitating
remedies.
CLXIV. In sthenic diseases, when they are gentle, the
appetite is often not much diminished, and oftener more
food can be taken than is serviceable. But, unless the
lightest vegetable matter only, and that in the form of wa-
tery potion, or in a fluid form, be given, every morsel of
it will do harm.
CLXV. But, when either from indulgence in food of a
rich nature, or from employing a stimulant plan of cure,
or from the disease having, from the beginning, arisen from
very violent, hurtful powers, and now attained its highest
degree of violence; in any, or all these circumstances, both
the other bad symptoms, mentioned above, break out
directly, and the violent disorders of the stomach, or an
acute pain of the thorax, show themselves indirectly,
CLXVI. In a violent diathesis, therefore, where there
is little appetite for food, but a very great desire for drink;
with the latter the patient is by all means to be gratified;
but the former should be avoided, as producing loathing,
sickness at stomach, and vomiting. Those symptoms are
not usually of long duration, unless when the diathesis is
now going, or actually gone, into the asthenic state by the
means that have been mentioned above (f), and, by remo-
moving the other symptoms by the proper debilitating plan
of cure, they go off; but when the stomach sickness and
vomiting are urgent, and begin now to be a little more ob-
stinate, and of a little more duration, one may know that
they
(f) Vide last paragraph and a few immediatley preceding it.

OF MEDICINE. 85
they still remain short of the change into indirect debi-
lity, by the following mark: if the pulse still maintains
moderation in its frequency, and does not abate much of
its fulness and force; if artificial vomiting and purging
diminish the morbid vomiting, and, in one word, if the
debilitating plan of cure still succeeds. But, it will then
at last be understood that the disease is altogether
changed, and its cause converted into the opposite, when
those symptoms every day increase; when the pulse be-
comes weaker and weaker; when gripes in the intestines,
and liquid stools, are superadded to the symptoms that
disturb the stomach, and when the antisthenic or debili-
litating plan of cure is now of evident detriment (g).
CLXVII. While the same symptoms (h) still stop short
of indirect debility, the excessive excitement in the sto-
mach being of quicker tendency to indirect debility there
than any where else, upon account of the stomach's great
sensibility, and the force of the most powerful stimuli be-
ing chiefly exerted upon it, produces symptoms of disturb-
ance (i); for the most powerful stimuli, and those that are
signally powerful in producing sthenic diathesis (k) are
first
(g) See above, CIX.
(h) of the stomach and intestines,
(i) See above, LIV.
(k) as high-seasoned animal food, wine, spirtuous drink, cordials,
and the whole train of high diffusible stimuli, some of these, as meat
and wine, have no effect upon the external surface, or any other part;
others, as some of the condiments," such as mustard and strong spirits,
and above all the diffusible stimulants, as æther, camphor, and opium in
a liquid form, do act upon the second, and by their application to it
support their own internal use. Thus to prevent or remove the gout,
anasarca, spraine, and so forth, the application of any of those high dif-
fusible remedies, just now mentioned, will greatly contribute, along with
their use as taken into the stomach, to support the general operation.
These, and innumerable others, are so many facts that have been sug-
gested by observations and trials made in the prosecution of this doc-
trine. 


86 THE ELEMENTS
first applied there, and exert a greater force upon the ex-
citability in that than any other part. Those stimuli are
the several preparations of animal food, the several con-
centrated strong drinks, the several condiments with which
they are seasoned, the various diffusible stimuli, as the
different preparations of opium, volatile alkali, camphor,
musk, and æther: and they all act upon the stomach with
that force which they exert not upon any other part; they
do not upon the intestines below, because they undergo a
change from the first digestion before they pass over into
the first portion of the intestinal canal; not upon the lac-
teal vessels, because they are not received into them till
they are further diluted, and undergo another change from
the digestive operation, and when so changed, they are
next carried to be mixed with the blood; not upon the
heart and arteries, upon account of the same dilution meet-
ing them also in those vessels, and of a constant change of
mixture occurring through the whole course of the circu-
lation; not upon the terminations of the arteries, whether
exhalant or glandular, and whether these excrete from the
body a matter already corrupted, or carry back by the
lymphatic vessels, an useful matter to the blood; and that
both for the reasons that have been given, and particu-
larly because some great change is made in the exhalants
and glands; not upon the lymphatic vessels, where a new
fluid is constantly flowing in upon the old in these parts
by means of anastomosing branches, and chiefly in the
thoracic duct; not upon the other blood-vessels, upon ac-
count of the great change that a repetition of the circula-
tion produces; nor upon the muscular fibres, whether
voluntary or involuntary, because the stimuli by no means
come in contact with these; nor upon the brain or me-
dullary substance for the same reason (l), as well as for
the
(l) to wit, that they do not come into contact with them, 
     

OF MEDICINE. 87
the great distance of these parts from the part that receiv-
ed the first contact of the stimuli. In one word, as all
exciting powers, whether salutary or hurtful, or curative,
act somewhat more powerfully upon certain parts than
upon others, as these parts are generally those which they
first affect, and with which they come into direct contact;
those, therefore, in preference to others, are most liable
to pass either from sthenic diathesis into asthenic, or from
the latter to the former; which, however, happens in
such a manner, that, because the excitability is one uni-
form, undivided property over the whole body; whether
the excitement has been increased in a peculiar part, or
diminished; and, whether its diminution has been owing
to direct or indirect debility, and in either way the asthe-
nic diathesis produced; all the rest of the body soon fol-
lows the kind of change that has taken place; and, since
the powers that have acted, have been, and are the same,
that is, either excessively (m) or insufficiently stimulant (n),
or so to an ultimate excess; and as the excitability upon
which they have acted, and still act, is the same, that is,
the whole consideration of the cause is the same; the effect
must also be the same, that is, the same sort of actions,
whether in excess or defect (o), must be established over
the whole body.
CLXVIII. The inflammation which accompanies the
phlegmasiæ (p), occupies an external part, as far as its
mature has been yet ascertained. And the reason of that
is,
(m) in so far as they produced sthenic diathesis,
(n) that is, debilitating, in so far as they produce the asthenic diathe-
sis, that depends on direct debility, or in fo far as, they produce the ast-
henic diathesis that depends upon indirect debility.
(o) whether sthenic or asthenic,
(p) diseases that are sthenic and accompanied with an inflammation
of a part, as a portion of the lungs, the throat, some of the joints, and
in which, as has been formerly said, the inflammation is like any other
symptom, an effect of the cause of the disease, not itself the cause. 
 

88 THE ELEMENTS.
is, thar heat, which is the most powerful hurtful agent in
those diseases, either alone, or alternating with cold, or
succeeding to it, has much more power externally, where
it is directly applied, than internally, where the tempera-
ture is nearly stationary, in stimulating, and, therefore,
raising the general diathesis, to the degree of actual in-
flammation in a part. Hence the throat, hence the dif-
ferent joints, hence the face, where the form of inflam-
mation is different (q), hence the lungs, which are to be
considered as an external part, because the air has direct
access to them, all these are affected with inflammation in
preference to other parts. And, besides the energy of
the exciting hurtful power, just now mentioned, there is
in the part, that is to undergo the inflammation, a greater
sensibility (r) than in others, or a more accumulated ex-
citability; by which it happens, that, of the parts that
have been mentioned, sometimes one, sometimes another
is affected, more than the rest (s). To this considera-
tion
(q) as when the inflammation of erysipelas appears there;
(r) See above, LIII. λ.
(s) In the inflammatory sore throat the inflammation affects the
throat, which is also sometimes the seat of an erysipelatous inflamma-
tion. In erysipelas, sometimes the face, sometimes one of the legs, some-
times the ear, sometimes the temples, are inflamed. I have frequency
been affected with an erysipelas, that begins with an acute inflammation
and pain in one ear, which is thickened to four times its usual dimen-
sion; from that it spreads over the whole hairy-scalp till it reaches the
neighbourhood of the ear in the opposite side, never, however, affecting
that ear; this progress has been sometimes from the right to the left,
sometimes from the latter to the former, in proportion as either had been
more expofed than the other to heat, or the alternation of heat with
cold, or the succession to each other. This disease is sthenic, but in a
mild degree, and to be removed by coolness, cold water, low vegetable
fluid diet, and a slight purge. It was once greatly aggravated by wine,
spirituous drink, and the high diffusible stimuli. In rhematism, the in-
flammation attacks a large joint, sometimes shifting from one to another,
sometimes 


89 OF MEDICINE. 
tion of the cause, it is to be added, that which ever of the
parts we have mentioned has been injured, in whatever
manner it may have undergone the inflammation peculiar
to the phlegmasiæ, that part, in every after attack of a
new phlegmasia, is in more danger of being inflamed than
the rest. This is the true cause of the recurrence of some
of the phlegmasiæ, as the inflammatory sore throat, and
rheumatism (t). Peripneumony is a disease less frequent
than any of the rest of this form, because "the seat of its
inflammation" is exempted from many stimuli, liable
to produce sthenic diathesis with its accompanying in-
flammation.
H. As
sometimes several at a time, and, in contradistinction to the erysipelatus,
is deep seated, extending to the interior part of the true skin, which is
the case with every such inflammation, called, therefore, phlegmonic;
while its seat in erysipelatus is betwixt the scarf-skin and the outer part
of the true skin upon the corpus mucosum. To these phlegmasiæ, ac-
companied with an inflammation of a part, depending upon the general
cause of the disease, and especially upon the effect of temperature, may
be added that which an inflammation in one of the ears accompanies,
though this case is seldom admitted into the number of the phlegmasiæ.
It is, indeed, sometimes local, arising from local injuries, but is as cer-
tainly at others, a general disease, and to all intents and purposes a
phlegmasia.
(t) Those two diseases, in young vigorous persons, are very liable to be
exceeding troublesome by the frequency of their occurrence. In the
younger part of my life the violence in degree, and frequency of recur-
rence, of the sthenic inflammatory sore throat, was very distressing, as
the least variation of the external temperature, superadded to a full
nourishing diet, not without the stimulus of a chearful glass, was ready
to renew it, not only the inflammation, but the whole phænomena of
the disease. The same thing I have often observed in the frequent re-
currence of the rheumatism in persons of the same age and habit, per-
haps with some difference of temperament. But it is to be observed,
that, in proportion to the advance of life, and diminution of vigour, both
these diseases become much less frequent, and much less violent. Nor
is any thing more common than their giving way at this time to a very 
opposite


90 THE ELEMENTS
H. As the inflammatory fever, catarrh, the gentle small-
pox, are unattended by inflammation (unless that in the
last a local inflammation from a local cause, quite differ-
ent from that which makes our present subject, takes place)
and as the inflammation in peripneumony, violent erysi-
pelas, and similar other cases of great violence, is found
the highest in degree; for that reason the conclusion is,
that the degree of inflammation, which is a symptom of
general sthenic diseases, is proportioned to the degree of
the sthenic diathesis (y).
CLXIX. The inflammation, in this case, is nothing else,
but a state of the inflamed part of a common nature with
that in the rest of the body. And as the inflammation is
produced by a greater degree of excitement in the inflam-
ed, than in any other equal part; so before the disease
comes on, of which the inflammation is only a part or
symptom, the excitement of that part is understood to be
proportionally greater than in any other part (z).
CLXX.
opposite disease, the gout, which depends upon a superaddition of direct
debility to the indirect, that laid the foundation of it. I am pretty cer-
tain my inflammatory sore throat, or erysipelas, never happened sponta-
neously, nor without an addition of stimulant power, to these that pro-
duce that disease, in consequence of carrying to some excess the plan of
cure suited to the removal or prevention of the gout.
(y) It shall by and by be shewed, that this sort of inflammation is only
a part of the general diathesis, somewhat higher in degree than any o-
ther part, but far short of the degree constituted by the whole general
affection.
(z) See above, par. L. and LI. Suppose the excitement in every part
of the system to be 45 at some point in the period of the predisposition,
and 54 in the part to be inflamed; after the coming on of the disease
the same proportion will hold; when the excitement has now mounted
up to 60, the excitement of a part will be understood to have gone to
69; keeping up still the same proportion. But this 9 degrees of greater
excitement in a part, comes far short of the sum total of excitement in all
the parts affected with the general sthenic diathesis; that you may sup-
pose 


91 OF MEDICINE.
CLXX. This inflammation, which for the sake of dis-
tinction is to be called general sthenic inflammation, should
be distinguished from another, which is a local affection,
arising from local hurtful powers, and depending upon a
fault in the organ, or a solution of continuity (a).
CLXXI. To this the term of sthenic local inflamma-
tion applies. The general always depends upon sthenic
diathesis, is a symptom or part of it, never precedes it,
always succeeds to it sooner or later, arises from the same
hurtful powers (b), and is reduced by the same remedies.
In contradistinction to which, the local affection, as it a-
rises from local injury, producing a solution of continuity,
or deranging the texture of the part; so, if the labouring
part is not very sensible, the affection extends no further.
In the case of a part being endued with a high degree of
sensibility, suppose the stomach, the intestines, among the
internal parts; among the external, the tender substance
under the nails; in these cases, the effect of the inflam-
mation is propagated over the whole system, and, in con-
sequence of an affection of all the vessels, excites a tumult
every where. The same local sthenic inflammation, whe-
ther it be fixed in the part, or from its propagation, gives
more general disturbance, yields to no remedies, but those
that act upon the affected part first, and heal the solution
of continuity (c). Let it suffice to have said so much at present
upon
pose 3000: and then the conclusion will be, that the general sthenic
diathesis consists in a sum total of morbid affection, as 3000; while the
inflammation of the part is only an affection of 3 degrees of excitement.
(a) Solution of continuity in all its forms, whether as being the effect
of puncturing, cutting, bruising, compression, erosion from acrid matter
or from heat, or cold, is always followed by an inflammation, which
when it goes on briskly, and needs to have its violence restrained, should
be called as is expressed in the next paragraph.
(b) which produce the other symptoms,
(c) or reparation of united substance, 


92 THE ELEMENTS
upon these inflammations, for the sake of establishing ne-
cessary distinctions, as more is afterwards to be said upon
the local, in its proper place. There are as many inflam-
mations still remaining, universal and local, to be more
fully explained in that part of our work where the proper
order requires it.
CLXXII. Inflammation, also, as often as it affects a
vital part, produces symptoms of disturbance. Whether
ever the general sthenic inflammation affects the brain and
its membranes, is hitherto not ascertained (d). And it is
more probable, that the commotion of the head, and
other disturbing symptoms of phrenitis, do not depend up-
on inflammation, as the following phænomena seem to
show: The first of those is, the ease by which the cure
is effected, the whole tumult of symptoms readily yield-
ing to bleeding, purging and other asthenic (e) remedies;
and, it not being very credible, that the effect of actual in-
flammation in a part so delicate, and so necessary to life,
could be so easily effaced. Then another argument a-
gainst the same opinion is, that there is no certain proof,
after recovery, of the existence of inflammation during
the disease. Next, analogy makes for the same conclu-
sion which we are disposed to draw; for, it has been said
above, general inflammation does not arise internally in
any sthenic diseases (f); on the contrary, as often as it oc-
curs, it is always in an external part (g). Nay, all the
symptoms
(d) Phrenitis has been thought, and commonly even defined, an in-
flammation of the brain; an opinion that, however universal, seems to
be liable to much doubt: nay, there are many reasons for adopting an
opposite one, as will appear from the reasoning in this paragraph of the
text.
(e) What are commonly called antiphlogistic, we call debilitating.
(f) See above, par. CXIII.
(g) It was long an opinion, that the inflammation in rheumatism
might be transferred to an internal part, at the stomach; but that, also,
is
 

93 OF MEDICINE. 
symptoms are such as arise from the general sthenic hurt-
ful powers, and that, also yield to the general antisthenic
remedies, and in proportion to their degree.
CLXXIH. The same (h) is the cause of head-ach, red-
ness of the eye, as well as of delirium.
CLXXIV. There is, however, no reason to doubt, but
that inflammation is the cause of that disturbance, which
happens to the lungs in peripneumony. To the part where
the pain is felt externally, whatever part of the thorax it
is, an actual inflammation is opposed internally. And, as
the inflammation is proportioned to the degree of general
sthenic diathesis, and never happens but in a high degree
of that diathesis; so that the pain is proportioned to the
degree of inflammation (i); and the state of the pulse
must be estimated by paying a due regard to its cause.
In the case of an high diathesis, and high degree of in-
flammation, its effects, the pain, seated in some part of the
thorax, sometimes about the sternum, sometimes nigh the
nipples, sometimes farther back on either side, sometimes
in the back between or above the shoulders, is acute and
pungent,
is now laid aside, and all the cases where there could be the least appear-
ance of any such transference, have been found to be cases of the gout,
or some analogous disease of debility.
(h) that we have assigned as the cause of phrenitic affection also.
(i) The inflammation was supposed a chief and primary circumstance.
and its cause and seat, the cause and seat of the whole disease; while the
general sthenic diathesis, and all the symptoms depending on it, was sup-
posed to be the offspring of the inflammation. But the truth is, in every
respect, the reverse of this account. The general sthenic diathesis is the
effect of the general exciting hurtful powers. As the effect of these, in
a lesser degree, it exists during the predisposition, and before the arrival
of the disease; and, after the disease is come on, it subsists as certainly
as such, for one, two, or three days, as afterwards, when the sign of the
inflammation, the pain, makes its appearance. It is only an increase of
it, that induces the latter; and it is not to be cured by any contrivance
of 


94 THE ELEMENTS
pungent, and the pulse very hard and strong. When the
diathesis, and the part of it we call inflammation is less, the
pain is less acute, more dull, and easier to be borne; the
pulse is (k) still hard and strong, though less so than in
the other case. Afterwards, in the progress of the dis-
ease, the pain abates, becomes dull, the respiration, which
had been much disturbed by it, becomes more easy and
free. The pulse, now, which formerly was only hard,
becomes truly and positively soft, and that in proportion
to the degree of indirect debility, occasioned by a neglect
of the proper plan of cure; or in proportion to the pro-
duction of direct debility, from the antisthenic or debili-
tating plan of cure having been pushed too far. But the
hardness of the pulse, and increase of the pain, is never to
be imputed to the inflammation being seated in the mem-
brane; nor is the softness of the former, and dullness of
the latter to be attributed to its occupying the soft paren-
chymatous substance (l), it being impossible that an in-
flammation, if it occupied either of those parts, should not
affect the next points of the vessels in the other. The
cause, therefore, of those symptoms that has here been al-
signed, must be admitted.
CLXXV. The pustules, which accompany certain sthenic
diseases,
of throwing any thing into the inflammed part, there being no such thing
to be found in nature, but by the several means of removing the com-
mon cause, that is, evacuant and other debilitating remedies. Those,
while, at the same time, they remove the other symptoms, by also re-
moving the disease, prove that the common cause of the whole is the ge-
neral diathesis. The inflammation, therefore, instead of being the cause
of the general disorder, is a consequence, like every other symptom.
(k) not soft and yielding, according to the common notion, but
(l) Such, however, and many other distinctions, equally false, frivo-
lous, and misleading in the practice, have been at all times universally
received by systematic, and lately by nosological writers, 


95 OF MEDICINE.
diseases arise from a contagion, taken into the body, dif-
fused over the whole, and, in passing out of it, detained
along with the perspirable fluid, under the scarf-skin.
The cause of the distension, and, therefore, of the great
number of pustules, is the sthenic diathesis, taking place in
a high degree over the whole body, but in a still higher
in the vessels of the skin, for the reasons formerly (m)
assigned. In which operation the muscular fibres of the
vessels, because they are as much increased in density, in
so far as they are considered as simple solids, as they re-
receive an increase of tone, in so far as they are considered
as living (n), are, on that account so shortened, as not
Sufficiently to transmit the imperceptible vapour of the
perspirable fluid. All the sthenic hurful powers have a
tendency to produce this effect, but heat, in a degree
within its stimulant range, and short of indirect debility,
more than any of them. The same is the cause of costive-
ness.
Φ Sthenic diseases are often followed by debility, some-
times direct, at other times indirect, as is exemplified in
the change of peripneumony into hydrothorax, the expla-
nation of which is evident from what has formerly been
said.
CHAP. V.
The Asthenic Diathesis.
CLXXVI. Before the symptoms of disturbance appear,
which only supervene upon a violent degree of mor-
2 bid
(m) See above, par CXIII. and CXIV.
(n) See Chap. V. 


96 THE ELEMENTS
bid state, all the senses are dull; the motions, both vo-
luntary and involuntary, are torpid; the acuteness of ge-
nius is impaired; the sensibility and passions become lan-
guid. The following functions are all in a state of lan-
guor, which is discoverable by the annexed marks: The
languor of the heart and arteries is discernible in the pulse;
as is also that of the extreme vessels on the surface, which
is evident from the paleness, the dryness of the skin, and
the shrinking of tumors, and drying up of ulcers (a), and
the manifest absence of the sthenic diathesis, to produce
any resemblance to those symptoms. That the muscles are
in a state of torpor is demonstrable by their weakened ac-
tion; and that the internal secretions are defficient, is e-
qually certain from the penury of semen and milk, and
the redundance of fluids in a state of degeneracy. The
languor of the digestive organs is manifested by want of
appetite, loathing of food, sometimes thirst, sickness of
stomach, vomiting, weakness of the system, and evident
penury of blood.
CLXXVII. In the same diathesis, whether as not having
attained to the height of disease, and only remaining with-
in the latitude of predisposition, or as raised to the mea-
sure of actual disease, the intellectual faculties and the
passions are impaired. In this way are the functions im-
paired.
CHAP. VI.
The Asthenic Diathesis illustrated by an explanation of its
Symptoms.
CLXXVIII. SHIVERING is not unusual at the com-
mencement of asthenic diseases of any considerable seve-
rity; 
(a) These symptoms have lately been construed into so many marks
amounting to a proof of the existence of spasm upon the extreme vessels;
but we shall, by and by, find a much better explanation of them. 
 

97 OF MEDICINE. 
rity; and that, as often as its cause, a very deficient per-
spiration takes place. In this case the cause of the defi-
ciency is, from the weakness of the whole system, that
weakness of the heart and arteries, in consequence of
which they propel their fluids every where with difficulty,
and in their extremities with still more difficulty, or
scarce at all. Hence the perspiration ceases. The same
is the explanation to be given of the sense of cold, when
it accompanies the shivering.
CLXXIX. In asthenic affections the pulse is weak,
soft, small, and very quick. The softness, when it can be
perceived for the smallness, as well as the smallness, is
occasioned by an under-proportion of blood, arising, dur-
ing the period of predisposition, from a scantiness of ani-
mal food, and an excess in the use of vegetable; or from
a deficiency of aliment upon the whole, whether from the
one or the other source. The cause of the weakness and
very great quickness of the pulse h the same deficiency of
nourishment, as well as of all the stimuli, such as that of
strong drink, that of mental or corporeal exercise, and an
under-proportion of blood.
CLXXX. Since the excitability can only be gradually
worn down (a) and the strength, thereby, repaired; if,
at any time, therefore, the pulse becomes full and hard
too soon, and without a proportional relief of the symp-
toms, that is a bad sign, and happens because the stimulant
plan of cure (b) has been pushed beyond the proper rule
(c); and it is a case of indirect debility superadded to the
direct (d).
CLXXXI. The same is the cause of the paleness and
dryness of the skin, as that of a checked perspiration; that
is, the weakness of the heart and arteries. Hence the
blood is not sufficiently propelled to the surface of the
body.
H CLXXXII.
(a) See above, par. XXVI. XLIII. 
(b) otherwise the proper one,
(c) See above, par. XLIX. 
(d) See above, par. CLVI. 


98 THE ELEMENTS
CLXXXII. Head-ach, which is a most frequent symp-
tom of asthenic affections, and pains in the joints, which
are more rare, are occasioned by a scantiness of blood:
for such is the effect of the blood in distending the vessels,
that a moderate distention, such as takes place in health,
excites an agreeable sensation; and every thing, either
above or below that standard, occasions an ungrateful one,
and, therefore, (e), pain. But, we are much less in this
case, than in that of sthenic pain (f), to suspect inflamma-
tion for the cause of the pain; because, not only the pain
here, but even delirium, yields so easily to the stimulant
method of cure; which would not readily happen, if so
delicate and sensible an organ, and one so necessary to life,
laboured under an affection so liable to destroy the tex-
ture of the affected part.
CLXXXIII. Neither in general, is delirium, and for
the same reason (g) to be imputed to inflammation. It
is, on the contrary to be attributed to a scantiness of blood,
and a deficiency of other stimuli. Nor is that by any
means to be doubted; since stimulant remedies, which
have no effect in filling the vessels, successfully and quickly
cure every delirium depending on debility (h).
And, when, in consequence of the removal of the dis-
ease, 
(e) when it rises to a certain degree,
(f) See above, par, CLVII.
(g) that has been just now mentioned,
(h) This is a fact as new, and of as much importance as any in this
whole work. Physicians hitherto, had no distinct notion of a variety
of inflammations, and had scarce any idea of any inflammation, but
such a one as was to be treated with bleeding and evacuation; nay, of-
ten, when they had no reason to suspect inflammation at all, the mere
circumstance of pain was, in their estimation of it, sufficient to warrant
a profusion of bleeding without end. But, the truth is, that pain may
not only arise from an inflammation, which they had no idea of, and
which was to be cured by stimulants, but it arises from spasms, convul-
sions, and even from emptiness.


99 OF MEDICINE. 
ease, and of the re-production and establishment of the
healthy state, enough of nourishment is taken in and di-
gested, then it is that, at last the mental function receives
a complete and solid re-establishment.
CLXXXIV. Thirst and heat, which do not less distin-
guish asthenic, than sthenic diseases, and are not less fre-
quent symptoms, arise from the asthenic diathesis in the
throat, and on the surface of the body, checking, in the
latter case, the perspiration; in the former, the excretion
of the saliva, the exhalable fluid, and the mucus, and that
from the atony and relaxation of the extreme vessels. In
consequence of the former, the throat being not sufficient-
ly lubricated with a due quantity of its respective fluids,
is scorched with thirst. The effect of the latter is, that,
the perspirable fluid being detained under the cuticle, to-
gether with it the heat, which in a free perspiration usu-
ally goes off in waste into the air, and remains nearly of
the same degree, is accumulated and increases. But the
increase of heat depends not on the state of excitement,
or, as it is commonly called, the principle of life, since it
happens both in the sthenic diathesis, and, likewise, in in-
direct, as well as direct debility. But the weakness of
the vessels on the surface of the body, under which the
throat and whatever part is accessible to air, is comprehend-
ed, is a part of the debility of the heart and arteries; the
latter a part of that of the whole system.
CLXXXV. This asthenic thirst, which is a much more
frequent and more violent affection than the sthenic, is
preceded by loss of appetite; the loss of appetite by loath-
ing of food; it is succeeded by sickness at stomach, vomit-
ing, often an acute pain of the stomach, and other trouble-
some symptoms; the explanation of which we next pro-
ceed to.
H2 CLXXXVI.


100 THE ELEMENTS
CLXXXVI. Want of appetite, loathing of food (i), de-
pend upon a debility of the whole body; as is proved by all
the debilitating antecedent powers that produce them, al-
ways acting by debilitating; and by all the remedies, which
both prevent and cure them, always acting by a stimulant
and strengthening operation. The cause of the appetite is
a strong and sound contraction of the fibres of the stomach,
by which digestion is supported (k), and the excretion of a
fluid
(i) These symptoms of want of appetite, loathing of food, thirst, sick-
ness at stomach, vomiting, and acute pain of the stomach, as well as those
that follow to the CXCV. and from that to the CXCVIII. form a chain
of symptoms depending upon increasing debility, which, instead of being
different in kind, are all connected by an uniform operation of nature.
And they furnish an instructive instance of the erroneous mode of
judging of the nature of symptoms, and morbid affections, which has been
so prevalent in all systems of physic, that we are yet acquainted with.
However different in appearance they are not only similar, but all unite
in forming one and the same kind of disease, one and the same morbid
affection: which is proved by their arising all from one and the same
set of hurtful powers, to wit, debilitating; and by their being cured by
one and the same set of remedies, to wit, stimulant. The former powers
may vary in degree, but they are all debilitating; and the latter may also
act with different degrees of force, but they are all stimulant. And the
state of the system, from which the former constitute a deviation, as well
as that, to which the latter produce a return, is health, which is always
the same.
(k) The fibres of the stomach are muscular, and partly longitudinal,
partly oblique, or approaching to circular. When the food is taken in,
the former are contracted and shortened, by which they raise the under
part of the stomach, which is unfixt upwards. These gradually relax
as the food, after its first digestion in this organ, and its conversion into a
more fluid form, in the same gradual manner, passes out of the pylorus,
or under orifice of the stomach. This operation takes off the distending
weight in the direction from above downward; and, as the food, in
proportion to its conversion from a more solid to a more fluid form, is
more and more collected into the under part of the cavity of the stomach,
this gives a pressure in the lateral way, and, therefore, throws the other
fibres into contraction, by which the sides of the stomach are squeezed
together, and, thereby, perform the office of throwing out, by the pylorus,
the 


101 OF MEDICINE.
fluid, such as the gastric (l) liquor, such as the saliva (m):
and to the effect of both a certain emptiness of the stomach
is necessary. But none of these circumstances can take
place in a state of debility. The fibres do not contract with
force; the extreme vessels do not pour out their fluids; the
matter of food, formerly taken in, is not dissolved and
properly mixed, and in that state thrown out of the sto-
mach; but continues in a great measure unchanged and
indissolved. Hence it is, that there is no appetite for food,
and in a higher degree of it, that a loathing takes place.
CLXXXVII. In the same manner has thirst been ex-
plained (n); and in the same manner is the sickness at sto-
mach, which is a higher degree of affection from the same
cause; for when there is strength and vigour, sensation is
most agreeable in every part of the system, as well as in
the stomach and neighbouring parts.
CLXXXVIII. With respect to vomiting; it is the chief
of all these affections, that we have been speaking of; for
to such a height has the atony and laxity of the fibres in
the stomach gone, when it comes on; to such a degree has
the
the remaining part of the alimentary matter. Besides these successive ac-
tions, the mufcular substance of the stomach is so constructed as to be pro-
vided with fibres, the motion of which, when the stomach is full, is upward
and downward; when empty downward only. All these motions give the
alimentary matter the mechanical agitation necessary to promote its
mixture.
(l) or fluid peculiarly secreted and excreted in the stomach.
(m) The gastric fluid, poured into the cavity of the stomach, as well
as the saliva that follows it from the palate, and the watery or other
drink taken in by the mouth, contribute to change the food more and
more into a fluid consistence, which is a change only of its form; but by
certain means, a change also of its nature, called in chemistry proper mix-
ture, takes place. This change is chiefly effected by the gastric fluid, to
which, perhaps, a certain relation that the other fluids bear to the alimen-
tary matter in this living organ, contributes. Another means of promot-
ing the solution that goes on in this process is the heat of the stomach.
(n) See par. CLXXXIV. 


102 THE ELEMENTS
the collection of crude nasty matters proceeded, and the
distention of the stomach from these last, and air let loose
is become so exquisite, that the fibres are oppressed, and
cannot perform their motion from the upper to the lower
part, which is commonly called the peristaltic motion. And
as in every case, both of health and disease, the tendency
of that motion is always from the stimulus in an opposite
direction; downward when the stimulus proceeds from
the mouth, and upwards when it comes from the stomach,
in that way it is that the crudities, and air let loose, of
which mention has been made, acting as a local stimulus,
direct all the motion, that they excite, towards the upper
parts of the canal. This inverted motion, being contrary
to nature, can never be agreeable; and hence, before
the arrival of the vomiting, stomach-sickness, arises;
which when it continues for any time, must be violent,
because the local stimulus rouses the muscular fibres into
violent aud irregular motions.
CLXXXIX. The cause of pain in the stomach and in-
testines, and other parts, both internal and external, under
a sthenic diathesis, is spasm. Spasm in any internal cavity,
that is, in the organs of involuntary motion, is, by means
of the debility in common to its seat with the whole body,
a relaxation and atony of the fibres, and together with that
a distending matter; what constitutes that matter in the
stomach is the sordes or foul crudities, in the intestines;
hardened excrement: in both air let loose. The effect of
this matter in the distention that it gives, does not so much
depend upon itself as upon the lax state of the fibres dis-
tended by it; for the fibres, when strong and vigorous,
easily repel the distending power, which overpowers them
in this state: but the relaxed fibres, of which we are speak-
ing, yield more and more, and that in proportion to the
urgent force exerted on them, till loosing all power of re-
silition 


103 OF MEDICINE. 
silition or contraction, all power of relaxation, they con-
tinue immoveably contracted. All which happens accor-
ding to the nature of that property in muscular fibres, by
which, when they are stretched, they do not, like com-
mon elastic matter, only contract when the distending
power is removed, but even while it remains. During
such action and suffering the sensible fibres undergo a cer-
tain violence; and hence the pain. But, that more is to
be attributed to their own laxity, than the distending mat-
ter, is proved by stimulants restoring the tone and density,
which are exactly in proportion to each other, as depend-
ing upon the same cause; by which means contracting
in the manner of sound fibres, and powerfully reacting,
they, without any assistance, as has lately been ascertained,
restore the peristaltic motion, and drive downward before
them the matter still remaining, and still continuing to
distend (o). In this way wine, aromatics, and volatile al-
kali, and, above all the rest, the various forms of opium,
dislodge from its seat all such hurtful matter without either
vomiting or purging, and that without any difficulty, and
in a very short space of time.
CXC. The pain, which is so often troublesome in the
external parts of the body, also depends upon spasm, but
not with the conjunction of a distending matter. And a
power takes the place of it, which is not to be referred to
any matter, but to a certain effort of the will in moving a
limb (p). By means of that the spasm is excited in the same
manner
(o) The prevailing notion with respect to this kind of affection has
been, and still is, that its cause is the matter here spoken of, which is
only an effect of the cause, and that its cure, when the affection is in the
stomach, is vomiting to carry off the supposed cause. But its true cause
is the laxity of the fibres, and their atony from the general debility,
yielding to the distending force of the matter, and thereby losing their
tone and density more and more; while vomiting therefore increases,
stimulating removes the disease.
(p) See LVIII.



104 THE ELEMENTS
manner as in the other case, by distention, and often with
the most exquisite pain, where, as the effect is the same,
that is, a spasm, arising from debility, and to be removed
by restoring the strength; for that reason the cause also
must be the same, and be reducible to debility, together
with something that altogether resembles debility, and pos-
sess a power equal to it. In this way of reasoning (q) we
may often safely rise from the contemplation of known ef-
fect to that of unknown cause. The pain we speak of at
present is that which respects the spasms of the muscles.
CXCIII. There is another pain, less confined to the same
part, more diffused, and equally troublesome, which is not
supported by distention, but by another local stimulus,
equally arising from debility, of equal tendency to increase
the debility, and, by its debilitating operation, together
with the other symptoms of debility, hastening on death.
This pain arises from a concentrated acid, which is some-
times predominant in the alimentary canal, when under
the influence of great debility, of which cholera chiefly is
a clear example; but, besides that, all the affections of
the alimentary canal, that are accompanied with vomiting
and a loose belly, are more or less examples of it.
CXCII. This acid is not the primary cause, but only
a symptom supervening upon the disease, already formed
in consequence of the debility, its proper cause, and now
fully
(q) a way of reasoning never made use of in medicine before, but which
runs through, and influences most of the propositions in this work. It is
further to be observed, that, upon no occcasion, can we ever arrive at an
adequate knowledge of abstract causes; that the eagerness of mankind
to rush into wild and fanciful explanations of them, without any regard
to real phænomena of nature, has been the cause of all the false phæno-
mena that ever appeared in the world, and that the only sure and faithful
guide to the study of causes is a cautious and painful investigation of the
effects and phænomena of nature that proceed from them. See more up-
on this important subject, and, indeed, a complete discussion of it, in my
book, entitled, "Observation on the old Systems of Physic." 


105 OF MEDICINE. 
fully established, arising from the same source as the other
symptoms, and to be removed by the same remedies.
When the same acid has arisen, it continues to increase
all debility that happens to be predominant, either in the
first passages, or in the rest of the body: And, while it
exerts the operation over the whole body, its influence is
in the part where it exists, and where the diminution of
the force of the disease is most wanted.
CXCIII. But, though it be itself in that way the off-
spring of debility, and of a tendency to create further de-
bility, in the same manner as spasm has been said to be;
still there is not, either for the sake of changing, or throw-
ing it out of the body, occasion for any other indication of
cure: For, as it has its rise at first from a general cause,
so upon that it all along depends; whatever has the effect
of overcoming the other symptoms, has also that of over-
coming this. For that purpose it is, that, as in the case
of spasm, stimulants, not emetics, nor purgatives, nor
any other debilitating powers, are required.
CXCIV. As the acid, which has been mentioned, pro-
duces the pain in the internal parts, or in the organs of in-
voluntary motion; so in the external parts, or organs of
voluntary motion, it is occasioned by something that pro-
duces the same effect as the acid, that depends upon the
will, and acts in conjunction with the convulsive state; and,
as in the case of spasm, there is no matter that corresponds
with the distending, so in this there is none to correspond
with that which produces the pain. Nay, as the spasmodic
case is represented by any cramp of the muscles, so is the
convulsive by any convulsion, but, above all, by epilepsy.
Finally, as in the former, the same reasoning from known ef-
fect to unknown cause proves the sameness of the external
and internal case, it equally proves their sameness in the
latter (r). 
CXCV. 
(r) All this reasoning with respect to spasm and convulsion, show-
ing 


106 THE ELEMENTS 
CXCV. The simple course of morbid affection from its
slightest to it most violent degree (to take a review of the
subjects from the place where we set out), is, that it begins
with loss of appetite, and is brought on by want of the sup-
ports of food and of other stimuli, or by an over-proportion
of stimuli, and proceeds through all the intermediate de-
grees to spasmodic or convulsive pain. For the reasons
lately assigned, there is first no appetite for food, and if
the patient perseveres in the debilitating process of cure,and
food is not administered, such, suppose, as can be taken in
the form of soups, a loathing of it follows. By-and-by, if
still nothing is used to produce stimulant effect, thirst will
come on; there will be the most keen desire for the most
debilitating power, cold water, which will be preferred
to the greatest dainties, and will be greedily swallowed (s).
To this stomach sickness immediately succeeds, which,
unless prevented by a diffusible stimulus, such as a glass of
the most pure and strong spirit, or, failing that, another
perhaps,
ing them to be the same, and only a part of the whole, a link in the chain
of the other asthenic affections, which have been mentioned, as well as
the facts and arguments next to be brought, which will serve to prove all
that follow to be also the same, is, of itself, of the highest importance to
mankind. In a particular manner, the whole tribe of diseases of the ali-
mentary canal, and almost all those of children, all indeed, but the con-
tagions eruptive ones, are both explained, and their principle of cure as-
certained, with geometrical exactness. Here, then, at once is a discovery,
upon scientific principles, of the true nature, and certain cure, of more
than one-half of the diseases of the human race; the method of cure aris-
ing from this doctrine having never failed in any of them, and never suc-
ceeded upon a contrary plan, the debilitating and evacuant, so universally
recommended by the authority of the schools. The spasms and convulsions
of the external parts, unless when immoderate in degree, are equally
certainly removed by the new method, and even epilepsy and tetanus
yield to it.
(s) When this asthenic thirst comes on, it is the highest luxury in na-
ture to be allowed a free indulgence in the use of cold water, which is
always hurtful in proportion to the degree of its coldness. 


107 OF MEDICINE. 
perhaps, in some cases a third, rushes instantly on to vomiting.
When the affection rises a little higher, during the vomiting
a violent pain arises in the stomach, giving a sensation as if
there were a bar of iron in it, forcibly stretching and tear-
ing it across (t). When the affection becomes still more
severe, and the cause of the disease still higher in degree,
every kind of torture is undergone; an head-ach comes on
with a feeling of strokes like those given by an hammer.
These symptoms of disturbance are communicated to the
alimentary canal, for the most part not immediately, but
in consequence of the disease remaining, and lurking, with
an intervention of intervals of deceitful respite. The
belly is often affected with gripes and great pains, and ex-
ceedingly loose; but, which will not be wondered at in
an inverted state of the peristaltic motion, it is oftener con-
stipated, and, from time to time, undergoes all the vicis-
situdes of alternate vomiting and purging. Among the
troublesome symptoms, that have been mentioned, are
comprehended dyspepsia, called in common English Indi-
gestion,
(t) A lady, after nursing her twelfth child for seven months, was
found by her husband, a physician well acquainted with the new doctrine,
very low spirited one evening. She was of a delicate, thin, exhausted
habit, and had been subject often before, towards the end of her peri-
ods of nursing, to loss of appetite, colic, dejection of spirit, and as often
cured by removing the child from her breast, and putting her upon a
rich stimulant regimen. Her friend and physician perceiving the cause
of her dejection, ordered two of their daughters, who happened to be
grown up. to sit up and rock the child in the cradle all night, and also
watch their mother to administer to her the things he had ordered.
They themselves went to bed. The reader should have been informed
that such was this lady's lowness of spirits, that tears bursted from her
eyes upon hearing the sudden order for the weaning of the infant. He
fell asleep; but in an hour's time was wakened by the noise of a most
violent vomiting she had fallen into. She had a pain in her stomach at the
same time, from her account of which the description above was taken.
All this had been occasioned by her applying the child's mouth to her
nipple.


108 THE ELEMENTS 
gestion, the gout, diarrhœa, loose-belly, dysentery, or
the bloody-flux, cholera (u), the colic (x), the iliac (y) pas-
sion,
(u) or that disease, the urgent symptom of which is alternate vomiting
and purging, the effect of which, while their cause is a general weak-
ness over all, but prevalent in the first passages, is to increase the weak-
ness, from which they proceed to such a degree, as to hurry on the pa-
tient's death, with every symptom of expiring debility, in the short
space of sixteen hours. This happens in the warm countries, as the sou-
thern parts of Europe, and especially in the torrid zone, whether in Asia,
Africa, or America.
(x) The colic has been commonly treated by purging and bleeding,
and low diet; but in no instance has that treatment of it been successful.
Opiates were particularly forbidden upon the supposition of their consti-
pating the belly; but the truth is, that the colic, as well as diarrhœa
(which has been supposed a disease of an opposite nature, from the seem-
ing contrariety of looseness of the belly, and costiveness to each other), are
the same kind of affection, only differing in degree. And the colic is to
be removed by no other means than those that remove the simple loose-
ness; that is by durable and diffusible stimulants.
(y) which is that higher degree of colic where vomiting comes on,
and the peristaltic motion is so inverted as to occasion the rejection of
stercoraceous matter by the mouth. Sometimes in the progress of the
same disease, especially when treated only by evacuation and bleeding,
a portion of gut is insinuated into the cavity of the next portion. This is
called in the art Volvulus, or Intus Susceptio. The quick and effectual
cure of colic before the symptoms of volvulus make their appearance, is
a good proof that the latter is induced by the purgative medicines, em-
ployed to clear away the obstructing cause, acting with such relaxing ef-
fect, and urgent violence, as to turn back the inverted motion in one part,
while it continues inverted in all the rest, and particularly in the portion
next to it. The ordinary evacuant plan therefore, is a cause of the violence
of the disease in all its stages; and lastly, of the last, which becomes a lo-
cal and immoveable affection. Nothing could be more absurd than the
reasoning that has directed the practice of physicians. In which, besides
the general rules of bleeding to cure bleeding, vomiting to cure vomiting,
and purging to cure purging, and besides the contradiction of employing
purging in colic, which by the last rule only applies to diarrhœa; they
have taken it into their head, that a good means of removing the ob-
structing 


109 OF MEDICINE. 
sion, the green purging of infants, the worms, that wasting
of the body called Tabes, or Consumption, and atrophia (z),
both
structing matter in colic, was to throw in a large quantity of heavy fub-
stance with the intention of forcibly displacing it; reasoning in that way
not so well as a soldier would do in clearing away any foul matter from
his firelock; for it should have been remembered, that whatever effect
such substances, as quicksilver, might have by their weight in pushing
downward any obstructing matter, they must operate with a contrary
effect, as often as in the convoluted state of the intestinal canal, the
course of any portion was upward. Neither did it ever strike them,
upon any one occasion, what they never should have left out of view
upon every occasion, that the idea of the action of dead matter upon
dead matter, whether mehanical or chemical, that is, perceptibly or im-
perceptibly mechanical, is never to be transferred, in sound reasoning,
to the mode of action of the same dead matter on living matter; the
excitement in no case whatever admitting of any such analogy.
(z) These two diseases, according to a theory that has at all times
prevailed in the schools, and has pervaded all medical systems, are sup-
posed to originate from an obstruction in the mesentric glands, through
which the chyle, or alimentary matter, after undergoing a double prepa-
ration, one in the stomach, and another in the first convolutions of the
intestines, has to pass before it arrives at its common receptacle, the
thoracic duct, in order to be thrown into the venous mass of blood; and
to remove it, still upon the same idea, as if all the cavities of the animal
economy, whether great or small, were to be cleansed, like the sol-
dier's firelock, no limits were set to the use of gentle aperients, and par-
ticularly the use of mineral waters. And they used gravely to tell us,
that with the help of a course of time, suppose the arrival of the in-
fant, or child, at the seventh year of his age, that would carry off the
disease by its determent operation, provided the obstruction were not so
great as to induce death before the lapse of that period. That all this is
silly theory devoid of all foundation in truth, is proved by the completion
of hundreds of cures in the shortest spaces of time, by means of durable
stimuli, which act upon their delicate frames with such efficacy as to su-
percede, unless in the most violent cases, all use of the diffusible. This
remark applies likewise to worms, for the cure of which no bounds were
set to the use of purgative, upon the idea of clearing away the stuff in
which this vermin nestled; a practice not so judicious as that of some
foolish boys, who place their success in bird-catching upon the chance or
bringing 


110 THE ELEMENTS 
both of them diseases chiefly of children, and by far the
greatest part of the diseases of that age.
CXCVI. As the cause of the disease proceeds, and the
exciting hurtful powers prove more urgent; the external
parts are drawn into consent, and now the organs of vo-
luntary motion are affected. Sometimes the legs, some-
times the arms, and other parts, differently upon different
occasions, are tortured with cramps; sometimes the thorax
variously all round; sometimes the shoulders, sometimes
the sides, sometimes the back, sometimes the neck, are
affected with pain, from which pains no part of the hu-
mon body is exempted, and the region of the lungs, of
the liver, and of the stomach, are especially liable to them.
The smart pains that affect those parts, and are supposed to
proceed
bringing down the nests from the top of high trees, by throwing sticks
and stones at them; while other boys, both more sensible and alert, climb
up and seize every one of them. The cause of worms is the same as that
of all the other diseases we have spoken of, differing in nothing but in 
what they all differ from each other, mere degree. Debility over all,
but prevalent in the alimentary canal, occasions a weakness both in all
the other functions, and particularly in that of the peristaltic motion.
This state implies a similar weakness in the vessels that pour their fluids
into that cavity; their weakness implies an enlargement of their diame-
ters, and that enlargement an increase of the quantity of fluids thrown
in, without any increased impulse behind. Hence arises a colluvies of
matter, which the increased peristaltic motion is not able to throw off.
The colluvies is increased by the use of vegetable matter and fruit taken
into the stomach, and depositing their feculent parts upon the intestines.
The indication of cure is not to increase either the general, or particu-
lar part of the cause, by purging, and the use of other debilitating pow-
ers, but to strengthen the whole living system; and especially the intef-
tinal canal, by the whole round of stimulant remedies diffusible or dur-
able. To this treatment the tabes and atrophia will yield in a few days,
or even hours; the worms in as many weeks. And they are all increased
by the common plan of cure, as universal experience has proved to a de-
monstration. 


111 OF MEDICINE. 
proceed from internal inflammation, are, in reality, owing
to spasmodic or convulsive affection (a). That this is
their true origin is proved by the renewal of stimuli, remo-
ving the affections, often immediately, always in a short
time, and reproducing the healthy state. It is proved by
the
(a) Endless have been the bleedings and other evacuations employed
to remove those painful affections, and as dismal has been the effect of
that method of cure. The universal rule suggested by the principles,
and confirmed by the practice of this new doctrine, is to invigorate the
whole system, and apply any diffusible stimulus, particularly laudanum,
to the pained parts. By that practice I know not one cure, of some
hundreds, that either I or my pupils have performed, that has failed.
The gout will sometimes make its attack in this way. But whatever be
the particular force of disease, with which they may seem to have any
connection, the only diagnosis here necessary is to be sure that the true
peripneumony, is not the morbid state. When that is out of the ques-
tion, and whether the painful complaint be denominated bastard peri-
pneumony or not, the only indication of cure is what has been just now
mentioned. A young lady, with whom I am nearly and tenderly con-
nected, has been often affected with an acute pain in her right side, most-
ly fixed and solitary, sometimes accompanied with a certain numbness
and senselessness in her extremities, commonly with loss of appetite, and
some degree of head ach. The effectual method of cure is to apply
rags dipped in laudanum, volatile alkali, or æther, and renew them as
often as they become dry, and to support her internally with durable
and diffusible stimuli, proportioned in kind and quantity to the exigence
of the case. This method of cure of a morbid affection, that upon the
contrary debilitating evacuant plan would be readily and quickly con-
verted into an incurable asthenic disease, has always proved infallible in
removing the attacks, which never after return but when she has enfee-
bled herself by keeping the house too much, and neglecting air, exercise,
and the use of the other diffusible stimuli. Friction used over all the af-
fected parts, is also found useful in supporting the stimulant operation
of all the other remedies. There is in the fens of Lincoln, where an e-
minent physician, and follower of this doctrine, practises, a disease call-
ed a bastard peripneumony; in which, though it had always baffled all
the efforts of the common evacuant practice, he never lost a patient, by
exercising the contrary one. 


112 THE ELEMENTS
the unsuccessfulness of the contrary method of cure, which
proceeeds upon bleeding, the various modes of purgation
and abstinence. Nay, what even makes more for the same
conclusion, is, that, while abstinence almost alone is often
sufficient to produce the pains, rich diet also alone has
been sufficient to remove them (b).
CXCVII. The same pains, sometimes combined with
enormous motion (c) sometimes without it (d), are abso-
lutely free from inflammation. To distinguish them, then,
from the pains that flow from inflammation or a similar o-
rigin, the concourse of accompanying symptoms must be at-
tended to. Sthenic diathesis points out that whatever pains
occur are sthenic; and the information received from the
asthenic diathesis is, that the pains appearing in it are parti-
cipant of its nature and as certainly asthenic. This remark
is of deep application to diseases of daily occurrence, and
overturns the common practice. Even head-ach, which
is so frequent an affection, is ten times to be removed by
the stimulant plan, for once that the contrary answers (e).
2 CXCVIII.
(b) This I have often experienced in the case of the gout. Before
dinner, when my stomach was empty, I have limped in going abroad to
dine. But after having made that meal heartily, and taken a glass or
two of wine, have returned with-a perfect firm step, and free from all
feeling of pain and uneasiness.
(c) as in the convulsive kind so lately spoken of, where the enormity
of motion is sometimes external and in the organs of voluntary motion,
sometimes internal, as in cholera and so forth.
(d) as in the spasmodic pains, head-ach, pains in the legs and soles,
where there is an inability to perform the due motion.
(e) The true reason for all this, and innumerable errors in the prac-
tice, is that the leaders in the profession never understood any diathesis
but a sthenic one, or any indication of cure but an asthenic, to which
they gave the name of an antiphlogistic, as they did that of phlogistic to
the diathesis. By his reformation of the erroneous plan of cure, that his
cotemporaries, the Alexipharmacs, had introduced, in the small-pox and
the few other sthenic diseases that ever occur, in all the rest of the ge-
neral 
 

113 OF MEDICINE.
CXCVIII. Symptoms of disturbance occur also in as-
thenic diseases as well as the sthenic. Such a state of dis-
turbance takes place in the alimentary canal in the cases
of hysteria, colic, dyspepsy, and the gout. Thus in the
alimentary canal, besides the pains, mentioned above, a cer-
tain sense of burning, anguish, contortion and direful tor-
ture, exhibit a set of appearances, formidable in the high-
est degree, both to the patient and by-standers, and which
beget a suspicion of their proceeding from inflammation as
their cause. But that those affections have nothing to do
with inflammation as their cause, and that they depend
upon a state of the part quite the reverse, has been proved
by the stimulant method of curing them turning out suc-
cessful in every instance in which it has been tried (i).
I The
general diseases, Dr Sydenham's authority confirmed the error. He left
also the measles as he had found that disease, and all other general dis-
eases, which are much more in frequency than 97 out of the 100, or 97
to 3 of the sthenia. Great men had need to be cautious, as the least in-
advertency in them, not to say essential mistakes, never fails to lead their
followers, who are commonly servile imitators, and implicit believers,
into capital error. If ever they attempt any thing of themselves it is
commonly to raise a crazy superstructure upon a false foundation, it is
commonly to refine upon error ad infinitum.
(i) Till this doctrine appeared, it was impossible to erase from the
minds of physicians an impression that had been deeply made there, that,
nothing but the only inflammation, that they were acquainted with,
could be the cause of such pain and torture, as is described in the text.
I have more than once experienced the whole concourse, here mentioned,
and have always found them to yield to the most stimulant method of
cure, that I could contrive. I once laboured under this modification of
asthenic disease for no less than ten days, and was always able to over-
come it in two hours, and procure an interval of complete ease and re-
lief for the rest of the day. The remedies employed were the whole
round of diffusible stimuli, as opiates in all their forms, camphor, musk,
volatile alkali, and æther, &c. By these the functions for the time were
completely restored. But their stimulant effect was no sooner perfectly
gone off, that is, after the interposition of a long sleep, through the night,
than 


114 THE ELEMENTS. 
The same fact is confirmed by the use of wine, opium,
and other diffusible stimuli. After that, and still in con-
junction with their use, animal soups, and next solid
meat, and the usual way of living, and guarding against
debility, effectually re-establish the ealthy state (k.)
This
than the symptoms returned with a violence little short of what it had
been the day before. This was proof positive, that their nature was
asthenic, or consisting in debility; since they yielded to stimulant reme-
dies; and that the debility was exquisitely great, since it required so
high a degree of stimulant operation to remove it. While that is the
undoubted fact, there is a nicety with respect to proportion to be attend-
ed to in this case. It is a rule, that the degree of curative means, whe-
ther in the cure of sthenic or asthenic diseases, should be accommodated
to the degree of the diseased state or degree of the cause. If too little
of the curative means is employed, a proportional part of the disease
will remain; if too much, the disease will be more than removed, that
is, another state which may be morbid in another extreme, may take
place. Too much was once employed in this affection, and the effect
was, that the disease was not eradicated till the tenth day of its course
from the beginning.
(k) The rule here is, if indirect debility be the cause, to begin with a
high degree of stimulant cure, and gradually reduce it to the ordinary de-
gree that is sufficient for the healthy state. And the caution is to be sure
of this gradual reduction, otherwise the indirect debility will be liable to
return the moment the effect of the stimuli is gone off. By an attention
of this kind a disease depending upon indirect debility may be cured in
the sixth part of the time, that would be taken up by the cure, when
the remedies are every day carried beyond the due bounds. For exam-
ple, if the indirect debility be in the table the effect of an application of
71 decrees of exciting power instead of 40, that is to say, the excitement
is worn down to 9 instead of being up at 40; it is evident, that an appli-
cation of 71 degrees by way of remedies, will leave the disease where it
was. Suppose only 65 degrees of stimulant power administered; the ex-
citement will fall to 66, and the wasted excitability rise to 15. Next
day let only a degree of exciting power as 60 be applied; then the degree
of excitement will be that number, and that of excitability 20. Five
decrees of exciting power still less will reduce the morbid excitement to
55, and raise the excitability to 25. And so on may the matter go,
till the excitability is raised to 40 and the excitement reduced to the same
number. 
 

115 OF MEDICINE.
This plan of cure proves to a demonstration, that those
affections are most foreign both from sthenic inflammation
and every degree of sthenic diathesis; and, besides the
general sthenic inflammation, not appearing to affect inter-
nal parts, it affords another argument against inflamma-
tion in this case being the cause (l).
CXCIX. The asthenic pulmonary disturbance distresses
the patient with so intolerable a fixed pain, that no bounds
have been set to bleedings for the cure of it. But all such
bleedings have not only been useless, but detrimental, and
often fatal; whereas, on the contrary, the stimulant plan
of cure has always succeeded (m). By it the respiration is
interrupted, and nearly all the symptoms that accompany
an actual peripneumony, distress the patient, and to such a
degree, that it has been suspected, there was an inflamma-
tion in the case, or rather it has confidently been believed
that there was. Or, if any difference was discerned betwixt
this affection and that phlegmasia, or sthenic general affec-
tion with inflammation; that was only a shadow of distinc-
tion, and led not to the rejection of the notion of inflamma-
I2 tion
number. But, if the reduction be much less by the day, the cure will
be proportionally slower. Nay, such an error may be committed as to
increase the disease instead of reducing it, which will happen, as often
as a degree of stimulant power is applied, which is more than equivalent
to that which produced the disease. All this attention and caution is ne-
cessary in the cure of asthenic diseases of indirect debility; while that of
those of direct debility is easy and simple, to wit, to give the stimulants
in small proportion and often repeated, till the disease is removed, un-
less, which may happen, you can guess the proportion, which may suf-
fice to remove the disease at once, or, at least, twice.
(l) See CLXXXII. and CLXXXIII. par. above.
(m) A young lady afflicted with these symptoms was in the course of
a month bleeded thirty times, always with a temporary relief, but with
a return of the disease more violent than ever. She was then put upon
a stimulant plan, and in less than a month restored to her perfect health.
That was among the most early cures taken from this doctrine. 


116 THE ELEMENTS
tion being the cause, but only gav« occasion to a question
about its seat. But truly, that there is no inflammation
at all here, at least as a cause, and that the disease depends
upon pure debility, is sufficiently proved by the arguments
that have been brought before. The disease is increased
by the antiphlogistic, and diminished and removed by the
stimulant plan of cure.
CC. The formidable symptoms of disturbance, that
accompany epilepsy, apoplexy, and fevers, such as stu-
por, a disposition to sleep, in them all; in fevers often
that false watching, that is called typhomania, and some-
times coma (n); in the latter, (or fevers), starting of the
tendons, in the former, (or epilepsy and apoplexy), con-
vulsion or a diminution of the voluntary motions; which
by most physicians have been partly imputed to irritation (o),
as
(n) or an insuperable proneness to sleep,
(o) No diseases are more opposite to each other than high sthenic dis-
eases, such as the common inflammatory fever, or peripneumony, and
proper fevers; the former, in the table, standing at the head of the
scale of increased excitement, and the latter at the bottom of the scale
of diminished excitement. And the same method for the cure of both
has been pursued, to wit, the evacuant, debilitating. If, in peripneu-
mony, large quantities of blood were taken at a time, the difference has-
been made up in the cure of fevers by repeating it the oftener; while
all the other evacuations were carried on with the same profusion in
both. When they talked of the respective causes of those diseases, phlo-
gistic diathesis was the word for the high sthenic diseases, and irritation
for the high asthenic. But these were words only, while in fact the me-
thod of treatment of both was the same at least in kind; and scarcely
different in degree. To whatever part of any system of physic we turn
our attention, we constantly see one mode of practice running through
the whole, and that too, notwithstanding of the supposed great number
of diseases very limited. It turns all upon bleeding, other evacuations,
starving, and some other trifling directions under the title of regimen.
It was all antiphlogistic to use their own language; and whatever other
language they held, the nature of the disease, if we are to judge from
their treatment, was phlogistic. 


117 OF MEDICINE.
as typhomania and the starting of the tendons; partly to
plethora, either alone and pure, or together with its mobi-
lity: All these without distinction are evidently owing to
the same cause, upon which all asthenic diseases depend,
that is, debility. Which is proved by the debilitating
hurtful powers, whether acting directly or indirectly, a-
lone producing those diseases; and by the remedies, the
whole action of which depends on stimulus, alone relieving
or removing them. But it is in vain to impute apoplexy
to plethora (p); as if at that time of life, when the body
is nearly worn out and almost bloodless, that is, when
the usual degree of aliment is neither desired, nor taken in,
nor digested, more blood could be produced than in the
flower and vigour of human life. On the contrary, at the
time when apoplexy comes on, in consequence of indirect
debility, induced by old age and excessive excitement in
the mode of living, the solids are languid, the quantity of
fluids deficient, as also their fountain, the blood. Epilepsy
depends upon the same debility, and the same scantiness
of fluids, only that its debility is oftener of the direct kind.
Fevers may depend upon indirect debility, as in the con-
fluent small-pox (q), or where drunkenness has been the
principal hurtful power producing them, but at the same
time their most frequent cause is direct debility. And in
all
(p) or an over proportion of blood, see above, CXXXI.
(q) The confluent small-pox, as depending upon a very high degree
of debility, is ranked among the high fevers in the after part of this
work, because the scale is not regulated by the appellations given by
physicians, or by any of their erroneous distinctions, but by strict re-
gard to the degree of excitement. And for the same reason is the vio-
lent cholera marked nearly in the same place; because the debility, ta-
king place in it, is nearly equal in degree to the most sinking febriie de-
bility; in a word, because the same degree of debilitating power pro.
duces, and the same degree of stimulant operation, removes the diseases
so assorted.


118 THE ELEMENTS
all the cases, that have been just now mentioned, debility
is the primary cause and final termination both of all the
rest of the symptoms and of those of disturbance.
CCI. To the symptoms of disturbance sometimes also
belong the following that affect the head; great head-ach
in fevers, imbecility of the intellectual function, confusion
of thought, and delirium, the last often sufficiently fierce,
though occuring in the highest degrees of debility, and
leading to efforts beyond the strength. This state often
happens towards the end of a nervous fever, even when
violent. Inflammation is apprehended, blood is let, but
directly from the head; blisters, which are extreme unc-
tion in the art, are clapped on, silence and darkness are
prescribed, even the most gentle stimulants are forbid. In
consequence of the emptiness of the stomach, as well as
of the vessels of the whole body, and of the highest de-
gree of languor from the want of many stimuli, vertigo is
superadded to delirium, and the patient, deprived of
strength, sense and intellect, breaths out his last. 
CCII. But in this case there is either no inflammation,
or, if there be, it is altogether of a different nature from
the general sthenic one. That it is not the latter, the
unsuccessfulness of the debilitating plan of cure, and the
incredible success of that which first stimulates, and after
fills the vessels, afford certain proof: and that it is not
any other inflammation is evinced by the so sudden resti-
tution of health. Now, as an impaired use, or confusion
of the intellectual faculty is, in a certain degree, always
the consequence of debility, whether arising from any
other source, or from emptiness, or a general inanition of
the vessels, and, that too even in those, who are otherwise
sound; where is the wonder, if, in the highest degree of
inanition, compatible with life, in the highest degree of
diminution of excitement, scarcely leaving a shadow of
life 


119 OF MEDICINE. 
life, also the highest degree of failure in the intellectual
function, that is, delirium, among other instances of im-
paired function, should take place. Nay this very fact
is certain, and proved to a demonstration. Thus famine,
thus drinking water contrary to custom, after a course of
drinking to excess, of both eating and drinking with in-
temperance, a gloomy state of the animal spirits, grief,
terror, despair, not only induce a temporary delirium,
but frequently bring on downright madness. The same
conclusion applies to any considerable loss of blood. For
how many persons, after being wounded either in line of
battle or on the highway, have never after, and often du-
ring a long life time, come to the right use of their senses.
To say nothing of contusions, wounds and other inju-
ries, by which the texture of the brain is injured, as be-
longing to local diseases, of which we are to treat after-
wards; how does cold induce death? Is it not, amidst
a diminution of all the other functions, by a delirium pre-
ceding death? From these facts, of such weight, both
from their number and validity, and that bring forward
all the powers in support of the argument, it must be ad-
mitted, that both head-ach, and every failure of the in-
tellectual function, in every degree, and that highest de-
gree of such failure, delirium, depend not at all upon
general sthenic inflammation, the only inflammation hi-
therto known; but arise from the highest defficiency, both
of other stimuli, and of that which depends upon a pro-
per fulness in the vessels, that is, debility. Debility then
is the most frequent cause of the symptoms, that have
been mentioned, as is proved by the restoration of health
so quickly upon the new plan of cure.
CCIII. But if ever the asthenic inflammation, menti-
oned (r) before, excited the tumult of symptoms, which
are
(r) See above, paragraph CLXXI. and CCII. It is to be defined in
the next paragraph.


120 THE ELEMENTS
are our present subject; it produces that effect in the same
manner precisely, that debility produces it, by means of a
penury of blood and deficiency of other stimuli. For,
CCIV. The general asthenic inflammation is nothing
else but asthenic diathesis, somewhat more violent in a
part than in any other equal part (s); and upon this foot-
ing, that the degree of asthenic diathesis constituting the
inflammation is by no means to be compared with the de-
gree of diathesis in all the rest of the system; because the
affection diffused over the whole body is far greater than
that confined to a part (t).
CCV. Inflammation, in this case, is nothing else but
a state of the inflamed part, of the same kind with that of
all the rest of the body. And, as the inflammation is con-
stituted by a lesser excitement in a part, than in any other
equal part; so, before the arrival of the disease (u), of
which the inflammation is a part, a symptom, or sequel,
the excitement of that part is understood to be proportion-
ally less, than that of any other part.
CCVI. This inflammation (x) should be distinguished
from another, which is local; It is general, and depends
upon
(s) See above, paragraph XLIX.
(t) See above, XLVIII. XLIX. L. LI.
(u) See above, par. CLXIX. and compare it with this. The meaning
in both is, that as certain parts of the system have more excitability than
others (LI.), so those parts, which in the diseased state are more affected
than any other, that is, are either more excited, as in sthenic inflamma-
tion, or less, as in asthenic, than in any other, keep up the same proportion
of disparity before the arrival of the disease, before the appearance of
any of the symptoms, and while, as yet, nothing but mere predisposition
has taken place. The truth of this proposition is established by that of
another so comprehensive as to extend to the whole subject of life; which
is, that over the whole living creation, throughout the universe, health,
predisposition to disease, and disease itself, are the same state, only dif-
fering in degree, (vid. par. XXIII. and LXV.). Health, therefore,
is also comprehended under this same proposition.
(x) mentioned in the two last paragraphs, CCIV. and CCV. 


121 OF MEDICINE.
upon a general diathesis and only happens when the diathe-
sis has attained to a certain degree; while the local arises
from some hurtful power, that produces a solution or viti-
ation of the texture of the part, without regard either to
diathesis or degree: The general inflammation is brought
on by the same hurtful exciting powers, which produce
the general diathesis, only applied in a higher degree;
and the same remedies remove both the diathesis and the
inflammation: The local inflammation depends upon hurt-
ful powers, that only harm a part, and is removed by re-
medies that change the state of the part; but is not affected
either by general hurtful powers, or general remedies. Ex-
amples of the universal are these inflammations, which ac-
company the gout, the putrid sore throat, the gangrenous
sore throat, and that inflammation which produces sore
eyes: The local inflammation will be illustrated by exam-
ples, to be produced in their proper places (y): The gene-
ral inflammation is attended by debility over the whole
system; which debility is only a sequel of the local, and
not always. To remove the former the general method of
cure (z) is adapted; but the cure of the latter turns upon
healing up the part. In this way, then, there are four
sets of inflammation, two universal, a sthenic, and an as-
thenic, and two local; one of which is sthenic, snd the
other asthenic. The former often ends insuppuration, often
in solution; the latter in gangrene, and sometimes sphace-
lus, sometimes at the last in death. If, in the end of a
typhus
(y) as in the inflammation, that is produced by a wounding instrument
when a person, previous to such an accident, is in health, and continues
to be so after the accident. Or it may still be local, though a person is
in bad health when it happens, but so, however, as that the general state
of the health is understood to have no concern in it. A wound in a very
tender part may induce disorder over the general system; but still all
the symptoms can be traced to the wound, and not to the ordinary cause
of general disease.
(z) See par. LXXXVIII.


122 THE ELEMENTS
typhus fever (a) inflammation affects the brain or its mem-
branes, which (b) is neither yet proved, nor a very likely
fact, it will serve for an instance of an asthenic general in-
flammation.
CCVII. As the general sthenic inflammation is occa-
sioned by a quantity of blood, excessively distending the
vessels, which are its seat, by that distention stimulating
them, by stimulating increasing their excitement, by the
last producing more forcible and more frequent contrac-
tions, by these increasing the tone of the fibres as living,
and their density as simple solids, and thereby diminishing
their
(a) or a low nervous fever, which is a disease of the highest debility,
next to the plague, and often not inferior to that disease in malignity,
and, therefore, to be arranged in the scale, as next to that disease, which
stands at the bottom of diminished excitement. Physicians have con-
stantly confounded the different degrees of this disease with sthenic ones,
affecting the pulse. But they are diametrically opposite as shall be point-
ed out when we come to the proper place for such distinctions.
(b) though strongly asserted. A professor in his lectures gives a case
of a typhus fever, where, upon account of delirium and some other symp-
toms, thought to announce an inflammation in or near the brain, the
patient was so freely bleeded, that the state of the pulse (which is said
to have been, in his words, "a pulsus vacivus, if ever there was such a
"pulse",) forbid any further bleeding. The patient was given up, and
the extraordinary physicians withdrew, leaving the ordinary one of the
family, only, about him. This gentleman, from some impression on
hisrrind, began to think, that another bleeding might be tried with
advantage. He bleeded him, and the patient recovered. This is an ac-
count of a case that I pretend not to understand, and I believe it will be
no less puzzling to my readers, and the more puzzling the more sense
they have. It is, however, brought as an example, that in a seeming
expiring debility, the highest degree of asthenic diathesis, there may be
an universal sthenic debility, that requires bleeding. I have mentioned
it, not for the sake of information, but of caution to the reader. Any
person may see the frivolity and lightness of the theories of our profession,
but it requires knowledge and discernment to guard against the seduc-
tion of facts. 


123 OF MEDICINE. 
their diameters (c); and, consequently, making the blood
flow with great effort through the contracted vessels, and,
during its flow, produce pain from the high force of the
contractions, and the narrowness of the space through
which it has to pass; and as the same, though in a lesser
degree, is the cause of sthenic diathesis over the whole
vascular system, whether red or colourless: So,
CCVIII. The cause of general asthenic inflammation
is also abundance of blood in the inflamed vessels, pro-
ducing the same effects in the inflamed portion as in the
sthenic inflammation; and; notwithstanding of the penury
of blood in every part of the vascular system besides, flow-
ing abundantly into the inflamed vessels, upon account of
a greater atony and laxity in them, than in the others, di-
stending them and producing the phænomena peculiar to
any inflammation (d).
CCIX. As the indication of cure for the former is, to
diminish the quantity of blood, which is the first cause of
the struggle, and, thereby, to reduce the excessive excite-
ment to the degree that suits the healthy state, and the ex-
cessive contractions, which constitute the struggle, to the
moderate ones, which are pleasant and agreeable to
health (f): So
CCX. The indication of cure for the latter is, first,
by
(c) See LXI. above, and CXXXI.
(d) These definitions, apply to all the four inflammations (par. CCVI.)
with respect to the state of the inflamed vessels; their differences only
depending upon the general state of all the rest of the vessels, which in
the local, may be quite the healthy state of these, while, in sthenic gene-
ral inflammation, it is the sthenic, and in this the asthenic diathesis, that
are conjoined with the inflammatory state. Further, as their cause is
influenced by these general circumstances, so also is their cure; the sthe-
nic and asthenic general inflammations requiring the remedies of the
diathesis to which they respectively belong, and the local only the reme-
dies suited to heal up the part.
(f) See above, CXXXIV. 


124 THE ELEMENTS.
by powerful stimuli, to drive on the quantity of blood
which there is in every part of the system, that the portion
which loiters in the languid vessels of the inflamed part,
may be thereby propelled, and the vessels relieved of their
burthen; and then by the gradual administration of sea-
soned animal food, in the form of soups, and, soon after,
and when now the strength is recruited, in a solid form, to
fill the whole system of vessels.
CCXI. The two other inflammations, both local, will
be treated of afterwards, each in its proper place.
CCXII. That inflammation of the throat, which ends
in what they call a putrid (g), sore throat, is singularly in-
sidious. During the first days it differs little in its ap-
pearance from the sthenic sore throat. The general symp-
toms are also similar. The pulse scarce exceeds the mea-
sure of the sthenic pulse in its frequency and other charac-
teristics. For some time the whole disease proceeds with
gentleness and tranquillity, excepting that a constant re-
jection by spitting of a tough mucous matter is trouble-
some. At last, when head is not made against it by means
of the most powerful stimuli, a period arives, when all the
symptoms are suddenly precipitated into a bad state; when
the pulse becomes very quick, very weak, and remarkably
small; when the strength, over the whole system, sinks;
and now it is not a moderate portion of diffusible stimulus,
not before administered, that will stop the much to be
lamented death of the greatest ornament of human na-
ture (h). The best plan of curing this disease, is to pre-
vent
(g) The disease, here mentioned, is neither described nor, seemingly,
understood, in medical books and lectures. In this work it is taken, as
every thing else is, from nature at the bed-side of the sick, and deserves
so much the more attention, that, though it is a disease of the utmost ma-
lignity, it seems to have been altogether overlooked. Its appearances
are mild at first, but, without both skill and attention, will end fatally.
(h) All this refers to a lady in Scotland, of singular worth and amiabi-
lit


125 OF MEDICINE.
vent the mortal period by employing the most powerful
stimuli.
CCXIII. The diffusible stimuli are so powerful in re-
moving the inflammation of the gout, that, sometimes,
strong strink, undiluted, as wine, and spirits, or the latter
diluted with water, as warm as can be borne, have in a
few hours removed the most violent fit, and restored the
use of the affected foot. And the same remedies, as have
been mentioned before, are of equal efficacy in removing
the general symptoms (i).
CCXIV. The inflammation of the throat, in the gan-
grenous sore throat, is not, according to the common
opinion, a primary affection; but, like every other general
asthenic inflammation, depends upon the general diathesis,
which, in this case is manifestly asthenic, being a part or
symptom of the diathesis, when that has attained a cer-
tain high degree.
This inflammation has nothing in common with the
sthenic
lity, who died, but not in consequence of the plan of cure, which this
doctrine enjoins, having been followed; especially at the period of the
disease when it was most wanted.
(i) Treated in the way, here and formerly (vid. the pref.) mentioned,
the most violent degree of the disease always gave way in a few days,
and milder cases in as many hours. I never found a single case baffle me
but one, where the patient, who, with his valet, had quacked himself
into the gout as well as other complaints, and particularly an habitual
costiveness, by forcing every passage by the belly, for the space of seven-
teen years. I was dismissed without having my directions complied
with; and without being allowed to accommodate the remedies to his
practice of purging and throwing up injections, so as to endeavour, at
least, to prevent or mitigate their hurtful effect. For, it must be observ-
ed here, that, as every directly debilitating power is an exciting hurtful
means of bringing on any asthenic disease, so the effect of every evacu-
ation, and particularly that by the belly, is well known to be a certain
means of bringing on a fit of the gout. Among many other means of
inducing that disease, a single dose of Glauber's salt, though that be but
a mild cathartic, will bring a fit of the gout on me at any time. 
sthenic

126 THE ELEMENTS
sthenic general inflammation, which distinguishes the
sthenic inflammatory sore throat, (k) or with the two local
inflammations.
CCXV. The crowded pustules, in the small-pox, when
it is now converted into the confluent disease of that name,
that is, into an asthenic general disease, become partakers
of the new diathesis, and, instead of sthenic, which was
their first state, become aststhenic; and, as by their local
stimulus before, they quickly changed the sthenic into the
asthenic diathesis, by means of indirect debility; so they,
now, by the debilitating influence of their asthenic nature,
confirm asthenia, or a state of debility, over the whole sy-
stem; they increase it, and carry it quickly on to death (l).
CCXVI. To throw light and illustration upon
them, by comparing their respective methods of cure;
it is to be observed that the cure; in the one ease
is
(k) Yet in their systems of nosology, which are laboured volumes of
distinctions without differences, begun, within this half century, to be
superadded to the former modes of systematizing, which, without this
new one, had sufficiently disgraced the art, and needed no more than the
most absurd of the whole, or that the misled fancy of men could invent,
to complete, in all its copartments, the vast fabric of error, and particu-
larly in the last of these, that published in Edinburgh, the putrid sore
throat, as described (above CCXII.) was left out, and the gangrenons,
which is that just now alluded to in the text, conjoined with the com-
mon sthenic sore throat, though diametrically in its nature opposite to it.
(l) There cannot be a more exquisite stimulus in living nature, than
that universal cake of inflamed pustules, which covers the whole surface
in a crowded small-pox. It is no wonder then, that, when it is super-
added to the ordinary stimulant hurtful powers, to which this disease
first owes its violence, and afterwards, that very eruption, the united
effect of both should soon pass the whole range of excessive stimulus, and
quickly run into the state of indirect debility (see par. CC ). Such is
the nature and progress of the small pox, in passing from the sthenic in-
to the asthenic state, that is, from one disease into another of a most op-
posite nature. 
 

127 OF MEDICINE.
is quite different from that of the other (m). The
remedies of the distinct small-pox, and of its accom-
panying eruption, are cold, and whatever, by evacuation
or otherwise, debilitates. The remedies of the confluent
disease, as well as of its accompanying eruption, are heat,
remaining within the indirectly debilitating degree, and all
the powers, which stimulate as quickly, and as power-
fully as possible, and consequently, the most diffusible.
CCXVII. They differ besides in this, that all the hurt-
ful powers in the distinct: case are sthenic; all in the con-
fluent asthenic. And this difference equally applies to
both diseases, and both eruptions.
CCXVIII. And as the sthenic or distinct pustules have
a direct tendency to produce asthenic inflammation, and
sthenic eruption; so the tendency of the asthenic or con-
fluent, is as directly to gangrene, sphacelus, and death.
CCXIX. The boils, carbuncles, and buboes, which of-
ten accompany the plague, and sometimes the typhus fe-
ver (n) arise from a contagious matter, taken into the body,
and then detained with the perspiratory fluid, under the cu-
ticle, and in the glands. The case of the detention, and,
therefore, of this eruption, is a total cessation of motion in
the extreme arteries, especially the glands and perspiratory
terminations, upon account of the universal debility, and
the very great languor of the heart and arteries. That this
is the case, is proved by their being no eruption during the
period of predisposition, when some vigour still remains;
and,
(m) The cure of the distinct small-pox is the debilitating; that of the
confluent, the stimulant plan. The cause of the former is sthenic dia-
thesis, that of the latter the asthenic, occasioned by indirect debility;
which is a distinction unattended to in general, and with very bad effect
upon the practice. For, when the confluent small-pox is established, the
pustules flat, and signs of mortification coming on, the covering the pati-
ent with a single sheet is as common as in the distinct small-pox.
(n) See above, the note (c), under par. CCVII. 


128 THE ELEMENTS
and, therefore, the perspiration goes on in a certain de-
gree; none in the cases of sudden death from the violence
of the disease; neither eruption nor disease in all the
cases, whether these are early prevented by the use of the
more powerful stimulants; by the disease being always
gentle, and the eruption always sparing, in proportion
to the proper management of the stimulant plan of cure.
For, whether the suppression of perspiration be the con-
sequence of a very great degree of sthenic diathesis, or
of an equal degree of sthenic as in the present case; all the
foreign matter, that should be thrown out of the system
along with the perspirable is, together with it, detained,
and so detained below the cuticle, by stagnating, and ac-
quiring a more acrid nature, it produces local inflammation,
either of a sthenic or asthenic nature, in proportion to the
different nature of each, or rather of the habit of the body.
CCXX. In the same manner is that eruption which
diversifies the skin in the gangrenous sore throat to be ex-
plained; as well as another, which supervenes upon that
state of the small-pox, which by reason of the debility of the
system, would otherwise turn out well; but if the new e-
ruption be not opposed by the most powerful stimuli, is
sure to end in death. Both these eruptions (o) are spotted
both of them red; but the former (p) is marked by smaller,
the latter by larger spots; in the latter the colour is a fine
scarlet, far exceeding all art, and almost the power of na-
ture herself in other respects (q). Both of them are owing
4 to
(o) A young child of mine, who had been long weakly, and often, in
consequence of that, snatched from the jaws of death by being properly
supported, according to the principles of the new doctrine, had been pre-
pared to receive the small-pox, and inoculated. After the eruption was
completed, and it was now certain it would be exceedingly moderate,
one morning he was brought before me covered over with the appear-
ance of the eruption described in the text.
(p) or that in the gangrenous sore-throat.
(q) The beautiful colours sometimes painted in the clouds are often
not to be copied by art.


129 OF MEDICINE. 
to a suppression of the perspiration by the debility that has
been mentioned: the former is removed, in practice, by
the stimulant plan of cure, which removes all the other
symptoms; in the latter or uncommon eruption, the debility
produced of purpose in the preparatory plan of manage-
ment, to render the small-pox mild, must be opposed, as
soon as the eruption appears, and the strength must be re-
stored by the use of the most diffusible stimuli: the pustules
which are both few, and of no consequence, and do
not even attain to the measure of actual general disease,
and are, therefore, free from all danger, are not to be re-
garded. If this practice be executed, the recovery is both
certain and quick; but, if it be neglected, or if a contrary
plan of cure be set on foot, death is inevitable (r).
K CCXXI.
(r) It is certain, that the safe conduct of the small-pox depends upon
debilitating the habit which is to receive the infection; and it is as lit-
tle doubtful that we may carry that operation a great way, by lowering
the diet, purging the belly, and applying intense cold to the surface,
and, by all means, guarding against all alternation with heat. By this
means the phlogistic diathesis, chiefly arising from the ordinary powers
and in part, as it would seem, from the contagious matter, is prevented
or removed; the great flow of the fluids to the surface checked; and
the diameters of the perspiratory, as well as of all the other vessels, kept
open and patulous. But it had been long a question with me, whether
this debilitating operation might not be carried too far. If it be certain,
as it is, that extreme debility suppresses perspiration, surely the process
pushed near to that degree must endanger that event. This phenome-
non happening to my child, solved the doubt that I had not yet decided,
and it seemed to be in perfect conformity to the principles of this doctrine
to understand, that, as this child had been formerly weak, and, perhaps,
still retained some degree of that state, the further weakening him by the
preparatory management, for the better regulating this disease, had been
carried too far. A surgeon happened to be by when the child was un-
der examination; I asked him if he had ever seen such a case, for I had
neither seen, nor heard, nor read, of any thing like it. His answer was,
that he had seen three, and all of them fatal, I knew how that would
happen, that-is, that they would continue the debilitating practice they
had


130 THE ELEMENTS 
CCXXI. Heat is not peculiar to sthenic pyrexiæ (f),
but belongs also to other diseases of the same stamp.
Nor is it so confined to those, as not also to arise in all the
degrees of predisposition to those diseases, and in proportion
to each degree (t). But the matter does not end here. The
same heat distinguishes all asthenic diseases, whether fe-
brile, which is a distinction without any good meaning,
or not febrile, and also the predispositions to them all
and that in proportion to the degree of debility. There is not
a more certain mark of a departing disease, whether sthe-
nic or asthenic, than a return of that temperature, which.
is commonly called cool, to distinguish it from morbid
heat.
CCXXII. The heat is then only natural, when neither
diathesis is present. From that point it encreases, through
all the degrees of encreased excitement, till indirect debi-
lity, from excess of stimulus, is established; and it en-
creases in proportion to the degree of excitement, rendering
the perspiratory vessels always less and less patulous. It
also encreases through all the degrees of diminished ex-
citement
had been following. On the contrary, I ordered the child spirit and wa-
ter, and a little of an opiate, then restored the meals that had been ta-
ken from him, and brought him about to his perfect health (for the small-
pox gave no trouble), in twelve or sixteen hours.
(s) Pyrexia is the word for sthenic diseases affecting the pulse, called
febrile, or fevers, very improperly, while the term fever is reserved for
the high asthenic diseases that have been confounded with the pyrexiæ.
(t) That heat takes place in predisposition, is a matter of daily obser-
vation. Thus, when a person has no other symptom of disease, it is of-
ten remarked, sometimes by himself, sometimes by another, who may
have happened to feel his hands, that he is certainly not quite well as
his hands are hot. When this heat happens, either in the hands or feet,
without any cause to account for it consistently with health, it is a sure
prelude of disease, that is a fure mark of a considerable predisposition to
disease: and the kind of disease, of which it is the harbinger, is of-
tener asthenic than sthenic. 


131 OF MEDICINE. 
citement to certain boundaries, which are fixed by a cause
by-and-by to be explained, and encreases in proportion to
the degree of decreasing excitement, though the latter all
along renders the perspiratory vessels more patulous; and,
thereby, among other effects, diminishes the motion, both
of all the vessels, and particularly of the perspiratory.
CCXXIII. When the heat has now been the greatest
it can be, and the debility encreased in proportion, at last
in the exremities, and afterwards gradually in the rest of
the body, cold, which is always a bad sign, succeeds to it.
In the progress of the debility motion begins to be very
languid, first in the extreme vessels of the extremities of
the limbs, and then to be destroyed altogether. Hence,
as heat, whether in due proportion, or in excess, depends
upon the motion of the blood and other fluids, being per-
formed in due proportion, in excess, or to a certain extent,
in a deficient degree; if, therefore, the heat is either no-
thing, or next to nothing, as in the present case, the effect,
together with the cause, by an universal law in nature,
ceases. The same thing happens in both extremes of ex-
citability, that is, of excessive abundance in direct, and of
nearly a cessation of it, in indirect debility; and so much
more readily will this happen, because, whatever be its
source, debility is always the same.
CCXXIV. Because the excitement in sthenic diseases
is for the most part much and equally encreased over the
whole body; the heat, on that account, is also equally
diffused over the whole. From which fact no cases are
excepted, but those, in which, in certain parts, as the
stomach, under a strong disposition to vomiting, and,
therefore in danger of falling into indirect debility, indi-
rect debility either actually takes place, from the, disease
proceeding with an excessive force of stimulus; or direct
debility comes on, when the debilitating plan of cure has-
been pushed beyond the rule. But, so long as the sthenic
K2 diathesis 


132 THE ELEMENTS
diathesis is vigorous, and supports a high force of excite-
ment the heat will almost always be equal.
CCXXV. The same thing happpens in moderate de-
bility. Accordingly, through the whole course of predis-
position, and in those diseases, where the matter has not
gone iq far as almost a total cessation of motion, the heat
is pretty sequal. The effect of cessation of motion has
been explained (u). But, before that happens, if any ine-
quality of heat occurs in diseases of moderate debility, as
is frequently the case in the hands and feet; the reason
of that is, that a greater degree of debility as in cold, la-
bour, and sweat from these, or any other source, and that
sweat cold and clammy, has been applied to those parts,
than to others. Not only in the gout, but also in other
affections both of direct and indirect debility, a burning
heat, chiefly distressing to the soles of the feet, torments
the patient, especially in walking. That that arises from
debility, checking perspiration, is proved by fatigue, cold,
and other debilitating powers proving hurtful to it; and
heat, rest, and other stimulant powers, giving it ease.
CCXXVI. It remains now, that it be explained, how
too great excitement, in high sthenic diseases, impairs
some functions, but never, by a debilitating operation; and
how too small an excitement in violent asthenic diseases,
gives an appearance of encreasing some functions, but
always a false one.
CCXXVII. If, in peripneumony, synocha (x), and,
violent rheumatism, the voluntary motions are impaired,
and to such a degree, that a person can neither use his hands
nor his feet, more than a paralytic person; that that is not
owing to debility, that is, diminished excitement whether
directly or indirectly (y), is evident from this double proof;
that,
(u) See above, CCXXIII. 
(x) or the inflammatory fever.
(y) When the excitement is at 40 all the functions are performed in
the


133 OF MEDICINE. 
that, if the apparent debility were real, stimulants would
be of service, and debilitating remedies of disservice (z).
But the reverse is the truth. For the same debilitating pow-
ers, which cure the other symptoms of confessed excessive
excitement, also remove this indisposition to the perform-
ance of motion; and the contrary encrease the affection.
CCXXVIII. Again, in spasms and convulsions, either
of the involuntary motions, in the internal parts, as in
dyspepsia
the best and completest manner. Above that there is more force through
all the steps of predisposition, but with less durability and steadiness;
which is exemplified by the comparison of hard labourers, who at the
same time are well supported, and gentlemen, who live well, without
using a proportional degree of labour or exercise to prevent a luxuriant
state of vigour. When two such persons are subjected to a comparative
trial of their vigour in any exertion, the former will be found to go
through the exertion with more steadiness, and to hold out longer and bet-
ter than the other; even though his first efforts may have been inferior in
force to those of his antagonist. And the reason is evident; a moderate
and proper degree of vigour, will bear an addition of stimulant operation
longer than a higher degree of it approaching to morbid state; because
the distance of the excitement from indirect debility, which puts an end
to excitement, is greater in the former than in the latter case. The dif-
ference in the well-supported labourer is 30 before he can reach an en-
crease that leads up to 70; whereas that of the gentleman is perhaps not
more than 20. The exertion in the struggle adds stimulus; which will
be better borne by him who has least and yet enough, than by him who
has more, but of a superfluous degree, and more liable to ran into the
extreme of a cessation of excitement. The effect of exertion in the la-
bourer will be to carry him soon up, by its stimulant operation, to the
degree of excitement where the gentleman began, suppose that to be 50,
and perhaps by and by to 60. But the same stimulus of exertion in the
gentleman will have the effect of first mounting up to 60. and by and by
to 70, where the excitement begins to cease.
(z) Who would administer wine, opium and the other high stimuli,
whether durable or diffusible, to cure the inability to perform motion in
either peripneumony or that rheumatism which is highly sthenic? Or
rather, who would think of any other means of removing that symptom,
than the debilitating powers, so effectual in removing all the rest, and
not less so in reaming them? 


134 THE ELEMENTS 
dyspepsia (a), in colic, in dysentery (b), in cholera (c), in
hysteria, in any violent attack either of vomiting or loose-
ness of belly, (great numbers of which affections happen
every day, without being distinguished by names); or in
the burning affection of the alimentary canal (d), which is
considered by physicians as an inflammatory affection; or
in affections of the voluntary motions externally, as in the
lock-jaw, in tetanus (e), and in many spasms of other parts;
or
(a) in English indigestion: 
(b) in English the bloody-flux.
(c) or that disease the urgent symptom of which is vomiting and
purging.
(d) See above, CXCVIII. and the annexed notes.
(e) Tetanus is a violent spasmodic motion of the muscles of the head,
neck, and upper part of the thorax, whereby the head is kept immove-
able in the same position, in which it had been found upon the coming
on of the spasm. The teeth also, from the affection occupying the mus-
cles of the under jaw, are kept immoveably locked, and hence the name
of lock-jaw. Besides the affection of the muscles, that has been mention-
ed, there is scarce one muscle in the whole body, free from one degree
or other of the affection. Further, there is a most painful feeling over
all, but especially in the parts most affected. This disease sometimes
happens in cold countries, such as this, in consequence of a wound in
any sensible part, or when small bones, as the ossa spongiosa are bruised,
crushed and dashed into the softer parts. The part of it called lock-
jaw is frequently a symptom in fevers. But the disease is more frequent
ill warmer countries than this, as in the south of Europe, where the ex-
cess of heat is liable to ran into indirect debility. It is most frequent of
all in the Torrid Zone, where indirect debility is the most constant at-
tendant on heat. As a violent and permanent contraction of the muscles
was the most striking symptom of it, and systematic physicians supposed
every such contraction the effect of an encrease of excitement, or, to use
their own words, an increased flux of the nervous fluid or nervous
power into the parts affected; consequently their indication of cure was
to relax the rigid contracted parts. Hence no bounds were set to their
emolient relaxing measures. Such were bleeding, other evacuations,
and warm-bathing. But experience soon taught, that all these increased,
instead of removing the disease. Of late opium, because it was thought
a sedative, was tried. The trial succeeded. But immense quantities of
that 

135 OF MEDICINE. 
or in convulsion, epilepsy (f), and many other convulsive
affections; if these functions seem very much encreased;
that that is not owing to encrease of strength, that is,
encrease of excitement, shall also be proved to any unpre-
judiced judge by the following two-fold fact; that, if
this were a case of really encreased strength, debilitating
powers, or the remedies of sthenic diathesis, would remove
it, and stimulants (g) not proceeding to their ultimate effect
of inducing indirect debility, but remaining within that
range, in which they remove asthenia (h) would increase it.
But to such a fact also is the truth in diametrical opposi-
tion (i). For stimulants alone, which remove the other
signs of acknowledged debility, also remove those spasms
and convulsions; and debilitating powers encrease them,
or change the disease into a worse (k).
CCXXIX.
that medicine were found necessary to effect the complete cure. Lauda-
num used to be thrown in without measure, or any other rule, but to give
it on till the disease ceased.
(f) or the falling-sickness in English,
(g) keeping within their stimulant range, and
(h) or affections of debility,
(i) Who does not now know, that bleeding, evacuations of other
kinds are hurtful, and that stimulants proportioned to the degree of the
cause, are the only successful remedies?
(k) A certain gentleman in his desk, speaking of the method of cur-
ing epilepsy or the falling sickness, and recommending among other eva-
cuant and other debilitating means, small but frequently repeated bleed-
ings, unguardedly contradicts himself in his very next sentence.—
"However," says he, "we regular practitioners are liable to be too cau-
"tious and even timid sometimes. For I have known a bold practiti-
"oner in the country, who cured an epilepsy by very profuse bleeding.
"In a few mouths after the patient died of an universal dropsy, but the
"epilepsy never returned." I would ask this gentleman, what sort of a
cure that was, that converted a disease, which may come and go for ma-
ny years, nay even for a long life time, into one that, in a very short
time, proved fatal? What reason would a podagric have to thank any
one, who should convert the gout in him upon any violent attack, into
a 
CCXXIX.

136 THE ELEMENTS 
CCXXIX. Because we know not what contraction is,
or almost any function of living systems (l); we shall not,
therefore, wrangle about whether it be an increased or
diminished function (m); but we will by no means give up
the point of those spasmodic and convulsive motions being
an impaired function (n); for, if, within certain bounda-
ries,
a fatal dropsy? That sort of treatment is not curing a disease but en-
creasing it, and even that to death. The convulsive symptoms of an
asthenia may pass away, but the asthenia remains. You may cease to
call it epilepsy; but dropsy still shews that the cause of the disease re-
mains, nay is prodigiously increased. This fatal mistake of an encrease
of the disease upon the whole, for the cure of an inferior degree of it.
proceeds from an improper use of directly debilitating powers in place
of the proper stimulant ones. But there are cases, where the last, by be-
ing carried too far, produce the same fatal mistake. Thus in peripneu-
mony, to get rid of the hard pulse, and the acute pungent pain (see a-
bove, CLXXIV, and the notes), the bleedings are carried so far as to
produce a fatal hydrothorax, or dropsy of the chest.
(l) This is, perhaps, the first philosophical performance in which care
has been taken to keep clear of abstract causes. The prosecution of them
has contaminated almost every department of knowledge that had been
treated scientifically. See the introduction to my Observations on the
several erroneous Systems of Physic, &c. where it will appear, that even
the great Sir Isaac Newton did not altogether avoid this error, especially
in the questions he put, however modestly, with respect to an all-per-
vading æther; the wanton and aerial theoretical fabrics that have been
raised upon which, have, in spite ef Lord Bacon's better directions, dis-
graced the philosophy of the middle of the eighteenth century. Com-
pare what you will find in the book with the III. Chap. paragraph
XVIII. in this.
(m) See above, Chap. V. throughout.
(n) I know not what the abstract state of muscular fibres is, either
when they contract and relax with rapid, violent, and morbid force, or
when they remain immoveably fixed in one forcible permanent contrac-
tion: But I know, that nothing but debilitating powers produce them,
and nothing but invigorating ones remove them, which is enough for
me, who mean to prove myself a sure and cautious observer of the phæ-
pomena of nature; and in my practice as a physician, to avoid, after
the 


137 OF MEDICINE.
ries, (o), excitement, when increased, produces more
strength, and less when it is either diminished without limi-
tation, or ultimately encreased; and if every function so
arising is properly defined to be either a function encreased
in proportion to the encrease of excitement as contained
within its boundaries, or as a function diminished in pro-
portion to the deficiency of the same excitement, without
any boundary, or to the ultimate encrease of exciting power
beyond the stimulant range; consequently, in the last of
these cases it is a most proper definition to say, that the
function is diminished; and in the first, that it is increa-
sed (p).
CCXXX. 
the example of many others, groping in the dark under the guidance of
abstract reasoning, but to view every subject of observation, by nature's
cleared light,
(o) See above, par. XXIV.
(p) In the spasmodic and convulsive state of the function of motion,
when compared with the vigour of the same function in its healthy state,
who would say that the former is greater than the latter? The healthy
and vigorous state of motion consists not in the degree of contraction,
but, with a certain degree of that, in the well proportioned alternation
between contraction and relaxation; of which we have proof indisputa-
ble in this mode of motion being best performed in that middle state of
vigour, that intervenes betwixt the extreme of the healthy, or moderate-
ly encreased vigour, and the other extreme of direct and indirect debi-
lity. The encrease of vigour and excitement keep pace to a certain ex-
tent, even through some degrees of morbid excess of the latter: but a
period, and that short of indirect debility, arrives, as in peripneumony,
where the excitement is increased beyond the healthy state, and must be
reduced in order to restore the due healthy vigour. There are other ca-
ses, as that of mania, or sthenic insanity, where the conjoined encrease of
vigour and excitement will still go further. But in every case the en-
crease of vigour, still judging of it from its effects in the healthy state,
ceases before that of excitement; and, perhaps, we may make a step to-
wards finding the boundary, by observing, that the greater the sum total
of excess of exciting power is, the sooner does the point arrive, beyond
which the vigour does not proceed. In peripneumony it ceases at a cer-
tain


138 THE ELEMENTS
CCXXX. The notion, therefore, hitherto received with
respect to these motions is false. It proceeds upon a sup-
position (q), as if the motions proceeded from an ex-
cessive influx of the nervous fluid, according to a mode
of style which they first held (r), or of the nervous pow-
er
tain period of the disease, where the salutary effect of bleeding and other
debilitating means shows that the encrease of excitement is still going on.
But here the sum total of excitement, considering the state of all the other
functions, is greater than in mania, where the function chiefly encreased
in vigour is only that of voluntary motion, while all the functions of in-
voluntary motion are very little affected. From this investigation we
can clearly discern, that every increase of excitement leads to a morbid
encrease of vigour, and that there is, somewhere or other, a point in the
scale of encreasing excitement, and below the point of indirect debility,
where the vigour is no further encreased; and this inference arises with
respect to the practice, that we should be very observant of both facts,
ats pointing out a very material distinction in the indications of cure; that
in indirect debility being to stimulate, while that at the cessation of vigour
is to continue to debilitate till the sum total of excessive vigour be redu-
ced to the proper and healthy. The inability to the performance of
motion in peripneumony is an instance of the latter; that of the conver-
sion of the same disease from excess of debilitating cure is an instance of
the former.
(q) Indeed they have talked so confidently of it, that they may more
justly be arraigned of going upon a petitio principii, or that error in lo-
gic where a point, chiefly required to be proved, is taken for granted,
and made a ground work of other reasoning.
(r) From a microscopical observation of Leuenhoeck, where he once
thought he saw a hollow cavity in the nerves (but could never see it a-
gain, nor any body after him, though that instrument has been infinite-
ly improved since his time), the celebrated Dr Boerhave took his noted
intertexture of vessels, making the whole mass of living bodies consist of
such. The functions were, at that time, supposed to depend upon an
inelastic fluid secreted in the brain, and distributed in the cavities of the
nerves, to every part of the system. Much reasoning has been em-
ployed in refutation of that beautiful, though fanciful, system. But the
only reason, that should have been employed against it, was to deny the
truth of the hypothesis upon which it was built; and that negative argu-
ment might have been supported by this positive one, that it is now
known, 


139 OF MEDICINE. 
er (s), which is now the common language, that is, if it has
any meaning, from an excessive excitement in the fibres that
have been mentioned (t); and, as according to the phraseology
of the logicians, "error draws on error;" so this notion of
the abstract cause led to another (u) with respect to the ope-
ration of opium. And as they senselesly enough supposed
excessive motions to be occasioned by an excess in the prin-
ciple of life, at least in the labouring parts, so they either
thought, or taught, that opium possessed the virtue of check-
ing or allaying, as a sedative, those motions, and that con-
trary to the whole analogy of nature, and the certain proof
afforded
known, that the nerves are solid substances, and not hollow tubes.
The next theory that was taken up was, that though the nerves were so-
lid substances; yet they were porous, and, therefore, fitted to receive
into their pores an elastic fluid, like the electrical, the magnetical, and,
like, or rather a modification of, the supposed æther of Newton; that
this inelastic fluid also floated upon the surface of the nerves, and formed
an atmosphere around them, and by it all the functions of living systems
even those of the most perfect, the human, were explained. For a full
account of it see the Preface to the Observations on the Principles of the
old Systems of Physic, from page 19 to page 58. Among other applica-
tions of the æther, under the denomination now of nervous power, one
was to make its influx into the muscular fibres affected with spasm, or
convulsion, the cause of these morbid motions; as its influx, as an inelas-
tic fluid, into the hollow cavities of the nerves had been before supposed
to afford the same explanation.
(s) That, was their word, after an ingenious philosopher in Edinburgh,
whose dissertation upon this subject is given at full length in the place of
the Observation referred to, had ridiculed them out of their æther.
(t) It is here to be observed, that the change of the theory here has
led into a vagueness of terms. It might have been proper, had the notion
of either an inelastic, or elastic, fluid been retained, to have called the
supposed cause of the function a fluid, and to have talked of its influx as
such; but now that we know nothing about it, or whether it has any
existence at all, to call it a power, and yet to talk of its influx or efflux,
its flowing in or out, is surely vague and incoherent.
(u) that is, they supposed the most powerful stimulus, opium a seda-
tive. 


140 OF MEDICINE.
afforded by all the exciting powers, every one of which has
been proved to be stimulant, not one sedative (x) but if it
were in any respect doubtful, that nothing in nature, at
least in those powers, that are commonly applied to animal
bodies is sedative, how can there be any uncertainty of
that point as to opium, much less, that the contrary con-
clusion should be held for the truth? Has not it the same
effect upon the Turks, that wine has upon us? Or, are
we to suppose, that the troops of that people, on their
march to the onset of battle, chew opium, with the in-
tention of checking their natural alacrity and propensity to
action, and of blunting and depressing their high spirits
and courage? If fevers, if the gout, if indigestion, if the
colic, if asthma, and the whole train of spasmodic and con-
vulsive diseases, in fine all asthenic diseaes, have lately,
to the conviction of every person who gave the subject a due
consideration, and, contrary to the expectation and opinion
of all men hitherto, been proved to yield to the various
forms of opium without difficulty; and if all these diseases,
in which it is serviceable, have been demonstrated to be af-
fections depending on debility, are we to agree, that opium
proves of service, by an operation that is further debili-
tating, or rather that extinguishes the miserable remains of
nature's motions? If the various forms of wine, and other
strong drinks, have a very great effect in removing the same
diseases, which has likewise been discovered by late expe-
riments, and are, therefore, understood to be beneficial by
the same mode of operation as opium, are we to agree, that
that similitude of operation argues, a diversity, nay a di-
ametrical opposition in the nature of the powers that unite,
with such harmony, in producing the same effect? Lastly,
if it cures diseases, that depend upon a confessed deficiency
of
(x) See above, par. XIX. to XXII. with the additions and notes.


141 OF MEDICINE. 
of motion (w), equally as those, the motions in which,
though seemingly increased, are in reality diminished;
what can any person say in objection to so strong an argu-
ment, added to so many and so powerful ones already ad-
vanced? In faith opium is not a sedative; on the con-
trary, as it is the most powerful of all the agents that sup-
port life, and that restore health, and a truly blessed re-
medy, to the divine virtue of which the lives of so many
mortals has been owing, and, in future, will be owing;
so it must be acknowledged, that spasms and convulsions,
over which it has so great power, do not consist in increas-
ed, but diminished excitement, and that opium cures them
by the same operation by which it cures any of the diseases
depending upon debility.
CCXXXI. Sometimes in diseases there is a preternatu-
ral flow of blood. Thus in sthenic diseases blood drops
from the nose: it is sparingly expectorated from the
lungs, and tinges the urine. The first and last of these
three are considered as critical signs; but they have no
other meaning than an abatement of sthenic diathesis,
and a disposition to indirect debility. This is an ef-
fect, that, for the most part soon goes off, leaving behind
it a state of convalescence (z), and soon after a restoration
of health, seldom passing into an establishment of indirect
debility.
CCXXXII.
(w) In one fit of the gout, when its paroxysms were allowed to return,
in consequence of a disrelish that I had taken for a certain stimulus of
the drink kind, and, therefore, all at once abstaining from stimulus, I
fell into a state of perfect inaction, and, though without feeling of pain
or uneasiness, so devoid of muscular force, or capability of producing
any motion or exertion, that even tha slight degree of muscular contrac-
tion necessary to support my posture in bed failed. In that state, when
my eyes were glazed, the whole dangerous paroxysm was removed by
changing my drink into a more agreeable one; any strong drink would
have answered, and opium best of all.
(z) or of recovery. 


142 THE ELEMENTS
CCXXXII. Great and continued bleeding discharges,
whether from the womb, from the anus, or from around
the latter, or by the nose, depend upon pure debi-
lity (b). An over-proportion of blood, distending the ves-
sels beyond bounds, and establishing indirect debility, may
sometimes be the primary cause. But, in this case, if no
other debilitating power, and particularly directly debili-
tating, has acceded so the cause; if the discharge be stopt
by a stimulant plan of cure; if the body be strengthened,
and the laxity of the vessels taken off, the whole affection
will soon disappear, and the health be restored. On the
contrary, when indirect debility has not preceded, and
other directly debilitating powers have been applied; such
as those are which have been spoken of; and more espe-
cially, if the diseases are treated by bleedings and other
evacuations, by abstinence, or by vegetable food and watery
drink; in such a case the diseases become chronic (c),
troublesome, at last direful and fatal. That they depend
upon
(b) These are the several hemorrhages of systematic and nosological
authors.They have hitherto been supposed to depend upon sthenic,
what they call phlogistic diathesis, and the particular discharge to be sup-
ported by an activity, an effort, what they call a molimen hæmonhagi-
cum, in the vessels pouring out the blood and the parts of the vessels im-
mediately behind. Their continuance was accounted for upon the sup-
position of there being an over-proportion of blood in the system, or what
is commonly called a plethora; but they are all asthenic diseases, de-
pending upon relaxation and atony both of all the rest of the vaf-
cular system, and particularly of the bleeding vessels. (See above
CXXXIV. χ.) and, instead of a plethora, there is a penury of blood;
all which is proved by the phenomena during the predisposition, when
little food is taken in, and less, upon account of the weakness of the di-
gestive organs, is digested; these circumstances are increased after the
arrival of the disease. The pulse withal is weak, small and frequent;
and the patient puny and emaciated. The disease is encreased by bleed-
ing and other evacuations, and both relieved and removed by wine, spi-
rits and diffuble stimuli; a method of cure which, till within these fif-
teen years, would have startled all the physicians upon earth.
(c) of long duration,


143 OF MEDICINE.
upon debility, is proved by the failure of the cure just now
mentioned, and by the great success of the stimulant plan.
The true cause of bleeding discharge is not plethora,
which cannot happen in the case of persons ill nourished,
in water drinking, and under the application of other hurt-
ful powers, that equally destroy the tone and density of the
vessels (d). For as food is nearly the only material, from
which blood is formed; how, when it is withheld in the
absence of the cause, can the effect remain? and, if, upon
account of the debilitating effect of other hurtful powers,
any food that is taken is not digested, how can there be an
over-proportion, and not a manifest scantiness of blood?
But it may be alleged, that loss of blood, and every sort of
debilitating power, diminish perspiration, and that from that
circumstance the quantity of blood is increased. How can
that happen? The matter, from which the blood is made,
it may be added, is taken into the stomach, and a smaller
quantity of fluid passes off by perspiration. But, to that it
is to be answered, that in the first place it is not taken in;
and next the little that is, is not digested (e); then after
the serous part has been separated from the red, will it,
if
(d) See above, CXXIV. and χ.
(e) No idea in medical writings seems ever to have been formed of
the body as a whole. On the contrary, nothing has been more common,
than to talk of the functions as operating in a great measure, each from
a cause existing within itself, or but slightly and arbitrarily connected
with some other. This false notion was carried to its most ridiculous
pitch in the doctrine of sympathy, and not rendered much more decent,
after the word consent of parts came to be substituted in its place. Thus,
the common expressions were the sympathy and consent of the stomach
with the head, of the stomach with the face, of the stomach with the
external surface, of the latter with the internal, and particularly with
the intestines, of the excretions with each other, of the feet with the
kidneys, and so forth. It was never dreamed, that there was one over-
ruling principle throughout upon which all the functions depended.
The stomach, for instance, cannot be strong while the perspiratory or-
gans are weak, and therefore take in and digest too much while they can-
not throw out their fluid. 


144 THE ELEMENTS 
if detained and thrown back into the blood, again become
blood? If these questions, to which there is no possibility
of returning any answer, should seem in any degree ambi-
guous; are we to believe that one part of the body is in
such a state of vigour, as to produce an over-proportion of
blood, and another in so languid a state, as not to be able
to carry off by the due outlets its corrupted matter? And
must we, giving up our fundamental principle after so com-
plete an establishment of it, allow, that the excitability over
the whole body is not the same uniform, undivided property
over all the system; that the powers acting upon it are not
the same, finally that matter can be created out of no-
thing (f)? It is in vain to talk of the fattening of chickens
and
(f) It has been proved in the IVth chapter, Part I. that the excita-
bility is one uniform, undivided property over all, and that, in whate-
ver part of its seat it is ailed upon, that action extends instantaneously
over all; that though some parts, differently upon different occasions,
may be more acted upon than any other, equal in size and nervous im-
portance, that that is only in so insignificant a proportion as to have
no effect in constituting an inequality of action in the system. Again
the force of the powers that act is a given force, being either weak, in
due proportion, or excessive, or weak again from ultimate excess. Their
effect then upon the system, which receives their action in every degree in
which it is communicated, and that with the utmost exactness, must al-
ways be the same, that is, either direct debility, health, sthenic diathesis,
or indirect debility. To apply this to the present case, the stomach can-
not be healthy, or under a predisposition to sthenic state, and thereby
take in and digest, with the help of the other digestive organs, too much
of the matter, from which blood is made; while the perspiratory ves-
sels are too weak to perform their function of throwing off their excre-
mentitious matter. On the contrary, the state of the stomach must run
through the whole living system. If it can perform its functions pro-
perly, or in whatever degree it performs it, all the other organs of di-
gestion, the upper part of the intestines, biliary vessels, the lacteals, the
veins betwixt their common trunk and the heart, the heart through at
its cavities, the whole arterial system, and the colourless terminations of
that system, whether exhalant or glandular, and the excretory orifices of
these, 


145 OF MEDICINE.
and cattle by keeping them from exercise and in a state of
rest. The condition of health and disease is very different.
In the former there is a certain latitude of the strength of
the stomach; in the latter, and especially when debility is
the cause, there is a prostration of strength. In fine, it is
an universal and constant effect of all debility, to produce
a deficiency of the fluids in the internal parts of the system
with a relaxation of the vessels over all, especially about
their excretory terminations, and a discharge of the fluids
by some out-lets. The death, that happens, during the
time of an entertainment, is not to be imputed to an over
proportion of blood, which cannot happen in so short a
space of time. The drink has no effect in filling the vessels.
Nor do any persons, but those who are under direct or
indirect debility, meet with such an end, never those
who have an over-proportion of blood; which as the ap-
petite is gone, and the digestive powers destroyed, cannot
be produced. In what diseases was it that plethora was
supposed to take place? Not in those, in which the diges-
tive organs, and those that produce blood, in fine, in which
the whole system, are in a state of vigour, where the appe-
tite is very keen, and the digestion most perfectly perfor-
med, and the digested matter most completely converted in-
L to
these, the inhalents, and all the venous blood returned by the arteries;
lastly, all the excretories upon the external and internal surface, all these
will perform their functions in the same degree as the stomach whether
properly or imperfectly. To promote the most perfect health all the
exciting powers must be applied, each in its due proportion. And the
want of any one or more may make some odds, which is insignificant to
this point. If a person has not had his usual exercise a chearful glass will
prepare him for sleep. For want of the same exercise the appetite will
be impaired, but so is the function of perspiration. Too much exercise
under heat will impair the appetite, but it also impairs the perspiration
after a person gets into a state of rest. In short, any slight inequality
from want of any one or more stimuli can be made up by others. See
above, par. XLI. 


146 THE ELEMENTS
to blood; but in those, in which upon account of the de-
bility propagated over the whole body, all the functions
are in a state of languor, and in which the only matter,
suited to make blood, is either not applied, or not assimi-
lated. In this way, the gout, apoplexy, epilepsy, palsy,
asthma and hysteria, the indigestions of persons, who have
been formerly addicted to luxury, in fine, those very disea-
ses, which make our present subject, the hemorrhages, as
they are called and falsely defined by that term, lastly; the
far greatest part of asthenic diseases, have been thought, at
all times and by all physicians to depend either upon plethora
with vigour, or plethora with mobility. But in fact and truth,
that both all the rest of those diseases, and those accompani-
ed with bleeding discharge, depend upon a penury of blood
and other debilitating powers is proved, by the constant
failure of the antisthenic plan of cure to the great disgrace
of the profession, and by the incredible success of the new
stimulant plan. And with respect to the bleeding dischar-
ges, consider the persons affected with them in the hurt-
ful powers, that precede them, and in the symptoms that
attend them. During the whole period of predisposition,
quite delicate and weakly, they have very little appetite for
food, and take very little, and what they take, is not di-
gested, and often rejected by vomitting. In their weak
state they are not supported by the stimulant operation of
corporeal, or mental exercise, nor by that of the animal
spirits, which are quite puny and dejected, nor by that of
pure air, which they are not able to go out to take, nor by
that of agreeable sensation, nor by that of strong drink, which
from the misleading advice of their physicians, they look
upon as poison, nor by that of the distention of the vessels,
which are not sufficiently filled with blood, nor by that of
the secretory small vessels, upon account of their sluggish
motion, and the stagnation of their degenerated fluids every
where, and the direct debility constantly arising from that.
What 


147 OF MEDICINE.
What sort of pulse have they? Such, as it is in all diseases of
manifest debility, for instance, fevers, (in which last, which
is surprising their favourite plethora, was seldom suspected
by them), small, weak and very quick and almost empty.
Upon the whole, what like are their intellectual functions,
those of passion and emotion, and their corporeal functi-
ons, either in sense, or motion whether of the voluntary
or involuntary kind? All weak, all frail, all such, as show
that they have not a third part of life to support them.
What, on the contrary, is the state of those, who abound
in blood, and yet never experience discharges of it? They
are strong and full of vigour in all their functions, with
redness of countenance, sparkling eyes, strong, hard and
moderately frequent pulse. Their appetite for food is keen,
the quantity they take is great and well digested. As those
persons, may experience droppings of blood of no con-
sequence, and yet not often, so they fall into no dif-
charges of blood. And it is in perfect consistency
with all that has been said, to add, that the various
forms of strong drink, and these particularly, which are
the strongest, such as are called spirits, are surprisingly
successful remedies of bleeding discharges, in spite of
every thing that has hitherto been thought to the con-
trary, in spite of rooted prjudices: But the preparati-
ons of opium (h) and of the other diffusible stimuli are
L2 still
(h) Opium, though much used in the cure of certain symptoms of dis-
eases was never understood by those physicians, who, in books and lec-
tures assumed to themselves the province of directing the profession of
physic. Every property they assigned to it was the reverse of the truth.
Instead of allowing it to be the strongest stimulant in nature, they made
it a sedative; and, though they found great difficulty in finding a single
sedative more, to help to make out their catalogue of a class of such bo-
dies in nature, they were confident that it was one (see above, CCXXX.
and the notes). Another property they ascribed to it was that of bring-
ing on sleep; whereas, it is the most powerful body of all others in pro-
ducing and keeping up the watching state (see above, XXX. XXXI.
note 


148 THE ELEMENTS
still more successful. This is a fact, that proves to a de-
monstration, that in the bleeding discharges there is no
excessive activity, no hemorrhagic effort as it is called, and
on the contrary, that there is only a falling off of the natu-
ral moving energy. The hemorrhages, then, that have
been the subject of so much false explanation, and false de-
nomination, must be rejected from the number of sthenic
diseases, and transferred to the asthenic diseases, under
the title of Hæmorrhaeæ.
CCXXXIII. If any person be seized with a cough at
first rather dry and bound, then more moist and free, and
after
note (b). They also assigned it the virtue of allaying pain, but there is
a kind of pain, that it encreases, and besides that, aggravates every other
symptom of the disease. They never could deny, that opium, was ex-
ceedingly improper in inflammatory diseases, that is, the several sthenic
diseases with affection of a part whether inflammatory or cattarhal. And
wherever they found it of service in pain, they might have perceived,
that such pain was different from what they called inflammatory, or our
general sthenic pain. The truth is; it is not a palliater of pain, but a
remover of its cause, as often as that depends upon debility, while it as
certainly aggravates every other. The pains, that opium is calculated
to remove, are all these, that depend upon general asthenic affection, as
those of the gout, of chronic rheumatism, that of the gangrenous, as
well as the putrid, sore throat, all spasmodic and convulsive pains, all
pains from pure debility, as in the legs, ankles and soles, or in any part
of the skin, nineteen head-achs out of twenty, which are in that pro-
portion asthenic; the pain of any deep-seated sore or gun-shot wound af-
ter every degree of sthenic diathesis is removed from the habit; It is an
equal remedy against the asthenic inflammation whether local or gene-
ral, as preventing their tendency to mortification and sphacelus. Nay,
when these latter states have come on, it is a most powerful means of re-
moving them, and of correcting the degeneracy; for the effecting of
which the bark had so often failed. All this is the discovery of the au-
thor of the Elementa, though the credit of the last and smallest part of it,
from their ignorance of the high merit of the whole, they have shewn
disposition to give another, a gentleman and eminent author in London.
But a treatise on the gout, with a full, account of all the virtues opium
will soon be presented to the public, in which all this will be cleared up.
Blessed as opium in all these cases is, it is equally bad in all sthenic ones. 


149 OF MEDICINE. 
after that accompanied with a large expectoration, if the
hoarseness at first is deep, and afterwards slighter and
freer, in proportion as the cough becomes more and more
moist; if the chest all round, over the whole region of the
lungs, is distressed with a degree of diffusive pain; if there
is either no vomiting, or what of it there is, seems forced
up by the convulsive motion of the cough ending in expec-
toration, and in such a manner, as either not to return, of
to have no spontaneous tendency to a return; if the
strength is otherwise good, and the pulse strong, full, and
more or less hard, and not much exceeding the frequency
of a healthy pulse: Such a case will be found to be sthenic,
and to depend upon heat and every other stimulus (i), to
be cured by cold and every other debilitating remedy (k).
The cause of these symptoms is a high degree of sthenic
diathesis (l) over the whole body, higher on the external
surface of the body, and especially in the throat, which
is a part of that surface (m). The same symptoms in what-
ever morbid case they occur, are to be explained in the
same manner. Consequently, the catarrhal symptoms,
which are an inseparable part from the measles, admit pre-
cisely of the same conclusion; and, as well as the whole
disease, are to be understood to arise from excessive excite-
ment, and to be cured by the debilitating plan. The same
is the judgment to be formed of the influenza. In all
which cases it is easy to make trial of the truth. Give a
glass
(i) See above the following paragraphs CXIII. CXIV. CXXII.
CXXIV.
(k) and also CXVII. CXXVIII. CXXXIV. and all the debilitating
powers throughout the whole chapter; while all the stimulant ones in
it will be found to be such as contribute according to their degree of sti-
mulus towards the production of the morbid effect, which makes our
present subject,
(l) or stimulant operation or excessive excitement, or wasted excita-
bility.
(m) See above, par. CXIII. 


15O THE ELEMENTS
glass of wine or brandy, give a little opium; the hoarse-
ness will encrease, the cough will be more hard and bound,
the expectoration will suffer a temporary suppression.
Give a large draught of cold water, and all the symptoms
will be relieved. Often does it happen that a person trou-
bled with a cough when he sits down to drink wine, is
freed from it in the course of the circulation of the glass (n).
The reason of which is, that asthenic diathesis was the
cause, which was converted by the drink into a cessation
of all diathesis, or into a temporary sthenic diathesis. Of-
ten at the end of a debauch in drinking, the cough, and
that very violent, returns for this reason, that the sthenic
diathesis has made considerable advances. It will be cur-
ed by drinking a tumbler or two of cold water, and drink-
ing no more wine; which precautions operate by stop-
ping the excess of excitement.
CCXXXIV. From the description just now given (o)
it appears, that symptoms, commonly supposed to be the
same, are however of a diametrically opposite nature (p);
which
(n) Whenever his cough is cured he should stop; as the carrying
the stimulus too far will endanger the return of the cough from a
very opposite cause. The cough at first, suppose, to be from an excite-
ment as 26; its cure to be brought about by an excitement at or above
40; its return to an excitement at or above 60, will bring on a sthenic
cough.
(o) of the nature and cure of the symptoms we have been speaking of,
compared with that which is next to be given.
(p) This mistake of symptoms in consequence of judging of their inte-
rior nature from the similarity or dissimilarity of their appearance is the
false idea, upon which the whole fabric of a department, lately introdu-
ced into the art of medicine, has been reared. It is to be observed, that
symptoms the most similar to each other in their appearance are, in rea-
lity, the most different, and those, that have the least resemblance in
their appearance, have the nearest affinity in their interior nature, and
indeed are one and the same, with no other difference, but a difference
of degree, and even that often very slight, sometimes next to none at all.
The 


151 OF MEDICINE. 
which will be evinced by a fuller explanation. If, there-
fore any one has a very great cough, a very great ex-
pectoration, either at first with hoarseness, and afterwards,
through
The great variety of symptoms that distinguish the whole form of asthe-
nic diseases affords as many proofs of the truth of this proposition, as the
instances of dissimilarity or difference in opinion are numerous. What
is seemingly more opposite than diarrhœa and colic, than typhomania
and coma, than epilepsy and general dropsy, than the cold and hot fit of
agues, than spasmodic and convulsive affections compared with those in
which there is no fault in the motions either as to excess or regularity,
than the several degrees of morbid diminution of menstruation down to
the actual suppression, and the several degrees of the morbid encrease of
that natural discharge till their flow, at last, attains its ultimate excess
both in degree and duration? And, with respect to febrile and non-fe-
brile diseases, what is more similar than a slight synocha or inflammatory
fever and a typhus in the same degree, which, yet, are diametrically op-
posite both in their cause and cure? What is more dissimilar than the va-
rious phenomena of fevers of the intermittent kind through all their
degrees of intermitting and remitting and those of the mor« continued
kind? And yet they all arise from causes highly debilitating, and are
effectually removed by remedies equal in their degree of stimulus. In
one word, to show the insignificancy of the distinction of diseases into
febrile and non-febrile, and, when the degree of debility constituting
the cause in both, is considered and compared; is there any reason for
separating the high dropsy, the high dysentery, and sinking cholera from
their place betwixt intermittent and remittent fevers and the most con-
tinued kind? Lastly what two things can be liker one another, than a
crowded distinct and confluent small-pox, or than the common inflam-
matory sore throat and that which was lately described (see above, par.
CCXII.) Such have been the ideas, that have guided the directors of
the art of medicine in their inquiries into the natures, causes and cures
of diseases. If botanists and natural historians, by all their artificial me-
thods of arrangement, have made little progress in exploring the true
nature of their subject, and on the contrary, with scarce a single excep-
tion, have confounded it; if it was ridiculous to unite into one genus a
man, a monkey, and a bat, how much more absurd was the attempt to
arrange the mere qualities of matter in the same way. Yet upon this
hopeful employment has John Bull expended vast sums of money, while
he left the most solid and important departments of science neglected
and 


152 THE ELEMENTS
through the whole course of the disease, without the hoarse-
ness; if he is of a very advanced age, or arrived at the
last stage of life; if he is of a weak habit; if his pulse is
neither strong, nor full, and withal very quick; if this con-
course of symptoms has been preceded by either direct
or indirect debility, as usually happens in the case of famine,
of water drinking, of a long course of ebriety, and of
having led a life of luxury: one may be certain, that all
these symptoms are asthenic (q), and to be removed by
stimulant remedies.
CCXXXV. The explanation of the dry cough is easy,
and such as was formerly given (r). The origin of the cough
and expectoration is quite the reverse (s). For, whether
the system has been weakened directly or indirectly, as
the excitement over the whole body is diminished in the
highest degree, as the debility in every part is exquisite;
the consequence is, that in the vascular system the tone, and
in proportion the density, is every where diminished; and
the diminution chiefly takes place in the extreme termina-
tions of the arteries, that are most remote from the center
of activity, and above all other parts of the vascular sys-
tem, in the perspiratory vessels (t). When all this has taken
place; the quantity of fluid that is thrown up by expec-
toration is incredible. Indeed (u) it is great enough, not
to be inferior in its degree to the greatest profusion that
ever takes place in consumption, and even to exceed it.
CCXXXVI.
and covered by the dirt among his feet. We have too little useful sci-
ence yet, it is time to improve our scanty store (see the Introduction to
Observations, &c.)
(q) or depend upon debility. 
(r) See above, par. CLX.
(s) CXXVIII, in the M. S. addition CLXI. and particularly
CXXXIV.
(t) LIX. LX. LXI.
(u) though it has never been attended to, 


153 OF MEDICINE. 
CCXXXVI. The cure of it, however, in all the cases
that depend upon direct debility, is by no means difficult (x).
unless the disease has proceeded beyond the boundary of
admitting a cure, and life is now approaching to its end.
The cure, however, is a good deal more difficult in the
case of indirect debility, and for this good reason, that
there is no other plan of cure, but stimulating, to remove a
disease occasioned by an excess of stimulant operation (y).
Nay, the same debility, as shall afterwards be observed,
produces the same relaxation both of the bronchia and of
the rest of the body, but it does not always produce con-
sumption. With this profusion of expectoration appear-
ing sometimes in the form of fever (z), sometimes in that
of the gout, the physician has often a long struggle, while
he employs his diffusible stimulants, the event of which is
such,
(x) I have experienced such a case more than once, and have seen and
treated it in great numbers. It is sometimes a part of the concourse of
symptoms, that form that asthenic case of disease, which is commonly
called fever. A gentleman, under or about the thirtieth year of his age,
had been ten days in a typhus fever, occasioned by extreme cold, suc-
ceeding to the debilitating effects left upon his habit by too great mode-
ration in his diet, and, certainly, not a good choice of the different arti-
cles of it. To aid the debilitating effects arising from these, he had ex-
perienced all the extremes of the heat and fatigue, that fall to a soldier's
lot, in very warm countries. He was, over and above, of a small size,
slender and emaciated. He had also, from his infancy, been affected
with a short cough sometimes dry, and sometimes with a little expecto-
ration. During the course of his cure, he had been more than once
bleeded, though his disease had ushered itself in by a great profusion of
bleeding, which suddenly took him as he was on a journey in a cold day
of about 44 miles in a carriage. He was vomited, purged, blistered pro-
digiously, and glystered. The whole force of the old plan of cure was
exhausted upon him, and he so exhausted by it, as to be given up for an
incurable of two diseases, a bad fever, and rotten lungs. His face was
hippocratic, he had the dead rattle, and his cough and expectoration
were assiduous. By the stimulant new plan of cure he was put out of
danger in ten days, and set upon his feet in as many more.
(y) See above, CIII. 
(z) See the last note (x). 


154 THE ELEMENTS
such as to produce a complete restoration of health, and
thereby to leave not the least suspicion, of there being any
local affection in the lungs, which is so much the object
both of the faith and fear of physicians (a).
I. When
(a) A description of this disease, in which the lungs are supposed to
be affected with ulcers or tubercles, has been given in the note under
this paragraph at (x). But, as the subject is both as new and interest-
ing as any in this work, it may be proper to give a further illustration
of it by the exposition of another set of facts. Both is persons liable to
the gout, and other asthenic diseases, sometimes of direct and at other
times of indirect debility, and especially in those who have been much
exposed to cold, without the debilitating effect of the cold being over-
come (vide par. CXXII.), by an alternation with, or succession of,
heat, and in very many old people, especially among the poorer sort,
who have been, and naturally are, much exposed to various debilitating
powers, there is often, especially in winter, a very great cough and ex-
pectoration. This sometimes goes to such a height as to give suspicion
of the affection of the lungs just now spoken of. But the completeness
of its cure, which when it arises from indirect debility, is effected by 
the use of animal food, avoiding vegetable, and fish, and by good wine
and diluted spirits in moderate proportion at a time, but freqnently re-
peated, avoiding claret and other French wines, and all four and all
beer-drink, unless perhaps a little warm porter in cold weather, and a
very moderate use of diffusible stimuli, keeping the feet and the body
in general moderately warm; shows sufficiently, that there had been no
local affection in the lungs. When the debility of the disease is of the in-
direct kind, in which the cure is more difficult, there is, still, as little
reason to be apprehensive of the pulmonary or any other local affection.
For the cure of it also proves the contrary. In it the means of cure are
to change the forms of stimulus, and to proceed from the use of the
stronger to that of the weaker, till at length the patient can do without
much of the very strong ones. (See above, par. XCIX. and those
that follow). When the disease cannot be overcome in that way, the
excitability must be understood to be worn out, and life come to its end;
but still from general debility, not local disease. For, if ever any lo-
cal affection does appear, it is always the last effect, not the primary
cause. In this way I lost two gentlemen, after having been able to sup-
per: them for many weeks, when the prognosis upon the common prac-
tice 


155 OF MEDICINE.
I. When, in all the vessels, the fluids are not agitated
by a sufficient action, they are proportionally more imper-
fectly mixed, and therefore in a vitiated state. But in the
extreme terminations of the vessels, as being at a greater
distance from the center of motion, they often, from a
total cessation of motion, stagnate, and degenerate into a
foreign nature. This is an effect net produced by heat
alone (b) but by cold (c), not only by this, but by all the
powers that debilitate in an equal degree (d).
CHAP VII.
Of Sleep and Watching, whether salutary or morbid.
CCXXXVII. AS death finishes the operations of all
life, so sleep finishes those of every day; and as the former
is the consequence of a perfect extinction of the excite-
ment, from, either a complete exhaustion or ultimate
abundance of excitability; so the latter (a) succeeds to a
diminished excitement, while the excitability is either di-
minished, but in such sort that it can be accumulated again,
or abundant, in such sort that the abundance can be
wasted, and the excitement, in both cases, renewed.
CCXXXVIII. Such is the nature of the excitability
of animals, that it can neither be deficient nor over-abun-
dant,
tice did not allow them as many hours. The cause of their indirect de-
bility had been hard drinking. But even in those who die of a con-
firmed consumption, there is not often reason for the suspicion of tuber-
cles in the lungs. Their bodies have been opened after death and the
lungs found quite sound. And in the dissections, where the tubercles
have been found, still they were only an effect.
(b) See above, paragraph CXV. 
(c) See also paragraph XVII.
(d) See also CXIX. which compare with par. XXVIII, Nay, all the
power mentioned in par. XI. and XII. and fully explained in Part Second,
Chapter I. throughout.
(a) or sleep, 


156 THE ELEMENTS 
dant, without detriment; a deficiency producing indirect
and a superabundance, direct debility. And, as any ex-
citing power, carried beyond its boundary (b), can pro-
duce the former, and the with-holding of any, give oc-
casion to the latter (c); so the same proposition holds good
of the excessive or too sparing use of several of them, or of
them all (d). Sleep, then, is the effect of the actions of the
day, at first giving always more and more excitement, but
less and less in proportion to the continuance of their opera-
tion (e), but in such sort as always to add some excitement,
till the matter at last comes to a point, where the degree of
excitement, necessary to constitute the waking state, no
longer exists. Of this we have the most certain proof
in every day's experience, and in the confirmation of it,
which the complete induction of the effects of all the ex-
citing powers afford (f).
Thus,
(b) See par. XXVIII. 
(c) See par. XXXVIII.
(d) This is completely illustrated through the whole first chapter of
the second part, from par. CXI. to par. CXLVII. inclusive. Nay, the
proposition is constantly alluded to through the whole that has yet been
said, and will be in what remains to be said.
(e) See par. XXXVI.
(f) To illustrate this, let us take the exciting powers one by one, and
begin with wine. When a person is insufficiently excited with respect
to that stimulus, and rises not, suppose above 30° in his excitement, a
glass carries him up 2°, another 2° more, and so forth, till after five glasses,
and their effect in carrying him up to 40°, he finds himself well and vi-
gorous in all his functions. But, still, we are not so flimsily made, as
not to bear a little of what is either too much or too little. Suppose
him then to take five glasses more, and, consequently, to be raised to
50°, or 10° above the standard. As his spirits, his intellectual, and all
his other functions, were low, while his excitement remained below
40°, so they are all proportionally exalted by the time that his excite-
ment is elevated to 50°. Let him still go on, and his intellectual func-
tion will rise still higher; he will now display the full extent of his ge-
nius; his passions and emotions, of whatever kind, will rise in the same
proportion; 


157 OF MEDICINE. 
Thus, heat not ultimately excessive, or reduced, by cold,
from that excess to its stimulant degree (g), and food, and
drink, and labour, either of body or mind,and the exercise
of passion and emotion, when their stimulus neither stops
short of the proper point, nor goes beyond it, all give a
disposition to sleep. This is the most salutary state of sleep.
K. Pre-
proportion; he will, in one word, be an example of the effects of Alex-
ander's feast. Suppose, to bring him to all this he has swallowed, be-
sides those he had before, other five glasses. Let him go on, till he has
taken five glasses more, and we shall see the effect: In the course of
time, employed in taking these, he gradually falls off in his spirits, in
his intellectual, and in his corporeal, functions; his tongue, his feet, his
eyes, his memory, his judgment, all, fail him; he, at last, becomes drow-
sy, and then falls fast a-sleep. The same is the progress of excitement
as it arises from labour or exercise through the day, whether of mind or
body. The same is the effect of the stimulus of eating, especially nou-
rishing stimulant things, and in great plenty. Before dinner, the occu-
pations of the former part of the day, are not yet sufficient to prepare
one for sleep; which however after a heavy dinner, will, unless the in-
terference of some other stimulus prevent it, very readily happen to
most people, especially to those, whose frailty, from age or any other
cause, renders them more liable to be fatigued by the past operations of
the day than others. The younger and more vigorous will be able to
hold out to the end of the day; when they too, after having undergone
the degree of stimulus necessary to give that waste of excitability that
disposes to sleep, will be overcome by it. The very flow of the blood in
the vessels, and the exercise of the involuntary motions, that keep it up,
tend at least to the same effect. The same thing applies to the motion
constantly going on in the stomach and intestines, as well as the motions
that occur in all the secretory and excretory small vessels. Light, stimu-
lating the eyes, and found, the ears, and the several substances that act
upon the organs of the other three senses, all, tend, by wasting the ex-
citability, to wear down the excitement to that point in the scale where
sleep commences. And the process, in every case, is, first a low, then a
higher and higher, then the highest, vigour of all the functions; which,
again, gradually falls till its termination in sleep. We have, therefore,
after viewing their effects singly, to suppose them, in one degree or in
another, united, and sleep the finishing effect of their united operation.
(g) See above, par. CXXII. 


158 THE ELEMENTS 
K. Premature, unseasonable, or morbid sleep, is produ-
ced by either indirect or direct debility.
Λ. With respect to the effect of the former, an exces-
sive energy of any one or more of the stimuli (i) produces
it; accordingly, any one or more of those that have been
mentioned, by acting in excess, and wasting the excitabi-
lity, such as hurried drinking, produce that effect.
M. Of the directly debilitating powers, which produce
the same effect, the want, or sparing application, of the
powers, which, by a due degree of stimulus, produce
sleep, will surprise into a bad kind of it; accordingly,
when a person is in that state, that he wants excitement
in order to be in health, the defect of light, of sound, and
of the various contacts of the bodies that excite the other
senses, the defect of both sets of motions, the voluntary and
involuntary, as well as of the exercise of the mind, of the
exercise of passion, of heat, acting in its stimulant degree,
and too long continued sleep itself, all these produce hurt-
ful sleep (k).
CCXXXIX. On the contrary, sound watching is the
effect of the suspence of the same diurnal actions during the
period of sleep, taking off more and more excitement,
most at first, and less and less after, but always adding to
the sum of diminution of excitement, and accumulation of
excitability; that is, always continuing to take off sti-
mulus, till the matter comes to the degree of diminished
excitement, 
(i) Of indirect debility in producing premature sleep, see par.
CXXXVIII.
(k) Coma, or an Insuperable disposition to sleep, is most commonly
owing to the want of most of the stimuli mentioned in the text, as that
of food, of wine, at least in the ordinary practice of cure, of good animal
spirits, of the power of thinking in a pleasant exciting train, of a due
quantity of blood in the vessels, of pure open air, of corporeal exercise,
and of the absence of certain stimuli, that otherwise irritate in the wea-
kened state, and produce watchfulness. 


159 OF MEDICINE. 
excitement, and encreasing excitability necessary to the
watching state. In this way does sleep prepare the system
for the watching state, which is afterwards kept up, for,
the due length of time, by the several exciting powers,
acting through the day, till at last, by a certain failure of
their action, sleep is produced again (l).
N. Too long or morbid watching is also brought on in
a two-fold way, by indirect and direct debility. Thus,
intense thinking (m), violence of passion in extreme (n), ul-
timate excess in corporeal labour (o), unusual and high
relaxing heat, debauch in eating and drinking, a great ex-
cess in the use of the diffusible stimuli (p), a great abun-
dance and velocity of blood; all, or any of these, rising
to indirect debility by an ultimate excess in their operation,
are notorious for their effect of repelling sleep. Again,
cold, not in that extreme degree which immediately pre-
cedes death; abstinence from food, or that sort of it that
is not sufficiently nourishing, or of sufficient indirect sti-
mulus to produce the requisite distention; weak drink, as
tea, coffee, or watery drink, especially when a person has
been accustomed to more generous; intermission of usual
labour or exercise, whether of body or mind; a sense of
shame from disgrace, and fear, and grief; all these, by
their operation not sufficiently approaching to indirect de-
bility, produce an undue or morbid state of watchfulness.
CCXL. As debility, therefore, whether indirect or di-
rect, or in part a mixture of both (q), is the cause of sleep,
the first of sound sleep, the two latter of an improper or
morbid state of that function; so an excess of the same de-
bility, whether indirect or direct, is also a cause of im-
proper
(l) See last par. CCXXXVIII. 
(m) See above, CXXXVIII.
(n) See CXL. 
(o) See CXXXVII. r.
(p) See CXXIV. CXXV. CXXVI. o. ρ.
(q) See par. XLVII. and the note belonging to it. 


l60 THE ELEMENTS.
proper or morbid vigilance. The only salutary sleep is
that which is produced by a proper degree of excitement,
occasioned by a proper action of the exciting powers upon
the excitability; all the extremes of either excessive sleep,
or excessive vigilance, are either so many tendencies to
disease, or actual disease (r).
A person, fatigued with his usual exercise, is imme-
diately composed to sleep; which, equally, flies from
him who has had either less, or more, than that middle
degree (s).
4 CCXLI.
(r) Too much, or too long continued, sleep, is hurtful, because it im-
plies a suspension of that excitement, to which proper health and due vi-
gour is owing, it is, consequently, a state of direct debility. Too little
sleep, or of too short duration, is of equal detriment, as implying a de-
gree of excitability, not sufficiently accumulated to receive a sufficient
impression from a renewal of the exciting powers. From the former
arise most of the complaints of the rich and indolent; from the latter,
many of the diseases of the poor and laborious. As the action of the ex-
citing powers should be adapted to the strength, a little indulgence iu
sleep is the safest extreme to the weak, as in the case of children, and
persons labouring under debility.
(s) When a boy, I valued myself much for enduring the fatigue of
walking: About the fifteenth year of my age I walked, in a summer
day, from Berwick on Tweed to Morpeth, which, with two miles wan-
dering out of the high road, I found to be a journey of fifty miles. But
I got not a wink of sleep the whole night, from the excess of the exerti-
tion; and the next day, so pained and enfeebled were all my joints, that
it was with the utmost difficulty I made out the single stage from Mor-
peth to Newcastle, which was only a walk of fourteen miles. Some
years after that, when I was now arrived at my full strength, and my
joints perfectly knit, I walked and wandered in all sorts of ground, in
roads and out of them, over smooth and plain, and heathy and moun-
tainous tracts, from four o'clock P. M. to two o'clock, P. M. next day,
with only an hour's rest, and one hearty meal at betwixt ten and eleven
o'clock in the forenoon, when I was now within six miles of my destina-
tion. The hills over which I wandered in the course of the night are
those called Lammer-muir, situated betwixt East Lothian and the Mers: 
the 
 

161 OF MEDICINE. 
CCXLI. As the effect of both indirect and direct de-
bility is sometimes sleep, sometimes watching, both of them
unsound, both hurtful; so the cause of bad sleep is either
sort of debility; without a stimulus acting upon the system
in a weakened state, and, thereby, throwing the system in-
to a state of disturbance. The same debility of either
kind, with such a stimulus, produces the morbid watch-
ing; in which case it is a small stimulus that acts as an
irritating power (t);
M N. Instan-
the places I travelled between in this rout were Edinburgh and Duns,
the place of the nativity of the celebrated schoolman and metaphysician,
John Duns Scotus, and that of my grammar education. In this great
exertion I was sustained by a great stimulus, high animal spirits, and
love. At the end of my journey, and finding myself among my friends,
and the object my affection, I had vigour enough to dance with the
latter. This time I slept well, and was perfectly recruited next day,
(t) Volumes have been filled with the doctrine of irritation as a cause
of morbid state and the indications of cure and remedies to remove it
have been equally tedious and laboured. In sthenic diseases, phlogistic
diathesis instead of plethora and vigour (for the belief in which two last
there might have been some foundation in that form of diseases, see
above from CXXXI. to CXXXIV) has been the universal pathology;
and bleeding, other evacuations, and cold, the universal idea, or, as it is
called, indication of cure; and while they thought of no other method
or means of cure for the asthenic form of diseases, the pathology, applied
to them, was plethora with vigour or with mobility in other cases, and,
in the febrile, irritation. By irritation they explained the startings of
the tendons, the restlessness, the frequency of the pulse, the typhoma-
nia or constant working, of so frequent occurrence and so noted a symp-
tom in those diseases. But as we have proved, that the reverse of ple-
thora and vigour is the true state of the system in every disease of debi-
lity; so we assert with the same solidity of argument, and the same
weight of proof, that irritation, as being considered, either as the cause
of morbid watchfulness or of any other symptom, is nothing that re-
quires either evacuant, or any other debilitating remedies, to remove
it. It is merely a weakened state of the system, thrown into flutterings
from the slightest exertion of the ordinary functions, as when a person
falls into tremors from noise, or into a sweat from walking a step or two. 


162 THE ELEMENTS 
N. Instances of morbid sleep occur in the predispositions
to diseases, and the actual diseases, that depend upon sthe-
nic diathesis, and in the ordinary state of intoxication
from drinking. But all the exciting powers, when con-
verted into hurtful ones of excessive stimulus, each in
proportion to its degree of excess, have the same tenden-
cy (u). But, when the exciting power proceeds beyond
the sleep-inviting point; or when any stimulus, still find-
ing unwasted excitability to act upon, continues to act;
in that case, the watching will be continued with bad
effect (x).
CCXLII. Instances of morbid sleep occur in all the
diseases of indirect debility, and in pains that have advanc-
ed to the same degree of exhausted excitability in the scale (y);
as in the several cases of the phlegmasiæ, that arise from
the violent progress of the morbid state, or the improper
administration of stimulants for the cure; which is par-
ticularly
(u) A heavy dinner, excessive fatigue from either corporeal or mental
labour, a high fit of passion, and heat, are, each of them, noted for giv-
ing a disposition to sleep; which is an effect, arising from their high
degree of stimulus, hurrying the excitement to that degree of waste in
which the sleep-inviting point consists; and it will the more readily take
place, that no exciting power, by still finding excitability to act upon,
continues, therefore, to act, and prevent the sleep.
(x) as in the harrowing watchfulness, which is liable to accompany
the phlegmasiæ, or the several sthenic diseases with inflammation of a
part,
(y) That happens in the phlegmasiæ, where the effects, not only, of
the inflammatory pain, but of the whole diathesis, and of every other
symptom, as well as that of pain, is to run up into indirect; debility.
The last part of debility, that ushers in a fit of the gout, is commonly of
the direct kind; but the effect of the continuance of the pain is often
sleep, the origin of which is indirect debility, its consequence an encrease
of the disease, and its remedy an interruption of the morbid sleep for the
purpose of administering such diffusible, and other stimuli, as have the
effect of removing the debility which occasions both the sleep, aud other
symptoms of the disease. 


163 OF MEDICINE.
ticularly exemplified in the dropsy of the breast, that of-
ten arises from peripneumony under such management.
With respect to sleep from direct debility, women, who
have had many deliveries, who have often suckled, as well
as all lazy persons, and those of both sexes, who are ad-
dicted to luxury, and whole custom it is to sleep too much,
are all liable to fall into this sort of morbid sleep.
CCXLIII. When either direct or indirect debility,
sometimes produces sleep that gives no refreshment (z),
sometimes an ungentle, turbulent waking state, neither
of them accommodated to health; as the debility pro-
ductive of either effect, exceeds that in which sound sleep
consists; the use of that degree of stimulus which may re-
pel the former, and convert the latter into sleep, will re-
move the complaints, and serve for an illustration of the
nature of both (a). In asthenic diseases the watching state
M2 for
(z) which often happen in fevers and many other cases of debility,
besides those mentioned in the text (CCXLII.) and ought never to be
encouraged, but repelled by every means of exciting the patient.
(a) Let the point of indirect debility, in which sleep consists, be as 15
degrees in a particular scale, and the greater debility, than that which
either constitutes morbid sleep or morbid watching, be 20 degrees or up-
wards in the case of its being indirect, or 10 or downward in the case of
its being direct debility. It is evident, that, to bring on salutary watch-
ing on the one hand, or salutary sleep on the other, or to convert both
into salutary sleep, if that be required by the circumstances, the deficient
degree of stimulus must be administered; that is five degrees to bring
up the excitement from 10 to 15 degrees, and as many for the purpose
of renewing the worn-out excitement by means of a new exciting power
which may still find a portion of excitability to act upon, or to remove
certain stimuli, which, however slight and mild, are fatiguing and dis-
turbing to the system in its weakened state. Accordingly in fever,
when the patient, amidst every sort of directly debilitating powers, had
besides wanted sleep for ten days, a small portion of an opiate given
him every quarter of an hour, in three hours time laid him asleep, which
in spite of an urgent cough and profuse expectoration, lasted for sixteen,
hours, 
 

164 THE ELEMENTS
for the most part is the consequence of direct debility,
with some power acting with slight stimulant effect; the
reason of which is, that the disease depends upon more
debility than that which constitutes sleep. Hence it comes
about,
hours, and was followed by the most surprising relief. The continuance
of this practice with only an encrease of the doses in proportion as the
abundant excitability was gradually worn off, and alternating them with
wine and beef soup, in ten days removed all danger, child of three
months had had no sound sleep for ten days, but had cried night and day
from a complaint in his belly; which the ordinary practitioners would
have called an obstruction in the mesenteric glands. A large dose of
the tiuctura thebaica, for the patient's age, was administered, which laid
him in a profouud sleep, that continued near 36 hours, and at once re-
moved the disease. Numberless are the cases of a kind similar to this
where the morbid watchfulness was partly from direct, partly from in-
direct debility, that have been constantly removed by the same practice.
A child of 7 years of age, in a fever of great direct debility, in conse-
quence of a most rapid growth happening during the disease, which was
not completely removed till near the end of 7 weeks, after having been
under the disease near a fortnight, was affected with the most constant
disposition to sleep, so sound that no noise or shaking of his body could
waken him. The administration of the opiate repeated in small doses
till the effect took place, kept him awake. Some time after, in the
course of the same lingering disease, when he had not yet acquired any
permanent strength, but was only better supported by the diffusible and
other stimuli, than he had been till I was called in, his predominant
symptom came to be great watchfulness, which was partly the effect of
a certain, though not a great degree of excitement that the tincture
and other cordial powers had given him. It, however, induced too
great a degree of indirectly debilitating exertion for his still very weak
state, and it, therefore, became necessary to give him an addition of ex-
citement to bring him to the state of salutary and recruiting sleep, and
thereby to suspend the action of a number of exciting powers, however
slight their operation was, which were too much for the enfeebled
state of his system. In the cases of children whose diseases are almost
all asthenic, and in other diseases of high debility, the instances of such ef-
fects of the diffusible stimuli, (for more than one was employed upon this
as well as many other occasions) are equally numerous and surprising.
In a very large practice I am sure I never, in the very worst cases, lost
three patients.


165 OF MEDICINE.
about, that every thing that stimulates, every thing that
raises the excitement as it were to that point, which com-
poses the system to sleep, produces that effect by a stimu-
lant, not a sedative, virtue. In a small degree of debility,
where the excitement has fallen only a little below the
point of sleep, a very small degree of stimulus, such as a
little animal food, if the weakness had been owing to
vegetable food, such as wine, or any drink of equal pow-
er, after a water regimen; such as consolation in affliction.
of mind; heat, when cold has been the debilitating pow-
er; gentle exercise or gestation; or the stimulus of a plea-
sant train of thought, when one has been deprived of the
stimulus of corporeal or mental exercise, is sufficient.
In a higher degre of debility (for the curative force should
always be adapted to the degree of the disease (b); either
a proportional higher degree of the stimuli which have
been mentioned, or some more powerful one, such as
those, which are called diffusible, should be employed.
CCXLIV. In both which cases, the virtue, of opium
is great; its virtue, however, is not peculiar to it, or a-
ny other than what it possesses in common with all the o-
ther stimulant powers, differing only from the rest in the
higher degree of its (c) virtue. Thus in great debility, as
in
(b) See above, par. XLIV. and XCII.
(c) The notion of some powerful remedies, as opium, mercury, the
Jesuits' bark, &c. acting by an operation peculiar to each, and different
from every other power in nature, was long prevalent in the schools of
medicine. Those they called specifics; an idea, which, like many other
of their vague conceptions, was altogether contrary to sound philosophy;
since the more careful our inquiries into nature's operations are, the
more and more reason have we to be convinced, that simplicity and uni-
formity pervade the whole phenomena of the universe. Accordingly,
in the exciting powers that act upon the excitability of our bodies, we find
only one action, that of stimulating, varying only in its degree, to take
place in all animal as well as vegetable bodies, nay in every thing that 
we


166 THE ELEMENTS
in fevers, as in a violent fit of the gout, disturbing with tu-
multuary disorder the internal parts, and in other similar dis-
eases of debility, in which the violence of the disease keeps
off sleep; opium often, after the watchful state has remained
many days, brings on profound and sound sleep; in which
case, because the excitability is very abundant, and, there-
fore, can bear but a very small force of stimulus, we should,
on that account, begin with the smallest degree of stimulus,
and proceed gradually to more and more (d); till at last we
arrive at the point of sleep, which will soon happen, as it
is placed much within the range of direct debility: And
with respect to coma, or that sleep which is not recruit-
ing: such is the effect both of other diffusible stimuli and
of opium, that it converts morbid sleep into vigilance;
vigilance, after a certain space of time, into refreshing
sleep, and, in that way, conducts the patient safely, gently,
and pleasantly, to health. But as the influence of the sti-
mulant operation, that supports excitement, is of so
great importance, and as sleep of longer duration than to
prove refreshing may arise even from good remedies, the
rule to be observed when that happens is, whenever any at-
tack
we know to possess life in the universe. We also find, to the same ex-
tent, only one property in living systems upon which it acts, that is, the
excitability; and one effect produced by the mutual relation betwixt
them in that respect, to wit, the excitement. Instead of the distracted
notion of vortices, or atmospheres in rapid motion, governing the mo-
tion of the planets, Sir Isaac Newton found the whole planetary systems
of the universe governed in their motions by one single principle. In-
stead of the infinite difference of habits and temperaments, I have found
every individual precisely the same as every other. Whatever produces
the gout in one; will produce it in another, prepared to receive its influ-
ence. And whatever cures it in any one, cures it also in every other;
and so forth with respect to every other disease. The deeper we explore
the works of nature, the more will we be convinced of this wonderful
simplicity, so that, to a philosopher, all nature would appear the effect
of one single instrument in the hand of the all-wise all powerful creator,
(d) See above, par. CVII.
 

167 OF MEDICINE. 
tack of sleep, upon account of too long a suspension of sti-
mulant action, has been of less service than was expected,
to shorten its next attack, and renew the operation of the
stimulus.
CCXLV. In asthenic diseases, and those arising from
indirect debility, in which sleep is also kept off; in order
both to restore it, and remove the other symptoms, and
bring about the healthy state, both other stimuli should be
employed according to the degree of debility requiring their
use, and, when the degree of debility is very considerable,
the diffusible stimuli, and among the rest opium, should
not be omitted.
CCXLVI. These are the times and circumstances of
the body in which opium produces sleep. In all the other
states either of health or disease, it excites the functions
both of body and mind, as well as of passion and emotion;
among others it banishes sleep and produces great activity
and vigilance. Thus if any one is under the pressure of
sleep without an evident cause, he will by opium be ren-
dered surprisingly sprightly, lively, and vigilant; it banish-
es melancholy, begets confidence, converts fear into bold-
ness, makes the silent eloquent, and dastards brave. No-
body, in desperate circumstances, and sinking under a dis-
relish for life, ever laid violent hands on himself after ta-
king a dose of opium, or ever will. In one word, through
all the intermediate degrees of excitement from direct to
indirect debility, opium is by far the most powerful of all
the agents, and as such must be most hurtful in sthenic di-
athesis; because, when added to the other stimulant pow-
ers, it not only banishes sleep, but is liable to precipitate
those diseases from the sthenic state to indirect debility, and
from this last to death.
CCXLVII. That the debility, upon which coma de-
pends, is less than that which supports morbid vigilance,
is 

166 THE ELEMENTS
in fevers, as in a violent fit of the gout, disturbing with tu-
multuary disorder the internal parts, and in other similar dis-
eases of debility, in which the violence of the disease keeps
off sleep; opium often, after the watchful state has remained
many days, brings on profound and sound sleep; in which
case, because the excitability is very abundant, and, there-
fore, can bear but a very small force of stimulus, we should,
on that account, begin with the smallest degree of stimulus,
and proceed gradually to more and more (d); till at last we
arrive at the point of sleep, which will soon happen, as it
is placed much within the range of direct debility: And
with respect to coma, or that sleep which is not recruit-
ing: such is the effect both of other diffusible stimuli and
of opium, that it converts morbid sleep into vigilance;
vigilance, after a certain space of time, into refreshing
sleep, and, in that way, conducts the patient safely, gently,
and pleasantly, to health. But as the influence of the sti-
mulant operation, that supports excitement, is of so
great importance, and as sleep of longer duration than to
prove refreshing may arise even from good remedies, the
rule to be observed when that happens is, whenever any at-
tack
we know to possess life in the universe. We also find, to the same ex-
tent, only one property in living systems upon which it acts, that is, the
excitability; and one effect produced by the mutual relation betwixt
them in that respect, to wit, the excitement. Instead of the distracted
notion of vortices, or atmospheres in rapid motion, governing the mo-
tion of the planets, Sir Isaac Newton found the whole planetary systems
of the universe governed in their motions by one single principle. In-
stead of the infinite difference of habits and temperaments, I have found
every individual precisely the same as every other. Whatever produces
the gout in one; will produce it in another, prepared to receive its influ-
ence. And whatever cures it in any one, cures it also in every other;
and so forth with respect to every other disease. The deeper we explore
the works of nature, the more will we be convinced of this wonderful
simplicity, so that, to a philosopher, all nature would appear the effect
of one single instrument in the hand of the all-wise all powerful creator,
(d) See above, par. CVII.

 

169 MEDICINE.
arly effectual, and that in proportion to their greater
and more diffusible stimulant power, than that which
others possess.
CCXLIX. Nor is it unconnected with this explanation
of the nature of sleep and watching, and of both of them
being sometimes repelled, sometimes induced, by a certain
degree of stimulus (g): that excessive motions, as the spas-
modic and convulsive, which have been mentioned (h), such
as the quick pulse in fevers (i) and other motions, are remo-
ved by an equal force of stimuli, to that which is required
to remove morbid affection without any motions. Hence
it is plain, that irregular motions are not only encreased
functions (k), independent upon debility, but that they are
impaired functions, and consist nearly in the same degree
of debility. 
CCL. From what has been said, the analogy between
watching and life, and sleep and death, and their depen-
dence upon the same laws of nature, that govern all the
other functions, clearly appears; and the most solid pro-
bation has been adduced, that the most vigorous vigilance
consists in the highest degree of salutary excitement; that
the middle and deep period of sleep depends on the high-
est debility that is consistent with the healthy state; that
true sleep depends on a-middle degree of indirect debility,
and that both morbid sleep and morbid watching are the
offspring of great debility, whether of the indirect or di-
rect kind.
CHAP.
(g) See above, par. CCXLI. where this proposition is reduced to,
its exact principle.
(h) See above, par. CCXX. 
(i) See par. CLXXIX.
(k) See above, CCXXIX.


170 THE ELEMENTS
CHAP. VIII.
The Cure of both the Diathesis.
CCLI. AS the cause of both the diatheses is that which
has been formerly (a) related; the indication of cure,
therefore, to be taken from that is, in the sthenic diathesis
to diminish excessive excitement over the whole system;
in the asthenic to encrease deficient excitement likewise
over all the system, till it be brought to that degree, which
proves the cause of health.
CCLII. The remedies that produce that effect in the
cure of sthenic diathesis, are the powers, which, when
their stimulant operation is excessive, produce that very
diathesis, in this case, acting with that slight and reduced
force of stimulus, by which they produce less excitement
than health requires, or by which they prove debilita-
ting.
CCLIII. The powers which produce the same effect
in the asthenic diathesis, are those that, when their stimu-
lus is small, produce that diathesis, in this case, exciting,
with that high dagree of stimulus, by means of which
they give more excitement, than suits the healthy state, or
by means of which they stimulate.
CCLIV. In the sthenic diathesis that temperature (c)
which
(a) See above, par. CXLVIII.
(c) The same order is followed here, that has all along been obser-
ved, to wit, that of the enumeration of the powers in par. XI. and XII.
and that of the explanation of them, when viewed as the hurtful powers
producing either diathesis in Chap. I. Part II, and it will be kept to
throughout the whole work. Nothing can be more simple and natural,
and better suit the simplicity of the subject, while nothing is more artifi-
cial and arbitrary than the arrangements either of Systematics or Noso-
logists. Just order could never be expected from an erroneous and confu-
sed


171 OF MEDICINE.
which is called heat, must by all means be avoided;
and for this very good reason, that the only degree of it
which proves debilitating, that is the excessive to an ex-
treme, cannot be carried to that height, in which it de-
bilitates, without the risk of hurtful or pernicious conse-
quence from the excess of stimulus (d).
CCLV. But, when the diathesis, and its cause the en-
creased stimulus, is gentle in the actual diseased state,
there is no occasion for forbidding that degree of heat,
which accompanies the operation of sweating and pediluvi-
um (e); because the waste of fluids in the former, and
the agreeable sensation in the latter, promise somewhat
more advantage than the moderate degree of heat employ-
ed in this case threatens disadvantage.
CCLVI. In a particular manner, after the applica-
tion of cold in an intense degree, must the application of
heat be avoided, because its operation, from the encrease
of the excitability of cold, becomes more effective (f).
And the consequence is the more to be dreaded, that, at
the same time, other stimuli are usually urgent.
CCLVII.
sed view of the subject to be treated of; while a clear conception of the
subject as a whole, infallibly leads to a distinct distribution of the several
parts that compose it; so that what Horace says of language, equally ap-
plies to order, and the same thing applies here as to his Verba & lucidus
ordo. Rite paratam rem verba haud in vita sequentur.
(d) See above, par. CXV. Though very intense heat relaxes the
simple and induces atony on the living solids, who in a peripneumony,
would think of using it with that view? That disease from its own vio-
lence, often mounts up so high in the scale of increased stimulus, as
nearly to approach the point of indirect debility, and it sometimes actu-
ally gains that point. The addition, therefore, of more stimulus, from
the application of heat, would ensure that effect, and thereby occasion
the conversion of the disease into a much worse one, such as hydrotho-
rax, or the dropsy of the breast.
(e) Pediluvium is the warm bath of the legs and feet.
(f) See above, par, XXXVII. θ and note (d).


172 THE ELEMENTS 
CCLVII. Cold is the beneficial degree of tempera-
ture in the cure of this diathesis, but it must be cold not
followed by any considerable degree of heat. That mi-
stake, therefore, in medical practice, of thinking cold
hurtful in sthenic diathesis by a stimulant operation,
should be corrected; and its benefit in the small-pox is not
to be understood to arise so much from its mere debilita-
ting degree, as from avoiding the stimulus of heat after
its operation. When the same precaution is employed,
the same cold either alone, or in conjunction with other
debilitating powers, has lately been found the most effect-
al remedy of catarrh (g).
CCLVIII. From which circumstance, and because
a cap of fresh dug up earth put upon the head, has been of
service in phrenitis; and that degree of cold, which produ-
ces frost and snow, when applied to the naked body, has
removed a synocha accompanied with delirium (h); and
because
(g) or the common cold in English, a name stampt upon it by the ve-
ry blunder we have been speaking of.
(h) It is called the common inflammatory fever, very improperly, as
being no fever, but a general pyrexia, or affection of the whole system,
without inflammation or local affection, and producing heat overall
and tumultuous effect upon the pulse. Its proper generic name is pyrex-
ia. See above par. LXVIII. where that appellation is assigned to it;
an appellation to avoid mistaking its nature, that should be accurately
attended to. Great mischief has been occasioned by this vague term.
Thus when a person is said to be affected with a disease, when it is asked
what disease it is, and the answer given, that it is a fever, immediately
bleeding is thought of, though that, and every, evacuation is. as hurt-
ful in proper fever as it may be serviceable in the pyrexia. To give an
example of this pyrexia, the particular appellation for which is synocha,
or sthenic pyrexial disease; many years ago, a person in the old town o£
Edinburgh, labouring under it, escaped the vigilance of his nurse; flew
naked out of the house in a very keen frost with snow upon the ground,
across the streets, passed over into the new town, and from that to the.
fields beyond it. He soon became sensible of his state, stole into, a house 
next


173 OF MEDICINE 
because cold is so efficacious a remedy in the small-pox;
it ctearly follows, that the use of cold should be extended
to the whole range of predisposition, the whole circle of
diseases, depending upon sthenic diathesis.
CCLIX. That no hurtful effect arises from the sup-
posed astringent power of cold in the sthenic diathesis (i),
is proved by its very high influence, when applied to the
surface of the body in the small-pox, in keeping up a free-
dom of perspiration in proportion to the degree of its ap-
plication. And its influence in producing atony with
proportional laxity of the fibres of the vessels, is in con-
formity to the same observation (k).
CCLX. For the removal of asthenic diathesis the stimu-
lus
next to him, got some clothes thrown about him, and was carried home
in a chair, perfectly cured of his disease. From which, and a prodigi-
ous number of facts to the same purpose, all concurring in the proof of
the debilitating operation of cold, there can hardly arise a doubt in the
mind, that in a certain high degree, if it could he conveniently used, or
if there were occasion to have recourse to it for want of efficacious reme-
dies, it would at once remove the highest degree of sthenic state that
ever occurs in disease, and reduce the excitement from the nearest ap-
proach to 70 down to 40. Nay it might run into the opposite extreme
and go all the way to death. But we shall, by and by, have occasion to
observe, that we are so well provided with effectual remedies as not to
be under any temptation of straining this to its height. And we shall
also find that a number of remedies in a moderate degree are preferable
to any one, or to a smaller number in a higher degree. The discovery
of the principle upon which the cure of sthenic diseases turns, has ena-
bled us to render the cure both more complete and exact, than it could
have been without principle.
(i) I remember, when I was a young student, of hearing the old phy-
sicians in Edinburgh very gravely forbid a draught of cold water in an
inflammatory pyrexia and even in a common catarrh, for fear it should
produce an inflammation in the stomach.
(k) The fibres being relaxed describe a greater cavity, and hence the
check given to the perspiration by the contrary effect of the sthenic dia-
thesis in encreasing their density in diminishing their diameters, is taken
off.


174 THE ELEMENTS
lus of heat is signally useful, and chiefly for the follow-
ing reason; that it must be as useful in this diathesis,
where the excitement is too low, as it is hurtful in the sthe-
nic, by giving a further encrease of the excitement, too
much increased already. Hence in fevers, in the gout,
in dyspepsia, in the colic, in rheumatalgia (l), and in all
asthenic diseases, the system is very much cherished by
heat, and debilitated by cold: Which, by its debilitating
effect, is ranked among the powers that produce the dis- 
ease (m), and is destructive in fevers.
CCLXI. As cold is hurtful in asthenic diathesis in the
proportion in which it is serviceable in the sthenic (n); it
is accordingly, for this further reason, to be avoided in
difeafes of the highest debility, that, like intense heat, it
relaxes the extreme vessels, and produces a putrefaction 
in the fluids (o).
CCLXII. The more certainly to moderate the sthenic
diathesis while as yet it remains within the range of pre-
disposition, a sparing use should be made of flesh and the
preparations from it, and vegetable dishes used with grea-
ter freedom. But, when the same diathesis is encreased to
the degree, that constitutes disease, abstinence from animal
food, especially in a solid form, and a free, but still not
excessive, use of vegetable matter, especially in a fluid
form, are the best means of removing it, as far as the ma-
nagement of diet goes.
CCLXIII.
(l) or what is improperly, as it has been said before, called the chro-
nic rheumatism.
(m) No gouty person can bear the operation of much cold, and every
one can endure more heat, than most other persons. And the reason it
evident: So debilitating a power must, in proportion to its degree, be
peculiarly hurtful in all diseases, in which the debility constituting their
cause, runs high, as it naturally does in the gout, where it is encreased
by the advance of age, and other causes, and much more so in fevers.
(n) See par. CCLVIII. 
(o) See above, CXVII.
 

175 OF MEDICINE. 
CCLXIII. In that degree of this diathesis, which does
not exceed predisposition, it is proper to avoid seasoning,
which is destructive in diseases.
CCLXIV. Watery drink is very suitable to it, and all
pure and strong drink hurtful, and that in proportion to
the quantity of alkahol that it contains. The latter sort
of drink, unless taken very weak, is destructive in diseases.
In the number of which pure water, especially with an ad-
dition of something to acidulate it, is preferable to small-
beer, which a great authority admitted. But the diffusible
stimuli in this diathesis are above all others hurtful.
CCLXV. Since the indirect stimulus of food assists the
direct, that is, propagates itself over the whole body; for
that reason bounds should be set to the bulk even of the
suitable matter (q).
CCLXVI. In every degree of asthenic diathesis, vege-
table food should be avoided, and recourse had as soon as
possible to that, which consists of meat and animal matter.
And, as that can seldom be executed immediately upon
account of the weakness of the stomach; the diffusible sti-
muli should, therefore, be used; such as the different forms
of wine when the debility is moderate, and opiates when
it is greater. And at the same time, from the very begin-
ning rich soups should be given in great quantity upon the
whole, and a gradual transition made to the use of more
solid matter.
CCLXVII. As it is animal matter in this case, that
is of service, so the degree of stimulus, that seasoning adds
to it, improves its effect (r).
CCLXVIII. During the predisposition to asthenic dis-
eases, watery, cold, acid, fermenting drink is hurtful, and
that proportion of pure strong liquor, that the degree
of debility requires, is beneficial. But, after the diseases
have
(q) See above, par. CXXVII. 
(r) Sec above, par. CXXV.


176 THE ELEMENTS.
have actually taken place, and have how attained a high
degree of vehemence, the same strong drink becomes so
indispensibly necessary, that excepting the soups, and the
still more diffusible stimuli, it is the only support required
for a long time. There is no occasion for any dread of the
indirect stimulus of food, when the matter, which chiefly
affords it, that is, vegetable matter, is guarded against (t).
CCLXIX. For the purpose of diminishing the stimulus,
which an over proportion of chyle and blood (u), directly
applied to a great extent of the body, produces; the over
proportion, when it is very great, should be removed by
abstinence, bleeding, and purging: when it is more mo-
derate, but yet adequate to the effect of producing diseases,
the directions lately given (x), respecting a moderate dia-
thesis, ought to be observed; that is, we should adhere to
the practice of vomiting and purging from time to time,
and to a sparingness in diet. But blood should not be let.
And, if upon any occasion, the patient should give way to a
little fulness in his use of food, he should use vegetable
matter, abstinence, gentle and frequent exercise, and sweat-
ing, and, thereby, keep up a full perspiration.
CCLXX. The same are the means of cure for an ex-
cess in the velocity of the blood (z), in o far as it depends
upon an over proportion: when the velocity depends upon
violent motion of the body, the means of lessening it, when
the
(t) Compare this with what was lately said in paragraph CCLXV.
(u) The chyle is the alimentary matter, that has undergone a prepa-
ration in the stomach, and an after one in the upper part of the intesti-
nal canal, and, which, so prepared, or in part digested, is taken up by
the mouths of a nnmber of small vessels that open into the intestines;
these carry it to a great trunk, in which all these vessels, called lacteal,
unite, and through that trunk, to be afterwards mixed, first with the
venous, and then with all the other blood in succession. Such is the nou-
rishing matter of animals.
(x) See above, par. CCLV
(z) See above, par. CXXXI. to CXXXIV.
 

177 OF MEDICINE. 
the diathesis is so moderate, as only to produce predispo-
sition, or a gentle degree of actual disease, are an abate-
ment of exercise, more indulgence in rest, and a reduction
of other stimuli. In the very great diathesis, that which
occasions severe diseases, in order to retard the motion of
the blood, a point must be made to avoid the stimulus of
all the exciting powers, and blood must be taken profuse-
ly. Here it is superfluous to lay down a rule for the ob-
servance of keeping the body in a state of rest, as rest, even
in spite of the patients, is unavoidable (a).
CCLXXI. Withdrawing the powers that occasion an
over-proportion of the secreted fluids in the excretory
ducts, is the best method of removing the stimulus, which
that over-proportion, by its distending energy, produ-
ces (b . The cure, therefore, consists in more frequent
coition, drawing off the milk, taking in food of a less
nourishing nature, and in restoring the perspiration by re-
moving the sthenic diathesis upon the external surface.
CCLXXII. To remove the debility, or atony and
laxity, of the vessels, which is occasioned by a penury of
chyle and blood over a very great extent of the system (c),
N first
(a) It would be ridiculous to require of a patient in the rage of peri-
pneumony not to run a race, when his real state is, that he cannot move
or turn himself in the bed without pain.
(b) In par. CXXXVI. you will find, that the secreted fluids, here al-
luded to, are the milk, the semen, and the perspirable fluid. As the
distention occasioned by the over-abundance produces the morbid stimu-
lus, so the subduction of the fluids must, of course, take it off, and give
the desired relief.
(c) How great the space or extent of the system that, in the sthe-
nic diathesis, receives the stimulus of an over abundance of blood; and,
in the asthenie diathesis is subjected to the debilitating power of an un-
der-proportion of the same fluid, may easily be conceived from the
well known fact, that there is not a soft part in the whole system, into
which the insertion of the point of the smallest needle will not draw blood;
consequently, the stimulus arising from an over-abundance of blood, as
well 


178 THE ELEMENTS. 
first, the strength must be gradually brought back by dif-
fusible stimuli (d) and soups; next, we should gradually
use the latter more sparingly, and solid matter more plenti-
fully: lastly, to give the whole system still more strength,
it should be fortified by exercise, and the rest of the du-
rable stimuli; but no further use should be made of the
diffusible, than to employ them so long as considerable de-
bility remains (e).
CCLXXIII.
well as the debility arising from too small a quantity, must be the most
considerable of all others. Every circumstance here concurs to render
the one the greatest sthenic, and the other an equal asthenic, hurtful
power. If the force of every stimulus, of every exciting power, be in
proportion, first, to the degree of it applied; secondly, to the sensibility
of the part on which it acts; and, thirdly, to the extent of that part, it
will be no wonder, that these two powers should prove the most formi-
dable of all others. Hence it is, that, in the curative part, bleeding is
the most powerful remedy of sthenic, and filling the vessels an equal one of asthenic diathesis. 
(d) which act by giving vigour to the whole system, and more espe-
cially to the stomach, with which they come into actual contact. Hence
digestion, and the conversion of the matter taken in into good chyle, and
blood; and hence, at last, the fulness of the vessels first indicated. The
process of emptying the vessels in the cure of sthenic diathesis has the
advantage of being the first in order; and hence is it that the cure of
sthenic diseases is mere quickly effected than that of the asthenic; it be-
ing, over all nature, much more easy to take away than replace. See
and compare par. CXXVI. and CXXX. and subjoined notes, and a lit-
tle above, par. CCLXVI.
(e) The sole use, and a great one, of the diffusible stimuli is, in great
weakness, where they are only required, to support the system, while it
cannot be supported by the ordinary durable stimuli; and, after the ex-
citement is so far restored, that the ordinary supports are now sufficient,
to lay aside the extraordinary; the continuance of which would now be
hurtful, and to manage the convalescent, and restored, state of health by
the powers employed in health. When the diffusible are continued lon-
ger, they are equally hurtful, and a cause of disease, as they are service-
able when disease requires their support; analogous to wine, they bring
about the system in a weakened state to be sustained by its natural and
ordinary. 
 

179 OF MEDICINE. 
CCLXXIII. In a weak state both of the vessels and
of the rest of the body, every motion of the body, any
way considerable, and all other stimuli, which quicken
the motion of the blood, and bring on an indirect tem-
porary debility, should be with-held. But in a case of
siighter debility, such motion as does not prove fatiguing,
but acts as an agreeable stimulus, and gives recruit,
should not be avoided. When a person is recovering from
a disease, he should be gradually brought back to his usual
plan of life; nor should it be forgot, that, till that is
done, the health is never completely restored.
CCLXXIV. The debility which an under-propor-
tion of secreted fluids, or a degenerate, though plentiful
state of them, produces in the excretory ducts, is removed
by the stimulant plan of cure which has just now been spo-
ken of (f), not by an antiseptic one (g).
CCLXXV. The suitable remedy of that sort of stimu-
lus, which arises from either violence or assiduity of think-
ing, is an abatement in the degree of thinking, or that
high stretch of the intellectual function, whether its de-
N2 gree
ordinary supports; but, analogous to it in another respect, when the
strength of the system requires not their additional stimulus, they carry
it up into indirect debility, and prove the cause of diseases and death.
In one word, whatever has been said against the propriety of the use of
excessive, and ultimately excessive stimulant powers, the former produ-
cing sthenic diathesis, and the latter indirect debility, all that applies,
with propriety, for the discontinuance of the use of diffusible stimuli,
when the durable are now sufficient for the purposes of the system. And
another argument that still remains against the superfluous use of both
the diffusibles and strong drink, when debility requires not their use;
which is, that, independent of death.or even diseases, being their immediate
consequence, predisposition to diseases must; consequently, as the system
must at last be worn by stimuli, all the unnecessary, that is, all that do
not contribute to that middle vigour, in which sound health consists,
should be avoided.
(f) See above, CCLXXII. 
(g) See above, CXVII. and CXVIII.


180 THE ELEMENTS
gree or frequent repetition be regarded, that, by wasting
the excitability, proves, at last, indirectly debilitating:
Which is a rule, however it may suit the state of predis-
position, that is by no means safe, after the disease has
once made its appearance, and especially if it is a violent
one; because there is no access to any benefit from it, but
through the intermediate degrees of that stimulant range,
which by encreasing the excitement, already too great,
would do mischief (h).
CCLXXVI. In order to cure a slight sthenic diathesis,
such as occurs in predisposition, and to prevent disease,
habitual passion should be avoided; but the removal of
actual disease requires, that every first gust of passion should
be prevented. The ultimate excess of passion, upon account
of the intermediate danger of stimulating too much, is
by no means to be thought of.
CCLXXVII. In so far as debility depends upon ex-
cess in mental exertion, or upon a languid state of that
faculty, the excess should be diminished, and the languor
removed, and an agreeable train of thinking set on foot;
without which latter, however much all the other sti-
mulant powers may have been employed, it may be de-
pended upon, that perfect health, in every respect, will
not be brought about (i).
CCLXXVIII. 
(h) See above, CCLIV.
(i) The state of the intellectual function has a great influence upon
that of excitement; and, often, when all other stimuli have been ap-
plied in due proportion, the deficiency of that single stimulus will point
out a want in the proper measure of excitement. There is not a finer
stimulus than the pleasurable feeling arising from a happy train or flow
of thinking; hence the high delight, that arises from a flight of wit,
or from a pleasant vein of humour; hence all the fine feelings of the bel-
les letters; hence, in youth, the ardent keenness to be acquainted with
the learning, wisdom, and elegant productions of the ancients, as well
as of those, who have made a distinguished figure in later times; hence
the
 

181 OF MEDICINE. 
CCLXXVIII. In every degree of debility that high
force of the passions, that produces indirect debility, must
be avoided; and it must not be forgot, that a very small
degree of them is sufficient for that effect: we are not to
give loose reins to agreeable passions (k).
CCLXXIX.
the enthusiasm so natural to the human feelings, to outstrip others in
every mental excellency: The arts, the sciences, every department of
human knowledge, are all the effects of that intellectual propensity.
How happy would it be for mankind were this noble stimulus duly che-
rished! What benefits, which society is deprived of, would not accrue
from a proper cultivation of it! How fine was that feeling in Julius
Cæsar Scaliger, when he declared he would rather be the author of Ho-
race's few stanzas of Lydia and Telephus, than accept of the crown of
Arragon! What must have been the delight of Pythagoras, when he
found out the XLVIIth proposition of the first book of the mathema-
tical elements, commonly called Euclid's? He jumped about in an ecstacy,
crying out Eυρηηα, and was so much more substantial than some of his
few brother discoverers, as to possess the means of offering a sacrifice of
an hundred fat bullocks to the gods. See Observations on the principles
of the old Systems of Physic, from page ix. to xv. of the introduction.
How delightful must the feelings of Horace have been, in whose works
every Ode is an effort of the most beautiful, and frequently, of the most
sublime, conceptions of human genius! What must have been the fire
and force of Milton's soul, in the description that he gives of the appear-
ance of the Son of God in his cœlestial panoply, "his countenance too
severe to be beheld!" How towering that soul, how exalted that intellect,
which the great Marquis of Montrose displayed in a stratagem, which
converted into a glorious victory a blunder in one of his officers, that
might have proved fatal to both his cause and his glory. When it was
whispered to him, standing in the center of his army, that one of his
wings was overpowered, he shouts out to the commander in the other:
"My Lord Aboyn, shall you and I stand here doing nothing, and
Mc Donald carry off all the honour of the day!"
(k) See above par. XLIII. and CXLI. Recollect the method pre-
scribed in the XLIII. paragraph of this work for preventing the fatal ca-
tastrophe of the Roman woman, when her son, whom she had counted
upon, for certain, in the nunber of the dead, was contrary to every
expectation, presented to her is perfect health. The danger and fatality
it 


l82 THE ELEMENTS 
CCLXXIX. When there is a deficiency in the force of
any of the passions, as in sadness, grief, fear, terror and
despair, which are only lesser degrees of gladness, confi-
dence, and hope, and imply only a diminution of exciting
passions; such deficiency or diminution must be expelled,
and the exciting degree of passion recalled; hop eand as-
surance must he infused, and the patient gradually carried
up to feelings of joy.
Π. For there is only a sum total of the passions, which
act in the same manner as all the other stimuli, that is, by
stimulating, either in excess, or in due, or in deficient,
proportion; nay, like the rest, as often as any one is defi-
cient, it, by accumulating the excitability, has the ef-
fect of making the other stimuli act more powerfully (l).
Take, for instance, the terror of an army before the
found of trumpet for the onset of battle, and the courage
with which they are afterwards inspired, from the con-
sciousness of their bravery, the General's speech to ani-
mate them, or perhaps, his commemoration of their for-
mer brave deeds.
Ρ. An ultimately excessive voluptuousness in the exer-
cise of the senses, as well as the effect of disagreeable ob-
jects, presented to them, in asthenic diathesis, should
equally
of her state was, that her excitability was too accumulated, with respect
to the stimulus of exciting passion, to bear such a strong impression as
that which the presence of her son, in life and health, had made. She
was in the state of a famished person, whose accumulated excitability is
overpowered by a single morsel of food, or of a person, who had been
long affected with thirst, where the smallest indulgence in drink may
prove fatal; or of a person, near starved to death by cold, in whom a
rash approach to heat, might induce the same fatal effect; all which are
precisely upon the same footing, and equal instances of an excitability
too accumulated to bear any degree of stimulus.
(l) See above, par. XXXVII. and the note annexed to it.
 

183 OF MEDICINE. 
equally be avoided; and in the sthenic diathesis, their tur-
bulent force should be guarded against (m).
Σ. Nothing is better accommodated to the asthenic state
than purity of air; which, either alone, or conjoined with
exercise, must, consequently be of the greatest benefit to
convalescents.
T. Since the matter of contagion, in so far as it has any
tendency to produce general disease, produces either sthe-
nic (n) or asthenic diathesis (o), and acts by an operation
similar to that of the general hurtful powers; the infer-
ence to be drawn from that is, that in the cure, general
remedies should be employed; and debilitating ones op-
posed to sthenic, stimulant ones to asthenic, diathesis (p).
CCLXXX. These powers, the same in kind with those
that produce the diatheses, differing only in degree, and
in that respect diametrically opposite, remove the diathesis
seldomer, and less successfuly, one by one; oftener, and
more effectually, when several co-operate, but, best of
all, if all of them be taken together, especially when
there is occasion for great assistance.
CHAP IX.
A Comparison of the different Parts of the Sthenic Plan of
Cures with each other.
CCLXXXI. AS, in the sthenic diathesis, bleeding is
the most powerful remedy of all others, being that, which
completely carries off a stimulus, as much more powerful
than any other, as it is directly applied to a greater extent
over the system; consequently, as often as the diathesis
is
(m) See par. CXLHI. and CXLIV.
(n) as in the small-pox and measles.
(o) as the contagious typhus, the gangrenous sore-throat, dysentery,
and the plague,
(p) Par, CXLVII. and CLXXV. 


184 THE ELEMENTS
is very high, it should be freely used; but never risked
during predisposition, and sparingly, or not at all, ventured
upon in diseases of a gentle nature; in which other reme-
dies should be preferred (a).
CCLXXXII. The next place of importance to bleeding,
when heat and other stimuli are guarded against, is claim-
ed by cold. Heat is always hurtful, and still more so af-
ter a previous application of cold; but it is most hurtful,
when it is also combined with other excessive stimulant
powers. Cold is always of service, and in proportion to
its degree; provided foreign stimuli, blended with it, and
overcoming its debilitating effect, be cautiously shunned,
CCLXXXIII. The third place in rank after these re-
medies is claimed by vomiting and purging and sweating.
These evacuations have a powerful effect in removing
sthenic diathesis, and therefore do they, with great advan-
tage, supersede the oftener imaginary than real, necessity
pf profuse bleeding. They are often alone sufficient to
restore the healthy state.
CCLXXXIV. Together with all these, the articles of
diet, the stimulant operation of which prevents the bene-
fits to be received from them, should be sparingly used,
and that in exact preportion to the degree of the diathesis.
This precaution alone is adequate to the removal of pre-
disposition, and often to that of diseases, especially those
that depend upon a small and gentle diathesis.
CCLXXXV.
(a) See abpve, par. CCLXIX. With the exception of peripneumony,
phrenitis, and violent and mismanaged cases of the small-pox and mea-
sles, and rheumatism; in the last in their mild state, as well as the other
sthenic cases, the lancet should never be unsheathed. That is to say, in
seven cases out of ten even of the sthenic diseases, which are the only
ones that either require or bear any degree of it, the practice must be
laid aside, and never thought of in any asthenic affections whatever.
Consequently, the cases, where it is in any degree allowable, are exceed-
ingly few. 
 

185 OF MEDICINE. 
CCLXXXV. Also with all the remedies yet mentioned
we must conjoin rest, when the diseased state has taken
place, and moderation in motion during the period of pre-
disposition (b).
CCLXXXVI. The practice of the common run of
physicians is very bad, in going too much upon any one of
the remedies that have been mentioned, and overlooking
all the rest, or enjoining them carelessly. We are not to
depend upon bleeding alone, not even in peripneumony it-
self; but employ all the rest either in concourse or suc-
cession.
CCLXXXVII. The disturbed functions, or those that
are impaired (c) not from a debilitating cause, admit of the
general plan of cure, and no other.
CCLXXXVIII. The symptoms of debility, which are
the consequence of the violence of the sthenic diathesis, in
the progress of the disease, and that threaten death by in-
direct debility, ought to be prevented by an early interpo-
sition of the remedies.
CCLXXXIX. The same early cure serves to prevent
suppuration, effusion, and gangrene, which arise from ul-
timately excessive excitement, passing into indirect debility.
υ. If sthenic diathesis should happen to be conjoined
with a local disease, the former, to prevent it from aggra-
vating the latter, should be removed by its own respec-
tive remedies.
CHAP.
(b) So considerable a stimulus is exercise, that, if in such a degree of
sthenic diathesis, as that, which forms only predisposition to the diseases
depending on it, exercise may of itself be sufficient to effect the conver-
sion of the predisposition into the actual diseased state. Often has the
highest of these diseases, and even peripneumony itself, been brought on
by violent exertion in exercise.
(c) See above, par. CXLVII. CLI. CLXXII. 


i86 THE ELEMENTS
CHAP. X
The same Comparison of the different Parts of the Asthenic
Plan of Cure with one another.
CCXC. IN asthenic diathesis, and the diseases depen-
ding upon it, reproducing the lost quantity of blood, is
the most powerful remedy, when we, at last, find access
to it, as being the only means of restoring a stimulus of so
much more power and efficacy, that its direct application
is made to so great an extent of the system (a). For
which reason, as, in every degree of debility, the quan-
tity of food, from which only blood is made, that is taken
and digested, is always in an inverse proportion to the de-
gree of debility, (b); so much, and of such a form, as can
be taken and digested, should immediately, and without
loss of time, be administered; on which account, if the
debility be moderate, giving solid animal food sparingly
each time, but often repeated, is proper and suitable.
When the debility is greater, and solid animal food can
neither be taken, nor if taken, digested, broth made from
it, as rich as possible, and as free of fatty matter, should
be carefully administered (c). With this view to excite the
stomach, and render it more fit for receiving and digest-
ing the food just now mentioned; the diffusible stimuli,
such as different kinds of wine, and more particularly
still opiates and other remedies of similar powerfulness,
ought to be constantly employed; sparingly at first, and
afterwards more fully, if the debility be direct; after
which, the use of the diffusible should be gradually laid
aside
(a) Compare this with par. CCLXXXI. above, and with all the pa-
ragraphs from CXXXI. to CXXXVI.
(b) or in a direct proportion to the degree of excitement.
(c) Compare this with par. CCLXXII. 


187 OF MEDICINE.
aside, and, in the same gradual way, recourse be had to a
larger and larger use of the more durable and natural sti-
muli (d). In the case of indirect debility, we should al-
fo gradually proceed from the highest to the lowest force
of stimulus, as has been mentioned formerly (e), and, in
an inverse manner, go on from the smallest force of dura-
ble stimulus to the greatest. Lastly, in that moderate de-
bility, which constitutes the predisposition to asthenic
diseases, it must always be kept in mind, that an abun-
dance of blood is the greatest support of health (f), and
that we are not to give way to a weakened appetite (g).
CCXCI. To the vital fluid, and the several means
of encreasing its quantity, which have just now been men-
tioned, the next remedy in the cure of asthenic diathesis is
heat; as being the power by which animals (i), in their
first formation, in their growth, and most especially in
their decay, are brought forth into existence, are nourish-
ed, and acquire vigour, and afterwards, through the seve-
ral degrees of their declining state, are to some extent up-
held, till their excitement is all extinguished (k). By heat,
understand that point of external temperature, which in-
tervenes as a mean betwixt cold, as it is called, and high
heat (l); under which our sense of temperature is agree-
able
(d) See last note (e), and compare it with this. 
(e) Par. CIII.
(f) How widely different is that maxim from any that have hitherto
ever been received in the profession of physic; in which flying to the use
of the lancet, was the first thought that arose in the mind, with respect
to the idea of cure of every disease; and bleeding and evacuations
through the course of each disease, the only remedies.
(g) This is equally the reverse of the general practice of inanition in
almost every disease, without a single exception.
(i) And we may add vegetables.
(k) Compare this with par. CXII. and CCLIV. and CCLX.
(l) The Latins have a single word for this which we want; the word
is a root.


188 THE ELEMENTS
able and pleasant; under which the body is neither weaken-
ed by that relaxation which produces sweat, nor by that
torpor (m) which cold begets, where the debility is, in this
case, direct, and in the former indirect; under which
the functions of the whole body are excited, called forth,
and, as it were, cherished in the sun beams; without
which all other stimuli are of no effect (n).
CCXCII. Such a temperature as that is suited to eve-
ry state of the body, but still more to its different states of
debility; because in the latter case, as the excitement, is
deficient from other sources, there is so much more occasi-
on for this stimulus, which is much easier come at than
many others, to supply such deficiency. Hence both in
other diseases of great and direct debility, and particularly
in fevers, heat is found to be of the greatest benefit, and a-
bove all others in all such complaints of that kind as cold
has had any share in producing (o). In the same diseases
cold must be most carefully avoided, as it is always of a di-
rectly debilitating operation, and never of service but in
sthenic diseases, and those that are in a progress to indirect
debility (p). We must be equally on guard, in every de-
gree of asthenic diathesis, against excessive heat; which is
equally
(m) Or benumbed state,
(n) It is plain, that though all the other powers should be in full acti-
on upon our bodies, and that with the effect of keeping up in them a
due degree of excitement over all; yet plunging any person naked into a
dense medium, suppose that of water, in a degree of cold at or under the
freezing point, will most certainly, in an instant, put an end to life.
(o) See again, par. CCLX.
(p) The operation of cold has been so widely mistaken by all physici-
ans, that it comes to be of the greatest consequence to understand the se-
veral propositions stated in this work with regard to it. For that pur-
pose consult par. XXXVII and the note upon it marked θ, as well as
par. CCLX. and all that has been said upon the subjects of either heat
or cold in Chap. I. of the second Part from CXII. to CXXIII. as
alaso par. CXX. 


189 OF MEDICINE.  
equally debilitating as cold, and equally productive of a-
toay, laxity and gangrene of the vessels, as well as stag-
nation and corruption of the fluids, in consequence of the
inactive state of the vessels (q).
CCXCIII. As refilling the vessels is the greatest reme-
dy, because its direct stimulus is applied over such an ex-
tent of the system; for that reason heat, which is imme-
diately applied to the whole surface of the body, and di-
rectly affects the body to that extent, should be next in
virtue to it.
CCXCIV. Since vomiting, purging (r) and sweating (s)
are so powerful in debilitating, as to claim the third place
of rank in the sthenic cure; they must, for that reason,
by the same debilitating operation, be equally hurtful in
asthenic diathesis, and the stimuli that stop their operation,
and, consequently, both the other stimuli, and particularly 
the diffusible ones, equally serviceable.
CCXCV. To run over the list of stimuli, that answer
this purpose, we must begin with the cure of that slighter
loss of fluids that occur in those diseases, and proceed to
the more violent kinds of them.
In a slight looseness of belly, such as happens in predis-
position to asthenic diseases, or in the slighter degrees of the
latter; it will be commonly sufficient to abstain from ve-
getable food, and from weak, watery drink, or that kind
of it that ferments in the first passages, such as the several
drinks make from barley, called beers; to use animal food,
as well seasoned and as rich as possible, and free of all
fatty matter; to drink pure wine, or spirit in different de-
grees of strength; and to take such exercise as is gentle
in degree, and often repeated (t).
CCXCVI.
(q) With this proposition compare par. CXV. CXVlI. and CXVIII.
(r) See par. CCLXXXIII. 
(s) See par. CCLV.
(t) See and compare, for the more clear understanding of this para-
graph, the CCLXVI. CCLXVIII. CCLXXIII. 


190 THE ELEMENTS
CCXCVL. When the belly is still, looser and with that
affected with gripes and pains, as happens in the violent
diarrhœa, and in the dysentery, in which the loose stools
are accompanied with vomiting; or when, without these
troublesome symptoms affecting the belly, distressing vo-
miting is an urgent symptom; or, when the vomiting is
conjoined with a moisture upon the surface, or macerating
sweat; or when sweat is the only urgent symptom, and as
such wastes the strength, exhausts the body, and dissipates
the fluids: in all these cases, we must have immediate re-
course to the most diffusible stimuli, and check such an
impoverishment of the fluids of the system.
CCXCVII. In which case, the use of stimuli will be
so much the more necessary, that other symptoms usually
accompany those encreased excretions. Their great effi-
cacy, and stimulant power, is proved by their singular vir-
tue in removing those and other symptoms, in fevers and
other most violent sthenic diseases, nay, in the article of
death itself, from ultimate debility.
CCXCVIII. Accordingly, in spasms and convulsions
in the internal, in the external, parts (u) in bleeding dis-
charges (x) in the direful delirium of fevers, and other
very violent diseases (y), in asthenic inflammation (z); when
those stimuli which have a more permanent influence fail,
or act to no good purpose; the virtue of the diffusible
stimulants, the principal of which is opium, is eminent.
CCXCIX. As, therefore, the energy of that stimulant
virtue serves to check looseness of the belly, and vomiting,
or even sweating, when these symptoms are gentle, and
depend upon a less violent degree of the cause; so that de-
gree
(u) See par. CXCV. and CXCVI.
(x) See par. CXXXIV. χ. †. and CCXXXII. and the subjoined
notes.
(y) See par. CXCVIII. CC. CCI. 
(z) See par. CCIV. to CCXII. 
 

191 OF MEDICINE. 
gree of its power, which is fitted to check these affections
in the greatest height of their violence, and to re-establish
the state of health, is by far the greatest of all the powers,
which are ever applied to the human body; which may
be known from this proof, that when the action of all the
other powers by which life is supported is of no effect,
they turn aside the instant stroke of death.
CCC. The most weak degree of the diffusible stimuli (a)
are the white wines, except madeira, canary, good sherry
and the red wines, except port and spirits procured by
distillation, so diluted, as to equal the strength of the
wines, or exceed it a little. Still higher than these are
the latter taken pure, and higher still, those that have
undergone many rectifications. The strength of which
is in proportion to the quantity of water expelled, and of
the alkahol retained.
CCCI. A higher place in the scale is claimed by musk,
volatile alkali, camphor; our trials of which are not yet
so complete, as to ascertain its force exactly; next comes
æther, and, last of all, opium. Of all which, however,
unless, when, as they sometimes do, they have lost their ef-
fect by a continuance of their application, and are, there-
fore substituted in place of each other for the sake of a re-
newal of the operation of each; and when, in that way
we make the complete round of them, for the sake of re-
pelling extreme debility; in every respect, the preparations
of opium are sufficient for most purposes of high stimu-
lating. 
4
CCCII. Together with all these (d), regard must be
had to the articles of diet (e).
And,
(a) See above, par. CXXVI. o. π. p. c.
(d) They are animal soups, and solid meat (CCXC.) heat, (CCXCI.)
stimulants (CCXCV.) diffusible stimulants (CCXCIX.)
(e) See par. CCLXXXIV.


192 THE ELEMENTS
And, as in great debility, and the diseases depending
upon it, of the only suitable matter, that is meat, nothing
solid can be taken; for that reason, the matter to be used
must be fluid, but strong. Animal soups should be given
sparingly at a time, but repeatedly, in proportion to the
degree of debility, and jellies both along with the diffusible
stimuli. After that, when, chiefly by means of the dif-
fusive stimuli, the strength is in part restored; at first solid
meat, likewise in sparing quantities, but often repeated;
then given more plentifully, and at greater intervals, should
be taken. In which progress the patient should gradually
receds from the use of the diffusible stimuli.
CCCIII. When now the diffusible stimuli are altoge-
ther laid aside, and the convalescent is given up to his usu-
al diet and manner of living, and that management, which
persons in health commonly observe, (only that more care
is taken than in perfect health, to avoid any thing that might
prove hurtful); then it is, that every attempt of the physician
should be directed to the consideration of the strength of
his patient, as returning, but not yet quite established (f).
In his movements he should first use gestation, and then
gentle but frequent exercise, and the latter should always
end in some, but not an high, degree of fatigue. His sleep
should neither be too long, nor too short, lest the former
produce direct, the latter indirect debility (g): the most
nourishing food should be taken, but not in too great a
quantity, lest the excitability of the stomach be worn off,
without the attainment of a due degree of vigour; but it
should be often taken, in order to reduce the excitability
gradually, which only serves to produce proper vigour, and
reduce it to its half wasted state (h); that degree of heat,
which stimulates, should be employed (i), and both excess
of it, as well as cold, as they are equally debilitating, should
be
(f) See above, par CV. and CIX. 
(g) See par. CCXLII. and sequent.
(h) See above the XXIV. XXV and XXIV. 
(i) See par. CXII. 


193 OF MEDICINE. 
be avoided; the patient should breathe pure air, and avoid
impure; he should keep his mind in gentle action, observe
moderation in his passions, and court agreeable objects of
sense; he should have no companions, around him, but a-
greeable ones, and be in frequent gay entertainments; he
should travel through a pleasant country, and be moderate
in love. Neither is the management of the senses, and any
return of contagious matter to be neglected.
CHAP. XI.
How the Remedies should be varied.
CCCIV. AS the hurtful powers, that produce predis-
position to diseases, or diseases themselves, act some on
one part, some on another, with somewhat more force than
on any other equal part; and as such a part is commonly
that which they directly affect (a); so the powers, which
are employed as remedies, in order that their general effect
may reach the whole body with the more certainty, should
be in the same manner, differently applied to different
parts.
CCCV. The cure of any sthenic disease whatever, is
improperly entrusted to bleeding alone, though that is one
of the most powerful of the debilitating remedies. And
the reason is, that, though the excitability is sufficiently
reduced by that remedy in the greater blood-vessels, per-
haps too much, yet in the extremities of these, as well as
in the rest of the body, it is not sufficiently reduced (b).
O Nor
(a) Par. XLIX.
(b) The action of every exciting power, whether salutary or hurtful,
or curative, always extends over the whole body, the whole seat of ex-
citability, but still with the inequality mentioned in the fourth Chapter
of part first. This is the basis of the distinction with respect to the pre-
sent 
 

194 THE ELEMENTS
Nor is the alternation of bleeding with purging a perfect
sort of cure; because, though the excessive excitement be
sufficiently, and more than sufficiently, removed in the
greater blood-vessels, and in the innumerable small ar-
teries whether exhalent or mucous, which discharge their
fluids into the intestines; yet, neither on the perspiratoy ter-
minations of the arteries, nor on the rest of the body, is
an equal debilitating energy exerted: for instance, the
small vessels which open into the stomach, are not suffici-
ently relieved of their distending (c) load. And although vo-
miting (d), which has been improperly lest out of the cure
of sthenic diseases, and still more improperly employed in
every one of the asthenic, should be conjoined with the two
remedies just now mentioned, even that would not be e-
nough to produce an equality of diminished excitement;
as there would still remain in the perspiratory vessels, the
same state of the excitement, which has been mentioned,
as in the rest of the body, that is not vascular. In vio-
lent sthenic diseases, therefore, after diminishing the dia-
thesis, and in the slighter from the beginning of the dis-
ease, the addition of the operation of sweat to the evacuati-
ons that have been spoken of, will produce a more equal di-
minution of excitement, a more perfect solution of the
disease. For by means of this evacuation, not only from
the larger blood-vessels, in the interior parts of the body,
but from an infinity of outlets both of the external, and
internal
sent subject: which is, that as every power acts most effectually on the
part where its action is immediately exerted, it is better to trust to a
number, every one of which possesses that advantage, than rely on any
one, however powerful otherwise; as by that means, whatever be the
indication, whether it be to encrease or diminish excitement, the effect
will be more equally produced over all in consequence of there being a
number of parts that have had a strong action exerted upon them.
(c) And therefore stimulating load, the stimulus in any vessel being
the quantity of its fluid.
(d) See par. CCLXIX. 
 

195 OF MEDICINE. 
internal surface of the body, an immense quantity of flu-
ids, every where distending, and, thereby, producing a ve-
ry great sum of excitement, is withdrawn. But the mat-
ter stops not even here. For, since in slight sthenic affecti-
ons much nourishing food, and in them all, too much, can
be taken; the consequence of that must be, that, however
much the quantity of the blood and other fluids has been
diminished, if the food, which is the only power that can
produce blood, continues to be taken, all the vessels, in
proportion to the quantity that has been taken, will a-
gain go on to be filled, and to be fired with the fuel of
excessive excitement. To prevent which inconvenience,
and to diminish excitement, still with greater equality over
the system; abstinence, or an allowance of vegetable mat-
ter in a fluid form, and watery drink, will have a very
great effect. But neither does the matter end here. For,
if, after taking all the precautions and securities that have
been recommended, the degree of heat, that proves hurt-
ful from its stimulus, be allowed to approach the external
surface of the body; it will produce another inequality of
excitement, however much that may have been properly
and equally diminished by the other means of cure. Where-
fore, as the sthenic diathesis depends so much upon the sti-
mulus of heat, directly affecting the skin (e), and is, on
that account, prevalent in the skin in preference to other
parts; to make sure of rendering the diminution of excite-
ment as equal as possible,the debilitating effect of cold should
be opposed to the high degree of excitement, which the heat
has produced. When, at last, all the directions, which have
been so fully pointed out, have been executed, still to re-
produce the equality of excitement, suited to good health;
it remains, that we be on our guard against the stimuli
that arise from the intellectual functions and passions. For,
O2 as
(e) See par. CXIII. 


196 THE ELEMENTS.
as they have a great effect in producing sthenic diathesis (f)
so the guarding against them, or prevention of them, must
be equally effectual in removing that diathesis, and in re-
producing that equality of excitement, upon which health
depends (g).
CCCVI. If the cure of sthenic diseases hitherto has
consisted in bleeding, purging of the belly, and in the
use of refrigeration in a few cases; and, if the other ob-
jects of attention, which have now been so fully treated of,
have either been totally neglected, or mentioned in a slight
way, by the by, and as if they had been of no consequence,
and, in the cures which were prescribed in that way, not
reduced to any principle; it will easily now appear, from 
what has been said above, and in other parts of this work,
how much the knowledge of those diseases has been im-
proved, both in the practical and reasoning part: and
it will now, at last, be found a certain and established
fact, that both the nature and true theory of sthenic dis-
eases, as well as the practice of the cure of them, consi-
dered either as an art and imitative, or as rational and
scientific, has been discovered and demonstrated.
CCCVII. As the debilitating or antisthenic (h) reme-
dies are the same with the asthenic hurtful powers (i); so
the sthenic remedies (k) are also the same as the sthenic
hurtful powers.
ϕ. And as the remedies of asthtnic diathesis, to what-
ever part they are applied,also stimulate that part more than
any
(f) See par. CXXXVIII. CXL.
(g) As the most healthy state of man is occasioned not by the opera-
tion of any one, or of a few exciting powers, but by the united operation
of them all; so neither is its re-establishment to be effected, but by the
same united operation of all the remedies, the last of which come to be
the ordinary means of the support of the healthy state.
(h) See par. XC. 
(i) See par. CCCI. to CCCVII. the present one.
(k) See par. XCI.


197 OF MEDICINE. 
any other; some of them one, others another part, and
encrease the excitement;
CCCVIII. So, in asthenic diseases, if we want to rouse
the excitement with more equality, and restore the lost
strength, we must not depend upon the most diffusible sti-
muli alone (m). For, while they indeed encrease the ex- 
citement over the whole body, at the same time, they
produce that effect in the stomach with greater force
than any where else. Hence, even from the beginning of
the cure, when almost no food can be taken, and other
durable and more natural stimuli (n) are most imperfectly
applied; yet, together with the diffusibles, soups (o)
should be given, and as much haste as possible should be
made to bring the patient to take solid meat, while care,
at the same time, should be taken to apply a proper degree
of heat. For, by this method, we most properly secure
both the internal and external surface. Nay, in the same
way, we move that inanition of the vessels which takes
place in asthenic diseases in an exact proportion to their
degree. For, as in that abundance of blood, which is the
most powerful means of bringing on sthenic diseases, there
is an opportunity of making a quick cure by immediate
taking of blood; so it is only by insensible, gradual, im-
perceptible, and obscure successive steps, that we open
the access to the removal of that penury of blood, which
proves the most hurtful power in asthenic diseases, and
effect the filling of the vessels again.
CCCIX. After this management of both surfaces of
the body, and this partial filling of the vessels; still the
excitement is not, equally enough encreased. To effect
this further in part; at the same time some most diffusi-
ble
(m) See par. CCCI. 
(n) as that of pure air, exercise, the stimulus of the motion of the
food and other fluids in their respective vessels,
(o) See par. CCCII. 


198 THE ELEMENTS
ble stimulus, suppose any preparation of opium, should
be administered, and the little animal food, or meat, that
there is any appetite for, and that can be taken and di-
gested, should be added. The idea of giving food is evi-
dent from the late explanation given about soups (q).
But, the use of the more durable, and less diffusible, sti-
mulus depends on this, "that when the excitability is
worn out by any one stimulus, any new stimulus finds ex-
citability, and draws it forth, and thereby produces a
further variation of the effect.
CCCX. Hitherto the stimulus of the motion, by which
all the muscles, which, from their situation on the fur-
face of the body, by their contractions propel the blood
along the veins to the heart, are thrown into action, has
not been supplied (r); and, therefore, both upon account
of the emptiness of the vessels, and the flow circulation
from the want of that impulse, the excitement is not
sufficiently aroused over all that tract. After the strength
has, then, been so recruited, that rich food can now be
taken, the body can now be roused, first by foreign, then
by its own organs, of which the former is called geltation,
the latter exercise, and also refreshed by air; when all that
has happened, then it is, that the excitement is further rai-
sed in several points, and becomes more equal upon the
whole.
CCCXI. The last stimuli to be mentioned, which,
along with those already mentioned, have a natural tenden-
cy to produce an equalization of excitement over the whole
system, arise from the action of the mind, the energy of
passion or emotion, and a still greater purity of air, than
is attainable by persons shut up in a room (s). In this
state
(q) See par. CCCVIII.
(r) See par. CXXXVII. α.ç.γ.δ. CCLXXIII. CCCIII.
(s) See and compare with these last mentioned stimuli the following
paragraphs CCLXXV. CCCLXXVIII. CCLXXIX. π. 


199 OF MEDICINE. 
state of convalescence, the same management, which was
formerly mentioned upon the going off of sthenic diseases,
perfectly applies (t).
CCCXII. The stimulant plan of cure, in all its parts,
is new, whether the reasoning part, or the merely practi-
cal be regarded; and, whether the cause and the exci-
ting hurtful powers, or the indication of cure and the
remedies, be considered. May it, therefore, be put as
a question, whether the whole doctrine, which has hitherto
been delivered, has, at last, brought forward clear proof,
that the art of medicine, hitherto conjectural (u), incon-
sistent
(t) The convalescent state from either of the two general forms of
diseases, or from local ones, the effect of which had drawn the whole sys-
tem into consent, is much the same ; being a state of some remaining de-
bility in all; in the sthenic from the excitement either going too low,
by the remedies being pushed to some excess, or not equally diffused
over all the parts in consequence of the natural supports only beginning
to be brought fully into play; in the asthenic from the perfect point of
health being not quite gained, either from the stimulant remedies nor
having been carried exactly up to 40, or from some of them having
been carried further than the wasted excitability could receive them with
invigorating effect, and thereby an inequality left upon the whole. The
convalescence, from the general effects upon the constitution sometimes
arising from local diseases, is to be explained upon the principles laid
down, with respect to the two other cases of convalescence.
(u) Celsus says, ars nostra conjecturalis est. And every man of sense,
whether of the profession, or out of it, has held the same sentiments of
it. Nothing is more glaring than the contradictions in medical writings
and reasoning of every kind, nothing ever could be more incoherent. If
a piece of knowledge, that sets out with a fixed principle, which applies
to all the parts of the detail, while they reflect on it, both illustration
and confirmation, be entitled to be considered as a science, the reader is
desired to consider, how far that criterion will apply to this doctrine.
The pedantry of mathematicians has contributed as much to bring their
science into disgrace, as any other circumstance, particularly in allowing
no sort of probation, but that which is made out by lines and diagrams;
while, except the elements of that science, every application of that de-
partment 


20O THE ELEMENTS
sistent with itself, altogether incoherent, is now reduced
to an exact science, proved not by mathematical principles,
which is only one kind of probation, but by physical ones,
and established by the certain testimony of our senses, nay,
and by the very axioms of the mathematical elements?
CHAP. XII.
As the Action of all the other Powers, that act upon living Bodies,
is the same, that that of the Remedies is also the same.
CCCXII. As it is found certain, and proved, that the
common effect of all the exciting powers is precisely the
same, to wit, the production of the phenomena peculiar to
life, that is, that sense, motion, intellectual operation, and
passion and emotion, are the same; for what else is the ef-
fect of heat, of food, of seasoned food, of drink, of the
blood, of the colourless fluids secreted from it, and of the
air, among external bodies; what else in the functions of
the living body itself, is the effect of muscular contraction,
of thought, of the passions, and of sensation, but to excite,
preserve, and continue as the sustaining cause of those
functions in common to animals? And, as it is from
that evident, that the operation of all the same powers is
also the same, (for it must be granted, that the same cause
by an universal law in nature, tends to the same effect (a):
and further, as the operation betwixt cause and effect depends
upon
partment of knowledge has led to as many false conclusions as any other.
If they will not allow the proof, that arises from our feelings, compared
with those of all men, whose organs of sense are not deranged, what
will they make of their own axioms? They must admit of other proba-
tion; while human reason hold its reign, truth and falshood will be
discriminated, without regard to such empty and useless prepossessions.
(a) See par. XX. with the annexed note 


201 OF MEDICINE. 
upon stimulating(b), and that stimulus produces all the
phœnomena of life, health, disease, and those intermedi-
ate degrees between both, which are called predisposi-
tions (c); from these certain and demonstrated fasts it fol-
lows, and must be admitted, that the operation of the re-
medies, both in sthenic and asthenic diseases is the same.
For, if there is no difference betwixt health and sthenic
diseases, except an excess of excitement in the latter, and
none betwixt the former and asthenic diseases, but defi-
cient excitement in these last, what else, can the operation
of the remedies, to remove sthenic diseases be, but to di-
minish, and of those that remove the asthenic, but to en-
crease the excitement (d).
CCCXIII. Whatever thing produces the same effect
as another, or several things, it must be the same thing as
each of them, each of them the same thing as it, and every
individual of them the same thing as every other individual.
ζ. In sthenic diseases, bleeding (e), vomiting, and pur-
ging (f), sweating, abstinence (g), rest of body and mind (h)
tranquility with respect to passion, all those restore health
by nothing else but a diminution of excitement,
CCCXIV. In asthenic diseases, the administration
first of diffusible stimulants, for the purposes of gradually
bringing back the appetite for the greatest remedy, food, as
well as keeping the food upon the stomach, and of assisting
in the digestion of it (i), then the application of heat (k),
then the life of the less diffusible and more durable stimu-
lants as animal food, without and with seasoning, wine,
gestation, gentle exercise (l), moderate sleep, pure air, ex-
ertion of mind, exertion in passion and emotion, an agree-
able
(b) See XIX and XXII 
(c) See XXIII.
(d) See LXXXVIII. 
(e) See CCLXXXI.
(f) See CCLXXXIII.
(g) See CCLXXXIV.
(h) See CCLXXXV. 
(i) See CCXCIV. to CCCII.
(k) See CCCII. 
(l) See CCCII. CCCIII. 


202 THE ELEMENTS
able exercise of the senses, all those reproduce health, by no
other operation, but that of only encreasing excitement,
CHAP. XIII.
That all the Powers, which support any Sort of Life, or the
fundamental Principal of Agriculture, are the same.
CCCXV. AGAIN, are not the powers, which produce
perfect health, the same as those, which, by an excess of
force, produce, sthenic diseases; by a deficiency of force,
asthenic, as well as the predispositions to both, are they
not the same, with no other variation but that of de-
gree(a)?
CCCXVI. Further, as we learn from the whole doc-
trine delivered above, the hurtful exciting powers, which.
produce sthenic diseases, are the remedies of asthenic; and
those which produce the latter, are the remedies of the
former (b).
CCCXVII. All the powers, therefore, that support
any state of life, are the same in kind, only varying in de-
gree; and the proposition is true, of every sort of life, to
its full extent over the animal creation.
Such is the life of animals (c). Concerning which, all
that has been said applies to the life of vegetables.
CCCXVIII. Accordingly, as animals, in every state
of life, have their exciting powers (d) in predispositions 
and diseases, their hurtful exciting powers (e) in the cure 
of both those, their indications, and remedies adapted to
each (f); all that, in every respect, is precisely the case
in plants.
CCCXIX.
(a) See XXIII. LXXIII. 
(b) See LXXXIX. XC. XCI. XCIII. XCIV.
(c) See from X. to XIII. inclusive. 
(d) See LXII. LXVII. LXVIII. LXIX. LXXIII. CXII. to an CXLVII.
(e) See the same. 
(f) See LXXXVIII. LXXXIX. XC. XCI. 


203 OF MEDICINE.
CCCXIX. The powers that support plants, in every
state of life, are heat, air, moisture, light, some motion,
and their internal juices.
CCCXX. The action of plants also consists in stimu-
lus (g); by means of which, the phœnomena peculiar to
that sort of life, sense, some motion, and verdure, are ex-
cited: and the cause of this state is excitement, an effect in
common to all exciting powers (h).
CCCXXI. Nay, in this case too the exciting powers,
when applied in due proportion, produce health; but their
too great or too sparing action occasions diseases, or pre-
disposition to diseases; of which the former depend on an
excessive, the latter upon a deficiency of stimulus. Ac-
cordingly, excess or scantiness of moisture, excessive heat
or cold, by an equality of hurtful operation, lead to dis-
ease and death, indirectly or directly. And, as the rays of
the sun or darkness, when their operation is either too
great, or too long continued, prove debilitating, the for-
mer indirectly, the latter directly; so the alternate suc-
cession of night to day, of darkness to night, seems to be
the effect of an intention in nature, to prevent too great an
effulgence of the light of day, or too long a continuance of
it, from stimulating either in excess or in ultimate excess,
and thereby inducing sthenic diseases, or those of indirect
debility; or to prevent an excess, or long continuance of
darkness from producing direct debility, and the diseases
peculiar to it (i).
CCCXXII. Nor do plants want their excitability,
which, equally as in animals, " is not different in diffe-
" rent parts of its seat; nor is it made up of parts, but one,
" uniform,
(g) See XVII. XIX. and notes. 
(h) See Part I. Chap. II.
(i) Chap. IV. We have no less proof, than that of the universal feel-
ing of mankind, of the truth of what has been advanced, with respect to
the stimulus of light and the debilitating effect of darkness. 
 

204 THE ELEMENTS
"uniform, undivided, property over the whole system (k)."
The effect of which is, that, to whatever part of a plant
any exciting power is applied, its operation, whether in
excess, in due proportion, or in under-proportion, im-
mediately affects the excitability over the whole.
CCCXXIII. This effect is also produced with the same
inequality as in animals, being, for instance, greater in any
part to which its exciting power is directly applied, than
in any other equal part. And, as there are two reasons
for that fact in animals, the direct impression of the pow-
er upon the part more affected, and a greater energy of
the excitability of a part or relation to which it is so applied,
than on that of any Other equal part (l); the very same
is the fact with respect to plants. Further, as the exci-
tability bears a greater relation to the impression of the
exciting powers, on the brain, the stomach, and inte-
stines, than on any of most of the other parts; so the part
in plants, that corresponds to these parts, is the root,
which is affected in the highest degree by the exciting
powers. It is the root of plants, in preference to any
of their other parts, to which the conflux of moisture is
made. The heat there is the best, which is neither ex-
cessive, and therefore liable to produce sthenic affection,
nor ultimately excessive, and therefore ready to induce in-
direct debility (both which disadvantages are prevented by
the depth of the ground); nor deficient, or what is called
cold, which would bring on direct debility (m).
CCCXXIV. But the only use of the soil, through the
pores of which the powers that have been mentioned pe-
netrate,
(k) See Part I. Chap, IV. 
(l) See XLIX. and addition L. LI.
(m) Hence it would appear, that it should be a general rule in plough-
ing and harrowing to adapt the depth, where the seed is to be laid, to
the state of the surrounding temperature. It would seem, when other
circumstances are equal, that the seeds of plants may more safely lie su-
perficially in warm than in cold countries. The same fact seems to be
favoured by the difference of perfection that planted and natural woods
attain 


205 OF MEDICINE.
netrate, is to furnish that sort of a strainer, by which the
powers may neither, from the pores being too patulous,
go down in too great quantity, and produce first a sthenic,
or too luxuriant a state of the plant, and then indirect de-
bility; nor, from the contractedness of the pores, be in-
sufficiently admitted to the root, and occasion indirect
debility, or the decaying state of a plant. But that the
soil is not otherwise necessary to the production of some de-
gree of vegetable life, is proved by plants often living, to
a certain degree, in pure water. That however, it is
useful as a filter, is proved by the good effect of ploughing,
of breaking the clods, of dividing the tough clay by lime
and other absorbent earths, and by these means relaxing
the pores: On the other hand, we have proof of the same
thing in the success of contracting the pores by making
ground, naturally too friable, more tenacious with dung,
and covering light ground with rags and stones, and there-
by keeping in both heat and moisture.
CCCXXV. From this view of the facts, the reason is
evident, why every sandy as well as clay soil, when the
former has not received, and the latter parted with its
toughness, is barren and unfruitful. Hence it is that very
hot summers and countries are hurtful to clay grounds, by
shutting up the pores; and serviceable to friable and lean
grounds, by diminishing their porosity. Hence, dry sea-
sons are suitable to low-lying rich grounds, which, from
all quarters, conduct a quantity of moisture around the
roots of the plants; while rainy seasons are those that an-
swer in grounds that are high and of a thin soil. Decli-
vities facing the north, which are commonly of a thin and
poor soil, are cherished and protected by hedges and clumps
of
attain in cold countries; the former, the seeds of which are lodged in a
certain depth, turning to better account than the latter, which rise from
seeds that have randomly been scattered upon the surface. Might not
the hills in the west of Scotland, upon some such principle, be made use-
ful oak forests? 


206 THE ELEMENTS
of trees, and a great number of bare stones, covering
every thing, which some persons, of more industry than
sense, often remove with hurtful effect; their good effect
being to give heat and keep in moisture. But in those
places, the declivity of which looks towards the south,
there is not equal occasion for such protection from cold
and dryness, as they, from their more happy situation, are
cherished by the sun, defended from the cold winds, and
exposed to those which blow from the southern points
that are seldom too dry (n).
CCCXXVI. To return from this digression on agricul-
ture to our proper subject; from what has been said upon
the cultivation and nature of plants, we learn, that their life
is similar to that of animals; that every thing vital in na-
ture is governed by excitement, which the exciting pow-
ers only afford; that there is in no living, system, whe-
ther of the animal or vegetable kind, any inherent power
necessary to the preservation of life; that the same powers
which form life at first, and afterwards support it, have
at last a tendency to produce its dissolution; that life,
the prolongation of life, its decay and death, are all states
equally natural; that every living system lives in that which
it procreates; that the generations of animals and ve-
getables are in that way renewed, that the system of nature
remains, and maintains an eternal vigour; in one word,
that all the phœnomena of nature are fabricated by one
single organ (o).
There
(n) While the northern winds, that is, the wind due north, and all the
intermediate ones in every point of the compass from due east to due
west, are cold and dry, and commonly of a tendency to bring snow; the
southern, or the winds that blow from any point of the compass towards
the south, from the same points of due east to due west, are as common-
ly warm and moist, and often productive of mild fertilizing rains.
(o) No discovery, of any importance or extent over nature, has yet
been made, that does not warrant, as far as the smallness of the number
of such discoveries go, the truth of this assertion. See the Introduction
to my Observations. 


207 OF MEDICINE. 
There are many circumstances that give reason to
believe, that this globe has undergone great changes,
and that whatever is now sea, has been land; whatever
is land at present, has been sea; and that the fossil
kingdom of nature has not been more retentive of the
respective form of each of its individuals. But whether
the last, like animals and plants, have a sort of life, so as,
after their manner, to be produced into living existence,
to grow, to run through a period equally without growth
and diminution of bulk, to decay, to die, and, in death
lose their proper form; the great duration of their age,
and the shortness of ours, deprive us of any possibility of
learning.
CCCXXVII. As all the motions of the planets, which
latter were formed to remain and continue their courses
for ever, depend upon this one principle, to proceed straight
onward, according to the manner in which all projectiles
move, and then by the influence of gravity, which affects
them all, to be pulled downward, and thereby, upon the
whole, thrown all into circular motions; so, in the lesser
and living bodies with which those greater bodies are filled,
that is, animals and plants, of which the whole species re-
main though the individuals of each species die; whatever
is the cause of their functions, whatever gives commence-
ment and perfection to these, the same weakens, and, at
last extinguishes them. It is not, therefore, true, that
some powers are contrived by nature for the preservation
of life and health, others to bring on diseases and death.
The tendency of them all is indeed to support life,
but in a forced way, and then to bring on death, but by
a spontaneous operation.
PART 


208 THE ELEMENTS
PART THE THIRD.
OF GENERAL DISEASES.
THE FIRST FORM, OR STHENIC DISEASE.
CHAP. XV.
CCCXXVIII. IN every sthenia, in all sthenic dis-
eases, in the whole first form of diseases (a) an universal
criterion is encreased excitement over the whole system,
evidenced, during the predisposition, by an encrease of
the functions of body and mind (b), and demonstrable,
after the arrival of disease, by an encrease of some of the
function, a disturbance of others, and a diminution of
others; in such sort, that the two latter are easily per-
ceived to arise from the hurtful powers that produce the
former, and to depend upon their cause. As by that com-
mon band of union the diseases of this form are connected
together; so
CCCXXIX. There are certain circumstances, by which
they are distinguished by a difference of their degree: for,
there are some sthenic diseases, accompanied with py-
rexia (c) and the inflammation of some external part; there
are others without the latter of these, and others without
both.
2 CCCXXX.
(a) See above par. LXlX. LXXXVIII. CXLVIII. CLI. CCLI. Chap.
IX. 
(b) See par. CLI. throughout.
(c) See par. LXVIII. and the subjoined note, for the meaning of py-
rexia, which will be just now repeated. 

209 OF MEDICINE. 
CCCXXX. The general sthenic diseases, with py-
rexia and inflammation, are some of them called phlegm-
usiæ, others exanthemata. But they will all, without dis-
tinction, be treated here according to their rank in excite-
ment, from the highest to the lowest degree of excitement.
CCCXXXI. The phlemasiæ and exanthematic disea-
ses have the following symptoms in common to thern.
The first of these is that degree of sthenic diathesis, that
distinguishes predisposition (d). This diathesis upon the for-
mation of the disease, is succeeded by shivering, a sense of
cold, languor, and a certain feeling like that which we have
in fatigue from labour, called by physicians, lassitude. The
pulse at first, in every case, and in mild ones through their
whole course is moderately frequent, and, at the same time,
strong and hard; the skin is dry, and there is a retention
of other excretions (e): The urine is red; there is great
heat and often thirst.
CCCXXXII. The symptoms peculiar to the phlegma-
siæ (f), are an inflammation of an external part, or an
affection nearly allied to it; while the general affection,
for the most part, precedes this local one, and never suc-
ceeds to it (g). This general affection, for the greater
P convenience
(d) From the first deviation from perfect health to the commence-
ment of actual sthenic disease, the sthenic diathesis takes place in an en-
creasing scale from 40° to 55°.
(e) Such as that by the belly, and that which pours out the saliva and
mucus, and forms the matter of expectoration.
(f) The phlegmasiæ are sthenic diseases, accompanied with inflamma-
tion in an external part, as has been said somewhere before, according to
the definition of nosologists. But, as there is no difference betwixt them
and synocha or the catarrh, which latter are unaccompanied with in-
flammation, we therefore pay no regard to the distinction; and shall
regard nothing either in these or any other diseases, but what is constitu-
ted by a real difference of excitement. It is the excitement by which
we are to be guided through our whole distribution of diseases.
(g) Long before any part of this doctrine was discovered, when I was
in 


210 THE ELEMENTS
convenience of distinguishing it from fevers, is to be de-
nominated pyrexia (h). In the exanthematic sthenic dis-
eases, an eruption of spots or pustules, more or less crowd-
ed, according to the degree of the diathesis, covers and di-
versifies the skin. The eruption appears upon the occasion
of a foreign, contagious matter, having been taken into the
body, and detained below the cuticle.
CCCXXXIII. The explanation of all those symptoms
easily flows from the doctrine delivered above. The sthe-
nic diathesis in the manner, that has been so fully explain-
ed
in search of certain facts respecting peripneumony and pleuritis, I disco-
vered one which I was not looking for, of more importance than all the
rest put together. It had been asserted, by most systematics and all the
nosologists, that the primary symptom in the phlegmasiæ was the inflam-
mation of a part. I saw that was not true with respect to rheumatism,
in which the general affection or pyrexia often rages one, two, or three
days before the sign of inflammation, pain, is perceived in any of the
joints. I could also discern, that from the moment the pain and inflam-
mation appeared in erysipelas, or the rose, there was also the general af-
fection equally conspicuous. In short, in no one of that set of diseases,
did the fact appear that the inflammation was primary, and the pyrexia,
or affection of the whole system dependent upon it. But as peripneu-
mony was said in Edinburgh to be an exception, the detection I made
equally disproved that. In all the works of Morgagni, where peripneu-
mony and erysipelas are treated, and in all those of Trillerus, a professed
writer on that subject, and in a thesis in Sandifort's Thesaurus, taken
from no less than 400 cases of that disease (for they are now by others,
as well as me, considered as one), I found that in somewhat more than
one-half of the given number, which was very respectable, the general
affection appeared from one to three days before the pain came on, and
in all the rest of the cases that, though for any thing these authors said to
the contrary, they might sometimes have come on together, yet, there
was not one, in which it could be fairly alledged, that the pain was the
first and primary appearance. Hence I found, that all the theories rais-
ed upon that hypothesis of course fell to the ground. Indeed the fact
is quite confident with every one here.
(h) Of this designition warning has been given more than once. See
note at CCCXXIX. 
 

211 OF MEDICINE. 
ed (i) precedes. The characteristics of the pulse are ne-
ver to be referred to the affection of a part, having been
demonstrated to arise from the diathesis (k).
CCCXXXIV. The frequency of the pulse in sthenic
diseases is moderate, because, while the stimulus in the sys-
tem cannot fail to produce some frequency, the quantity
of blood, to be thrown into quick motion, sets bounds to
it and prevents its rising to quickness. But, at the same
time, it is evident, that a quantity so great cannot be trans-
mitted with the same celerity, as an under proportion (l).
The strength of the pulse is occasioned by the degree of ex-
citement in the moving fibres of the vessels, which is com-
monly called their tone, and by that of their density con-
sidered as simple solids (m). The hardness of the sthenic
pulse is nothing else, than the continuance for some time
of each strong contraction, closely embracing a great co-
lumn of blood, and, thereby, as it were, resembling a
stretched rope (n).
P2 CCCXXXV.
(i) See above all the paragraphs, where the operation of the powers
producing sthenic diathesis, are accounted for.
(k) See also par. CLV. and CLVI. and particularly CLXXIV.
(l) In fevers and other asthenic diseases of great debility, from the
weakness of the stomach and other digestive organs, and the small quan-
tity of nutrient matter taken in, the quantity of blood which is diminish-
ed in every one of those diseases, cannot be more than one-third less than
that which overfills the vessels in sthenic diseases. Consequently, by a
given power, it may be propelled in the same proportion, that is, one-
third faster than in the sthenic diseases, which also appears in fact; for
while 100 beats in a minute is a frequent pulse in sthenic diseases, till
their approach or actual conversion to indirect debility, the common
frequency in fevers and the other high asthenic diseases, is 150 beats in
the same time.
(m) See above LIX. LX. and LXI.
(n) See par. CLV. If it should be alledged, that, though in fevers
and the other cases mentioned just now in the note (a), the deficient
quantity of blood to be put in motion will account for the greater cele-
rity 
 

212 THE ELEMENTS
CCCXXXV. That this is the exact state of the arte-
ries is proved by the great quantity of food taken with a
good appetite, before the arrival of the disease, and du-
ring the period of predisposition; it is proved by the same
and other powers, giving an unusually great excitement
over the whole system (o), and, therefore, among their
other effects encreasing the digestive energy; and it is pro-
ved by evacuant, with other debilitating remedies, both
preventing and removing the diseases. The confounding,
therefore, this state with one diametrically opposite (p),
which has hitherto been an universal practice, was a very
capital blunder, and could not miss of producing the worst
consequences, by equally perverting the theories and ac-
tual practice of the art.
CCCXXXVI.
rity of motion, than in the diseases which make the present subject; still
the great weakness of the heart, for want of the stimulus of a due quan-
tity of blood, as well as of many others, should overbalance the effect
arising from the small quantity to be moved. But the answer to that
objection is easy. It arises from the explanation of the strength and
hardness of the pulse just now mentioned in the text. The febrile pulse
is indeed one-third quicker than the sthenic pyrexial, but it is weak, and
small, and soft, while the other is strong, and full, and hard. An equal
force then of the heart to that in the sthenic case is not required to ac-
count for the difference of the effect. A third left of blood, with an
equal force behind, will be driven not only one third faster, but with
strength and hardness. The want of these two last then is to be set to
the account of the heart's greater weakness. Though the blood then be
driven one-third quicker, yet the impulse communicated upon the whole
is one third less, as the characteristics of both kinds of pulse readily ex-
plain to us.
(o) See the whole of the first Chapter of Part II. upon the powers
producing sthenic diathesis.
(p) Which authors and too many practitioners have universally done,
in jumbling proper fevers with the present diseases, under the vague and
false denominations of febrile or feverish diseases. In nosology the sy-
nochus is conjoined with typhus, the gangrenous sore-throat, which is
a typhus fever, with the common sthenic inflammatory pyrexia. 


213 OF MEDICINE. 
CCCXXXVI. The shivering and sense of cold depend
for their cause upon the dryness of the skin. The languor
and feeling of lassitude point out a higher degree of excite-
ment in the brain and fibres of the muscles, than can be
conveniently borne by the excitability, confined within
certain boundaries (q). They are therefore functions im-
paired from a stimulant, not from a debilitating cause (r).
CCCXXXVII. The dryness of the skin is occasioned
by the great excitement and density of the fibres that en-
circle the extreme vessels, diminishing their diameters to
such a degree, that the imperceptible vapour of perspira-
tion cannot be taken into them, or, if taken in, cannot
be transmitted (s). This state is not spasm, is not con-
striction from cold, but a sthenic diathesis, somewhat grea-
ter on the surface, than in any other part. The stimulant
energy of heat, especially after the application of cold,
which is otherwise a powerful exciting cause of sthenic
diseases, is applied to this part with more force than to any
of the interior parts, and encreases the sum total of stimu-
lant operation (t).
CCCXXXVIII. The same, in general, is the cause of
the temporary retention of the other excretions (u); only
that the operation of heat, just now mentioned (x), is
foreign from the present explanation; and on that ac-
count, the diathesis that affects the interior vessels is
more gentle. These vessels, for that reason, and because
they
(q) See above CLIV. 
(r) See above par. CLXVI.
(s) See LXIX. and CXIII.
(t) See XXXVII. θ. and CXIII. just now quoted.
(u) See CCCXXXI. and note (d); and also the par. CLIX. CLX.
CLXIII.
(x) in the CCCXXXVIII. and the reason is, that heat being statio-
nary in the interior parts, has not that force which it has upon the exter-
nal surface. See above par. CXIII. 


214 THE ELEMENTS
they are naturally of a large diameter, are sooner relaxed
in these diseases, than the pores upon the skin (y).
CCCXXXIX. The redness of the urine is owing to
the general diathesis affecting the vessels that secrete it, and
proving an obstacle to the secretion (z). Hence arises the 
straining of the fluid to be secreted to distend the small ves-
sels (a), and the counterstraining of the moving fibres,
by their contractions, to diminish the cavities which the
distention encreases; and, in so far as they perform the
function of simple fibres, to resist the distention. But,
as, in this forcible action of the vessels, the cohesive force
of all the simple solids yields somewhat, the effect comes
to be the transmission of some particles of blood. This
transmission happens not at first, because the distension does
not suddenly, but after some time, overpower the cohesion
of the mass of simple solids.
CCCXL. The cause of the great heat is the interrup-
tion of the perspiration, preventing the heat generated in
the inner parts of the system to pass off by the skin.
CCCXLI. The thirst is occasioned by the sthenic dia-
thesis, closing up the excretory vessels of the throat, and
there opposing the excretion of the peculiar fluid (c). And
the heat, by dissipating what fluid is excreted, contributes
to the effect.
CCCXLII. The inflammation and affection nearly al-
lied to it (d), whether of a catarrhal or of any other nature,
is a part of the sthenic diathesis, greater in the affected, than
any other equal, part of the system (e): Which is mani-
fested
(y) It is reasonable to think, that vessels, which pour out a watery flu-
id, have a larger diameter than those, which, like the perspiratory, even
in their healthy state, only transmit an imperceptible vapour.
(z) See par. CLXIII. 
(a) Or tubuli uriniferi.
(c) See par. CLIX.
(d) mentioned above in par. CCCXXXII.
(e) CLXVIII. CLXIX. CLXX. CLXXI.


215 OF MEDICINE. 
fested by the exciting powers, also in this case acting upon
the whole system, by the symptoms of the diseases showing
an affection in common to the whole, and by the reme-
dies driving that affection, not from the inflamed part on-
ly, but from the whole system (f).
CCCXLIII. The general affection, for the most part,
precedes that confined to one part, or is synchronous with 
it, never comes after it, because its cause, the excessive
excitement(g), producing the diathesis, exists before the
disease itself (h); and, though it forms the rudiments of
the affection of the part during the predisposition (i), yet
it does not, at that time, form that affection itself, and not
always even during the disease, but only in a certain high
degree both of the disease and of the particular affection
itself (k). Hence, when the diathesis is great, the affec-
tion of the part is in proportion (l) and slight under a lesser
degree of the diathesis (m); while in a moderate and gentle
diathesis it does not happen at all (n) and for this reason,
that a high degree of diathesis is necessary to the formation
of it. Thus in peripneumony, where the diathesis is the
greatest, and in rheumatism, where it is next in greatness,
the inflammation is found proportionably great (o). And
even
(f) LXXXIX. See also part first, Chap. IV.
(g) See LXII. LXIX. 
(h) See CLXXIV.
(i) See above CLXIX. 
(k) See above CLXVIII. 
(l) as in peripneumony and rheumatism, inflammatory sore throat,
and mild erysipelas, sore throat.
(m) as in the sthenic.
(n) As in synocha, or the common inflammatory fever and catarrh.
(o) This proposition does not go so far as to assert, that there may not
be a sthenic disease, without any actual inflammation, but with an affec-
tion of a part nearly allied to it, which depends upon an equally high
diathesis as either peripneumony or rheumatism, and even higher than
the latter. Such we find, as I have formerly said (CLVII and CLVIII.)
in phrenitis. But the meaning is, that the inflammation, when it does
happen, is always in proportion to the degree of diathesis. 
 

2l6 THE ELEMENTS
even in the measles, the danger of which turns entirely
upon the degree of sthenic diathesis, the danger of inflam-
mation is equal, by which, and often in a high degree,
the lungs themselves are affected. Synocha is never phre-
nitic, but when a great diathesis occurs, threatening the
brain with inflammation, or the danger of it. Nor is
there any danger to be apprehended in erysipelas (p),
even when its inflammation affects the face, but when the
pyrexia is violent. And the mildness of the diathesis ensures
a good termination. Simple synocha is nothing else but a
phlegmasia, consisting of a pyrexia and diathesis, inade-
quate, upon account of their small degree, to the produc-
tion of inflammation. Yet, as all the hurtful powers pro-
ducing it, and all its remedies are precisely the same, with
those of any phlegmasia; the separating it from them, and
uniting it with fevers, which are diseases of extreme debi-
lity, was an unpardonable blunder (q); and so much the
more so, that inflammation, which was falsely supposed
essential to the nature of the phlegmasiæ, does take place
in it, as often as the diathesis, necessary to produce it, is
present (r). Yet this fact, upon account of another blun-
der, neither of a slighter nature, nor of less hurtful con-
sequence, that of supposing inflammation the cause of the
phlegmafiæ, could not be discerned. In fine, to remove
all doubt of inflammation being compatible with the na-
ture of catarrh, but commonly not taking place in it, upon
account
(p) or the rose, or St. Anthony's fire.
(q) This has been more than once hinted at, and once a little above.
The Nosologists have excluded synocha from their order of phlegmasiæ,
because forsooth, though it was in every other respect the same, it want-
ed the inflammation of a part, and they united it with proper fevers
though in the powers producing it, in its proper cause, and in the reme-
dies that remove it, it was in every respect diametrically opposite to those
diseases. But their rule of judging was different from ours.
(r) What is a peripneumony, a rheumatism, or any phlegmasiæ, but
a synocha, with a diathesis sufficient to produce inflammation? 


217 OF MEDICINE. 
account of the moderate general diathesis, upon which it
usually depends; even in it, as often as the diathesis rises
high, which sometimes happens, when the proper plan
of cure for it has been neglected, and the effect of the ex-
citing hurtful powers has been carried to excess, an inflam-
mation, and a formidable one indeed, arises, often affec-
ting the throat (s), and sometimes the lungs, and producing
there an affection rising to all the rage of peripneumony.
CCCXLIV. It is in vain to talk of a thorn thrust un-
der the nail, wounding it, superinducing inflammation
upon the wound, and spreading a similar affection along the
arm to the shoulder, and a pyrexia over the whole body.
As an illustration and proof of the manner, in which the
phlegmasiæ arise from inflammation. For nothing like
a phlegmasiæ follows, this, or any similar affection of a
part, unless the sthenic diathesis previously happens to
have taken place, and is now upon the eve of spontaneously
breaking out into some one or other of its respective dis-
eases. But, without that diathesis, no general affection
takes place, and if an opposite diathesis be present when
such an accident happens, an opposite general affection will
be the consequence, to wit, a typhus fever, arising as a
symptom of gangrene (t), and dangerous to life.
CCCXLV. That the affection of the part depends
upon the general affection is proved by the frequent oc-
currence of inflammation, without being followed by any
phlegmasiæ.
(s) When that happens it is still commonly a mild disease, as will be
shewn by and by.
(t) It is with much regret, that I should have had occasion to observe
the bad, and too often fatal, consequence of treating such local affections,
without discrimination of the habit with which they may coincide. The
disease is treated by evacuation and starving, even in habits the most
weakened, and drink is withheld from persons even the most accustomed
to it. The disease increases, and, as if that were for want of more such
treatment, the same treatment is persevered in till death closes the scene. 


218 THE ELEMENTS
phlegmasia. Which happens, as in the case just now
mentioned, as often as the general diathesis is absent, or
the inflamed part is not an internal one and of high sen-
sibility (u). Accordingly, all the examples of phlegmone,
all those of erythema or erysipelas, without general dia-
thesis (x), are foreign from the phlegmasiæ, absurdly con-
joined with them, and more absurdly still considered as
their prototypes; being in fast all only local affections,
or symptoms of other diseases. This conclusion is not
weakened by a certain resemblance of diseases with inflam-
mation in an internal part to the phlegmasiæ; these dis-
eases being neither preceded by the usual hurtful powers,
that produce either the phlegmasiæ, or any general disease
whatever, nor cured by the usual remedies of the latter.
It was, therefore, a very bad mistake, and of most hurt-
ful consequence to the practice of cure, to enumerate
among
(u) See above CLXXI.
(x) See also par. LXXXI. The Nosologists, under their genus of
phlegmone which in one of them is divided into two species, proper
phlegmone, and erythema, have raked together a number of local, and
most of them insignificant affections, which they have considered as lay-
ing the foundation of their phlegmasiæ, or general sthenic diseases with
an inflammation in a part. But will any man in his senses see any con-
nection betwixt chill-blanes, which is one of them, or anthrax, which is
a local symptom of the plague, or the slight inflammation upon the eye,
called a stie, or the inflammation in the groins of children from their
being scalded by their urine, or the bites of infects, the effects of which
are confined to the bit part; will he see any connection betwixt these
and a peripneumony; which arises from hurtful powers affecting the
whole system, and no part in particular; and is cured by remedies that
affect the whole system, and the inflamed part not more, nor even so
much as many others? All these, however, have been made the proto-
types of inflammation, by which they meant their phlegmasiæ; as if
there were nothing to be regarded in them but the inflammation, which,
in fact, is their most insignificant part, bearing no higher proportion to
the sum of morbid state over the system than that of 6 to 3000, or even
less. See above Part first, Chap. IV. and particularly par. L. 
 

219 OF MEDICINE. 
among the phlegmasiæ those diseases, that arise from sti-
mulants, acrids, and compression, and are only curable
by removing their local cause, which is seldom effected
by art (y).
CCCXLVI. It is not without good reason, that the ap-
pellation of pyrexia has been given to the general affection,
which appears in the phlegmasiæ and exanthemata; they
being by it most advantageously distinguished on the one
hand from fevers, which are diseases of debility in extreme,
and on the other from a similar, but altogether different,
affection, which is a symptom of local diseases (z) and may
be called a symptomatic pyrexia.
CCCXLVII.
(y) See above par. LXXXI. Take for an example gastritis, which
the Nosologists have made one of their phlegmasiæ, and put upon the
same footing with the peripneumony and the other diseases that may be
admitted as phlegmasiæ;. That affecticn is an inflammation in a portion
of the stomach, in consequence of a solution of continuity from the pre-
vious swallowing of ground glass, small fish bones, a quantity of Cayen
pepper; or symptomatic of a schirrous obstruction and tumor. These,
not the ordinary hurtful ones that operate upen the whole system, as in
the true phlegmasiæ, are the powers that induce that affection. It has
no connection with the excitement, the affection of which is only an ef-
fect of the local stimulating power, and of the sensibility of the sto-
mach; its true cause being the solution of continuity or obstruction,
keeping up the inflammation; and its remedies such, as are adapted to
the removal of that local state. It may happen to a found habit, where
there is no diathesis in any degree, in which case it is purely local; or
it may accidentally coincide with either diathesis; in which case it is a
combination. When the combination is with sthenic diathesis, debili-
tating evacuant remedies can only palliate, but they bring life into dan-
ger when the asthenic diathesis is present, which is 17 times out of 10
for the other.
(z) The general affection arising in the system from the effect of a
thorn pushed under the nail (see par. CCCXLIV. and note), and that
occurring in the gastritis, mentioned in the last paragraph of the text
(see the note on that garagraph) are good examples of cases to which
the term symptomatic pyrexia shouid be applied. 


220 THE ELEMENTS
CCCXLVII. The true sthenic diseases (a) accompa-
nied, except one, with pyrexia (b) and external inflam-
mation (c), are peripneumony, phrenitis, the small-pox,
the measles, as often as these two last are violent, the se-
vere erysipelas, rheumatism, the mild erysipelas, and the
cynanche tonsillaris. Those free of inflammation are
catarrh, simple synocha, the scarlet fever, the small-pox,
the measles; when in the two latter cases, the eruption
consists only in a few pustules.
The Description of Peripneumony.
CCCXLVIII. The symptoms peculiar to peripneu-
mony (d) (under which pleurisy, and, as far as it is a gene-
ral disease, carditis, are comprehended), are pain some-
where in the region of the chest, often changing its seat;
difficult breathing; cough, for the most part bringing up
an expectoration, and sometimes a mixture of blood in
the matter of expectoration.
CCCXLIX. The seat of the disease is the whole body,
the whole nervous system (e); which is proved by the dis-
ease being produced by an increase of the diathesis, which
took place in the predisposition, and by no new circum-
stance (f); by the inflammation within the chest, for the
most part following the pyrexia at a considerable interval
of time, and never preceding it (g), and by bleeding and
other
(a) See above CCCXXIX.
(b) See par. CCCXXXII. 
(c) See CLXVIII.
(d) The symptoms in common to it and the other diseases of the same
form, enumerated in the last paragraph, have been described in par.
CCCXXXI. These peculiarly distinguishing the phlegmasiæ: and exan-
themata, that is the diseases either accompanied with inflammation, or
an approach to it, are described in par. CCCXXXII.
(e) See par. XLVII. XLVIII. XLIX. LIV. LV. and not the in-
flamed portion of the lungs, according to the common opinion,
(f) See above LXXV. LXXVII.
(g) See above CCCXXXII. and the note (b). 


221 OF MEDICINE. 
ther remedies of similar operation, which affect not the
inflamed part, more than any other equally distant from the
center of activity, removing the disease. The proper seat
of the inflammation, which is only a part of the general
diathesis, is the substance of the lungs, and a production
of the pleura, covering their surface, or any part of that
membrane, whether the part lining the ribs, or that con-
taining, within the external surface of it, the thoracic vi-
scera, different in different cases, and in the same case at
different times.
CCCL. Pain, in some part of the chest, depends upon
an inflammation of the corresponding internal parts just
now mentioned (h), which is proved by dissection; only
that it is oftener occasioned by an adhesion of the lungs
to the pleura costalis, seldom to an inflammation of that
membrane, as we learn from the same evidence.
CCCLI. When the inflammation takes place on the sur-
face of the lungs, it is impossible it can be confined either to
the substance of the lungs, or the membrane covering their
surface. For how can any person suppose, that the points of
the same vessels, either as distributed upon the membrane,
or plunging into the substance of the lungs, or emerging
from it, can alone be inflamed without a communication of
the affection to the next points(i). The distinction, there-
fore,
(h) See above, par. CLXXIV.
(i) Yet one Nosologist, upon that very supposition, makes two orders
of phlegmasiæ, one seated on the membrane, the other in the interior
surface of each viscus. Into this error, he had been led, by observing,
that, after death, the interior substance of the liver exhibited signs of
previous inflammation. And, as other dissections showed the membrane
upon other occasions to have been in a state of inflammation, he thence
drew his rash conclusion. But it is to be observed, that the first menti-
oned state of the liver was not a phlegniasiæ at all, as it had not during
life exhibited any of the symptoms of that disease, or even given any sign
of the presence of inflammation. It is a case, then, we have nothing to
do 


222 THE ELEMENTS
fore, of the inflammation accompanying the phlegmasiæ in-
to perenchymatose, or that affecting the substance of the vis-
cus, and into membranous: as well as the notion which
makes the latter case universal, is equally remote from the
truth. The reason of neither the membrane contiguous
to the lungs, nor the substance of the latter, being always
inflamed, but of the inflammation being sometimes com-
municated to some part of the neighbouring membrane, is
explained by the vicinity of the part inflamed in the last case
to that which receives the air, and, therefore, varies in its
temperature (k).
CCCLII. The pain often shifts its seat (l) in the course
of the disease, because its immediate cause, the inflamma-
tion, is equally liable to change, being disposed to leave
its first seat, or in part to remain in it, while in its great-
est part it rushes into another. Which is a fact proved by
the comparison of the known change of the pain with
the
do with upon this subject, even so far as it applies to the liver. But the
extending the application to all the viscera, which he was pleased to
make the seats of some phlegmasiæ or other, was looseness of reasoning,
and carelessness of matter of fact, in extreme. A gentleman, whose
"works have lately been buried, without any struggle or signs of life, but
that of a feeble unintelligible found from within the tomb, which no
living reason could make any sense of in their life time, took it into his
head to maintain (for the fake of seeming to differ with men of name
and reputation, his highest ambition), that the inflammation in the phleg-
masiæ; was always seated in the membrane: the answer to which is
given in the text.
(k) So far is it from being true, that this fort of inflammation can
be confined to a few points of the affected vessels (see the note here at
(i) that in; fact we find it, though not so often as has been supposed,
sometimes in the mediastinum, sometimes in the external membrane of
the pericardium, sometimes in the superior membrane of the diaphragm.
Boerhave's notion of the translation of inflammation from one viscus
to another, was an error in the opposite extreme.
(l) See above CCCXLVIII. 


223 OF MEDICINE. 
the traces of inflammation in the corresponding parts, dis-
covered after death (m).
CCCLIII. This fact, added to those already produced,
brings another solid argument (n) in refutation of the opi-
nion of the disease being produced or kept up by inflamma-
tion, or in any shape depending upon it; confirms that
here advanced, and proves that the inflammation is regula-
ted by a strong general diathesis, and directed by it some-
times to one part, sometimes to another; that, as depend-
ing on that cause, it increases and is in a manner multipli-
ed. And the same conclusion is confirmed by the inflam-
mation abating, becoming more simple, and at last rece-
ding from every part it had occupied, in proportion to the
progress of the cure in relieving or removing the diathesis.
The same fast is confirmed by the nature of rheumatism,
the pains of which are severer and greater in number, in
proportion as the diathesis runs higher; and milder and
fewer in proportion to its gentleness. These pains, that
have their dependance upon the general diathesis, and are
a part of the general disease, ought to be distinguished
from local ones, which often occur, and may accidentally
precede this disease (o).
CCCLIV. The difficult breathing is owing to no fault
in the lungs, as an organ, to no defect of excitement in
them, but to the air alone in inspiration, by filling and
distending its own, compressing the inflamed, vessels.
CCCLV. The cause of the cough is a large secretion
and excretion of the exhalable fluid, and mucus, irritating
the
(m) Many such are to be found in Morgagni, Bonnetus, and Leutaud.
(n) See all that has been said.
(o) Stitches, as they are called, frequently happen from slight acci-
dents, and may appear before the arrival of rheumatism, but they should
be distinguished from the pains that arise from the diathesis, constitu-
ting that disease; a distinction. that has seldom been attended to, for
want of a right principle to lead to such attention. 


224 THE ELEMENTS
the air vessels, encreasing their excitement, as well as that
of all the powers, that enlarge the cavity of the thorax;
then suddenly suspending it, and thus performing a full in-
spiration, and a full expiration, partly in conjunction with
the operation of the will (p).
CCCLVI. The cough is less or none at all at first; be-
cause, on account of a strong diathesis occupying the ex-
tremities of the vessels, the same fluids flow on in the form
of an insensible vapour, are less irritating in that form, and
dismissed with less effort.
CCCLVII. Again, the cough is afterwards followed
by expectoration; because the accumulated fluids, with
their effect, the effort of coughing, are carried forward in
the rapid action of the air rushing out, as it were, in a tor-
rent (q). And the mixture of blood with them point out
the force of secretion formerly explained.
CCCLVIII. The softness of the pulse, commonly ta-
ken into the definition of the disease (r), has been here
rejected, because the characteristics of the pulse do not fol-
low the inflammation, but the general diathesis(s). With
respect to the diathesis, the proper language is, that the
pulse, instead of soft, is less hard; and when the effect,
that the cure has produced upon the pulse, is considered, it
may then be said to be soft (t).
CCCLIX. Nor is the varying feeling of pain, which is
described as sometimes acute, and pungent, sometimes ob-
tuse, gravitative, and rather to be considered as an uneasi-
ness than pain, though immediately dependent upon the
2 inflammation,
(p) See above CLX. and CLXI. 
(q) See above par. CCXXXIX.
(r) at least, when they called it peripneumony,
(s) See above CLV. CLXXIV.
(t) It is an universal effect of sthenic diathesis to render the pulse hard
in one degree or another. And peripneumony is not an exception from
that fact. But the distinction arose from the mistake of inflammation
being the all, instead of an unimportant part of, the disease. 


225 OF MEDICINE.
inflammation, to be considered as of any consequence in
pointing out the state or seat of the inflammation: because,
however great the inflammation is, wherever it is seated,
whatever danger it denounces, the only means of remov-
ing it, and of averting the danger, is to remove the gene-
ral diathesis. The notion, therefore, of the membrane
being inflamed, when the pain is acute, and the interior
substance, when it is obtuse, must be. rejected as good for
nothing, must be guarded against as destructive (u). For
often, when the disease has arrived at an advanced stage, a
sudden abatement of the pain taking place, without a pro-
portional relief of the breathing, to an unskilful person
gives an appearance of a return of health. But the cause
of that, while it has nothing to do with the seat or sort of
inflammation, is that degree of excitement, which shows,
that the excitability is exhausted, the excitement come to
an end, and that the vigour, before excessive, is now con-
verted into direct or indirect debility (x). Hence arises in
the vessels, especially the labouring vessels, in place of the
excessive excitement, with which they were before affect-
ed, no excitement at all; and extreme laxity takes place of
their former density. Hence, instead of an excretion en-
creased by violence, an immense discharge takes place
without force, without effort, and merely by the watery-
part of the fluid, from the inert state of the vessels, leav-
ing the more consistent; and a sudden suffocation takes
place, in consequence of an effusion of fluids from all quar-
ters into the air vessels.
CCCLX. The carditis, or inflammation of the heart,
is a disease of rare occurrence, is ill understood, and for
Q the
(u) See par. CCCLl. and the note under it at (i).
(x) The direct debility may be owing to the proper cure, which is
directly debilitating, having been carried too far, or to the indirect de-
bility arising in the course of the disease, seldom now to alexipharmac
treatment. See above par. XLVII. and the subjoined notes. 


226 THE ELEMENTS
the most part a local affection. When the latter is the
case, there is no use for the interference of a physician.
And, if ever it be a general disease, it admits of no other
definition or cure but those of peripneumony. From pe-
ripneumony then, as it arises from the same antecedent
hurtful powers, and is removed by the same remedies, it
is not to be separated.
The Description of Phrenitis.
CCCLXI. Phrenitis is one of the phlegmasiæ (y), with
a slight inflammatory or catarrhal affection of some one, or
more joints, or of the sauces, with head-ach, redness of
the face and eyes, impatience of light and sound, watch-
fulness, and delirium.
CCCLXII. Inflammation, in its proper form, appears
not in this case. And yet there is an approach to inflam-
matory state in the joints, in the muscles, and especially
over the spine, or about the chest, or in the bottom of the
throat; or there is a catarrhal state, which is an affection
depending, however, upon the same cause, as inflammation,
and only differing from it in being less.
CCCLXIII. The head-ach, and redness of the face
and eyes, arise from an excessive quantity of blood in the
vessels of the brain and its membranes, distending, stimu-
lating in excess, exciting in excess, and contracting the
vessels, to a degree that gives pain (z). To the production
of which last inflammation is not necessary; independent
of which, this excessive action is painful, because it ex-
ceeds that mediocrity in which agreeable sensation takes
place (a). The redness both points out and explains the
over-proportion of blood. And that the over-proportion
gives pain by its distending operation, is shewn by the re-
lief
(y) See above par. CCCXLVII. 
(z) Sec above CLVII. and CLVIII.
(a) See par. CLXXXII. CLXXXIII. 
 

227 OF MEDICINE. 
lief that bleeding and every thing that diminishes the quan-
tity, and moderates the impetus of the blood, administers.
CCCLXIV. It is the overabundance also that produ-
ces the impatience of light and sound. For, as a certain
impulse of the blood is necessary to the exercise of every
sense, by wheting the organ of sensation (b); so, when
the cause rises to excess, an equal encrease of the effect
must be the consequence. But these very symptoms, with
pain, arise in an opposite state of excitement, to wit, the
asthenic.
CCCLXV. The vigilance and delirium are occasioned
by the same excess of excitement, produced by the excessive
stimulus of the abundance of blood and of the other pow-
ers. Other hurtful powers, contributing their effect, are
intense thinking, and a high commotion of passion. Excited
by those, no body, even in health, sleeps; and, therefore,
the wonder is the less, that a high degree of them, and
under the influence of a violent disease, should repel sleep.
Both encreased watching and delirium are symptoms of
disturbance.
An Explanation of the Sthenic Exanthemata.
CCCLXVI. The sthenic exanthemata, after the ap-
plication of a contagious matter, and of the usual hurt-
ful powers which produce sthenic diathesis, appear first in
the form of a sthenic pyrexia, or synocha, and then after
a space of time, not certain to a nicety, are followed with
small or larger spots.
CCCLXVII. That the exanthematic sthenic diseases
differ not from the other sthenic diseases not exanthematic,
Q2 in
(b) There is commonly in the organ where ahy nicety of sense is to
be exercised an extraordinary apparatus of blood vessels. Blood flowing
into these, encreases, by its heat and the stimulus of its motion, the sense,
to which it is subservient.


228 THE ELEMENTS
in any circumstance of consequence, is proved by this strong
argument; that, except the eruption and the phænomena
peculiar to it, there is nothing in the symptoms, and ex-
cept the contagion, there is nothing in the hurtful excit-
ing powers, but what happens in any sthenic disease;
and the preventatives, as well as the remedies, are the same
in all. While that is the state of the fact, it was the
height of absurdity, merely for the fake of the eruption and
its peculiar phænomena, to separate the exanthematic from
their kindred diseases, and to unite them with the most
opposite diseases both to them and to one another (c). For
how,
(c) The nosologists have separated the exanthematic diseases, real or
imaginary, into a class or order by themselves, which they have filled
up with diseases, of which there is not two, but the small-pox and mea-
sles, that have any other connection, than their mere eruptive appear-
ance, while they are separated from others, with which, in every respect, 
they have the most essential connection. Thus the small-pox and mea-
sles are taken from the natural place to which they are here restored.
And it is unaccountable, that we should have it to say, that even ery-
sipelas, which has surely no right even to the slim distinction of eruptive,
has also been placed among them. Again, the plague, which is to all
intents and purposes a typhus fever, its eruptive part not always disjoin-
ing it from that, is separated from it, though it is so nearly the same,
scarcely excepting degree, and conjoined with sthenic diseases of a dia-
metrically opposite nature. And the gangrenous sore throat, which is
also a typhus, has neither been placed among fevers, in its proper place,
nor among the exanthemata; to which the efflorescence, that it produ-
ces on the external surface, according to their own rules of arrangement,
seemed better to entitle it than some others, especially the erysipelas.
And it again (for there is no end of the confusion of this pretended order
of some physicians), is conjoined not only as a genus with sthenic dis-
eases, but even as a species of one of those genera. The truth is, that
systematics, who were otherwise no nosologists, have made too much
work about eruptive and contagious diseases, and have never dived into
the interior nature either of them or almost of any other. They have
all followed each other from their first leader, and never once deigned
to turn a glance of their eye upon the phænomena of nature as these
arose 
 

229 OF MEDICINE. 
how, when the usual plan of cure removes the effect of
the eruption, whatever that be, and thereby shews it to be
the same, can any one imagine, that the cause should be
different and not precisely the same? unless we must again
have to do with those who maintain, that the same effect
may, flow from different causes. Truly, the operation of
contagion, in so far as it affects general disease, is not of
an opposite nature to the general sthenic operation, but
precisely the same.
CCCLXVIII. Contagion is a certain matter, imper-
ceptible, of an unknown nature, and like most of the
phænomena of nature, only in any measure open to
our enquiry in its evident effects. Taken from the body
os one affected with it, or from any gross matter (such as
clothes or furniture, where it happens to have been lurk-
ing), and received into a found body, it ferments without
any change of the solids or fluids, it sills all the vessels,
and then is gradually ejected by the pores.
CCCLXIX. And, as no effect, except sthenic diathesis,
follows it, and the hurtful powers, that otherwise usu-
ally produce the diathesis, always precede it, and an ast-
henic or debilitating plan of cure always, and only, suc-
ceeds in removing it, and consequently its effect no ways
differs from the diseases hitherto mentioned; it is, therefore,
with justice, that the diseases arising from it, are conjoined
with those others, as belonging to the same form.
CCCLXX. Betwixt them there is only this difference,
that in the exanthematic cases of sthenic disease, the matter
requires some time to pass out of the body, which time is
different in different cases: and it passes out more copious-
ly
arose before them. Hippocrates misled his followers, they misled theirs
from age to age, and they all misled the poor nosologists. Who have
laid on the cap-stone of the absurdity of the art, and, having finished
the fabric of folly, lest mankind, is they are not pleased with it, to look
out at their leisure for a better and more solid. 


230 THE ELEMENTS
ly or scantily, the more free or impeded the perspiration
is (d). But it is impeded by no spasm, by no constriction
from cold, and only by the prevalence of sthenic diathesis
upon the surface of the body; as is evident from this fact
that cold, by its debilitating operation, procuring a free
issue for the matter, clearly promotes the perspiration (e).
And that it produces this effect, by diminishing the diathe-
sis, not by removing a spasm, has been demonstrated for-
merly. As the issue of the matter is in this way promoted
by inducing a free perspiration; so
CCCLXXI. Whatever part of it is detained below the
cuticle, by that delay, it acquires a certain acrimony, pro-
duces little inflammations, and conducts them, when pro-
duced, to suppuration. These, by irritating the affected
part, create a symptomatic pyrexia symptomatic sthenic
diathesis, which should be distinguished from the general
pyrexia and general sthenic diathesis (f).
CCCLXXII. The period of eruption is more or less
certain, because the operation of fermentation, being in
some measure certain and uniform, to that extent requires
a certain uniform space of time, for being finished, diffused
over the system, and reaching the surface of it, as is at-
tested by the effect. Again, it is not exactly certain,
because the perspiration, in the varying state of vigour,
that must occur, must, at different times, and under dif-
ferent circumstances, be more vigorous or more languid.
CCCLXXIII. The pyrexia, symptomatic of the erup-
tion, sometimes takes on the form of an actual fever:
The reason of which is, that the high degree of stimulus,
which the eruption throws upon the whole surface, produces
ultimately
(d) See above par. XXI. and LXXVI.
(e) See par. CXVII. CXVIII. CXX. CXXI.
(f) See above par. CLXXV. and CCCXLVI.


231 OF MEDICINE. 
ultimately excessive excitement, and therefore puts an end
to it in the establishment of indirect debility (g).
The Description of the violent Small-pox.
CCCLXXIV. The violent small-pox is a sthenic exan-
thema, on the third or fourth day of which, sometimes
later, small spots or points, inflamed, and by and by to
be transformed into exact pustules, break out; containing
a liquor which, generally on the eighth day after the erup-
tion, often later, is changed into pus, and dwindles away
in the form of crusts. The eruption, the degree of which
is always in proportion to that of the sthenic diathesis, in
this case is the greatest that ever occurs.
CCCLXXV. All these phænomena are governed by
the laws of fermentation, lately mentioned (h). The num-
ber of pustules, being proportioned to the degree of diathe-
sis, shows that, without the hurtful powers, that other-
wise, and without any co-operation of contagious matter,
produce that diathesis, the contagion has not much effect
in producing the real morbid state, and that it chiefly re-
gulates the exterior form of the disease (i).
CCCLXXVI. But a violent small-pox is distinguished
by the following symptoms: Before the eruption there
is a very severe pyrexia; this is succeeded by an universal
crust of pustules over the whole body. Antecedent to which
the hurtful powers are very violent sthenic ones, and par-
ticularly heat; the remedies that remove it are very asthe-
nic, and in preference to any of them cold.
The Description of the violent Measles.
CCCLXXVII. The violent measles is a sthenic exan-
thematic disease (k), beginning with sneezing, watery eyes,
dry
(g) See par. CCXV. CCXVI. 
(h) See above par. CCCLXVIII.
(i) Which, without diathesis, is of no consequence, and does not
amount to general morbid state. 
(k) See above par. CCCLXVI. 


232 THE ELEMENTS
dry cough, and hoarseness; on the fourth day of which,
or later, there appears an eruption of small numerous pa-
pulæ, or little points; that on the third day, or later,
terminate in an appearance of branny scales. This dis-
ease, when preceded with a high degree of sthenic diathe-
sis, is proportionally violent.
CCCLXXVIII. The sneezing, watery eyes, dry cough,
and hoarseness, are catarrhal symptoms, and, therefore,
depend upon sthenic diathesis (l). And, since they ap-
pear, four days or more, before the eruption, that is, be-
fore the matter might seem to have reached the affected
parts, and are constant and universal; hence are we to
suppose, that the sthenic diathesis follows the hurtful
powers, that usually produce it, and not entirely the pecu-
liar matter in this case, and that it is indispensably neces-
sary to the measles. But though that supposition should be
rejected, and it should be contended, that those symptoms
arise from the contagious matter; it still must be granted,
that this disease differs, however, in nothing from the
Other sthenic diseases, but equally depends upon sthenic
diathesis, and yields to antisthenic or debilitating remedies.
And it must be allowed, that, since the matter produces
the same effect as the usual hurtful powers, its operation
must be absolutely the same, and the cause of the disease
the same. Consequently, we find nothing in the indica-
tion of cure, but what is in common to this disease with
other sthenic exanthematic ones, which is, that time must
be given to the matter to pass out of the body, and the
perspiration be conducted in the same manner, as the
sthenic diathesis is usually treated upon other occasions (m).
CCCLXXIX. The eruption admits of the same rea-
soning that has been delivered (n). The circumstance
of
(l) See above par. CLXXV. 
(m) See above par. XCVI.
(n) See above par. CCCLXXV. 
 

233 OF MEDICINE. 
of its being a violent disease when preceded by a violent
sthenic diathesis, and mild in a mild degree of that diathe-
sis, is a further instance of the little difference that there
is betwixt the operation of contagion, and that of the or-
dinary powers producing sthenic diathesis.
CCCLXXX. When the diathesis runs so high as to
suppress the perspiration, the eruption often disappears
for a time, as if it went into the interior parts of the body:
Which is a danger, that is chiefly threatened at the end
of the disease; and shows, that this matter, in the same
manner as the variolous, kindles up a symptomatic in-
flammation over the surface of the body, and then, by a
farther increase of the diathesis, suppresses the perspira-
tion. Hence, with other viscera, the lungs (p) are often
inflamed.
CCCLXXXI.
(p) That the lungs should be inflamed in a violent state of the diathe-
sis in the measles is not to be wondered at; as the common catarrh,
when its diathesis runs high, is liable to produce the same effect. (See
par. CCCXLIII. towards the end). But, considering how many facts
in medical writings I have found false, the effect of that on my mind, is
to render the weight of testimony in favour of the various internal visce-
ra being so liable to be inflamed, from this supposed striking in of the
measly eruption, very light, and to dispose me to doubt of the fact alto-
gether; Which I am the more inclined to do, from the analogy of a
broad fact in direct contradiction to it: Which is, that the inflamma-
tion, depending upon the general diathesis in sthenic diseases, never, as
I have yet found, affects an interior part. (See par. CXIII. CLXVIII.)
Neither is inflammation, from any other source, near so frequent in in-
ternal parts as vulgar opinion has taught us Dissection has shown inflam-
mation in the intestinal canal ui dysentery, or what is called in English
the bloody flux. But that only happened under the evacuant, debilitat-
ing vegetable, plan of cure: and, even in that case, seems to have been
an ultimate, not an early, effect, much less a cause. And it has been
shown, that what has been considered as a burning inflammation in the
first passages, is not an inflammation at all. (See above par. CXCVIII).
Nay, even when inflammation does happen internally, it is never of 
the


234 THE ELEMENTS
CCCLXXXI. The violent state of the small-pox, of-
ten from the great stimulus of the eruption, converts both
the sthenic diathesis and eruption into the asthenic ones,
and thereby produces the confluent small-pox, of which
we are afterwards to treat. Whether any thing like that
is the consequence of the measles, is not yet ascertained:
But, as every excess of exitement, as in the conversion of
peripneumony into a dropsy of the chest, is liable to run
into indirect debility, it is, therefore, scarce to be doubted,
but that the same thing happens to this disease, which is
inferior to none in violence.
The Description of the violent Erysipelas.
CCCLXXXII. The violent erysipelas is a phlegmasia,
always beginning with pyrexia, and followed by inflam-
mation. The inflammation is seated in some external part
of the body, oftenest in the face, sometimes in the throat,
with redness, of an unequal edge, somewhat raised, creep-
ing from one place to another, and attended with a sense
of burning.
CCCLXXXIII.
the sthenic, but always of the general, or local asthenic kind, and, when
quickly cured, cannot be inflammation. If there be any truth in the
frequency of inflammation towards the end of the measles, it must be
of the asthenic kind. Which is the more likely from its late appearance,
and from a circumstance that, though no where taken notice of, has
great weight with me; which is, that the distinct small-pox passes into
the confluent, peripneumony into dropsy of the chest, and any sthenic
disease with its diathesis, into any asthenic disease, and the diathesis on
which it depends; there is nothing in the nature of the animal œcono-
my and of the powers acting on it, to prevent the same conversion of
sthenic into asthenic state in the measles. And if, which is most pro-
bable from the alexipharmac practice, that was then used in this disease,
indirect debility can induce such a change, no disease has a fuller chance
for it than the measles. But I am sure, were the debilitating plan used
from the beginning, no such consequence would happen. 
 

235 OF MEDICINE. 
CCCLXXXIII. It is peculiar to this inflammation,
and foreign from the other general ones, to invade the
corpus mucosum. To assign a reason for which is of no
consequence; since this inflammation does not differ from
the others either in the operation of the exciting powers
producing it, or in that of the remedies which remove it.
CCCLXXXIV. The cause of the redness of the in-
flammation, in this as well as in every case, is an excessive
quantity of blood in the inflamed vessels; for the question
about the degree of redness is of no importance. There
is less swelling in the inflamed part, than in other sthenic
inflammations, because there is here a free space betwixt
the scarf-skin and true skin, allowing the effused humour
room to spread and diffuse itself. The same is the cause
of the flow motion of the inflammation, and of the inequa-
lity of its edges. The sense of burning is owing to an
acrimony of the contained fluid, acquired by stagnation.
CCCLXXXV. The attack of the inflammation upon the
face is not more dangerous than upon any other place,
except when the diathesis, upon which it depends, is great,
rendering the inflammation proportionally great (q). In
which latter case, whatever part is inflamed, the disease
must be held for a severe one; but still severer, if the in-
flammation seizes the face; in which case a great tumult
of affection internally accompanies the disease.
CCCLXXXVI. When such a sthenic diathesis, and af-
fection of the head depending on it, happens, no disease
is more dangerous, none more rapid in its race to death;
while in a mild diathesis no disease is milder.
A Description of the Rheumatism.
CCCLXXXVII. Rheumatism is a phlegmasia, espe-
cially in that temperament, which inclines to the san-
guine.
(q) See par. LXXXV. CCCXLIII. 
 

236 THE ELEMENTS
guine. It is a consequence of heat succeeding to cold, or
so alternating with it as to prove the more stimulant: It
is accompanied with pain nigh, or between, the joints,
chiefly the greater ones, and proportioned to the degree
of the diathesis (r): And the inflammation always comes
after the pyrexia.
CCCLXXXVIII. External temperature is hurtful in
this disease in the same way, as it has been often now ex-
plained (s). 
CCCLXXXIX. The rage of the pain is in the parts
that have been mentioned (t), because it is in these parts
that the inflammation, or more encreased part of the gene-
ral diathesis (u), chiefly acts. Which again happens, for
this reason that the nearly most powerful of the exciting
hurtful causes, the temperature, that has been mention-
ed (x), is only directed thither. There is no translation of
the inflammation to the internal parts, for this reason, that
these parts, which preserve nearly an equal temperature
amidst every change of it externally, are not acted upon
by the same hurtful power which annoys the external parts.
CCCXC. Cold, according to the common opinion,
is not hurtful in this disease; because the rage of the dis-
ease is greatest under the operation of heat, which has an
effect quite opposite to that of constriction (y). This fact
is confirmed by stimulant diet, in all its articles, proving
always hurtful, and by abstinence being always service-
able, and often alone making out the cure. And it brings
a sufficient refutation of that mistaken notion, according to
which, temperature is alleged to be more hurtful, and
sweating more serviceable, than is consistent with the
truth; as if there were no other hurtful powers but the for-
mer, no other remedies but the latter. In this, as well as
in all other general sthenic diseases, it is the general sthenic
diathesis
(r) CCCXLIII. 
(s) CXIII. et passion. 
(t) CLXVIII.
(u) Ibid. 
(x) CXIII. 
(y) Ibid. 


237 OF MEDICINE.
diathesis alone that produces, and the solution of it alone,
that removes the disease. Which is a clear fact, and sup-
ported by the evidence of every part of this doctrine that
has yet been delivered. The pains of parts, which some-
times precede this disease, oftener happen without being
followed by it, and that, in both cases, have nothing to do
with sthenic diathesis, upon which this disease entirely
hinges, are a local affection, or belong to a very different
general disease, rheumatalgia, of which more afterwards (z).
CCCXCI. The reason of the greater joints being
affected in this disease, and the lesser ones in the gout, is
the following: In rheumatism, because both the rest of
the disease and the pains depend upon a violent sthenic
diathesis; therefore it is, that the greater joints, which,
for the reasons assigned, undergo more of the diathesis,
have also a greater share of the disease. But as the gout
consists in debility, its influence will be greatest, where
there is naturally the greatest debility, and therefore in the
extreme parts, and those most remote from the centre of
activity (a).
A Description of the mild Erysipelas.
CCCXCII. Both the definition and explanation of the
violent erysipelas (b), delivered before, suffice for those
of
(z) CCCLIII.
(a) To make this subject simple to any apprehension. A person has
been exposed to intense cold a whole day. He comes home at night, is
set by a warm fire, receives hot meat and warm cordial drink. He is
next covered up in his bed with an addition of clothes, receives more
warm strong drink. He falls asleep, and next morning feels a pain in
some part or other of his upper extremities, high or between, the great
joints; and, previous to that, a high flats of heat and bouncing pulse,
with a certain feeling of uneasiness in different parts of his trunk. The
pains encrease in the bed next night in proportion to the encrease of the
general affection; and cold, evacuation, and abstinence from food, from
alternation of temperature, cure him.
(b) From CCCLXXXII. to CCCLXXXVII. 
 

238 THE ELEMENTS
of the mild; but in such sort, that the latter, both in its
antecedent hurtful powers and symptoms, and in the whole
nature of its cause, must be understood to be much mil-
der than the former, and not only so, but a remarkably
mild disease.
CCCXCIII. It is often not so much a sequel of the
sthenic cynanche, which is commonly called tonsillar, or
the common inflammatory sore-throat, as a supervention
upon it before it has finished its course. It often appears
alone and unaccompanied with the cynanche, arising from
a similar lenity of the hurtful powers, and manifesting a
similar mildness of symptoms through its whole course.
CCCXCIV. Nay, in the same persons, in the same
state of the hurtful powers, sometimes the erysipelas, some-
times cynanche, sometimes catarrh, promiscuously arise,
and are all removed by the same gentleness in the method
of cure (c).
A Description of the Cynanche Sthenica.
CCCXCV. The sthenic cynanche is a phlegmasia, with
an inflammation taking place in the throat, and especially
the tonsils, never preceding the pyrexia. It is accompanied
with swelling and redness, and an aggravation of pain in
swallowing, especially any thing fluid.
CCCXCVI. The reason for the inflammation occupy-
ing the place mentioned here, has been given before (d).
And,
(c) I have often experienced them all, sometimes singly, sometimes
all three, in the course of the same disease, oftener a combination of in-
flammatory sore-throat, and the mild erysipelas, and, as far as I could
observe, could discern, that the degree of phlogistic state that produced
them, and of remedies that removed them, were both gentle, the for-
mer as stimulants, and the latter as debilitating powers; and both so
nearly of the same degree, that in arranging them, I was at a loss which
to place over the other in the scale.
(d) See CXIII. CCCXLII. 


239 OF MEDICINE. 
And, when it has once taken place, it is afterwards ti-
llable to frequent recurrence, because its seat being in the
way of the most hurtful power (e), and less covered than
other parts (f), is exposed: And the vessels first distended
by the inflammation, and then afterwards relaxed, take in
an over-proportion of blood upon every increase of its im-
petus (g).
CCCXCVII. As the inflammation, like that of the
other phlegmasia never precedes the pyrexia (h), for the
reason assigned (i); so, if an unskilful person should think
it did, the reason of that is the gradual degeneracy of the
general sthenic inflammation into a local disease, from its
frequent recurrence, and always leaving a taint behind it
in the affected part. This latter inflammation may happen,
without a general sthenic diathesis, and therefore, without
being followed by a sthenic cynanche; and it may acci-
dentally coincide with the former, or sthenic diathesis, and,
therefore, precede the latter or sthenic cynanche: But, in
both cases, it ought to be distinguished from the pure ge-
neral case, for the sake of guarding against the commission
of a hurtful mistake in the cure (k). In an asthenic habit,
whether succeeding to the former or not, there is again an-
other
(e) Heat and alternation of temperature. See XXXVI. with addition,
(f) See par. CLXVIII. Ione is walking in the evening, when a
sudden fog comes on, with cold and chilliness, he may cover his throat
externally, but it is impossible to defend it internally.
(g) This is so liable to happen, when any person has once experienced
this disease, that the encreased motion of the blood in walking in a warm
day, and then sitting down in a cool place, has sometimes produced oph-
thalmia, sometimes this sore-throat.
(h) See the definitions of them all, &c.
(i) See par. CLXVIII. CCCXLIII.
(k) This might happen to a person under an asthenic diathesis, which
would be encreased by the debilitating plan of cure, and would be useless
in the absence of diathesis; 


240 THE ELEMENTS
other general inflammation, to be referred to asthenic dis-
eases.
CCCXCVIII. If any person can explain why the
pain is aggravated in swallowing, he may communicate his
knowledge; if he cannot, it is no matter.
CCCXCIX. The cynanche oesophagaea has been here
omitted, because it is a rare affection, and admits of
the same reasoning and cure as the tonsillar, from which
it differs not but in the inflammation being farther down,
and in some redness only coming within view. But, as a su-
spicion that it may be local, as when the aesophagus hap-
pens to be eroded or burnt, by a stimulus, or some acrid
matter; the distinctions, therefore, should be attended
to (l), and made use of for the sake of practice.
CCCC. There is likewise a rare disease, sometimes
happening in certain countries, never in others, called the
croup (m). In it the respiration is laborious, the inspira-
tion sonorous, with hoarseness, a ringing cough, and a
swelling scarce to be discerned (n). It is a disease that in-
fects very young children almost only. And in all other
particulars it is of a doubtful nature (o). 
CCCCI. Concerning which, when it happens to oc-
cur in practice, use the following marks of judgment. As
the sthenic diathesis, in the degree requisite for the forma-
tion of actual disease, which depends upon a high degree of
2 diathesis
(l) See above LXXXI. LXXXIII. CLXX.
(m) by nosologists cynanche stridula.
(n) It is perceived upon dissection of the dead subject.
(o) I never saw this disease, but when I was so young a student, that
any observations I could make, can be of no use to me now. There
have been many battles of words about, whether it be inflammatory or
spasmodic, without any adequate meaning of the difference betwixt
these two words, at least so far as to influence the practice; which re-
mained much the same betwixt the parties, and probably the right one
missed by both.


241 OF MEDICINE. 
diathesis, happens less, either in the beginning, or to-
wards the end of life; because the high degree of excitabi-
lity in the former, and the low degree of it in the latter,
admit a smaller degree of the effect of the exciting power,
that is, a smaller force of excitement(p), than the long pe-
riod of human age betwixt these two extremes; yet it is
not altogether foreign from either (q). In childhood, the
high degree of excitability compensates for the slightness
of the stimulus; while, in old age, the high degree and
force of the latter may compensate for the deficiency of
the former, and suffice to induce some sthenic diathesis,
even to that degree which constitutes disease. In this way
infants undergo wonderful vicissitudes of excitement, and
within the shortest spaces of time. This day they will
show every sign of extreme debility, next day every one
of restored vigour; because the operation of any stimulus
given them soon rises to its highest, upon account of their
high degree of excitability, and sinks as soon to its lowest,
upon account of its own small degree (r). Hence every
sthenic diathesis, that happens to them, is short, acute,
and soon removed (s); nor is their asthenic state of long
continuance, or difficult to be removed; provided there is
no local affection (t), and a proper method of cure is em-
ployed (n).
2R CCCCII.
(p) See par XXV. and XXVI.
(q) Though it is seldom that either a child, or very old man, will be
so sthenic as to need bleeding and much evacuation, yet they will some-
times.
(r) A child of mine was given over for death by his nurse: His mo-
ther gave him some of the diffusible stimulus. He slept two hours, and
waked he waked made signs; for he could not yet speak, to have a little
pie, most of which he ate.
(s) A single gentle purge will do it.
(t) which very seldom, indeed, happens,
(u) Which, till of late, has been very rare: The antiphlogistic cure
has made away with three-fourth of mankind, before they arrived at
the seventh year of their age. 


242 THE ELEMENTS
CCCCII. The marks of sthenic diathesis at this age
are, great frequency of pulse, when compared with that
of adults, more frequent than their own in health, dis-
tinctly meeting the singer upon feeling it; a boundishness
of belly at first, which becomes more free in the progress
of the disease; dryness of the skin; burning heat, thirst,
hatching, strong crying.
CCCCIII. The signs of the asthenic diathesis at the
same age are, a pulse not to be reckoned from its frequen-
cy, small, falling softly like snow upon the singer of him
who reckons it, so that he is uncertain if he touch it at-
all; a very loose scouring belly, with green matter; fre-
quent vomiting; dryness of the skin, heat greater than
natural, and greater in some parts than others; interrupted
sleep, never refreshing; a feeble voice in crying, fit to
excite compassion.
CCCCIV. The former diathesis, besides other hurtful
powers, is preceded by the use of found milk, animal food,
an abuse of opium or strong drink; excessive heat after cold
and moisture, which latter encreases the debilitating effect
of the former; a strong set of simple solids.
CCCCV. The latter, together with the known hurt-
ful powers, is preceded from the use of milk by a weak,
sickly nurse; that of vegetable food, with sugar in it; wa-
tery diet; watery drink; habitual vomiting, habitual pur-
ging, both by other means used for the latter, and particu-
larly by magnesia, given with the intention of absorbing
an acid; cold not followed by heat; a weak mass of
simple solids.
CCCCVI. Consider which of these sets of signs pre-
cede or accompany the croup, and whether its pyrexia be
sthenic or asthenic. Weigh the different sentiments of
authors upon the subject. Suspect their theories, but their
facts still more. Be on guard not to be misled by the va-
nity, emptiness, and rashness of young physicians; as well
as 


243 OF MEDICINE.
as by the obstinacy and bigotry of the older sort, that en-
creases with their age and practice, to be bent by no force
of reasoning, no weight of truth, scarce by the power of
God: Regard their minds as bound in the setters of preju-
dice: Remember, that a whole age of physicians were in
the wrong, except one man (x), and persisted obstinately in
their error, in the case of the Alexipharmac physicians:
And, reflect within yourself, good reader! whether the pre-
sent physicians, who follow the doctrines delivered in the
schools, judge better than their predecessors, and do not run
into the contrary extreme of madness, doing as much mis-
chief in fevers, and diseases of pure debility, as they did in
sthenic diseases, and in fact take a wide range of spreading
destruction among mankind. Thus secured against mis-
take, consider the cures of this disease that have appeared.
If in those, or in any trial that you may make, you shall
R2 find
(x) The improvement that Dr Sydenham made was good for the
length it went, which was, to use cool and gentle evacuants for the cure
of the small-pox, peripneumony, and one or two more of the sthenic dis-
eases. The bias, in favour of the alexipharmac practice, for the cure
of catarrh and measles, he never got over. His theories were vague,
but with respect to the practice in the diseases among which his refor-
mation lay, they were innocent. He attained not any idea of the na-
ture of diseases depending on debility: And his practice was hurtful in
them: He fell a victim to his gout, which could not have happened had
he been acquainted but with one disease of the debility. His practice,
even when right, was destitute of principle: he had no sort of compre-
hension of the doctrine of life as a whole, and as a department of know-
ledge distinct from all others. It would have been lucky, however, for
posterity, had his successors done as much in asthenic, as he did in sthenic
diseases. From that beginning, the ingenuity of some, at last under a
right direction, might have brought out more information, and by gra-
dual and sure steps, at last attained a comprehension of their whole sub-
ject. But professors of universities ruin every thing: For while they
find out nothing themselves, they throw into false lights the useful hints
of others. This was the effect first of the Boerhaavian, then of the Hoff-
manian and Stahlian doctrines. See our Observations, Outlines,
p. lxxxiv. to cxlix. 


244 THE ELEMENTS
find that either bleeding and purging, or antispasmodics, as
they are called, that is, stimulants succeed; then be as-
sured, that in the former case, the disease is sthenic, in
the latter asthenic; of which you will be still more certain,
if you shall find that the exciting hurtful powers and symp-
toms, which have been enumerated, at the same time
agree with the other marks of judgment.
A Description of Catarrh.
CCCCVII. Catarrh is a phlegmasia, in which, to the
general symptoms mentioned before (y), are added cough;
hoarsness; and first a suppression, or slight encrease of
the excretion from the nose, fauces, and bronchia, fol-
lowed afterwards by a further encrease; arising from sti-
mulant powers, often heat alone, but chiefly after a pre-
vious application of cold; and to be removed by debilitating
powers, often by cold alone, guarding against heat (z).
CCCCVIII. The explanation of the cough is the same
as that given before. But it is freer, than in peripneumony,
and not avoided, because there is no inflammation in the
neighbourhood to aggravate it, and raise pain (a).
CCCCIX. That the hoarseness is owing to a suppres-
sion of the vapour that should be exhaled into the bron-
chia, may be known from this; that, when the hoarseness
has remained long, almost without expectoration and
cough, or with a moderate degree of them, while the
sthenic diathesis continued in full sorce, and did not abate
in the bronchia; upon the diathesis giving way, and the
expectoration and cough becoming more free, the hoarse-
ness abates, or goes off. That this can be effected by a
stimulus
(y) CCCXXXI.
(z) See par. CXII. CXlIV. CXVII. CXXII. and all the stimulant pow-
ers, from CXII. to CXLVII.
(a) See par. CLX. CCCLV. 


245 OF MEDICINE. 
stimulus of that kind and degree, that constitutes sthenic
diathesis, is shown by the effect of strained speaking pro-
ducing temporary hoarseness, by silence removing the
hoarseness, and cold drink relieving it.
CCCCX. The suppression of excretion is that of the
mucus and exhalable fluid, related before (b), and it ad-
mits of the same explanation that was formerly given.
CCCCXI. That stimulants produce catarrh is evident
from this, that heat alone, fulness in food, strong drink,
and moderate exercise, for certain produce it; cold, cold
drink, spare diet, and rest, as certainly and effectually re-
move it. It was, therefore a very unlucky mistake, to
think it arose from cold alone, and was to be cured by
heat. On the contrary, cold is never hurtful in it, but when
its action is succeeded by that of heat, to be explained as
before (c). The occurrence of catarrh so often in summer,
where its action can be a thousand times traced back to
heat, but not to cold; the influenza never needing the
assistance of cold, which catarrh often does, in the man-
ner just now said; its never succeeding to pure cold, but
immediately to heat, facts known to old women, to shoe-
makers and taylors, to sore-eyed persons and barbers, un-
known to medical authors and professors, all confirm the
same fact.
A Description of the simple Synocha.
CCCCXII. The definition of simple synocha is the
same with that of phrenitis (d), excepting the symptoms
affecting the head. It is a slight disease, ending in health,
often in one, always in a few days, unless when new hurt-
ful powers, either accidentally, or from the use of a stimu-
lant plan of cure, have been superadded.
A De-
(b) See par. CCCCVIII. 
(c) See CXXII.
(d) See par. CCCLXI. 


246 THE ELEMENTS
A Description of the Scarlet Pyrexia.
CCCCXIII. The scarlet pyrexia is an exanthema (e);
about the fourth day of which, or later, the face swells
somewhat, and at the same time the skin is here and there
affected with a red efflorescence, and then chequered with
large spots; which are afterwards to unite, and in three
days to end in little scales, as if branny ones. This erup-
tion does not arise, but in consequence of sthenic diathesis
produced from another source. And there is another si-
milar to this, which accompanies an opposite disease, af-
terwards to be mentioned.
CCCCXIV. The eruption, appearing at a certain time,
and remaining for some time, must be imputed to the
fermentation, requiring a certain time, different in differ-
ent diseases, and is to be explained in a similar manner as
before (f).
CCCCXV. The swelling of the face depends upon a
greater degree of sthenic diathesis there, than any other
equal part. And we are to imagine, that, besides the hurt-
ful powers that usually produce it, it is encreased by the
contagious matter, now approaching the surface.
CCCCXVI. This matter of itself produces no morbid
state, only giving the exterior and exanthematic form (g),
and following the nature of the sthenic or asthenic diathe-
sis. Hence, after its application, the disease that arises is
sometimes sthenic, as this is, of which we have given a
definition, sometimes asthenic, as that disease which we
are afterwards to mention in its proper place, This view
of it serves to reconcile the jarring and contradictory ex-
planations, and methods of cure of authors, who have
gone into such controversies to settle its nature.
A De-
(e) See CCCXXX. 
(f) See par. CCCLXVII. and CCCIXXVIII.
(g) See par. CCCLXXV.


247 OF MEDICINE. 
A Description of the mild Small-Pox.
CCCCXVII. The definition of the mild and violent
small-pox is the same; excepting that there are often very
few pustules, never exceeding one or two hundred in num-
ber: Sometimes the place only, which was inoculated, is
beset with pustules, without any other in the rest of the
body; and besides these, there may be only one.
CCCCXVIII. The number of pustules and crowded
eruption is occasioned not by the nature of the contagious
matter, nor by its quantity, but by the sthenic diathesis,
in so far as it is induced by the sthenic hurtful powers, in
which the matter has very little participation (h). If,
therefore, that diathesis be prevented, and especially upon
the surface, the eruption will never be crowded; and, af-
ter it has appeared, if it be immediately removed, the erup-
tion will never be dangerous.
CCCCXIX. As the contagious matter does not con-
tribute much towards sthenic diathesis, for the reasons al-
ledged (i); so, that it does contribute something, is prov-
ed by a crowded eruption both appearing and encreasing,
when the diathesis, after the reception of the contagion,
was not encreased by the ordinary hurtful powers (k).
CCCCXX. And, therefore, while the excitement should
be reduced below that degree which suits perfect health;
there are, however, certain boundaries, beyond which
we should not proceed in the debilitating process.
CCCCXXI. For, when the sthenic diathesis is very
much reduced, and the excitement immoderately diminish-
ed,
(h) See par. CCCLXX. CCCLXXII. CCCLXXV.
(i) From CCCCXVII. to CCCCXIX.
(k) This indeed is a clear proof, that the matter contributes some-
thing, and that there may be a degree of diathesis, compatible with
health, unless when it is encreased, and the perspiration diminished, by
such contagious matter. 


248 THE ELEMENTS
ed, there appears over the whole body, an eruption quite
unlike the variolous, of a high scarlet colour, and in its
progress proceeding constantly from a spotted appearance
into a continued sheet of efflorescence (l); which, unless
treated upon a stimulant plan, would prove fatal.
A Description of the Mild Measles.
CCCCXXII. The definition of the mild measles is the
same with that of the violent. To which all the reason-
ing that has been employed about the small-pox will ap-
ply. If, immediately upon the arrival of the catarrhal
symptoms, the asthenic diathesis contrary to every mode
of curing this disease hitherto thought of, be removed;
often no disease of that kind which affects the whole body,
follows. And the disease always proceeds with the same
gentleness as the small-pox treated in the same way (m).
CCCCXXIII. The catarrhal symptoms are of the same
nature as in the catarrh, and admit of the same cure, that
is, asthenic (m).
CCCCXXIV. Catarrh, and simple synocha, are free
from all inflammation, whether general or local. The
scarlet fever, and the mild small-pox and measles, are free
from the general, and exhibit upon the surface a local in-
flammation of no consequence (n).
A Description of the Sthenic Apyrexia.
CCCCXXV. The sthenic apyrexiæ which are equally
free of pyrexia (o) and every degree of inflammation, arise
from
(l) from the top of the head to the ancles. See above par. CCXX.
and two notes.
(m) All this has been well proved by every cut of my children, and
by an hundred patients at once.
(n) See par. CLXX. and CCXI. 
(o) See par. CCCXXIX. 


249 OF MEDICINE. 
from a sthenic diathesis, that has less effect upon the vas-
cular system, than the other sthenic diseases (p).
A Description of Mania.
CCCCXXVI. Mania is a sthenic apyrexia; in which the
mind is disordered, and forms false ideas of every thing.
CCCCXXVII. In so far as mania does not arise from
a fault of the substance of the brain, which is a local
case that sometimes happens: the powers that have the
chief share in producing it, are excessive exercise of the
mental function, and a high exuberance of passion. These,
however, while they act more upon the brain than any
other part, at the same time do act more or less also upon
the whole body, though not to the degree of drawing py-
rexia after them (q). Which is proved by the disease be-
ing cured by a debilitating plan, and by other stimuli,
as well as those just now mentioned, not immediately
applied to the brain, but to a distant part of the system
from it.
CCCCXXVIII. The most powerful of those stimuli
are, spirituous or vinous drink, and opium, and, perhaps,
some other things, taken into the stomach, and first acting
there. Of the other asthenic hurtful powers, some of them-
selves, and operating alone, have less effect in inducing ma-
nia, and yet, even they, by their stimulant operation en-
crease the force of those, that have that hurtful effect;
as is proved by the effect of removing them in relieving
the disease.
CCCCXXIX.
(p) So much so, as never to have been thought in any sort connected
with that affection we call pyrexia.
(q) Compare this with par. XLIX. L. LI. LII. LIII. and indeed with
that whole chapter, as the severest trial of the truth of it; nothing being
more natural, than than the supposition that a mad man is only affected
in his head, but we shall find that not true. 


250 THE ELEMENTS
CCCCXXIX. If poisons sometimes produce mania,
without hurting the substance of any solid part, their ope-
tation must be supposed the same, as that of the general
stimulants, their effect the same, and the disease a genera
one, and the same (r). But if these very poisons act by de-
stroying the texture of a part, they must be considered as
the origin of a local disease (s).
CCCCXXX. The heart and arteries are less affected
in mania, than in any of the pyrexial diseases; because, the
hurtful power, which chiefly affects the vessels, too much
food, has less concern in the number of the hurtful pow-
ers here. And yet that the food, superadded to the other
hurtful powers, does prove hurtful even in this disease, is
evident from a contrary power, abstinence, being, among.
other remedies, found of very great efficacy in restoring the
healthy state. Which, with what has been said above,
proves that mania is not a disease confined to a part, but
extended to the whole system.
CCCCXXXI. Although, in the diseases that have just
now been mentioned (t), the pulse is commonly said, and
believed, to be not at all affected, that, however is not
exactly the truth; for in mania, so long as it continues to
be a sthenic disease (u), more or less of sthenic state can be
perceived (x).
The Description of Morbid Watchfulness.
CCCCXXXII. Pervigilium, or morbid watchful-
ness, is a sthenic apyrexia (y); in which there is no sleep,
or
(r) See par. XX. 
(s) See par. V. VL. XX.
(t) from CCCCXXV. to CCCCXXXII.
(u) that is, so long as it is realy mania,
(x) The characteristic of hardness of the pulse is never wanting, and
therefore also fulness. See CCCXXXIV.
(y) See par. CCCCXXV. 
 

251 OF MEDICINE. 
or no found sleep, and the mind, in a startled state, is agi-
tated with vivid, strong, or uneasy impressions.
CCCCXXXIII. The hurtful powers, that produce
perviligium, are the same with those that produce mania,
but inferior in force. It is evidently produced by hard
thinking, commotion, or disturbance of mind, in prefer-
ence to other hurtful powers. The degree of thought, that
has that effect, is not ultimately excessive; for, if it were,
by effecting a temporary waste of the excitability, it would
produce found sleep; or if it repelled sleep, it could only
act so, by means of indirect debility, the consideration of
which is foreign from this place (a). And the same is the
degree of disturbance of feeling, that proves hurtful, in so
far as it produces this disease: Every ultimate excels of
which (b), either ends in sleep, or induces that vigilance,
of which indirect debility is the cause. But it is not a sin-
gle operation of the intellectual faculty, or of the state of
any passion, or one that happens but rarely, that proves
adequate to the effect. For the effect, in that case, would
be either too slight, or of too short continuance; to merit
the title of disease. It is an often returning, or, deeply af-
fecting, irritation upon the brain, and, therefore, one that
leaves a lasting impression, which has any considerable
force in producing this disease. In this last way, an eager,
inordinate, and vast desire for the attainment of high ob-
jects of pursuit, the impulse that hurries on to the revenge
of a great injury, and the horror that arises upon the per-
petration of it, the fear of future punishment for crimes,
are held up to us as productive of high commotion of mind,
in the examples of Cataline, Orestes, and Francis Spira.
As often, therefore, as the mind is so excited in its ideas
and passions, as not to be capable of being composed to rest
and found sleep, after a certain short continuance of those,
or
(a) Sec CXLI. 
(b) See CXLI.
 

252 THE ELEMENTS
or other stimuli; so often are we to conclude, that this
disease takes place.
CCCCXXXIV. As the hurtful powers just now men-
tioned(c), produce this disease; so there are others, which
belong not to this place, but are to be mentioned, that al-
so repel sleep.
CCCCXXXV. To pervigilium belong all the hurtful
powers that have been already mentioned in mania (e),
whether acting within or without the brain, but acting
with less force, and which yield to the asthenic plan of
cure.
CCCCXXXVI. As the powers stimulating vigour-
sly in this way (f), and without any dimunition of their
sum of stimulating, produce pervigilium; from that we learn
that the cause of this disease is the same with that of the
rest of the sthenic form of diseases (g), and that the same is
the state of the body in which every one of those diseases
consist: Nor is it understood, that different hurtful powers,
but precisely the same, with only a variation in the propor-
tion of their force, which often happens to other sthenic
diseases precede this disease.
CCCCXXXVII. The same fact is also discovered from
the functions, of which, though these diseases are called
apyrexiæ, or without pyrexial state, the pulse, however,
is not altogether free of disease (h). On the contrary, it is
as much stronger than in health, in the predisposition
asthenic to diseases, or in those diseases themselves, as there
is more vigour, and more excitement upholding that vi-
gour, in the system (i). And the state of the other func-
tions,
(c) See the par. CCCCXXX. and CCCCXXXIII.
(e) See from CCCCXXVI. to CCCCXXXII.
(f) See CCCCXXCIII. 
(g) from CXLI. to CXLVIII.
(h) See CCCCXXX. and CCCCXXXI. and the note to the latter.
(i) For a proof of their vigour meniacs have often four times the
strength, they used to have in health. 
 

253 OF MEDICINE. 
tions, except those of the brain, that are chiefly affected,
is truly the same as in the milder sthenic affections, or in
the predisposition to these. But, if the brain in this dis-
ease, and in mania, is much more affected than the rest
of the body; there is nothing unusual in that circum-
stance; it being an universal fact with respect to both dis-
eases and the predisposition to them, that some part is
more affected than any other part (k).
A Description of Obesity.
CCCCXXXVIII. Obesity is a sthenic apyrexia (l); in
which in consequence of an excessive health, rich living,
especially in the article of food, and an easy sedentary way
of life, the fat rises to the degree of incommoding the
functions.
CCCCXXXIX. That obesity, so defined, is a disease,
is understood from the definition of disease (m); and that
it is a sthenic disease, appears from the certain signs of
sthenic diathesis in it. Of which, the strong action of
the stomach, whether the appetite or the digestion be
considered(n), and the strength of the other digestive or-
gans, are a glaring proof.
CCCCXL. And as in this disease, the stimulus of the
exciting powers, raises the excitement above that degree
of it which suits good health, to that in which sthenic
diathesis consists, without which last there could not be
such force in the action of the stomach, and of the organs
that form chyle and blood; so it is in common to this
with the other diseases called sthenic apyrexiæ that the
sum of all the stimuli is much less than in the other
diseases of the same form, that is, those with pyrexia and
inflammation; that it never rises to the extreme height
at which indirect debility is produced, and is never indeed
so
(k) See part first, Chap. IV. and in it XLIX. and LII. CLIX. CCV.
(l) See CCCCXXV. 
(m) See IV. 
(n) See par. CCLXII.


254 THE ELEMENTS
so great as to be sufficient to have any considerable effect on
the heart and vessels.
CCCCXLI. But it happens to all those diseases, that
both these last and all the other functions, get somewhat
above the standard of the found functions, and a great
deal above asthenic diathesis. And the sthenic apyrexiæ
differ from the other sthenic diseases chiefly in this, that the
exiting powers keep much within that degree of force, that
wastes the excitability much; as is perceived from the
proof of the effect; for they are diseases of much longer
standing than any other asthenic diseases.
CCCCXLII. From which fact, however much the
brain may be affected by its own proper stimuli; however,
great the quantity of blood in its vessels may be; unless to
the excitement arising from these, that excitement, which
the other stimulant powers produce, be added, it is cer-
tain, that the general effect will be much less, and that
the united energy of all the powers has more effect, than
the separate force of any.
CCCCXLIII. The diathesis, then, in these diseases,
is upon the whole, less than in the rest of the sthenic dis-
eases; that of a part, as of the brain in mania and pervi-
gilium, and of the blood vessels in obesity, is pretty consi-
derable. The whole is in general as great as that in the
predisposition to the other diseases, and exceeding its force
in the labouring part. Hence it comes out, that, con-
trary to the nature of those other diseases, and similar to the
predisposition to them, they are usually of long standing
and duration, and for this reason, that the mediocrity of
the sum of stimulant operation never consumes the excita-
bility, and always produces too much excitement. The
great tumult of symptoms in the brain and blood-vessels in
these diseases does not imply a great sum of excitement,
for this reason, that the affection of a part, however for-
midable, compared with the affection of all the rest of the
body, 


255 OF MEDICINE. 
body, is infinitely inferior in its degree (o). However
much then, any stimulus presses upon a part, and from
that spreads at large over the rest of the body; unless, how-
ever, other stimuli, applied to other parts, sustain its ope-
ration, so as that the sum of the operation of them all
may deeply affect the whole body; the effect of the soli-
tary stimulus, making a figure in a part, will be less consi-
derable in the rest of the body: In fine, it must be kept
in mind, that every violent disease always arises from the
excitement which the united force of several stimuli has
produced.
CCCCXLIV. In these sthenic apyrexiæ, as a certain
part, the brain in the two first, and the blood vessels in
the last (p), is much more affected, and in greater propor-
tion, than in the other sthenic diseases, because the affec-
tion of the part is much less supported by stimuli acting
upon the other parts; so the stimuli, acting in that way
apon the labouring parts, are, however, understood to
affect the rest of the body, though less considerably. That
this is the fact, is proved by there being in this case, no
asthenic diathesis, and evidently such a sthenic one, as up-
holds the predisposition to other diseases of the sthenic
form; by the remedies, which affect other parts, as it will
by and by appear, being aiding in the cure here, and by
powers of a contrary nature, always proving hurtful.
Whence, it is an evident and certain truth, even here,
where it might have been least expected, that every stimulus
that affects a part, affects the whole body, upon account
of the excitability being one uniform. undivided, property
over the whole.
CCCCXLV. With respect to obesity in particular;
that the other hurtful powers, as well as food have more
or less effect, one may know from the certain fact of the
digestive
(o) Sec par. XLIX. to LIII. 
(p) See par. CCCCXLIII. 
 

256 THE ELEMENTS
digestive powers, which depend upon the influence of
these powers, being of such force and vigour, as to perform
their functions more perfectly in fat persons, than in
others, who are, nevertheless, not by any means weak.
Yet these hurtful powers are applied in a degree short of
that, which being ultimately excessive, or approaching
nearly to that, puts an end to excitement by wasting the
excitability, or which tends, by a high degree of disturb-
ance, to exhaust tire body.
CCCCXLVI. Thus passions are not with such per-
sons too stimulant; a circumstance known to the generality
of mankind, among whom it is an adage, that sat persons
are commonly good natured (p), while morose persons
are for the most part lean. Thus it is observable, that
fat persons are averse to thinking, which is a great stimu-
lus (q). They are averse to bodily motion, by which all
the functions, and particularly that of the vessels, are much
excited, and the perspiration proportionally promoted;
and they have so far reason for it, that all motion is more
fatiguing to them than to others. Hence, that quantity
of
(p) This must be taken with more than grains of allowance; since
such is the effect of the different motives to human action received from
example and education, that the passions themselves are drawn into a
subserviency to every persons predominant pursuit. I have known a
person in Edinburgh get great credit for his integrity, though that was
not extraordinary, from roughness of manners and an affectation of pas-
sionateness, while the dissimulation of that real disposition is the more
general engine among men of promoting their interest. At any rate, so
much more than mere appearance of temper, which may be so much
over ruled, is necessary to the establishment of maxims; that I should
think my life or property upon an insecure footing, if it depended on the
good nature of a person, for which the only security was his fatness.
(q) The most poring persons are the atrabilarians, who, though they
are not calculated for the elevation of mind that discovery requires, have
by their assiduity, contributed much to the improvement of many of the
arts. They are commonly very meagre indeed, and indefatigable in
any pursuit, to which they give themselves up.


257 OF MEDICINE. 
of fluids, which under motion is usually thrown off by
the pores on the surface, and turned out of the course to
the adipose cells, has a great opportunity of quitting the
direction to the former, and of turning aside, in a state of
rest, to the latter.
CCCCXLVII. After explaining the peculiarities of
these diseases; it is now to be observed, that, since the af-
fection of a part in general disease, depends upon the gene-
ral affection, is of the same kind, arises from the same ex-
citing powers, and is removed by the same remedies (r);
it is from that reasonable to believe, that the affection of a
part, whether it be inflammation, or a greater affection of
the brain or vessels, than of any other part, is not different
in different cases, but altogether the same in all; that it
only differs in some trifling circumstances of no significa-
tion, and by no means requires a different plan of cure, or
affords fundamental distinctions; and that a mistake,
which has had the most ruinous effect upon the art, must
be done away. It is with propriety, then, that all the dis-
eases that have been treated of have been reduced not first
to two genera, and after to species, but without regard
either to genera or species, only to two forms.
CCCCXLVIII. Further, as in all those diseases the
whole morbid state, either in so far as it is universal in the
system, or confined to a part, proves hurtful by giving too
much excitement, and as the remedies, that remove the
general morbid state, also remove the portion of it con-
fined to a part, and are never to be directed to a part (t),
with the view of removing, by their action upon it, the
disease, as if all locked up in it; the meaning of all that
is, to lay a sure foundation for the establishment of a cer-
tain series, or scale, of encreasing strength from perfect
S health
(r) See Part. first, Chap. IV. and particularly par. LIII.
(t) See par. LVI. and XCII. 
 

258 THE ELEMENTS
health to the most sthenic diseases. In that scale perip-
neumony holds about the highest, and obesity the lowest,
degree.
CCCCXLIX. Peripneumony and phrenitis in the up-
per end are followed by two diseases, that sometimes equal
them; the violent small-pox and measles. These two
are succeeded by a disease, that sometimes vies with
them, the erysipelas, when accompanied with a most se-
vere affection of the head. Equal to this, not in danger,
but for the most part in the degree of diathesis; rheuma-
tism comes next. Next to rheumatism is marked the mild
and gentle erysipelas, far short of those above it in vio-
lence, and claiming nearly an equal place to the sthenic
cynanche, being much more nearly allowed to the latter
than any of the former. Those are the diseases accompa-
nied with pyrexia and inflammation.
CCCCL. Of these two which stand lowest, the mild
erysipelas and the stnenic cynanche, or common inflam-
matory sore throat, are of so doubtful a rank with respect
to each other and catarrh (u), a disease without the accom-
paniment of inflammation; that it is doubtful which of
them all should be set above the others. Below them,
however, the simple synocha and scarlet fever, in so far as
the latter is an asthenic disease, and in so far as the usual
state of them both is considered, are to be placed without
any hesitation (x). The lowest part of the scale of sthenic
diseases
(u) See CCCXCIV. and the note to it.
(x) The simple synocha is so similar to a gentle typhus, that it requires
great judgment to distinguish them at first. The safest way, when the
doubt cannot be determined, is to keep the patient in a moderate tempe-
rature, and in a state of rest; as any debilitating power, in case the dis-
ease should turn out a typhus, would be dangerous; and, though it
should afterwards manifest itself a synocha, still its mildness renders the
omission of any thing that might have been done, innocent; and it is
always easy to take down sthenic diathesis. 


259 OF MEDICINE. 
diseases with pyrexia, is assigned to the small-pox and
measles, in their mild state.
CCCCLI. Through this whole scale it is not so much
the titles and names, that have been made use of, but mor-
bid energy, that is regarded; it being the certainty derived
from the cause, not the uncertain and perfectly deceitful
consideration of symptoms, that was to be considered (y).
The investigation of symptoms, which has hitherto been
devoid of all benefit, has been of the highest detriment to
the art; and as much in medicine the most productive
source of fundamental blunders, as the question about ab-
stract causes had been in the other departments of philo-
sophy (z), must be laid aside, and Nosology damned.
CCCCLII. Below the last mentioned diseases, mania,
pervigilium, and obesity are set. Betwixt which, and the
diseases mentioned above, is the point of perfect health to
be fixed (a).
The Cure of the Sthenic Form of Diseases.
CCCCLIII. To apply the indication of the cure of
the sthenic form of diseases to practice; that mentioned
before (b) will be accommodated first to a violent degree
of the diathesis and danger of parts, in such a manner, as
that regard only will be had to the degree of force in the
remedies (c). 
CCCCLIV. When, therefore, a violent diathesis is de-
cerned, as in peripneumony, phrenitis, the small-pox, the
measles, and erysipelas, in the highest degree of these three
last, immediate recourse must be had to the most powerful
S2 and
(y) See par. LVIII.
(z) See par. XVIII. and look into Observations on the different sys-
tems of physic, and in the introduction throughout.
(a) It will be easy for the reader with the direction above to make
out the table for himself.
(b) See par. LXXXVIII. 
(c) See also par. XCII. 


260 THE ELEMENTS
and quickly effectual remedy; and so much blood should
not be taken, as many who entrust nearly the whole cure
of the disease to it, think (d), but more, however, than
others are of opinion, should be taken away (e).
CCCCLV. No measure suits all cases; the quantity
to be taken being different in different cases, as those differ
in age, sex, strength, and in the degree of force applied by
the exciting hurtful powers. In childhood, which, ex-
cepting the measles, and small-pox (f), is seldom affected
with the diseases we have mentioned, and in a very advan-
ced age, which is also in less danger than that at the flower
of human life; sparing bleeding succeeds for this reason,
that, at both those ages, it is a lesser degree of excitement
that upholds the disease as a cause; while in the former,
the high degree of excitablility, in the latter the necessity
for more stimulus or exciting power, than formerly, set
bounds to the measure of the remedy.
CCCCLVI. A better rule for limiting the degree of
bleeding is the relief, or temporary solution, of the urgent
symptoms. If, therefore, after blood has be been taken, the
great heat, the hardness of the pulse, the affection of the
head or the lungs, and dryness of the surface, shall have
gone off, or been much abated; and now the temperature
is discerned to be much more moderate, the pulse more
soft and less frequent, and the surface of the body more
moist, at least less dry, if the pain is every where quieted,
the
(d) which is the common practice;
(e) The most early among the Alexipharmac practitioners, after once
making his escape from peripneumony without bleeding, fell a victim to
the folly of his theory in the next attack. The Alexipharmacs in gene-
ral were too moderate in their bleedings in the true, though few sthe-
nic diseases that require it, and all in the wrong in their use of heating
stimulant prescriptions in them,
(f) See par. CCCCI. 


261 Of MEDICINE. 
the breathing relieved, and the delirium removed (g); then
it may be looked upon as certain, that enough of the vital
fluid has been shed for the time.
CCCCLVII. To obtain that benefit, in the most vi-
gorous adult state 10 or 12 ounces, and much less either
before or after that period of life, will for the most part be
found sufficient. As this rule will not answer in every case,
when it fails, recourse must be had to that, which recom-
mends the abatement of the symptoms as a direction more
to be depended upon (h).
CCCCLVIII. Since the local affection depends upon
the degree of the general (i) diathesis, remember, there-
fore that there is no occasion for any particular direction
with regard to it, any farther, than to take advantage of
its being accessible to help the general remedy by an ap-
plication of it to the part (k).
CCCCLIX. When that has been done, and the first vi-
olence of the disease is now broken; we must next have
recourse to purging the belly, as a great remedy in point
of efficacy (l). To effect which, we should not employ
violent means, such as many formerly employed (m); the
stimulus accompanying the first operation of which being
liable to be hurtful; but it is the gentle cathartics that
should be depended upon, such as Glauber's salts, which
are highly debilitating, and carry a great quantity of fluids
out of the vessels. Though a man of good sense in the
last century used these day about with bleeding; yet, if
the
(g) The references for facts are CLIX. CLV. CCCXXXIV. CLVII.
CLXXIV. CCCXLIX. to CCCLV. CLIV. CLIX. CLXXXIV.
CCCXXXIII. to CCCXXXVI. CLV. CCCXLIII. CCCLIV. CLVIII.
(h) See CCCCVI. 
(i) See above LVI. and CCCXLII. to CCCXLVI.
(k) Ibid. an instance of such assistance may be the local bleedings
over the pained part in rheumatism and the gout, and some other asthe-
nic remedies are aided by local stimuli.
(l) See CCLXXXIII. 
(m) the Alexipharmacs particularly. 


262 THE ELEMENTS
the violence of the disease should be urgent, there is no-
thing to hinder the use of them the same day that the blood
has been taken.
CCCCLX. Purging, after a sparing bleeding, has more
effect in overcoming sthenic diathesis, than any bleed-
ing without it; because, as it has been mentioned above,
in that way the debilitating power (which has always more
debilitating effect in the place to which it is first applied
than in any other), is applied to more parts; and not only
to the greater blood-vessels, but also to a prodigious num-
ber of their terminations; and the excitability is more ex-
tensive, and therefore, with more equality diminished (n).
Vomiting, which, in asthenic diseases, where it is
pernicious, has hitherto never been admitted in the common
practice, and in sthenic ones, where it is of the greatest
benefit, ever neglected, comes in here as a proper part of
cure; being of the same evacuant nature, and in another
part of the same canal, and admitting of all the reasoning
that has been applied to purging.
CCCCLXI. At the same time that the excessive, and
therefore hurtful, use of the lancet is superseded by those
two last mentioned evacuations; its use, however, is not
altogether to be laid aside in the diseases of excessive ex-
citement: and for this reason, that the excitement, by
its stimulating operation often rises to that high degree,
that, from the consumption of excitability which puts
an end to its existence, threatens instant death (p).
CCCCLXII. Besides, those remedies (q), the patient
should always be required to abstain from every sort of food
but vegetable, and in a fluid form, as well as from all strong
drink, and indeed all but watery drink, accidulated (r)
This
(n) See par. CCCCLXXXIII. CCCCLXXXVI. also CCCV.
(p) See par. CCLXXXI. and CCLXXXIII. CCLXXXIV.
(q) From CCCCLIV. to CCCCLXII. 
(r) See CCLXXXIV. 
 

263 OF MEDICINE. 
This direction does not seem to have been so much ne-
glected in words by former writers and authors, as in fact
and actual application to the practice; it having been de-
livered lightly, by the by, and as if it had been thought
of no consequence, with such effect, that its force made no
impression upon the mind of the reader or hearer. No sti-
mulus is more powerful, and, therefore, in this part of
the practice, more hurtful, than that of the articles of di-
et: Consequently, whatever quantity of blood is taken
from its vessels, whatever quantity of serous fluid is carri-
ed off by the mouth and anus,if that stimulus is not round-
ly guarded against, all this evacuation may easily be frustra-
ted. While that is the case, still fluid vegitable matter
is not to be discharged, and for this good reason, that wa-
tery matter is not kept in the vessels; but, easily entering
the smallest of them, flows out in all directions by their va-
rious outlets; and, at the same time, supports the efficacy
of another remedy (s), by and by to be mentioned.
CCCCLXIII. Conjointly with the use of the first bleed-
ing, of the first vomiting and purging, and that of absti-
nence and watery drink, it must not be forgot, that parti-
cular regard must be paid to temperature (t); For, if cold
always debilitates, and if that is its proper operation (u),
if it only seemingly acts otherwise, because heat succeed-
ing to its action, or alternating with it (x), converts it into
a stimulant one, if it alone is adequate to the cure of the
small-pox (y), and prevents the violence of that disease, if
it is the best remedy for catarrh (z), and, when heat is
avoided, of the greatest assistance in every sthenic disease; it
is not to be doubted, but that it is of the greatest benefit in
the diseases of the highest sthenic diathesis.
CCCCLXIV. Its operation in the small-pox, and in
the rest of the sthenic diseases, is not different, but altoge-
ther
(s) sweat. 
(t) See par. CCLXXXII. 
(u) See par. CXVII.
(x) See XXXVII. 
(y) See par. CXXI. 
(z) See CCCCVII. 


264 THE ELEMENTS
ther the same. Nay, in all the diseases of this form, as cold
alone is sufficient to effect the cure; so whenever the dia-
thesis, which is the case in the diseases that make our pre-
sent subject, rising to its greatest rage, demands instant re-
lief; because, in that case, every moment's delay brings in-
stant danger; because the remedies, which we have men-
tioned, are sufficient for the solution of the disease, of which
We have the direct proof in the practice; because that de-
gree of cold, which could produce that effect, is neither al-
ways within our reach, nor can be managed by every per-
son; and many persons might not be disposed to believe its
effects so beneficial: For those reasons we should not desist
from the plan of cure here laid down (a), and do our best
for our patient, by taking off the blankets, and other clothes,
by cooling the room, and, instead of laying him on a couch
or bed, putting him into a chair.
CCCCLXV. This plan of cure should, for the most
part, be preferred to that of the most intense cold, for this
further reason, that the shortness of the time in which any
one could possibly remain in it, would oblige him immedi-
ately to return to higher temperature, which would produce
a greater stimulus of excitement, than that he had been un-
der before his exposure, at least too great a stimulus (b).
CCCCLXVI. Since such is the operation of cold (c),
the power falsely imputed to it of occasioning the striking
in of the measles, is to be imputed not to cold alone, but
to heat and other stimuli; giving, as has been explained,
more excitement (d), than if it had not preceded And
why not? If cold does not interrupt the eruption in the
small-pox; but, on the contrary, by an enlargement of
the diameters of the perspiratory vessels, which are shut
up by sthenic diathesis, highly promotes the discharge of
that
(a) From CCCCLIV. to CCCCLXV. 
(b) See XXVI.
(c) Look back from CCCCLXIII. to CCCCLXVI.
(d) See XXVII. and the addition, and CCCLXXX. 
 

265 OF MEDICINE. 
that matter (e): Why, in a most particular case, should its
operation be supposed different, not to say, diametrically
opposite? Must we again have the trouble to refute the false
notion of thinking a cause precisely the same should pro-
duce contrary effects? Cold diminishes the eruption in the
small-pox: It makes it disappear in the measles. What
then? Take a nearer view of the fact: Is its effect in both
these cases to be supposed the same, or different? How
comes any person to know, that the matter, which has
disappeared, is driven into the intetior parts? What proof
will you bring of that? Confess the truth. And be candid
enough to acknowledge, that this is another relic of the
alexipharmac doctrine, handed down to us, which supposed,
that the stimulus of heat as well as other stimuli promote
ed, and that cold impeded, perspiration. And after a great
man had shown the error of that doctrine, both in the
small-pox and other diseases (f), because he did not carry
the application so far as the measles, neither has any one
of his followers, who never could step a nail's breadth be-
yond his words. But it might have been observed, if ob-
servation had been any part of their employment, that the
measles was a sthenic disease as well as the small-pox. Are
not all the successful remedies in both of the debilitating
kind? And as was manifest, that in the small-pox also
cold debilitated, or in the common language, acted as a
sedative; might not some suspicion have, from that very
circumstance, occurred to their mind, that cold, in the
measles, did not stimulate, or act as an astringent; and
in that way, repel the eruption, but perform the same
Operation as in the small-pox? Is it, to such a degree,
difficult and up-hill work, to think and use one's own
good
(e) See CCCLXXVI.
(f) In peripneumony he took his patients out of bed, and set them in
a chair, for the sake of cooling them, and avoiding the hurtful effect of
heat. 


266 THE ELEMENTS
good sense, that, a great part of mankind, even those who
take upon them the business of teaching and taking the lead
of others, in no case ever think of exercising a moment's
reflection of their own? But, in this case, it may be con-
tended, that the action of cold is peculiar, because, after
the eruption which is supposed to check, has disappeared,
all the symptoms encrease in rage and violence. Con-
sider what that circumstance makes for the argument, or
whether it makes any thing, and not absolutely against it?
Was the action of cold, that is supposed, followed by
that of stimulant or debilitating powers? If it was by the
former, the cause of the mischief must be imputed to
them; which, as has been said just now (g), produce ex-
cessive excitement after a previous application of cold, and
more than without it; if the latter, or debilitating powers
were used, then there would not be wanting a suspicion,
that cold had a concern in the effect. But it is not so:
And, in every case, in which the action of cold has been
followed by sthenic diathesis, the true cause of that effect
is not sufficiently guarding against the stimulus of heat, as
well as that of other noxious powers. And this is most
clearly proved by the use of heat being positively ordered,
instead of being forbid, in the common practice. Nor is
that to be wondered at: For if the cause of catarrh (h)
deceived physicians so much, the catarrhal symptoms in the
measles could not fail to deceive them. And, if doc-
trines, discarded in words, are often kept up in fact: what
was, there to hinder this part of the alexipharmac doctrine
from meeting with a similar fate?
CCCCLXVII. If cold, therefore, can scarce be so
managed, as that the effect occasioned by the accompani-
ment, the succession, or the alternation, of stimulants
with
(g) in the last paragraph but one.
(h) See from CCCCVII. to CCCCXII.


267 OF MEDICINE. 
with it, may be prevented, whether that be the fault of
the physician, or owing to the difficulty of the nature of
the thing (i); it is, notwithstanding, a rule in common
to the measles and other exanthemata of the same stamp,
to avoid heat, and compensate for the degree by the
greater duration of cold, and to guard with all possible
care against every stimulant power. It is now then mot
evident, that the opinion of cold being peculiarly hurtful
in the measles, both in that and every other disease of the
same form, falls to the ground.
A Repetition of the Cure.
CCCCLXVIII. After using the Remedies which have
been mentioned (k), when the symptoms are renewed, the
same train of medicines must be again gone through: Blood
must be again taken, emetics and purgatives again admi-
nistered; nor must we desist from the use of the refrige-
rant and attenuant plan: And all these particulars must
be executed, till the tumult of the symptoms be allayed,
and the healthy state, at least for the time, be restored;
and perhaps the repetition may be required a third time
or oftener: After doing which;
CCCCLXIX. If the diathesis seems now nearly remov-
ed, if the affection of the head, of the lungs, or any in-
ternal one, seems alleviated or repelled; and yet there is
some apprehension of a likelihood of the return of the dis-
ease: in that case, recourse must be had to more gentle
debilitating powers. Sweating, the stimulus accompany-
ing the first operation of which, the body, as the diathesis
is now rendered mild or ended, will be able to bear, must
be preferred to bleeding, vomiting, and purging. But
before proceeding to speak of it, it seems proper to say a
few
(i) Turn back to CCCCLXV. and CCCCLXVI.
(k) from CCCCLIV. to CCCCLXVIII. 


268 THE ELEMENTS
few things upon the sum total of blood that should be ta-
ken during the course of the whole disease.
CCCCLXX. As in single bleedings, so also in the
whole quantity of blood to be taken, the sum should be a
mean betwixt those, which the common run of physicians
approve, while some think too much, some too little,
should be taken. The reason for this recommendation is
strengthened, by the consideration of their being now less
occasion for shedding a great deal of the vital fluid, since
the cure is now more divided among the other remedies
that have been spoken of. The age must be regarded, as
was formerly recommended (l), the former mode of life must
be looked to, the quantity of stimulus, that may lately have
preceded the morbid state, must be considered, and the
state of the body compared with the degree of the symp-
toms and the effect of the cure. From those circumstances
a judgment should be formed of bleeding and other eva-
cuations; and it should be estimated, what further of the
same sort may seem proper to be put in practice, or what
difference of management may be required. Upon the
whole, it will be found, that there will be the less occasion
for any one medicine, the more freely others have been
brought into use; and it will be understood, that the dan-
ger of too great evacuation will be thereby avoided, and
the health better secured (m).
CCCCLXXI. With respect to the kind of bleeding, it
should always be made from a very large vein; because
the cutting a lesser one, or opening an artery, does not
afford a sufficient quantity for the relief of the vessels, and
arteriotomy is further attended with certain inconvenien-
ces (n). As far as any certain rule, in an affair of such
variety,
(l) See CCCCLV. 
(m) See CCLXXXVI. and CCCV.
(n) The blood is ready to break out again after the tying up; and if,
as some advise, the arterial twig should be cut through, it diminishes the
number 


269 OF MEDICINE. 
variety, can be established, two pounds of blood in three
or four days, with the assistance of the other remedies,
will for the most part, be sufficient at the middle age of
life, and less at a more early or later period.
CCCCLXXII. All bleeding should be followed by
vomiting and purging, so long as any considerable part of
the sthenic diathesis remains; nor should the other parts
of cure, that have been pointed out, be neglected. But
purging, a single dose of which can at any time, bring
back a fit of the gout; which cures the sthenic cynanche
or common inflammatory sore throat, and the mild erysi-
pelas, when even the face or head is affected; which is of
manifest detriment in fevers, which, in dyspepsia, in asth-
ma, and every sort of diseases depending upon debility,
whether direct or indirect, does very great and conspicu-
ous mischief; and is a great part of the very bad, common
method of cure over the whole form of asthenic diseases;
in proportion as it ought to be avoided in all those diseases,
should be as certainly laid hold of in sthenic diseases, and
not omitted in any considerable one, such as those are that
require bleeding, but be managed according to the direc-
tions given (o) lately, and as it was directed to be managed
before (p). And we must, above all things, be on our
guard against that dissidence in the use of this remedy, as
well as in that of vomiting, where they are serviceable, and
that confidence in them when of disservice, both intro-
duced by the spasmodic doctrine; and know that they
were both admitted upon a false and absurd principle (q).
CCCCLXXIII.
number of the few accesses to this mode of bleeding; neither does there
seem to be any use in destroying such vessels, especially as no good pur-
pose can be shewn for doing so.
(o) See CCCCLXI. 
(p) See CCLXXXIII.
(q) The principle, at least with respect to purging, was, that it dimi-
nished perspiration, and, therefore, was understood not to act as an an-
tispasmodic. 


270 THE ELEMENTS
CCCCLXXIII. As nothing in asthenic disease; has
been more used than these two modes of evacuation, no-
thing with more hurt, and often with instantaneous de-
struction; so, for that very reason, nothing is more happy
and successful than their use in cure of sthenic dis-
eases.
CCCCLXXIV. It is scarce credible to say, how far
the aversion to the alexipharmac method of cure has had
the effect of branding the very best medicines, what a de-
praved use of them it has suggested, and to what a degree
it has perverted their proper use. Not to repeat what has
been formerly said of that kind in other instances; sweat-
ing, which is of the highest service, and a most efficacious
means of cure, in every moderate sthenic diathesis, in every
degree of it, that is not the highest, or where it presses not
upon any organ of importance to life; that is, in all the
diseases of this form, except in the beginning of those of
which we are here treating, has, however, of late been
completely banished from the cure of every one of them,
but one, not only, as useless, but as hurtful; which has
chiefly happened since the spasmodic doctrine began to be
received into this country, and, for a few years only, gra-
dually to gain ground (r).
CCCCLXXV. But, in truth and fact, except rheuma-
tism (which, at least as produced by one form of a medi-
cine, it is allowed to cure), if it most certainly either re-
lieves or removes the sthenic cynanche, erysipelas itself, and
catarrh, and the simple synocha, in proportion to the more
free or sparing use of it; if that be known to the very vul-
gar,
tispasmodic. A balance betwixt the excretion by the belly, and that
on the surface was talked of, and they were held for opposite operations.
In such theoretical nonsense they deferred their only good leader, at
least in those diseases, who alternated his bleedings and purgings, and,
as I have found upon the best foundation.
(r) Turn back to CCCCLXIX. 


271 OF MEDICINE. 
gar, and most certainly to physicians, of any other than the
spasmodic practice; what reason, what certain and well
proved fact, will any one bring, to shew why sweating
should not be used, after the most violent diathesis as much
diminished by the other medicines, and is now reduced to
that small degree, to which that remedy is adapted; what
eloquence would be requisite to bring any man of sense
into such a persuasion?
CCCCLXXVI. They will say, that the heat, which
accompanies the first part of the operation of sweating,
may be hurtful; for as he never made trial of it, he has
it not in his power to say, that for certain it will be hurt-
ful (s). As that effect will readily be admitted in an high
rage of diathesis, threatening indirect debility (t); it will
not also be granted, that in a moderate degree of the dia-
thesis, either from the beginning, or effected by the other
remedies, and, consequently, after the plan of cure, that
we have laid down, has been executed, that such heat will
not be compensated by the great profusion of fluids taken
away over the whole body; and that, when this part of the
vascular
(s) It is laughable to hear such persons talk of their practice, from
which they never can receive information; it being not the effect of any
thing they know themselves, but what they have been told by others.
In that way, without any exercise of judgment; without a single obser-
vation, that they can call their own in the course of a long life, do they
jog on, like the blind beggar led by his more faithful dog, or, like chil-
dren in the play of blind Harry, groping about with their eyes tied up,
through the whole course of a practice boasted of, God knews, by no
body who knows it but themselves.
(t) If the diathesis should rise within two or three degrees of indirect
debility, in that case the heat of the first part of a sweat, by exhausting
the little excitement that remaps, may have a most hurtful effect. But
if the diathesis be any where below that high point, the addition of sti-
mulus can be borne for the short time of its continuance; and be after-
wards much more than compensated by, the large and continued flow
ever all. 


272 THE ELEMENTS
vascular system has been freed from a violent stimulus, the
diminution of excitement will not be more equal in all the
vessels, and over the whole nervous system. If the nume-
rous vessels, that open into the intestines and into the sto-
mach, are so powerful in diminishing sthenic diathesis, how
should a similar evacuation in the similar perspiratory ves-
sels have no tendency to produce the same effect? With
which reasoning, if the facts just now related be further eon-
joined, what will any person have to say against the use of
sweating, when a degree of heat, not greater than what can-
not be avoided, attending the operation of the sweat, can no
longer be hurtful, and the sweat itself certain to be of great
service (u) Let the spasmodic caviller against the use of
that remedy, in the cases of sthenic affection where it is ad-
missible muster up all his facts and all his theories, let him
turn himself into all shapes, he will never produce a solid
argument against this remedy. But what, again, is all this
about? Will there never be an end of running from one
extreme of error into the opposite? Shall no mean be found
betwixt the Alexipharmac plan of cure, and an equally
bad or worse one? If that doctrine hesitated not to pre-
scribe sweating in the rage of a peripneumony, and that too
by means of the most heating stimulant powers; does it
therefore follow that a plan of cure must be admitted, which
rejects the certain and safe use that remedy, when con-
ducted by the most gentle means? If it was the opinion of
2 Dr.
(u) In an excitement of sixty-seven, within three degrees of indirect
debility, the heat in the first part of the sweat, by adding these, might
kill the patient, if you will, without leaving any chance of relief from its
evacuant effect. But if the excitement be no higher than 60°, the ad-
dition of the three degrees will keep greatly within the point of indirect
debility, and therefore, be safe; while the succeeding evacuation may
reduce the excitement perhaps 10°, and bring it within the range of pre-
disposition; and a new course, or a little prolongation of this, carry it
down to the point of health, and finish the cure. 
 

273 OF MEDICINE. 
Dr. Sydenham, that heat should be avoided in the cure of
sthenic diseases, which was quite right, as heat certainly en-
creases the excitement; are we, for that reason, to avoid
that tolerable degree of heat which accompanies a remedy
the most powerful in restoring the healthy state, and, there-
by, deprive ourselves of great benefit upon the whole? If
such persons did not know, that several remedies dimi-
nished excitement more powerfully than any one; and, if
they were to be forgiven for that; were they also t to be ex-
cused for not seeing, what any empiric might have seen, that
is, that some things were of service, and others of differ-
vice; was that want not of genius, which is not required
of them, but of common sense, also to be pardoned? If
thinking without a leader, and making any sort of disco-
very, was too much, and not to be expected from them;
is it not somewhat surprising, that out of a thousand per-
sons, who had treated of every part of medicine, and enter-
tained different sentiments from one another, in some mea-
sure right, and, no doubt, wrong too, they could squeeze
no information, but always trod in the footsteps of one
single man?
CCCCLXXVII. Sweat, therefore, after the manage-
ment that has been mentioned, is to be excited, and so
much the more determinedly, if there should seem some-
thing still wanting to the complete return of health, some
degree of sthenic diathesis still remaining, and a spontane-
ous tendency to it should appear.
CCCCLXXVIII. When the signs of a spontaneous
sweat arising are perceived, nothing more is to be done, but
first to lay the clothes about the patient, remove the sheets,
put the blankets next to his body, guard against the ap-
proach of air, and keep up the discharge for a sufficient
length of time, at least ten or twelve hours. If, by this
management, there shall ensue a copious and universal
flow of sweat, there will be no occasion for giving a me-
T dicine. 


274 THE ELEMENTS
dicine. After it has succeeded, and encreased the relief
formerly procured; if it should sink in toward the end, it
should at last be supported by Dover's powder, or by laud-
anum alone, covering the body, so as that it may get as
quickly as possible to the surface, till the expected bene-
fit be obtained. And to this management it must be ad-
ded, that, if a draught of cold water be sometimes given,
and then the body well covered up and properly managed,
the business often succeeds to our wish. But, as in the
other cases, that belong to this part of our indication, the
sweating must then only be set on foot, when the medio-
crity of the diathesis, procured by the other remedies, will
permit; so in the small-pox and measles, because there is
occasion for a certain time to allow the matter to pass away,
we must also keep that in our eye, and never be too early
in making trial of this remedy. Lastly, if the heat should
happen to prove hurtful, if at any time the flow of the
sweat should be attended with less relief, or with some in-
convenience, it should be immediately stopped: For it
was not for no purpose, but for that of making the reme-
dies supply the defects of one another, and of reducing the
excitement more equally over the whole body, that a num-
ber was recommended.
CCCCLXXIX. In all the cases of a violent diathesis,
all the remedies that have been mentioned, are more or
less, and differently on different occasions, in proportion
as the remaining part of diathesis may require, each in a
higher or lower degree, or in a larger or smaller quantity,
to be brought into play, and the curative circle enlarged:
And besides them,
CCCCLXXX. Some of slighter consequence, such as
acids and nitre; some of uncertain use, such as leeching,
cupping, and blistering, are mentioned, as of the first con-
sequence. Of these, the acids, in so far as they render
the drink more agreeable, and, in an affection of the lungs
do not produce cough, and prove, in a certain measure,
refrigerant, 
 

275 OF MEDICINE. 
refrigerant, are to be permitted; and more certainly, if
there should be a desire for them. Every body should
know, that the refrigerant power of nitre is less than is
commonly thought. In rheumatism, and the sthenic cy-
nanche if the latter should be unusually severe, blisters,
leeches, and cupping-glasses, applied in the neighbourhood
of the inflamed parts, may, in some measure, be of ser-
vice. Nor does there seem to be any reasonable objection
to the clapping a cap of recently dug-up earth upon the
head in the case of phrenitis.
The other Part of the Indication of Cure.
CCCCLXXXI. To pass over to the other part of the
Indication of cure (y): When there is a gentler diathesis
in the habit, as in the other phlegmasiæ, and sthenic affec-
tions, that have not been yet named in the cure; as in the
mildest state of erysipelas, of the sthenic cynanche, catarrh,
simple synocha, the scarlet fever, and the mild small-pox
and measles; a smaller force of debilitating power is re-
quired; and, therefore, neither all the remedies that have
been mentioned, nor in general so much of each, as in
the other part are demanded.
CCCCLXXXII. In all these cases, not even with the
exception of rheumatism, which depends upon a very great
diathesis, bleeding is not necessary; and with the exception
of that disease, bleeding, with any degree of freedom, is
hurtful: For, when the excitement is not the greatest,
and, on the contrary, is moderate, scarce exceeding that de-
gree that produces the predisposition to other diseases;
in that case it is absurd to make use of a most debilitating
power, by way of a remedy, as if we had to combat a ve-
ry violent disease. And, since the intention in bleeding
is to prevent an ultimate excess of exciting power from
T2 producing
(y) CCCCLI. 


276 THE ELEMENTS
producing a cessation of excitement in death, an event of
which there is not the least danger, in a moderate diathesis,
such as that, which is the cause of the diseases here in ques-
tion; for that reason, the cure must be adapted to the cause,
and bleeding must be either abstained from altogether, or
very sparingly used.
CCCCLXXXIII. It is not, therefore, only in diseases
of debility, which belong to the other form (in most of
which it has, nevertheless, been, and still is, the custom,
to spill more or less of the vital fluid), but also in all the
diseases of this form, except the very violent ones, that
the lancet is to be restrained.
CCCCLXXXIV. Though in rheumatism the diathe-
sis often runs considerably high, the usual profuse bleeding,
is not, however, required. For, as every diathesis is always
greater in some parts than in any other equal one, so it is
with the sthenic diathesis in this case; which is found much
greater upon the surface of the body, than in any other equal
space within. And the reason is, that the most powerful
noxious agent, heat, succeeding to cold, or so alternating
with it, that its own stimulus is encreased by its effect (z),
directs its principal energy to the surface of the body.
Hence, after excessive bleeding, the disease, notwithstand-
ing, often obstinately recurs. The cause of which fact,
if the principles of this doctrine be well understood, can-
not, be obscure. Bleeding diminishes the sthenic diathesis
chiefly in the red vessels, less in any of the extremities,
least of all in the perspiratory vessels, and those disposed of
in the tract of the muscles; and still less in the last, because
the operation of the bleeding is counteracted by that of
heat: Which is an explanation confirmed by the certain
testimony of physicians; who often complain that their
favorite remedy fails them.
CCCCLXXXV.
(z) See XXXVII. and addition. 
 

277 OF MEDICINE. 
CCCCLXXXV. Upon which account, sweating,
which we spoke of so lately, is remarkably adapted to-
the cure of this disease: To it, therefore, after a previous
bleeding to twelve ounces, and observing the rule of tem-
perature and diet before directed, must we have immediate
recourse, if the diathesis happens to be considerably vio-
lent, and is signalized by heat of the body, by pains raging
most in the night time, and by a strong and hard pulse.
In order to render the sweat universal, and of sufficient
duration, it should be brought out by Dover's powder, or
laudanum, as before hinted, and kept up for twelve hours
in full flow, and then some hours longer, or till the abate-
ment of the symptoms, in the form of a moisture or free
perspiration, and repeated when the symptoms return. The
rest of the cure must be entrusted to low diet and an exact
temperature.
CCCCLXXXVI. In this case, after the sweating
course, and also in that of a simple synocha, of the scarlet
fever, of the sthenic sore-throat, of catarrh, erysipelas, and
the gentle small-pox and measles, when the diathesis is
somewhat considerable, but far short of that rage which
constitutes the case of cure first taken notice of; we should
use either a very small bleeding, and then chiefly the eva-
cuations before mentioned (a); then a slight and short
sweat ought to be kept up not longer than eight or ten
hours; and, during the whole time of the cure, we should
go on with abstinence, weak drink, rest of body and mind,
and cold, unless in the time of sweating, and even then
with as little heat as possible; and, finally, with tranquil-
lity of mind, as there were formerly enjoined: The united
use of which is perfectly equal to the removal of any of
these diseases; but there will not always be occasion for
them all.
CCCCLXXXVII.
(a) See CCCV. 


278 THE ELEMENTS
CCCCLXXXVII. Often so gentle a diathesis occurs,
that one or two of them, once or twice employed, is suf-
ficient for the cure: So slight a diathesis that is, in which,
unless for a little at first, the shivering, languor, and then
heat, is very moderate, pointing out a proportional slight-
ness of diathesis upon the surface; in which there is scarce
any lassitude, showing the same moderation of diathesis in
the organs of voluntary motion; in which the vigour of
the stomach remains, manifesting a moderate excess of ex-
citement in it; in which, in fine, the other functions, over
the whole body are sufficiently calm, and only suffer con-
spicuously in the labouring part: In these cases often a
single purge with Glauber's salt, often, without that, cold,
rest, and abstinence, have conducted the morbid excite-
ment to its salutary degree. A thousand times has the
sthenic cynanche, a thousand times has catarrh and the
simple synocha, nay erysipelas itself with affection of the
face, been in that way removed. And the scarlet fever is
often so gentle as to yield to the same management.
CCCCLXXXVIII. In this way must a constant re-
gard be had to the degree of excitement and diathesis in
the method of cure, and often terms must be disregarded.
For, as it was with this view, that the simple synocha
was before distinguished from the phrenitic, and the gentle
erysipelas from the violent; so, it often happens, that
catarrh rises to that magnitude that threatens or brings on
a peripneumony, and that the latter proceeds with much
more gentleness than usual. In which circumstances, it
is the degree of excitement alone, that ought to govern the
physician, without respect to names.
CCCCLXXXIX. Another useful caution here is, to
judge of the state of the pulse, of the temperature upon
the skin, and the skin in other respects, with good sense,
and due reflection upon these principles. The frequency
of the pulse in all sthenic diseases is moderate: With that
there 
 

279 OF MEDICINE. 
there is conjoined some hardness and fulness. Whenever,
therefore, the pulse is very quick, it is to be suspected,
that the sthenic diathesis has passed into the asthenic, the
excessive excitement into a cessation of excitement, or that
the disease has been sthenic from the beginning. To re-
move which doubt and ascertain the truth, the habit of
body, the age, must be considered, and an enquiry be made
to know whether the disease has been preceded, or not,
by contagion. Heat of the skin is in common to these
diseases and fevers, which are diseases of an opposite stamp
and therefore a doubtful mark. Which, as it depends up-
on an interruption of perspiration, from whatever source,
is never to be strained into a proof of the state of excite-
ment. And, since dryness of the skin, which is in com-
mon to the same diseases however different from each
other, in the asthenic diseases depends upon debility; in
order to know the amount of what that symptom means,
the other symptoms and the exciting hurtful powers,
should be considered. In fine, the only enquiry should be,
whether the excitement is abundant or deficient, and all
the signs should be consulted with that view; nor are we
to judge rashly of any peculiar form.
CCCCXC. When, therefore, the signs, than have been
related, are compared with all the rest and with the diathe-
sis, we are then to set about the antisthenic or stimulant
plan of cure. The violent sthenic diseases, which we first
considered can scarce be confounded with the contrary
ones; the more gentle are daily confounded. But, while
it is easy to distinguish them from the asthenic diseases re-
sembling them; if, however, any person should think the
marks of distinction ambiguous, let him know, that, upon
account of that gentleness, though the disease under exa-
mination should be asthenic, blood is not even to be let,
much less under the apprehension that they may turn out ast-
henic to which last so debilitating a power is destructive, as
it 
 

280 THE ELEMENTS
it has so often already been said upon former occasions;
and, with that information, let him understand, that his
method of cure conducted in that way, will be senced and
secured from all mistake. For, if the diathesis, though
sthenic, be slight, bleeding will often precipitate it into
the opposite, and will at the best be useless (b). If, on
the contrary, the disease that passes for a sthenic one,
should, in its progress, show itself an evident asthenic one;
in that case every drop of blood that may have been taken
will go to the encrease of the disease (c). Yet this perni-
cious and daily practice sends more men out of this world,
than all the curses of human life (d).
CCCCXCI. As abstinence, cold, and the management
of the belly are sufficient to prevent a gentle state of the
small-pox; so when that proper preparatory plan has been
neglected, and now a crowded eruption appears; be-
sides those, trial must be made also of the other reme-
dies (e), except sweat. But sweat must be avoided, be-
cause the tendency of the stimulus accompanying it, by
encreasing the sthenic diathesis on the surface, would be to
check the perspirable fluid, and detain the contagious mat-
ter under the scarf-skin, and produce that pyrexia, symp-
tomatic of the inflammation, which is called the secondary
fever. This particularity of cure is taken from the parti-
cularity of the symptom just now mentioned, and forms
no
(b) Suppose the diathesis be two degrees above the highest of the points
of predisposition. at 57°; and bleeding to the degree of producing 35°
of debilitating influence be employed; it is evident, the excitement will
go down not only the 17° necessary to bring it to the point of health,
but sink to 20°, that is, 3° below the range of predisposition to asthenic
disease, and therefore complete the conversion of the sthenic into an ast-
henic desease.
(c) See CCXLIX. CCLXXXI. CCXC.
(d) See par CCCLVI. towards the end.
(e) CCCCLIII. to CCCCLXVIII. 
 

281 OF MEDICINE. 
no objection to the principles of this work. In perfect
consistency with which, though there is all the proof that
can be derived from sure practice, that the remedies we
have mentioned are sufficient; yet, before the eruption
comes on, there is nothing can be objected either to sweat-
ing or bleeding, as remedies in common to this with every
other sthenic disease (f). In fine, as the success of low di-
et, cold and purging, in this manner, is certain; at the
same time, the other remedies that remove sthenic diathe-
sis, in this case likewise operate to the same effect (g). It
was proper to say so much for the sake of showing the un-
exceptional steadiness and universality of the principles of
this work. Nor are we to think, that the small-pox and
measles, differ from other sthenic diseases attended with
pyrexia, but in the particularity of their eruption in run-
ning a certain course, and not admitting of an accelerated
cure.
CCCCXCII. We are not to wait the arrival of the
symptoms of debility, that follow a violence of diathesis,
and threaten certain death by indirect debility, with the
view, forsooth, that, when they have happened, we may
cure them: On the contrary, they ought to be prevented
by the early administration of the remedies, now so fully
commented upon. If that should be omitted, the consi-
deration of the diseases that will be the consequence, and
which is altogether an asthenic consideration, must be re-
ferred to the asthenic form.
CCCCXCIII.
(f) The small-pox is, in one word, to be treated as any sthenic disease,
according to its degree of morbid state, and the eruption is only to be
regarded during the period of its existence, either with respect to the
exception of sweating then, or of any thing else.
(g) It is not, that low diet, cold, and purging, operate by any peculi-
arity, but because they debilitate to the degree, and in the manner re-
quired of the other remedies. 


282 THE ELEMENTS
CCCCXCIII. As often as sthenic diathesis happens to
be conjoined with the pyrexia, which is induced by the
operation of stimulants, of acrid substances, of compression,
of obstruction, and similar hurtful powers acting upon a
sensible part, of which we have examples in gastritis, ente-
ritis, nephritis, cystitis, hysteritis, hepatitis, or the inflam-
mations of the stomach, of the intestines, of the kidneys,
of the bladder of urine, of the womb, of the liver (h); the
diathesis, because it aggravates the pyrexia, should be re-
moved by its respective remedies, to wit, the debilitating
ones. And, when neither it nor the asthenic diathesis is
present, nothing should be attempted: But, if the asthenic
diathesis should be present, which very readily may hap-
pen; the stimulant plan should be proceeded upon, to pre-
vent a very bad disease (i). Nor, when that is as much as
possible attended to, are we to forget, that, in so doing, the
principal affection is not touched; that, on the contrary,
it is its effect, not its cause, that is tampered with; and
that the full consideration of such cases belongs to the lo-
cal diseases afterwards to be taken notice of.
CCCCXCIV.
(h) See LXXXI. LXXXIII. LXXXV. LXXXVII.
(i) As asthenic diseases to sthenic ones are in the proportion of ninety-
seven to three of the hundred; such also must be the frequency of pre-
disposition to them: The inference from which is, that as we are sel-
dom in the most perfect state of health, and consequently, for the most
part, under the same degree of predisposition, all the chances are greatly
in favour of that predisposition being the asthenic one. Hence the impro-
priety of treating all local diseases in the same way, and as if they were
general sthenic ones. Death has been too often the consequence of that
practice, when the local fault, for which it was intended, was bo more,
perhaps than a thorn pushed under a nail, a cut, or contusion of a finger.
In such circumstances, however fully the person may have lived, wine
is withheld, fluid vegetable matter prescribed, and the rotine of every
species of evacuation gone through. Dismal are the consequences of
gun-shot wounds on this plan of cure. Turn back to the paragraphs
LXXX. and LXXXI. and the notes subjoined to them. 
 

283 OF MEDICINE. 
CCCCXCIV. Besides all the remedies now mentioned,
it is of advantage in every degree of diathesis to keep the
mind easy and unruffled with passion or emotion; a prac-
tice that in the very high degrees of the diathesis is indis-
pensably necessary. Our attention will especially be di-
rected to this particular, when we observe, that the stimu-
lus of thinking and of any passion, carried to a great
height, has had a share in the production of the disease.
CCCCXCV. In mania, therefore, and pervigilium, this
direction must be particularly, and as much as possible, at-
tended to. In the latter of which diseases, thinking, and
every state of commotion, and more certainly an habitual
practice in them, must be shunned, especially before going
to bed. When the patient is resting there, he should have
stupid books read to him, all inordinate desires, the pro-
pensity to revenge, the remembrance of any degree of cri-
minality, of which he may have been guilty, should be
diverted from his recollection (k).
CCCCXCVI. That fact of great consequence, to give
corroboration to this whole doctrine, is confirmed by this
other, that the same things, which are serviceable in pervi-
gilium, or the morbid watchful state, are also serviceable
in mania, or madness, only administered in a higher degree,
as that is a disease of a higher degree of excitement. Thus,
it is not ease and tranquillity of mind that are to be pre-
scribed here, both of which are quite gone, but a state op-
posite to that high commotion of spirits and irregular vi-
gour in the exercise of the intellectual function: And, as
an excessive energy of the intellectual powers, or of the
animal spirits, or both, are the most noxious powers in
this case; for that reason, the patient should be struck with
fear and terror, and driven, in his state of insanity, to des-
pair: As a remedy against the great excitement of the or-
gans
(k) See above par. CCCCXXXIII. 


284 THE ELEMENTS
gans of voluntary motion, the labour of draft-cattle should
be imposed on him, and assiduously continued; his diet
should be the poorest possible, and his drink only water (l):
In water as cold as possible, the patient should be immer-
sed, and kept under it, covered all over, for a long time,
till he is near killed.
CCCCXCVII. If, in phrenitis the brain, in peripneu-
mony the lungs, in rheumatism the external joints, possess
more diathesis than any other part; why may not ma-
nia and pervigilium consist more in an affection of the
brain, upon which the principal noxious powers act, than
of the other parts, over which the influence of those pow-
ers is less considerable? Lastly, since remedies, the first
action of which falls upon other parts, are of service in
those diseases (m), that proves, that not even in them,
where you might most be disposed to believe it, the whole
morbid affection depends upon the part conspicuously af-
fected; but that the whole body is concerned in it, that
the excitability is one uniform undivided property over all;
that the force both of the exciting hurtful powers and of
the remedies is directed to the whole, with the inequality
so often mentioned (n); and that the foundations of this
doctrine are sure and stable.
CCCCXCVII. As these are the principal hurtful
powers in mania and pervigilium, and the brain principally
affected; so in obesity, the hurtful powers most consider-
able are animal food (o) and rest, or sedentary life; in
consequence of which last, the stimulus of exercise, which,
by
(l) See CCCXXVIII. CCCCXXX. CCCCXXXV. CCCCXXXVI.
(m) Part I. Chap. II. 
(n) Part I. Chap. IV.
(o) Because no effect can arise without a cause, the exciting powers,
therefore must here have operated with more force, than in the other
case; and if it should be objected, that the circumstances in both cases
were equal, the difference then must be set to the account of the greater
vigour of the excitability in the case of obesity. 

 

285 OF MEDICINE. 
by wearying and fatiguing the body, tends to indirect de-
bility, is understood to be wanting. But, since, in con-
sequence of using the same food, both in quality and
quantity, and the same indulgence in rest and ease, some per-
sons become fat, others continue lean; from thence it is
ascertained, that all the digestive powers have more force
in the former, than in the latter, and consequently, that
the other exciting hurtful powers have contributed to the
effect, and that a proportional excitement follows. Of
the hurtful powers, that belong to this place, an easy ex-
ercise of the intellectual faculty, and tranquillity of mind,
which are moderate stimuli, favour obesity; over strained
thinkings and habitual indulgence in any passion, such as
that of anger, the repetition of which constitutes ill nature,
oppose it. Corporeal motion, which diminishes the
quantity of fluids in the system, and as often as it is con-
siderable, proves fatiguing and debilitating, opposes it.
Equally unfavourable to it is hard drinking; which, in a
similar manner, wears out the excitement, by constantly
wasting the excitability from the high degree or long conti-
nuance of its stimulus. On the contrary, the powers that
favour it, are those that act gently, and with some excess:
but never attain that high degree of activity, that inclines
to indirect debility: They are powers that go on softly and
pleasantly, that particularly keep up moderation in the
perspiration, and thereby fill the vessels with blood; but,
because motion is avoided, they do not very much encrease
the excitement of the vessels, and by means of the tran-
quillity of motion kept up in the latter, allow a fluid, that
would otherwise pass off by the external pores of the sur-
face, to turn aside into the cells of fat. Hence, though
as it has been said before, an abundance of blood is indeed
a very great stimulus; yet, without other stimuli, and that
most powerful one, which muscular motion affords; it is
evident, that a considerable degree of stimulus can be borne
without 


286 THE ELEMENTS
without any considerable disease, and that it always pro-
duces a predisposition to sthenic diseases, but does not
immediately bring them on. Hence, it is understood
what place in the scale of excessive excitement, or of sthe-
nic diathesis, obesity holds ; what the degree of stimulant
power is, and what the stimuli in particular, are that pro-
duce it.
CCCCXCIX. As the degree of curative force must be
accommodated to the degree of force in the cause (p); hence
it must be observed, that for the cure also of this disease the
common indication is sufficient (q); that is, that the excess
of excitement must be reduced to the salutary degree, and a
remedy opposed to every hurtful power, equal to the re-
moval of it.
D. In this case, therefore, as food is the principal hurt-
ful power, less of it should be given, and more exercise en-
gaged in. These are sufficient for the cure (r).
DI. But, for the fake of bringing both further confir-
mation, as well as illustration of this doctrine; it is to be
observed, that all the powers, which very much affect the
excitement, and in a greater degree, than the hurtful power
of this disease mentioned above, and that have a tendency,
by their stimulant operation, to indirect debility, have the
same effect; that they either prevent or cure obesity, and
continue productive of that effect, till they induce that de-
gree of meagerness which is connected with debility.
DII. The best method of lowering the diet, is to com-
bine a quantity of vegetable matter with a moderate por-
tion of animal. The next rule to that, is to refrain from the
latter, and use the former in greater abundance. The
first of these is suitable to all such persons as are liable to
diseases of debility, such as the gout, the indigestion that
after a long time succeeds to luxury, asthma, epilepsy and
similar
(p) See CIX. 
(q) XLVIII. CCCCLIII. 
(r) CCCCXCVIII. 


287 OF MEDICINE. 
similar others. The latter management is more accom-
modated to those, who otherwise enjoy great vigour, are
under predisposition to sthenic pyrexia, and in the flower of
their age. But, it is not, even in the latter state of the
body, to be prosecuted, unless for a time; because, such is
the debilitating influence of that practice, that, while it is
sufficient to remove any degree of obesity, especially with
the additions of exercise, it is found to have signal efficacy
in producing asthenic diathesis, and all the diseases depen-
ding on that.
PART 


288 THE ELEMENTS
PART THE FOURTH.
THE SECOND FORM OF
GENERAL DISEASES.
OR
THE ASTHENIC DISEASES.
CHAP. I.
DIII. THE form of asthenic diseases, and which is to be
called asthenia, for the sake of distinguishing it
from the form of sthenic diseases, which is called sthenia,
is a state of the living body, in which all the functions are
more or less weakened, often disturbed, almost always with
a more conspicuous affection of some function. In the
treatment of which, that order will be observed, in which
the progress from the smallest degree of his kind to the
greatest through all the intermediate degrees, is to be fol-
lowed out.
DIV. In this part of our subject, there occurs a great va-
riety of symptoms; of which, because it is without mean-
ing, and even misleading, no use is to be made in marking
the scale of diseases. But, for the sake of placing what is
about to be delivered in a clearer, if not more specious,
point of view, we shall begin with a simple enumeration
of the principal diseases to be afterwards fully treated of.
DV. The asthenic diseases are macies, inquietude, or
restlessness without sleep, the asthenic amentia, the scabby
2 eruption, 
 

289 OF MEDICINE. 
eruption, the slight diabetes, the asthenic scarlet fever, the
rickets; the hæmorrhæae, or general bleeding dischar-
ges, such as menorrhæa, or a morbid excess of the men-
ses, epistaxis, or bleeding from the nose, hæmorrhois, or
the piles; and also three morbid states seemingly in ap-
pearance opposite to these, the loitering, impaired, or
suppressed menstruation; next come thirst, vomiting, in-
digestion, diarrhæa, or loose belly, and colic without
pain; after these the affections of children, as the worms,
the general consumption, called tabes, dysentery and cho-
lera in the gentle state of these two; angina, the scurvy,
the gentle hysteria, rheumatalgia, asthenic cough, cystirhæ-
a, or mucous discharge from the bladder; the gout of
strongish persons, asthma, cramp, anasarca, dyspepsia with
pain, the violent hysteria, the gout of weakened persons,
the hypochondriasis, dropsy, chin-cough, epilepsy, or the
falling sickness, palsy, the lock-jaw, apoplexy, tetanus;
lastly fevers, as the quartan, tertian, and quotidian, inter-
mittents or remittents, dysentery, and cholera, both in their
violent degree, synochus, simple typhus, the gangrenous
sore throat, the confluent small-pox, the pestilential typhus,
and the plague.
DVI. This scale of asthenic diseases is to be understood
in this way, that those diseases, which in their most usual
state are slight, and claim a higher place in the scale, are
sometimes more, sometimes most, violent; and those
that in their most common state are severe, such as the
gout of weakened persons, the pestilential fevers, and the
plague itself, sometimes proceed with the greatest gentle-
ness (a).
DVII. The affections of parts, which often accompany
those diseases, such as ulcer, tumor, encreased excretion,
bleeding discharge, inflammation, spasm, convulsion, point
out indeed some degree of debility as their cause, but in
U such
(a) See par. CCCCL. 

290 THE ELEMENTS
such sort that the same degree may happen without therm
Hence, because it is the influence of debility that is funda-
mentally regarded in this scale; with the diseases, that
are often conjoined with these affections, others, without
them, as hysteria and the cramp are blended; and, with
the cases that are accompanied with spasm and convulsion,
dropsy is conjoined, by keeping to the idea of an equal de-
gree of debility; and all this without any regard to remar-
kable symptoms, but keeping the degree of debility only in
view. Neither is the violent cholera kept back from its
place among fevers, which last are distinguished by failure
in the intellect and affections of the head, because it shews
a degree of debility equal to the febrile. The idea in
proportioning this division is to show, that true morbid
energy does not consist in an affection of any parts, but of
the whole body; and that the restoration of health is not
to be attempted by a change of the state of parts only,but,
without excluding that, by a change of the state of the
whole system.
Of Leanness.
DVIII. Leanness is an asthenia, less discernable in the
other functions, but evident from the weakness of the di-
gestive function; in consequence of which, the system,
though receiving proper aliment, does not become plump.
DIX. Since the cause of this disease is debility, both
in the rest of the system, and in the stomach and other or-
gans of digestion; it thence follows, that the general indi-
cation for the cure of it, should be chiefly directed to the
most languid part, that is, the organs of digestion and the
perspiratory vessels. More nourishing food, therefore,
should be used, less labour undertaken, and moisture on the
surface, or too free perspiration, should be checked by more
rest of body, by proper gestation, and rubefaction, and a
plan 


291 OF MEDICINE.
plan, quite contrary to that which is suited to the cure of
obesity should be pursued.
Of Restless Watching.
DX. In the asthenia called inquietudo, or restless; watch-
ing, the other functions are under some degree of lan-
guor, and the patient is affected with a constant necessity
to change his posture, and toss about his limbs without be-
ing able to fall asleep.
DXI. As the cause in this case, in the same manner
as in every other general disease, is universal over the sys-
tem; so it affects the organs of voluntary motion, and the
brain in particular, with the inequality so often formerly
mentioned (b): Consequently, to remove the disease, ulti-
mate excess in either mental labour, or exertion in any pas-
sion, as well as the opposite extreme of deficiency in either,
should be avoided; and that stimulus of both, which is
agreeable, ultimately excessive corporeal labour when
it has proved hurtful, as well as deficient when it has had
a concern in the cause, should be guarded against; and
the proper medium betwixt the extremes of excessive acti-
vity and indolence restored: Or the disease should be re-
pelled by wine, and the other stimuli have, each its propor-
tion, in the cure.
Of the Scabby Eruption.
DXII. In the scabby eruption, the face is pale, the
skin discoloured, dry, lank, and variously dissigured with
pustules; there is a lowness of spirits, and the functions of
the body weak and sluggish.
DXIII. In this case, while the debility is universal,
there is a prevalence of it in the perspiratory vessels. And,
therefore, the chief parts of cure are, together with the re-
U2 medies,
(b) See par. XLIX. 


292 THE ELEMENTS
medies, the operation of which is directed to the whole sy-
stem, such as nourishing food, strong drink, to support
the perspiration by its respective remedies; to bathe the
surface of the body in tepid water, to render it accessible
to air, to order clean linen for the patient, and every thing
clean about his cloathes.
Of the Gentle Diabetes.
DXIV. In that asthenia, which is named the gentle
diabetes, there is an excess in the quantity of urine dis-
charged, but the profusion is not immoderate as in the most
violent case of the same name. The organ of respiration
labours under the same weakness and sluggishness, as in
the scabby eruption.
DXV. To remove this affection much more frequent
than it has been hitherto believed, the system should be sti-
mulated by food (c), by strong drink (d), and by proper
exercise (e), such as is neither immoderately excessive, and
therefore debilitating nor deficient in degree,and therefore,
not supplying enough of stimulus: And, above all things,
the perspiration should be sustained. The contrivances
for checking the flow of urine, which have no existence,
are to be passed from.
Of the Rickets.
DXVI. The rickets is an asthenia; to the general
symptoms of which are added an unusual bulk of the head,
especially the sore part of it, and likewise of the knees
and abdomen, a flatness of the ribs and meagerness.
DXVII. The rickets is a disease of children, chiefly
arising from uncleanliness, want of dandling or exercise,
cold, either without moisture or with it, food not giving suf-
ficient nourishment, and bad air.
DXVIII.
(c) See par. CCLXVI. 
(d) See par. CCLXVIII. 
(e) CCLXX. 

 

293 OF MEDICINE. 
DXVIII. For its cure the common asthenic indication
must be employed; remedies, of an opposite nature to the
hurtful powers that excite the disease, must be looked out
for; the surface of the body should be kept clean (f), the
perspiration should be carefully restored by the stimulus of
pure air and of heat; the child should be more carefully
dandled, and kept much in the open air, animal food
should be administered, vegetable withheld, and strong
drink allowed (g).
Of Retarded Menstruation.
DXIX. Retarded menstruation is also an asthenia: In
which, besides the discharge not making its appearance at
that time of life, when it should, other evidences of debi-
lity, such as a slender make of body, weakness, laxity of
habit, want of appetite, or a craving for things not aliment-
ary, paleness of the skin, and similar symptoms, appear.
Of Impaired Menstruation.
DXX. Impaired Menstruation is that state of asthenia,
in which after it has appeared, and the flow continued for
some time, the discharge is made in too sparing quantity,
or after too long intervals of time, with other signs of
weakness accompanying it.
Of the Suppression of Menstruation.
DXXi. Suppression of menstruation is that degree of
asthenia, in which the discharge is totally stopt at any pe-
riod betwixt their natural commencement and the time
when, in the course of nature, they cease altogether. 
DXXII. An enquiry must be made into the cause of na-
tural menstruation, before it should be proper to enter upon
that
(f) See DXIII. 
(g) See CCXCV. CCCIII. 
 

294 THE ELEMENTS
that of the retardation, or deficiency, of the discharge in
any of its degrees.
Of the Cause of Menstruation.
DXXIII. The cause of menstruation is a conformation
of the vessels that pour out the blood in this discharge,
taking place at a certain time of life, that is, about the age
of puberty, and a stimulant energy in women, more power-
ful than in the females of the other species of animals,
DXXIV. Of other animals there are very few, the fe-
males of which undergo any sort of menstruation out of
the venereal orgasm.
DXXV. As all the vessels are, gradually unfolded in the
course of the growth of the body, so the same thing hap-
pens to the genital and uterine vessels, but last of all to
these. The ends of the latter, terminating, on the sides of
the womb about the age of puberty, are at last so very
much expanded, as now to transmit first the serous part of
the blood, and then, after an effort kept up for some time,
pass to formal blood.
DXXVI. At this time of life a great change over the
whole system takes place. Now the desire for coition, a
stimulus, never experienced before, produces a commotion
over the whole body; and, in preference to other parts, in
the genitals of both sexes, in the female, over the whole
region of the ovaria, womb and vagina: By this stimu-
lus, the uterus, its seat, being nearly incessantly solicited,
is the more powerfully affected, the more there is of exci-
tability, hitherto acted upon by no such stimulus, existing
In the system. Hence, among other organs, the muscular
fibres of the next vessels, as well as the nerves interwoven
with them, undergo the highest degree of excitement: This
excitement encreasing over the whole system, again en-
creases that in the uterus: The mutual contact of the sexes,
whether 


295 OF MEDICINE.
whether in kissing, in shaking hands, or otherwise, fires
both sets of genitals, and the uterus in a remarkable man-
ner; but the actual embrace produces the highest degree
of that effect. The remembrance of each embrace remains,
renews the dear idea of the delightful scene, and continues
more or less to excite the uterus.
DXXVII. This new affection is further cherished and
nourished by every stimulus that is usually applied to the
system: Hence, in the absence, in the presence, of the
beloved object, at all times generally, scarce with the ex-
ception of that which passes in dreaming, a stimulus so
steady, and the more powerful, that its novelty implies,
that the excitability in this case is entire, rouses the fibres
of the vessels, already sufficiently unfolded, to violent con-
tractions. The blood is carried into the region of the ute-
rus with the greatest rapidity, a rapidity momentarily en-
creased, in proportion as the blood, by powerfully disten-
ding the vessels, and agitating them by its impetuous flow,
stimulates the fibres more and more, and thereby encrea-
ses the activity by which it is driven on. This is, the first
cause of menstruation: In that way the two circumstances,
a sufficient enlargement of the diameters of the vessels,
and the stimulus acting more powerfully, from its novel-
ty, upon the unwasted excitability (h), are sufficient for
the whole business,
DXXVIII. This state is not inconsistent with other
states of the body, but bears an analogy to some well known
ones: Accordingly, different vessels, from the mere dif-
fence of their diameters, are subservient to different pur-
poses: The perspiratory vessels are destined to the trans-
mission of a vapour, the excretory vessels of the alimentary
canal to that of a thin fluid, the renal vessels to that of a
grosser one; so as to take off our surprise at finding vessels
fitted
(h) See DXXIII.


296 THE ELEMENTS
sitted by their degree of diameter, for the purpose of trans-
mitting red blood.
DXXIX. The reason that the females of other animals
do not menstruate but in their orgasm, and riot at other
times, is, that it is only at certain times that they are ex-
posed to that energy of stimulus which produces men-
struation.
DXXX. How much is owing to the stimulus just now
mentioned (i), in the production of menstruation, is fur-
ther evident from the following chain of facts: Which are,
that, the less addicted to love women are, the less they
menstruate; the more they give way to that passion, the
freer do they experience this discharge within certain
boundaries; that, before puberty, and after the time of life
when menstruation ceases (which are the two periods, at
which the fitness for effective love has not yet commenced,
or is now passed), the menstrual discharge is constantly
wanting; that the privation of enjoyment, which, by its
debilitating effect, produces chlorosis (k) and other similar
diseases, is remarkable for bringing on a menorrhœa, or
a retention of menstruation; and, finally, that girls, who
are of a forward growth, of great strentgh,and large limbs,
and consequently sooner ripe for love, are also more early
in menstruation; while those, who are weakly, puny,
and of a small size, and, consequently, later in attaining
to the period of puberty, are proportionally late in attain-
ing the first menstrual discharge. Lastly, if, like all the
other functions, that of love is limited at the same time by
its duration and degree; and if, as the commencement of
the love embraces it more or less early, it is proportionally
more early or late in coming to its final termination, and
if the duration of menstruation does not usually exceed
that period; that fact also, which it certainly is, added to
those
(i) See DXXIII. DXXVI. 
(k) or the green sickness. 
 

297 OF MEDICINE. 
those above, gives weight to our conclusion, and shows,
in a clearer point of view, how much menstruation de-
pends upon the venereal emotion. It is to be asserted,
therefore, again (k), that, besides the conformation of the
vessels, suited to the function of menstruation, and the stimu-
lus which has been mentioned (k), there is occasion for no
other circumstance to explain either commencement, esta-
blishment, or continuation, of the menstrual discharge.
DXXXI. The cause of full menstruation, and that of
a moderate degree of it, happening within the boundaries
of health, is the same; only differing in degree; the degree
of the latter being smaller, and that of the former greater.
DXXXII. And, as the stimuli, mentioned above, ex-
plain, why women menstruate more than the females of
other animals; so their immoderate operation upon wo-
men serves to show, why their effect, the menstrual dis-
charge, becomes greater than natural (l).
DXXXIII. The stimuli that produce abundant men-
struation, short of morbid state, are unchaste ideas, and a
high energy of passion. In this way, the influence of
reading to ones' self, or to others, of conversation, of
pictures, contrived to kindle up lustful appetite, and the
uncovering of parts that modesty conceals, which all pro-
duce a lively impression on the imagination of the thing so
much desired, can be indistinctly felt by none perhaps but
eunuchs. The same is the effect of nourishing food, and
generous drink, and high seasoning; and hence the pro-
verb, without meat and drink love starves: Likewise, that
degree of exercise, or even labour, that does not prove fa-
tiguing, but that keeps within the boundary of stimulant
operation;
(k) DXXIII. DXXVI.
(l) Women menstruate more than other females, because they are sub-
jected to a higher degree the stimulus, which is its cause; and such
women as are exposed to more of the same stimulus than others, will al-
so experience more of the effect; precisely upon that same principle. 


298 THE ELEMENTS
operation; as also an abundance of blood, both from that
circumstance and from rich diet; lastly, frequent and ar-
dent dalliance, or inconcessa hujus imitatio; all these, en-
crease the menstrual discharge, in proportion to the high
degree of their stimulus, but still do not carry their effect
to morbid excess.
DXXXIV. The same conclusion applies to the effect
of these stimuli, which was formerly applied to an over-
proportion of blood producing sthenic diathesis: For the
ultimate end of all the stimuli, that produce excessive
menstruation, is such, that, if excessive menstruation and
an encrease of love be the consequence of the excess of the
stimuli, one or other of the following must be the effect:
that is, it will either be such as remains within the lati-
tude of health, or such, as first produces sthenic diathesis,
and then, in a higher degree of it, runs rapidly into indi-
rect debility.
DXXXV. That that is the fact, is proved by the hurt-
ful powers that produce excessive and morbid menstrua-
tion; and by remedies, that are stimulant and suited to fill
the vessels, removing the disease according to our late dis-
covery; and also by the unfortunate effect of the debilita-
ting evacuant plan of cure in the same diseases.
DXXXVI. As it is stimulant operation that produces
both proper menstruation and that which goes to a little
excess; so when once menstruation is established, the con-
formation and stimulus, that have been mentioned, re-
maining, are sufficient to support it. The same opera-
tion is renewed during every interval of menstruation: The
stimulus acts and quickens the motion of the blood in eve-
ry part, but chiefly in that where it is most powerful and
most required, that is, in the region of the womb: The
blood thrown into quick motion, and rushing with a
more rapid slow, encreases its cause, the stimulus: And,
as this mutual stimulus continues incessantly to affect the
women 
 

299 OF MEDICINE.
women through the whole interval, when they are allowed
scope of love; the uterine vessels gradually unfolded,
till at last, within three weeks, or a lunar month, they
are opened to their ultimate extremities: And, when the
fluid, first serous for a little, and afterwards sanguine, and
afterwards serous again for a little, has flowed one, two, or
three days, in healthy persons, the vessels are at last shut up.
DXXXVII. During the whole time of this process, the
more excitability there is, and consequently at the begin-
ning of each menstrual effort, the more violently the sti-
mulus acts, and produces proportionally more excitement:
And it has, from this time, always less and less effect to the
end, in proportion as the excitability is more wasted;
though, till the excitibility, in so far as it has a relation to
the stimulus, is altogether exhausted, the stimulus always
adds something to the sum of excitement (m), though con-
stantly less and less. The same is the explanation of the
operation of food, of drink, and of all the exciting pow-
ers,
DXXXVIII. As what has been said of the stimulus,
productive of menstruation, is conformable to the effects
of all the other stimuli; the same is its conformity to the
whole sum of menstrual effect from the beginning to the
end of the process. Thus, in the beginning of that long
period, the force of the stimulus is far the greatest, upon ac-
count of its novelty, and the unwasted state of excitability
that relates to it. At this period, above all others, love in
persons in health is exquisite; and, in consequence of the
stimulus which excites it, menstruation, when once esta-
blished, is most exactly performed; that is, it does not,
either from deficiency or excess, deviate into morbid state.
DXXXIX. But after the beginning of this function,
and when now the office of menstruation is established;
because
(m) See XXXVI. 


300 THE ELEMENTS
because in this, as well as every other function, the exci-
tibility is gradually diminished in the progress of life, the
stimulant power also has gradually less, and, at last, no
effect: Consequently, in the same gradual way, the power
of love in women, and, in proportion, that of menstrua-
tion, is diminished, and at last altogether extinguished.
DXL. While both the faculties, that of love as well as
that of menstruation, in this way decrease from the begin-
ning to the end; so, menstruation is often interrupted, in
pregnancy, in suckling, in the diminution or suppression of
of menstruation. This interruption in the two former is
natural and suitable to health; but in the diminution or
suppression of the menstrual evacuation, it becomes mor-
bid.
DXLI. Since the stimulus with the conformation of the
vessels is the cause of menstruation, and the latter depends
upon the former; so again the defect of the stimulus, and,
therefore, of the conformation, produces both the retar-
dation, diminution, and, at last, the complete suppression of
the discharge.
DXLII. Whether ever the defect of menstruation, like
that of perspiration, or of any internal excretions, as that
in the sauces and alimentary canal, is sometimes to be im-
puted to sthenic diathesis, is uncertain, for this reason; that,
while the diameters of the small vessels on the skin and in
the intestines are more nearly allied to such a contraction
for a reason formerly assigned (n); so great a force of excite-
ment, so high a degree of sthenic diathesis, as would be suf-
ficient to shut up vessels destined to the transmission of
blood, is not easy to be conceived. And the doubt is
further encreased by a certain fast; which is, that both in
the retardation of the menstrua, and all the degrees of
their diminution to their total suppression, when local af-
fection
(n) LVII. LXII. CXII. CXIII. 


301 OF MEDICINE. 
fection is out of the question, there are evident proofs of
a debilitating cause.
DXLIII. To ascertain that fact, which is of the greatest
consequence for this reason, that it directly interests the
method of cure, and, if not explained, would leave a gap
in our principles; we have to observe, that, as some men,
in consequence of the stimulus of excessive love, in the case
of a most beautiful woman being the subject of it, have,
by means of sthenic diathesis, been so inflamed as to fall
into a temporary fit of impotence, and been cured by bleed-
ing; so, besides that that is a rare fact (o), it is not very pro-
bable, that the patulous uterine vessels can be so contracted
in their diameters, as to be incapable of transmitting their
fluid. Nay facts contradict it: The retardation or defici-
ency of menstruation receives a temporary alleviation from
the debilitating plan of cure; but the discharge is not usu-
ally brought back, on the contrary it is more kept off:
But allowing an over-proportion of blood and an excess of
stimulus to be the cause of the first deficiency of menstru-
ation, after it has been removed by bleeding and the rest
of the debilitating plan of cure, can it again be the cause
of a disease, which resists a degree of evacuant and debili-
tating plan of cure, that would cure ten peripneumonies?
And since any stimulus, as well as that of an over-propor-
tion of blood, may, from its excessive force go into indi-
rect debility; why may not the same thing happen in a
disappointment in love, and first deficiency of menstruation;
and, in both cases, atony, ushering in manifest debility,
and not excess of tone, be the cause? As peripneumony,
where the over-proportion of blood and sthenic diathesis
is by far the greatest that ever happens, in consequence
of indirect debility passes into hydrothorax; why may not
a similar cause in this case produce a similar effect?
DXLIV. 
(o) I remember one instance in Dr. Whyte, and I think I have only
heard of another.


302 THE ELEMENTS
DXLIV. The cause, then, of deficient menstruation,
whether partial or complete, is a languid excitement over
the whole body, especially in the uterus, from a deficien-
cy of the stimulus of love (p), and of all those stimuli
that support it (q), and from a penury, or under-propor-
tion of blood.
DXLV. That that is the fact, is proved by the hurtful
powers mentioned in the retardation of menstruation, and
other debilitating ones in every deficiency of that discharge,
producing each disease; it is proved by the stimulant and
filling plan of cure removing it, and also by the hurtful
effect of the debilitating plan of cure (r).
DXLVI. The remedies for the cure of retarded men-
struation are, rich food, generous drink, gestation, exer-
cise accommodated to the strength, pediluvium and semi-
cupium, or the warm bath of the under-extremities, and
gratification in love (s).
DXLVII. The same remedies are required for the
suppression, and the same, but inferior in their degree of
force, for the diminution of menstruation: When there is
an unusual force of the disease, either in degree or dura-
tion, we must have recourse to the assistance of the diffus-
ible stimuli.
Of Menorrhœa, or the excessive Discharge of Menstruation.
DXLVIII. Menorrhœa is an effusion of blood from
the uterus, or an over-copious menstruation, or too long a
continuance of it in a more moderate degree of the ex-
cess, accompanied by all the symptoms of asthenia.
DXLIX. This disease is occasioned not by an over-pro-
portion of blood, not by a vigorous state of body, but by
an
(P) DXXIII. DXXVI. DXXIX.
(q) DXXVI. DXXVII. DXXXII. DXXXVII.
(r) DXXXV. 
(s) DXXVI. 
 

303 OF MEDICINE. 
an under-proportion of the former, and an exhaustion of
the latter. The hurtful powers, therefore, that produce
it, are food not nourishing enough, or too small a propor-
tion of what is so, watery drink, or that over-proportion
of pure strong drink that produces indirect debility, ex-
cessive heat, or cold not prevented from its debilitating
operation by any stimulus, and salacity.
DL. Its remedies are the reverse of the hurtful powers;
rich food, generous strong drink, heat acting within its
stimulant range, cold kept from direct debility by the
stimulus of heat and other stimuli, and gratification in
love.
DLI. The effect of the hurtful powers and remedies
of which we have spoken, that of the former in produc-
ing, and that of the latter in removing, the disease, and
the failure in success of the debilitating plan of cure, all
confirm the fact.
Of Epistaxis, or bleeding from the Nose.
DLII. Epistaxis is an asthenia; which, besides the ge-
neral symptoms of the latter, is distinguished by bleeding
from the nose, without any force behind, an affection
troublesome at any age, but particularly to young persons
under a rapid growth, and to enfeebled old age.
Of Hæmorrhois.
DLIII. The characteristic of hæmorrhois, or the piles,
added to other signs of asthenia, is a slow of blood from
the anus, or the parts around it.
DLIV. The same thing, nearly, that has been said of
menorrhœa, is to be said of the hurtful powers and reme-
dies of this disease.
DLV. The cause of the piles is manifest, from the hurt-
ful powers producing it, the remedies removing it, and the
unhappy effect of the common asthenic plan of cure; that 
is


304 THE ELEMENTS
is to say, it is debility of the whole body, from the defici-
ency of other stimuli, and chiefly that of the blood (t):
Which debility, while it relaxes all the vessels, and impairs
their tone, produces that effect, in a special manner, upon
the labouring vessels. The reason of which is, that, in con-
sequence of the inequality so often mentioned, the chief
prevalence of the cause operates in the seat of the urgent
symptom (u). Nor is it to be thought wonderful, that
the blood should slow through the vessels of the uterus that
are patulous, and in the habit of pouring out blood, through
the pendulous hemorrhoidal vessels, and those of the nose,
which are delicate, and weakly supported, in preference
to others. In this case plethora, which has no existence (x)
is equally unnecessary to our reasoning (y).
Of Thirst, Vomiting, and Indigestion, as well as the Kindred Dis-
eases of the Alimentary Canal.
DLVI. There is a very frequently occurring affection,
beginning with thirst and proceeding to vomiting (z). It
often proceeds no farther than those symptoms; it oftener
ushers in the most severe affections, such as sometimes dys-
pepsia, or indigestion, sometimes colic, sometimes the gout,
sometimes proper fevers, and many other asthenic diseases.
It most frequent source by far is weakness, being the at-
tendant sometimes of too long suckling, sometimes in the
diarrhœa incident to women, wasted with a long course
both of that and repeated pregnancies.
DLVII. There are two causes of as many affections
which have got only one name between them, that of
thirst: The one is sthenic, the other asthenic (a). The
former arises from the stimulus of salt, of rich and plenti-
2 ful 
(t) See par. DXLIX. 
(u) See XLIX. L. LI.
(x) See par. CXXXI. CXXXIV. 
(y) CXXXII.
(z) CLIX. CLXXXV. CLXXXVI. and CLXXXVII. 
(a) Ibid. 


305 OF MEDICINE. 
ful meals, of heat and labour, and some others; never
ending in vomiting till the sthenic state is over, which is
seldom. Its cure, with which we have here no concern,
is cold water and the several debilitating powers.
DLVIII. The asthenic thirst, which is our present
subject, depends always on pure debility, sometimes in-
direct, sometimes direct (b). Its tendency is always to
stomach sickness, and, as that encreases, to vomiting (c);
and when the vomiting becomes any way considerable,
the consequence is that most acute pain, which a cramp in
the stomach produces (d), and the other affection formerly
explained (e). This progress is spontaneous, direct, and
for the most part rapid.
DLIX. The hurtful powers here are all debilitating.
The indirectly debilitating hurtful powers are, debauch
in eating and drinking (f), drunkenness, extreme fatigue,
ultimately excessive heat (g), violent passions (h), excessive
exercise of the intellectual faculty (i), debilitating food (k),
an over-proportion of blood now converted into an under-
proportion, together with the conversion of the sthenic
diathesis that attended the former, into the asthenic, the
inseparable attendant on the latter. The following pow-
ers act by a directly debilitating operation; cold corrected
by no stimulus (l), cold drink, vegetable food (m), penury
of blood (n), of other fluids (o), want of pure air (p), anxie-
ty, grief, fear (q), and in fine, that weakness of the system,
which arises from all those. The affection is often of a
mixt origin, from a mixture of both these sorts of hurtful
powers: For, as direct debility always increases the indirect,
so does the latter the former, both in this and all cases (r).
X DLX.
(b) CLXXXV. 
(c) See CLXXXVII. CLXXXVIII.
(d) Sec par. CLXXXIX.
(e) CXC. to CXCV. and from that to CXCVIII.
(f) CXXVIII. CXXX. 
(g) CXV. 
(h) CLXI. 
(i) CXXXIX.
(k) CXXVIII. 
(l) CXXII. 
(m) CXXVIII. 
(n) CXXXIV.
(o) CXXXVII. 
(p) CXLVI. 
(q) CXLII. 
(r) XLVII. LXXI. 


306 THE ELEMENTS
DLX. A corruption of the common mass of fluids,
whether it be called acrimony, or putrefaction, has no con-
cern in the cause; because, while life remains, and the ac-
tion of the vessels upon their respective fluids continues,
such a faulty state of the fluids cannot make its havock
over such an extent of the system, that being only the ef-
fect of a cessation of motion of the fluids under heat; nor
can it happen, but in the extreme vessels and excretory
ducts, which, by their atony, do occasion such a cessation
of motion, and likewise in the alimentary canal.
DLXI. The cause of this thirst is the common one of
every asthenia, but predominant in the throat and stomach,
upon account of the atony of the salivary, and other ex-
cretory ducts (s).
DLXII. The remedies are also the common ones of
every asthenia, to be accommodated to the degree of debi-
lity in the cause. In a slighter degree of thirst a glass or
two of brandy, or of any similar spirit, or, which is a better
rule, given till the complaint is removed, is sufficient. It
should be either pure, or diluted with a very little hot wa-
ter (t). That should be followed by eating some animal
food (u); and it should afterwards be supported by other
stimulants taken moderately, and in the degree that suits
good health. After which the proper practice is, to pro-
ceed to the use of the permanent stimuli.
DLXIII. When the thirst, not quenched by these means,
proceeds directly to vomiting, and when, by and by, an
excruciating pain supervenes upon the vomiting; which,
excepting
(s) CLXXXVI. CLXXXVII.
(t) The addition of cold water counteracts, that of hot co-operates
with, the effect, which has been ascertained in a thousand trials.
(u) When the thirst was but just coming on, and not yet established,
I have found a hearty breakfast carry it off. But when it is come to a
head, the mixture of stomach sickness, that now begins to take place
with it, renders eating impracticable. 


307 OF MEDICINE.
excepting the pain, is an affection, that together with the
symptoms that have been mentioned (x), should receive
the appellation.
Of Dyspepsanodyne, or Indigestion without Pain:
And when, besides the pain of the stomach, now induc-
ed, the affection going downward to the intestines, some-
times produces a loose, sometimes a bound, belly; at other
times only a loose belly, and at others only a bound one;
which is an affection, when unaccompanied by costiveness
that is distinguished by the title.
Of Diarrhœa.
DLXIV. And, when accompanied with costiveness, is
entitled to the denomination.
Of Colicanodyne, or Colic without Pain:
DLXV. In all those cases recourse must be had to a
larger dose of the drink: And, when that does not succeed
to our wish, we must next fly to opium, and other more
diffusible stimuli, if they are to be found: When, by
these, relief is procured, rich and pure soups, without
grease, should, from time to time, be poured in, and the
canal carefully bathed all over with them. After which,
the other stimulants should be added; in the use of
which, a straight direction between direct and indirect de-
bility should be held, without the least deviation towards
either; And our efforts must always be continued till the
disease is radically removed.
DLXVI. The necessity for this direction in the cure is
so much the greater; that, by neglecting it, or depending
upon the common purgative debilitating plan, the conse-
X2 quence
(x) From DLVI. to DLXII. 


308 THE ELEMENTS
quence is, that often a proper general disease degenerates
into a local affection. To proceed to the consideration
Of the Kindred Diseases of the Alimentary Canal.
DLXVII. Among them, besides those that have been
mentioned above (y), there are not wanting, others, which,
when compared with them in the similitude and nature of
the cure, absolutely claim this place in the scale.
Of the Diseases of Children.
DLXVIII. The diseases of children are, dryness of
the skin, sudden slaver, or salivation of short continuance;
a similar rejection of milk, without effort (z); a green
scouring; at other times costiveness; both commonly with
gripes; the usual mark of which is, a pulling up of their
knees towards their stomach, with very severe crying;
unequal heat. A little more severe than those are the two
following cases, the one of which has the name.
Of Worms.
DLXIX. Which are distinguished by a thickening of the
columna nasi (a); by a custom of picking the nostrils; by
loss of complexion; by paleness of the face and of the rest
of the skin; by a swelling of the belly; and, lastly, by the
discharge of worms by stool. The most distinct symp-
toms of the other affection, or 
Of Tabes, or the general Wasting of the Body,
DLXX. Are meagerness all over the body, an unusual
bulk of the abdomen, almost constant watching, such a
weak,
(y) From DLVI. to DLXVI. 
(z) See CCCCIII.
(a) It it that longitudinal depression which runs down from the par-
tition of the nostrils perpendicular to the upper-lip. 
 

309 OF MEDICINE. 
weak, distressed, assiduous, and hoarse manner of crying,
as excites tenderness and compassion.
DLXXI. The hurtful powers, producing all those af-
fections, are in common to them with every asthenia;
that is, they are every thing that has an effect of debilita-
ting the whole system, and especially the alimentary canal:
Such as, at this age, are, milk not nourishing enough, and
at the same time acescent and flatulent; want of food, or
made of watery matter and bread; cold, and moisture,
the latter encreasing the effect of the former; habitual vo-
miting and purging; too little dandling; mistiming sleep,
and meals, and every part of management; nastiness; im-
pure air; a neglect of natural likings and dislikings.
DLXXII. The remedies are the converse of all those,
nourishing exciting milk; three or four meals a day, con-
sisting chiefly of warm milk, pure animal soups, not weak,
with a mixture of flower or bread of the same kind; heat
without being carried so far as to produce sweat, or too
much redness, and free from moisture; laying aside every
sort of evacuation; a great deal of dandling and gestation;
a proper timing of sleep, of food, and of every part of ma-
nagement of these delicate systems; cleanliness; tepid ba-
thing in cold weather, and cold bathing in warm; and
pure air, being out in the fields as often as possible in all
but moist weather; such a judicious attention to desires
and propensities as not to neglect scratching any part that
itches (b).
DLXXIII. These directions suit the gentler cases
under consideration. To remove the more violent, while
they also are not by any means to be neglected; at the same
time others to be subjoined. When the green scour-
ings, great looseness, and boundness of belly, are vexatious;
recourse must be had to pure wine, spirits, more or less
diluted
(b) See above DXVIII. 
 

310 THE ELEMENTS
diluted as the occasion may require, or if there should be
need, not diluted at all: More of the soup that has been
mentioned and of a richer kind.
DLXXIV. If those should not succeed to the physician's
mind, which will seldom be the case; in the same affec-
tions and more certainly in worms, and still more certainly
in the tabes, or general consumption, with the remedies
that have been spoken of, the more diffusible stimuli of
opium and musk should be alternated. Both sorts of re-
medies (c), should be so accommodated to the violence of
the symptoms, as not to be dropped till the whole morbid
tumult is allayed, and the healthy state replaced; which
will, upon trial, be found more practicable, than has yet
been imagined from the employment hitherto of the con-
trary plan of cure, to the great comfort of mankind in their
sufferings.
DLXXV. From what has been said it will appear,
that these affections of children, all flow from the same
cause, are removed all upon the same indication of cure,
as any other asthenia, or disease of debility, that has either
yet been, or is to be, mentioned in this work. The un-
happy termination of them hitherto, is to be imputed not
to their cause, but to the depravity of the common method
employed for their cure (d): Nay, though they do dege-
nerate into local affections, as in the instance of the tabes,
or general comsumption, ending in an obstruction of the
mesentery;
(c) The durable and diffusible.
(d) I cannot help repeating again, because the importance of the sub-
ject calls upon me to do so; that the practice of the new plan of cure,
in all the diseases of children, as well as in the others lately spoken of,
has ever succeeded in my hands, as well as in those of my pupils, to a
miracle. I cannot say that I ever met with an instance where it could
be said to have failed. Let then who will compare that account with
the known mortality that is every day the result of any other practice
yet thought of in the profession.


311 OF MEDICINE.
mesentery; in that of cholic at every age, terminating in an
inflammation, tumor, or complication of the intestines;
and in those of both cholic and long-neglected diarrhœa,
running into a gangrene in the same part; that is a mis-
fortune that never happens, when a proper method of cure
is early enough used to remove primary disease: And, on
the contrary, it most commonly arises from the perversity
of that plan of cure, or the neglect of this, which is the
proper one. To the same kindred diseases of the alimen-
tary canal (e), further belong the two following ones, un-
der the title.
Of the gentle Dysentery and Cholera.
DLXXVI. To which, every thing that has been said
of those kindred ones, will apply: Or, if there be occasion
for any particular observation upon them, it will be taken
up, after we come to treat of them in their more severe and
violent state: Of a similar nature to all these, but of a
degree so much higher as to merit the next place in rank
below them, and, at the same time, not unconnected with
them, as having the feat of its predominant symptom in
the same canal, is the disease to which I have given the
name
Of Angina.
For the symptoms and method of cure of which turn
back to number CCXXII. where it is introduced, in
the explanation of asthenic symptoms.
Of Scurvy.
DLXXVII. Scurvy is an evident asthenia: The prin-
cipal symptoms of which are, want of appetite, loathing
of 
(e) From DLXVI. to the present paragraph. 
 

312 THE ELEMENTS
of food, laxity of the living solids considered as simple so-
lids; an oozing of blood, both from other parts, and par-
ticularly from the gums; aversion to labour; low spirits,
and a langour in all the functions.
DLXXVIII. The hurtful powers producing this dis-
ease, are the common asthenic ones, appearing in the fol-
lowing form; It is cold in this case, but conjoined with
moisture in the northern seas, and, as we may well suppose,
in the parts of the southern ocean of the same temperature,
that generally produces the peculiar form of the disease.
But with it all the other debilitating powers contribute their
share: Such are, grief for the loss of liberty, relations,
kindred, and friends; a horrid dislike to their present state
of life; a longing desire for that which they have parted
with; the awe which the severity of discipline keeps them
in; the effect of a calm, where there is nothing to do, pro-
ducing direct debility on them; a storm, where they have
to labour above their powers, as certain a cause of indirect
debility; there not having been allowed, till of late, fresh
meat, which is the only nourishing and envigorating (f)
form of it; their being kept upon salted and spoiled meat,
and not even corrected by recent vegetable aliment, such as
that is (g); watery or small drink; the terror which the
expectation of a battle at sea inspires.
DLXXIX. All those particulars prove, that scurvy is
so far from being the effect of one or two hurtful powers,
and from resting upon so narrow a basis of the cause pro-
ducing it, as has hitherto been imagined; that it is rooted
in a multiplicity of debilitating powers, and is a real ast-
henia, or universal disease of debility.
DLXXX. And this fact is confirmed by both the true
and false method employed for its cure: For, though nearly
all the common powers concur in the production of scur-
vy; if, however, it be considered, how easily, upon the remo-
moval of the hurtful powers, and the patient getting ashore,
the 
(f) SCXXIV. (g) See CXXVIII. 


313 OF MEDICINE.
the disease is got under, by fresh meat, either with or with-
out greens, by wine, gestation, and exercise, in fine, by the
recovery of his usual manner of living; it will be impos-
sible to entertain a doubt of its being both an asthenia, and
by no means a violent one. The pretence of its cure being
effected by greens, roots, four crout, and similar things, so
much boasted of lately, which, without the remedies just
now enumerated, could not fail, by their debilitating ope-
ration, to aggravate the disease, is derived from a noted
blunder among physicians, by which they are led to over-
look the most certain, simple, and evident facts, and take
up in place of them, the greatest falsehoods, or such fasts
as have a very narrow foundation in truth.
Of the gentle Hysteria.
DLXXXI. The gentle hysteria is a form of asthenia,
of frequent occurrence among women, but very rarely
happenning to men; in which a noise is heard in the belly,
and the patient has a sensation of a ball rolling within the
bowels, rising up to the throat, and there threatening the
patient with suffocation.
DLXXXIII. The striking symptom in this disease is a
spasm, not fixed in a part, but running the course just now
described. The disease attacks in fits, for the most part
leaving long intervals betwixt them, and often never re-
curring more than once or twice.
DLXXXIII. The fits are soon removed by small doses
of opium, repeated at short intervals: The intervals should
be secured from danger by full diet, and a moderate and
naturally stimulant management.
Of Rheumatalgia, or the Chronic Rheumatism.
DLXXXIV. Rheumatalgia is an asthenia, not so much
a sequel of rheumatism when left to proceed in its own
spontaneous


314 THE ELEMENTS
spontaneous course, as of the profusion of blood and of
other fluids employed for the cure of it, and of too debi-
litating a cure; with a change of the sthenic diathesis and
the inflammation, which is a part of that, into the asthenic
diathesis and inflammation. Paleness of the skin takes the
place of complexion: The appetite is diminished, the in-
voluntary motions are impaired, debility and torpor pre-
vail over all. So far the disease is understood to be chronic.
As in rhematism, the joints are pained and inflamed: As
that, which has been assigned, is the most frequent cause
of rheumatism, so it sometimes arises not from a sthenic
origin, and an excess in the means of reducing that.
DLXXXV. The cause of the disease is the usual one
of any asthenia, predominant in the moving fibres of the
muscles, situated below the skin over the whole surface of
the body.
DLXXXVI. Its worst morbific powers are, penury of
blood, cold, especially with the addition of moisture, im-
pure air, and besides these, as many of the other powers
that act by a debilitating operation as happen to be applied,
contribute, in proportion to the degree in which they are
applied to the morbid effect. Of these excessive indo-
lence and the reverse are particularly hurtful.
DLXXXVII. As all stimulants contribute to the resto-
ration of the healthy state; so the most powerful of them
in this case is nourishing food, friction, gestation, wine,
taken in moderation, exercise, rather frequent than violent,
and being as much as possible in the open air. If it is an
acknowledged fact, that rheumatalgia is one of the reproa-
ches of physicians, it is more so than has been hitherto un-
derstood; it being an asthenic disease, while they at all
times made use of the same kind of cure, as if it had been
the 
 

315 OF MEDICINE. 
the most sthenic, or even upon the whole more debilita-
ting (h).
Of the Asthenic Cough.
DLXXXVIII. The asthenic cough is an asthenia, which
with the constant symptoms of the latter, depends upon
a frequent expectoration, that the cough excites; affecting
every age which has been under the influence of either
direct, or indirect debility, and therefore old age, which
is unavoidably the prey of indirect debility.
DLXXXIX. As consisting in direct debility, it is the
effect of an excessive violence of all stimuli that have been
applied either for a short time, or for a great part of life,
their operation coming to the same amount, that of the for-
mer from its degree, and that of the latter from its long
continuance (i). In so far as its cause is direct debility, a
deficiency of all the stimuli, leaving the excitability to be
accumulated, allows this form of asthenia to happen from
the spontaneous tendency of nature, of which life is only
a forced state (k).
DXC. The cough, which depends upon indirect debi-
lity, is cured by reducing the stimulus which occasioned
it, gradually and cautiously to the proper and natural degree.
And 
(h) If they should pretend to say that their bleeding and other evacu-
ations were more moderate than in rheumatism; the answer is, that they
were not so profuse at any given time: But, considering the length of
time, that rheumatalgy draws out into, the frequent, and almost constant
evacuations, conjoined with every species of inanition, made the debili-
tating practice upon the whole far exceed that used in the sthenic case.
No wonder, then, that much mischief was done.
(i) See above XXIX. XXX. and CCCCI.
(k) So great is nature's tendency to that particular encrease of exer-
tion, which forms the matter of expectoration in this disease, that every
case of death from disease is an instance of it. Hence the dead rattle in
the throat is universally the expiring symptom. Sec LXXII. and
CCCXXVI. 
 

316 THE ELEMENTS
And when it originates from indirect debility, the encrease
of the stimulus, the want of which occasioned the disease,
till the degree of excitement, which constitutes health is
replaced, effects the cure.
DXCI. Such is the nature of direct and indirect debi-
lity; that if the remedies of the former be pushed beyond
the boundary, the cough appears again; and the same is
the event of the same excess in the use of the remedies of
the latter (l).
DXCII. Frequent and violent cough with copious ex-
pectoration has been always held for a sure mark of a vi-
tiation or faulty state in the lungs. That faulty state was
esteemed to be of a sthenic nature, and to give assurance of
the presence sometimes of phthisipneumony, or consump-
tion from an ulcer in the lungs, sometimes bastard perip-
neumony, sometimes of a burning inflammation in the ali-
mentary canal. In the former case an ulcer, or, in their
way of speaking, and what amounts to the same thing,
tubercles were believed the cause of the disease; in the se-
cond case inflammation either in the intercostal muscles,
or a different one from that, which in true peripneumony
was, in their opinion, its primary cause, was considered
as the cause; and in the last case, no one of them would
have hesitated a moment to have ascribed the state of the
bowels to the only inflammation they were acquainted with,
that which requires bleeding and evacuation for its cure.
And no other enquiry was made, but whether the matter
that was spit up, was mucus or pus. To ascertain that
premiums were proposed.
DXCIII. But, in fact, besides that no phthisipneumony,
no bastard peripueumony, as they call it, no inflammation
in the alimentary canal, was ever cured by antisthenic
or 
(l) See par. XXXIII. XXXIV. and XLIII. XXX. CXXXIV. and
especially CCXXXIII. to CCXXXVI. 
 

317 OF MEDICINE. 
or debilitating remedies; and that, in the several trials that
have yet been made, the first of these cases has been evi-
dently assisted, nay frequently completely removed, and the
two latter, thoroughly cured in numberless instances, and
in all in which it has been used by the sthenic, or stimu-
lant plan of cure; I say, besides these large and compre-
hensive facts, so little signification is there, either in the
quantity or appearance of the expectoration, that in cer-
tain fevers, in other diseases of debility, quite free of all
local affection, and finally in this very cough of which we
are speaking, there is often a more violent cough, and a
greater expectoration of matter putting on every form and
every appearance, than usually happens in a confirmed
consumption, and where every hour is expected to be the
last. And yet the whole tumult, hitherto so alarming,
could be stopt in a few hours, and quite cured in as many
days.
DXCIV. And, who does not know, that there are
many persons, who have an immoderate cough, and pro-
portional expectoration for a whole and long life time,
whose lungs, however, are found, and free from any or-
ganic taint? How often in phthisipneumony itself after
finishing its course, and at last terminating in death, has
the whole fabric of the lungs been found upon dissection
as found as ever happens in death from any cause (m)?
DXCV.
(m) There are several cases upon record, of the lungs after death from
a confirmed consumption, having been found perfectly found. A most
respectable pupil of mine went to Lisbon with a young gentlemen of
considerable rank in Scotland, under a confirmed consumption, whom
he brought back perfectly freed from his disease. He also saved either
two or three ladies, I am not just now sure which; equally given up up-
on the common practice. He happened to assert before the physician of
the factory, that a person just dead of the same disease had no local af-
fection in the lungs, and upon dissection it was found to be as he had
said. I have restored many phthisipneumoniacs, but am obliged to own,
that 
 

318 THE ELEMENTS
DXCV. The cause of cough has hitherto been un-
known. To pass over the sthenic cough, with which we
have nothing to do in this part of our subject (n); the
cause of the asthenic, is the same as that of any asthenia,
but more vehement in the fountain of expectoration, to wit,
the exhalant and mucus arteries, the secreted fluids of
which, inspissated by stagnation in the bronchia, compose
the matter to be expectorated.
α. α. The most powerful of the asthenic hurtful agents
in exciting asthenic cough, is cold, just as heat has been
demonstrated the most hurtful agent in catarrh (o). Nay,
in the asthenic cough, such is the rage of cold, that the
slightest breath of air reaching the body, excites a most
prodigious tumult of coughing, and brings out the whole
series of subsequent symptoms; and heating the body in the
bed, as soon allays the cough, prevents the threatening,
and cures the urgent disturbances.
DXCVI. In this as well as the sthenic cough, it is the
serous and mucous fluids that chiefly flow to the bronchia.
Which bear their pressure for a little, till, distended by the
load, they can bear it no longer. The disagreeabless of
the stimulus excites a commotion in the excitability of the
labouring part, and, therefore, over its whole seat, and
rouses the excitement. A cough arises and throws off
its cause, the collected humours.
DXCVII. This disease is always to be treated for its
cure, first with stimulant remedies, and then with such as
also 
that I have lost three, to whom I was called too late. Their loss, how-
ever mortified me, because there were many reasons for my setting my
heart upon the cure. I also lost in Edinburgh the most amiable young
man of that kingdom, after curing a prodigious hemorrhagy from his
lungs. This was he whom my pupil two years before brought home
safe from Lisbon. But I was prematurely dismissed in this, and coun-
teracted, in the other cases.
(n) See CLX. CCXXXIII. 
(o) See par. CCCCVII. to CCCCXII. 
 

319 OF MEDICINE. 
also fill the vessels. If indirect debility has been the mor-
bific power, still we must stimulate, but at first with a
force of stimulus little less than that, which occasioned
the disease, and then with still less; and, after changing,
from time to time, the form of the stimulus, with less still;
till we come down to the stimuli that are agreeable to na-
ture, those that suit the most perfect health (q). In that
way is ebriety, in that way is every form of intemperance,
to be treated. If direct debility has been the cause, the
cure will be a good deal more easy: That is we must go
on to stimulate more and more, till we get up to that point
of excitement, to which we came down in the case of in-
direct debility. In this way is the first stage of phthisip-
neumony, as well as its middle course, and also bastard
peripneumony, nay, most cases of the debility affecting
young people, and the disease to which the name
Of Chincough
DXCVIII. Is given, to be encountered in practice.
Chincough is attended by a contagious matter; which va-
ries in its degree, but in such sort, however, that a sthenic
plan of cure, adapted to the degree of the disease, for cer-
tain cures it. The change of climate or place is a tale, the
practice of vomiting is death (r). And, since the disease is
an 
(q) See par. CIII.
(r) Still to the old tune "cantilenam eandem canunt" They confes-
sed they knew nothing about this disease, yet they prescribe change of
air and place: If they knew nothing about the disease, how could they
know what would be of service?—Others told them so. But why do
they prescribe vomiting?—They heard that from their master's desk
at school, and found, that the same authority, was the reason of others
for doing the same thing. Why vomiting? For the same reason, and
because a relique of the doctrine of morbific matter has run through all
their systems. Hence in bleeding diseases, the universal rule has been to
bleed; in vomiting to give emetics, in diarrhœa to give cathartics, in
imitation, 

 

320 THE ELEMENTS
an asthenia, vomiting, which is so very debilitating an
agent, cannot fail to be of the highest detriment (s).
Of the Cysterrhœa, or the mucous Discharge from the Bladder of
Urine.
DXCIX. Cysterrhœa is that mode of asthenia; in
which, to the general symptoms of asthenia, and the par-
ticular ones of asthenic cough, there is an addition of mu-
cus, rendering the urine turbid, without any previous pain
or symptom of internal local affection.
DC. In so far as this is a general affection, the laxity
proportioned to the atony must be removed equally in it,
as in other cases of encreased excretion; and particularly
the stimuli of health must be accurately administered.
Of the Gout of stronger Persons.
DCI. The gout of stronger persons is a form of asthe-
nia; in which, after a long habit of luxury and indolence,
and especially, when to those hurtful powers directly de-
bilitating, ones have been recently superadded, indigestion,
or diarrhœa, or rather both conjoined, with manifest signs
of a diminished perspiration, precede; then the lower extre-
mities are affected with languor. Of the lesser joints, al-
most always the one or other foot is seized with an inflam-
mation, which, if not resisted by a piece of art quite new,
will prove most severe, most painful, and of a short dura-
tion, comparatively to its state in that respect in the after
part of the disease.
2 DCCII.
imitation, forsooth, of nature. The symptoms of disease have been mis-
taken for efforts of the constitution to remove the disease. It is now;
however, proved that there are no such efforts. Every symptom, and
particularly every morbid evacuation, is to be stopt. The contrary prac-
tice is as good sense, as it would be to propose bringing on a dead rattle
to cure he morbid one.
(s) See par. CXXXVII. and CCXCIV. 


321 OF MEDICINE. 
DCII. This disease may be called the indigestion or
dyspepsia of the luxurious, that is, depending upon indirect
debility; while dyspepsia may be denominated the same
disease, that is the gout of persons under direct debility,
as having every symptom of the gout, except the inflam-
mation (t). For, in diseases, so little is there in names,
that not only those diseases, of which we have been just
now treating, but likewise asthma, hysteria, the cholic,
and most of the diseases, which have taken their appella-
tions from any remarkable disturbance of the alimentary
canal, are equally prevented and cured by the same me-
thod of cure precisely. Which is indeed the reason why
the gout has been ranked in the number of the diseases of
the same canal. 
DCIII. A taint transmitted from parents to their off-
spring, and celebrated under the appellation of hereditary,
is a tale, or there is nothing in the fundamental part of this
doctrine. The sons of the rich, who succeed to their fa-
thers estate, succeed also to his gout: those who are exclu-
ded from the former, are also from the latter, unless they
bring it on by their own merit. Nay, if there be but on-
ly two diseases in the strict sense of the word, they must be
either all, or none of them, hereditary. The former supposi-
tion makes the hurtful powers superfluous, which have
Y been 
(t) There are very few persons, who at one time or another in their
life have not experienced painful twiches in some part or other of one
of their feet, especially when they happened to be in a state more languid
and sluggish than ordinary. Every which case may be considered as a
gout in miniature. But when the whole phenomena, except the inflam
mation, happen to any person, call it dyspepsia, or what you will; it is
to all intents and purpose, a gout. Indeed, from all that has been said
through this work, general morbid state appears to be a very simple af-
fair, being nothing but an encrease or diminution of the cause of the
functions or powers of life, without any other difference, but that of the.
mere appearance of the symptom to our senses, an appearance by which,
when we look no further for information, we are also constantly deceived, 
 

322 THE ELEMENTS
been proved to be every thing respecting disease; and, as it
is, therefore absurd, so the truth of the latter must be ad-
mitted. The stamina, or bulk of our simple solids, are
so given in our first confirmation, that some persons are
distinguished by a gross, others by a slender state of the
whole mass. That variety of the stamina, if the exciting
powers, upon which the whole phœnomena of the life de-
pend, be properly directed, admits each its respective state
of health, suited to its respective nature, and sufficiently com-
modious, if the excitement suited to each, from a proper di-
rection of the stimuli producing it, be properly applied.
Though Peter's father may have been affected with the
gout, it does not follow that Peter must be affected; because,
by a proper way of life, that is by adapting his excitement
to his stamina, he may have learned to evade his father's
disease.
β. β. If the same person, who from his own fault and
improper management has fallen into the diseases; after-
wards by a contrary management, and taking good care of
himself, both prevents and removes the disease, as it has
been lately discovered; what then is become of hereditary
taint?
Lastly, if the gout is the same disease as dyspepsy, ari-
ses from the same hurtful powers, is removed by the same
remedies; and the only symptom, in which it can pos-
sibly be thought to differ, the inflammation, is only a slight
part of the disease, depending upon the same original cause,
and ready to yield to the same remedies; what signify di-
stinctions about either, that do not apply to both (x)? No-
thing
(x) If I have kept off my gout for seven years past, after having been
subjected to the most severe rage of the disease, might not I, much more
easily, have prevented it before? But, it may be said perhaps, that ex-
cruciating pain makes a great difference in the scale of comparison of
any two diseases: The answer to that is, that since the pain is as easily
removed as the other symptoms, the difference is removed, and the
weights in the scale equalized, 


323 OF MEDICINE. 
thing by them further is set forth, than, that a certain tex-
ture of stamina is favourable to certain forms of diseases,
which (forms) are of no consequence, in such sort, that,
when the excitement is adapted to the stamina, even those
forms can be prevented or cured.
DCIV. The hurtful powers producing the gout are,
first, indirectly debilitating, not effectual all of a sudden,
nor commonly before the meridian of life, that is, before
the thirty-fifth year of one's age. Rich food, too much
ease, have a very great effect, drink has less. To that all
that have a tendency, to wear out life, to consume the ex-
citability, contribute. But the first fit scarce comes on till
directly debilitating hurtful powers have been superadded
to the indirect (y). The following are particularly hurtful,
abstinence, vegetable food, the hurtful effect of which is in
proportion to the imbecility of the matter that composes
it. The farinaceous substances, which are by no means
safe (z), and less hurtful than roots, and these less so than
greens (a); but fruits are the most hurtful of all (b). Cold
Y2 water,
(y) My gout came on at the thirty-sixth year of my age, after five or
six month's low living: It returned not again till betwixt five or six
years after, because all the intermediate time I had been well supported:
And this second fit was ushered in with low living, immediately previ-
ous to it, for near the same length of time, as before the coming on of
the first fit. Nay, no gout ever came on but in consequence of direct
debility; the indirect has not so quick an effect in that respect; at the
same time it has a tendency to be hurtful, and therefore should be
avoided.
(z) A mess of porridge, a dish used in Scotland, with small beer pour-
ed upon it, and taken over night, would bring on a fit of the gout next
day.
(a) The juice of turnips, of cabbage, and even pease-pudding and pease-
soup, which are commonly reckoned substantial dishes, have the same
effect: When those substances, after being boiled, are used with a good
solid meal of meat, I have always found them innocent. Green pease
ate, with lamb or fowl, are both harmless and grateful.
(b) Apples and pears are such: but the cold fruits, as melons, cu-
cumbers, are almost instantaneous in their hurtful effect. 


324 THE ELEMENTS
water, in the height of the diathesis, given to quench thirst,
immediately produces nausea, vomiting, and other distres-
sing symptoms of the stomach and of the rest of that canal,
and hurries on a formal fit (c). The mixture of an acid
with pure cold water encreases the hurtful effect. Of the
strong drinks; those prepared from barley by fermenta-
tion, that is, the different ales and beers, all the white wines
in common use, except Madeira and Canary; and among
the red wines claret, indeed all the French wines, and punch
with acid, all these are remarkably hurtful. And as indo-
lence helps on with the first fit, so fatigue, especially that
of walking, hurry on all future ones. Want of a suf-
ficient quantity of blood is so hurtful at all times, that,
though the theory of physicians led them to the notion
that the diseases depended on plethora and vigour, yet no
body ever thought of taking blood (d). Vomiting is bad,
and indeed one of the natural symptoms of a very bad state
of the disease; but purging the belly is worse (e). Every
evacuation has a similar bad effect, with this distinction,
that the artificial are much more hurtful than the sponta-
neous.
DCV. One is to be excepted, that is, exercise in venery,
to which, though it be a spontaneous and natural, not an
artificial, evacuation, gouty persons are so addicted, and
so exceed others in power,that in the very middle of a very
bad fit, they are not sparing of it. That effort at first is
not perceived; but in the advance of age, and after many
returns of the disease, it is felt at last with a vengeance (f).
Great
(c) See CLXXXIV. to CXC. to CCXXXVII.
(d) This is one of their many contradictions between theory and
practice.
(e) At any time I can bring on a fit by a single dose of Glauber's salt,
unless I happen to be very strong and quite free of all diathesis.
(f) At an advanced period of age, in persons who had been vigorous,
an 


325 OF MEDICINE. 
Great heat, by its indirectly debilitating operation, does
some hurt (g), but great cold, by its direct debility, much
more (h). Impurity of air is inimical (i), as well as an
interruption in the train of thinking (k); but hard thinking
is more hurtful. A deficiency in the stimulus of passion is
a pretty considerable hurtful power (l): but a high inten-
sity of it will convert this immoderate degree of the gout in-
to that highest degree of it, that attacks the head; lays a
snare to life, and brings on certain death (m).
DCVI. Long sleep is bad (n), as producing direct debi-
lity, by deferring the re-application of the stimuli, which
the watching state afford; but short sleep is much more
hurtful, leaving behind it a degree of fatigue still remaining
from the effect of the stimuli of the former day (o). Often
after the upper parts of the body have been recruited with
enough of sleep, after getting up, the podagric feeling a
state of languor in his lower extremities, and a demand
for more sleep to them, is obliged to go to bed again, and
give the unrecruited limbs their respective share of sleep.
When a person is torpid from short sleep, how great is the
luxury to cherish again by the heat of the bed-clothes all
the parts that have been exposed to cold, that is, the whole
surface of the body and thighs, but especially the legs and
feet, which last, during the presence of the fit, is the feat
of the inflammation; and, how delightful in that way, to
make up the necessary complement of the sleep that is
wanted.
DCVII.
an unnatural power of execution sometimes, even an actual morbid state,
will take place, so as that the person will be able to outdo all his former
doings in that way. But it is a false power, it is a symptom of disease:
It is like unnatural appetite for food a midst a weakness of the powers of
digestion.
(g) CXV. 
(h) CXVII. 
(i) CXLVI.
(k) CXXXIX. 
(l) CXLI. 
(m) Ibid.
(n) CCXLV. 
(o) See Part II. Chap. VII. CCXXXVII. 
 

326 THE ELEMENTS
DCVII. To prolong the intervals of health, and pre-
vent a fit, the remedies are all the reverse of the hurtful pow-
ers: They are, rich food taken in plenty (p), but remain-
ing within its stimulant range, consequently of the animal
kind, with a rejection of all sorts of vegetable matter, or a
very sparing use of it; strong drink, not taken cold, unless
when there is no danger of the disease (q) (at which time
cold water is safe after a good meal), not mixed with acid
not acescent, not under a turbid fermentation while it is ta-
ken (r); gestation (s) exercise short of bringing out sweat, or
giving fatigue (t), a small quantity of blood, which is pro-
cured by food, and the motion just now mentioned (u), no
evacuation (x), sparing venery, if that be made good in such
persons (y), a moderate temperature (z), kept equally be-
tween the extremes of direct and indirect debility, and in-
clining to neither; pure air (a), consequently cleanliness, and
being much in the open fields, a happy train of thinking (b);
such 
(p) See par. CCLXVI.
(q) I know well when I may take cold drink and use some vegetable
matter; it is, when, for some time past, I have been well supported, and
feel strong and vigorous. I also know, if I have, either in food or drink,
taken any thing improper in kind, how to correct it; which is, by hav-
ing recourse to a proper stimulus. By eating an exotic fruit, which had
a mixture of the qualities of the water melon the orange and lime, in
a quarter of an hour I had an attack in my stomach, in the middle of
my lecture last summer, at the Devil Tavern. By some of the diffusible
stimulus I repelled it, and went well on with my lecture. At other times
I have prevented such an effect, by anticipating the remedy. This doc-
trine puts much more in our power: But we should not, therefore, play
tricks with it. On the contrary, we have great reason to be thank-
ful for the command it gives us over our health, and that also, by the
use of means not inelegant, nauseous and clumsy, but quite the contrary.
The old motto of Ascleiades, tuto, celeriter, et jucunde, is verified and
improved by the important addition of salubriter.
(r) CCLXVIII. 
(s) CCLXIX. 
(t) Ibid.
(u) CCXC. CCXCV. 
(x) CCXC. 
(y) DCXIX.
(z) CXII. 
(a) CCCIII. 
(b) DXIII. DXVIII. 
 

327 OF MEDICINE. 
such a state of excitement as to passion, as keeps between
fiery excess and stupid apathy, with as great tranquillity of
mind as possible (c); moderate sleep, rather inclining to be
long than short, a rule which should be so much the more
observed, as the disease is of longer standing and greater
severity: In fine, sleep should be allowed to continue till
the most vigorous watching state is procured (d).
DCVIII. From what has been said it must appear cer-
tain, that the gout of stronger persons is not also itself a
disease of strength, or a sthenic one; and that it does not
depend upon vigour of the constitution and plethora, as it
has been commonly hitherto imagined; but that it is ma-
nifestly asthenic, like all the rest of the cases belonging to
asthenia, and proved to be so by the strongest evidence;
and that it is not to be treated by an asthenic, as it has
hitherto been the notion, but by a sthenic plan of cure;
and that there is every encouragement for treating it in
that point of view.
DCIII. What had hitherto deceived physicians, and
passed for a cause of the gout, was the appearance of vigour
and an over-proportion of blood, in most podagrics, from
the bulk of simple solids in consequence of their way of
life, and often from great strength. But, good men! they
never recollected, that vigour and a great quantity of blood
was not a property inherent in animals, but that it depend-
ed upon foreign circumstances every day and every hour (e).
If any one, according to that idea, who has happened to
get a great bulk of simple solids, and who has had abun-
dance of proper diet, and lived in that way to the thirty-
fifth or fortieth year of his age, should all at once be depri-
ved of all the articles of diet; and if a dwarf two feet high,
who has lived poorly, and is, therefore meagre, and slender
should equally suddenly be put upon a rich living; will
there
(c) CXL.CCCIII. 
(d) DC. 
(e) X. XI. XII. XIII.


328 THE ELEMENTS
there be the least probability, that the former will, not-
withstanding his present absolute want, continue plethoric
and vigorous; and that the latter, from being now cram-
med with unusual plenty, will continue empty, as he
had been before? Is the fundamental proposition of this
doctrine, in which it has been demonstrated, that we are
nothing of ourselves, and that we are altogether governed
by foreign powers, to be forgot? Is a person liable to the
gout, who has for twenty years undergone an excess of sti-
mulant operation, about the fortieth years of his age, or e-
ven afterwards, to be reckoned fuller of blood and more
vigorous, either than another person who has lived lower,
or than himself twenty years before? Where, pray, was
the necessity of comparing gouty persons with others free
from all bias to that disease, and not comparing them with
themselves (f)?
(f) Such is the effect of the powers operating upon us, that a certain
degree of that operation produces an effect that would not arise under
another. If the accustomary operation has been moderate, habit will
render the excitement arising from it, in some measure, sufficient for the
demands of the system: Hence, day-labourers, are supported upon less sti-
mulus than gentlemen. Again, which is a circumstance liable to happen
to the latter, if the accustomary operation has been excessive, there will be
a necessity for a continuation of some degree of the excess. A podagric
may be stronger than a labourer, and yet fall into the gout. For, though
compared with the other person, he is strong; compared with himself at
another time he is weak: And the reason is, that though he is still bet-
ter supported than the labourer, he is worse supported, than the usual
state of his system requires. Further, the labourer, though he falls not
in to the gout, may, by carrying his moderation too far, fall into indiges-
tion, or some other disease, in every essential respect the same as the gout.
A double inference arises here; Which is, that, though both excess and
deficiency can be borne to a certain degree, so as to require a continu-
ance of them, or a gradual correction, yet they should both be avoided
as entailing that sort of necessity for their continuance while their effect
makes no sort of compensation, being, at best, not the best state, that of
perfect health, but a state of predisposition to disease; the one to sthenic
and 
 

329 OF MEDICINE. 
Of the gentle Asthma.
DCIV. Asthma is an asthenia; in which, to the symp-
toms in common to all astheniæ, there is superadded a diffi-
cult respiration, returning at uncertain spaces of time, of-
ten unequal, without any unusual expectoration accom-
panying the fits.
DCXI. The same are the hurtful and curative powers
here, as in the gout: In the same manner are the fits both
prevented and removed (g).
Of Cramp.
DCV. Cramp is also one of the cases of asthenia; in
which, often from pain, often from drunkenness, and not
seldom from sweat, and disagreeable soaking heat, some-
times the wrists, sometimes one of the calves of the leg, in
fine, any external part, are affected: Of the internal parts,
it is sometimes the stomach, sometimes some part in the
intestinal canal, sometimes the bladder of urine, that suf-
fers:
and at last indirect debility; the other to asthenic, as depending on di-
rect debility. The perfect rule for ensuring the healthy state, is to keep
within the extremes of excess and defect, and thereby produce the due
degree of excitement; and to apply all the exciting powers equally,
each in its due proportion. The due degree may be secured by one or
a few, but the equality of it over the system can only be secured by their
equal application. This proposition goes to the bottom of two extensive
doctrines, that of life, and that of morals; the last of which has as yet
not attained to any thing like a fundamental principle. I intend to pro-
secute the idea upon some future occasion. I know a book filled with
valuable ethic facts, but have not yet had time to consider, whether they
all point to a general one, in which they all agree, and which reflects
proof and confirmation upon them; without which it would fall short of
scientific exactness.
(e) This has been proved, both upon other occasions, and particularly
in the case of a young gentleman, who lived with me during my first ma-
nagement of my gout, See Preface to the Elements. 


330 THE ELEMENTS
fers: The disease is not confined to indirectly debilitating
powers, as producing it; it also arises from directly de-
bilitating ones, such as abstinence, vomiting, loose belly,
and drinking water contrary to custom.
DCXIV. To remove this disease; when it does not
exceed the gentleness that is here understood, the whole bo-
dy must be invigorated by moderate stimuli, every most ur-
gent exciting power should be taken out of the way, ge-
station, and that exercise, which does not exceed the
strength, should be put in practice. A more severe degree
of the disease; will by and by be treated under tetanus.
Of Anasarca.
DCVI. Anasarca is a form of asthenia, distinguished by
water betwixt the fell and the flesh, occasioning an ex-
ternal swelling of the body, without the signs of any suffu-
sion of the same fluid into the interior parts.
DCIX. In the cure, the body must be invigorated, and
in that part of it chiefly, where the greatest laxity and ato-
ny prevails, that is the skin. This indication is answered
by stimulating heat, by friction, by pure and dry air, by
nourishing stimulant diet, and the Peruvian bark: No
internal local affection gives occasion to it, which may be
known from the symptoms yielding to this plan of cure.
Of Cholic with Pain.
DCX. Cholic with pain is a form of asthenia, and a
higher degree of the cholic without pain; in which, to
the signs of debility in common to all the asthenic cases,
are superadded a greater violence of the same symptoms,
and twisting pain about the navel, with pain in some part
of the belly, often enormous, and sometimes with a tu-
mour, that can be felt externally (h).
Of 
(h) Immediately above the brim of the pelvis, on the right-side, at
the place of the blind-head of the colon. 


331 OF MEDICINE. 
Of the Dyspepsodynia, or Indigestion with Pain.
DCXI. Indigestion with pain is an asthenia, which
adds to the symptoms of indigestion without pain, a pain
and gnawing feeling in the region of the stomach, and
is highly expressive of a very severe disease.
Of the violent Hysteria.
DCXII. The violent hysteria is a higher degree of
the gentle hysteria: in which, besides the symptoms there
described, mobility and changeability of mind, disposition to
sleep, convulsive state, and a great resemblance to epilepsy,
are conspicuous. The temperament, that favours hypo-
chondriasis, is of an opposite nature to this, which is com-
monly called the sanguine. Both the temperament and
predisposition in this case are produced by a moist, lax,
set of simple solids.
Of the Gout of weakened Persons.
DCXIII. The gout of weakened persons, which is an
encreased degree of the gout of strong persons, is that ast-
henia, in which the inflammation runs out to greater length,
and at last, does not form at all; and the general affection
encreases in violence, in obstinacy, and, at last, attains
its highest degree; exhibiting, towards the end of the dis-
ease, almost all the symptoms of debility, every form of
asthenia, and sometimes by a false resemblance, counter-
feiting synocha.
DCXIV. As the diseases affecting the alimentary canal,
formerly mentioned (i), have, in a great measure, a com-
mon nature; so, these also, that is, the colicodynia (k), the
dyspepsodynia (l), the violent hysteria (m), and the gout (n),
are 
(i) From DLVI. to DLXXVI. 
(k) DCX.
(l) DCXI. 
(m) DCXII. 
(n) DCXIII. 
 

332 THE ELEMENTS
are equally participant of the same, differing only from the
former in their higher degree of violence. Their most di-
stinguished symptoms are either spasm, which takes place
in the cholic, and indigestion, both with pain, or a spas-
modic convulsive affection, distinguishing the rest. But
neither, in that respect, do these differ from each other in
any thing essential; since they all, without distinction, de-
pend not only on debility, but also nearly upon an equality
in the degree of it, as the similarity of their morbific powers
and remedies proves. For a very full explanation of
spasm and convulsion go back to the following numbers,
CLXXXVIII. to CXCV. and from the latter to CCI.
DCXV. For the cure of them all (o), abstinence, fa-
tigue, evacuations, acids, and acescents, cold, directly and
indirectly debilitating passions, the debility arising from
exertion of the intellectual function, and impurity of air,
must be avoided. The cure of every one of them must be
stimulant. When each of them is but slight, beef soup
and similar rich ones, which act partly by dilution, partly
by a nourishing and stimulant operation, in the weak state
of the stomach, and by supporting the system, and after-
wards, when the strength is so far recovered, solid animal
food, and moderately diluted drink, which, at last, con-
firm the strength, are sufficient. In a higher degree of
violence of any of them, while the soups should still be
continued, at the same time pure strong drink should be
administered. And when the violence of any case baffles
this whole form of stimulus, recourse must be had to musk,
volatile alkali, camphor, æther, and opium. These must
be administered in large doses; and all acid and fermen-
ting things, every thing cold, though accompanied with
stimulus, must be guarded against.
DXXCII.
(o) Peruse the whole of Chap. IX. Part II. from numb. CCLXXXI. 
 

333 OF MEDICINE. 
DCXVI. For the patient's management in the inter-
vals, all debilitating powers must be avoided, such as fa-
tigue, abstinence, cold, and excessive heat (p); and take it
for a certain and demonstrated fast, that the fits of recur-
rent diseases, do not return from any inherent power of na-
ture, but from human folly. Accept of that as a joyous
piece of news, and such as nobody ever expected. The
recurrence of fits of the gout itself is not unavoidable (q);
but, by guarding against the hurtful powers mentioned, may
be repelled for any length of time; and, when it happens
at any time to come on from the fault of the patient, it
can often be removed in two hours, and almost always in
as many days, and the state of health secured in every re-
spect. In all the same diseases of similar vehemence,
whenever any stimulus, from a long continuation of its
use, has begun to have less effect, we should lay it aside,
and proceed to the use of another, from that still to another,
and in that way go over the whole circle (r).
Of Hypochondriasis.
DCXVII. The hypochondriasis is an asthenia, in which,
with the symptoms of dyspepsy, there is a noise in the bel-
ly, flatulency, and uneasiness, and a rooted opinion in the
patient, of the disease being always worse than it is. The
way is paved to the disease by a dry set of simple solids,
and that temperament, in which there is a natural slow-
ness to passion; which, however, once excited rises to the
highest violence, and continues long with obstinacy. It
is further distinguished by a fixed attention of mind, where-
by the patient is liable to dwell to excess upon any pursuit
or study, and not to be easily diverted to another, as also by
a dry
(p) See again the same Chapter, which compare with the preceding,
the VIIIth of the IId Part.
(q) See par. DXCVII. 
(r) XLI.


334 THE ELEMENTS
a dry state of the surface of the body, a rough skin, with
black hair, and black eyes, and always a dark complexion
and serious aspect.
DCXVIII. From the definition given of it by hypo-
chondriacs, it is beyond doubt an asthenia, as being ac-
companied with a noise in the belly and flatulency; and
the course of the disease distinguished by slowness to pas-
sion, keenness in thinking, and that state of the simple so-
lids, which requires a high force of stimulant operation to
procure, and keep up a sufficient degree of excitement.
DCXIX. Since the state of the simple solids is a state
given by nature, and not to be changed by art, and the
only indication of cure left in the physicians power, is to
fit a certain degree of excitement to that given state, which
is exactly the case in this disease; it follows, therefore,
that the stimulus of food, drink, and others, should be
employed in the cure of hypochondriasis. The patient
should be kept cheerful, by being placed in agreeable com-
pany, and gay entertainments, by entering upon a journey,
and amusing himself with the various scenes of nature and
art through which he passes. He should ride, that in guid-
ing the horse, his mind may be more occupied. His stu-
dies and every subject of his ordinary contemplation should
be often changed and varied. He should have generous
wine given him to relieve the symptoms of his stomach
and intestines, and to raise his animal spirits. And if these
should fail of success, the diffusible stimuli, as opiates,
should have their turn for a time, for the purpose of strik-
ing a stroke at once. And their use again gradually laid
aside in proportion as the strength can now be supported
by the more natural and accustomary stimulants. Dark-
ness and bad air should be shunned; pure light, and all
lively objects, should be sought after. No hypochodriac,
even 
 

335 OF MEDICINE. 
even in a fit of delirium, should be provoked, but by every
contrivance soothed (f).
Of Dropsy.
DCXX. Dropsy is an asthenia, commonly in the form
of an anasarca, with a swelling in some viscus, which, for
the most part, at least in the beginning, attacks some place
in preferrence to others, and more than any other.
DCXXI. The cause of dropsy, in so far as it respects
the collection of water, is easily explicable upon this doc-
trine, but altogether inexplicable upon any other. For
the universal debility, that is laxity and atony, is chiefly
predominant in the extreme red arteries, and the exha-
lants immediately continued from these, as well as in the
commencements of the absorbent veins; and, of the same
kind of vessels, it is often urgent in a particular part in
preference to others.
DCXXII. As all the debilitating hurtful powers con-
cur in producing this, as well as any other asthenia; so
those powers have the greatest influence in this case, that
press most urgently upon the vascular system. Hence, as
we see in the conversion of peripneumony into the dropsy
of the chest, profuse bleeding, and a large draught of cold
water,
(f) I have heard of an hypochondriac so provoked at his physicians,
who maintained that nothing ailed him, that he, on the contrary, to car-
ry his opinion of his disease to the utmost; at last took it into his head,
that it had attained its utmost height, by depriving him of his life. He
continued obstinately in the notion of his being dead, till a more sensible
practitioner was called in to see him. This gentleman agreed that he
was dead, but as he could not discern the particular cause of his death;
he, therefore, proposed to open the body: In setting about which, he
made such a clashing with a great apparatus of instruments, provided for
the purpose he intended, that the patient was roused from his obstinate
sullenness, and allowed, that this gentleman had come nearer to his case
than any of the rest; but acknowledged, that he now found he had some
remains of life. 
 

336 THE ELEMENTS
water, when the body is fatigued, over-heated, and burn-
ed up with thirst, are the most powerful agents in bring-
ing on this disease. The hurtful effect of the latter of
which, in every case of debility, when its operation is fol-
lowed by no stimulus, has been more than sufficiently ex-
plained above (t). Besides, in this case, when all the ves-
sels are open, the water flowing to their most weak termi-
nations, passing out by these, and being not at all transmit-
ted from the exhalants into the absorbents, is collected in-
to every neighbouring cavity (u). And hence the com-
mencement of the urgent symptom in this disease.
DCXXIII. To this asthenia belong all the watery ef-
fusions, which do not arise from a local affection, but de-
pend on pure debility. And, therefore, if at any time
any other form of asthenia, whether from wrong treatment,
or other hurtful powers, in its progress terminates in this
effusion; every such case should be held as a proper drop-
sy (x); and it should be ever present to our recollection,
that there are only two general diseases, and that the dis-
tinctions hitherto received, are devoid of all solid founda-
tion. Accordingly, both from other improprieties, and
particularly from bleeding, epilepsy, palsy, the gout, ter-
minate in real dropsy. Nay, the same is the termination
of peripneumony itself, when it is either converted into in-
direct debility, from the debilitating plan of cure having
been pushed to excess, or into direct debility, from having
been left to itself, and the body not sufficiently debilitated.
The affections, confined to parts, which are considered as
the remote causes of dropsy, will be treated among the lo-
cal diseases, to which they belong.
DCXXIV. After this explanation of the nature of drop-
sy, the cure of it, provided that it be a proper one, and early
2 enough
(t) See par. CXVII. to CXXIV. 
(u) LIX. LX. LXI.
(x) See LXXXI.


337 OF MEDICINE.
enough set about, ought by no means to be so much des-
paired of, as it should be when local affection, with a simi-
lar effusion, and the general disease are blended together
without distinction, and considered as one and the same (y).
If long before the effusion there was no internal complaint,
if the disease rather came on suddenly, and in consequence
of evident hurtful powers, and yields to the first part of
the curative means, there is reason to doubt of a cure.
DCXXV. Besides the general indication of cure for
asthenia, that suited to this case must be particularly directed
to the whole vascular system, and especially about their ter-
minations, and the commencements of the absorbent veins.
The remedies are also the usual ones; that is diet, as
nourishing and stimulant as possible; first in a fluid form,
when the solid cannot be admitted upon account of the
debility of the stomach; then, also in a solid; and toge-
ther with both, strong drink, such as the best wine that can
be got, fermented spirit, sometimes pure, sometimes diluted.
If the disease does not yield to these, after their use has
been continued for a proper length of time; recourse
must be had to the diffusible forms: By this means, when
the effusion has not yet attained to that high degree that
constitutes a local affection, not to be altered by any state
of the excitement, this asthenia can be as easily cured as
any other.
DCXXVI. But, when a great quantity of water has
now got into some large cavity, it should immediately be
removed by the catheter; when that has been done, and
the emptied cavity secured with as much care as possible,
and the strength supported by wine, strong drink, and any
stimulus more diffusible, we must return to the manage-
Z ment
(y) Sometimes the predominant symptom rises to the degree of being
above the power of the excitement, as in the tumor of schirrus, and the
effusion here. 


338 THE ELEMENTS
ment mentioned a little above. And if it should likewise
fail now, our judgment must be, that either the general
disease, has degenerated into a local, or that the affection
has been local from the beginning.
Of Epilepsy.
DCXXVII. Epilepsy is an asthenia; the distinguishing
symptoms of which are, some heaviness of intellect, dul-
ness in the exercise of the senses; and then a very impaired
state, or temporary extinction of the latter, accompanied
with various convulsions over the body: Fits, consisting of
such a concourse of symptoms usually return afterwards
at uncertain spaces of time, and each of them terminates in
a foaming at the mouth.
DCXXVIII. As all the debilitating hurtful agents are
productive of this disease; so the loss of the blood and other
fluids, excess in venery, passions, such as fear, terror, assi-
duous and intense thinking in great geniuses; a deficiency
of that kind of stimulus in stupid persons, are particularly
so (z). These powers that produce the first fit, more ea-
sily bring on after ones: And besides them, certain unu-
sual impressions upon the senses, some of them disagree-
able, some highly agreeable; such as the flavour of some
foods, the smell of a rose, have the same tendency; and
certain poisons (a) are said to have the same effect.
DCXXIX. But the appearance of symptoms is a thing
full of fallacy, and unless the nature of the hurtful powers
producing them, and of the remedies removing them, be
thoroughly understood, it is incomprehensible. To solve
the present difficulty about poisons, and to settle the ques-
tion, whether the symptoms belong to universal, or local
disease; we must consider, whether the latter one produced
2 by 
(z) See above par. CXXXIV. CXXXVII. CXLII. and CXXXIX.
(a) See XX. 
 

339 OF MEDICINE. 
by a vitiated state of a part, suppose that part either the
stomach or brain, such a vitiated state, as in some point
of the lower extremities proves the cause of the aura epi-
leptica; and whether this vitiated state resists the virtue of
the remedies, that perform their cure by changing the ex-
citement; or whether all the symptoms are either relieved
or removed by the change of excitement. If the former is
the cause, the affection must be considered as local (b); if
the latter be the truth, the disease must be held for a ge-
neral one, and a true, but a great asthenia. Nor must we
forget, that a great many symptoms of general diseases
from the same origin, are dissimilar; and many from differ-
ent, nay, opposite causes are similar; that many local
symptoms have a great resemblance to those of general
diseases, and that they sometimes, by a most false appear-
ance, counterfeit epilepsy, sometimes apoplexy, sometimes
certain other general diseases besides.
DCXXX. For the purpose of preventing this disease,
we must both avoid other debilitating powers, and those
that have the greatest power in producing it. The vessels
should be filled, by giving food as nourishing, and as effec-
tual in producing blood as possible; the indulgence in ve-
nery must be moderated, chearfulness and tranquillity of
mind must be favoured, an agreeable train of thinking
must be found, and all the objects of the senses, which
give them disturbance, guarded against; the strength must
be fortified by recruiting exercise, by the Peruvian bark,
if the approach of the fits can be perceived, and by wine
and the more diffusible stimuli. A length of sleep, that
is a medium betwixt too long and too short a continuance
of it, should be kept up. Stimulant heat should be applied;
and all excess of it as well as cold avoided (c). The
Z2 purest
(b) See above CCXXIV.
(c) See CXXIV. CXXVI. CCXXVIII. CCLXXVII. CXXXVII.
CXXX. CCXXXVIII. CCXXXIX. CCLX. 


340 THE ELEMENTS
purest air, such as that in the fields, which is free from
moisture should be fought after. The surface of the body
should be excited by friction, and cleanliness, for the pur-
pose of cherishing the organs of voluntary motion, that are
most closely connected with the animal power in the
brain.
DCXXXI. The same remedies, which radically cure
the gout, also cure epilepsy, and precisely in the same
manner (d).
Of Palsy.
DCXXXI. Palsy is an asthenia, in which, with the
ether proofs of the usual debility, often with some degree
of apoplectic fit, commonly all on a sudden, the motion of
some part of the body, and sometimes the sense of feeling
is impaired. When the fit is slight, and of short continu-
ance it terminates in health; but the consequence of a
higher degree and greater duration of it is death.
DCXXXIII. The hurtful powers, that usually pro-
duce epilepsy and apoplexy, also tend to produce palsy.
And
(d) This paragraph is the answer to the question proposed in that
which stands in the Elements, answering to the same number. That
paragraph therefore is erased, and this put in its place. I had heard
from some of my pupils, that they had been able by their diffusible sti-
muli, to remove epileptic fits. But in case of any mistake I would not
venture to mark the fact for certain, which I have now done from my
own perfect conviction. A young man lately married had the most a-
larming fit of epilepsy that ever was: His case was thought beyond re-
medy: as an extreme one, however, he got from some person the full of
a tea-cup of tinctura the baica up to a blue ring a little below the brim.
He got out of his fit some how or other. But was perfectly stupid and
senseless for a fortnight. Upon his falling into another I was sent for,
and brought him about in twenty minutes, as I am told, (for I did not
wait), so completely, that he got out of bed, and ate a hearty meal of
beef stakes. Many weeks after, by mismanaging himself, and neglecting
directions given him, he fell into a slighter one, and was cured in the
same way. 


341 OF MEDICINE.
And besides these, all the common debilitating powers that
produce any asthenia directly or indirectly; great com-
motion of the nervous system by means of too diffusible
stimuli; more affecting the circumference of the body,
where the organs of voluntary motion are chiefly seated,
and the internal parts and the brain less; as is evident in
ebriety, gluttony, and every sort of intemperance; likewise
an indolent way of life, which is commonly connected
with these hurtful powers, have all the same tendency.
DCXXXIV. When the disease has once taken place, as
it is kept up equally by directly or indirectly debilitating
powers; so
DCXXXV. For the indication of cure, which is precisely
the same as in epilepsy as the energy of the cause operates
more immediately upon the surface of the body, conse-
quently according to what was said upon the subject
of epilepsy, the principal remedies are those, that have the
greatest power in invigorating the surface of the body:
Such are friction, gestation, that degree of exercise which
the strength can bear, for the purpose of rousing by their
powerful operation, the languid excitement in the fibres
of the muscles; likewise a proper degree of heat of pure
air, and therefore, as much as possible, the open air; lastly,
as none of the powers endued with stimulant virtue, by any
means should be omitted, in order that the excitement,
which is of great consequence in every cure, be more equal
and vigorous all over; so in that extreme debility which
produces such an impotency of voluntary motion, as it is
of the greatest consequence to make an impression upon
the principal symptom; we should, therefore, employ a
great deal of an opiate, (CXXX. and CCXXX.) the in-
fluence of which, upon the surface, is the most consider-
able of all other powers, and press the cure, till some com-
mencement of returning motion be procured; and then,
without neglecting the assistance of any of the other sti-
muli, 


342 THE ELEMENTS
muli, but using them all in concourse or succession, for the
sake of rendering their common effect more powerful and
more equal, to eradicate the disease.
DCXXXVI. Debilitating and evacuant powers are to
be avoided for this reason, that it is not vigour, it is not an
over-proportion of blood, but a scantiness of the latter, and
a deficiency of the former, that is the cause.
Of Apoplexy.
DCXXXVII. Apoplexy is an asthenia, resembling the
two just now mentioned, in its cause and cure, differing in
the appearance of the symptoms, which makes no differ-
ence in the truth (e): In which, besides the symptoms in
common to it with them and the other astheniæ, all of a
sudden, sense, intellectual energy, and the voluntary mo-
tions, are impaired, the respiration remains, but with snor-
ing, the pulse is weak, and the whole fit is finished with
appearance of a profound sleep (f).
DCXXXVIII. The heads of the patients are large and
not well formed, their necks short and thick: The dis-
ease arises from both direct and indirect debility, but chiefly
from the latter. Of the indirect debilitating powers, the
most powerful is the luxury of food, drink, and sloth,
which, after its course of stimulating and filling the vessels
is run, is truly debilitating and productive of a penury of
fluids: And, as each sort of debility is encreased by the
other, and consequently the indirect by the direct, so that
is remarkably the case in this disease. Hence the effect of
the debilitating plan of cure is so pernicious in apoplexy,
that it is received as a rule, that the third fit is not often,
the fourth never, got the better of.
DCXXXIX. The cause of epilepsy, palsy, and apo-
plexy, is the same with that of every asthenia; affecting
the 
(e) LXXXI. DXXIX. 
(f) CLIII. CC. 


343 OF MEDICINE.
the head less in palsy, excepting in the beginning and end,
but greatly in the two others; and in all the three produ-
cing a disturbance in the organs of voluntary motion. This
disturbance, whether the motion be destroyed or dimi-
nished, in convulsion seemingly increased, amounts to the
same thing, and as was formerly explained, depends upon
debility (g).
DCXL. The same here too is the indication of cure;
with that, which runs through this whole form of diseases,
and the force of the remedies is especially, and as much as
possible, to be directed to the parts most affected. To pre-
vent, therefore, the fits, in every respect alarming and full
of danger, we ought to recollect, how far indirect debility
has a share in producing this disease, and how far the di-
rect concurs with it; and also consider the operation of a
greatly advanced age. All excessive stimulus, therefore,
must be avoided in such a manner, that the body may be
invigorated and direct debility guarded against, the stimu-
lant plan of cure should be set on foot with moderation
and accuracy; and in the place of the forms of stimuli, that
have, either from long or excessive use, lost their stimulant
operation, according to the rule of nature, others, which
the excitability, yet not worn out with respect to them, can
receive, should be substituted, that is, the kinds of food,
of drink, and of diffusible stimuli, should be changed all
round, and upon the failure of each lately used one, to re-
turn to those that have been long ago laid aside (h).
DCXLI. The three diseases we are treating of, are
commonly supposed to arise from a plethora, attacking
the head, and proving hurtful by compression upon the
brain. But, besides that, plethora has no existence in any
case where it has been supposed (i), at that extreme age at
which
(g) LVIII. CCXXX. 
(h) CCCI.
(i) CXXXI. CXXXIV. DXLIX. DLV. 


344 THE ELEMENTS
which those diseases happen; or sometimes in epilepsy,
when it affects weak and starved children, how can the
blood be in over proportion? Can penury of food, which
alone is the matter that forms blood in the latter, and in the
former a vigour long gone, create an over-proportion of
blood, and not, on the contrary, a penury of it?
DCXLII. As plethora has then no share in inducing
those diseases, so neither is an effusion of blood or of se-
rum (k) upon the brain, to be accused of it. Nay, a similar
effusion happens in every case of the vessels, from great de-
bility as well as in this case.
Of the Lock-Jaw.
DCXLIII. The lock-jaw is a less degree of tetanus,
its spasm being confined to the lower jaw and the neigh-
bouring parts. This is a rare affection, without others
equally conspicuous; as being a formidable symptom of fe-
vers and wounds. When the former of these happens, it
will be treated of in fevers; when the latter, it will give
occasion to an enquiry, whether it belongs to local or ge-
neral disease.
DCXLIV. Since it never arises immediately after a wound
is inflicted, but usually happens, either when the latter is
healed up, or after a considerable interval of time; the in-
ference from that is, that it either arises from the violence
and duration of the pain, which is always a cause of very
much debility, or from that debility, which the usual an-
tisthenic plan of cure produces, or from an unknown taint
in the substance of the nervous system.
DCXLV. That it depends upon debility we have rea-
son to believe, from every sort of spasm always depending
on debility (l); from tetanus, which is precisely the same
affection,
(k) CXXXVIII. and the addition. 
(l) CLXXXIX. CXI. 
 

345 OF MEDICINE. 
affection, only differing in degree (m), having no other ori-
gin; and, in fine, from the success of the stimulant plan
of cure in this as well as all other spasms; and the want
of success of the antisthenic, or debilitating evacuant one.
All the other particulars regarding this subject will be ta-
ken notice of under the next head of disease, tetanus.
Of Tetanus.
DCXLVI. Tetanus is an asthenia, and, therefore, always
affecting persons under debility, whether direct or indirect;
in which, sometimes with conciousness, sometimes not,
sometimes with difficulty, sometimes with freedom of res-
piration, the whole body, or the neck and its neighbour-
hood only, are bent sometimes forward, sometimes back-
ward, and held fast by a rigid spasm.
DCXLVII. Tetanus is the offspring of cold countries,
as the northern parts of Europe, but rarely; more fre-
quently of the warm southern regions of that division of
the world; but most frequently of the torrid zone. The
rare case, such as that among us, is the sequel of a debili-
ty scarce usual in other general diseases: On the contrary,
it almost always arises from that unusual debility, which is
occasioned by a lacerating wound, through which fractu-
red bones are dashed, increasing the sum of that debility
that existed before, or that happened to be induced in the
course of the cure. To produce the more frequent case, or
that most frequent one of all, which is quite common in
the torrid zone. The most powerful of the debilitating
powers, and a very great many, if not all of them, con-
cur. The most powerful of these is, that degree of heat,
which is intolerable, to persons engaged in exercise or la-
bour (n), to whom almost only, and therefore to the slaves,
it is hostile. Hence, even under the slightest corporeal mo-
tion
(m) CCXXVIII. 
(n) CXXVII. and the addition 


346 THE ELEMENTS
tion, fatigue, and sweat, are produced (o), and from the
sweat a scantiness of blood and other fluids. From all
those arises a languor over the whole body, and, therefore,
in the stomach (p): From the languor of the stomach there
is a puny appetite, and food, which is another cause of
penury of the fluids, is either not taken in, or thrown up
again. All these affections, as well as that indolence both
in mind and body, which is inseparable from such a state
of circumstances, are followed by the highest degree of de-
bility over the whole body: And, as the most noxious
power, the intense heat distresses the head more than any
other part, as well as the organs of voluntary motion, whe-
ther in the neighbourhood of the head, or more distant
from it; that is the cause of the urgent symptom, the
spasm, occupying the parts that have been mentioned.
DCXLVIII. As tetanus is occasioned by all the debili-
tating powers, according to the different degrees in which
they possess that effect, and, consequently, like every other
asthenia, depends upon debility as its cause; and, as all
the astheniæ, are removed by remedies, exciting the whole
system in such a manner, as to exert the greatest influence
possible upon the labouring part; the same, accordingly,
is the nature of tetanus, however little that disease has
been understood, the same simplicity of nature is found in
it: And if there is occasion in it for the very highest reme-
dies, that circumstance shows, that the whole disease does
not depend upon the spasm, and that the labouring muscles
are not its whole feat, but that there is vast debility in every
part, only greater in the muscles, than in any other equal
part, according to the law we have mentioned (q).
DCXLIX. From what has been said, after tetanus has
taken place, and upon account of the teeth being shut by
the
(o) CXV. CXXVII. and the addition. 
(p) CLXXXVI. CXCIV. to CXCVIII. 
(q) XLIX. 
 

347 OF MEDICINE.
the lock-jaw, there is neither access to the weaker and
less powerful stimuli of food, drink, and such like, which
are often sufficient for the cure of diseases of lesser debility,
nor any sense in using them; we must, therefore, immedi-
ately have recourse to the most powerful and most diffu-
sible stimuli possible, and continue their use without re-
gard to quantity, not even that of opium itself, till the
whole tumult of the disease is allayed (r).
Of Intermittent Fevers.
DCL. Paroxysms, consisting of a cold, hot, and sweat-
ing fit, are a sort of phænomena that occur in every inter-
mittent; and, in a certain proportion, in every remittent
fever. They often come on in consequence of a certain
taint received from neighbouring morasses, or from a simi-
lar state of a neighbouring foil; but they also happen and of-
ten too, after an application of cold only (s); at other times
after that of heat only (t), when the common asthenic hurt-
ful power accompanies either: And they return with a
remarkable
(r) CCXCV. to CCCII.
(s) as in the vernal intermittents in Scotland. In the Mers, or coun-
ty of Berwick, where I laboured three months under a tertian, that is,
from the beginning of March to the beginning of June, and in the Carse
of Gowrie, and some other places in that country, nothing is more com-
mon than the tertian ague happening at the time at which I was affect-
ed; and nothing is more certain, than that the cold and moisture are the
chief powers inducing it. It is somewhat strange, that a man born in
that country, if he would patch up a system of fevers, should have over-
looked a form of them, that occurred to his eye-sight everyday, and bor-
rowed his hypothetical course from a marsh miasma, supposed to be the
produce of great heat and moisture, though he had only heard or read
of the intermittents of warm countries.
(t) In the warm countries agues often occur, when it is easy to discern
heat to be an hurtful power; but when moisture is much less prevalent,
for that very reason that the heat is prevalent, that at other seasons
when the disease does not occur. 


348 THE ELEMENTS
remarkable exacerbation, after a temporary solution of the
disease, or an abatement of it; in the cold fit, exhibiting
manifest debility; in the hot, counterfeiting a deceitful
appearance of vigour; and scarce ever observing any strict
exactness in the time of their return (x); but returning
sooner in a higher, and later in a lower degree of the dis-
ease; and not unfrequently, besides the remittent, also gra-
dually assuming a continued form; and, on the contrary,
sometimes without interference, oftener in consequence
of an improper method of cure, before the disease is ended,
changing into quintans (y), septans (z), nonans (a) or into
sextans, octons, and decans (b).
DCLI. The fever of this kind, which, returns every
fourth day, and is therefore called a quartan, is milder that
that which receives the name of tertian, from its recurrence
being on the third day, and the latter is milder than that
which, from its return everyday, is denominated quotidian.
The disease, that degenerates into a remittent or continued
form, is of a worse nature than that which is regular in its
returns, or that which puts off fits, and protracts the inter-
vals betwixt them: And, the form and type of each case
being given, the whole set is both of more frequent recur-
rence, and of a more severe kind in hot, than cold, climates.
DCLII. That this sort of fever depends upon debi-
lity throughout the cold fit, is proved by the symptoms,
by the exciting hurtful powers, and by the method of
cure, whether successful, or the contrary.
DCLIII.
(x) Dr. Sydenham was content to count the periods by the day, which
was even too particular, but Nosology has refined the matter into the
wonder of exactness to an hour.
(y) Where the fit does not return till the fifth.
(z) Where its return is not till the seventh day.
(a) Where the intermission continues till the ninth day.
(b) That is, prolonged their intermission till the sixth, eighth, or
tenth day. 


349 OF MEDICINE. 
DCLIII. The whole disease, as well as every paroxysm,
begins with a sense of cold, the greatest desire for a warm
situation (c), with trembling, and that shaking motion in
which the whole body is lifted up from the bed (d), with
paleness, dryness, and shrivelling of the skin, with the di-
minution of tumors and drying up of ulcers, that the pati-
ent may happen to have had before the arrival of the dis-
ease, with an impaired state of the intellectual faculty, a
want of steadiness in its exertions, and sometimes delirium,
with a dulness of sensation, languor of spirits, torpor of
the voluntary motions, a listlesness of mind and body in all
the functions, in fine, a manifest debility.
DCLIV. If terror, horror, cucumbers, cold melons, fa-
mine, debauch in eating and drinking, food of difficult di-
gestion, have been found for certain, to have a great effect
in bringing back paroxysms, after a long intermission of
them; if in cold situations, where cold is the principal
hurtful power, it is the poor people, who are ill clothed,
starved in their diet, and enfeebled by labour, who in gene-
ral are only affected with disease; if in warm regions of the
globe, those who have been most exposed to debilitating
hurtful powers of all kinds, who, in preference to others
are seized with it (f); if in most places, those who live
well in their diet, and cheer themselves with their bottle,
escape the disease (g), and water drinkers and persons in a
state
(c) I remember yet, that it was the highest luxury for me, when the
cold fit came on, to be put in bed, and covered under such a load of blan-
kets (for the cold of sheets was intolerable) as would, at any other time,
have oporessed me. I was then about eleven years of age.
(d) By authors and lecturers in Latin absurdly called rigor.
(f) See DCXLVII.
(g) as in Holland; where the Dutch students who live not near so
well as the English, are very liable to the disease, while the jolly living
English, who do not like the weak Rhenish wines, and the weak ill ma- 
naged


350 THE ELEMENTS
state of inanition from low living peculiarly experience it;
all these facts shew, how far this disease is from depending
upon heat and moisture alone; and prove, that it also arises
from cold, and not from either alone, but also from all the
usual hurtful powers, like every other asthenia.
DCLV. Further, if every kind of evacuation, as of-
ten as it has been tried, is found without the possibility of
a doubt, to be hurtful; if no person in his senses has scarce-
ly ever attempted bleeding (h); if, before the Peruvian and
some other barks of similar operation were found out to act
as remedies, a variety of strong drinks (i) were used with
sufficient success; and if it now also is found and demon-
strated in fact, that the diffuble stimuli are by far more ef-
fectual than any bark; nay, that the bark often fails, while
they are perfectly effectual in the re-establishment of health;
from
naged vin de Bourdeaux, which is a cheap dirty claret, almost never fall
into the disease at Leyden, while the Dutch are perpetual victims to it
as often as it is epidemic.
(h) They have talked of taking a little blood in the spring intermit-
tents, but that was a theory of Dr. Sydenham's, who divided the diseases
of the whole year, into inflammatory and putrid, and I do not find, that
that idea has ever been followed in practice. For though they follow
him most servilely in most respects, especially where he is wrong, their
vanity, that they may now and then seem to strike out something from
themselves, disposes them to differ from him in others, especially where
he is right, as in the objection of purging in some sthenic diseases
(CXXXVII).
(i) as ale, wort, wine, spirits, strong punch. Riverius followed this
plan; and I remember it was customary among the common people to
cure themselves by getting tipsy. But I was allowed neither the one
method of cure, nor the other. The authority of Dr. Stahl and Boer-
haave, had thrown the hark into disrepute in Britain. And my mother,
"who trusted in God, and not in physicians," lest me to the course of
desires and aversions, which were chiefly to avoid cold, and anxiously
seek for heat. She kept me upon a vegetable diet in the intermissions,
which I even then did not much like. It was the kindly warmth of sum-
mer, which then set in early, that had the chiefest effect in gradually fi-
nishing that cure. 
 

351 OF MEDICINE. 
from this sort of argument and certainty in point of fact,
we derive the most solid conviction, that there is nothing in
this disease different from other astheniæ, but that it per-
fectly agrees with them in the exciting hurtful powers, in
the cause, and in the cure. And, if it differs in the appea-
rance of the symptoms, that shows no difference of nature,
and not even any thing unusual; as all the astheniæ that
have been mentioned, however much they have been pro-
ved to be the same (k), differ notwithstanding, in a similar
manner, from each other, and symptoms lead not to truth,
give no real information. For, though precisely the same
found functions slow from the same state of perfect health;
yet when the latter is so changed, as that the excitement is
either encreased or diminished, the functions are changed
from the standard into every sort of appearance, in such
sort, however, that they point out no difference in the cause
as has been commonly believed, and not always even a
difference of degree (l).
DCLVI. Accordingly, the following demonstrated facts
of spasm, convulsion, tremor, inflammation from weakness,
deficiency of menstruation (m), bleeding discharges (n), loss
of appetite, thirst, nausea, vomiting, diarrhaea with pain,
diarrhaea without pain, and all the other asthenic affec-
tions (o), arising from one and the same cause, and being
removed by one and the same operation of the remedies (p),
and not even in their morbid state, expressing degrees of
debility in such a manner, as that it can be thought
proper to take any order of arrangement from that mark;
all these serve to confirm the observation just now made,
and by their analogy, to demonstrate, that the fevers also
are
(k) See par. LXXI. and the addition, LXXXI. DCXXIX.
(l) DIV. DVII. 
(m) DXLV. and the following paragraph.
(n) DXLVIII. 
(o) CLXXVI to CXCV. and to CXCVII.
(p) CXXII. DLVI. DLXI DLXXI. DLXXII. DLXXIV. to
DCXCV. and from that to DCXCVIII. Look also carefully over the
whole IVth Chapter of the second part. 
 

352 THE ELEMENTS
are distinguished by intervals of freedom from febrile state,
sometimes greater, sometimes scarcely perceived in com-
mon with what happens to many other diseases, not from
any peculiarity in the cause, but from a variation in its force.
If fevers sometimes intermit their febrile impulse, sometimes
exert it more remissly, and sometimes, by performing the
latter imperceptibly, go on almost in a continual career (q);
do they, in that respect, differ from the gout (r), which
never goes on with an equal force, but abates from time to
time; and even, when it has interposed an interval of health
returns with more severity than ever? Or do they differ
from asthma, as well as many other diseases, in all which
the same thing precisely happens? And what is more
usual, in indigestion, and often violent vomiting (s), ac-
companied
(q) DCL.
(r) When the gout in the old way, is left to patience and flannel and
low diet and watery drink, it shews both remissions and considerable in-
termissions. I have been often mortified, at finding, in consequence of
walking a little too freely, when I thought the fit was gene, a more vio-
lent return than the first part had been; when I had not yet attained to
the full knowledge of the nature and management of that disease. Which
is a circumstance, that every podagric, who is still treated in the old way,
can bear witness to. Dr Sydenham fell a victim to his ignorace of its
nature.
(s) A gentleman in Scotland, came to dine with his brother, who lived
with me and my family, in a house in the neighbourhood of Edinburgh.
He ate and drank so sparingly, that I predicted, from a knowledge I had
of his manner of living, which was an excess of temperance and abstemi-
ousness to a faulty degree, that if he did not indulge a little more in these
respects, he would soon fail into a disease of debility. The prediction
was verified in a few days; when his brother having occasion to go to
town, found him, in the intervals of a violence of vomiting, making his
testament. By a good dose of the diffusible stimulus, he removed the
whole disease at once, and enabled him, with the additional help of some
good found port and genuine Madeira, in a few minutes to eat heartily
of beef stakes. Before his brother's arrival he had been treated in the
usual evacuant, and, as they call it, the antiphlogistic way. Upon the
return of his medical friends a glister was prescribed, which threw him
back 
 

353 OF MEDICINE. 
companied with a rage of other symptoms, than the inter-
vention of the intervals of the greatest relief? The same
is the nature of the chin-cough (t) the same as that of
the asthenic cough (v). In fine, where is there one of all
the sthenic, or all the asthenic diseases, the morbid career
of which continues the same from beginning to end?
There is none (u). For, as life in all its states (x) is
always in proportion to the action of the exciting pow-
ers, upon the excitability, and both predisposition to
diseases, and diseases themselves supervene in proportion to
its being greater or less than the proper degree; so the
course of diseases follows the same rule; and, according to
Aa the
back into his disease, from which, with the same ease and in the same
short space of time, he was extricated upon his brother's return to his
post. This young gentleman from that beginning, like many other of
my pupils, is now a most respectable man in his profession. Some time
after that, he performed the greatest cure, that ever happened since the
first annals of medicine. In a very dirty ship, the Dutton, which was
going to the East Indies, he stemmed, in the latitude of Rio Janeiro, a
fever that was carrying off numbers every day, losing not one; as can
be attested by the ship's books, for no less than five weeks—his name is
Dr. Campbell.
(t) See 579. 
(v) And from DLXXXVII. to DXCVII.
(u) All this confirms, and not only the point at present meant to be
settled, which is that the distinctions, that physicians have made about
the differences of fevers, are without all foundation, and that they are all
the same with no other difference but in degree, and that, unless in that
respect, they do not differ from other diseases of the same form; but it
likewise adds additional weight to our fundamental proposition, that we
are nothing in ourselves, but according to the powers acting on us. Ma-
ny circumstances in the course of diseases, that escape the observation
both of patients and physicians, are of hourly and momentary occurrence,
and sufficient, when their importance is weighed according to the prin-
ciples of this doctrine, to account for the variations in the progress of dis-
eases. We shall, by and by, see that the circumstance of heat, from the
gratification of indulging in which the patient is not to be turned aside,
by any advice, is with its consequences upon the whole system, sufficient
to account for the gradual conversion of the cold into the hot, and the
hot, into the sweating, stages. 
(x) See par. IX. 


354 THE ELEMENTS
the variation of the degree of that action, is one while en-
creased, another while diminished, another while exhibits
a temporary eruption; just like what happens in this sort
of fevers.
DCLVII. The cause of them is the common one of
all astheniæ, whether febrile or not; but under such di-
rection and application to the system, that, after an interval
of some hours, all their morbid energy departs entirely,
or in some degree. And the reason of that is, that the
exciting hurtful powers in the same proportion are either
removed, or more gentle in their operation; in one word,
the excitement is encreased for the time. The variation
of types is not owing to a matter, subject to the same va-
riation: For, if that were the case, how could the same
case run through all the forms, sometimes of intermission,
sometimes of remission, and at other times of nearly going
on with a continued movement and the contrary? Is the
matter, which is supposed to produce each form, in order
to produce another form, changed into that matter, which
is supposed necessary to the latter (y)? Is the vapour, or,
as they call it, the effluvium, proceeding from animals,
which is supposed to produce any typhus, or continued fe-
ver, and, therefore, the Ægyptian one, when this is chan-
ged into an intermittent, or remittent nature, also, together
with the change of type, changed into a marsh miasma,
or defilement arising from morasses, which is supposed
to produce that form of fever? Or rather does the matter,
which at first produced each type, still continue the same,
and become the cause of another form? If any person
should fix upon the latter as being the truth, how should the
same
(y) The ancients supposed, that every type arose from a matter suited
to produce it. Now, suppose a quotidian type to depend upon any giv-
en matter, and a tertian upon any other, different from that; when ei-
ther type is changed into the other, are we to suppose that the matter is
also changed, and so forth of the rest? 


355 OF MEDICINE. 
same cause produce different effects? But, if he inclines
to adopt the former supposition, what proof is there, that
can be admitted upon any principle of reasoning, that, as
often as the form of the fever changes, so often its cause,
the matter, is also changed? It has been already proved,
that marsh miasmata, or defilements, are not the cause (z).
And it shall be by and by evinced, that the animal effluvi-
um, or vapour, arising from the body, when affected with
a continued fever, is not: Nay, it has been proved by the
most solid argument, that neither is any other matter tak-
en into the body, either in this or any case, that which pro-
duces the disease, and that the change of excitement alone
is the universal source of all general diseases (a).
DCLXI. To enquire into the return of fits; it is
not peculiar to this form of fevers, to have a return of the
general affection after its temporary solution; the same
thing happens to the gout, as often as a return of the dis-
ease again succeeds to a return of health (b), and for the
same reason (c): For, as those diseases are repelled by in-
vigorating means, so they are brought back by the debi-
litating powers, which were their first cause. Accordingly,
when the disease is left to itself, when it is treated by a de-
bilitating plan of cure, it perseveres in returning; when it
is treated with Peruvian bark, and still more certainly by
the forms of wine and diffusible stimuli, and when that
mode of cure is persisted in, till the strength is quite con-
firmed, it never returns.
DCLX. The tertian vernal fevers of Scotland go off
without medicines, in process of time, first in consequence
of the heat of the bed, and then, as the summer sets in, by
basking in the rays of the sun, and by a moderate use of food
Aa2 and
(z) DCLIII. DCLIV. DCLV.
(a) See the paragraphs XXII. XXIII. LXII. LXIX. LXX LXXII.
LXXIII. and LXXXVIII.
(b) DCLVI. 
(c) DCLVII.

356 THE ELEMENTS
and strong drink, their duration commonly not exceeding
the space of three months. In all the southern regions, and
even in England, the Peruvian bark, when the whole cure
is entrusted to it, often fails, and they are not removed
but by very diffusible stimuli (d).
DCLXI. The debility during the cold stage is the
greatest, that of the hot less, and that of the sweating stage,
which ends in health for the time, is the least of all. Hence,
in a gentle degree of the disease, as cold is the most hurtful
power, the consequence is, that its effect is gradually ta-
ken off by the agreeable heat of the bed or of the sun, and the
strength,
(d) Dr. Wainman, as it was said before, found that to be the case in
the fens of Lincolnshire. From which we may learn how little depend-
ence is to be had on the facts in medicine, as they are delivered from
desks or in books; from both which we have always been taught to be-
lieve, that the Peruvian bark was a catholicon in intermittent fevers.
But, if it fails in the cure of the mild state of that disease in this country,
what must we think of its efficacy in the malignant intermittents and re-
mittents of the warm countries? And, if that medicine, with its univer-
sal high character, shall turn out next to an imposition, what are we to
think of testimonies in favour of any thing? One of the ways of admini-
stering the bark is in strong wine or spirit, and it can hardly be doubt-
ed, but in that compound form it may have been of service. But where
shall we find a panegyrist on the bark, who will make any allowance
for the powerful medicine conjoined with it? They talk of it as a ve-
hicle, without allowing it any other credit. In the same manner, at all
times, have many powers of great operation been overlooked in the ac-
counts given us of remedies, and the merit of the cure imputed to the
most inert. I have most generally found an analogy betwixt the reme-
dies, that are, in reality, powerful, and our ordinary supports of health.
The wines and strong drinks are certainly a part of diet with most people,
and so is opium among the Turks. But what analogy can be found be-
twixt the same ordinary supports of life, the same durable and natural sti-
muli, and the bark of a tree, whether brought from South America, or
growing among ourselves? I will not pretend to say, that the bark is de-
void of all virtue; but I must have greater proofs of its power over dis-
ease than I have yet met with, before I can retract much of what I have
said. 


357 OF MEDICINE.
strength, thereby gradually drawn forth. The heart and
arteries, gradually excited by the same heat, acquire vi-
gour, and at last, excited in their perspiratory terminations
by the same stimulus the most hurtful symptom being
thereby removed, they restore the hot fit, and afterwards
carry on the same process to the breaking out of sweat.
DCLXII. When the force of the disease is greater,
these powers are ineffectual; and, unless the most power-
ful remedies are applied, the disease, instead of producing
intermissions, rushes head-long into the remittent state
only, or even into those very obscure remissions, which
give the appearance of a continued disease.
DCLXIII. And, since in every case of disease of any
energy, the disease returns, for this reason, that either the
lesser force, by which it is kept up, is not stopt by a lesser
force of remedies, or the greater force of the former by a
greater force of the latter (e); the remedies, therefore,
should be given both before the cold fit, and during it, as
also through the whole course of the intermission to the
next paroxysm, and they should be continued even through
this, and after it is over. Lastly, like the practice in every
other cure of asthenic diseases, we should gradually re-
cede from the use of the highest stimuli, in proportion as
the body can now be supported by the lesser and more
natural (f).
Of the severe Dysentery.
DCLXIV. The severe dysentery, or bloody flux, is
an asthenia; in which, besides the symptoms in common
to that whole form of diseases, so often now repeated, there
are pains in the intestines, gripes, innumerable dejections,
chiefly
(e) For the curative force must always be accommodated to the mor-
bific, or cause of the disease. See above XCII. CIX.
(f) CV. and CVII.


358 THE ELEMENTS
chiefly mucous, sometimes bloody, for the most part with-
out the natural matter that passes that way, all which hap-
pen often after contagion has been applied.
Of the severe Cholera.
DCLXV. The severe cholera adds to the common
symptoms of every asthenia, those of vomiting and purg-
ing, alternating with great violence, and for the most part
consisting of bilious matter.
Of Synochus.
DCLXVI. Synochus is a very mild typhus, and such
as chiefly happens in cold countries and cold seasons; in
the beginning deceiving physicians by a certain resemblance
to synocha, but a couterfeit one.
Of the simple Typhus, or Nervous Fever.
DCLXVII. The simple typhus, or nervous fever, is
such a synochus, as appears in warm countries or seasons,
but somewhat more severe, and yet sufficiently simple.
Of the Cynanche Gangrenosa.
DCLXVIII. The gangrenous cynanche is a typhus, a
little more severe than the simple typhus, or nervous fever,
with an eruption upon the skin, and a red tumid inflamma-
tion of the throat, and with mucous crufts of a whitish
colour, and concealing ulcers below them. The end of
the angina, formerly mentioned (g), equals or exceeds the
violence of this disease.
Of the confluent Small-pox.
DCLXIX. The confluent small-pox is a typhus chiefly
depending upon indirect debility. It is preceded by
a great
(g) CCXXII. CCXXIV. 


359 OF MEDICINE. 
s great eruption of the distinct kind, and an universal crust
of local inflammation over the whole body; which, by
their local and violent stimulus, convert the sthenic into
the asthenic diathesis, and the inflammatory affection into
a gangrenous one. Its cure is to be conducted upon the
stimulant or antisthenic plan, but in such a way, however,
as is suitable to indirect debility.
Of the pestilential Typhus, the jail, putrid, or the petechial Fever,
and the Plague.
DCLXX. The pestilential typhus, or the jail, putrid,
and petechial Fever, is an asthenic disease of the highest de-
bility, scarce excepting the plague itself; in which the sur-
face of the body is first dry, pale, hot, shrivelled; then,
chiefly towards the end, moist, drivelled with spots, and
colliquative sweats, diversified with vibices, or long strokes
like those laid on by a whip, and wasted with colliquative
diarrhœa; in which the stomach is affected with the want
of appetite, loathing of food, nausea, often with vomiting;
in which the belly is first boundish, and then, as it has been
said subject to colliquative evacuation; in which the in-
tellectual function is first impaired, then becomes incohe-
rent, afterwards delirious, and that often in the highest de-
gree; in which the spirits are dejected and wasted with
sadness and melancholy; in which the voluntary motions
are early impaired, and then so destroyed, that the patient
cannot be supported in his posture in bed by his own mus-
cles, or prevented from slipping down, from time to time,
from the upper to the lower part, and the senses are either
blunted or preternaturally acute. In fine, the urine, the
fœces, the breath, and all the excrementitious discharges,
have a singular fœtid smell.
DCLXXI. The plague begins, holds on in its course,
and ends with similar symptoms: To which, however,
carbuncles, 
 

360 THE ELEMENTS
carbuncles, buboes, and anthraces, or fiery sores, are added.
These are most frequent in the plague, but not so confined
to it, as to be excluded from the pestilential fever (g).
DCLXXII. Contagious matter sometimes accompa-
nies typhus, always the plague: The former is of a com-
mon nature, or such as is liable to happen in any part of
the globe; the latter is thought peculiar to the eastern part
of Europe, and the western of Asia, possessed by the Turks,
called the Levant.
DCLXXIII. With respect to the contagious matter
of typhus; the corruption of the fluids is by no means to
be imputed to it (h), nor is heat so much to be blamed;
for cold has an equal power in producing that effect as
heat (i), as has also every thing, as well as heat, that either
directly, like cold, or indirectly like it, debilitates (k).
Nay, the emptiness of the vessels, from want of food, or
from the incapability of the digestive organs to take it in
and assimilate it, as also that debility which is induced by
melancholy and grief, though, in these cases, no matter at
all is present, admit of the same application. By means of
that debility in the extreme vessels, internally, as well as
externally, and, therefore, especially in those of the ali-
mentary canal and in the perspiratory vessels, the fluids
stagnate; and by stagnating under the heat of the body,
degenerate into that foreign quality, which, in a more ex-
tensive sense, is called corruption, but in a more uncertain
one, putrefaction (m).
DCLXXIV.
(g) CCXIX. 
(h) See above CXV. CXXII. CCXXXVI.
(i) Ibid. and CCLXI, 
(k) See again CCXXXVI.
(m) There are three states or qualities produced in fluids by as many
different fermentations, the saccharine, acid, or putrefactive. To one or
other of those we are apt to refer every state of corruption in our fluids;
but they are liable to degeneracies, which do not exactly correspond to
any of those: And, as we are not yet acquainted with any of those de-
viations 


361 OF MEDICINE. 
DCLXXIV. As the cause of all these diseases is the
same with that of the diseases not febrile, to wit, debility;
differing only in this, that it is the greatest debility compa-
tible with life, and not long compatible with it; so,
DCLXXV. The indication also of cure is the same as
that of the other astheniæ, but must be conducted with a
good deal of more attention than is necessary in them, up-
on account of their much greater mildness (n). It is, then,
debility alone, that is to be regarded in the cure; and sti-
mulant or antisthenic remedies alone, that are to be ad-
ministered. Nor is there occasion for any distinction in
the method of cure, but what direct or indirect debility
requires (o).
DCLXXVI. The indirectly debilitating powers, are
the violent and local stimulus of the eruption in the con-
fluent small-pox (p), so often inducing prostration of
strength, and drunkenness (q), heat (r), or long continued
luxury
viations from the natural state, it is safer to use the general term corrup-
tion. Even the word acrimony is too general as we can by no means
pretend to say, that perfect blandness is the natural and healthy state of
our fluids: Nay the different uses and subserviency to the functions seem
to require a considerable deviation from blandness; the urine, the per-
spirable fluid, the bile, and others, being intended, by a certain poignan-
cy, to answer certain purposes. These, compared to certain blander
fluids, may be said to be acrid; while compared to their state in morbid
degeneracy, they, may be called bland, and the latter acrid.
(n) Fevers will require many more visits from the physician than are
commonly either bestowed or required, and often a good deal of watch-
ing. While this is more generally the case in fevers, at least in the
high degree in which these fevers exist, at the same time they are not the
only ones that require such strict attention; as every disease, when it has
attained to the same degree of debility, endangering life, will claim the
same circumspection and vigilance from the judicious and conscientious
physician.
(o) See par. CIII. CVII.
(p) See CLXXV. CCXV. CCXVI. CCXVII. CCXVIII.
(q) CXXX. 
(r) See CXV. 


362 THE ELEMENTS
luxury (s). To these hurtful powers, thus indirectly de-
bilitating, all the others may more or less be added (t).
DCLXXVII. And as it never happens, that either di-
rect or indirect debility alone proves hurtful, hence we
have a third case given, where we have to combat both
sorts of debility (u).
DCLXXVIII.
(s) See above par. CXXVII. (t) Look for them in Part. I. Chap. I.
(u) Suppose any direct debility has occasioned a disease, when that is
established, the excitability is so morbidly accumulated, that the slightest
exertion of any exciting power becomes too much for it; which immedi-
ately constitutes an admixture of indirect debility. The stimulus of cor-
poreal motion, which is a great and rough indirectly debilitating power,
is often too long continued, after a typhus fever has begun its insidious
attack upon the habit; and hence the after-part of the disease becomes
more severe and dangerous. It is also to the same cause that we owe the
propriety of excluding light and found, when they prove causes of irri-
tation, their stimulus, though slight, being too strong for their accu-
mulated excitability. The guarding against gusts of passion and emotion,
as well as mental exertion, is all upon the same principle. When a per-
son falls into a fever from excessive labour and low diet at the same time,
that is an instance of a mixture of debility from the beginning. Again,
when any disease, chiefly of indirect debility, is treated by bleeding,
other evacuations and starving, that is an instance of a super inducement of
direct upon indirect debility. A judicious practitioner, and who pre-
scribes according to the rules that arise from a near acquaintance with the
operations of the inanimate part of matter upon living systems, will find
plenty of scope for the exercise of his judgment in these and many other
niceties: And he will find that the Brunonian doctrine, as it is now nick-
named by those who know it not, is not a doctrine to be practiced without
knowledge, without judgement, and without sense; but that it requires
every part of knowledge requisite to throw light upon so extensive a sub-
ject, as that of the science of life over all nature, and all the judgement
and good sense of the soundest understanding to carry it into application
upon many occasions of nicety and difficulty. The trash that has hitherto
too often passed for knowledge,is to be acknowledged not only useless, but
hurtful. But the true knowledge of nature must be always elegant, al-
ways satisfactory, always useful. It is to be hoped the day is not far
distant, when this doctrine will change its present appellation, into that
of 
 

363 OF MEDICINE.
DCLXXVIII. The directly debilitating powers are
known, to wit, cold (x), low diet, (y), bleeding, and other
evacuations (z), rest of body and mind, and want of passion
and emotion (a), and impure air (b).
DCLXXIX. As both those sets of powers act by de-
bilitating; be, at the same time, on your guard from be-
lieving, that some of them are septic, and prove hurtful by
fermentation, and are to be cured by antiseptics, or pow-
ers that resist putrefaction; and that, among the former,
heat is to be reckoned; among the latter, cold, wine, the
Peruvian bark, and acids (c).
DCLXXX. In the gentle cases, as in the agues of
cold places, and especially the vernal agues (d), and like-
wise in synochus, in the simple typhus, and in the plague
itself, when mild; scarce any stronger stimulus than wine
is required; and the rest of the cure is to be conducted
according to the directions so often now laid down in the
mild asthenic diseases.
DCLXXXI. In the most severe fevers, such as the
remittent (e), in the warmer regions of the earth, and in
the torrid zone, and in the severe typhus, when it is pe-
stilential, in the very violent dysentery and cholera of the
same places, and in the most violent plague itself (e), the
cause of all which affections, is in general direct debility;
or in gentler cases of the same disease at first, and that have
now acquired a great deal of virulence in their progress
from
of the doctrine of Nature, over the living part of her productions; com-
prehending not only the morbid but healthy phœnomena, and the dis-
tinctions between the living and the dead state.
(x) See par. CXVII. 
(y) CXXVIII. 
(z) CXXXIV. CXXXVII.
(a) CXXXVII. and CXXXIX. and CXLII.
(b) CXLVI. Compare the whole with Part II. Chap. X. all from
CCXC. to CCCXII. and from that to par. CCCXV.
(c) See par. DCLXXIII. 
(d) See DCL. DCLIV. DCLX.
(e) DCL. DCLX. DCLXIV. DCLXV. 
 

364 THE ELEMENTS
from the neglect of the proper, or the use of an improper
plan of cure; we ought immediately to begin with the
highest diffusible stimuli, such as opium, volatile alkali,
musk, and æther, in small doses but often repeated (f);
and afterwards, when the strength is restored, and the force
of the stomach confirmed by their use, to proceed to the
use of food, drink, gestation, pure air, cheerfulness, and,
last of all, to the usual offices and occupations of life.
DCLXXXII. When indirect debility has had more
concern in the cure, as in agues, or more continued fevers,
occasioned by drunkenness, and in the confluent small-
pox; the same remedies are to be employed, but in an
inverted proportion of dose. We should, consequently,
set out here in the cure with the largest doses, and which,
are next in quantity to that degree of stimulus, which pro-
duced the disease (g); then recourse should be had to lesser
stimuli,
(f) XLI. XLIII. CXIII. DCLX. to DCLXIV.
(g) This may be exemplified by the treatment of a person the next
and second day after he has been hurt by drinking. His excitability has
been worn out by an unusually strong stimulus, the effect of the first
night's sleep is to allow it to accumulate again: In this state much exer-
cise fatigues, for want of excitement to enable it to be born: Fluid nou-
rishment is commonly used, but it is not strong enough to waste the re-
dundance of excitability, and bring the patient back to his healthy ex-
citement. The dram drinkers know the remedy, but they know not its
bounds. They have recourse to a glass of strong spirit, and they would
be right if they stopt at one, two, or a very few, according to the quan-
tity, that their former habit may render necessary, and take no more
than what gave them an appetite for solid nourishing animal food;
which, whatever the quantity that is required to produce it be, is the best
general rule: But they go on, and every day till that of their death,
which soon arrives, renew the disease. The rule is to take a little of
what proved hurtful, till a return of appetite comes on: After eating a
little, a walk or a ride will add more stimulus: The air, in which the
exercise or gestation is performed, will furnish another. In that way,
more strength will be acquired in proportion as a greater number of sti-
muli 
 

365 OF MEDICINE. 
stimuli, and a greater number of them, till, as was said just
now (h), the strength can be supported by the accustomary
and natural stimuli (i).
DCLXXXIII. To give some estimate of the dose in
both cases (k); in direct debility, where the redundancy of
excitability does not, for the time, admit of much stimu-
lus (l), ten or twelve drops of laudanum given every quar-
ter 
muli have wasted more excitability, and with more equality. A second
day's management by applying the stimuli in still a lesser degree, will
commonly remove all the complaints. When a habit of hard drink-
ing has brought on, as it always will sooner or later, a very bad and
confirmed disease; if the excitability is nearly worn out, and what re-
mains is very unequal, as having been produced chiefly by an alteration
betwixt one stimulus acting with partial excess and sleep, either imper-
fectly removing the excess, or by its length superadding direct to the in-
direct debility, which the drink occasions; the patient should have
somewhat a lesser quantity, than that which at any time hurts him;
then the next day still less; and so on, till very little will serve him, and
he should add all the other stimuli in proportion as he diminishes the
morbid one.
(h) DCLXXXI. 
(i) CCCVIII. to CCCXII.
(k) DCLXXXI. and DCLXXXIII.
(l) The abundant excitability of aH infant cannot be reduced at once
to that wasted degree, in which the strength of an adult consists; it must
be by the gradual application, of what it can bear always for the present
time that that can be brought about; and, therefore, not sooner than a
space of time equal to half the individual's given period of existence. In
a similar manner, an excitability that has been accumulated from defici-
ency of stimuli for a number of weeks or months, will require a space of
time, somewhat proportioned to that, to wear it out in the manner most
suitable to restore the lost vigour. Some health will be sooner brought
about, but the effectuating of perfect health must be a work of time. A-
gain, the direct debility of a few days will be easily removed in a few
days. In fevers, and every case of high debility, the accumulation of ex-
citability for want of stimulant power to produce excitement, must be
estimated by the number of stimuli that have been with-held, as well as
the degree of force of each of them. In a fever, then, the stimulus of
exercise, of the open air, of conversation, of diversion of every kind, of
an


366 THE ELEMENTS
ter of an hour, till the patient, if, as is usually the case,
in such a high degree of debility, he has wanted sleep
long 
an agreeable slow of spirits, of a pleasant train of thinking, of light and
found in a great measure, as well as of the exercise of all the other senses,
and particularly the stimulus of a due quantity of blood, and other fluids,
and most especially that of nourishing food, and, at least upon the com-
mon plan of practice, that of wine and exhilarating drink, all these, are
with-held, and, therefore, for want of them, the diminution of excite-
ment must both be great and unequal. What then is required as to the
idea of the cure? Since most of those, which are the ordinary stimuli, by
which the ordinary health is supported, cannot be applied; the proper
idea is to look out for a power in nature, that can, as nearly as possible,
supply, both the degree and equality of stimulant operation that is want-
ed. Such a power we find in the few diffusible stimuli, and particularly
in opium (See par. CXXX.) Any of those act powerfully on the sto-
mach, and diffuse proportional excitement over the system. So soon
and effectually do they pervade it, and act with the most powerful ef-
fect upon the surface, that it is often an object of attention in the prac-
tice to think of means to prevent it from going too far. By the blessed
use of those remedies, the excitement of the stomach is restored, so that
with a return of appetite, food can be taken in, and digested, in so far
as the powers of that organ go; which are confined chiefly to the first
part of digestion, or what is called the first concoction. Next the ex-
citement is restored in the other digestive organs, in the duodenum, in
the biliary vessels, the pancreatic duct, in the lacteal vessels, through their
whole course from the intestines to their common receptacle, as all the
vessels that return lymph from every part of the body, in the veins be-
twixt the thoracic duct and the heart, in all the cavities of the latter, in
all the red arteries, in the colourless terminations of all these, whether
exhalant or glandular, and whether only simply separating, or also chan-
ging the property of the fluid they secrete, in all the internal cavities of
the body, in the commencing extremities of the absorbent vessels, and
in their progress through their lymphatic trunks to the receptacle in com-
mon to them with the lacteals, which are a part of their number, in
the thoracic duct again; as also from that to the heart, and from the
heart to the extremities of the arteries: Lastly the influence of excite-
ment is extended to these terminations of the arterial system, whether
exhalant or glandular, which perform the several functions of excremen-
titious secretion and excretion, by which every portion of fluids, now be-
come 
 

367 OF MEDICINE. 
long (m) falls into it: After sleep, when now some vigour is
acquired both by that and the medicine, and now some of
the excessive excitability is worn off, a double quantity of
the diffusible stimulus should be added, and, in that way,
gradually encreased, till the healthy state can now be sup-
ported by stimuli lesser in degree, greater in number, and
more natural (n).
DCLXXXIV. In indirect debility an hundred and
fifty drops should forthwith be thrown in; and then the
superaddition to be made, should be less and less, till we ar-
rive at the boundary just now mentioned (o). Both the mea-
sures recommended (p), are in general applicable to adults;
but less will suffice at an early or late age. Nay, the rule
further varies according to the habit, the way of life, the
nature of the place, and the peculiarities of the patient (q).
DCLXXXV.
come useless, or, if they were retained, hurtful to the system, are thrown
out by their several emunctories. When, by the use of the diffusible sti-
muli, the stomach, and all the organs can perform their respective func-
tions, the natural stimuli begin to be restored; the stomach the intes-
tines, the lacteals and blood vessels, and all the other vessels, are gradu-
ally filled with their respective fluids; the muscles on the surface, and
the muscular fibres recover their tone and density; the brain recovers
its vigour; heat and air can be now restored to the surface; exercise can
now add its useful stimulus; and all the functions return to their usual
capability of being acted upon by the usual and ordinary exciting powers.
(m) Want of sleep is an indirectly debilitating power; and, in this
weakened state of the system, in this redundancy of excitability, where
every exciting power is liable to be too much for the excitability, the
want of sleep, by not allowing this partial waste of excitability to be re-
paired, is the occasion of so much more indirect debility being added to
the direct; and hence the sum total of debility is encreased. The effect
of sleep in removing this partial indirect debility becomes so far an invi-
gorating power.
(n) See above par. CIII. and CVII. 
(o) DCLXXXIII.
(p) in par. DCLXXXII. and this.
(q) When the habit is delicate, the patient's way of life moderate a
to the use of the stimuli, the place cold, or both cold and moist, and 
the 


368 THE ELEMENTS
DCLXXXV. And since the use of the diffusible stimuli
only succeeds, when life cannot be preserved by the usual
and more congruous to nature, and a due quantity of blood
and other stimuli soon become sufficient to finish the heal-
thy state; we should on that account, even from the be-
ginning immediately give animal food, if not in a solid form
in which it can neither be taken nor digested, at least in
a fluid form, in that of soups; which should be alternated
with all the doses of the diffusible stimulus: Then, in a
gradual way, proportioned to the return of vigour, first a
very little of something solid, and afterwards more and more
should be thrown in, and the other stimuli, each at its pro-
per time, brought into play; till the whole cure termi-
nate in the management commonly observed in good
health, where there is less occasion for medical injunc-
tions.
DCLXXXVI. When the affection is more a mixture of
both sorts of debility, these proportions of the doses must
be blended together.
DCLXXXVII. Contagion, which either adds nothing to
the effect of the usual hurtful powers, or proves hurtful
by the same operation by which they are so, is not otherwise
4 to 
the patient easily affected with stimuli of all kinds; in all these cases the
rule, which common sense prescribes, is to diminish the dose of the dif-
fusible. A lady in Edinburgh, who had born and nursed many children,
had lived exceedingly moderately, had been and still was very assiduous
in the management of her family affairs, and usually stimulated with lit-
tle air out of her own house, fell into a cholic, and, by the evacuant
and starving plan, had been kept in it for a full month, till the urgent
symptom of vomiting required further assistance: When I came, I first
retarded the vomiting by a glass of whisky: And, by two more, with
no other help but that of a mixture containing 30 drops of the Thebaic
tincture, which the surgeon had been administering in miserable small
portions, in three hours removed the whole disease. As I have said
somewhere before, the disease, from her neglect in fulfilling directions
had very nigh returned next day; but another glass repelled it. 
 

369 OF MEDICINE. 
to be regarded, than that time be allowed for its passing
out by the pores, together with the perspiratory fluid, and,
therefore, the perspiration be properly supported; which, as
it is effected by stimulating, is no addition to the general
indication (r).
DCLXXXVIII. Lastly, the corruption of the fluids in
the extreme vessels must be obviated (s), not by means,
that by a direct operation remove it, but by the powers that
act upon the excitement of the solids, and that encrease
excitement over the whole body, and therefore, among
other parts upon the labouring vessels.
DCLXXIX. Having now run over the whole scale of
decreasing exciting power from peripneumony to the
plague, and from death by indirect, to death by direct de-
bility; and having so executed the work, as to present the
public with a new science, if not finished off in an elaborate,
elegant, and highly polished manner, at least marked in
outlines, and, like a rough statue, to be polished afterwards,
in some measure fashioned in all its limbs, and embracing
an entire plan of a work, connected in all its parts; we
must next pass over to the consideration of local diseases.
(r) See LXXXVIII. XCVIII.
(s) CCXXXVI. and CCLXXIV.
Bb THE
 

370 THE ELEMENTS
THE FIFTH AND LAST PART.
LOCAL DISEASES.
CHAP. I.
Of Local Diseases.
DCXC. LOCAL diseases (a) are divided, according
to an order of nature, into five parts; the
first of which consists of organic affections, where no dis-
sease over the whole system arises, none but in the hurt part.
This is a sort of affection, that happens in parts less sensi-
ble, according to common language, or more devoid of
excitability.
DCXCI. The second part, likewise made up of or-
ganic affections, occurs in parts of the system, whether inter-
nal, or external, that are very sensible, endued with a great
deal of excitability (b); where the effect of the local affec-
tion 
(a) V. VI. VII.
(b) The excitability is here not talked of in its comparative states of
abundance or deficiency, but in the degree in which any part possesses
it in preference to other parts. It is used in the sense of the greater or
lesser vitality of parts: Accordingly we can say, that some parts possess
an exquisite sensibility, as the stomach, the brain, and intestines, and, I
believe, most of the interior, soft, fleshy part, and the shut cavities;
and externally, the parts immediately under the nails; that others pos-
sess less, as the bones, ligaments and cartilages and ligaments; and ex-
ternally, the cuticle, or scarf-skin. It is, with respect to the difference
of 


371 OF MEDICINE. 
on is propagated over the whole body, over the whole ner-
vous system, and where a very great many symptoms arise,
similar to those which are peculiar to universal diseases.
DCXCII. The third part of local diseases, takes place
when a symptom of general disease, that at first arose from
encreased or diminished excitement (c), arrives at that
height of degree, at which, being no longer, under the in-
fluence of excitement, it cannot be affected by remedies
that correct the excitement.
DCXCIII. The fourth part, or division of local disea-
ses, consists of those, in which a contagion, externally ap-
plied to the body, is diffused over all, without affecting the
excitement (d).
DCXCIV. The fifth part of local diseases, arises from
poisons that have been applied to the body, and slow
through all the vessels in such a manner, that they are un-
derstood not immediately, nor at first, to have any tenden-
cy either to encrease or diminish the excitement, but fal-
ling upon parts, some on one, some on another, hurt the
texture of these in different manners; and, after occasion-
ing that local hurt, by means of it produce disturbance over
the rest of the body.
of sensibility, or excitability, or capability, to be acted upon by exciting
powers, that we use the expression of more or less excitability. See
above par. XLIX. and the addition, and LIII. and addition.
(c) like all the other symptoms, of which it was one,
(d) If it affected the excitement its effect would be general disease,
which sometimes happens, as in the small-pox, measles, contagious ty-
phus, and the plague.
Bb2 CHAP.


372 THE ELEMENTS
CHAP II.
The first Part of Organic Local Diseases, where no Effect, but
in the hurt Part, arises.
DCXCV. WITH regard to the first part of local, organic
diseases; the hurting powers, that produce them, are such
as produce a solution of the continuity of a part, by wound-
ing, eroding, or poisoning; or that derange a part by con-
tusion, compression, or spraining.
DCXCVI. The hurting powers, producing solution of
continuity, are all cutting, pricking, or missive, weapons:
Acrid bodies and poisons produce solution of continuity
in another manner.
DCXCVII. When any of these hurting powers slightly
divide the surface, and scarcely, or not at all, get to the
bottom of the skin; for the cure of so trifling an affection,
there is occasion for nothing but shutting out the air, and
cold, and excessive heat, and avoiding every irritating sub-
stance. For the only use of the cuticle is, by means of its
insensibility (a), (it being a simple (b) solid, and devoid of
all excitability), to keep off the air, and all excess of tem-
perature, and every rough or rude matter, which are all
inimical to living solids (c), whether external or internal.
DCXCVIII. When the surface, therefore, is hurt in its
texture, either by being cut, or bit, or stung by venemous
animals
(a) See DCXCI. and the note. 
(b) not a living,
(c) So hurtful is the air and temperature to parts below the cuticle,
that nothing is a more certain cause of gangrene than their exposure,
even for a very short space of time: Nor is there any other way of ac-
counting for the fatal effect of slight, superficial, but extensive burning.
Death has been the consequence of a burn, that extended no farther than
the sore-part of the thorax, or the breast, and was not of longer contin-
uance, than the time taken to tear off the burning clothes that occasioned
it. 
 

373 OF MEDICINE 
animals, or by being burned, or by a very high degree of
cold; in that case a thin, mild, oily plaster is sufficient for
the cure.
DCXCIX. The division, therefore, of phlegmasiæ, into
phlegmone, or erythema, is without foundation, and mis-
leading, both as to the cause, and as to the cure, from the
knowledge of the truth (d): For, however much they dif-
fer in their remote cause, as they call it, and in their seat,
and in their appearance; since the exclusion of the air and
of other stimuli is their effectual cure; it, consequently,
follows, that their cause is the same, that is, that the na-
ture of all these affections is the same.
DCC. In the cure of contusion, compression, and
sprains (e), the same, in general are the remedies; and be-
sides them, there is occasion for rest of body, and bland te-
pid fomentation.
DCCI. Through this whole division of local affec-
tions, there is a certain energy of nature, that tends to the
restoration of the healthy state; but it is not the celebra-
ted vis medicatrix naturæ of physicians: For in this case
nothing else happens, but what equally happens in the cure
of general diseases. If proper remedies are applied, the
found state in both sorts of diseases follows: If the reme-
dies be neglected, the solution of continuity degenerates
into a worse and worse nature, and then into gangrene, or
the death of the part (f). It is the excitability, or that
property
(d) See the seventh Genus in Genera Morborum Culleni, where you
will find Linnæus's prototype of inflammation, that is, of inflammatory
diseases, or what is in this work called phlegmasiæ, or sthenic diseases
with inflammation or an approach to it also adopted by this author. It
is nothing else but a collection of local affections, or, in a few cases, symp-
toms of disease, and that they almost all come under this head of local
diseases, and every one of them under one of these heads.
(e) See par. DCXCV.
(f) Of this we are presented with examples in every day's experi-
ence; 
 

374 THE ELEMENTS
property of life, by which the functions are produced (g),
that, wherever life, whether in a part, or over the whole
body, is hurt, procures the return of the healthy state by
means of the external powers acting upon it. It is, then,
the excitability, affected by the action of those powers, that
is to say, the excitement, that governs the state of the so-
lids, both in parts, and over the whole body (g).
CHAP. III.
The second Division of Local Diseases.
DCCII. THE local organic diseases of the second
division are the inflammation of the stomach (a), and that
in the intestines (b); as also bleeding discharge, with an
inflammation subsequent to it; and in fine, an inflamma-
tion in any very sensible part in consequence of a wound,
producing commotion over the whole body.
Of 
ence; where we find the slightest sores, from the neglect of the simple
rule of cure laid down here, degenerate into very troublesome affections.
(g) See above par. X. to XIV. If I cure a peripneumony by bleed-
ing, other evacuations, and other debilitating powers, that are not eva-
cuant, it is by diminishing the force of exciting powers; if I cure a fever
by opiates and other stimulant powers, whether stimulating by filling the
vessels, or without that, it is by encreasing the same force; and if I cure
a sore on the surface, by the method just now mentioned, I thereby pre-
vent the force of exciting power from rising too high, from an excess of
stimuli, or from running either into direct or indirect debility, from too
little stimulus, or an ultimate excess. If either these general or local
cures are neglected, or mismanaged, the cure will not be supplied by
any effort of the system; and if the cure is made out by regulating the
excitement, such effort is superfluous. The vis medicatrix then is as
little real in local as general diseases. See above par. LXII. and the
addition.
(a) or gastritis. 
(b) or enteritis. 


375 OF MEDICINE.
Of the Inflammation in the Stomach.
DCCIII. The principal symptoms in gastritis are,
pain in the region of the stomach, a burning heat, deep
seated, encreased by every thing that is either ate or drank,
or in any shape taken into the stomach; hiccup, an incli-
nation to vomiting, and the sudden throwing up what is
taken in; and the pulse soon getting into a state of debi-
lity, quickness, swiftness, and hardishness.
DCCIV. The exciting hurtful powers, and which pro-
duce the solution cf continuity in this case, are such as act
by cutting, pricking or erosion. Such are the small bones
of fishes, ground glass, or Cayenne pepper and such like
things.
DCCX. Inflammation is a consequence of the wound
or erosion, that are the effect of the operation of those ex-
citing powers: The effect of which, in the very sensible
organ of the stomach, is to diffuse the disturbance before-
mentioned (c) over the whole system. The burning heat
and pain, inseparable from every inflammation, and the
anxiety (d), are the offspring of the inflammation (e): And,
of them, the anxiety is more peculiar to the stomach, the
latter being its accustomary seat (f), and the pulse becomes
such as has been related, because it is peculiar to every
rude, fixed, and permanent local stimulus (g); to weaken
and to be so much the more liable to that effect, the greater
the excitability of the part is. Hence, in the external parts
of the body, that are less endued with excitability, a pretty
considerable inflammation by no means affects the pulse or
the body any way generally; though even there, when a
part is sensible, as in the case of a burn spread to any ex-
tent, or of a thorn having been thurst below the nails, an
equal
(c) DCXCVI. 
(d) CLXXI. CCCXLV. 
(e) CLXXI.
(f) CCCXLV. 
(g) XVII. 


376 THE ELEMENTS
equal disturbance arises over the whole body (h), which con-
firms a former proposition, in which it is asserted, that the
more abundant the excitability is (i), the less stimulus can
be born.
DCCVI. The disease is easily known, both from the
symptoms above described, and, with not a little more cer-
tainty, from the known taking in of the hurtful powers;
and over and above, by this, particular sign, that, as it has
been said before, without such marks, inflammation scarce
seizes upon an internal and shut part (l).
DCCVII. As this is a local disease, and does not, like
the general ones, depend upon the encrease or diminution
of excitement; consequently, the indication suited to the
latter, to wit, to diminish encreased, or encrease diminished,
excitement, over all, will not apply. On the contrary un-
less a general disease happen to be combined with it, no-
thing else is to be done, but, by throwing in bland, demul-
cent liquors, to defend the tender part from the rude contact
of the stomach's contents, and give the inflammation time to
finish its course; and, if the physician is called soon enough,
to wash off the hurtful matter with a diluent drink.
Of the Inflammation in the Intestines,
DCCVIII. The inflammation in the intestines is a lo-
cal affection; in which there is an acute pain in the belly,
and 
(h) CCCXLIV. CCCXLV. 
(i) XXXVI.
(l) CXIII. and CLXVIII. The stomach is sometimes inflamed from
a schirrous tumor occupying the pylorus; and that case also is taken in
by the systematic and nosological writers, as belonging to their gastritis:
But the consideration of it does not belong to this head of local diseases,
but to the third division of them. At the same time, both it and the pre-
sent case are local diseases, and not phlegmasiæ, differing from the phlegm-
asiæ, so fully treated of in the third part of this work. It, as well as en-
teritis, of which we are next to speak, have every mark of difference
from the general diseases mentioned in the VIth paragraph. See also
Chap. I. of the fifth Part. 
 

377 OF MEDICINE. 
and distention, and sometimes a sort of twisting of the pain
around the navel, with vomiting, and an obstinate cos-
tiveness, and such a pulse as in the inflammation of the in-
testines.
DCCIX. The hurtful powers, exciting this disease, are
precisely the same, as those that have been said to excite the
inflammation of the stomach, that is:
DCCX. The inflammation arises in a similar manner,
as in the inflammation of the stomach, and the more rea-
dily, that the intestines are more sensible than the sto-
mach (m). And hence also, in a similar manner, is a state
of disturbance diffused over the whole body.
DCCXI. The acute pain of the belly depends upon
the inflammation: Its distension and the costiveness is the
offspring of the detained fæces. The same is the cause of
vomiting; for the peristaltic motion being prevented, upon
account of the obstruction, to proceed downward in its usu-
al way, from its restless nature recoils in the direction up-
ward; as affecting neither direction, unless in so far as the
stimulus, by the impulse of which it is regulated, either
commences from above, as health requires, or from below,
as happens in other diseases, and in this in particular (n).
The pain twisting about the navel, is produced by the in-
flammation, for this reason that the principal, and by far
the greatest part of the intestines, is thrown in a convoluted
state about the navel.
DCCXII. The diagnosis is the same as in the gastri-
tis; excepting, that the seeds of fruits, hairs, and similar
foreign bodies, sometimes upon account of the torpor of
the peristaltic motion, adhering to the sides of the intestinal
canal, gradually, by their irritation, kindle up an inflamma-
tion 
(m) Baron de Haller, from some experiments that he made, found
the intestines more sensible than most parts of the body, more than the
stomach, and equal in sensibility to the brain. 
(n) See par. CLXXXVIII. CLXXXIX. 
 

378 THE ELEMENTS
tion: Which is a fact, that if examined attentively,
and once rightly considered will not disturb our diagno-
sis.
DCCXIII. The cure is precisely the same as in the
inflammation of the stomach.
DCCXIV. All the rest of the pretended phlegmasiæ,
distinguished by the appellation of "itides," as the spleni-
tis (o), hepatitis (p), the true nephritis (q), the cystitis (r),
without a stone, or the hysteritis, not arising from schirrus
(s), and the peritonitis (t), do not belong to this place; as,
besides the doubt of their ever being inflamed, not arising
from stimulants and acids, neither of which have access
to the shut viscera (for these substances are not carried in
the vessels, or can be carried), but from the relics of other
diseases, of which we are to speak afterwards, with the fol-
lowing exception:
DCCXV. The exception is, that if any one falls from
a height, if he is run through any part of his bowels with
a sword, if a poisoned arrow, thrown by any savage, has
pierced any of his inward parts, he will in
DCCXVI. The case of the inflammation affecting the
liver, be affected with a pain in his right hypochondrium,
with vomiting and hiccup: If
DCCXVII. The inflammation affect his spleen, the
pain will be in his left hypochondrium; in
DCCXVIII. The case of the true nephritis, or inflam-
mation of one of the kidnies, he will be pained in the re-
gion of the kidney, and seized with vomiting, and a stu-
por of his leg; in
DCCXIX.
(o) or inflammation of the spleen
(p) or the inflammation of the liver
(q) or inflammation of the kidnies.
(r) or inflammation of the bladder of urine;
(s) or inflammation of the womb.
(t) or inflammation of the peritonæum. 


379 OF MEDICINE. 
DCCXIX. The case of the inflammation happen-
ing in his bladder, he will have a tumour and pain in the
under belly.
DCCXX. Bleeding discharge, followed by inflamma-
tion (u), such as happens in the inflammation of the womb,
or of any neighbouring part, and in abortion, and in the
wound of any internal part, is easily distinguished by the
pain of the affected part; and by the preceding accident.
DCCXXI. In the inflammation of the womb, or
any neighbouring part, the lower belly is affected with
heat, tension, tumor, pain, and these symptoms accompa-
nied with vomiting (x).
DCCXXII. The hurtful powers, that excite the hy-
steritis, or inflammation of the womb and parts in its neigh-
bourhood, all amount to violence done to the womb. Thus
using violence during the labour, hurrying the birth, often
produce a solution of continuity, and wound the womb
with a tearing rudeness.
DCCXXIII. And, since a great deal of blood is often
lost in that way, and the local affection followed by debili-
ty of the whole system (y); for that reason bleeding, ac-
cording to the common practice, any mode of evacuation,
are not to be practiced, nor is the patient to be forbid to
eat; but, in the first place, regard is to be had to the affect-
ed part, the body must be laid in an horizontal posture,
she must be kept from motion, and be allowed rich soups
and wine: By and by more solid animal food should be used
morsel by morsel frequently repeated, and she should
have
(u) DCCII. 
(x) The inflammation is frequently not in the womb, but in a neigh-
bouring portion of the intestines, or mesocolon, or in the peritoneum it-
self, as dissection has frequently shown. This is a disease, than which
none has been more enquired into, and none yet less understood.
(y) Pain and loss of blood are in one degree or another inevitable
causes of debility. 
 

380 THE ELEMENTS
have her belly bathed: And, if the debility should get
a-head, recourse must be had to more wine, drink still
stronger, and opiates: The use of which last should not
be neglected, even at first.
Of Abortion.
DCCXXIV. In abortion, the back, the loins, the
belly, are pained, like what happens in child-labour; and
there is either an unusual slow of the menses, or an extra-
ordinary discharge from the vagina.
DCCXXV. The hurtful powers, that force abortion,
are falling from a height, slipping a foot, a rash step, in-
tense walking, running, going up and down hill. This
disease seldom, however, happens but to persons previously
weak; and the most powerful agent in bringing it on, is
some taint left since a former abortion, which encreases in
proportion to the number of abortions. When the dis-
ease happens in consequence of the local hurting powers
just now mentioned, in that case it is perfectly local: But
when debility is blended with the effect of those powers
it is a case of combination of general with local affection.
DCCXXVI. The indication for preventing the dis-
ease is, to guard against all the hurting powers that induce
the disease; to ride out, when the patient has any degree of
strength; but, in case of any apprehension of danger from
weakness, to go in a carriage, which will be more safe; to
be upon guard from the third month of pregnancy till the
seventh is passed; to invigorate the system, and keep up
the patient's spirits, and intellectual amusements.
DCCXXVII. The indication of cure is, to keep the
body in a horizontal position, with the buttocks higher
than the head; to be studious to keep the patient easy in
body and mind; to repair the loss of blood with soups,
to secure the vessels, for the purpose of contracting their
enlarged 
 

381 OF MEDICINE. 
enlarged diameters, with wine and opiates, and, in that
way, take off, at the same time, the atony and laxity, which
are the principal cause of the discharge.
Of Difficult Child-Labour.
DCCXXVIII. In difficult child-labour, the most
common cause of which by far is weakness, and which
always produces weakness when it proves lingering; the
lying-in woman should be supported with wine, and when
the labour proves more difficult, and is now like to be te-
dious, opium should be administered.
DCCXXIX. When now some part of the uterus is
hurt by the hurting powers that have been mentioned (a),
and the child and placenta are now both delivered, the
woman should be kept in an horizontal posture, as was
recommended in abortion; she should be invigorated by
soups, chicken, wine and the still higher stimuli; every
thing contrary should be avoided; and the healing up of
the wound waited for.
Of deep-seated Wounds.
DCCXXX. In deep seated, or gun-shot, wounds when
the ball, if a ball occasioned the wound, is now extracted,
or though it still remains in the body, in a place not necessa-
ry to life; first of all the whole system is very much irrita-
ted, heated, pained, chased, and distressed with restlessness
and tossing, the pulse is strong, full and more frequent
than in health. The cause of all those symptoms is the
commotion, which, as we have said, the local stimulus,
either of the ball or of the inflammation supervening upon
the wound, by its constant irritation of a sensible part, gives
to the whole system.
DCCXXXI. 
(a) See par. DCCXXV. 
 

382 THE ELEMENTS
DCCXXXI. Because, in this case asthenic diathesis
is commonly supposed to arise over the whole body, upon
account of the irritation from the wound; the antisthenic
plan of cure is, therefore, always employed through the
whole course of the disease; and the use of opium, which,
in this case is conjoined with the antisthenic, or stimulant
remedies, is admitted only for the purpose of acting as a se-
dative and duller of pain, is admitted: Consequently, upon
account of the fear of a fever being to supervene, though
often a great quantity of blood is lost by the wound; still
large bleeding is practiced, the belly is purged, nourish-
ment is with-held, abstinence enjoined: The most frequent
consequence of which treatment is death, and never a re-
covery that is not owing to accident.
DCCXXXII. But all this is a method of cure con-
ducted upon an erroneous theory, which is proved by all
the principles of this doctrine, and by the very unfortunate
issue of that practice. In a person, who has lost a great
deal of blood, an over-proportion of blood, can ne-
ver be the cause of sthenic diathesis: Neither can
any tolerable reason be assigned for the profuse evacu-
ation of the serous fluid, or for not rather supplying new
fluids by the use of food. It is in vain to accuse fre-
quency of the pulse, as a sign of an excess in the quantity
of blood, and of too much vigour, or of any irritation that
wants an antisthenic plan of cure: For, besides its hard-
ness, if the pulse is not, at the same time, strong and full;
it has been now often above demonstrated, that all its cele-
rity depends upon debility and penury of blood (c). Fi-
nally, as the asthenic diathesis depends upon the general
sthenic hurtful powers, as the energy of pain, from local
affection, and particularly inflammation, has no tendency to
induce that diathesis, but the contrary one of debilitating (d);
that is another reason for the supposition of the habit, either
remaining
(c) See par. CLXXIX. to CLXXXI. 
(d) DCCV. 
 

383 OF MEDICINE. 
remaining such as it was before the wound was received (e),
or, which is more probable, of degenerating into the asthe-
nic diathesis. Lastly, the true explanation of the distinction
betwixt irritation and sthenic diathesis is in confirmation of
the same conclusion; the sthenic diathesis being that state
of the system, which is produced by all the powers, the ope-
ration in common to which is stimulant, over the whole
system, and, by fullness in the vessels producing the same
effect, and to be removed by debilitating powers weakens
also the whole system, and by evacuant remedies acting by
the same general operation; whereas, on the contrary, it is ir-
ritation or that state, in which the whole body is often, with-
out any stimulus, debilitated (f); and often a local stimulus,
such as distention exciting spasm, or a concentrated acid, in-
ducing convulsion, or the pain of a wound that producing
the general commotion here (g), and effect enormous moti-
ons 
(e) Which can hardly happen if blood has been lost, which must di-
minish the excitement, and in proportion to its degree.
(f) When the body is debilitated, the ordinary stimuli, that in its
healthy state invigorate it, and even a much less degree of stimulus, will
produce the irregular motions, which are supposed owing to irritation;
not that any thing irritating is applied, but that the excessive abundance,
or defect of excitability, admits not, without such effects, the degree of
stimulus, which, applied to it in its healthy half-wasted state, would
produce healthy vigorous motions. (See XXV. and XXVI) The
tremors that are occasioned by the turning of a door upon its hinge, the
sweat occasioned by slight exertions in walking, are so many instances
of that, and the irregularities of the pulse are owing to the same cause.
As the weakness upon which fevers depend encreases, so also do the
supposed symptoms of irritation, such as colliquative sweats, colliquative
diarrhœa, subsultus tendinum, &c. But they are all the effect of the
general weakened state being flutterred by every slight stimuli. At other
times irritating powers, in the same weakened state, do occur; such as
those mentioned in the text.
(g) But even in that case, the real state is debility, and the indication
of cure is to remove it, as well as the irritating powers: Which, while
they encrease it, are at the same time its offspring, and require stimu-
lants to enable the system to resist its effect. (DCLXXXVIII.) 
 

384 THE ELEMENTS
ons in a weakened system. But, whether the debility be
without stimulus, or excited by it, there is never occasion
for debilitating evacuant remedies, but always for mode-
rately stimulant ones: And we have only to take care,
that the sthenic diathesis be not produced by the method
employed for the cure, and thereby a general disease, at
least, a predisposition to general disease be superadded to the
local, which could not fail to aggravate the latter.
DCCXXXIII. As, therefore, the antisthenic plan of
cure is not to be practiced, from an apprehension of a fever
being about to come on, with a view to allay the distur-
bance arising from it; which has the contrary tendency,
that of inducing the fever, and of exciting the disturbance
apprehended; so, neither is the stimulant plan to be at-
tempted, till the wound is healed, or the disease has arrived
at an advanced stage, and a great deal of debility is now
induced by the continuance of the pain, left, if that me-
thod should be sooner employed, the blood should be car-
ried with more rapidity than the case would admit of, and
with an encreased momentum, into the still open termina-
tions of the vessels: For it is understood, that neither dia-
thesis takes place in this case, and that the only affection
present is a commotion over the system, depending upon
local affection; and that, consequently, there is no occasion
for the remedies of either; excepting this single considera-
tion, that, as the loss of blood, in proportion to its degree
has a tendency to produce more or less of asthenic diathe-
sis; there will, therefore, in that proportion, be occasion
for some sthenic remedies.
DCCXXXIV. During the first days of the disease, be-
cause the patient, all at once, does not any longer engage
in gestation, exercise, and the other functions both of body
and mind, and of passion or emotion, according to custom,
and of course, less nourishment and recruit is now requi-
red; therefore, there should be such an abatement in his
2 allowance 
 

385 OF MEDICINE. 
allowance of the usual stimuli, as to accommodate what is
used to the present condition of the system and the state of
the wound just now described (h). Therefore, to prevent
too great an impetus in the vessels, silence should be kept
around the patient, he should not speak himself, he should
lie quiet and without motion, his posture should not be
changed, but to avoid the disagreeable feeling of too long
continuance of it, and even then it should be done as warily
as possible. He should make his water lying, and in an
urinal; he should rather use soups, than solid meat; his
wound should be examined every day, for the fake of keep-
ing it clean; its progress should be observed; it should be
dressed with fresh, soft, and bland matter; and if even at
this early period, any faintishness appears, a glass of wine
should not be with-held.
DCCXXXV. After some days, which may be more, or
fewer, according to the strength of the patient, when now
the habit is rushing into debility, upon account of the great-
ness or long continuance of the pain; in that case, besides
the soups formerly allowed, meat as rich and delicate as
possible should be given; wine should be administered
sparingly at a time, but often, and upon the whole in large
quantity; and then at last, recourse should be had to opium,
which, in the common practice, is usually given from the
beginning of the disease, and to the other diffusible stimuli;
and the disease should be treated precisely in the same way
as a typhus.
DCCXXXVI. When very tender external parts are viola-
ted by any rude matter, such as happens in that case, where
a thorn is pushed below any of the nails, and an inflam-
mation spreads from the affected part to a considerable ex-
tent, and then, upon account of the great sensibility of the
part, the whole body is drawn into consent; the injured
Cc part
(h) See last paragraph. 
 

386 THE ELEMENTS
part should be fomented with warm water, and dressed with
lint, and soft and bland ointment: And as long as the di-
sturbance of the system remains, the patient should be kept
quiet, and free from motion, and nothing more attempted.
CHAP. IV.
Of a Part of a General Disease, degenerating into a Local.
DCCXXXVII. To set about the treatment of that divi-
sion of local, organic, diseases; in which a part, or symp-
tom, of general disease degenerates into a local one; we
next proceed to
Suppuration.
DCCXXXVIII. Suppuration, with which we begin, is
for the most part a consequence of any general inflamma-
tion, whether sthenic, or asthenic, or that inflammation,
which is a symptom of general diseases, or it is a conse-
quence of local inflammation, whether sthenic, or asthenic,
as a symptom of local affection. In it the pulse is softer,
fuller, and a little flower, than in sthenic disease when
that precedes it; but a great deal flower, than in asthenic
disease, if it happen to supervene upon it, and it is accom-
panied with an undulatory, and as it were, a pulsatory,
motion of the labouring part; these symptoms are com-
monly preceded by a shivering: If the affection is internal,
the patient should be kept quiet, and free from motion, and
be stimulated; if it be external, the affected part should,
over and above, be fomented, dressed, and covered, and
the pus, when ripe, let out.
Of Pustule.
DCCXXXIX. A pustle is a purulent vesicle, turgid,
and at last of its own accord opening in consequence of
having become tender, and full of pus.
DCCXL. 


387 OF MEDICINE. 
DCCXL. It follows the small-pox, arising from the
contagion peculiar to that disease: In the small-pox the
number of the pustules is greater or less in proportion, as
more or less sthenic diathesis, occasioned by improper treat-
ment, or a neglect of the proper, has preceded (a).
CCCXLI. The indication of cure for them is, first to
remove sthenic diathesis, and then, if that has passed into
the asthenic, to remove it, each by its respective remedies;
and to be sprinkle the pustules with a strong spirit, or with
laudanum, and in the former case to guard against cold, in
the latter against heat, and to open the pustules and foment
them.
Of Anthrax.
DCCXLII. Anthrax is a glandular tumor under the
skin, gangrenous in the top, and inflamed in its edges all
round.
Of Bubo
DCCXLIII. Bubo is a glandular tumour, especially
affecting the one or the other groin, and of a tendency to
suppuration.
DCCXLIV. These two affections the anthrax and
bubo as well as carbuncle, are almost always combined with
a general disease, to wit, sometimes with typhus, much of-
tener with the plague. They depend upon a contagious
matter, and in so far as they do not sufficiently yield to the
general remedies, they must be treated with a very strong
spirit poured upon them, and with laudanum, and opening
them.
Cc2 Of
(a) XXI. LXXVI. XCVI. XCVII. XCVIII. 


388 THE ELEMENTS
Of Gangrene.
DCCXLV. Gangrene is an imperfect inflammation of a
part, not terminating in suppuration, discoloured, scarce
painful, consisting of pustules of a bad matter, and at last
inducing the death of the part.
DCCXLVI. The hurtful power, that precedes gangrene,
is always inflammation, often ultimately violent in a sen-
sible part, oftener languid and occupying a part less sen-
sible, less supported by the powers of life (b); it is some-
times a symptom of the phlegmasiæ, sometimes of fevers,
sometimes of local phlegmone (c).
DCCXLVII. The method of cure, when the gangrene
is seated in the alimentary canal, is to pour in spirit and lau-
danum; when the shut viscera are affected, to place some
hope in the same and other stimuli, but much less. And,
as the same remedies also suit gangrene, when it is exter-
nal, consequently liquid opium should be rubbed in upon
the dying part, spirit should be poured upon it, the parts
already dead should be cut out, the edge of the living part
all round should be stimulated, and an inflammation made
in it.
Of Sphacelus.
DCCXLVIII. Sphacelus is a more perfect and more ex-
tended gangrene, with an extinction of sense, motion,
and heat; in which the part becomes soft, blackish, com-
pletely black, putrid, and at last thoroughly putrid to the
very 
(b) The inflammation, out of which gangrene arises, is always un-
supported, and the gangrene always a state of either direct or indirect
debility: the high excitement in the phlegmasiæ, and the low in fevers,
causing that.
(c) CCCXLVII. DCL. to DCLXXIX. 


389 OF MEDICINE. 
very bones, thoroughly cadaverous, and shifts rapidly to
the neighbouring parts, and quickly extinguishes life.
DCCXLIX. The remedies are in general the same as in
gangrene, but they should be stronger, and administered in
greater quantity, and with greater nicety, and in less ex-
pectation of a cure. When any limb is greatly affected,
it should be immediately cut off, to prevent the found parts
from being infected.
Of Scrofulus Tumor and Ulcer.
DCCL. When a scrofulous tumor and ulcer has been
of long standing, has disfigured the parotid gland and
neighbouring parts, and all the remedies, that have any
effect in removing scrofula, have been employed; after that
no more is to be done, but to keep the ailing part clean,
bathe it often, and defend it from the injury of the air; un-
less that, as local debility also takes place here, spirit and
laudanum, applied to the part, may be of service.
Of Schirrous Tumor.
DCCLI. When the tumor, which while it was mo-
derate, was a part or symptom of the general disease, call-
ed schirrhus, has now attained a certain bulk; if it be ex-
ternal, or situated in the exterior or convex part of the li-
ver, it should be cut off, and the system invigorated: If it
be internal, nothing can be attempted, but to prevent its
encrease by stimulant remedies, and in that way keep the
patient as long alive as possible, and in as good health as
the present circumstances will admit of.
DCCLII. The two heads of division that remain (e),
are of so obscure and abstract a nature, that if ever they
are
(e) DCXCIII. and DCXCXIV.


39O THE ELEMENTS
are to be attempted, they must be passed over at present.
The third head (f) is here only imperfectly sketched and
scarce begun: But because it both admits of a complete
execution, and when so executed, will make an important
addition to the work; shall be prepared for the public pe-
rusal, as soon as I shall be happy enough to find as much
leisure and scope for thinking as are requisite to rescue the
subject from its present intricacy, disorder and obscurity.
(f) DCXCII. DCCXXXVII. to DCCLII.
FINIS. 

INDEX.
A.
ABORTION, page 380.
Abstinence, not less im-
moral and irreligious than
excess,—64.
Abstract reasoning, cautions a-
gainst,—136.
Acid in the alimentary canal
symptom, not cause of dis-
ease,—104.
Acrimony, in what sense may
be admitted,—361.
Agents, external, what,—2.
Agriculture, hints respecting,—204.
what should be so termed,—1.
Air, atmospheric, if too pure
would be perhaps injurious,—77.
impure, produces asthenic
diathesis, ibid.
inimical to living solids.—372.
Air, stimulus of, necessary to
convalescents,—198.
Aitiolgy, absurdity of,—37.
Anasarca,—330.
Angina, putrid, described,—124.
Anthrax,—387.
Antiseptics, notion of, to be
guarded against,—363.
Apoplexy,—342.
not owing to plethora,—117.
Appetite, cause of,—100.
Apyrexiæ, sthenic,—248.
Asthenia, meaning of,—30.
Asthenic diathesis, cause of,—78.
cure of,—170.
may be converted into sthenic,—33.
symptoms of,—96.
predisposition to,—95.
diseases,—288.
cure of—363.
Asthenic plan of cure, different
parts of, compared,—4.
Asthma, advantages of a full
diet in,—IV.
gentle,—329.
Author's inducements to trans-
late his own work,—XI.
B.
Bark, Peruvian, not to be de-
pended on in intermittents,—355.
Bathing, cold, remarks on,—14.
Bladder, inflammation of. See
cystitis.
Bleeding, cautions against,—98, 279, 379.
remarks on,—259, 268.
should always be fol-
lowed by other evacuations,—269.
singular instance of
benefit from, in typhus, 120.
when necessary,—176, 177, 183.
Blisters, in what cases useful,—274.
Blood, great extent of the sti-
mulus of,—177.
irritates by its quantity,
not quality,—66.
slight discharges of
from indirect debility ap-
proaching,—142.
vessels, usually more
numerous in most sensible or-
gans,—227.
Breathing, difficulty of, to what owing,—223.
Bubo,—387.
C.
Calcutta, death in the black-
hole at, occasioned by ty-
phus,—77.
Canal, alimentary, asthenic dis-
eases of,—304.
Carditis,—220, 225.
Catarrh described,—244.
method of cure of,—275. 


INDEX.
produced by heat, and
removed by cold,—VIII. 172.
Causes, inquiry into, to be a-
voided,—5.
Changes to be brought about
gradually,—18.
Children, diseases of, 38.
generally
owing to debility, V. 241.
signs of asthenic dia-
thesis in,—242.
sthenic ditto,—ib.
Chincough,—319.
Cholera, gentle,—311.
severe,—358.
Circulation, how carried on, 60.
Cold, effects of,—14, 58, 60, 170.
how diminution of bulk in
animals produced by,—60.
remarks on, as a remedy,—184, 264.
succeeding to heat, bad
symptom,—131.
Colic, observations on,—109.
with pain,—330.
cure of,—332.
Colicanodyne,—307.
Colliquative sweets, &c. cause
of,—57.
Coma, causes of,—158.
remarks on,—167.
Constitutions of individuals not
fundamentally different,—165.
Contagions act by stimulus,—6.
produce a fermentation,—229, 231.
remarks on,—35, 77, 127, 182, 267, 368.
Contraction and its effects con-
sidered,—27.
Contusions, cure of,—373.
Convalescent state, remarks on,—199.
Convulsions, observations on,—105.
Corruption of the fluids,—57, 58, 360.
Cough, asthenic,—151, 315.
in peripneumony, how
occasioned,—223.
sthenic,—82, 148, 244.
Cramp.—329 
Croup, remarks on,—240.
Cupping-glasses when may be
serviceable.—275.
Cure, general indications of—43.
means of, cautions repect- 
ting,—45, 50, 267.
Cuticle, not a living substance—373.
Cynanche, gangrenosa,—124, 358.
sthenic,—238.
cure of,—275.
Cystirrhæa—320.
Cvstitis, remarks on,—282, 378
D.
Darkness debilitates,—203.
Day, alternation of, with night,
end of,—ib.
Death, how brought about,—III. 3, 11, 17.
effected by the powers
which produce life,—207.
Debilitating powers, in what
cases to be used,—52.
Debility, direct.—15.
cure of,—53.
lessening stimu-
lus in cases of, carefully to be
avoided,—20.
who subjects of,—50.
indirect,—III. 13.
cure of—51.
how progress to be retarded,—13.
who subject to,—50.
Debility, one kind of, never to
be cured by the other,—50, 52.
Delirium produced by deficient
stimulus,—98. 118.
superabundant stimulus,—172.
Diabetes, gentle,—292.
Diagnosis, general,—41.
Diarrhœa,—307.
Diet. See food.
Diseases, asthenic enumeration
of,—288.
Difeafes, asthenic, general re-
marks on,—30, 288. 
 

INDEX.
method of curing—363.
cause of,—III. 30, 78,
general and local,
mark of distinction between,—1, 39.
how to distinguish,—42.
how produced,—40.
general principles and
method of cure of,—VIII. 9, 29, 43.
local,—370
causes of,—40.
in what way cured,—373. 
sthenic, enumeration of,—220.
method of cure of,—229.
remarks on,—30, 208, 254.
Drink, abstinence from, recom-
mended,—52.
cautions respecting,—51, 65, 364.
may be given freely in
sthenic diseases,—84.
Dropsy,—335.
Dysentery, gentle,—311.
severe,—357.
Dyspepsanodyne,—307.
Dyspepsia, effect of debility,—V.
Dyspepsodynia,—331.
cure of,—332.
E.
Earth, fresh, cap of useful in
phrenitis,—275.
Enteritis, cure of,—378.
description of,—376.
remarks, on,—281.
Epilepsy, case of, converted in-
to dropsy by bleeding,—136.
description of,—338.
owing to debility,—117,
Epistaxis,—303.
Erysipelas, mild, described,—237
method of curing,—275.
violent,—234.
cure of,—254,
Eruptions, cause of, in diseases,—127.
scabby,—291.
Exanthemata, sthenic diseases,—210.
explained,—227.
Excitability;—3.
boundaries of,—10.
effects of the ex-austion of,—11.
general, not partial,—22, 144.
how increased or diminished,—9.
seat of,—22.
superabundant, to be taken off gradually,—18.
what or how affected, unknown,—4.
when wasted by
one stimulus may be acted
upon by another,—11, 197.
Excitement defined,—4.
effects of,—29.
highest degree of,
how produced,—9.
loss of, from over
action, how to be repaired,—12.
Excitement, loss of, may be-
come irreparable,—18.
proportioned to de-
gree of stimulus,—8.
Exciting powers act more on
some parts than others,—23, 25, 370.
universally—23,
effects of,—4.
what implied by,—3.
Excretions, cause of temporary
retention of,—213.
Exercise, observations on,—73, 179, 192, 198.
Expectoration, natural tenden-
cy to, great,—315.
of pus, not always owing to organic lesi-
on—316.
F.
Fermentations, effects of,—229, 231. 
 

INDEX.
remarks on,—360.
Fever, intermittent,—347.
jail, putrid, or petechial,—359.
nervous,—358.
requires more attention
from physicians than usually
bestowed,—361.
yellow, purging necessary in,—72.
Fish, not a nourishing food,—IV.
Fluids how produced,—29.
Food, remarks on,—III. IV. 61, 62.
as a remedy,—184, 186, 191, 282.
should be stimulant to a
certain degree,—246.
vegetable, debilitating,—ibid.
Force, what,—27.
Fossils, perhaps, not without
life,—207.
Functions acting on the living
animal,—2.
may be impaired by
sthenic diathesis,—132.
increased by asthenia,—ibid.
G.
Gangrene described,—388.
to prevent,—148, 185,
Gastritis,—348.
cure of,—40, 376.
remarks on,—40, 219, 281.
Gentoos, imbecility of, owing
to diet,—63.
Globe, great change of, 207.
Gout brought on by low living,—II.
cured by stimuli,—III. VI 125.
not hereditary,—321.
of stronger persons,—120,
of weak persons,—331.
H.
Habits, effects of, to be consi-
dered,—328.
Hæmorrhages always owing to 
debility,—68, 142.
blood deficient
in cases of,—VII. 142.
stimuli salutary in,—VI. 142.
Hæmorrhois,—303.
Health and disease not differ-
ent states,—30.
good and bad, defined,—1, 29.
Heart, inflammation of. See
carditis.
Heat, a remedy of asthenic di-
athesis,—187.
acts more externally than
internally,—253.
excessive, cautions against
application of,—188.
unusual, cause of,—214.
symptom of disease or predisposition,—130.
Hepatitis, remarks on,—281, 378.
Hereditary diseases do not exist,—321.
Hypochondriasis,—333.
curious case of,—335.
Hysteria, gentle,—313.
violent,—331.
cure of,—332.
Hysteritis, remarks on,—282, 379.
I.
Identity of effect proceeds from
identity of cause,—5.
Imbecility, mental and corpo-
real, induced by food insuf-
ficiently stimulating,—63.
Inflammation, asthenic, causes of,—119,123.
cure of—123.
attacking the
brain at the end of typhus
doubted,—IV.
in phrentis, not probable,—92.
Boerhaave's opinion 




INDEX.
of the translation of, from
one viscus to another, erro-
neous,—222.
changes its seat
sometimes,—ib.
distinction of, into
parenchymatose and mem-
branous in phlegmasiæ, ex-
ploded,—221.
erisypelatorus, seat of,—88.
four kinds of,—121.
in general diseases
always external,—82, 89.
local,—91, 123.
not the cause, but
effect of disease,—VIII. 90, 215.
produced by debi-
lity in various diseases,—V.
rheumatic, seat of—88.
sthenic, causes of,—122.
cure of,—123.
Influenza, a sthenic disease,—149.
Intellectual functions, failure
of, owing to debility,—119.
Intermissions, not peculiar to
fever,—355. 
Intestines, inflammation of. See
Enteritis.
Irritation, not owing to extra-
neous matter,—161.
J.
Joints smaller, affected in gout,
greater in rheumatism, and
why,—237.
K.
Kidney, inflammation of. See
Nephritis.
L.
Labour, difficult,—381.
Lassitude, cause of,—213.
Leanness,—290.
Leaches, in what cases may be
applied,—275.
Life, defined,—2.
different periods of, diffe-
rent excitability in, requiring
different degrees of stimuli,—9. 
not a natural but a forced
state,—34. 
powers supporting, differ
not from those which bring
death,—207.
have not various qualities,—302.
Light, a stimulus,—203.
Liver, inflammation of. See
Hepatitis.
Lock-jaw,—344.
Lungs, not always affected in
confirmed consumption,—155, 317. 
Lungs, tubercles in, symptoms
not cause of disease,—155.
M.
Mania,—249.
cure of,—283.
sometimes arises from
fault of the substance of the
brain,—249.
Mathematicians, pedantry of,—200.
Matter morbific, remarkson,—46.
Measles, antiphlogistic plan
useful in,—VIII. 148.
mild, described,—248.
no danger of striking
in by cold,—264.
violent,—231. 
cure of,—259. 
Medicine, science of, what,—1.
Menorrhæa,—302.
Menstruation, cause of—294.
impaired,—293.
retarded,—ib.
suppressed,—ib.
Mind, exercise of, to a certain
degree, necessary to health,—75.
Moisture increases hurtful ef-
fect of temperature,—61.
Mortality, causes of,—32.
Motion, inability to perform,
may not proceed from debi-
lity,—32. 138.
Motions, involuntary,—80.
voluntary,—79.
N.
Nature, healing powers of, non-
existent,—46, 374.
 

INDEX.
Nephritis, remarks on,—281, 378.
Night, alternation of with day,
how useful,—203.
Nitre, not so refrigerant as com-
monly supposed,—275.
Nosologists, common, errors of,—229.
Nourishment, solids not always
necessary to,—176.
See food.
O. 
Oaks perhaps might be planted
in parts of Scotland with ad-
vantage,—204.
Obesity,—253.
cure of,—284.
Opium, an excellent stimulus,—VI. 62.
cold to be avoided du-
ring the operation of,—59.
in what doses to be given
in different cases,—365.
large dose of given in
epilepsy,—340.
prevents mortification,—147.
sedative quality attributed
to, false notion,—141, 148, 167.
under what circum-
stances sleep produced by,—17, 76.
P.
Pain, causes of,—108. 104.
occasioned by emptiness
as well as fullness,—98.
Palsy,—340.
Part most affected, in general
disease, not acted on before
the rest,—26. 214.
Passions, cautions on exciting,—19, 75, 181, 192.
or emotions, strongly
influence our activity,—72.
sometimes necessary to
be excited,—180, 182, 198.
termed opposite, differ
not in nature but degree,—8, 75.
violent, produce dis-
ease and death,—75. 
Peripneumony,—220.
cure of,—40, 259.
difference in
symptoms of, not owing to
seat of the disease but degree,—94.
not a merely local disease,—24.
spurious, cure of,—110.
Peritonitus, remarks on,—378.
Perspiration, diminished, cause
of,—28, 565.
more difficultly
brought on in sthenia than
the other excretions,—213.
produced by cold,—173.
by extreme heat—57.
to be kept up in
diseases, and by what means—48.
Phlegmasiæ, local, cure of,—373.
symtoms of,—227.
Phrenitis,—226.
cure of,—256.
inflammation of
brain, in, not probable,—92.
Physician does not bestow suffi-
cient attention to patients in
fever,—361.
province of,—2.
Plague,—359
Plethora, error of the schools
respecting,—67.
Pleurisy, the same with perip-
neumony,—220.
Poison produce local disease,—37, 77.
remarks on,—5, 77.
Poor, diseases of, owing to want
of stimulating food.—63.
Predisposition, a criterion be-
twixt local and general dis-
ease,—39.
differs from disease
only in degree,—37.
knowledge of, important,—38.
necessarily precedes general disease,—35. 


INDEX.
Predisposition to disease defin-
ed—2, 35.
Prognosis, general,—42.
Pulse, celerity of, owing to de-
bility,—97, 382.
Observations on,—211.
Purging remedies considered,—184, 262, 269.
Pustules produced by contagion,— 94.
remarks on,—386.
Pyrexia,—31. 210.
scarlet,—246.
cure of,—275.
symptomatic,—220, 280.
R.
Remedies, a single one never
to be trusted to in violent
diseases,—46.
general and local,
what,—ibid.
remarks on the vari-
ation of,—242.
several in a moderate
degree to be preferred to few
in excess,—173, 175, 184.
uniform in their ac-
tion,—200.
Rest necessary in sthenic dia-
thesis,—184.
Rheumatalgia,—363.
Rheumatic-inflammation can-
not be transferred to stomach,—92.
seat of,—88.
Rheumatism described,—235.
method of curing,—276.
Rickets,—292.
S.
Scarlet fever. See Pyrexia,
scarlet.
Schirrous tumor,—389.
Scrofulous tumor and ulcer,—389.
Scurvy,—311.
not cured by vegetables,—313.
Sedative powers are but lesser
degrees of stimuli,—8.
do not, as such,
exist in nature,—139.
Sensation, not different in dif-
ferent parts of its seat,—22.
Senses, exercise of, remarks on
the,—75.
Shivering and sense of cold,
cause of,—213.
Skin, dryness of, how occa-
sioned,—213.
Sleep considered,—155, 240.
morbid, how produced,—158.
of convalescents to be
attended to,—312.
owing to a stimulant,
not sedative power,—163.
remarks on, producing,—166.
Small-pox,—358.
confluent, a disease of
debility,—126.
distinct, sthenic dis-
ease,—35, 127.
mild,—247.
cure of,—275, 280.
rare case of,—312, 241.
remarks on the debi-
litating plan in,—129.
violent,—230.
cure of,—259.
Solids, formation and prefer-
vation of,—29.
Spasmodic diseases, cautions a-
gainst evacuants in,—VI. 290.
owing to
debility.—VI. 210. 289.
Specifics, idea of, an error,—165.
Sphacelus,—388.
Splenitis, remarks on,—373.
Sprains, cure of,—377.
Stenia, meaning of,—215.
Stenic diathesis, cause of,—78.
cure of,—170.
may be converted into asthenic,—32.
symptomatic,—230.
symptoms of,—80, 209.
of predisposition to,—79.
plan of cure, different
parts of compared.—183.


INDEX.
Stimuli, cautions on the appli-
cation of,—18, 51, 186.
deficiencies of some
may be supplied by others,—17.
diffusible, cautions on
the use of,—62, 179.
properties of,—62.
scale of,—62, 190.
durable,—197, 201.
effects of may be les-
sened by mixture,—7.
general, affect most the
part to which applied,—23.
hurtful effect of, how
to cure,—52.
indirect,—62.
local and universal de-
fined,—4.
proper in a state of
health,—61.
sum of the action of,
composed of power multipli-
ed by continuance,—11.
what degree of, necessary
in various cases,—161. 365.
Stomach, most affected by inter-
nal remedies,—23. 85.
inflammation of. See
gastritis.
Studies, the author's, progress
of,—I.
Suppuration,—386.
Sweating, utility of, as a reme-
dy,—178. 268. 278.
Symptoms, apparently very
different, arise from the same
disease, and vice versa,—150.
deceitful,—34.
Synocha, simple,—245.
cure of,—295.
Synochus,—358.
System, no power inherent in,
productive of disease,—77.
Systems, old, exploded, and a
new one established,—78.
T.
Tabes,—308.
Temperaments of every indi-
vidual the same,—160.
Temperature, due return of,
best sign of returning health,—130.
Tetanus, description of,—133, 344.
Thinking has great influence
on our activity,—74.
straining in, may
prove hurtful,—74.
Thirst, asthenic—304.
causes of,—81, 99, 214.
not always to be allay-
ed by the same means,—53.
Typhus, occasioned by impure
air, remarkable instance of,—77.
pestilential,—334.
simple,—358.
U.
Urine, redness of, how produ-
ced,—213.
V.
Vegetables subject to the same
laws as animals,—2, 202, 204.
Vessels, contracted in state of
strength, enlarged in state of
weakness,—29.
Vigour, abatement of, not al-
ways owing to debility,—138.
Vomiting, cause of,—84, 101.
considered as a remedy,—184. 262. 269.
W.
Watching causes of,—158,
morbid,—159, 250.
cure of,—283.
owing to over-fatigue, instance of,—160.
restless, or asthenic,—291.
Womb inflammation of. See
Hysteritis.
Worms,—308.
Wounds, deep-seated, or gun-
shot,—381.
irritating susceptible
parts,—385.
necessity of keeping
air from,—372.