FIRST LINES
OF THE
PRACTICE of PHYSIC,
For the Use of Students in the University
of Edinburgh.
By WILLIAM CULLEN, M. D.
Professor of the Practice of Physic in the University of Edinburgh;
First Physician to his Majesty for Scotland;
Fellow of the Royal College of Physicians of Edinburgh,
Of the Royal Society of London, &c. &c.
PART II.
PHILADELPHIA:
Printed by CHARLES CIST, in Market-
Street.
M,DCC,LXXXIII.

 

CONTENTS.
PART II.
Of Neuroses, or Nervous Diseases - 1
BOOK I.
Of Comata - 3
CHAP. I.
Of Apoplexy - ib.
CHAP. II.
Of Palsy - 23
BOOK II.
Of ADYNAMIÆ, or DISEASES consisting in a WEAK-
NESS or LOSS of MOTION, in either the VITAL or
NATURAL FUNCTIONS - 35
CHAP. I.
Of Syncope, or Fainting - ib.
CHAP. II.
Of Dyspepsia, or Indigestion - 44
CHAP. III.
Of Hypochondriasis, or the hypochondriac affection, com-
monly called Vapours, or Low Spirits - 58
BOOK

iv CONTENTS.
Page.
BOOK III.
Of Spasmodic Affections - 70
SECT. I.
Of the Spasmodic Affections of the Animal Functions 71
CHAP. I.
Of Tetanus 73
CHAP. II.
Of Epilepsy - 86
CHAP. III.
Of the Chorea, or Dance of St. Vitus - 109
SECT. II.
Of the Spasmodic Affections of the Vital Functions 112
CHAP. IV.
Of the Palpitation of the Heart - ib.
CHAP. V.
Of Dyspnœa, or difficult Breathing - 116
CHAP. VI.
Of Asthma - 118
CHAP. VII.
Of the Chincough, or Hooping Cough - 129
SECT. 

v CONTENTS. 
Page.
SECT. III.
Of the Spasmodic Affections of the Natural Functions 140
CHAP. VIII.
Of the Pyrosis, or what is named in Scotland the Water-
Brash - ib.
CHAP. IX
Of the Colic - 144
CHAP. X.
Of the Cholera - 153
CHAP. XI.
Of Diarrhœa, or Looseness - 157
CHAP. XII.
Of the Diabetes - 172
CHAP. XIII.
Of Hysteria, or the Hysteric Disease - 177
CHAP. XIV.
Of Canine Madness and Hydrophobia - 183
FIRST 

 

FIRST LINES
OF THE
PRACTICE of PHYSIC.
PART II.
Of NEUROSES, or NERVOUS
DISEASES.
MXXXII.
IN a certain view, almost the whole of the diseases of
the human body might be called Nervous; but there
would be no use for such a general appellation; and, on the
other hand, it seems improper to limit the term, in the
loose inaccurate manner in which it has been hitherto ap-
plied, to hysteric and hypochondriacal disorders, which are
themselves hardly to be defined with sufficient precision.
MXXXIII.
In this place I propose to comprehend, under the title of
Neuroses, all those preternatural affections of sense or mo-
Part II. A tion, 

2 PRACTICE
tion, which are without pyrexia as apart of the primary dis-
ease; and all those which do not depend upon a topical
affection of the organs, but upon a more general affection of
the nervous system, and of those powers on which sense and
motion more especially depend.
MXXXIV.
In this view I establish a class of diseases, under the title
of Neuroses or Nervous Diseases. These I again di-
stinguish, as they consist, either in the interruption and de-
bility of the powers of sense and motion, or in the irregula-
rity with which these powers are exercised; and accordingly,
I establish four orders of this class, under the titles of Coma-
ta, Adynamiae, Spasmi, and Vesaniae, to be defined, as we
proceed to treat of them more particularly.
BOOK 

3 OF PHYSIC.
BOOK I.
Of COMATA.
MXXXV.
Under this title are comprehended those affections which
have been commonly called the Soporose diseases; but they
are most properly distinguished by their consisting in some
interruption or suppression of the powers of sense and volun-
tary motion, or of what are called the animal functions.
These are indeed usually suspended in the time of natural
sleep; but in all those diseases, sleep, or even the appearance
of it, is not constantly a symptom. Of these diseases I can
mark and properly explain two genera only, which come
under the titles of Apoplexy and Palsy.
CHAPTER I.
Of APOPLEXY.
MXXXVI.
Apoplexy is that disease in which the whole of the ex-
ternal and internal senses, and the whole of the voluntary
motions, are in some degree abolished; while respiration
and the action of the heart continue to be performed. By
its being an affection of the whole of the powers of sense and
motion, we distinguish it from Palsy; and by its being with
the continuance of respiration, and the action of the heart,
it is distinguished from Syncope. I have further added to the
ordinary 

4 PRACTICE
ordinary definition of apoplexy, that the abolition of the
powers of sense and motion is in some degree only; meaning
by this to imply, that, under the title of Apoplexy, are
here comprehended those diseases which, as differing from it
in degree only, cannot, with a view either to pathology or
practice, be properly distinguished from it. Such are the
diseases sometimes treated of under the names of Carus, Ca-
taphora, Coma, and Lethargus.
MXXXVII.
Apoplexy, in all its different degrees, most commonly af-
fects persons advanced in life, and especially those above
sixty years of age. It most usually affects persons of large
heads and short necks, persons of a corpulent habit, persons
who have passed an indolent life, and used a full diet, and
especially those who have indulged in frequent intoxication.
Men who have long laboured under a frequent and copious
discharge of blood from the hemorrhoidal vessels, upon ei-
ther the suppression or spontaneous ceasing of that discharge,
are particularly liable to be affected with apoplexy.
MXXXVIII.
This disease frequently comes on very suddenly; but in
many cases, it is preceded by various symptoms, as, by fre-
quent fits of giddiness, frequent headachs, a hemorrhagy
from the nose, some transitory interruption of seeing and
hearing, some false vision and hearing, some transitory de-
gree of numbness, or loss of motion in the extremities, some
faultering of the tongue in speaking, a loss of memory, a
frequent drowsiness, and frequent fits of incubus.
MXXXIX.
An attention to these symptoms, and to the predisponent
circumstances, (MXXXVII.) will often enable us to foresee
the more violent attacks of this disease.
MXL. 

5 OF PHYSIC. 
MXL.
When the disease comes on to a considerable degree, it
has been frequently observed to have been immediately in-
duced by violent exercise; by a full and long continued in-
spiration; by a fit of anger; by much external heat, espe-
cially that arising from a crowded assembly of people; by
warm bathing; by intoxication; by long stooping with the
head down; and by a tight ligature about the neck. The
disease has been remarked to make its attaks most frequently
in the spring season, and especially when the vernal heat
suddenly succeeds to the winter cold.
MXLI.
The symptoms denoting the presence of this disease will
be sufficiently known from the definition given (MXXXVI.)
Though the whole of the body is affected with the loss of
sense and motion, it sometimes takes place more upon one
side of the body than the other, and, in that case, the side
least affected with palsy is sometimes affected with convul-
sions. In this disease there is often a stertorous breathing ;
and this has been said to be a mark of the most violent state
of the disease; but it is not always present even in the most
complete form, or most violent degree of the disease.
MXLII
The proximate cause of this disease may be, in general,
whatever interrupts the motion of the nervous power, from
the brain to the muscles of voluntary motion, or from the
sentient extremities of the nerves to the brain.
MXLIII.
Such an interruption of the motion of the nervous power
may be occasioned, either by some compression of the origin of
the nerves, or by something destroying the mobility of the ner-
vous

6 PRACTICE
vous power. Both thee causes we must treat of more par-
ticularly; and, first, of that of compression, seemingly the
most frequent occasion of apoplexy, and, perhaps, the occa-
sion of all those apoplexies arising from internal causes.
MXLIV.
The loss of sense and motion, in particular parts of the
body, may be occasioned by a compression, either of the
origin of certain nerves only, or of the same nerves in some
part of their course from the brain to the organs of sense
and motion. Such cases of partial compression I am to take
no further notice of here; for, as the affection I am to treat
of now is general, it must depend upon a very general com-
pression of the origin of the nerves, or medullary portion of
the brain; and, therefore, this only is to be considered here.
MXLV.
This compression of the origin of the nerves, or medullary
portion of the brain, may be produced in different ways, as,
1. By external violence fracturing, and pressing in, a part
of the cranium.
2. By tumours, sometimes soft, sometimes bony, formed
in different parts of the brain, or in its membranes, and be-
coming of such a bulk as to compress the medullary sub-
stance of the brain.
3. By the blood accumulated in the blood-vessels of the
brain, and distending them to such a degree as to compress
the medullary portion of the brain, or the origin of the
nerves.
4. By fluids effused in different parts of the brain, or into
the cavity of the cranium, and accumulated in such quantity
as to occasion the compression we treat of.
And, as to this last, it is to be remarked here, that the
fluids effused may be of two kinds, that is, they may be
either a portion of the common mass of blood poured out
from 

7 OF PHYSIC. 
from red vessels, or a portion of serum, or colourless fluid,
poured out chiefly by exhalants.
MXLVI.
Of these several causes of compression, the first is not to
be considered here, because the removing it does not belong
to our province; and the consideration of the second may
be omitted, as, in most instances, it is neither to be discern-
ed nor cured by any art yet known. The third and fourth
causes of compression, as they are the most frequent, and are
also most properly the subjects of our art, so they are those
which deserve our particular attention; and we shall there-
fore endeavour to trace them further back in the series of
causes which may produce them.
MXLVII.
Both the states of over-distension, and of effusion, may be
produced by whatever increases the afflux and impetus of the
blood in the arteries of the head, such as violent exercise, a
violent fit of anger, external heat applied, or any strong
pressure upon the descending aorta.
MXLVIII.
But both these states of over-distension and of effusion,
seem to be more frequently produced by causes that operate
by preventing the free return of the venous blood, from the
vessels of the head to the right ventricle of the heart.
MXLIX.
The venous vessels of the brain are of a conformation and
distribution so peculiar, as lead us to believe, that Nature in-
tended to retard the motion of the blood, and accumulate it
in these vessels; and, therefore, even very small additional
resistences to the motion of the blood from these, towards the 
right 

8 PRACTICE
right ventricle of the heart, may readily accumulate the
blood in them still more. Such accumulation will most
readily happen in advanced life, when the venous system, in
general, is in a plethoric state, and when this plethora takes
place, especially in the venous vessels of the brain. It will,
in like manner, be most apt to occur in persons whose heads
are large with respect to the rest of the body, and in persons
of a short neck, which is unfavourable to the return of the
venous blood from the head. The accumulation of blood
in the venous vessels of the brain will also be most likely to
occur in persons of a corpulent habit, either because these
may be considered to be in a plethoric state, or because obe-
sity gives a compression of the blood-vessels in many parts of
the body, and therefore fills those of the brain, which are en-
tirely free from such kind of compression.
ML.
These are the circumstances in the constitution of the
body, which, producing a flower motion and return of the
venous blood from the vessels of the head, favour an accu-
mulation and distension in them; and we now proceed to
mention the several occasional causes, which, in every per-
son, may directly prevent the free return of the blood from
the vessels of the head towards the heart. Such are,
1. Stooping down with the head, or other situations of the
body in which the head is long kept in a depending state,
and in which the gravity of the blood increases the afflux of
it by the arteries, and opposes the return of it by the veins.
2. A tight ligature about the neck, which compresses the
veins more strongly than the arteries.
3. Any obstruction of a considerable number of the veins
carrying the blood from the head, and more especially any
considerable obstruction of the ascending vena cava.
4. Any considerable impediment of the free passage of
the 

9 OF PHYSIC.
the blood from the veins into the right ventricle of the
heart; and it is commonly by this, and the immediately
preceding circumstance, that polypous concretions in the
cava, or right ventricle, are found to occasion apoplexy.
5. The return of blood from the veins of the head to-
wards the heart, is especially interrupted by every circum-
stance that produces a more difficult transmission of the blood
through the vessels of the lungs. It is well known, that, at
the end of every expiration, some interruption is given to
the free transmission of the blood through the lungs, and
that this, at the same time, gives an interruption to the mo-
tion of the blood from the veins into the right ventricle of
the heart. This clearly appears from that regurgitation of
the blood in the veins which occasions the alternate heaving
and subsiding that is perceived in the brain of living ani-
mals, when the cranium is removed, and which is observed
to be synchronous with the alternate motions of respiration.
From this we readily perceive, that, whatever occasions a
difficulty in the transmission of the blood through the lungs,
must also interrupt the free return of the venous blood from
the vessels of the head, and must therefore favour, and per-
haps produce, an accumulation of blood, and an over-disten-
sion in these vessels.
It is further to be observed, that, as a very full inspiration
continued for any length of time, occasions such an inter-
ruption of the free transmission of the blood through the
lungs, as produces a suffusion of face, and a manifest turge-
scence of the blood-vessels of the head and neck; so every
full and long continued inspiration may occasion an accumu-
lation of blood in the vessels of the head, to a very consider-
able degree. Thus, as every strong exertion of the muscular
force of the body requires, and is attended with a very full
and long continued inspiration, we thence learn why the vio-
lent exertions of muscular force have been so often the im-
mediate or exciting causes of apoplexy.
Part II. B It 

10 PRACTICE
It may also be remarked, that corpulency and obesity seem
to operate very much, by occasioning a more difficult trans-
mission of the blood through the vessels of the lungs. It ap-
pears that, in fat persons, from the compression of the blood-
vessels in many parts of the body, the vessels of the lungs
are thereby kept very full; so that, upon the least increase
of bodily motion, which sends the blood faster into the lungs,
a more frequent and laborious respiration becomes, in such
persons, immediately necessary. This shews that, in such
persons, the blood is not freely transmitted through the
lungs; a circumstance which, as in other instances, must
give a constant resistence to the return of blood from the
vessels of the head, and therefore favour or occasion an ac-
cumulation of blood in them.
Is the motion of the blood, in the vessels of the head,
rendered slower by study, care, and anxiety?
MLI.
It is to be observed further, that these several causes
(MXLVII.—ML.) of a preternatural fulness in the blood-
vessels of the brain, may produce apoplexy in different
ways, according as the fulness takes place in the arteries or
in the veins.
MLII.
Accordingly, first, the increased afflux of blood into the
arteries of the brain, and an increased action in these, may
either occasion a rupture of their extremities, and thereby
an effusion of red blood producing compression; or the same
afflux and increased action may occasion an increased ex-
halation from their extremities, of a serous fluid, which, if
not as quickly reabsorbed, may soon accumulate in such
quantity as to produce compression.
MLIII. 

11 OF PHYSIC.
MLIII.
Secondly, The plethoric state of the venous vessels of the
brain may operate in three different ways. 1. The fulness
of the veins may give such resistence to the blood flowing
into them from the arteries, as to determine the impetus
of the blood to be so much greater upon the extremities of
the arteries, as to occasion a rupture of these, and consequent-
ly an effusion of red blood, or the Haemorrhagia cerebri,
which HOFFMAN considers as a frequent cause of apoplexy,
and which we have before explained in (DCCXXXV.)
2. Whilst the same resistence to the blood flowing from
the arteries into the veins, increases the impetus of the blood
in the former, this may, without occasioning rupture, in-
crease the exhalation from their exhalant extremities, and
produce an effusion of a serous fluid, in the same manner as
such resistence in the veins produces hydropic effusions in
other parts of the body.
3. If we may suppose, as no lymphatics have been yet dis-
covered in the brain, that the ordinary absorbents are not
present there, and that the exhaled fluids are absorbed or
taken up by the extremities of the veins, this will shew still
more clearly that a resistence to the motion of the blood in
the veins of the brain, may readily produce an accumulation
of serous fluid in its cavities, and consequently a compres-
sion producing apoplexy.
MLIV.
Beside these cases of apoplexy from afflux in the arteries, or
resistence in the veins, an effusion of serum may happen
from two other causes. The one is a relaxation of the ex-
halants, as in other cases of hydropic diathesis prevailing in
the body; and it is not unusual for a general dropsy to end
in apoplexy. The second is an over-proportion of watery
parts 

12 PRACTICE
parts in the mass of blood, which is therefore ready to run
off by the exhalants, as in the case of an ischuria renalis,
which, when it proves incurable, very commonly terminates
in apoplexy.
MLV.
We have now mentioned the several causes of apoplexy de-
pending upon compression; and, from the whole, it will ap-
pear, that the most frequent of all these causes is a plethoric
state, or an accumulation and congestion of blood in the ve-
nous vessels of the head, operating, according to its degree,
in producing over-distension or effusion. The frequent ope-
ration of such a cause will especially appear from a conside-
ration of the predisponent circumstance (MXXXVII) and
from the antecedent (MXXXVIII).
MLVI.
From the view I have now given of the causes of apoplexy,
it will readily appear that there is a foundation for the com-
mon distinction of this disease into the two kinds, of San-
guine and Serous. But this distinction cannot be very use-
fully applied in practice, as both kinds may often depend on
the same cause, that is, a venous plethora, and, therefore,
requiring very nearly the same method of cure. The only
distinction of the apoplexies from compression, properly to be
made, is perhaps the distinction of serous apoplexy into that
depending on the plethora mentioned (MXLIX and fol-
lowing;) and that depending upon hydropic diathesis, or an
over-proportion of water in the blood, (MLIV); the former
causes giving a proper idiopathic, the latter giving only a
symptomatic disease.
MLVII.
Beside the causes now mentioned, occasioning apoplexy
by 

13 OF PHYSIC.
by compression, I allege there are other causes producing
the same disease, by directly destroying the mobility of the
nervous power. Such causes seem to be the mephitic air
arising from fermenting liquors, and from many other
sources; the fumes arising from burning charcoal; the fumes
of mercury, of lead, and of some other metallic substances;
opium; alcohol; and many other narcotic poisons. To all
which I would add the power of cold, of concussion, of elec-
tricity, and of certain passions of the mind.
MLVIII.
None of these poisons, or noxious powers, seem to kill by
acting first upon the organs of respiration, or upon the san-
guiferous system; and I believe their immediate and direct
action to be upon the nervous power, destroying its mobility,
because the same poisons shew their power in destroying the
irritability of muscles and of the nerves connected with them,
when both these are entirely separated from the rest of the
body.
MLIX.
It appears to me probable, that the apoplectic state, in
some degree accompanying, and almost always succeeding
an epileptic paroxysm, does not depend upon compression,
but upon a certain state of immobility of the nervous power,
produced by certain circumstances in the nervous system it-
self, which seem to be communicated from one part of the
body to another and at length to the brain.
MLX.
The same observation may be made with respect to many
instances of hysteric paroxysm; and the circumstances, both
of epileptic and hysteric paroxysms, ending in coma, or a
degree of apoplexy, lead me to think, that the apoplexy pro-
ceding 

14 PRACTICE
ceding from retrocedent or atonic gout, is of the same kind,
that is, it depends upon an immobility of the nervous power,
and not upon compression.
MLXI.
It may indeed happen, that the apoplectic and gouty pre-
disposition will often concur in the same person, and it may
consequently happen, that the apoplexy, coming upon gouty
persons, may depend upon compression; and, therefore, upon
dissection, may discover the circumstances of such a cause
preceding. But, in many cases of apoplexy following a re-
trocedent or atonic gout, no such antecedent or concomitant
circumstances, as commonly occur in cases of compression, do
distinctly or clearly appear, while others present themselves,
which point out an affection of the nervous power alone.
MLXII.
With respect, however, to the circumstances which may
appear upon the dissection of persons dead of apoplexy, there
may be some fallacy in judging from those circumstances of
the cause of the disease. Whatever takes off or diminishes
the mobility of the nervous power, may very much retard
the motion of the blood in the vessels of the brain, and that
perhaps to the degree of increasing exhalation, or even of
occasioning rupture and effusion; so that, in such cases, the
marks of compression may appear, upon dissection, though
the disease had truly depended on causes destroying the mo-
bility of the nervous power. This seems to be illustrated
and confirmed from what occurs in many cases of epilepsy.
In some of these, after a repetition of fits, recovered from in
the usual manner, a fatuity is induced, which commonly de-
pends upon a watery inundation of the brain; and in other
cases of epilepsy, when fits have been often repeated without
any permanent conference, there happens at length a fatal
paroxysm, 

15 OF PHYSIC.
paroxysm, and, upon dissection, it appears, that an effusion
of blood had happened. This, I think, is to be considered
as a cause of death, not a cause of the disease; for, in such
cases, I suppose that the disease had diminished the action of
the vessels of the brain, and thereby given occasion to a stag-
nation, which produced the appearances mentioned. And,
I apprehend, the same reasoning will apply to the cases of re-
trocedent gout, which, by destroying the energy of the brain,
may occasion such a stagnation as will produce rupture, ef-
fusion, and death; although, in such a case, the appearances,
upon dissection, might lead us to think that the apoplexy had
depended upon compression.
MLXIII.
The several causes mentioned in (MLVII.) are often of
such power as to occasion immediate death, and therefore
have not commonly been taken notice of, as affording in-
stances of apoplexy; but, as the operation of the whole of
these causes is similar and analogous, and as, in most in-
stances of the operation of these causes, an apoplectic state is
manifestly produced, there can be little doubt in considering
most of the instances of their effects as cases of apoplexy,
and, therefore, such as fall properly under our consideration
here.
MLXIV.
This disease of apoplexy is sometimes entirely recovered
from, but more frequently it ends in death, or in a hemiple-
gia. Even when an attack of the disease is recovered from,
we generally find it disposed to return; and the repeated at-
tacks of it almost always, sooner or later, bring on the events
we have mentioned.
MLXV. 

16 PRACTICE
MLXV.
These several events of health, death, or another disease,
may be expected and foreseen from a consideration of the
predisponent circumstances (MXXXVII.); of the antece-
dent symptoms (MXXXVIII.); of the exciting causes
(MXL.); of the violence and degree of the symptoms when
the disease has come on (MXLI.); of the duration of the dis-
ease; and of the effects of the remedies employed.
MLXVI.
From the great danger attending this disease when it has
come on (MLXIV.), it will readily appear that our care
should be chiefly directed to the prevention of it. This I
think may be often done by avoiding the remote and excit-
ing causes; and how this may be accomplished, will be ob-
vious from the enumeration of those causes given above
(MXL.). But it will also appear from what is said above,
that the prevention of this disease will especially depend
upon obviating the predisponent cause; and this seems, in
most cases, to be a plethoric state of the blood-vessels of the
brain, which may be obviated by different means; and, in
the first place, by a proper management of exercise and diet.
MLXVII.
The exercise ought to be such as may support the perspi-
ration, without heating the body, or hurrying respiration,
and, therefore, commonly, by some mode of gestation. In
persons not liable to frequent fits of giddiness, and who are
accustomed to riding on horseback, this exercise is, of all
others, the best. Walking, and some other modes of bodily
exercise, may be employed with the restrictions just now
mentioned; but, in old men, and in men of corpulent habits;
bodily exercise ought always to be very moderate.
MLXVIII. 

17 OF PHYSIC.
MLXVIII.
In persons who pretty early in life shew the predisposition
to apoplexy, it is probable that a low diet, with a good deal
of exercise, might entirely prevent the disease; but, in per-
sons who are advanced in life before they think of taking
precautions, and are, at the same time, of a corpulent habit,
which generally supposes their having been accustomed to
full living, it might not be safe to put them upon a low diet;
and it may be enough that their diet be rendered more mo-
derate than usual, especially with respect to animal food;
and that, at supper, such food should be abstained from al-
together.
In drinking, all heating liquors are to be abstained from,
as much as former habits will allow, and the smallest ap-
proach to intoxication is to be carefully shunned. The large
use of tobacco, in any shape, may be hurtful; and, except
in cases where it has been accustomed to occasion a copious
excretion from the head, the interruption of which might
not be safe, the use of tobacco should be avoided; and even
in the circumstance mentioned, where it may be in some mea-
sure necessary, the use of it should at least be rendered as mo-
derate as possible. For ordinary draught, small-beer is to
be preferred to plain water, as the latter is more ready to oc-
casion costiveness, which, in apoplectic habits, is to be care-
fully avoided.
MLXIX.
Evacuations by stool may certainly contribute to relieve
the plethoric state of the vessels of the head; and, upon an
appearance of any unusual turgescence in these, purging will
be very properly employed; but, when no such turgescence
appears, the frequent repetition of large purging might weak-
en the body too much; and, for preventing apoplexy, it
may, for the most part, be enough to keep the belly regular,
Part II. C and 

18 PRACTICE
and rather open, by gentle laxatives. In the summer season,
it may be useful to drink, every morning, of a gentle laxa-
tive mineral water, but never in large quantity.
MLXX.
In the case of a plethoric state of the system, it might be
supposed that blood-letting would be the most effectual means
of diminishing the plethora, and of preventing its conse-
quences; and, when an attack of apoplexy is immediately
threatened, blood-letting is certainly the remedy to be de-
pended on, and blood should be taken largely, if it can be
done, from the jugular vein, or temporal artery. But, when
no threatening turgescence appears, the obviating plethora is
not judiciously attempted by blood-letting, as we have en-
deavoured to demonstrate above (DCCX.). In such cir-
cumstanees, leeches applied to the temples, or scarifications
of the hind-head, may be more safe than general bleedings;
MLXXI. 
When there are manifest symptoms of a plethoric state in
the vessels of the head, a seton, or pea-issue, near the head,
may be very useful in obviating any turgescence of the blood.
MLXXII.
These are the means to be employed for preventing the
apoplexy which might arise from a plethoric state of the
vessels of the brain; and if, at the same time, great care is
taken to avoid the exciting causes (MXL.), these means will
be generally successful.
In the cases preceding from other causes (MLVII.), as
their application is so immediately succeded by the disease,
they hardly allow any opportunity for prevention.
MLXXIII.
For the Cure of apoplexy from internal causes, the usual
violence 

19 OF PHYSIC. 
violence and fatality of it require, that the proper remedies
be immediately and largely employed.
The patient is to be kept as much as possible in somewhat
of an erect posture, and in cool air, and, therefore, neither in
a warm chamber, nor covered with bed-clothes, nor surround-
ed with a croud of people.
MLXXIV.
In all cases of a full habit, and where the disease has been
preceded by marks of a plethoric state, blood-letting is to be
immediately employed, and very largely. In my opinion,
it will be most effectual when the blood is taken from the
jugular vein; but, if that cannot be properly done, it may
be taken from the arm. The opening of the temporal arte-
ry, when a large branch can be opened, so as suddenly to
pour out a considerable quantity of blood, may also be an
effectual remedy; but, in execution, it is more uncertain,
and may be inconvenient. It may be, in some measure,
supplied by cupping and scarifying on the temples or hind-
head. This, indeed, should seldom be omitted; and these
scarifications are always preferable to the application of
leeches.
With respect to every mode of blood-letting, this is to be
observed, that when, in any case of apoplexy, it can be per-
ceived, that one side of the body is more affected with the
loss of motion than the other, the blood-letting, if possible,
should be made on the side opposite to that most affected.
MLXXV.
Another remedy to be employed is purging, to be imme-
diately attempted by acrid clysters, and, at the same time, if
any power of swallowing remain, by drastic purgatives given
by the mouth. These however, lest they may excite vomit-
ing, should be given in divided portions at proper intervals.
MLXXVI.

20 PRACTICE
MLXXVI.
Vomiting has been commended by some practitioners and
writers; but, apprehending that this might impel the blood
with too much violence into the vessels of the head, I have
never employed it.
MLXXVII.
Another remedy to be immediately employed is blister-
ing; and I judge that this is more effectual when applied to
the head, or near to it, than when it is applied to the lower
extremities. This remedy I do not consider as a stimulant,
or capable of making any considerable revulsion; but, ap-
plied to the head, I suppose it useful in taking off the hæ-
morrhagic disposition so often prevailing there.
MLXXVIII.
It has been usual with practitioners, together with the re-
medies already mentioned, to employ stimulants of various
kinds; but I am disposed to think them generally hurtful;
and they must be so, wherever the fulness of the vessels, and
the impetus of the blood in them is to be diminished. Up-
on this principle it is, therefore, agreed, that stimulants are
absolutely improper in what is supposed to be a sanguine
apoplexy, but they are commonly supposed to be proper in
the serous. But, if we be right in alleging that this also
commonly depends upon a plethoric state of the blood-vessels
of the brain, stimulants must be equally improper in the one
case as in the other.
MLXXIX.
It may be argued from the almost universal employment
of stimulants, and sometimes with seeming advantage, that
they are not so hurtful as our notion of the causes of apo-
plexy 

21 OF PHYSIC.
plexy leads us to suppose. But this argument ia, in several
respects, fallacious and particularly in this, that, in a disease
which, under every management, often procedes so quickly
to a fatal termination, the effects of remedies are not with
certainty to be easily ascertained.
MLXXX.
I have now mentioned the several remedies which I think
adapted to the cure of apoplexy arising from compression,
and should next procede to treat of the cure of apoplexy aris-
ing from those causes that directly destroy the mobility of the
nervous power. But many of those causes are often so pow-
erful, and thereby so suddenly fatal in their effects, as hardly
to allow of time for the use of remedies; and such cases have
been so seldom the subjects of practice, that the proper reme-
dies are not so well ascertained as to enable me to say much
of them here.
MLXXXI.
When, however, the application of the causes (MLVII.)
is not so powerful as immediately to kill, and induces only
an apoplectic state, some efforts are to be made to obviate
the consequences, and to recover the patient; and even in
some cases where the causes referred to, from the ceasing of
the pulse, and of respiration, and from a coldness coming
upon the body, have induced an appearance of death; yet, if
these appearances have not continued long, there may be
means of recovering the persons to life and health. I can-
not, indeed, treat this subject completely; but, for the cure
of apoplexy, from several of the causes mentioned (MLVII.),
shall offer the following general directions.
1. When a poison capable of producing apoplexy has
been recently taken into the stomach, if a vomiting sponta-
neously arises, it is to be encouraged, or if it does not spon-
taneously 

22 PRACTICE
taneously come on, a vomiting is to be immediately excited
by art, in order that the poison may be thrown out as quickly
as possible. If, however, the poison has been taken into the
stomach long before its effects have appeared, we judge that,
upon their appearance, the exciting of vomiting will be use-
less, and may, perhaps, be hurtful.
2. When the poison taken into the stomach, or otherwise
applied to the body, has already induced an apoplectic state,
as those causes do commonly at the same time occasion a
stagnation, or slower motion of the blood in the vessels of the
brain and of the lungs, so it will generally be proper to re-
lieve this congestion by taking some blood from the jugular
vein, or from the veins of the arm.
3. Upon the same supposition of a congestion in the brain
or lungs, it will generally be proper to relieve it by means
of acrid clysters producing some evacuation from the intestines.
4. When these evacuations by blood-letting and purging 
have been made, the various stimulants which have been
commonly proposed in other cases, of apoplexy, may be em-
ployed here with more probability and safety. One of the
most effectual means of rousing apoplectics of this kind seems
to be throwing cold water on several parts of the body, or
washing the body all over with it.
5. When the poison producing apoplexy happens to be so
powerful as very soon to occasion the appearances of death
above mentioned, yet if this state has not continued long, the
patient may often be recoverable, and the recovery is to be
attempted by the same means that are directed to be employ-
ed for the recovery of drowned persons, and which are new
commonly known.
CHAP. II.

23 OF PHYSIC.
CHAP. II.
Of PALSY.
MLXXXII.
Palsy is a disease consisting in a loss of the power of vo-
luntary motion, but affecting certain parts of the body only,
and by this it is distinguished from apoplexy (MXXXVI.)
One of the most frequent forms of palsy is when it affects the
whole of the muscles on one side of the body, and then the
disease is named Hemiplegia.
MLXXXIII.
The loss of the power of voluntary motion may be owing
either to a morbid affection of the muscles, or organs of mo-
tion, by which they are rendered unfit for motion, or to an
interruption of the influx of the nervous power into them,
which is always necessary to the motions of those that are
under the power of the will. The disease, from the first
of these causes, as consisting in an organic and local affec-
tion, we refer entirely to the class of local diseases. I am
here to consider that disease only which depends upon the
interrupted influx of the nervous power; and it is to this
disease alone I would give the appellation of Palsy. A dis-
ease depending on an interrupted influx of the nervous pow-
er may indeed often appear as merely a local affection; but,
as it depends upon an affection of the most general powers of
the system, it cannot be properly separated from the syste-
matic affections.
MLXXXIV.
In palsy, the loss of motion is often accompanied with a
loss 

24 PRACTICE
loss of sense; but, as this is not constantly the case, and as,
therefore, the loss of sense is not an essential symptom of
palsy, I have not taken it into my definition (MLXXXII.);
and I shall not think it necessary to take any further notice
of it in this treatise, because, in so far as it is in any case a
part of the paralytic affection, it must depend upon the same
causes, and will be cured also by the very same remedies.
MLXXXV.
The palsy then, or loss of motion, which is to be treated
of here, may be distinguished as of two kinds; one of them
depending upon an affection of the origin of the nerves in
the brain, and the other depending upon an affection of the
nerves in some part of their course between the brain and
the organs of motion. Of the latter, as appearing in a very
partial affection, I am not to speak particularly here, but
shall treat of the more general paralytic affections, and espe-
cially of the hemiplegia (MLXXXII.). At the same time,
expecting that what I shall say upon this subject will readily
apply to both the pathology and practice of the more limited
cases.
MLXXXVI.
The hemiplegia (MLXXXII.) usually begins with, or
follows, a paroxysm of apoplexy; and when the hemiplegia,
after subsisting for some time, becomes fatal, it is commonly
by passing again into the state of apoplexy. The relation,
therefore, or affinity between the two diseases, is sufficiently
evident, and is further strongly confirmed by this, that the
hemiplegia comes upon persons of the same constitution,
(MXXXVII.) and is preceded by the same symptoms
(MXXXVIII.) that have been taken notice of with respect
to apoplexy.
MLXXXVII. 

25 OF PHYSIC.
MLXXXVII.
When a fit of apoplexy has gone off, and there remains
a state of palsy appearing as a partial affection only, it might
perhaps be supposed that the origin of the nerves is in a
great measure relieved; but as, at the same time, there com-
monly remain the symptoms of loss of memory, and of some
degree of fatuity, these I think shew that the organ of intel-
lect, or the common origin of the nerves, is still considerably
affected.
MLXXXVIII.
Thus, the hemiplegia, from its evident connection with,
and near relation to apoplexy, may be properly considered
as depending upon like causes; and, consequently, either
upon a compression preventing the flow of the nervous pow-
er from the brain into the organs of motion, or upon the
application of narcotic powers (MLVII.) rendering the ner-
vous power unfit to flow in the usual and proper manner.
We begin with considering the cases depending upon com-
pression.
MLXXXIX.
The compression occasioning hemiplegia may be of the
same kind, and of all the different kinds that produce apo-
plexy, and therefore, either from tumor, over-distension, or
effusion. The existence of tumor giving compression, may
often be better discerned in the case of palsy than in that of
apoplexy, as its effects often appear, at first, in a very par-
tial affection. 
MXC.
The other modes of compression, that is, of over-disten-
sion and effusion, may, and commonly do take place, in he-
miplegia, and when they do, their operation here differs
Part II. D from 

26 PRACTICE
from that producing apoplexy, by its effects being partial,
and on one side of the body only.
It may seem difficult to conceive that an over-distension
can take place in the vessels on one side of the brain only,
but it may be understood; and in the case of a palsy which
is both partial and transitory, it is perhaps the only condition
of the vessels of the brain that can be supposed. In a hemi-
plegia, indeed, which subsists for any length of time, there
is probably always an effusion, either sanguine or serous; but
it is likely that even the latter must be supported by a re-
maining congestion in the blood-vessels.
MXCI.
That a sanguine effusion can happen without becoming
very soon general, and thereby occasioning apoplexy and
death, may also seem doubtful; but dissections prove that in
fact it does happen occasioning palsy only; though it is true
that this more commonly depends upon an effusion of serous
fluid, and of this only.
MXCII.
Can a palsy occasioned by compression remain, though
the compression be removed?
MXCIII.
From what has been said (MLXXXVI.), it will be ob-
vious that the hemiplegia may be prevented by all the se-
veral means proposed (MLXVI—MLXXII.) for the pre-
vention of apoplexy.
MXCIV.
Upon the same grounds, the Cure of palsy must be very
much the same with that of apoplexy (MLXXIII.—
MLXXX.), and when palsy has begun as an apoplexy, it is
presumed 

27 OF PHYSIC. 
presumed that, before it is to be considered as palsy, all those
several remedies have been employed. Indeed, even when
it happens that, on the first attack of the disease, the apo-
plectic state is not very complete, and that the very first ap-
pearance of the disease is as a hemiplegia, the affinity between
the two diseases (MLXXXVI.), is such as to lead to the
same remedies in both cases. This is certainly proper in all
those cases in which we can with much probability impute
the disease to compression; and it is indeed seldom that a he-
miplegia comes on but with a considerable affection of the
internal, and even of the external senses, together with other
marks of a compression of the origin of the nerves.
MXCV.
Not only, however, where the disease can be imputed to
compression, but even where it can be imputed to the appli-
cation of narcotic powers, if the disease come on with the ap-
pearances mentioned at the end of last paragraph, it is to be
treated in the same manner as an apoplexy by (MLXXIII.—
MLXXIX.).
MXCVI.
The cure of hemiplegia, therefore, on its first attack, is
the same, or very nearly the same with that of apoplexy;
and it seems requisite that it should be different only, 1. When
the disease has subsisted for some time. 2. When the apo-
plectic symptoms, or those marking a considerable compres-
sion of the origin of the nerves, are removed; and particu-
larly, 3. When there are no evident marks of compression,
and it is at the same time known, that narcotic powers have
been applied.
MXCVII.
In all these cases, the question arises, whether stimulants
may

28 PRACTICE
may be employed, or how far the cure may be entirely trusted
to these remedies? Upon this question, with respect to apo-
plexy, I have offered my opinion in (MLXXVIII.); and,
with respect to hemiplegia, I am of opinion, that stimulants
are equally dangerous as in the cases of complete apoplexy,
and particularly, 1. In all the cases of hemiplegia, succeding
to a paroxysm of complete apoplexy, 2. In all the cases,
coming upon persons of the temperament mentioned in
(MXXXVII.) and after the same antecedents as those of
apoplexy (MXXXVIII.); and, 3. In all the cases, coming
on with some apoplectic symptoms.
MXCVIII.
It is, therefore, in the cases (MXCVI.) only, that stimu-
lants are properly admissible; and even in the two first of
these cases, wherein a plethoric state of the blood-vessels of
the brain may have brought on the disease; wherein a dis-
position to that state may still continue; and wherein even
some degree of congestion may still remain; the use of sti-
mulants must be an ambiguous remedy, so that perhaps it is
in the third of these cases only, that stimulants are clearly
indicated and admissible.
MXCIX.
These doubts, with respect to the use of stimulants, may
perhaps be overlooked or disregarded by those who allege
that stimulants have been employed with advantage even in
those cases (MXCVII.) in which I have said they ought to
be avoided.
MC.
To compromise this contrariety of opinion, I must observe
that, even in the cases of hemiplegia depending upon com-
pression, although the origin of the nerves be so much com-
pressed, 

29 OF PHYSIC.
pressed, as to prevent so full a flow of the nervous power, as
is necessary to muscular motion, yet it appears from the power
of sense still remaining, that the nerves are, to a certain de-
gree, still pervious; and, therefore, it is possible that stimu-
lants applied may excite the energy of the brain so much,
as in some measure to force open the compressed nerves, and
to shew some return of motion in paralytic muscles. Nay,
further, it may be allowed, that, if these stimulants be such
as act more upon the nervous than upon the sanguiferous sy-
stem, they may possibly be employed without any very hurt-
ful consequence.
MCI.
But still it will be obvious, that, although certain stimu-
lants act chiefly upon the nervous system, yet they also act
always, in some measure, upon the sanguiferous; so that,
when they happen to have the latter effect in any consider-
able degree, they may certainly do much harm; and in a
disease which they do not entirely cure, the mischief arising
from them may not be discerned.
MCII.
Whilst the employment of stimulants is so often an ambi-
guous practice, we may perhaps go some length towards as-
certaining the matter, by considering the nature of the se-
veral stimulants which may be employed, and some of the
circumstances of their administration. With this view, there-
fore, I shall now mention the several stimulants that have
been commonly employed, and offer some remarks upon
their nature and use.
MCIII.
They are in the first place to be distinguished as external
or internal. Of the first kind we again distinguish them as
they 

30 PRACTICE
they are applied to particular parts of the body only, or as
they are more generally applied to the whole system. Of
the first kind are,
A. The concentrated acids of vitriol or nitre, involved,
however, in oily or unctuous substances, which may obviate
their corrosive, without destroying their stimulant power.
B. The volatile alkaline spirits, especially in their caustic
state, but involved also in oils, for the purposes just now
mentioned.
C. The same volatile spirits are frequently employed by
being held to the nose when they prove a powerful stimulus
to the nervous system; but it is, at the same time, probable.
that they may prove a strong stimulant to the blood-vessels
of the brain.
D. A brine, or a strong solution of sea-salt.
E. The essential oils of aromatic plants, or of their parts.
F. The essential oils of turpentine, or of other such resin-
ous substances.
G. The distilled oils of amber, or of other bituminous
fossils.
H. The rectified empyreumatic oils of animal or vegetable
substances.
I. Various vegetable acrids, particularly mustard.
K. The acrid matter found in several insects, particularly
cantharides.
Some of these stimulants may be either applied in substance
or may be dissolved in ardent spirits, by which their stimu-
lant power may be encreased, or more conveniently applied.
MCIV.
The greater part of the substances now enumerated shew
their stimulant power by inflaming the skin of the part to
which they are applied; and when their application is so
long continued as to produce this effect, it interrupts the
continuance of their use, and the inflammation of the part
does 

32 OF PHYSIC. 
does not seem to do so much good, as the frequent repeti-
tion of a more moderate stimulus.
MCV.
Analogous to these stimulants is the stinging of nettles,
which has been frequently commanded.
Among the external stimulants, the mechanical one of
friction with the naked hand, the flesh-brush, or flannel, is
justly to be reckoned. Can the impregnation of the flannels
to be employed, with the fumes of burning mastic, oliba-
num, &c. be of any service?
MCVI.
With respect to the whole of these external stimulants, it
is to be observed, that they affect the part to which they are
applied much more than they do the whole system, and they
are therefore indeed safer in ambiguous cases; but, for the
same reason, they are of less efficacy in curing a general af-
fection.
MCVII.
The external applications which may be applied to affect,
the whole system, are the powers of heat and cold, and of
electricity.
Heat, as one of the most powerful stimulants of the ani-
mal oeconomy has been often employed in palsies, especially
by warm bathing. But, as both by stimulating the solids
and rarefying the fluids, this proves a strong stimulus to the
sanguiferous system, it is often an ambiguous remedy, and
has frequently been manifestly hurtful in palsies depending
upon a congestion of blood in the vessels of the brain. The
most certain, and therefore, the most proper use of warm
bathing in palsies, seems to be in those that have been occa-
sioned by the application of narcotic powers. Are the na-
tural 

32 PRACTICE
tural baths more useful by the matters with which they may
be naturally impregnated?
MCVIII.
Cold applied to the body for any length of time is always
hurtful to paralytic persons; but, if it be not very intense,
nor the application long continued, and if, at the same time,
the body be capable of a brisk reaction, such an application
of cold is a powerful stimulant of the whole system, and has
often been useful in curing palsy. But, if the power of re-
action in the body be weak, any application of cold may
prove very hurtful.
MCIX.
Electricity, in a certain manner applied, is certainly one
of the most powerful stimulants that can be employed to act
upon the nervous system of animals; and, therefore, much
has been expected from it in the cure of palsy. But, as it
stimulates the sanguiferous, as well as the nervous system,
it has been often hurtful in palsies depending upon a com-
pression of the brain, and especially when it has been so ap-
plied as to act upon the vessels of the head. It is safer when
its operation is confined to particular parts somewhat remote
from the head; and, further, as the operation of electricity,
when very strong, can destroy the mobility of the nervous
power, I am of opinion, that it is always to be employed with
caution, and that it is only safe when applied with moderate
force, and when confined to certain parts of the body remote
from the head. It is also my opinion, that its good effects
are to be expected from its repetition, rather than from its
force, and that it is particularly suited to the cure of those
palsies which have been produced by the application of nar-
cotic powers.
MCX. 

33 OF PHYSIC.
MCX.
Amongst the remedies of palsy, the use of exercise is not
to be omitted. In a hemiplegia, bodily exercise cannot be
employed, and in a more limited affection, if depending upon
a compression of some part of the brain, it would be an am-
biguous remedy; but, in all cases where the exercises of ge-
station can be employed, they are proper; as, even in cases
of compression, the stimulus of such exercise is moderate,
and therefore safe; and, as it always determines to the sur-
face of the body, it is a remedy in all cases of internal con-
gestion.
MCXI.
The internal stimulants employed in palsy are various,
but chiefly the following.
a. The volatile alkaline salts, or spirits, as they are called,
are very powerful and diffusive stimulants, operating especi-
ally on the nervous system; and even although they operate
on the sanguiferous, yet, if given in frequently repeated small,
rather than in large doses, their operation being transitory,
is tolerably safe.
b. The vegetables of the class named Tetradynamia are
many of them powerful diffusive stimulants; and, at the same
time, as quickly passing out of the body, and, therefore, of
transitory operation, they are often employed with safety.
As they commonly prove diuretic, they may, in this way,
also be of service in some cases of serous palsy.
c. The various aromatics, whether employed in substance,
in tincture, or in their essential oils, are often powerful sti-
mulants; but being more adhesive and inflammatory than
those last mentioned, they are, therefore, in all ambiguous
cases, less safe.
d. Some other acrid vegetables have been employed, but
we are not well acquainted with their peculiar virtues, or
proper use.
Part II. E e. Some 

34 PRACTICE
e. Some resinous substances, as guaiacum, and the tere-
binthinate substances, or their essential oils, have been, with
some probability, employed, but they are apt to become in-
flammatory. Decoctions of guaiacum, and some other su-
dorifics, have been directed to excite sweating by the appli-
cation of the fumes of burning spirit of wine in the laconi-
cum, and have, in that way, been found useful.
f. Many of the fœtid antispasmodic medicines have been
frequently employed in palsy; but I do not perceive in what
manner they are adapted to the cure of this disease, and I
have not observed their good effects in any cases of it.
g. Bitters, and the Peruvian bark, have also been em-
ployed, but with no propriety or advantage that I can per-
ceive.
MCXII.
With respect to the whole of these internal stimulants, it
is to be observed, that they seldom prove very powerful;
and wherever there is any doubt concerning the nature or
state of the disease, they may readily do harm, and are often,
therefore, of ambiguous use.
BOOK 

35 OF PHYSIC.
BOOK II.
Of A DYNAMIÆ;
or,
DISEASES consisting in a WEAKNESS, or
LOSS of MOTION, in either the VITAL
or NATURAL FUNCTIONS.
CHAP. I.
Of SYNCOPE, or FAINTING.
MCXIII.
THIS is a desease in which the pulse and respiration
become considerably weaker than usual, or in which,
for a certain time, these functions cease altogether.
MCXIV.
Physicians having observed that this affection occurs in
different degrees, have endeavoured to distinguish these by
different appellations; but, as it is not possible to ascertain
these different degrees with any precision, so there can be no
strict propriety in employing those different names, and I
shall here comprehend the whole of the affections of this
kind under the title of Syncope.
MCXV.

36 PRACTICE
MCXV.
This disease sometimes comes on suddenly to a considerable
degree, but sometimes, also, it comes on gradually; and, in
the latter case, it usually comes on with a sense of languor,
and of anxiety about the heart, accompanied at the same
time, or immediately after, with some giddiness, dimness
of sight, and sounding in the ears. Together with these
symptoms, the pulse and respiration become weak, and often
so weak that the pulse is scarcely to be felt, or the respira-
tion to be perceived, and sometimes these functions, for a
certain time, cease altogether. While these things happen,
the face, and whole surface of the body, become pale, and in
some measure cold, more or less, according to the degree
and duration of the paroxysm. Very commonly, at the be-
ginning of this, and during its continuance, a cold sweat ap-
pears, and, perhaps, continues on the fore-head, as well as
on some other parts of the body. During the paroxysm, the
animal functions, both of sense and motion, are always in
some degree impaired, and very often entirely abolished.
A paroxysm of syncope is often, after some time, spontane-
ously recovered; and this recovery is generally attended with
a sense of much anxiety about the heart.
MCXVI.
Fits of ayncope are frequently attended with, or end in
vomiting, and sometimes with convulsions, or an epileptic 
fit.
MCXVII.
These are the phenomena in this disease; and, from every
view of the greatest part of these, there cannot be a doubt
that the proximate cause of this disease is a very weak, or a
total ceasing of the action of the heart. But it may be a very
difficult matter to explain in what manner the several remote
causes 

37 OF PHYSIC.
causes operate in producing that proximate cause of it. This,
however, I shall attempt, though with that dissidence which
becomes me in attempting a subject that has not hitherto
been treated with much success.
MCXV1II.
The remote causes of syncope may, in the first place, be
referred to two general heads. The one is, of those causes
existing and acting in the brain, or in parts of the body re-
mote from the heart, but acting upon this by the interven-
tion of the brain. The other general head of the remote
causes of syncope, is of those existing in the heart itself, or
in parts very immediately connected with it, and thereby
acting more directly upon it in producing this disease.
MCXIX.
In entering upon the consideration of the first set of those
causes (MCXVIII.), I must assume a proposition which I
suppose to be fully established in Physiology. It is this:
That, though the muscular fibres of the heart be endowed
with a certain degree of inherent power, they are still, for
such action as is necessary to the motion of the blood, very
constantly dependent upon a nervous power sent into them
from the brain. At least, this is evident, that there are cer-
tain powers acting primarily, and perhaps only in the brain,
which influence, and variously modify the action of the heart.
I suppose, therefore, a force very constantly, during life,
exerted in the brain, with respect to the moving fibres of the
heart, as well as of every part of the body, which force we
shall call the Energy of the Brain, and which we suppose
may be, on different occasions, stronger or weaker with re-
spect to the heart.
MCXX.
Admitting these propositions, it will be obvious, that, if
we 

38 PRACTICE
we can explain in what manner the first set of remote causes
(MCXVIII.) diminish the energy of the brain, we shall, at
the same time, explain in what manner these causes occa-
sion a syncope.
MCXXI.
To do this, we observe, that one of the most evident of
the remote causes of syncope is a hæmorrhagy, or an evacu-
ation of blood, whether spontaneous or artificial. And, as
it is very manifest, that the energy of the brain depends up-
on a certain fulness and tension of its blood-vessels, for which
nature seems to have industriously provided by such a con-
formation of those blood-vessels as retards the motion of the
blood, both in the arteries and veins of the brain, so we can
readily perceive, that evacuations of blood, by taking off the
fulness and tension of the blood-vessels of the brain, and
thereby diminishing its energy, with respect to the heart,
may occasion a syncope. In many persons, a small evacu-
ation of blood will have this effect; and, in such cases, there
is often a clear proof of the manner in which the cause oper-
ates, from this circumstance, that the effect can be prevented
by laying the body in a horizontal posture, which, by favour-
ing the afflux of the blood by the arteries, and retarding
the return of it by the veins, preserves the necessary fulness
of the vessels of the brain.
It is farther to be remarked here, that not only an evacu-
ation of blood occasions syncope, but that even a change in
the distribution of the blood, whereby a larger portion of
blood flows into one part of the system of blood-vessels, and,
consequently, less into others, may occasion a syncope. It
is thus we explain the syncope that readily occurs upon the
evacuation of hydropic waters, which had before filled the
cavities of the abdomen or thorax. It is thus, also, we ex-
plain the syncope that sometimes happens on blood-letting,
but which does not happen till the ligature which had been
employed 

39 OF PHYSIC.
employed is untied, and admits a larger afflux of blood into
the blood-vessels of the arm. Both these cases of syncope
shew, that an evacuation of blood does not always occasion
the disease by any general effect on the whole system, but
often merely by taking off the requisite fulness of the blood-
vessels of the brain.
MCXXII.
The operation of some others of the remote causes of syn-
cope may be explained on the following principles. Whilst
the energy of the brain is, upon different occasions, mani-
festly stronger or weaker, it seems to be with this condition,
that a stronger exertion of it is necessarily followed by a
weaker state of the same. It seems to depend upon this par-
ticular in the constitution of the nervous power, that the or-
dinary contraction of a muscle is always alternated with a
relaxation of the same; that, unless a contraction procedes
to the degree of spasm, the contracted state cannot be long
continued; and it seems to depend upon the same cause that
the voluntary motions, which always require an unusual in-
crease of exertion, occasion fatigue, debility, and, at length,
irresistible sleep.
From this law, therefore, of the nervous power, we may
understand why a sudden and violent exertion of the energy
of the brain is sometimes followed by such a diminution of
it as to occasion a syncope; and it is thus we suppose that a
violent fit of joy produces syncope, and even death. It is
upon the same principle, also, we suppose that an exquisite
pain may sometimes excite the energy more strongly than
can be supported, and therefore, such a diminution follows
as must occasion fainting. But the effect of the principle ap-
pears more clearly in this, that a fainting readily happens
upon the sudden remission of a considerable pain; and thus
we have seen a fainting occur upon the reduction of a pain-
ful dislocation,
MCXXIII.

40 PRACTICE
MCXXIII.
It seems to be quite analogous when a syncope immedi-
ately happens on the finishing of any great and long conti-
nued effort, whether depending on the will, or upon a pro-
pensity; and in this way a fainting sometimes happens to a
woman on the bearing of a child. This may be well illu-
strated by observing, that, in persons already any how much
weakened, even a very moderate effort will sometimes occa-
sion fainting.
MCXXIV.
To explain the operation of some other causes of syncope,
it may be observed, that, as the exertions of the energy of
the brain are especially under the influence of the will, so it
is well known, that those modifications of the will which
are named passions and emotions, have a powerful influence
on the energy of the brain, in its actions upon the heart,
either in increasing or diminishing the force of that energy.
Thus, anger has the former, and fear the latter effect; aid
thence it may be understood how terror often occasions, a
syncope, sometimes of the most violent kind, named Asphy-
xia, and sometimes death itself.
MCXXV.
As, from what I have just mentioned, it appears that the
emotions of desire increase, and those of aversion diminish
the energy of the brain; so it may be understood, how a
strong aversion, a horror, or the feeling which arises upon the
sight of a very disagreeable object, may occasion fainting.
As an example of this, I have known more than one instance
of a person's fainting at the sigt of a sore in another person.
MCXXVI.
To this head of horror and disgust, I refer the operation
of 

41 OF PHYSIC.
of those odours which in certain persons occasion syncope.
It may be supposed that those odours are endowed with a
directly sedative power, and may thereby occasion syncope;
but they are, many of them, with respect to other persons,
evidently of a contrary quality; and it appears to me, that
those odours occasion syncope only in those persons to whom
they are extremely disagreeable.
MCXXVIT.
It is, however, very probable, that, among the causes of
syncope, there are some which, analogous to all those we
have already mentioned, act by a directly sedative power;
and such may either be diffused in the mass of blood, and
thereby communicated to the brain, or may be only taken
into the stomach, which so readily and frequently communi-
cates its affections to the brain.
MCXXVIII.
Having now recited, and, as I hope, explained the most
part of the remote causes of syncope, that either operate im-
mediately upon the brain, or which, operating upon other
parts of the body, are communicated to the brain, it is proper
to observe, that the most part of these causes operate upon
certain persons more readily and powerfully than upon others;
and this circumstance, which may be considered as the pre-
disponent cause of syncope, deserves to be inquired into.
It is, in the first place, obvious, that the operation of some
of those causes depends entirely upon an idiosyncrasy in the
persons upon whom they operate, which, however, I cannot
pretend to explain. But, in the next place, with respect to
the greater part of the other causes, their effects seem to de-
pend upon a temperament which is, in one degree or other,
in common to many persons. This temperament seems to
consist in a great degree of sensibility and mobility, and
these, again, arising from a state of debility, sometimes de-
Part II. F pending 

42 PRACTICE
pending upon original conformation, and sometimes produced
by accidental occurrences in the course of life.
MCXXIX.
The second set of the remote causes of syncope (MCXVIII.),
or those acting directly upon the heart itself, are, as we have
said, certain organic affections of the heart itself, or of the
parts immediately connected with it, particularly the great
vessels which pour blood into, or immediately receive it from,
the cavities of the heart. Thus a dilatation or aneurism of
the heart, a polypus in its cavities, abscesses or ulcerations in
its substance, a close adherence of the pericardium to the sur-
face of the heart, aneurisms of the great vessels near to the
heart, polypus in these, and ossifications in these, or in the
valves of the heart, are one or other of them conditions which,
upon dissection, have been discovered in those persons who
had before laboured under frequent syncope.
MCXXX.
It is obvious that these conditions are all of them either
such as may, upon occasion, disturb the free and regular in-
flux into, or the free egress of the blood from, the cavities
of the heart, or such as may otherwise disturb its regular ac-
tion, by sometimes interrupting it, or sometimes exciting it
to more violent and convulsive action. The latter is what
we name the palpitation of the heart, and it commonly oc-
curs in the same persons who are liable to syncope.
MCXXXI.
It is this, as I judge, that leads us to perceive in what
manner these organic affections of the heart and great vessels
may occasion syncope; for it may be supposed, that the vio-
lent exertions made in palpitations may either give occasion
to an alternate great relaxation (MCXXII.), or to a spasmo-
dic 

43 OF PHYSIC.
dic contraction, and, in either way, suspend the action of
the heart, and occasion syncope. It seems to me probable,
that it is a spasmodic contraction of the heart that occasions
the intermission of the pulse so frequently accompanying pal-
pitation and syncope.
MCXXXII.
Though it frequently happens that palpitation and syn-
cope arise, as we have said, from the organic affections
above mentioned, it is proper to observe, that these diseases,
even when in a violent degree, do not always depend on such
causes acting directly on the heart, but are often dependent
on some of those causes which we have mentioned above as
acting primarily on the brain.
MCXXXIII.
I have thus endeavoured to give the pathology of syncope,
and of the cure I can treat very shortly.
The cases of syncope depending on the second set of causes
(MCXVIII.), and fully recited in (MCXXIX.), I suppose
to be generally incurable, as our art, so far as I know, has
not yet taught us to cure any one of those several causes of
syncope (MCXXIX.).
The cases of syncope, depending on the first set of causes
(MCXVIII.), and whose operation I have endeavoured to
explain in (MCXXI. et seq.), I hold to be generally cure-
able, either by avoiding the several occasional causes there
pointed out, or by correcting the predisponent causes
(MCXXVIII.). The latter, I think, may generally be
done by correcting the debility or mobility of the system, by
the means which I have already had occasion to point out in
another place.
CHAP. II. 

44 PRACTICE
CHAP. II.
Of DYSPEPSIA, or INDIGESTION.
MCXXXIV.
A Want of appetite, a squeamishness, sometimes a vo-
miting, sudden and transient distensions of the stomach, eruc-
tations of various kinds, heart-burn, pains in the region of
the stomach, and a bound belly, are symptoms which fre-
quently concur in the same person, and therefore, may be
presumed to depend upon one and the same proximate cause.
In both views, therefore, they may be considered as forming
one and the same disease, to which we have given the ap-
pellation of DYSPEPSIA set at the head of this chapter.
MCXXXV.
As we shall maintain that this disease is often a secondary
and sympathic affection, so the symptoms above mentioned
are often joined with many others; and this has given occa-
sion to a very confused and undetermined description of it,
under the general title of Nervous diseases, or under that of
Chronic weakness. It is proper, however, to distinguish,
and we apprehend we have above enumerated, the symptoms
that are essential to the Idiopathic affection we are to treat
of.
MCXXXVI.
It is indeed to be particularly observed, that these sym-
ptoms are often truly accompanied with a certain state of mind
which may be considered as a part of the idiopathic affec-
tion; but I shall take no further notice of this symptom in
the 

45 OF PHYSIC. 
the present chapter, as it will be fully, and more properly,
considered in the next, which is under the title of Hypo-
chondriasis.
MCXXXVII.
That there is a distinct disease attended always with the
greater part of the above symptoms, is rendered very pro-
bable by this, that all these several symptoms may arise from
one and the same cause, that is, from an imbecillity, loss of
tone, and weaker action in the muscular fibres of the sto-
mach; and I conclude, therefore, that this imbecillity, may
be considered as the proximate cause of the disease I am to
treat of under the name of Dyspepsia.
MCXXXVIII.
The imbecillity of the stomach, and the consequent sym-
ptoms (MCXXXIV.), may, however, frequently depend up-
on some organic affection of the stomach itself, as tumor,
ulcer, or schirrosity, or upon some affection of other parts of
the body communicated to the stomach, as in gout, ameno-
rhœa, and some others. In both these cases, however, the
dyspeptic symptoms are to be considered as secondary or
sympathic affections, to be cured only by curing the primary
disease. Such secondary and sympathic cases cannot, in-
deed, be treated of here; but, as we presume that the imbe-
cillity of the stomach may often take place without either
any organic affection of this part, or any more primary af-
fection in any other part of the body, so we suppose, and ex-
pect it will appear, from the consideration of the remote
causes, that the dyspepsia may be often an idiopathic affec-
tion, and that it is, therefore, properly taken into the system
of methodical Nosology, and becomes the subject of our con-
sideration here.
MCXXXIX.

46 PRACTICE
MCXXXIX.
There can be little doubt, that, in most cases, the weaker
action of the muscular fibres of the stomach, is the most fre-
quent, and chief cause of the symptoms mentioned in
(MCXXXIV.); but I dare not maintain it to be the only
cause of idiopathic dyspepsia. There is, pretty certainly, a
peculiar fluid in the stomach of animals, or, at least, a pecu-
liar quality in the fluids, that we know to be there, upon
which the solution of the aliments taken into the stomach
chiefly depends; and it is, at the same time, probable, that
the peculiar quality of the dissolving, or digesting fluids, may
be variously changed, or that their quantity may be, upon
occasion, diminished. But it is no less obvious, that a change
in the quality or quantity of these fluids may produce a con-
siderable difference in the phenomena of digestion, and, par-
ticularly, may give occasion to many of the morbid appear-
ances mentioned in (MCXXXIV.).
MCXL.
This seems to be very well founded, and points out an-
other proximate cause of dyspepsia beside that we have al-
ready assigned; but, notwithstanding this, as the peculiar na-
ture of the digestive fluid, the changes which it may under-
go, or the causes by which it may be changed, are all matters
so little known, that I can found no practical doctrine upon
any supposition with respect to them; and as, at the same
time, the imbecillity of the stomach, either as causing the
change in the digestive fluid, or as being caused by that
change, seems always to be present, and to have a great share
in occasioning the symptoms of indigestion, so I shall still
consider the imbecillity of the stomach as the proximate,
and almost sole cause of dyspepsia. And I more readily ad-
mit of this manner of proceding, as, in my opinion, the
doctrine applies very fully and clearly to the explaining the
whole 

47 OF PHYSIC.
whole of the practice which experience has established, as the
most successful in this disease. 
MCXLI.
Considering this, then, as the proximate cause of dyspep-
sia, I proceed to mention the several remote causes of this
disease, as they are such, as, on different occasions, seem to
produce a loss of tone in the muscular fibres of the stomach.
They may, I think, be considered under two heads. The
first is, of these, which act directly and immediately upon
the stomach itself. The second is, of these, which act upon
the whole body, or particular parts of it, but, in consequence
of which, the stomach is chiefly, or almost only affected.
MCXLII.
Of the first kind are, 1. Certain sedative, or narcotic sub-
stances, taken into the stomach, such as tea, coffee, tobacco,
ardent spirits, opium, bitters, aromatics, putrids, and aces-
cents.
2. The large and frequent drinking of warm water, or of
warm watery liquids.
3. Frequent surfeit, or immoderate repletion of the sto-
mach.
4. Frequent vomiting, whether spontaneously arising, or
excited by art.
5. Very frequent spitting, or rejection of saliva.
MCXLIII.
Those causes which act upon the whole body, or upon
particular parts and functions of it, are,
1. An indolent and sedentary life.
2. Vexation of mind, and disorderly passions of any kind.
3. Intense study, or close application to business too long
continued.
4. Excess 

48 PRACTICE
4. Excess in venery.
5. Frequent intoxication, which partly belongs to this
head, partly to the former.
6. The being much exposed to moist and cold air when
without exercise.
Though the disease, as proceding from the last set of
causes, may be considered as a symptomatic affection only,
yet, as the affection of the stomach is generally the first, al-
ways the chief, and often the only effect which these causes
produce or discover, I think the affection of the stomach may
be considered as the disease to be attended to in practice;
and the more properly so, as, in many cases, the general de-
bility is only to be cured by restoring the tone of the stomach,
and by remedies first applied to this organ.
MCXLIV.
For the cure of this disease we form three several indica-
tions, a preservative, a palliative, and a curative.
The first is, to avoid or remove the remote causes just
now enumerated.
The second is, to remove those symptoms which especially
contribute to aggravate and continue the disease; and
The third is, to restore the tone of the stomach, that is, to
correct or remove the proximate cause of the disease.
MCXLV.
The propriety and necessity of the first indication is suffi-
ciently evident, as the continued application, or frequent re-
petition of those causes, must continue the disease; may de-
feat the use of remedies; or, in spite of these, may occasion
the recurrence of the disease. It is commonly the neglect of
this indication which renders this disease so frequently ob-
stinate. How the indication is to be executed, will be suffi-
ciently obvious from the consideration of the several causes; 
but

49 OF PHYSIC.
but it is proper for the practitioner to attend to this, that the
execution is often exceedingly difficult, because it is not easy
to engage men to break in upon established habits, or to re-
nounce the pursuit of pleasure; and, particularly, to per-
suade men that these practices are truly hurtful which they
have often practised with seeming impunity.
MCXLVI.
The symptoms of this disease which especially contribute
to aggravate and continue it, and therefore, require to be
more immediately corrected, or removed, are, first, the cru-
dities of the stomach, already produced by the disease, and
discovered by a loss of appetite, by a sense of weight and un-
easiness in the stomach, and, particularly, by the eructation
of imperfectly digested matters.
Another symptom to be immediately corrected, is an unusual
quantity, or a higher degree than usual, of acidity present in
the stomach, discovered by various disorders in digestion,
and by other effects to be mentioned afterwards.
The third symptom aggravating the disease, and otherwise
in itself urgent is costiveness, and therefore, constantly re-
quiring to be relieved.
MCXLVII.
The first of these symptoms is to be relieved by exciting
vomiting; and the use of this remedy, therefore, usually and
properly begins the cure of this disease. The vomiting may
be excited by various means, more gentle or more violent.
The former may answer the purpose of evacuating the con-
tents of the stomach; but emetics, and vomiting, may also
excite the ordinary action of the stomach; and both, by va-
riously agitating the system, and, particularly, by determining
to the surface of the body, may contribute to remove the
causes of the disease. But these latter effects can only be
Part II. G obtained 

50 PRACTICE
obtained by the use of emeticss of the more powerful kind,
such as the antimonial emetics specially are.
MCXLVIII.
The second symptom to be palliated, is an excess of acidity,
either in quantity or quality, in the contents of the stomach.
In man there is a quantity of acescent aliment almost con-
stantly taken in, and, as I think, always undergoes an ace-
tous fermentation there; and it is, therefore, that, in the
human stomach, and in the stomachs of all animals using ve-
getable food, there is always found an acid present. This
acid, however, is generally innocent, and occasions no disor-
der, unless either the quantity of it is very large, or the aci-
dity procedes to a higher degree than usual. But, in either
of these cases, the acidity occasions various disorders, as fla-
tulency, eructation, heart-burn, gnawing pains of the sto-
mach, irregular appetites and cravings, looseness, griping,
emaciation, and debility. To obviate or remove these ef-
fects aggravating and continuing the disease, it is not only
necessary to correct the acidity present in the stomach, but
specially as this acid proves a ferment, determining and in-
creasing the acescency of the aliments afterwards taken in,
it is proper also, as soon as possible, to correct the disposi-
tion to excessive acidity.
MCXLIX.
The acidity present in the stomach may be corrected by
the use of alcaline salts, or absorbent earths, or by such
substances containing these, which can be decomposed by
the acid of the stomach. Of the alcalines, the caustic is
more effectual than the mild; and this accounts for the ef-
fects of lime-water. By employing absorbents, we avoid
the excess of alcali, which might sometimes take place. The
absorbents are different, as they form a neutral more or less
laxative; 

51 OF PHYSIC.
laxative; and hence the difference between magnesia alba
and other absorbents. It is to be observed, that alcalines
and absorbents may be employed to excess, as, when em-
ployed in large quantity, they may deprive the animal fluids
of the acid necessary to their proper composition.
MCL.
The disposition to acidity may be obviated by avoiding
acescent aliments, and using animal food little capable of
acescency. This, however, cannot be long continued with-
out corrupting the state of the fluids; and, as vegetable food
cannot be entirely avoided, the excess of acidity may, in
some measure, be avoided, by choosing vegetable food the
least disposed to a vinous fermentation, such as leavened
bread, and well fermented liquors, and, instead of fresh native
acids, employing vinegar.
MCLI.
The acid arising from acescent matters, in a sound state
of the stomach, does not procede to any high degree, or is
again soon involved, and made to disappear; but this does
not always happen; and a more copious acidity, or a higher
degree of it, may be produced, either from a change in the
digestive fluids, become less fit to moderate fermentation,
and to cover acidity, or from their not being supplied in due
quantity. How the former may be occasioned we do not
well understand; but we can readily perceive that the latter,
perhaps the former also, may procede from a weaker action
of the muscular fibres of the stomach. In certain cases, se-
dative passions, suddenly arising, occasion the appearance of
acidity in the stomach which did not appear before; and the
use of stimulants often correct or obviate an acidity that would
otherwise have appeared. From these considerations, we
conclude, that the production and subsistence of acidity in
the stomach, is to be especially prevented by restoring and
exciting 

52 PRACTICE
exciting the proper action of the stomach, by the several
means to be mentioned hereafter.
MCLII.
But it is also to be further observed, that, though these
are certain powers in the stomach for preventing a too copi-
ous acidity, or a high degree of it, they are not, however,
sufficient for destroying acescency, and covering the acidity
altogether; and, therefore, as long as vegetable substances
remain in the stomach, their acescency may go on and in-
crease. From hence we perceive, that a special cause of the
excess of acidity may be the too long retention of acescent
matters in the stomach; whether this may be from these mat-
ters being of more difficult solution; or from the weakness
of the stomach more slowly discharging its contents into the
duodenum, or from some impediment to the free evacuation
of the stomach by the pylorus. The latter of these causes
we are well acquainted with, in the case of a schirrous pylo-
rus, producing commonly the highest degree of acidity. In
all the instances of this schirrosity I have met with, I have
found it incurable; but the first of these causes is to be ob-
viated by avoiding such aliments as are of difficult solution;
and the second is to be mended by the several remedies for
exciting the action of the stomach, to be mentioned after-
wards.
MCLIII.
The third symptom commonly accompanying dyspepsia,
which requires to be immediately removed, is costiveness.
As there is so much connection between the several portions
of the alimentary canal, with respect to the peristaltic mo-
tion, that, if accelerated or retarded in any one part, the other
parts of it are commonly affected in the same manner. Thus,
as the brisker action of the stomach must accelerate the action 
of the intestines, so the slower action of the intestines must,
in 

53 OF PHYSIC
in some measure, retard that of the stomach. It is, there-
fore, of consequence to the proper action of the stomach,
that the peristaltic motion of the intestines, determining their
contents downwards, be regularly continued, and that all
costiveness or interruption of that determination be avoided.
This may be done by the various means of exciting the ac-
tion of the intestines; but it is to be observed here, that, as
every considerable evacuation of the intestines weakens their
action, and is ready, therefore, to induce costiveness when
the evacuation is over; so these purgatives which produce
a large evacuation, are unfit for correcting the habit of co-
stiveness. This, therefore, should be attempted by medi-
cines, which do no more than solicit the intestines to a more
ready discharge of their present contents, without either hur-
rying their action, or increasing the excretions made into
their cavity, either of which effects might produce a purg-
ing. There are, I think, certain medicines peculiarly proper
on this occasion, as they seem to stimulate, especially the
great guts, and to act little on the higher parts of the intesti-
nal canal.
MCLIV.
We have thus mentioned the several means of executing
our second indication; and I proceed to the third, which is,
as we have said, the proper curative, and it is, to restore the
tone of the stomach, the loss of which we consider as the
proximate cause of the disease, or at least as the chief past
of it. The means of satisfying this indication we refer to
two heads. One is, of those means which operate directly
and chiefly on the stomach itself; and the other is, of those
means which operating upon the whole system, have their
tonic effects thereby communicated to the stomach.
MCLV.
The medicines which operate directly on the stomach,
are either stimulants or tonics.
The 

54 PRACTICE
The stimulants are saline or aromatic.
The saline are acids or neutrals.
Acids of all kinds seem to have the power of stimulating
the stomach, and, therefore, often increase appetite; but the
native acids, as liable to fermentation, may otherwise do
harm, and are therefore of ambiguous use. The acids, there-
fore, chiefly and successfully employed, are the vitriolic, mu-
riatic, and the distilled acid of vegetables, as it is found in
tar-water, which are all of them antizymics.
The neutral salts answering this intention, are especially
those which have the muriatic acid in their composition,
though it is presumed that neutrals of all kinds have more or
less of the same virtue.
MCLVI.
The aromatics, and perhaps some other acrids, certainly
stimulate the stomach, as they obviate the acescency and fla-
tulency of vegetable food; but their stimulus is transitory,
and, if frequently repeted, and taken in large quantities,
they may hurt the tone of the stomach.
MCLVII.
The tonics employed to strengthen the stomach are bitters,
bitters and astringents combined, or chalybeates.
Bitters are undoubtedly tonic medicines, both with re-
spect to the stomach and the whole system; but their long
continued use has been found to destroy the tone of the sto-
mach, and of the whole system; and, whether this is from
the mere repetition of their tonic operation, or from some
narcotic power, joined with the tonic in them, I am uncertain.
MCLVIII.
Bitters and astringents combined, are, probably, more
effectual tonics than either of them taken singly; and we
suppose 

55 OF PHYSIC.
suppose such a combination to take place in the Peruvian
bark, which therefore, proves a powerful tonic, both with
respect to the stomach and to the whole system. But I have
some ground to suspect, that the long continued use of this
bark may, like bitters, destroy both the tone of the stomach
and of the whole system.
MCLIX.
Chalybeates may be employed as tonics in various forms,
and in considerable quantities, with safety. They have
been often employed in the form of mineral waters, and
seemingly with success; but whether this is owing to the
chalybeate in the composition of these waters, or to some
other circumstances attending their use, I dare not positively
determine; but the latter opinion seems to me the more
probable.
MCLX.
The remedies which strengthen the stomach, by being ap-
plied to the whole body, are exercise, and the application of
cold.
As exercise strengthens the whole body, it must also
strengthen the stomach; but it does this also in a particular
manner, by promoting perspiration, and exciting the action
of the vessels on the surface of the body, which have a parti-
cular consent with the muscular fibres of the stomach. This
particularly explains why the exercises of gestation, though
not the most powerful in strengthening the whole system, are
however very powerful in strengthening the stomach, of
which we have a remarkable proof in the effects of fail-
ing. In strengthening the general system, as fatigue must
be avoided, so bodily exercise is of ambiguous use; and per-
haps it is, thereby, that riding on horseback has been so
often found to be one of the most powerful means of strength-
ening the stomach, and thereby of curing dyspepsia.
MCLXI. 

56 PRACTICE
MCLXI.
The other general remedy of dyspepsia, is the application
of cold, which may be in two ways; that is, either by the
application of cold air, or of cold water. It is probable,
that, in the atmosphere constantly surrounding our bodies, a
certain degree of cold, considerably less than the temperature
of our bodies themselves, is necessary to the health of the
human body. Such a degree of cold seems to strengthen the
vessels on the surface of the body, and therefore the muscu-
lar fibres of the stomach. But further, it is well known, that,
if the body is in exercise sufficient to support such a determi-
nation to the surface, as to prevent the cold from producing
any entire constriction of the pores; a certain degree of cold
in the atmosphere, with such exercise, will render the perspi-
ration more considerable. From the sharp appetite that in
such circumstances is commonly produced, we can have no
doubt, that, by the application of such cold, the tone of the
stomach is considerably strengthened. Cold air, therefore,
applied with exercise, is a most powerful tonic, with respect
to the stomach; and this explains why, for that purpose, no
exercises within doors or in close carriages, are so useful as
those in the open air.
MCLXII.
From the same reasoning, we can perceive that the appli-
cation of cold water, or cold bathing, while it is a tonic,
with respect to the system in general, and especially, as excit-
ing the action of the extreme vessels, must in both respects be
a powerful means of strengthening the tone of the stomach.
MCLXIII.
These are the remedies to be employed towards a radical
cure of idiopathic dyspepsia; and it might be perhaps ex-
pected here, that I should treat also of the various cases of
the 

57 OF PHYSIC. 
the sympathic disease. But it will be obvious, that this can-
not be properly done, without treating of all the diseases of
which the dyspepsia is a symptom, which cannot be proper
in this place. It has been partly done already, and will be
further treated of in the course of this work. In the mean
time, it may be proper to observe, that there is not so much
occasion for distinguishing between the idiopathic and sym-
pathic dyspepsia, as there is in many other cases of idiopathic
and sympathic diseases. For, as the sympathic cases of dys-
pepsia are owing to a loss of tone in some other part of the
system, which is from thence communicated to the stomach;
so the tone of the stomach restored, may be communicated to
the part primarily affected; and, therefore, the remedies of
the idiopathic may be often usefully employed, and are often
the remedies chiefly employed in sympathic dyspepsia.
MCLXIV.
Another part of our business here might be to say, how
some other of the urgent symptoms, beside those above men-
tioned, are to be palliated. On this subject, I think it is
enough to say, that the symptoms chiefly requiring to be im-
mediately relieved, are flatulency, heart-burn, other kinds
of pain in the region of the stomach, and vomiting.
The dyspeptic are ready to suppose that the whole of their
disease consists in a flatulency. In this it will be obvious
that they are mistaken; but, although the flatulency is not
to be entirely cured, but by mending the imbecillity of the
stomach by the means above mentioned; yet the flatulent
distension of the stomach may be relieved by carminatives,
as they are called, or medicines that produce a discharge of
wind from the stomach, such are the various antispasmodics,
of which the most effectual is the vitriolic æther.
The heart-burn may be relieved by absorbents, antispas-
modics, or demulcents.
Part II. H The 

58 PRACTICE
The other pains of the stomach may be sometimes relieved
by carminatives, but most certainly by opiates.
Vomiting is to be cured most effectually by opiates thrown
by injection into the anus.
CHAP. III.
Of HYPOCHONDRIASIS;
OR THE
HYPOCHONDRIAC AFFECTION,
Commonly called VAPOURS or LOW SPIRITS.
MCLXV.
In certain persons there is a state of mind distinguished by
a concurrence of the following circumstances: A languor,
listlessness, or want of resolution and activity, with respect to
all undertakings; a disposition to seriousness, sadness, and
timidity; as to all future events, an apprehension of the
worst, or most unhappy state of them, and therefore, often
upon 

59 OF PHYSIC.
upon slight grounds, an apprehension of great evil. Such
persons are particularly attentive to the state of their own
health, to every the smallest change of feeling in their bo-
dies; and, from any unusual feeling, perhaps of the slightest
kind, they apprehend great danger, and even death itself.
In respect to all these feelings and fears, there is commonly
the most obstinate belief and persuasion.
MCLXVI.
This state of mind is the hypochondriasism of medical
writers; see Linnæi genera Morborum, Gen. 76. Sagari
Systema Symptomaticum, Class XIII. Gen. V. The same
state of mind is, what has been commonly called vapours and
low spirits. Though the term vapours may be founded on
a false theory, and therefore improper, I beg leave for a
purpose, that will immediately appear, to employ it for a
little here.
MCLXVII.
Vapours, then, or the state of mind described above, is
like every other state of mind, connected with a certain state
of the body, which must be inquired into, in order to its be-
ing treated as a disease by the art of physic,
MCLXVIII.
This state of the body, however, is not very easily ascer-
tained; for we can perceive, that, on different occasions, it
is very different; vapours being combined sometimes with
dyspepsia, sometimes with hysteria, and sometimes with me-
lancholia, which are diseases seemingly depending on very
different states of the body.
MCLXIX.
The combination of vapours with dyspepsia, is very fre-
quent, 

60 PRACTICE
quent, and in seemingly very different circumstances. It is,
especially, these different circumstances that I would wish to
ascertain; and I remark, that the combination mentioned is
manifestly in two different states. First, as it occurs in young
persons of both sexes, of a sanguine temperament, and of a
lax and flaccid habit. Secondly, as it occurs in elderly per-
sons of both sexes, of a melancholic temperament, and of a
firm and rigid habit.
MCLXX.
These two different cases of the combination of vapours
and dyspepsia, I consider as two distinct diseases, to be di-
stinguished chiefly by the temperament prevailing in the per-
sons affected.
As the dyspepsia of sanguine temperaments is often with-
out vapours, and as the vapours, when joined with dyspepsia
in such temperaments, may be considered as, perhaps, al-
ways a symptom of the affection of the stomach; so to this
combination of dyspepsia and vapours, I would still apply
the appellation of Dyspepsia, and consider it as purely the
disease treated of in the preceding chapter.
But the combination of dyspepsia and vapours, in melan-
cholic temperaments, as the vapours, or the turn of mind pe-
culiar to the temperament nearly that described above in
(MCLXV.), are essential circumstances of the disease. As
this is often with few, or only slight symptoms of dyspepsia,
and, even, though the latter be attending, as they seem to
be rather the effects of the general temperament, than of any
primary or topical affection of the stomach; I consider this
combination as a very different disease from the former and
would apply to it strictly the appellation of Hypochon-
driasis.
MCLXXI.
Having thus pointed out a distinction between Dyspepsia
and 

61 OF PHYSIC.
and Hypochondriasis, I shall now, using these terms in the
strict sense above mentioned, make some observations which
may, I think, illustrate the subject, and more clearly and fully
establish the distinction proposed.
MCLXXII.
The Dyspepsia often appears early in life, and is frequently,
also, much mended as life advances; but the Hypochondriasis
seldom appears early in life, and more usually in more ad-
vanced years only; and more certainly still, when it has
once taken place, it goes on increasing, as life advances to
old age.
This seems to be particularly well illustrated, by our ob-
serving the changes in the state of the mind which usually
take place in the course of life. In youth, the mind is cheer-
ful, active, rash, and moveable; but, as life advances, the
mind, by degrees, becomes more serious, slow, cautious, and
steady, till, at length, in old age, the gloomy, timid, distrust-
ful, and obstinate state of melancholic temperaments, is more
exquisitely formed. In producing these changes, it is true,
that moral causes have a share; but it is, at the same time,
obvious, that the temperament of the body determines the
operation of these moral causes, sooner or later, and in a
greater or lesser degree, to have their effects. The sanguine
temperament retains longer the character of youth, while the
melancholic temperament brings on more early the manners
of old age.
MCLXXIII.
Upon the whole, it appears, that the state of mind which
attends, and especially distinguishes hypochondriasis, is the
effect of that same rigidity of the solids, torpor of the ner-
vous power, and peculiar balance between the arterial and
venous systems which occurs in advanced life, and which, at
all 

62 PRACTICE
all times, takes place, more, or less in melancholic tempera-
ments. If, therefore, there be also somewhat of a like state
of mind attending that dyspepsia, which occurs early in life,
in sanguine temperaments, and lax habits, it must depend
upon a different state of the body, and, probably, upon a
weak and moveable state of the nervous power.
MCLXXIV.
Agreeable to all this, in dyspepsia, there is more of spas-
modic affection, and the affection of the mind (MCLXV.)
is often absent, and, when present, is, perhaps, always of
a slighter kind; while, in hypochondriasis, the affection of the
mind is more constant, and the symptoms of dyspepsia, or the
affections of the stomach, are often absent, or, when present,
are in a slighter degree.
I believe the affection of the mind is commonly different
in the two diseases. In dyspepsia it is often languor and ti-
midity only, easily dispelled, while, in hypochondriasis, it is
generally the gloomy and riveted apprehension of evil.
The two diseases are also distinguished by some other cir-
cumstances. Dyspepsia, as we have said, is often asympto-
matic affection, while hypochondriasis is, perhaps, always a
primary and idiopathic disease.
As debility may be induced by many different causes, dys-
pepsia is a frequent disease, while hypochondriasis, depending
upon a peculiar temperament, is more rare.
MCLXXV.
Having thus endeavoured to distinguish the two diseases,
I suppose the peculiar nature and proximate cause of hypo-
chondriasis will be understood; and I proceed therefore to
treat of its cure.
So far as the affections of the body, and particularly of
the stomach, are the same here as in the case of dyspepsia, the
method 

63 OF PHYSIC.
method of cure might be supposed to be also the same; and
accordingly the practice has been carried on with little di-
stinction, but I am persuaded that a distinction is often ne-
cessary.
MCLXXVI.
There may be a foundation here for the same preservative
indication as first laid down in the cure of dyspepsia
(MCXLIV.); but I cannot treat this subject so clearly or
fully as I could wish; because I have not yet had so much
opportunity of observation as I think necessary to ascertain
tne remote causes; and I can hardly make use of the obser-
vations of others, who have seldom or never distinguished
between the two diseases. What, indeed, has been said with
respect to the remote causes of melancholia, will often apply
to the hypochondriasis, which I treat of; but the subject of
the former has been so much involved in a doubtful theory,
that I find it difficult to select the facts that might properly
and strictly apply to the latter. I delay this subject, there-
fore, till another occasion; but, in the mean time, trust, that
what I have said regarding the nature of the disease, and
some remarks I shall have occasion to offer in considering the
method of cure, may, in some measure, supply my deficiency
on this subject of the remote causes.
MCLXXVII.
The second indication laid down in the cure of dyspepsia
(MCXLIV.), has properly a place here; but it is still to
be applied with some distinction.
MCLXXVIII.
An anorexia and accumulation of crudities in the stomach,
does not so commonly occur in hypochondriasis, as in dyspepsia;
and, therefore, vomiting (MCXLVII.) is not so often ne-
cessary in the former as in the latter.
MCLXXIX. 

64 PRACTICE
MCLXXIX.
The symptom of excess of acidity, from the slow evacua-
tion of the stomach in melancholic temperaments, often arises
to a very high degree in hypochondriasis, and, therefore, for
the same reason as in (MCXLVIII.), it is to be obviated
and corrected with the utmost care. It is, upon this account,
that the several antacids, and the other means of obviating
acidity, are to be employed in hypochondriasis, and with the
same attentions and considerations as in (MCXLIX. and fol-
lowing), with this reflection, however, that the exciting the
action of the stomach there mentioned, is to be a little dif-
ferently understood, as shall be hereafter explained.
MCLXXX.
As costiveness, and that commonly to a considerable de-
gree, is a very constant attendant of hypochondriasis, so it is
equally hurtful as in dyspepsia. It may be remedied by the
same means in the former as in the latter, and they are to be
employed with the same restrictions as in (MCLIII.).
MCLXXXI.
It is especially with respect to the third indication laid
down in the cure of dyspepsia (MCXLIV. 3.), that there is
a difference of practice to be observed in the cure of hypo-
chondriasis, and that often a directly opposite to that in the
case of dyspepsia, is to be followed.
MCLXXXII.
In dyspepsia, the chief remedies are the tonic medicines,
which to me seem neither necessary nor safe in hypochondriasis;
for in this there is not a loss of tone, but a want of activity,
that is to be remedied.
Chalybeate mineral waters have commonly been employed
in hypochondriasis, and seemingly with success. But this is
probably 

65 OF PHYSIC. 
probably to be imputed to the amusement and exercise usu-
ally accompanying the use of these waters, rather than to the
tonic power of the small quantity of iron which they contain,
MCLXXXIII.
Cold bathing is often highly useful to the dyspeptic, and,
as a general stimulant, may sometimes seem useful to the
hypochondriac, but it is not commonly so to the latter;
while, on the other hand, warm bathing, hurtful to the dys-
peptic, is often extremely useful to the hypochondriac.
MCLXXXIV.
Another instance of a contrary practice necessary in the
two diseases, and illustrating their respective natures, is, that
the drinking tea and coffee is always hurtful to the dyspeptic,
but is commonly extremely useful to the hypochondriac.
MCLXXXV.
Exercise, as it strengthens the system, and thereby the
stomach, and more especially as, by increasing the perspira-
tion, it excites the action of the stomach, so it proves one of
the most useful remedies in dyspepsia; and, further, as, by the
operation last mentioned, it excites the activity of the sto-
mach, so, likewise, it proves an useful remedy in the hypo-
chondriasis. However, in the latter case, as I shall explain
presently, it is still a more useful remedy by its operation
upon the mind than by that upon the body.
MCLXXXVI.
It is now proper that we procede to consider the most im-
portant article of our practice in this disease, and which is,
to consider the treatment of the mind, an affection of which
sometimes attends dyspepsia, but is always the chief circum-
stance in hypochondriasis. What I am to suggest here will
Part II. I apply 

66 PRACTICE
apply to both diseases; but it is the hypochondriasis that I am
to keep most constantly in view.
MCLXXXVII.
The management of the mind, in hypochondriacs, is often
nice and difficult. The firm persuasion that generally pre-
vails in such patients, does not allow their feelings to be
treated as imaginary, nor their apprehension of danger to be
considered as groundless, though the physician may be per-
suaded that it is the case in both respects. Such patients,
therefore, are not to be treated either by raillery or by rea-
soning.
It is said to be the manner of hypochondriacs to change
often their physician, and, indeed, they often do it consistent-
ly; for a physician who does not admit the reality of the dis-
ease, cannot be supposed to take much pains to cure it, or
to avert the danger of which he entertains no apprehension.
If, in any case, the pious fraud of a placebo be allowable,
it seems to be in treating hypochondriacs, who, anxious for
relief, are fond of medicines, and, though often disappointed,
will still take every new drug that can be proposed to them.
MCLXXXVIII.
As it is the nature of man to indulge every present emo-
tion, so the hypochondriac cherishes his fears, and, attentive
to every feeling, finds in trifles, light as air, a strong con-
firmation of his apprehensions. His cure, therefore, depends
especially upon the interruption of his attention, or upon its
being diverted to other objects than his own feelings.
MCLXXXIX.
Whatever aversion, to application of any kind, may ap-
pear in hypochondriacs, there is nothing more pernicious
to them than absolute idleness, or a vacancy from all earned
pursuit. 

67 OF PHYSIC.
pursuit. It is owing to wealth admitting of indolence, and
leading to the pursuit of transitory and unsatisfying amuse-
ments, or exhausting pleasures only, that the present times
exhibit to us so many instances of hypochondriacism.
The occupations of business suitable to their circumstances
and situation in life, if neither attended with emotion, anxi-
ety, nor fatigue, are always to be admitted, and adhered
to by hypochondriacs. But occupations upon which a man's
fortune depends, and which are always, therefore, objects of
anxiety to melancholic men, and, more particularly, where
such occupations are exposed to accidental interruptions, dis-
appointments, and failures, it is from these that the hypo-
chondriac is certainly to be withdrawn.
MCXC.
The hypochondriac who is not necessarily, by circumstan-
ces or habits, engaged in business, is to be drawn from his
attention to himself by some amusement.
The various kinds of sport and hunting, as pursued with
some ardor, and attended with exercise, if not too violent,
are amongst the most useful.
All those amusements which are in the open air, joined
with moderate exercise, and requiring some dexterity, are
generally of use.
Within doors, company which engages attention, which
is willingly yielded to, and is, at the same time, of a cheer-
ful kind, will be always found of great service.
Play, in which some skill is required, and where the stake
is not an object of much anxiety, if not too long protracted,
may often be admitted.
In dyspeptics, however, gaming, liable to sudden and con-
siderable emotions, is dangerous, and the long continuance
of it, with night-watching, is violently debilitating. But
in melancholies, who commonly excell in skill, and are less
susceptible 

68
PRACTICE
susceptible of violent emotions, it is more admissible, and
is often the only amusement that can engage them.
Music, to a nice ear, is a hazardous amusement, as long
attention to it is very fatiguing.
MCXCI.
It frequently happens, that amusements of every kind are
rejected by hypochondriacs, and, in that case, mechanical
means of interrupting thought are the remedies to be sought
for.
Such is to be found in brisk exercise, which requires some
attention in the conduct of it.
Walking is seldom of this kind; though, as gratifying to
the restlessness of hypochondriacs, it has sometimes been
found useful.
The required interruption of thought is best obtained by
riding on horseback, or in driving a carriage of any kind.
The exercise of sailing, except it be in an open boat, en-
gaging some attention, does very little service.
Exercise in an easy carriage, in the direction of which
the traveller takes no part, unless it be upon rough roads, or
driven pretty quickly, and with long continuance, is of little
advantage.
MCXCII.
Whatever exercise be employed, it will be most effectual
when employed in the pursuit of a journey; first, because it
withdraws a person from many objects of uneasiness and care
which might present themselves at home; secondly, as it en-
gages in more constant exercise, and in a greater degree of
it than is commonly taken in airings about home; and, lastly,
as it is constantly presenting new objects which call forth a
person's attention.
MCXCIII. 

69 OF PHYSIC.
MCXCIII.
In our system of Nosology, we have, next to Hypochondri-
asis, placed the Chlorosis, because I once thought it might be
considered as a Genus, comprehending, besides the Chlorosis
or Amenorrhœa, some species of Cachexy; but, as I cannot
find this to be well founded, and cannot distinctly point out
any such disease, I now omit considering Chlorosis as a Genus
here; and, as a symptom of Amenorrhœa, I have endea-
voured before to explain it under that title.
BOOK 

70 PRACTICE
BOOK III.
Of SPASMODIC AFFECTIONS.
MCXCIV.
UNDER this title, I am to comprehend all the dis-
eases which consist in motu abnormi, that is, in a pre-
ternatural state of the contraction and motion of the mus-
cular or moving fibres in any part of the body.
MCXCV.
It will hence appear, why, under this title, I have com-
prehended many more diseases than Sauvages and Sagar have
comprehended under the title of Spasmi, or than Linnæus
has done under the title of Motorii. But I expect it will be
obvious, that, upon this occasion, it would not be proper to
confine our view to the affections of voluntary motion only;
and if those Nosologists have introduced into the class of
Spasmi, Palpitatio and Hysteria, it will be, with equal pro-
priety, that Asthma, Colica, and many other diseases, are
admitted.
MCXCVI.
It has been hitherto the method of our Nosologists, to
divide the Spasmi into the two orders of Tonici and Clonici,
Spastici and Agitatorii, or, as many at present use the terms,
into Spasms, strictly so called, and Convulsions. I find,
however, that many, and, indeed, most of the diseases to be
considered under our title of Spasmodic Affections, in respect
of 

71 OF PHYSIC.
of Tonic or Clonic contractions, are of a mixed kind; and,
therefore, I cannot follow the usual general division, but
have attempted another, by arranging the several Spasmodic
diseases according as they affect the several functions, Ani-
mal, Vital, or Natural.
SECT. I.
OF THE
SPASMODIC AFFECTIONS
OF THE
ANIMAL FUNCTIONS.
MCXCVII.
Agreeable to the language of the antients, the whole of
the diseases to be treated of in this section, might be termed
Spasmi; and many of the moderns continue to apply the
term in the same manner; but I think it convenient to di-
stinguish the terms of Spasm and Convulsion, by applying the
former, strictly, to what has been called the Tonic, and the
latter, to what has been called the Clonic Spasm. There is
certainly a foundation for the use of those different terms, as
there is a remarkable difference in the state of the con-
traction of moving fibres upon different occasions. This I
have, 

72 PRACTICE
have, indeed, pointed out before, in my treatise of Physio-
logy, but must also repete it here.
MCXCVIII.
In a state of health, the contractions of the moving fibres
are excited by the will, or by certain other causes appointed
by Nature for exciting the exercise of the several functions
of the animal œconomy, and by the will, and by these causes
only. The contractions produced are, in force and velocity,
directed by the will, or by those other causes which may be
called natural; and these contractions are always soon suc-
ceded by a state of relaxation, and are not repeted, but
when the causes we have mentioned are again applied.
MCXCIX.
But, in a morbid state, the contractions are involuntary,
and are excited by unusual and unnatural causes; and the
contractions produced may be in two different states. The
one is, when the contractions are to a violent degree, and
are neither succeded by a spontaneous relaxation, nor rea-
dily yield to an extension, either from the action of antago-
nist muscles, or from other extending powers applied, This
state of contractions is what has been called a Tonic Spasm,
and what we name simply and strictly a Spasm. The other
morbid state of contractions is, when they are succeded by
a relaxation, but, at the same time, are repeted without
the concurrence of the will, or the repetition of natural causes,
and are, at the same time, repeted more frequently, and
commonly more violently, than in a healthy state. This
state of morbid contraction is what has been named a Clonic
Spasm, and what we name, strictly, a Convulsion.
In this section, we shall follow nearly the usual division
of the Spasmodic diseases, into those consisting in Spasm,
and those consisting in Convulsion; but even here I cannot
follow such division exactly. 
CHAP. 

OF PHYSIC.
CHAP. I.
Of TETANUS.
MCC.
Both Nosologists, and Practical Writers, have distinguished
Tetanic complaints into the several species of Tetanus,
Opisthotonos, and Emprosthotonos; and I have, in my No-
sology, put the Trismus, or Locked Jaw, as a Genus distinct
from the Tetanus. All this, however, I now judge to be im-
proper, and am of opinion, that all the several terms men-
tioned denote, and are applicable only to different degrees
of one and the same disease; the history and cure of which
I shall endeavour to deliver in this Chapter.
MCCI. . .
Tetanic complaints may, from certain causes, occur in
every climate that we are acquainted with; but they occur
most frequently in the warmest climates, and most commonly
in the warmest seasons of such climates. These complaints
affect all ages, sexes, temperaments, and complexions. The
causes from whence they commonly procede, are cold and
moisture applied to the body while it is very warm, and
especially the sudden vicissitudes of heat and cold. Or, the
disease is produced by punctures, lacerations, or other lesions
of nerves, in any part of the body. There are, probably,
some other causes of this disease; but they are neither di-
stinctly known, nor well ascertained. Though the causes
mentioned do, upon occasion, affect all sorts of persons, they
seem, however, to attack persons of middle age more fre-
Part II. K quently 

74 PRACTICE
quently than the older or younger, the male sex more fre-
quently than the female, and the robust and vigorous, more
frequently than the weaker.
MCCII.
If the disease procede from cold, it commonly comes on in a
few days after the application of such cold; but, if it arise
from a puncture, or other lesion of a nerve, the disease does
not commonly come on for many days after the lesion has
happened, very often when there is neither pain nor uneasi-
ness remaining in the wounded or hurt part, and very fre-
quently when the wound has been entirely healed up.
MCCIII.
The disease sometimes comes on suddenly to a violent de-
gree, but more generally, it approaches, by slow degrees, to
its violent state. In this case it comes on with a sense of
stiffness in the back part of the neck, which, gradually in-
creasing, renders the motion of the head difficult and pain-
ful. As the rigidity of the neck comes on and increases,
there is commonly, at the same time, a sense of uneasiness
felt about the root of the tongue, which, by degrees, becomes
a difficulty of swallowing, and, at length, an entire interrup-
tion of it. While the rigidity of the neck goes on increas-
ing, there arises a pain, often violent, at the lower end of
the sternum, and from thence shooting into the back. When
this pain arises, all the muscles of the neck, and particularly
those of the back part of it, are immediately affected with
spasm, pulling the head strongly backwards. At the same
time, the muscles that pull up the lower jaw, which, upon
the first approaches of the disease, were affected with some
spastic rigidity, are now generally affected with more violent
spasm, and set the teeth so closely together, that they do not
admit of the smallest opening.
This 

75 OF PHYSIC.
This is what has been named the Locked Jaw, and is
often the principal part of the disease. When the disease
has advanced thus far, the pain at the bottom of the sternum
returns very frequently, and with it the spasms of the hind
neck, and lower jaw, are renewed with violence, and much
pain. As the disease thus procedes, a greater number of
muscles come to be affected with spasms. After those of the
neck, these along the whole of the spine become affected,
bending the trunk of the body strongly backwards; and this
is what has been named the Opisthotonos.
In the lower extremities, both the flexor and extensor mus-
cles are commonly at the same, time affected, and keep the
limbs rigidly extended. Though the extensors of the head
and back are usually the most strongly affected, yet the flex-
ors, or these muscles of the neck that pull the head forward,
and the muscles that should pull down the lower jaw, are
often at the same time strongly affected with spasm. During
the whole of the disease, the abdominal muscles are violently
affected with spasm, so that the belly is strongly retracted,
and feels hard as a piece of board.
At length the flexors of the head and trunk become so
strongly affected as to balance the extensors, and to keep the
head and trunk straight, and rigidly extended, incapable of
being moved in any way; and it is to this state the term of
Tetanus has been strictly applied. At the same time, the
arms, little affected before, are now rigidly extended, the
whole of the muscles belonging to them being affected with
spasms, except those that move the fingers, which often, to
the last, retain some mobility. The tongue also long retains
its mobility; but, at length, it also becomes affected with
spasms, which, attacking certain of its muscles only, often
thrust it violently out between the teeth.
At the height of the disease, every organ of voluntary
motion seems to be affected, and, amongst the rest, the mus-
cles of the face. The fore-head is drawn up into furrows;
the 

76 PRACTICE
the eyes, sometimes distorted, are commonly rigid, and im-
moveable in their sockets; the nose is drawn up, and the
cheeks are drawn backwards towards the ears, so that the
whole of the countenance expresses the most violent grin-
ning. Under these universal spasms, a violent convulsion
commonly comes on, and puts an end to life.
MCCIV.
These spasms are every where attended with most violent
pains. The utmost violence of spasm is, however, not con-
stant; but, after subsisting for a minute or two, the muscles
admit of some remission of their contraction, although of no
such relaxation as can allow the action of their antagonists.
This remission of contraction gives also some remission of
pain; but neither are of long duration. From time to time,
the violent contractions and pains are renewed, sometimes
every ten or fifteen minutes, and that often without any evi-
dent exciting cause. But such exciting causes frequently
occur; for almost every attempt to motion, as attempting a
change of pollute, endeavouring to swallow, and even to
speak, sometimes gives occasion to a renewal of the spasms
over the whole body.
MCCV.
The attacks of this disease are seldom attended with any
fever. When the spasms are general and violent, the pulse
is contracted, hurried, and irregular, and the respiration is
affected in like manner; but, during the remission, both the
pulse and respiration usually return to their natural state,
The heat of the body is, commonly, not increased; frequent-
ly, the face is pale, with a cold sweat upon it, and, very
often, the extremities are cold, with a cold sweat over the
whole body. When, however, the spasms are frequent and
violent, the pulse is sometimes more full and frequent than
natural, 

77 OF PHYSIC. 
natural, the face is flushed, and a warm sweat is forced out
over the whole body.
MCCVI.
Although fever be not a constant attendant of this disease,
especially when arising from a lesion of nerves; yet, in those
cases proceding from cold, a fever sometimes has supervened,
and is said to have been attended with inflammatory sym-
ptoms. Blood has been often drawn in this disease; but it
never exhibits any inflammatory crust; and all accounts seem
to agree, that the blood drawn seems to be of a looser tex-
ture than ordinary, and that it does not coagulate in the usu-
al manner.
MCCVII.
In this disease, the head is seldom affected with delirium,
or even confusion of thought, till the last stage of it, when,
by the repeted shocks of a violent distemper, every function
of the system is greatly disordered.
MCCVIII.
It is no less extraordinary, that, in this violent disease, the
natural functions are not either immediately or considerably
affected. Vomitings, sometimes, appear early in the disease,
but, commonly, they are not continued; and it is usual e-
nough for the appetite of hunger to remain through the whole
course of the disease; and what food happens to be taken
down, seems to be regularly enough digested. The excre-
tions are sometimes affected, but not always. The urine is
sometimes suppressed, or is voided with difficulty and pain.
The belly is costive; but, as we have hardly any accounts
excepting of those cases in which opiates have been largely
employed, it is uncertain whether the costiveness has been
the effect of the opiates or of the disease. In several instances
of 

78 PRACTICE
of this disease, a miliary eruption has appeared upon the
skin; but whether this be a symptom of the disease, or the
effect of a certain treatment of it, is undetermined. In the
mean while, it has not been observed to denote either safety
or danger, or to have any effect in changing the course of
the distemper.
MCCIX.
This disease has generally proved fatal; and this, indeed,
may be justly supposed to be the consequence of its nature;
but, as we know that, till very lately, physicians were not
well acquainted with a proper method of cure; and that
since a more proper method has been known and practised,
many have recovered from this disease: It may be con-
cluded, therefore, that the fatal tendency of it is not so una-
voidable as has been imagined.
In judging of the tendency of this disease, in particular
cases, we may remark, that, when arising from lesions of
the nerves, it is commonly more violent, and of more diffi-
cult cure than when proceding from cold; that the disease
which comes on suddenly, and advances quickly to a violent
degree, is always more dangerous than that which is slower
in its progress. Accordingly, the disease often proves fatal
before the fourth day; and, when a patient has passed this
period, he may be supposed to be in greater safety, and, is
general, the disease is the safer, the longer it has continued.
It is, however, to he particularly observed, that, even for
many days after the fourth, the disease continues to be dan-
gerous; and, even after some considerable abatement of its
force, it is ready to recur again with its former violence and
danger. It never admits of any sudden, or what may be
called a critical solution, but always recedes, by degrees only;
and it is often very long before the whole of the symptoms
disappear.
MCCX. 

79 OF PHYSIC. 
MCCX.
From the history of the disease now described, it will be
evident, that there is no room for distinguishing the tetanus
opisthotonos, and trismus, or locked jaw, as different species
of disease, since they all arise from the same causes, and are
almost constantly conjoined in the same person. I have no
doubt that the emprosthotonos belongs also to the same species,
and, as the antients have frequently mentioned it, we can
have no doubt of its having occurred; but, at the same time,
it is certainly in these days a rare occurrence; and, as I have
never seen it, nor find any histories in which this particular
state of the spasms is said to have prevailed, I cannot men-
tion the other circumstances which particularly attend it, and
may distinguish it from the other varieties of tetanic com-
plaints.
MCCXI.
This disease has put on still a different form from any of
those above mentioned. The spasms have been sometimes
confined to one side of the body only, and which bend it
strongly to that side. This is what has been named by Sau-
vages the Tetanus Lateralis, and by some late writers, the
Pleurosthotonos. This form of the disease has certainly ap-
peared very seldom; and in any of the accounts given of
it, I cannot find any circumstances that would lead me to con-
sider it as any other than a variety of the species already men-
tioned, or to take further notice of it here.
MCCXII.
The pathology of this disease, I cannot, in any measure,
attempt, as the structure of moving fibres, the state of them
under different degrees of contraction, and particularly the
state of the sensorium, as variously determining the motion of
the nervous power, are all matters very imperfectly, or not
at 


80 PRACTICE
at all known to me. In such a situation, therefore, the en-
deavouring to give any rules of practice, upon a scientific
plan, appears to me vain and fruitless; and, towards direct-
ing the cure of this disease, we must be satisfied with having
learned something useful from analogy, confirmed by expe-
rience.
MCCXIII.
When the disease is known to arise from the lesion of a
nerve in any part of the body, the first, and, as I judge, the
most important step to be taken towards the cure, is, by
every possible means to cut off that part from all commu-
nication with the sensorium, either by cutting through the
nerves in their course, or perhaps by destroying, to a certain
length, their affected part or extremity.
MCCX1V.
When the cure of the disease is to be attempted by medi-
cine, experience has taught us that opium has often proved
an effectual remedy; but that, to render it such, it must be
given in much larger quantities than have been employed in
any other case; and, in these larger quantities, it may, in
this disease, be given more safely than the body has been
known to bear in any other condition. The practice has
been, to give the opium either in a solid or a liquid form, not
in any very large dose at once, but in moderate doses, fre-
quently repeted, at the interval of one, two, three or more
hours, as the violence of the symptoms seem to require. Even
when large quantities have been given in this way, it ap-
pears that the opium does not operate here in the same man-
ner as in most other cases; for, though it procure some remis-
sion of the spasms and pains, it hardly induces any sleep, or
occasions that stupor, intoxication, or delirium, which it often
does in other circumstances, when much smaller quantities
only have been given. It is, therefore, very properly ob-
served, 

81 OF PHYSIC.
served, that, in tetanic affections, as the opium shews none of
those effects by which it may endanger life, there is little or
no reason for being sparing in the exhibition of it, and it
may be given, probably should be given, as largely, and as
fast as the symptoms of the disease may seem to demand.
It is particularly to be observed, that, though the first ex-
hibitions of the opium may have produced some remission of
the symptoms; yet the effects of opium do not long continue
in the system; and this disease being, for some time, ready
to recur, it is commonly very necessary, by the time that the
effects of the opium given may be supposed to be wearing
off; and especially upon the least appearance of a return of
the spasms, to repete the exhibition of the opium in the same
quantities as before. This practice is to be continued while
the disease continues to shew any disposition to return; and
it is only after the disease has already subsisted for some time,
and when considerable and long continued remissions have
taken place, that the doses of the opium may be diminished,
and the intervals of exhibiting them be more considerable.
MCCXV.
The administering of opium in this manner has, in many
cases, been successful, and, probably, would have been equally
so in many others, if the opium had not been too sparingly
employed, either from the timidity of practitioners, or from
its exhibition being prevented, by that interruption of de-
glutition which so often attends this disease. This latter cir-
cumstance directs, that the medicine should be immediately
and largely employed, upon the first approach of the disease,
before the deglutition becomes difficult; or that, if this op-
portunity be lost, the medicine, in sufficient quantity, and
with due frequency, should be thrown into the body by cly-
ster; which, however, does not seem to have been hitherto
often practised. 
Part II. L MCCXVI. 

82 PRACTICE
MCCXVI.
It is highly probable, that, in this disease, the intestines
are affected with the spasm that prevails so much in other
parts of the system, and, therefore, that costiveness occurs here
as a symptom of the disease. It is probably, also, increased
by the opium, which is here so largely employed; and, from
whichever of these causes it arises, it certainly must be held
to aggravate the disease, and that a relaxation of the intesti-
nal canal will contribute to a relaxation of the spasms else-
where. This consideration directs the frequent exhibition
of laxatives while the power of deglutition remains, or the
Frequent exhibition of clysters, when it does not; and the
good effects of both have been frequently observed.
MCCXVII.
It has been with some probability supposed, that the ope-
ration of opium, in this disease, may be much assisted, by
joining with it some other of the most powerful antispasmo-
dics. The most promising are most and camphire; and
some practitioners have been of opinion, that the former has
proved very useful in tetanic complaints. But, whether it
be from its not having been employed of a genuine kind, or
in sufficient quantity, the great advantage and propriety of
its use, are not yet clearly ascertained. It apears to me pro-
bable, that, analogous to what happens with respect to opium,
both musk and camphire, might be employed in this disease,
in much larger quantities, than they commonly have been in
other cases.
MCCXVIII.
Warm bathing has been commonly employed as a remedy
in this disease, and often with advantage; but, so far as I
know, it has not alone proved a cure; and, in some cases,
whether it be from the motion of the body here required, ex-
citing 

83 OF PHYSIC.
citing the spasms, or from the fear of the bath, which some
perfons were seized with, I cannot determine; but it is al-
lowed, that the warm bath hath, in some cases, done harm,
and even occasioned death. Partial fomentations have been
much commended, and, I believe, upon good grounds: And
I have no doubt but that fomentations of the feet and legs,
as we now usually apply them in fevers, might, without much
stirring of the patient, be very assiduously employed with ad-
vantage.
MCCXIX.
Unctuous applications were very frequently employed in
this disease by the antients; and some modern practitioners
have considered them as very useful. Their effects, however,
have not appeared to be considerable; and, as a weak auxi-
liary only, attended with some inconveniency, they have been
very much neglected by the British practitioners.
MCCXX.
Bleeding, has been formerly employed in this disease; but,
of late, it has been found prejudicial, excepting in a few
cases, where, in plethoric habits, a fever has supervened. In
general, the state of mens bodies, in warm climates, is un-
favourable to blood-letting; and, if we may form indica-
tions from the state of the blood drawn out of the veins, the
state of this, in tetanic diseases, would forbid bleeding in
them.
MCCXXI.
Blistering, also, has been formerly employed in this dis-
ease; but several practitioners assert that blisters are con-
stantly hurtful, and they are now generally omitted.
MCCXXII.
These are the practices that hitherto have been generally
employed; 

84 PRACTICE
employed; but, of late, we are informed by several West-
India practitioners, that, in many instances, they have em-
ployed mercury with great advantage. We are told that it
must be employed early in the disease; that it is most conve-
niently administered by unction, and should be applied in
that way in large quantities, so that the body may be soon
filled with it, and a salivation raised, which is to be conti-
nued till the symptoms yield. Whether this method alone
be generally sufficient for the cure of the disease, or if it may
be assisted by the use of opium, and require this, in a certain
measure, to be joined with it, I have not yet certainly learned.
MCCXXIII.
I have been further informed, that the Tetanus, in all
its different degrees, has been cured by giving internally the
Pisselaeum Barbadense, or, as it is vulgarly called, the Barba-
does Tar. I think it proper to take notice of this here,
although I am not exactly informed, what quantities of this
medicine are to be given, or in what circumstances of the dis-
ease it is most properly to be employed.
MCCXXIV.
Before concluding this chapter, it is proper for me to take
some notice of that peculiar case of the Tetanus, or Trismus,
which attacks certain infants soon after their birth, and has
been properly enough named the Trismus Nascentium. From
the subjects it affects, it seems to be a peculiar disease; for
these are infants not above two weeks, and commonly before
they are nine days old; insomuch that, in countries where
the disease is frequent, if children pass the period now men-
tioned, they are considered as secure against its attacks. The
symptom of it chiefly taken notice of, is the Trismus, or
Locked Jaw, which is by the vulgar improperly named the
Falling of the Jaw. But this is not the only symptom, as,
for 

85 OF PHYSIC. 
for the most part, it has all the same symptoms as the Opt-
sthotonos and Tetanus, strictly so called, and which occur in the
other varieties of Tetanic complaints above described. Like
the other varieties of Tetanus, this is most frequent in warm
climates, but is not, like those arising from cold, nearly con-
fined to such warm climates; as instances of it have occurred
in most of the northern countries of Europe. In these
latter, it seems to be more frequent in certain districts than
in others, but in what manner limited, I cannot determine.
It seems to be more frequent in Switzerland than in France.
I am informed of its frequently occurring in the Highlands
of Scotland; but I have never met with any instance of it in
the low country. The particular causes of it are not well
known; and various conjectures have been offered; but none
of them are satisfying. It is a disease that has been almost
constantly fatal, and this, also, commonly in the course of a
few days. The women are so much persuaded of its inevit-
able fatality, that they seldom or ever call for the assistance
of our art. This has occasioned our being little acquainted
with the history of the disease, or with the effects of reme-
dies in it. Analogy, however, would lead us to employ the
same remedies that have proved useful in the other cases of
Tetanus; and the few experiments that are yet recorded seem
to approve of such a practice.
CHAP. 

86 PRACTICE
CHAP. II.
Of EPILEPSY.
MCCXXV.
In what sense I use the term Convulsion, I have explained
above in (MCXCIX.).
The convulsions that affect the human body are, in several
respects, various; but I am to consider here, only, the chief
and most frequent form in which they appear, and which is
in the disease named Epilepsy. This may be defined, as con-
sisting in convulsions of the greater part of the muscles of
voluntary motion, attended with a loss of sense, and ending
in a state of insensibility, and seeming sleep.
MCCXXVI.
The general form, or principal circumstances of this dis-
ease, are much the same in all the different persons whom
it affects. It comes by fits, which attack persons seemingly
in perfect health, and, after lasting for some time, pass off,
and leave the persons again in their usual state. These fits
are sometimes preceded by certain symptoms, which to per-
sons who have before experienced such attacks, give notice
of the approach of a fit, as we shall hereafter explain; but
even these preludes do not commonly occur long before the
formal attack, which in most cases, comes on suddenly, with-
out any such warning.
The person attacked, loses, suddenly, all sense, and power
of motion, so that, if standing, he falls immediately, or, per-
haps, with convulsions, is thrown to the ground. In that
situation, 

87 OF PHYSIC.
situation, he is agitated with violent convulsions, variously
moving his limbs, and the trunk of his body. Sometimes
the limbs on one side of the body are more violently, or more
considerably agitated than those upon the other. In all cases,
the muscles of the face and eyes are much affected, exhibiting
various and violent distortions of the countenance. The
tongue is often affected, and thrust out of the mouth, while
the muscles of the lower jaw, are also affected, and shutting
the mouth with violence while the tongue is thrust out be-
tween the teeth, it is often grievously wounded.
While these convulsions continue, there is commonly, at
the same time, a frothy moisture issuing from the mouth.
These convulsions have at times some remissions, but are sud-
denly again renewed with great violence. Generally, after
no long space, the convulsions cease altogether, and the per-
son, for some time, remains without motion, but in a state of
absolute insensibility, and under the appearance of a pro-
found sleep. After some continuance of this seeming sleep,
he gradually, though sometimes suddenly, recovers his senses,
and power of motion, but without any memory of what had
pased from his being first seized with the fit. During the
convulsions, the pulse and respiration are hurried and irre-
gular; but, when the convulsions cease, they return to their
usual regularity, and healthy state.
This is the general form of the disease; and it varies on-
ly in different persons, or, on different occasions, in the same
person, by the phænomena mentioned being more or less
violent, or by their being of longer or shorter duration.
MCCXXVII.
With respect to the proximate cause of this disease, I might
say, that it is an affection of the energy of the brain, which
ordinarily under the direction of the will, is here, without
any concurrence of it, impelled by preternatural causes. But
I could go no further; For, as to what is the mechanical
condition 

88 PRACTICE
condition of the brain, in the ordinary exertions of the will,
I have no distinct knowledge, and, therefore, must be also
ignorant of the preternatural state of the same energy of the
brain under the irregular motions here produced. To form,
therefore, the indications of cure, from a knowledge of the
proximal cause of this disease, I must not attempt; but,
from a diligent attention to the remote causes which first in-
duced, and occasionally excite the disease, I think we may
often obtain some useful directions for its cure. It shall
therefore be my business now, to point out and enumerate
these remote causes as well as I can.
MCCXXVIII.
The remote causes of epilepsy may be considered as occa-
sional or predisponent. There are, indeed, certain remote
causes which act independently of any predisposition; but, as
we cannot always distinguish these from others, I shall con-
sider the whole under the usual titles of Occasional or Predis-
ponent. 
MCCXXIX.
The occasional causes may, I think, be properly referred
to two general heads; the first being of those which seem to
act by directly stimulating, and exciting the energy of the
brain; and, the second, of those which seem to act by weak-
ening the same. With respect to both, for the brevity of ex-
pressing a fact, without meaning to explain the manner in
which it is brought about, I shall use the terms of Excitement
and Collapse. And, though it be true, that, with respect to
some of the causes I am to mention, it may be a little uncer-
tain whether they act in the one way or the other, that does
not render it improper for us to mark the mode of their ope-
rating, wherever we can do it clearly, as the doing so may
often be of use in directing our practice.
MCCXXX. 

89 OF PHYSIC.
MCCXXX.
First, then, of the occasional causes acting by excitement,
they are either such as act immediately and directly upon the
brain itself, or those which are first applied to the other parts
of the body, and are from thence communicated to the brain.
MCCXXXI.
The causes of excitement immediately and directly applied
to the brain, may be referred to the four heads of, 1. Me-
chanicals Stimulants; 2. Chemical Stimulants; 3. Mental
Stimulants; and, 4. the Peculiar Stimulus of Over-Disten-
sion.
MCCXXXII.
The Mechanical Stimulants may be wounding instruments
penetrating the cranium, and entering the substance of the
brain; or splinters of a fractured cranium, operating in the
same manner; or sharp pointed ossifications, either arising
from the internal surface of the cranium, or formed in the
membranes of the brain.
MCCXXXIII.
The Chemical Stimulants (MCCXXXI.) may be certain
serous fluids from effusion; or purulent, in consequence of
inflammation, lodged in certain parts of the brain, and be-
come acrid by stagnation, or otherwise.
MCCXXXIV.
The Mental Irritations, acting by excitement, are, all vio-
lent emotions of the active kind, such as joy and anger. The
first of these is manifestly an exciting power, acting strongly,
and immediately, on the energy of the brain. The second is
manifestly, also, a power acting in the same manner; but it
must be remarked, that it is not in this manner alone anger
Part II. M produces 

90 PRACTICE
produces its effects; for it acts, also, strongly on the sangui-
ferous system, and may be a means of giving the stimulus of
over-distension, as, under a fit of anger, the blood is impelled
into the vessels of the head with violence, and in a larger
quantity.
MCCXXXV.
Under the head of Mental Irritations, is to be mentioned,
the sight of persons in a fit of epilepsy, which has often pro-
duced a fit of the like kind in the spectator. It may, indeed,
be a question, Whether this effect be imputable to the horror
produced by a sight of the seemingly painful agitations of the
limbs, and of the distortions in the countenance of the epi-
leptic person; or if it may be ascribed to the force of imi-
tation merely? It is possible that horror may sometimes pro-
duce the effect; but, certainly, much may be imputed to that
propensity to imitation, at all times so powerful and preva-
lent in human nature; and so often operating in other cases
of convulsive disorders, which do not present any spectacle
of horror.
MCCXXXVI.
Under the same head of Mental Irritation, I think proper
to mention as an instance of it, the Epilepsia Simulata, or the
Feigned Epilepsy, so often taken notice of. Although this, at
first, may be entirely feigned, I have no doubt but that the
repetition renders it at length real. The history of Quietism
and of Exorcisms leads me to this opinion; and which re-
ceives a confirmation from what we know of the power of
imagination, in renewing epileptic and hysteric fits.
MCCXXXVII.
I come now to the fourth head of the irritations applied
immediately to the brain, and which I apprehend to be that 
of 

91 OF PHYSIC.
of the over-distension of the blood-vessels in that organ.
That such a cause operates in producing epilepsy, is prob-
able from this, that the dissection of persons dead of epilepsy;
has commonly discovered the marks of a previous congestion
in the blood-vessels of the brain. This, perhaps, may be
supposed the effect of the last fatal fit; but that the conge-
stion was previous thereto, is probable from the epilepsy be-
ing so often joined with head-ach, mania, palsy, and apo-
plexy, all of them diseases depending upon a congestion in
the vessels of the brain. The general opinion receives also
confirmation from, this circumstance, that, in the brain of
perfons dead of epilepsy, there have been often found tumours
and effusions which, though seemingly not sufficient to pro-
duce those diseases which depend on the compression of a
considerable portion of the brain, may, however, have been
sufficient to compress so many vessels as to render the others
upon any occasion, of a more than usual turgescence, or im-
pulse of the blood into the vessels of the brain, more liable
to an over-distension.
MCCXXXVIII.
These considerations alone might afford foundation for a
probable conjecture with respect to the effects of over-disten-
sion; but the opinion does not rest upon conjecture alone.
That it is also founded in fact, appears from hence, that a
plethoric state is favourable to epilepsy, and that every occa-
sional turgescence, or unusual impulse of the blood into the
vessels of the brain, such as a fit of anger, the heat of the
sun, or of a warm chamber, violent exercise, a surfeit, or a
fit of intoxication, are frequently the immediately exciting
causes of epileptic fits.
MCCXXXIX.
I venture to remark, further, that a piece of theory may
be 


92 PRACTICE
be admitted as a confirmation of this doctrine. As I have
formerly maintained, that a certain fulness and tension of the
vessels of the brain, is necessary to the support of its ordinary
and constant energy, in the distribution of the nervous power,
so it must be sufficiently probable, that an over-distension of
these blood vessels may be a cause of violent excitement.
MCCXL.
We have now enumerated the several remote, or occasional
causes of epilepsy, acting by excitement, and acting imme-
diately upon the brain itself. Of the causes acting by excite-
ment, but acting upon other parts of the body, and from
thence communicated to the brain, they are all of them im-
pressions producing an exquisite, or high degree, either of
pleasure or pain.
Impressions which produce neither the one nor the other,
have hardly any such effects, unless when such impressions
are in a violent degree, and then their operation may be con-
sidered as a mode of pain. It is, however, to be remarked,
that all strong impressions, which are sudden and surprising,
or, in other words, unforeseen and unexpected, have fre-
quently the effect of bringing on epileptic fits.
MCCXLI.
There are certain impressions made upon different parts of
the body, which, as they often operate without producing
any sensation, so it is uncertain to what head they belong ;
but it is probable that the greater part of them adt by excite-
ment, and therefore fall to be mentioned here. The chief
instances are, the teething of infants, worms, acidity, or other
acrimony, in the alimentary canal, calculi in the kidneys,
acrid matter in abscesses or ulcers, or acrimony diffused in the
mass of blood, as in the case of some contagions.
MCCXLII. 


93 OF PHYSIC.
MCCXLII.
Physicians have found no difficulty in comprehending how
direct stimulants, of a certain force, may excite the action of
the brain, and occasion epilepsy; but they have hitherto
taken little notice of certain causes, which manifestly weaken
the energy of the brain, and act, as we speak, by collapse.
These, however, have the effect of exciting the action of the
brain in such a manner as to occasion epilepsy. We might,
upon this subject, speak of the vis medicatrix naturæ; and
there is a foundation for the term; but, as we do not admit
the Stahlian doctrine of an administering soul, I acknowledge
the term only as expressing a fact, and would not employ it
with the view of conveying any explanation of the manner
in which the powers of collapse mechanically produce their
effects. In the mean time, however, I maintain that there
are certain powers of collapse, which, in effect, prove stimu-
lants, and produce epilepsy.
MCCXLIII.
That there are such powers, which may be termed indirect
stimulants, I conclude from hence, that several of the causes
of epilepsy are such as frequently produce syncope, which we
suppose always to depend upon causes weakening the energy
of the brain (MCXIX.). It may give some difficulty to ex-
plain why the same causes sometimes occasion syncope, and
sometimes occasion the reaction that appears in epilepsy;
and I shall not attempt to explain it; but this, I think, does
not prevent our supposing that the operation of these causes
is by collapse. That there are such causes producing epi-
lepsy, will, I think, appear very clearly from the particular
examples of them I am now to mention.
MCCXLIV.
The first to be mentioned, which I suppose to be of this
kind, 


94 PRACTICE
kind, is hæmorrhagy, whether spontaneous or artificial.
That the same hæmorrhagy which produces syncope, often,
at the same time, produces epilepsy, is well known; and,
from many experiments and observations, it appears, that
hæmorrhagies, occurring to such a degree as to prove mortal,
seldom go this length, without producing epilepsy.
MCCXLV.
Another cause acting, as I suppose, by collapse, and there-
fore sometimes producing syncope, and sometimes epilepsy,
is terror, that is, the fear of some great evil suddenly pre-
sented. As this produces, at the same time, a sudden and
considerable emotion, (MCCXL.), so it more frequently
produces epilepsy than syncope.
MCCXLVI.
A third cause acting by collapse, and producing epilepsy,
is horror, or a strong aversion suddenly raised by a very dis-
agreeable sensation, and frequently arising from a sympathy
with the pain or danger of another person. As horror is often
a cause of syncope, there can be no doubt of its manner of
operating in producing epilepsy; and it may perhaps be ex-
plained upon this general principle, that, as desire excites ac-
tion, and gives activity, so aversion restrains from action, that
is, weakens the energy of the brain; and, therefore, the
higher degrees of aversion may have the effects I have men-
tioned.
MCCXLVII.
A fourth set of the causes of epilepsy, which I suppose also
to act by collapse, are certain odours, which occasion either
syncope or epilepsy; and, with respect to the former, I have
given my reasons (MCXXVI.), for supposing odours, in
that case, to act rather as disagreeable than as sedative. These
reasons 

95 OF PHYSIC.
reasons will, I think, also apply here; and perhaps the whole
affair of odours might be considered as instances of the effect
of horror, and therefore belonging to the last head.
MCCXLVIII.
A fifth head of the causes producing epilepsy, is the ope-
ration of many substances considered, and, for the most part,
properly considered, as poisons. Many of these, before they
prove mortal, occasion epilepsy. This effect, indeed, may,
in some cases, be referred to the inflammatory operation.
which they sometimes discover in the stomach, and other
parts of the alimentary canal; but, as the greater part of
the vegetable poisons show chiefly a narcotic, or strongly se-
dative power, it is probably by this power that they produce
epilepsy, and therefore belong to this head of the causes act-
ing by collapse.
MCCXLIX.
Under the head of the remote causes producing epilepsy,
we must now mention that peculiar one, whole operation is
accompanied with what is called the Aura Epileptica. This
is a sensation of some thing moving in some part of the limbs,
or trunk of the body, and from thence creeping upwards to
the head; and, when it arrives there, the person is immedi-
ately deprived of sense, and falls into an epileptic fit. This
motion is described by the persons feeling it sometimes as a
cold vapour, sometimes as a fluid gliding, and sometimes as
the sense of a small insect creeping along their body; and
very often they can give no distinct idea of their sensation,
otherwise than as, in general, of something moving along.
This sensation might be supposed to arise from some affection
of the extremity, or other part of a nerve acted upon by some
irritating matter, and that the sensation, therefore, followed
the course of such a nerve; but I have never found it follow-
ing 


96 PRACTICE
ing distinctly the course of any nerve; and it generally seems
to pass along the teguments. It has been found, in some in-
stances, to arise from something pressing upon, or irritating a
particular nerve, and that sometimes in consequence of con-
tusion or wound; but instances of these are more rare; and
the more common consequence of contusions and wounds is
a tetanus. This latter effect wounds produce, without giv-
ing any sensation of an aura, or other kind of motion pro-
ceding from the part to the head; while, on the other hand,
the aura producing epilepsy often arises from a part which
had never before been affected with wound or contusion, and
in which part the nature of the irritation can seldom be dis-
covered.
It is natural to imagine that this aura epileptica is an evi-
dence of some irritation, or direct stimulus, acting in the
part, and from thence communicated to the brain, and should,
therefore, have been mentioned among the causes acting by
excitement; but the remarkable difference that occurs in
seemingly like causes producing tetanus, gives some doubt on
this subject.
MCCL.
Having now enumerated the occasional causes, we procede
to consider the predisponent. As so many of the above
mentioned causes act upon certain persons, and not at all
upon others, there must be supposed in those persons a pre-
disposition to this disease: But in what this predisposition
consists is not to be easily ascertained.
MCCLI.
As many of the occasional causes are weak impressions,
and are applied to most persons with little or no effect, we
conclude that the persons affected by those causes are more
easily moved than others, and, therefore, that, in this case,
a 
 

97 OF PHYSIC. 
a certain mobility gives the predisposition. It will, perhaps,
make this matter clearer, to show, in the first place, that
there is a mobility of constitution in some persons more than
in others.
MCCLII.
This mobility appears most clearly in the state of the mind.
If a person is readily elated by hope, and as readily depressed
by fear, and passes easily and quickly from the one state to
the other; if he is easily pleased, and prone to gaiety, and
as easily provoked to anger, and rendered peevish; if liable,
from slight impressions, to strong emotions, but tenacious of
none, this is the boyish temperament, qui colligit ac ponit
iram temere et mutatur in horas; this is the varium et mutabile
fœtmina; and, both in the boy and woman, everyone per-
ceives and acknowledges a mobility of mind. But this is ne-
cessarily connected with an analogous state of the brain, that
is, with a mobility, in respect of every impression, and, there-
fore, liable to a ready alternation of excitement and collapse,
and of both to a considerable degree.
MCCLIII.
There is, therefore, in certain persons, a mobility of con-
stitution, generally derived from the state of original stamina,
and more exquisite at a certain period of life than at others,
but sometimes arising from, and particularly modified by oc-
currences in the course of life.
MCCLIV.
This mobility consists in a greater degree either of sensi-
bility or irritability. These conditions, indeed, physicians
consider as so necessarily connected, that the constitution,
with respect to them, may be considered as one and the same;
but I am of opinion that they are different, and that mobility
Part II. N may 

98 PRACTICE
may sometimes depend upon an increase of the one, and
sometimes on that of the other. If an action excited, is, by
repetition, rendered more easily excited, and more vigorously
performed, I consider this as an increase of irritability only.
I go no farther on this subject here, as it was only necessary
to take notice of the ease just now mentioned, for the purpose
of explaining why epilepsy, and convulsions of all kinds, by
being repeted, are more easily excited, readily become ha-
bitual, and are therefore of more difficult cure.
MCCLV.
However we may apply the distinction of sensibility and
irritability, it appears that the mobility, which is the predis-
ponent cause of epilepsy, depends more particularly upon de-
bility, or upon a plethoric state of the body.
MCCLVI.
What share debility, perhaps, by inducing sensibility, has
in this matter appears clearly from hence, that children, wo-
men and other persons of manifest debility, are the most fre-
quent subjects of this disease.
MCCLVII.
The effects of a plethoric state in disposing to this disease
appears from hence, that plethoric persons are frequently the
subjects of it; that it is commonly excited, as we have said
above, by the causes of any unusual turgescence of the blood;
and that it has been frequently cured by diminishing the ple-
thoric state of the body.
That a plethoric state of the body should dispose to this
disease, we may understand from several considerations. 1st,
Because a plethoric state implies, for the most part, a laxity
of the solids, and, therefore, some debility in the moving
fibres, 2dly, Because, in a plethoric state, the tone of the
moving 


99 OF PHYSIC.
moving fibres depends more upon their tension than upon their
inherent power; and as their tension depends upon the quan-
tity and impetus of the fluids in the blood-vessels, which are
very changeable, and, by many causes, frequently changed,
fo these frequent changes must give a mobility to the system.
3dly, Because a plethoric state is favourable to a congestion
of blood in the vessels of the brain, it must render these more
readily affected by every general turgescence of the blood in
the system, and, therefore, more especially dispose to this
disease.
MCCLVIII.
There is another circumstance of the body disposing to
epilepsy, which we cannot so well account for, and that is
the state of sleep; but whether we can account for it or not,
it appears, in fact, that this state gives the disposition we
speak of; for, in many persons liable to this disease, the fits
happen only in the time of sleep, or immediately upon their
coming out of it. In a case related by De Haen, it appeared
clearly that the disposition to epilepsy depended entirely up-
on the state of the body in sleep.
MCCLIX.
Having thus considered the whole of the remote causes of
epilepsy, I proceed to treat of its cure, as I have said it is
from the consideration of those remote causes only, that we
can obtain any directions for our practice in this disease.
I begin with observing, that, as the disease may be consi-
dered as sympathic or idiopathic, I must treat of these sepa-
rately, and judge it proper to begin with the former.
MCCLX.
When this disease is truly sympathic, and depending upon
a primary affection in some other part of the body, such as
acidity,

199 PRACTICE
acidity, or worms in the alimentary canal, teething, or other
similar causes, it is obvious that such primary affections must
be removed for the cure of the epilepsy; but it is not our
business here to say how these primary diseases are to be
treated.
MCCLXI.
There is, however, a peculiar case of sympathic epilepsy,
that is, the case accompanied with the aura epileptica, as de-
scribed in (MCCXLIX.), in which, though we can perceive
by the aura epileptica arising from a particular part, that there
is some affection in that part, yet, in many such cases, as we
cannot perceive of what nature the affection is, with respect
to them, we can only offer the following general directions.
1st. When the part can with safety be entirely destroyed,
we should endeavour to do so by cutting it out, or by de-
stroying it by the application of an actual or potential cautery,
2dly, When the part cannot be properly destroyed, that
we should endeavour to correct the morbid affection in it by
blistering, or by establishing an issue upon the part.
3dly, When these measures, cannot be executed, or do not
succede, if the disease seems to procede from the extremity of
a particular nerve which we can easily come at in its course,
it will be proper to cut through that nerve, as before pro-
posed on the subject of tetanus.
4thly, When it cannot be perceived that the aura arises
from any precise place, or point, so as to direct to the above
mentioned operations, but, at the same time, we can perceive
its progress along the limb, it frequently happens that the
epilepsy can be prevented by a ligature applied upon the
limb, above the part from which the aura arises; and this
is always proper to be done, both because the preventing a
fit breaks the habit of the disease, and because the frequent
compression renders the nerves less fit to propagate the aura.
MCCLXII.

101 OF PHYSIC.
MCCLII.
The cure of idiopathic epilepsy, as I have said above, is
to be directed by our knowledge of the remote causes: There
are, therefore, two general indications to be formed. The
first is to avoid the occasional causes; and the second is to re-
move or correct the predisponent.
This method, however, is not always purely palliative;
as, in many cases, the predisponent may be considered as
the only proximate cause, so our second indication may be
often considered as properly curative.
MCCLXIII.
From the enumeration given above, it will be manifest,
that, for the most part, the occasional causes, so far as they
are in our power, need only to be known, in order to be a-
voided, and the means of doing this will be sufficiently ob-
vious. I shall therefore here offer only a few remarks.
MCCLXIV.
One of the most frequent of the occasional causes is that
of over-distension (MCCXXXVII) which, so far as it de-
pends upon a plethoric state of the system, I shall say here-
after how it is to be avoided. But as not only in the ple-
thoric, but in every moveable constitution, occasional
turgescence is a frequent means of exciting epilepsy, the
avoiding, therefore, of such turgescence is what ought to
be most constantly the object of attention to persons liable
to epilepsy.
MCCLXV.
Another of the most frequently exciting causes of this dis-
ease are, all strong impressions suddenly made upon the
senses, for as such impressions, in moveable constitutions,
break 

102 PRACTICE
break in upon the usual force, velocity, and order of the
motions of the nervous system, they thereby readily produce
epilepsy. Such impressions, therefore, and especially those
which are suited to excite any emotion or passion of the
mind, are to be most carefully guarded against by persons
liable to epilepsy.
MCCLXVI.
In many cases of epilepsy, where the predisponent cause
cannot be corrected or removed, the recurrences of the dis-
ease can only be prevented by the strictest attention to avoid
the occasional; and, as the disease is often confirmed by re-
petition and habit, so the avoiding the frequent recurrence
of it is of the utmost importance towards its cure.
These are the few remarks we have to offer with respect
to the occasional causes, and must now observe, that, for
the most part, the complete, or, as it is called, the radical
cure, is only to be obtained by removing or correcting the
predisponent cause.
MCCLXVII.
We have said above, that the predisponent cause of epi-
lepsy is a certain mobility of the sensorium, and that this
depends upon a plethoric state of the system, or upon a cer-
tain state of debility in it.
MCCLXVIII
How the plethoric state of the system is to be corrected,
I have treated of fully above in (DCCXLVI. et seq.), and
I need not repeat it here. It will be enough to say, that it
is chiefly to be done by a proper management of exercise
and diet; and, with respect to the latter, it is particularly
to be observed here, that an abstemious course has been fre-
quently found to be the most certain means of curing
epilepsy.
MCCLXIX. 

103 OF PHYSIC. 
MCCLXIX.
Considering the nature of the matter poured out by issues,
these may be supposed to be a constant means of obviating
the plethoric state of the system, and it is, perhaps, there-
fore, that they have been so often found useful in epilepsy.
Possibly, also, as an open issue may be a means of determi-
ning occasional turgescences to such places, and, therefore,
of diverting them in some measure from their action upon
the brain, so also, in this manner, issues may be useful in
epilepsy.
MCCLXX.
It might be supposed that blood-letting would be the
most effectual means of correcting the plethoric state of the
system; and such it certainly proves when the plethoric state
has become considerable, and immediately threatens mor-
bid effects. It is, therefore, in such circumstances, proper
and necessary; but, as we have said above, that blood-letting
is not the proper means of obviating a recurrence of the ple-
thoric state, and, upon the contrary, is often the means of
favouring it, so it is not a remedy adviseable in every cir-
cumstance of epilepsy. There is, however, a case of epi-
lepsy, in which there is a periodical or occasional recurrence
of the fulness and turgescence of the sanguiferous system,
giving occasion to a recurrence of the disease. In such cases,
when the means of preventing plethora have been neglected,
or may have proved ineffectual, it is absolutely necessary for
the practitioner to watch the returns of these turgescences,
and to obviate their effects by the only certain means of doing
it, that is, by a large blood-letting.
MCCLXXI.
The second cause of mobility which we have assigned, is
a state of debility. If this is owing as it frequently is, to
original conformation, it is perhaps not possible to cure it;
but 

104 PRACTICE
but when it has been brought on in the course of life, it pos-
sibly may admit of being mended; and, in either case, much
may be done to obviate and prevent its effects.
MCCLXXII.
The means of correcting debility, so far as it can be
done, are the person's being much in cool air, the frequent
use of cold bathing, the use of exercise adapted to the
strength and habits of the person, and, perhaps, the use of
astringent and tonic medicines.
These remedies are suited to strengthen the inherent
power of the solids, or moving fibres; but, as the strength
of these depends also upon their tension, so, when debility
has proceded from inanition, the strength may be restored,
by restoring the fulness and tension of the vessels by a nou-
rishing diet; and we have had instances of the propriety and
success of such a practice.
MCCLXXIII.
The means of obviating the effects of debility, and of the
mobility depending upon it, are the use of tonic and anti-
spasmodic remedies.
The tonics are fear, or some degree of terror, astringents,
certain vegetable and metallic tonics, and cold bathing.
MCCLXXIV.
That fear, or some degree of terror, may be of ufe in pre-
venting epilepsy, we have a remarkable proof in Boerhaave's
cure of the epilepsy, which happened in the Orphan-house
at Harrlem. See Kauu Boerhaave's treatise, entitled Impe-
tum Faciens, § 406. And we have met with several other
instances of the same.
As the operation of horror is in many respects analogous
to that of terror, several seemingly superstitious remedies
have 

105 OF PHYSIC. 
have been employed for the cure of epilepsy; and, if they
have ever been successful, I think it must be imputed to the
horror they had inspired.
MCCLXXV.
Of the astringent medicines used for the cure of epilepsy,
the most celebrated is the viscus quercinus, which, when
given in large quantities, may possibly be useful; but I be-
lieve it was more especially so in antient times, when it was
an object of superstition. In the few instances in which I
have seen it employed, it did not prove of any effect.
MCCLXXVI.
Among the vegetable tonics, the bitters are to be reckon-
ed; and it is by this quality that I suppose the orange
tree leaves to have been useful; but they are not always so.
MCCLXXVII.
The vegetable tonic, which, from its use in analogous
cases, is the most promising, is the Peruvian bark; this,
upon occasion, has been useful, but has also often failed.
It is especially adapted to those epilepsies which recur at cer-
tain periods, and which are, at the same time, without the
recurrence of any plethoric state, or turgescence of the
blood, and, in such periodical case, if the bark is employed,
some time before the expected recurrence, it may be useful;
but it must be given in large quantity, and as near to the
time of the expected return as possible.
MCCLXXVIII.
The metallic tonics seem to be more powerful than the
yegetable, and a great variety of the former have been em-
ployed.
Part II. Q Even 

106 PRACTICE
Even arsenic has been employed in the cure of epilepsy;
and its use in intermittent fevers gives an analogy in its
favour.
Preparations of tin have been formerly recommended in
the cure of epilepsy, and in the cure of the analogous disease
of hysteria; and several considerations render the virtues of
tin, with respect to these diseases, probable; but I have had
no experience of its use in such cases.
A much safer metallic tonic is to be found in the prepara-
tions of iron; and we have seen some of them employed in
the cure of epilepsy, but have never found them to be ef-
fectual. This, however, I think may be imputed to their
not having been always employed in the circumstances of
the disease, and in the quantities of the medicine, that were
proper and necessary.
MCCLXXIX.
Of the metallic tonics, the most celebrated, and the most
frequently employed, is copper, under various preparation.
What preparation of it may be the most effectual we dare not
determine; but, of late, the cuprum ammoniacum has been fre-
quently found successful.
MCCLXXX.
Lately, the flowers of zinc have been recommended, by a
great authority, as useful in all convulsive disorders; but, in
cases of epilepsy, we have not hitherto found it useful.
MCCLXXXI.
There have been of late some instances of the cure of
epilepsy by the accidental use of mercury; and if the late
accounts of the cure of tetanus by this remedy are confirmed,
it will allow us to think that the same may be adapted also
to the cure of certain cases of epilepsy.
MCCLXXXII. 

107 OF PHYSIC.
MCCLXXXII.
With respect to the employment of any of the above men-
tioned tonics in this disease, it mall be observed, that in all
cases where the disease depends upon a constant, or occa-
sional plethoric state of the system, these remedies are likely
to be ineffectual; and if sufficient evacuations are not made
at the same time, these medicines are likely to be very hurt-
ful.
MCCLXXXIII.
The other set of medicines which we have mentioned as
suited to obviate the effects of the too great mobility of the
system, are the medicines named antispasmodics. Of these
there is a long list in the writers on the Materia Medica, and
by these authors recommended for the cure of epilepsy. The
greater part, however, of these taken from the vegetable
kingdom, are manifestly inert and insignificant. Even the
root of the wild valerian hardly supports its credit.
MCCLXXXIV.
Certain substances taken from the animal kingdom seem
to be much more powerful; and of these the chief, and
seemingly the most powerful, is musk, which employed in
its genuine state, and in due quantity, has often been an
effectual remedy.
It is probable, also, that the oleum animale, as it has been
called, when in its purest state, and exhibited at a proper
time, may be an effectual remedy.
MCCLXXXV.
In many diseases, the most powerful antispasmodic is cer-
tainly opium; but the propriety of its ufe in epilepsy has
been disputed among physicians. When the disease depends
upon a plethoric state, in which bleeding may be necessary,
the 

108 PRACTICE
the employment of opium is likely to be very hurtful; but,
when there is no plethoric or inflammatory state present, and
the disease seems to depend upon irritation, or upon in-
creased irritability, opium is likely to prove the most certain
remedy. Whatever effects in this, and other convulsive dis-
orders, have been attributed to the hyofcyamus, must pro-
bably be attributed to its possessing a narcotic power similar
to that of opium.
MCCLXXXVI.
With refpect to the use of antispasmodics, it is to be ob-
served, that they are always most useful, and, perhaps, only
useful, when employed in the time of epileptic fits, or near
to the times of their accession.
MCCLXXXVII.
On the subject of the cure of epilepsy, we have only to
add, that, as the disease, in many cases, is continued by
the power of habit only, and that, in all cases, habit has a
great share in increasing mobility, and, therefore, continuing
this disease; so the breaking in upon such habit, and chang-
ing the whole habit of the system, is likely to be a powerful
remedy in epilepsy. Accordingly, a considerable change of
climate, diet, and other circumstances in the manner of life,
has often proved a cure to this disease.
MCCLXXXVIII.
After treating of epilepsy, we might here treat of particu-
lar convulsions, which are to be distinguished from epilepsy
by their being more partial, that is, affecting certain parts
of the body only, and are not attended with a loss of sense,
nor end in such a comatose state as epilepsy always does.
MCCLXXXIX.

109 OF PHYSIC.
MCCLXXXIX.
Of such convulsive affections, many different instances
have been observed and recorded by physicians, but many of
these have been manifestly sympathic affections, to be cured
only by curing the primary disease, and, therefore, not to be
treated of here: Or, if they could not always be referred to
another disease, as many of them, however, have not any spe-
cific character with which they occur in different persons, I
must therefore, leave them to be treated upon the general prin-
ciples I have laid down with respect to epilepsy, or shall lay
down with respect to the following convulsive disorder,
which, as having very constantly, in different persons, a pe-
culiar character, I think necessary to treat of more particu-
larly.
CHAP. III.
OF THE CHOREA,
OR
DANCE OF St. VITUS.
MCCXC.
This disease affects both sexes, and almost only young per-
sons. It generally happens from the age of ten, to that of
fourteen years. It comes on always before the age of puber-
ty, and rarely continues beyond that period.
MCCXCI. 

110 PRACTICE
MCCXCI.
It is chiefly marked by convulsive motions, somewhat va-
ried in different persons, but nearly of one kind in all, af-
fecting the leg and arm on the same side, and generally on
one side only.
MCCXCII.
These convulsive motions commonly first affect the leg
and foot. Though the limb be at rest, the foot is often agi-
tated by convulsive motions, turning it alternately outwards
and inwards. When walking is attempted, the affected leg
is seldom listed as usual in walking, but is dragged along,
as if the whole limb were paralytic; and, when it is attempted
to be lifted, this motion is unsteadily performed, the limb
becoming agitated by irregular convulsive motions.
MCCXCIII.
The arm of the same side is generally affected at the same
time; and, even when no voluntary motion is attempted, the
arm is frequently agitated with various convulsive motions.
But especially when voluntary motions are attempted, these
are not properly executed, but are variously hurried or inter-
rupted by convulsive motions, in a direction contrary to that
intended. The most common instance of this is in the per-
son's attempting to carry a cup of liquor to his mouth, when
it is only after repeted efforts, interrupted by frequent con-
vulsive retractions and deviations, that the cup can be carried
to the mouth.
MCCXCIV.
It appears to me that the will often yields to these con-
vulsive motions, as to a propensity, and thereby they are often
increased, while the person affected seems pleased with in-
creasing, 

111 OF PHYSIC.
creasiag the surprise and amusement which his motions occa-
sion in the bystanders.
MCCXCV.
In this disease the mind is often affected with some degree
of fatuity, and often shows the same varied, desultory, and
causeless emotions, which occur in hysteria.
MCCXCVI.
These are the most common circumstances of this disease;
but at times, and in different persons, it is varied by some dif-
ference in the convulsive motions, particularly by these af-
fecting the head and trunk of the body. As, in this disease,
there seem to be propensities to motion, so various fits of
leaping and running occur in the persons affected; and there
have been instances of this disease, consisting of such convul-
sive motions, appearing as an epidemic in a certain corner of
the country. In such instances, persons of different ages are
affected, and may seem to make an exception to the general
rule above laid down; but still the persons affected are, for
the most part, the young of both sexes, and of the more ma-
nifestly moveable constitutions.
MCCXCVII.
The method of curing this disease has been variously pro-
posed. Dr. Sydenham proposed to cure it by alternate bleed-
ing and purging. In some plethoric habits I have found
some bleeding useful; but, in many cases, I have found re-
peted evacuations, especially by bleeding, very hurtful.
In many cases I have found the disease, in spite of reme-
dies of all kinds, continue for many months, but I have also
found it often readily yield to tonic remedies, such as the Pe-
ruvian bark and chalybeates.
The late Dr. De Haen found several persons labouring
under this disease cured by the application of electricity.
SECT. 


112 PRACTICE
SECT. II.
OF THE
SPASMODIC AFFECTIONS
OF THE
VITAL FUNCTIONS.
CHAP. IV. §
Of the PALPITATION of the HEART.
MCCXCVIII.
The motion thus named is a contraction, or systole of the
heart, that is performed with more rapidity, and generally,
also, with more force, than usual, and when, at the same
time, the heart strikes with more than usual violence against
the inside of the ribs, producing often a considerable sound.
MCCXCIX.
This motion, or palpitation, is occasioned by a great va-
riety of causes, which have been recited with great pains by
Mr. Senac, and others, whom, however, I cannot follow in
all
§ Though I have thought it proper to divide this book into,
actions, I think it necessary, for the conveniency of references, to
number the chapters from the beginning. 
all

113 OF PHYSIC.
all the particulars with sufficient discernment, and, there-
fore, shall here only attempt to refer all the several cases of
this disease to a few general heads.
MCCC.
The first is of these arising from the application of the
usual stimulus to the heart's contraction; that is, the influx
of the venous blood into its cavities, being made with more
velocity, and, therefore, in the same time, in greater quan-
tity than usual. It seems to be in this manner that violent
exercise occasions palpitation.
MCCCI.
A second head of the cases of palpitation is of these arising
from any resistance given to the free and entire evacuation of
the ventricles of the heart. Thus a ligature made upon the
aorta occasions palpitations of the most violent kind. Similar
resistances, either in the aorta, or pulmonary artery, may be
readily imagined; and such have been often found in the
dead bodies of persons, who, during life, had been much
affected with palpitations.
To this head are to be referred all those cases of palpita-
tion arising from causes producing an accumulation of blood
in the great vessels near to the heart.
MCCCII.
A third head of the cases of palpitation, is of these arising
from a more violent and rapid influx of the nervous power
into the muscular fibres of the heart. It is in this manner
that I suppose various causes acting in the brain, and, par-
ticularly, certain emotions of the mind, to occasion palpi-
tation.
Part II. P MCCCIII. 

114 PRACTICE
MCCCIII.
A fourth head of the cases of palpitation, is of these
arising from causes producing a weakness in the action of
the heart, by diminishing the energy of the brain with re-
spect to it. That such causes operate in producing palpi-
tation, I presume from hence, that all the several causes
mentioned above (MCXXI.-MCXXVIII.) as in this
manner producing syncope, do often produce palpitation.
It is on this ground that these two diseases are affections
frequently occurring in the same person, as the same causes
may occasion the one or the other, according to the force ef
the cause, and mobility of the person acted upon. It seems
to be a law of the human œconomy, that a degree of debi-
lity occurring in any function, often produces a more vigor-
ous exertion of the same, or, at least, an effort towards it,
and that commonly in a convulsive manner.
MCCCIV.
A fifth bead of the cases of palpitation, may perhaps
be of these arising from a peculiar irritability or mobility of
the heart. This, indeed, may be considered as a predis-
ponent cause only, giving occasion to the action of the
greater part of the causes recited above. But it is proper to
observe, that this predisposition is often the chief part of the
remote cause, insomuch that many of the causes producing
palpitation would not have this effect but in persons pecu-
liarly predisposed. This head, therefore, of the cases of
palpitation, often requires to be distinguished from all the
rest.
MCCCV.
After thus marking the several cases of palpitation, I
think it necessary, with a view to the cure of this disease,
to observe, that the several causes of it may be again re-
duced 

115 OF PHYSIC.
duced to two heads. The first is, of these consisting in, or
depending upon, certain organic affections of the heart it-
self, or of the great vessels immediately connected with it.
The second is of those consisting in, or depending upon cer-
tain affections subsisting, and acting in other parts of the
body, and acting either by the force of the cause, or in con-
sequence of the mobility of the heart.
MCCCVI.
With respect to the cases depending upon the first set of
causes, I must repete here what I said with respect to the
like cases of syncope, that I do not know any means of
curing them. They, indeed, admit of some palliation, first,
by avoiding every circumstance that may hurry the circula-
tion of the blood, and, secondly, by every means of avoiding
a plethoric state of the system, or any occasional turgescence
of the blood. In many of these cases, blood-letting may
give a temporary relief, but, in so far as debility and mobi-
lity are concerned, in such cases this remedy is likely to do
harm.
MCCCVII.
With respect to the cases depending upon the other set of
causes, they may be various, and require very different mea-
sures; but we can say here, in general, that these cases may
be considered as of two kinds, one depending upon primary
affections in other parts of the body, and acting by the force
of the cause, and another depending upon a state of mobility
in the heart itself. In the first of these, it is obvious, that
the cure of the palpitation must be obtained by curing the
primary affection, which is not to be treated of here. In
the second, the cure must be obtained partly by diligently
avoiding the occasional causes, partly and chiefly by correct-
ing the mobility of the system, and of the heart in particular,
for doing which we have treated of the proper means else-
where.
CHAP.

116 PRACTICE
CHAP. V.
Of DISPNOEA,
OR
DIFFICULT BREATHING.
MCCCVIII.
The exercise and organs of respiration have so constant
and considerable a connection with almost the whole of the
other functions and parts of the human body, that, upon al-
most every occasion of disease, respiration must be affected.
Accordingly, some difficulty and disorder in this function,
are, in fact, symptoms very generally accompanying disease.
MCCCIX.
Upon this account, the symptom of difficult breathing de-
serves a chief place, and an ample consideration in the ge-
neral system of Pathology; but what share of consideration
it ought to have in a treatise of Practice, I find it difficult to
determine.
MCCCX.
On this subject, it is, in the first place, necessary to distin-
guish between the symptomatic and idiopathic affections,
that is, between those difficulties of breathing which are sym-
ptoms only of a more general affection, or of a disease sub-
sisting primarily in other parts than the organs of respiration,
and that difficulty of breathing which depends upon a pri-
mary 

117 OF PHYSIC. 
mary affection of the lungs themselves. The various cases
of symptomatic dyspnœa we have taken pains to enumerate
in our Methodical Nosology, and, it will be obvious, they
are such as cannot be taken notice of here.
MCCCXI.
In our Nosology, we have also taken pains to point out,
and enumerate the proper, or at least the greater part of the
proper idiopathic cases of dyspnœa; but from that enumera-
tion it will, I think, readily appear, that few, and, indeed,
hardly any of these cases, will admit or require much of our
notice in this place.
MCCCXII.
The Dyspnœa Sicca, Species 2d, the Dyspnœa Aërea,
Sp. 3d, the Dyspnoea Terrea, Sp. 4th, and Dyspnœa Thora-
cica, Sp. 7th, are some of them with difficulty known, and are
all of them diseases, which, in my opinion, do not admit
of cure. All, therefore, that can be said concerning them
here is, that they may admit of some palliation; and this, I
think, is to be obtained chiefly by avoiding a plethoric state of
the lungs, and every circumstance that may hurry respiration.
MCCCXIII.
Of the Dyspnœa Extrinsica, Sp. 8th, I can say no more,
but that these external causes marked in the Nosology, and
perhaps some others that might have like effects are to be
carefully avoided, or, when they have been applied, and
their effects have taken place, the disease is to be palliated
by the means mentioned in the last paragraph.
MCCCXIV.
The other species, though enumerated as idiopathic, can
hardly be considered as such, or as requiring to be treated of
here. 
The 

118 PRACTICE
The Dyspnœa Catarrbalis, Sp. 1st, may be considered as
a species of catarrh, and is pretty certainly to be cured by
the same remedies, as that species of catarrh which depends
upon the increased afflux of mucus to the bronchiæ, more
than upon any inflammatory state in them.
The Dyspnœa Aquosa, Sp. 5th, is certainly to be consider-
ed as a species of dropsy, and is to be treated by the same re-
medies as the other species of this disease.
The Dyspnœa Pinguedinosa, Sp. 6th, is, in like manner,
to be considered as a symptom, or local effect of the Poly-
sarcia, and is only to be cured by correcting the general fault
of the system.
MCCCXV.
From this view of those idiopathic cases of Dispnœa,
which are, perhaps, all I could properly arrange under this
title, it will readily appear that there is little room for treat-
ing of them here; but there is still one case of difficult
breathing which has been properly distinguished from every
other, under the title of Asthma, and, as it deserves our par-
ticular attention, I shall here separately consider it.
CHAP. VI.
Of ASTHMA.
MCCCXVI.
The term of Asthma has been commonly applied by the
vulgar, and even by many writers on the Practice of Phy-
sic, to every case of difficult breathing, that is, to every spe-
cies 

119 OF PHYSIC.
cies of Dyspnœa. The methodical Nosologists, also, have
distinguished Asthma from Dyspnœa chiefly, and almost
solely, by the former being the same affection with the lat-
ter, but in a higher degree. Neither of these applications
of the term seems to have been correct or proper. I am of
opinion, that the term Asthma may be most properly applied,
and should be confined to a case of difficult breathing, that
has peculiar symptoms, and depends upon a peculiar proxi-
mate cause, which we hope to assign with sufficient certainty.
It is this disease we are now to treat of, and it is nearly
what Practical Writers have generally distinguished from the
other cases of difficult breathing, by the title of Spasmodic
Asthma, or of Asthma Convulsivum; although, by not distin-
guishing it with sufficient accuracy from the other cases of
Dyspnœa, they have introduced a great deal of confusion in-
to their treatises on this subject.
MCCCXVII.
The disease I am to treat of, or the Asthma, to be strictly
so called, is often a hereditary disease. It seldom appears
very early in life, and hardly till the time of puberty, or after
it. It affects both sexes, but most frequently the male. I
have not observed it to be more frequent in one kind of tem-
perament than in another, and it does not seem to depend
upon any general temperament of the whole body, but upon
a particular constitution of the lungs alone. It frequently
attacks persons of a full habit; but it hardly ever continues
to be repeted, for some length of time, without occasioning
an emaciation of the whole body.
MCCCXVIII.
The attacks of this disease are generally in the night time,
or towards the approach of night, but there are also some in-
stances of their coming on in the course of the day. At
whatever 

120 PRACTICE
whatever time they come on, it is commonly suddenly, with
a sense of tightness and stricture across the breast, and a sense
of straitness in the lungs impeding inspiration. The person
thus attacked, if in a horizontal situation, is immediately
obliged to get into some what of an erect posture, and re-
quires a free and cool air. The difficulty of breathing goes
on for some time increasing, and both inspiration and expi-
ration are performed slowly, and with a wheezing noise.
In violent fits, speaking is difficult and uneasy. There is
often some propensity to coughing, but it can hardly be ex-
ecuted.
MCCCXIX.
The symptoms often continue for many hours together,
and particularly from midnight till the morning is far ad-
vanced. Then, commonly, a remission takes place by de-
grees; the breathing becomes less laborious, and more full,
so that the person can speak and cough with more ease; and,
if the cough brings up some mucus, the remission becomes
immediately more considerable, and the person falls into a
much wished for sleep.
MCCCXX.
During these fits, the pulse often continues in its natural
state; but in some persons, the fits are attended with a fre-
quency of pulse, and with some heat and thirst, as marks of
some degree of fever. If urine be voided at the beginning
of a fit, it is commonly in considerable quantity, and with
little colour or odour; but, after the fit is over, the urine
voided is in the ordinary quantity, of a high colour, and
sometimes deposites a sediment. In some persons, during
the fit, the face is a little flushed and turgid, but, more com-
monly, it is somewhat pale and shrunk.
MCCCXXI. 

121 OF PHYSIC.
MCCCXXI.
After some sleep in the morning, the patient, for the rest
of the day, continues to have more free and easy breathing,
but it is seldom entirely such. He still feels some tightness
across his breast, cannot breathe easily in a horizontal po-
sture, and can hardly bear any motion of his body, without
having his breathing rendered more difficult and uneasy. In
the afternoon, he has an unusual flatulency of his stomach,
and an unusual drowsiness; and, very frequently, these sym-
ptoms precede the first attacks of the disease. But, whether
these symptoms appear or not, the difficulty of breathing re-
turns towards evening, and then sometimes gradually in-
creases, till it becomes as violent as in the night before;
or if, during the day, the difficulty of breathing has been
moderate, and the person gets some sleep in the first part of
the night, he is, however, waked about midnight, or some
time between midnight and two o'clock in the morning,
and is then suddenly seized with a fit of difficult breathing,
which runs the same course as the sight before.
MCCCXXII.
In this manner fits return for several nights successively;
but, generally, after some nights passed in this way, the fits
suffer more considerable remissions. This especially happens
when the remissions are attended with a more copious expecto-
ration in the mornings, and that this continues from time to
time throughout the day. In these circumstances, asthma-
tics, for a long time after, have not only more easy days,
but enjoy, also, nights of entire sleep, without the recurrence
of the disease.
MCCCXXIII.
When this disease, however, has once taken place in the
manner above described, it is ready to return, at times, for
Part II. Q the 

122
PRACTICE
the whole of life after; but thefe returns happen with dif-
ferent circumstances in different persons.
MCCCXXIV.
In some persons the fits are readily excited by external
heat, whether of the weather, or of a warm chamber, and
particularly by warm bathing. In such persons, fits are more
frequent in summer, and particularly during the dog-days,
than at other colder seasons. The same persons are also rea-
dily affected by changes of the weather, especially by sudden
changes made from a colder to a warmer, or what is com-
monly the same thing, from a heavier to a lighter atmo-
sphere. The same persons are also affected by every circum-
stance straitening the capacity of the thorax, as by any liga-
ture made, or even a plaster laid, upon it, and a like effect
happens from any increased bulk of the stomach, either by
a full meal, or by wind collected in it. They are likewise
much affected by exercise, or whatever else can hurry the
circulation of the blood.
MCCCXXV.
As asthmatic fits seem thus to depend upon some fulness
of the vessels of the lungs, it is probable that an obstruction
of perspiration, and the blood being less determined to the
surface of the body, may favour an accumulation in the
lungs, and thereby be a means of exciting asthma. This
seems to be the case of those asthmatics, who have fits most
frequently in the winter season, and who have commonly
more of a catarrhal affection accompanying the asthma,
which, therefore, occurs more frequently in winter, and more
manifestly from the application of cold.
MCCCXXVI.
Beside these cases of asthma excited, by heat or cold, there
are 

123 OF PHYSIC.
are others, in which the fits are especially excited by powers
applied to the nervous system, as by passions of the mind,
by particular odours, and by irritations of smoke and dust.
That this disease is an affection of the nervous system, and
depending upon a mobility of the moving fibres of the lungs,
appears pretty clearly from its being frequently connected
with other spasmodic affections depending upon mobility,
such as hysteria, hypochondriasis, dyspepsia, and atonic gout.
MCCCXXVII.
From the whole of the history of asthma now delivered,
I think it will readily appear that the proximate cause of
this disease is a preternatural, and, in some measure, a spas-
modic, constriction of the muscular fibres of the bronchiæ,
which not only prevents the dilatation of the bronchiæ ne-
cessary to a free and full inspiration, but gives also a rigidity
which prevents a full and free expiration. This preterna-
tural constriction, like many other convulsive and spasmodic
affections, is readily excited by a turgescence of the blood,
or other cause of any unusual fullness and distension of the
vessels of the lungs.
MCCCXXVIII.
This disease, as coming, by fits, may be generally distin-
guished from most other species of dyspnœa, whose causes
being more constantly applied, produce therefore, a more
constant difficulty of breathing. There may, however, be
some fallacy in this matter, as some of these causes may be
liable to have abatements and intensities, whereby the dys-
pnœa produced by them may seem to come by fits; but, I
believe it is seldom that such fits put on the appearance of
the genuine asthmatic fits described above. Perhaps, how-
ever, there is still another case that may give more difficulty,
and that is, when several of the causes, which we have
assigned, as causes of several of the species of difficult breath-
ing, 

124 PRACTICE
ing, referred to the genus of dyspnœa, may have the effect
of exciting a genuine asthmatic fit. Whether this can hap-
pen to any but the peculiarly predisposed to asthma I am
uncertain, and, therefore, whether in any such cases, the
asthma may be considered as symptomatic, or if, in all such
cases, the asthma may not still be considered and treated as
an idiopathic disease.
MCCCXXIX.
The asthma, though often threatening immediate death,
seldom occasions it; and many persons have lived long un-
der this disease. In many cases, however, it does prove
fatal, sometimes very quickly, and, perhaps, always at
length. In some young persons it has ended soon, by occa-
sioning a phthisis pulmonalis. After a long continuance it
often ends in a hydrothorax, and, commonly, by occasion-
ing some aneurism of the heart, or great vessels, it thereby
proves fatal.
MCCCXXX.
As it is seldom that an asthma has been entirely cured, I
therefore, cannot propose any method of cure which experi-
ence has approved as generally successful. But the disease
admits of alleviation, in several respects, from the use of
remedies; and my business now shall be chiefly to offer some
remarks upon the choice and use of the remedies which have
been commonly employed in cases of asthma.
MCCCXXXI.
As the danger of an asthmatic fit arises chiefly from the
difficult transmission of the blood through the vessels of the
lungs, threatening suffocation, so the most probable means
of obviating this seems to be bloodletting; and, therefore,
in all violent fits, practitioners have had recourse to this
remedy. 

125 OF PHYSIC.
remedy. In first attacks, and especially in young and ple-
thoric persons, blood-letting may be very necessary, and is
commonly allowable. But it is also evident, that, under
the frequent recurrence of fits, blood-letting cannot be fre-
quently repeated without exhausting and weakening the pa-
tient too much. It is further to be observed, that blood-
letting is not so necessary as might be imagined, as the
passage of the blood through the lungs is not so much inter-
rupted as has been commonly supposed. This, I particu-
larly conclude from hence, that, instead of the suffusion of
face which is the usual effect of such interruption, the face,
in asthmatic fits, is often shrunk and pale. I conclude the
same also from this, that, in asthmatic fits, blood-letting
does not commonly give so much relief, as, upon the con-
trary supposition, might be expected.
MCCCXXXII.
As I have alleged above that a turgescence of the blood
is frequently the exciting cause of asthmatic fits, so it might
be supposed that a plethoric state of the system might have
a great share in producing a turgescence of the blood in the
lungs, and especially, therefore, that blood-letting might
be a proper remedy in asthma. I allow it to be so in the first
attacks of the disease; but, as the disease, by continuing,
generally takes off the plethoric state of the system, so, after
the disease has continued for some time, I allege that
blood-letting becomes less and less necessary.
MCCCXXXIII.
Upon the supposition of asthmatics being in a plethoric
state, purging might be supposed to prove a remedy in this
disease; but, both because the supposition is not commonly
well founded, and because purging is seldom found to relieve
the vessels of the thorax, this remedy has not appeared to
be 

126 PRACTICE
be well suited to asthmatics; and large purging has always
been found to do much harm. But as asthmatics are always
hurt by the stagnation and accumulation of matters in the
alimentary canal, so costiveness must be avoided, and an
open belly proves useful. In the time of fits, the employ-
ment of emollient, and moderately laxative clysters, has
been found to give considerable relief.
MCCCXXXIV.
As a flatulency of the stomach, and other symptoms of
indigestion, are frequent attendants of asthma, and very
troublesome to asthmatics, so, both for removing these
symptoms, and for taking off all determination to the lungs,
the frequent use of gentle vomits is proper in this disease.
In certain cases, where a fit was expected to come on in the
course of the night, a vomit given in the evening has fre-
quently seemed to prevent it.
MCCCXXXV.
Blistering between the shoulders, or upon the breast, has
been frequently employed to relieve asthmatics; but, in the
pure spasmodic asthma we treat of here, I have rarely found
blisters useful, either in preventing or relieving fits
MCCCXXXVI.
Issues are certainly useful in obviating plethora; but, as
such indications seldom arise in cases of asthma, so issues
have been seldom found useful in this disease.
MCCCXXXVII.
As asthmatic fits are so frequently excited by a turgescence
of the blood, so the obviating and allaying of this by acids
and neutral salts, seems to have been at all times the object
of practitioners. See Floyer on the asthma.
MCCCXXXVIII. 

127 OF PHYSIC.
MCCCXXXVIII.
Though a plethoric state of the system may seem to dis-
pose to asthma, and the occasional turgescence of the blood
may seem to be frequently the exciting cause of the fits, yet
it is evident that the disease must have arisen chiefly from a
peculiar constitution in the moving fibres of the bronchiae,
disposing them, upon various occasions, to fall into a spasmo-
dic constriction; and, therefore, that the entire cure of the
disease can only be expected from the correcting of that pre-
disposition, or from correcting the preternatural mobility or
irritability of the lungs in that respect.
MCCCXXXIX.
In cases wherein this predisposition depends upon original
conformation, the cure must be difficult, and perhaps impos-
sible; but it may, perhaps, be moderated by the use of an-
tispasmodics. Upon this footing, various remedies of that
kind have been commonly employed, and particularly the
foetid gums, but we have not found them of any consider-
able efficacy, and have observed them to be sometimes hurt-
ful by their heating too much. Some other antispasmodics
which might be supposed powerful, such as musk, have not
been properly tried. The vitriolic aether has been found to
give relief, but its effects are not lasting.
MCCCXL.
As in other spasmodic affections, so, in this, the most
certain and powerful antispasmodic is opium. I have often
found it effectual, and generally safe; and, if there have a-
risen doubts with respect to its safety, I believe they have
arisen from not distinguishing between certain plethoric and
inflammatory cases of dyspnoea, improperly named asthma,
and the genuine spasmodic asthma we treat of here.
MCCCXLI. 

128 PRACTICE
MCCCXLI.
As, in many cases, this disease depends upon a predispo-
sition which cannot be corrected by our art, so, in such cases,
the patient can only escape the disease by avoiding the oc-
casional, or exciting causes, which we have endeavoured to
point out above. It is, however, difficult to give any gene-
ral rules here, as different asthmatics have their different
idiosyncrasies with respect to externals. Thus, one asthma-
tic finds himself easiest living in the midst of a great city,
while another cannot breathe but in the free air of the coun-
try. In the latter case, however, most asthmatics bear the
air of a low ground, if tolerably free and dry, better than
that of the mountain.
MCCCXLII.
In diet, also, there is some difference to be made with
respect to different asthmatics. None of them bear a large
or full meal, or any food that is of slow and difficult solution
in the stomach; but many of them bear animal food of the
lighter kinds, and in moderate quantity. The use of vege-
tables which readily prove flatulent are always very hurtful.
In recent asthma, and especially in the young and plethoric,
a spare, light, and cool diet, is proper, and commonly ne-
cessary; but, after the disease has continued for years,
asthmatics commonly bear, and even require, a tolerably
full diet, though, in all cases, a very full diet is very hurt-
ful.
MCCCXLIII.
In drinking, water, or cool watery liquors, is the only
safe and fit drink for asthmatics; and all liquors ready to
ferment, and become flatulent, are hurtful to them. Few
asthmatics can bear any kind of strong drink; and any ex-
cess 

129 OF PHYSIC.
cess in such is always very hurtful to them. As asthmatics
are commonly hurt by taking warm or tepid drink, so, both
upon that account, and upon account of the liquors weaken-
ing the nerves of the stomach, neither tea nor coffee is pro-
per in this disease.
MCCCXLIV.
Astmatics commonly bear no bodily motion easily bat
that of the most gentle kind. Riding, however, on horse-
back, or going in a carriage, and especially sailing, are
very often useful to, asthmatics.
CHAP. VII.
Of The CHIN COUGH,
OR
HOOPING COUGH.
MCCCXLV.
This disease is commonly epidemic, and manifestly con-
tagious. It seems to proceed from a contagion of a specific
nature, and of singular quality. It does not, like most
other contagions, necessarily produce a fever; nor does it
like most others, occasion any eruption, or produce, other-
PART II. R wise, 

130 PRACTICE
wise, any evident change in the state of the human fluids.
It has, in common with the catarrhal contagion, and with
that of the measles, a peculiar determination to the lungs,
but with particular effects there, very different from those of
the other two, as will appear from the history of this disease
now to be delivered.
MCCCXLVI.
This contagion, like several others, affects persons but
once in the course of their lives, and therefore, neces-
sarily, children are most commonly the subjects of this dis-
ease; but there are many instances of it occurring in persons
considerably advanced in life, though it is probable, that
the further that persons are advanced in life, they are the
less liable to be affected with this contagion.
MCCCXLVII.
The disease commonly comes on with the ordinary sym-
ptoms of a catarrh arising from cold, and often, for many
days, keeps entirely to that appearance; and I have had in-
stances of a disease, which, though evidently arising from the
chincough contagion, never put on any other form than that
of a common catarrh.
This, however, seldom happens; for, generally, in the
second, and, at farthest, in the third week after the attack,
the disease puts on its peculiar, and characteristic symptom,
a convulsive cough. This is a cough in which the expira-
tory motions peculiar to coughing are made with more fre-
quency, rapidity, and violence, than usual. As these cir-
cumstances, however, in different instances of coughing, are in
very different degrees, so no exact limits can be put to deter-
mine when the cough can be strictly said to be convulsive;
aad it is therefore especially by another circumstance that the
chincough is distinguished from every other form of cough.
This 

131 OF PHYSIC. 
This circumstance is, when many expiratory motions have
been convulsively made, and thereby the air is in great
quantity thrown out of the lungs, a full inspiration is neces-
sarily and suddenly made, which, by the air rushing in through
the glottis with unusual velocity, gives a peculiar sound.
This sound is somewhat different in different cases, but is,
in general, called a Hoop, and from it the whole of the di-
ease is called the Hooping Cough. When this sonorous in-
spiration has happened, the convulsive coughing is again re-
newed, and continues in the same manner as before till a
quantity of mucus is thrown up from the lungs, or the con-
tents of the stomach are thrown up by vomiting. Either of
these evacuations commonly put an end to the coughing,
and the patient remain free from it for some time after.
Sometimes it is only after several alternate fits of coughing
and hooping that expectoration or vomiting takes place, but
it is commonly after the second coughing that these happen,
and put an end to the fit.
MCCCXLVIII.
When the disease, in this manner, has taken its proper
form, it generally continues for a long time after, and gene-
rally from one month to three, but sometimes much longer,
and that with very various circumstances.
MCCCXLIX.
The fits of coughing return at various intervals, rarely ob-
serving any exact period. They happen frequently in the
course of the day, and more frequently, still, in the course
of the night. The patient has commonly some warning of
their coming on; and, to avoid that violent and painful con-
cussion which the coughing gives to the whole body, he
clings fast to any thing that is near to him, or demands to
be held fast by any person that he can come at.
When 

132 PRACTICE
When the fit is over, the patient sometimes breathes fast,
and seems fatigued for a little after, but, in many, this ap-
pears very little; and children are commonly so entirely re-
lieved, that they immediately return to their play, or what
else they were occupied in before.
MCCCL.
If it happens that the fit of coughing ends in vomiting up
the contents of the stomach, the patient is commonly imme-
diately after seized with a strong craving, and demand for
food, and takes it in very greedily.
MCCCLI.
At the first coming on of this disease, the expectoration is
sometimes none at all, or of a thin mucus only, and while
this continues to be the case, the fits of coughing are more
violent, and continue longer; but, commonly, the expecto-
ration soon becomes considerable, and a very thick mucus,
often in great quantity, is thrown up, and as this is more
readily brought up, the fits of coughing are of shorter dura-
tion.
MCCCLII.
The violent fits of coughing frequently interrupt the free 
transmission of the blood through the lungs, and, thereby,
the free return of blood from the vessels of the head. This
occasions that turgescence and suffusion of face which com-
monly attends the fits of coughing, and seems to occasion
also those eruptions of blood from the nose, and even from
the eyes and ears, which sometimes happen in this disease.
MCCCLIII.
This disease often takes place in the manner we have
now described, without any pyrexia attending it; but, though
Sydenham had seldom observed it, we have found the disease
very 

133 OF PHYSIC. 
very frequently accompanied with pyrexia, sometimes from
the very beginning, but more frequently only after the dis-
ease had continued for some time. When it does accompany
the disease, we have not found it appearing under any re-
gular intermittent form. It is constantly in some degree
present, but, with evident exacerbations towards evening,
continuing till next morning.
MCCCLIV.
Another symptom, very frequently attending the chin-
cough, is a difficulty of breathing, and that not only imme-
diately before and after fits of coughing, but as constantly
present, though in different degrees, in different persons. I
have hardly ever seen an instance of a fatal chincough, in
which a considerable degree of pyrexia and dyspnœa had not
been for some time constantly present.
MCCCLV.
When, by the power of the contagion, this disease has
once taken place, the fits of coughing are often repeted,
without any evident exciting cause; but, in many cases, the
contagion may be considered as giving a predisposition only,
and the frequency of fits depend, in some measure, upon va-
rious exciting causes, such as, violent exercise; a full meal;
the having taken in food of difficult solution; irritations of
the lungs by dust, smoke, or disagreeable odours of a strong
kind, and especially any considerable emotion of the mind.
MCCCLVI.
Such are the chief circumstances of this disease, and if is
of various event, which, however, may be commonly fore-
seen by attending to the following considerations:
The younger children are, they are in the greater danger
from this disease; and of those to whom it proves fatal,
there are many more under two years old than above it.
The 

134 PRACTICE
The older that children are they are the more secure against
an unhappy event; and this I hold to be a very general
rule, though I own there are many exceptions to it.
Children born of phthisical and asthmatic parents are in
the greatest danger from this disease.
When the disease, beginning in the form of a catarrh, is
attended with fever and difficult breathing, and with little
expectoration, it often proves fatal, without taking on the
form of the hooping cough; but, in most of such cases, the
coming on of the convulsive cough and hooping, bringing
on, at the same time, a more free expectoration, generally
removes the danger.
When the disease is fully formed, if the fits are neither
frequent nor violent, with moderate expectoration, and the
patient, during the intervals of the fits, is easy, keeps his
appetite, gets sleep, and is without fever or difficult breath-
ing, the disease is attended with no danger, and these cir-
cumstances becoming daily more favourable, the disease very
soon spontaneously terminates.
An expectoration either very scanty, or very copious, is at-
tended with danger, especially if the latter circumstance is
attended with great difficulty of breathing.
Those cases in which the fits terminate by a vomiting, and
are immediately followed by a craving of food, are gene-
rally without danger.
A moderate hæmorrhagy from the nose often proves salu-
tary, but very large hæmorrhagies are generally very hurtful.
This disease, coming upon persons under a state of much
debility, has very generally an unhappy event.
The danger of this disease sometimes arises from the
violence of the fits of coughing, occasioning apoplexy, epi-
lepsy, or immediate suffocation; but these accidents are
very rare, and the danger of the disease seems generally to
be in proportion to the fever and dyspnœa attending it.
MCCCLVII. 

135 OF PHYSIC.
MCCCLVII.
The cure of this disease has been always considered as
difficult, whether the purpose be to obviate its fatal tenden-
cy, when it is violent, or merely to shorten the course of it
when it is mild. When the contagion is recent, and con-
tinues to act, we neither know how to correct, nor how to
expel it; and, therefore, the disease necessarily continues
for some time; but it is probable that the contagion, in
this as in other instances, ceases at length to act, and that
then the disease continues, as in other convulsive affections,
by the power of habit alone.
MCCCLVIII.
From this view of the matter I maintain, that the prac-
tice must be different, and adapted to two different indica-
tions, according to the period of the disease. At the begin-
ning of the disease, and for some time after, the remedies
to be employed must be such as may obviate the violent ef-
fects of the disease, and the fatal tendency of it; but, after
the disease has continued for some time, and is without any
violent symptoms, the only remedies which can be required
are those which may interrupt its course, and put an entire
stop to it sooner than it would have spontaneously ceased.
MCCCLIX.
For answering the first indication. In plethoric subjects,
or in others, when, from the circumstances of the cough aad
fits, it appears that the blood is difficultly transmitted through
the lungs, blood-letting is a necessary remedy; and it may
be even necessary to repete it especially in the beginning of
the disease; but, as spasmodic affections do not commonly
admit of much bleeding, so it is seldom proper in the chin-
cough to repete this remedy often.
MCCCLX. 

136 PRACTICE
MCCCLX.
As costiveness frequently attends this disease, so it is ne-
cessary to obviate or remove it by laxatives employed; and
keeping an open belly is generally useful; but large evacu-
ations in this way are commonly hurtful.
MCCCLXI.
To obviate or remove the inflammatory determination to
the lungs, that sometimes occurs in this disease, blistering
is often useful, and even repeted blistering has been of
service; but issues have not so much effect, and should by
no means supersede the repeted blistering that may be indi-
cated. When blisters are proper, they are more effectual
when applied to the thorax than when applied to any di-
stant parts.
MCCCLXII.
Of all other remedies, emetics are the most useful in
this disease, both, in general, by interrupting the return of
spasmodic affections, and, in particular, by determining
very powerfully to the surface of the body, and thereby tak-
ing off determinations to the lungs. For these purposes, I
think full vomiting is frequently to be employed; and, in
the intervals necessary to be left between the times of full
vomiting, nauseating doses of the antimonial emetics may
be useful. I have never found the sulphur auratum, so much
praised by Clossius, to be a convenient medicine, on ac-
count of the uncertainty of its dose; and the tartar emetic,
employed in the manner directed by the late Dr. Fothergill,
has appeared to be more useful.
MCCCLXIII.
These are the remedies to be employed in the first stage
of the disease for obviating its fatal tendency, and putting
it 

137 OF PHYSIC. 
it into a safe train. But in the second stage, when, I sup-
pose the contagion has ceased to act, and that the disease
continues merely by the power of habit, a different indica-
tion arises, and different remedies are to be employed.
MCCCLXIV.
This disease, which often continues for a long time, does
not, in my opinion, continue during the whole of that time
in consequence of the contagion's remaining in the body,
and continuing to act in it. That the disease does often
continue long after the contagion has ceased to act, and that,
too, by the power of habit alone, appears to me probable
from hence, that terror has frequently cured the disease;
that any considerable change in the state of the system, such
as the coming on of the small-pox, has also cured it; and,
lastly, that it has been cured by antispasmodic and tonic
medicines, whilst none of all these means of cure can be
supposed either to correct or to expel a morbific matter, tho'
they are evidently suited to change the state and habits of
the nervous system.
MCCCLXV.
From this view we are directed to the indication that
may be formed, and, in a great measure, to the remedies
which may be employed in what we suppose to be the second
stage of the disease. It may, perhaps, be alleged, that this
indication of shortening the course of the disease, is not very
important or necessary, as it supposes that the violence and
danger is over, and, in consequence, that the disease will
soon spontaneously cease. The last supposition, however, is
not well founded, as the disease, like many other convulsive
and spasmodic affections, may continue for a long time by
the power of habit alone, and by the repetition of paroxysms
may have hurtful effects, more especially as the violence of
paroxysms, and, therefore, their hurtful effects, may he
Part II. S much 

138
PRACTICE
much aggravated by various external causes that may be ac-
cidentally applied. Our indication, therefore, is proper,
and we proceed to consider the several remedies which may
be employed to answer it.
MCCCLXVI.
Terror may possibly be a powerful remedy, but it is diffi-
cult to measure the degree of it that shall be produced; and,
as a slight degree of it may be ineffectual, and a high de-
gree of it dangerous, I cannot propose to employ it.
MCCCLXVII.
The other remedies which we suppose suited to our second
indication, and which, indeed, have been frequently em-
ployed in this disease, are antispasmodics or tonics.
Of the antispamodics, castor has been particularly recom-
mended by Dr. Morris, but in many trials, we have not
found it effectual.
With more probability musk has been employed; but
whether it be from our not having it of a genuine kind, or
not employing it in sufficiently large doses, I cannot deter-
mine, but we have not found it commonly successful. Of
antispasmodics, the most certainly powerful is opium; and,
when there is no considerable fever, or difficulty of breathing
present, opium has often proved useful in moderating the
violence of the chincough; but I have not known it em-
ployed so as entirely to cure the disease.
If hemlock has proved a remedy in this disease, as we
must believe from Dr. Butter's accounts, I agree with that
author, that it is to be considered as an antispasmodic.
Upon this supposition it is a probable remedy; and from
the accounts of Dr. Butter, and some others, it seems to
have been often useful; but, in our trials, it has often dis-
appointed us, perhaps from the preparation of it not having
been always proper.
MCCCLXVIII. 

139 OF PHYSIC. 
MCCCLXVIII.
Of the tonics, I consider the cupmoss, formerly celebrated,
as of this kind, as also the bark of the misletoe, but I have had
no experience of either, as have always trusted to the Pe-
ruvian bark. I consider the use of this medicine as the most
certain means of curing the disease in its second stage; and,
when there has been little fever present, and a sufficient
quantity of the bark has been given, it has seldom failed of
soon putting an end to the disease.
MCCCLXIX.
When convulsive disorders may be supposed to continue
by the force of habit alone, it has been found that a consi-
derable change in the whole of the circumstances and man-
ner of life has proved a cure of such diseases; and analogy
has applied this in the case of the chincough so far, that a
change of air has been employed, and supposed to be useful.
In several instances I have observed it to be so; but I have
never found the effects of it durable, or sufficient to put an
entire stop to the disease.
SECT. 

140 PRACTICE
SECT. III.
OF THE
SPASMODIC AFFECTIONS
IN THE
NATURAL FUNCTIONS.
CHAP. VIII.
Of The PYROSIS,
OR WHAT IS NAMED IN SCOTLAND
The WATER BRASH.
MCCCLXX.
The painful sensations referred to the stomach, and which
are probably occasioned by real affections of this organ, are
of different kinds. Probably, however, they procede from
affections of different natures, and should therefore be distin-
guished by different appellations; but I must own that the
utmost precision in this matter will be difficult. In my essay
towards 

141 OF PHYSIC.
towards a methodical Nosology, I have, however, attempted
it. For these pains that are either acute and pungent, or
accompanied with a sense of distension, or with a sense of
constriction, if they are, at the same time, without any sense
of acrimony or heat, I employ the appellation of Gastrody-
nia. To express those painful or uneasy sensations which
are from a sense of acrimony irritating the part, or from such
a sense of heat, as the application of acrids, whether exter-
nally or internally applied, often gives, I employ the term
of Cardialgia, and by this I particularly mean to denote
these feelings which are expressed by the term Heartburn in
the English language. I think the term Soda has been com-
monly employed by Practical Writers to express an affection
attended with feelings of the same kind.
MCCCLXXI.
Beside the pains denoted by the terms Gastrodynia, Peria-
dynia, Cardialgia, and Soda, there is, I think, another pain-
ful sensation, different from all of thefe, which is named
by Mr. Sauvages Pyrosis Suecica, and his account of it is
taken from Linnaeus, who names it Cardialgia Sputatoria.
Under the title of Pyrosis, Mr. Sauvages has formed a Ge-
nus, of which the whole of the species, except the eight under
the title we have just now mentioned, are all of them species
of the Gastrodynia or of the Cardialgia; and, if there is a
Genus to be formed under the title of Pyrosis, it can only
comprehend the species I have mentioned. In this case, in-
deed, I own that the term is not very proper; but my aver-
sion to introduce new names has made me continue to em-
ploy the term of Mr. Sauvage.
MCCCLXXII.
The Gastrodynia and Cardialgia I judge to be, for the
most part, symptomatic affections, and, therefore, have given
them 

142 PRACTICE.
them no place in this work; but the Pyrosis, as an idiopathic
disease, and never before treated of in any system, I propose
to treat of here.
MCCCLXXIII.
It is a disease frequent among people in lower life, but oc-
curs also, though more rarely, in people of better condition.
Tho' frequent in Scotland, it is by no means so frequent as
Linnæsus reports it to be in Lapland. It appears most com-
monly in persons under middle age, but seldom in any per-
sons before the age of puberty. When it has once taken
place, it is ready to recur occasionally for a long time after;
but it seldom appears in persons considerably advanced in
life. It affects both sexes, but more frequently the female.
It sometimes attacks pregnant women, and some women,
only when they are in that condition. Of other women, it
more frequently affects the unmarried; and, of the married,
most frequently the barren. I have had many instances of
it in women labouring under a fluor albus.
MCCCLXXIV.
The fits of this disease usually come on in the morning
and forenoon, when the stomach is empty. The first sym-
ptom of it, is a pain at the pit of the stomach, with a sense
of constriction, and as if the stomach was drawn towards
the back; the pain is increased by raising the body into
an erect posture, and, therefore, the body is bended forward.
This pain is often very severe; and, after continuing for
some time, it brings on an eructation of a thin watery fluid
in considerable quantity. This fluid has sometimes an acid
taste, but, very often, is without this, and absolutely insipid.
The eructation is for some time frequently repeted; and
does not immediately give relief to the pain which preceded
it, but does so at length, and puts an end to the fit.
MCCCLXXV. 

143 OF PHYSIC. 
MCCCLXXV.
The fits of this disease commonly come on without any
evident exciting cause; and I have not found it steadily con-
nected with any particular diet. It attacks persons using
animal food, but, I think, more frequently those living on
milk and farinacea. It seems often to be excited by cold
applied to the lower extremities; and is readily excited by
any considerable emotion of mind. It is often without any
symptoms of dyspepsia.
MCCCLXXVI.
The nature of this affection is not very obvious, but I
think it may be explained in this manner. It seems to begin
by a spasm of the muscular fibres of the stomach, which is
afterwards, in a certain manner, communicated to the
blood-vessels and exhalants, so as to increase the impetus
of the fluids in the vessels, while a constriction takes place
on their extremities. The increased impetus pours out a
larger quantity of fluid than usual, while the constriction
upon their extremities allows only the pure watery parts to
be poured out, analogous, as I judge, in every respect, to
what happens in the diabetes hystericus.
MCCCLXXVII.
The practice in this disease is as difficult as the theory. The
paroxysm is only to be certainly relieved by opium. Other
antispasmodics, as vitriolic æther, and volatile alkali, are
sometimes of service, but not constantly so. Although
opium, and other antispasmodics, relieve the fits, they have
bo effect in preventing their recurrence. For this purpose,
the whole of the remedies of dyspepsia have been employed
without success. Of the use of the nux vomica mentioned
as a remedy by Linnæus I have had no experience.
CHAP. 

144 PRACTICE
CHAP. IX.
Of The COLIC.
MCCCLXXVIII.
The principal symptom of this disease is a pain felt in the
lower belly. It is seldom fixed and pungent in one part,
but, in some measure, spreads over the whole of the belly,
and, particularly, with a sense of twisting or wringing round
the navel. With this pain the navel and teguments of the
belly are frequently drawn inwards, and often the muscles of
the belly are spasmodically contracted, and this as in separate
portions, giving the appearance of a bag full of round balls.
MCCCLXXIX.
Such pains, in a certain degree, sometimes occur in cases
of diarrhœa and cholera, but these are less violent and more
transitory, and are named Gripings. It is only when more
violent and permanent, and attended with costiveness, that
they constitute colic. This is also commonly attended with
vomiting, which, in many cases, is frequently repeted,
efpecially when any thing is taken down into the stomach;
and in such vomitings, not only the contents of the stomach
are thrown up, but, also, the contents of the duodenum,
and, therefore, a quantity of bile.
MCCCLXXX.
In some cases of colic, the peristaltic motion of the in-
testines is inverted through the whole length of the alimen-
tary 

145 OF PHYSIC.
tary canal, in such a manner that the contents of the great
guts, and, therefore, stercoraceous matter is thrown up by
vomiting; and the same inversion appears still more clearly
from this, that what is thrown into the rectum by clyster is
again thrown out by the mouth. In these circumstances of
inversion the disease has been named Ileus, or the Iliac
Passion, and this has been supposed to be a peculiar disease
distinct from colic, but to me it appears that the two dis-
eases are owing to the same proximate cause, and have the
same symptoms, only in different degree.
MCCCLXXXI.
The colic is often without any pyrexia attending it;
sometimes, however, an inflammation comes upon the part
of the intestine especially affected, and this inflammation
aggravates all the symptoms of the disease, being probably
what brings on the most considerable inversion of the peri-
staltic motion; and, as the stercoraceous vomiting is what
especially distinguishes the Ileus, this has been considered as
always depending on an inflammation of the intestines. How-
ever, I can affirm, that, as there are inflammations of the
intestines without stercoraceous vomiting, so I have seen in-
stances of stercoraceous vomiting without inflammation; and
there is, therefore, no ground for distinguishing ileus from
colic but as a higher degree of the same affection.
MCCCLXXXII.
The symptoms of the colis, and the dissections of bodies
dead of this disease, shew very clearly, that it depends upon
a spasmodic constriction of a part of the intestines, and that
this, therefore, is to be considered as the proximate cause
of the disease. In some of the dissections of persons dead of
this disease, an intus-susception has been remarked to have
Part II T happened; 

146 PRACTICE
happened; but whether this be constantly the case in all
the appearances of ileus is not certainly determined.
MCCCLXXXIII.
The colic has commonly been considered as being of dif-
ferent species, but I cannot follow the writers on this sub-
ject in the distinctions they have established. So far, how-
ever, as a difference of the remote cause constitutes a dif-
ference of species, a distinction may, perhaps, be admitted;
and, accordingly, in our Nosology, I have marked seven
different species; but, I am well persuaded, that, in all these
different species, the proximate cause is the same, that is,
a spasmodic constriction of a part of the intestines, and,
consequently, that in all these cases the indication of cure
is the same, that is, to remove the constriction mentioned.
Even in the species named Stercorea Callosa, and Calculosa,
in which the disease depends upon an obstruction of the intes-
tine, I am persuaded that these obstructions do not produce
the symptoms of colic, excepting in so far as they produce
spasmodic constrictions of the intestines; and, therefore,
that the means of core in these cases, so far as they admit
of cure, must be obtained by the same means which the
general indication above mentioned suggests.
MCCCLXXXIV.
The cure, then, of the colic, universally, is to be ob-
tained by removing the spasmodic constrictions of the in-
testines; and the remedies suited to this purpose may be re-
ferred to three general heads:
1. The taking off the spasm by various antispasmodic
powers.
2. The exciting the action of the intestines by purgatives.
3. The employing mechanical dilatation.
MCCCLXXXV. 

147 OF PHYSIC.
MCCCLXXXV.
Before entering upon a more particular account of these
remedies, it will be proper to observe, that, in all cases of
violent colic, it is adviseable to practise blood-letting, both
as it may be useful in obviating the inflammation often to
be apprehended, and even as it may be a means of relaxing
the spasm of the intestine. This remedy may, perhaps be
improper in persons of a weak and lax habit, but in all per-
sons of tolerable vigour it will be a safe remedy; and in all
cases where there is the least suspicion of an inflammation
actually coming on, it will be absolutely necessary. Nay, it
will even be proper to repete it, perhaps several times, if,
with a full and hard pulse, the appearance of the blood
drawn, and the relief obtained by the first bleeding, shall
authorise such repetition.
MCCCLXXXVI.
The antispasmodic powers that may be employed, are the
application of heat in a dry or humid form, the appli-
cation of blisters, the use of opium, and the use of mild
oils.
The application of heat, in a dry form, has been employed
by applying to the belly of the patient a living animal, or
bladders filled with warm water, or bags of substances which
long retain their heat; and all these have sometimes been
applied with success; but none of them seem to me so pow-
erful as the application of heat in a humid form.
This may be employed either by the immersion of a great
part of the body in warm water, or by fomenting the belly
with cloths wrung out of hot water. The immersion has
advantages from the application of it to a greater part of the
body, and, particularly, to the lower extremities; but immersion
cannot always be conveniently practised, and fomentation
may have the advantage of being longer continued, and it
may

148 PRACTICE
may have nearly all the benefit of immersion, if it be, at
the same time applied both to the belly and to the lower
extremities.
MCCCLXXXVII.
From considering that the teguments of the lower belly
have such a connection with the intestines, as, at the same
time, to be affected with spasmodic contractions, we per-
ceive that blisters applied to the belly may have the ef-
fect of taking off the spasms both from the muscles of the
belly and from the intestines, and, accordingly, blistering
has often been employed in the colic with advantage. Ana-
logous to this, rubefacients applied to the belly have been
frequently found useful.
MCCCLXXXVIII.
The use of opium, in colic, may seem to be an ambiguous
remedy. Very certainly it may, for some time, relieve the
pain, which is often so violent and urgent, that it is diffi-
cult to abstain from the use of such a remedy. At the same
time, the use of opium retards or suspends the peristaltic
motion so much, as to allow the intestines to fall into con-
strictions, and may, therefore, while it relieves the pain,
render the cause of the disease more obstinate. On this ac-
count, and, further, as opium prevents the operation of
purgatives, so often necessary in this disease, many practi-
tioners are averse to the use of it, and some entirely reject
the use of it as hurtful. There are, however, others who
think they can employ opium in this disease with much ad-
vantage.
In all cases where the colic comes on without any previ-
ous costiveness, and arises from cold, from passions of the
mind, or other causes which operate especially on the nervous
system, opium proves a safe and certain remedy; but in
cases 

149 OF PHYSIC.
cases which have been preceded by long costiveness, or where
the colic, though not preceded by costiveness, has, however,
continued for some days without a stool, so that a stagnation
of fæces in the colon is to be suspected, the use of opium is
of doubtful effect. In such cases, unless a stool has been first
procured by medicine, opium cannot be employed but with
some hazard of aggravating the disease. However, even in
these circumstances of costiveness, when, without inflam-
mation, the violence of the spasm is to be suspected, when
vomiting prevents the exhibition of purgatives, and when,
with all this, the pain is extremely urgent, opium is to be
employed, not only as an anodyne, but also as an anti-
spasmodic, necessary to favour the operation of purgatives,
and may be so employed, when, either at the same time with
the opiate, or not long after it, a purgative can be exhibited.
Is the hyoscyamus, as often showing, along with its narcotic,
a purgative quality, better suited to this disease than opium?
MCCCLXXX1X.
It is seemingly on good grounds that several practitioners
have recommended the large use of mild oils in this disease,
both as antispasmodics and as laxatives; and, where the palate
and stomach could admit them, I have found them very use-
ful; but, as there are few Scottish stomachs that can admit
a large use of them, I have had few opportunities of em-
ploying them.
MCCCXC.
The second set of remedies adapted to the cure of colic are
purgatives, which, by exciting the action of the intestines,
either above or below the obstructed place, may remove the
constriction; and, therefore, these purgatives may be given
either by the mouth, or thrown by clyster into the anus.
As the disease is often seated in the great guts; as clysters
by 

150 PRACTICE
by having a more sudden operation, may give more imme-
diate relief; and as purgatives given by the mouth are ready
to be rejected by vomiting; so it is common, and, indeed,
proper, to attempt curing the colic in the full place by cly-
sters. These may at first be of the mildest kind, consisting
of a large bulk of water, with some quantity of a mild oil;
and such are sometimes sufficiently efficacious; however,
they are not always so; and it is commonly necessary to
render them more powerfully stimulant by the addition of
neutral salts, of which the most powerful is the common, or
marine salt. If these saline clysters, as sometimes happens,
are rendered again too quickly, and on this account, or other-
wise, are found ineffectual, it may be proper, instead of these
salts, to add to the clysters an infusion of senna, or of some
other purgative that can be extracted by water. The anti-
monial wine may be sometimes employed in clysters with ad-
vantage. Hardly any clysters are more effectual than those
made of turpenthine properly prepared. When all other in-
jections are found ineffectual, recourse is to be had to the
injection of tobacco smoke; and, when even this fails, recourse
is to be had to the mechanical dilatation to be mentioned
hereafter.
MCCCXCI.
As clysters often fail altogether in relieving this disease,
and, even when they give some relief, they, are often still
imperfect in producing a complete cure, it is generally proper,
and often necessary, to attempt a more entire and certain
cure, by purgatives given by the mouth. The more power-
ful of these, or, as they are called, the Drastic Purgatives,
may be sometimes necessary, but their use is to be avoided,
both because they are apt to be rejected by vomiting, and be-
cause, when they do not succede in removing the obstruc-
tion, they are ready to induce an inflammation. Upon this
account it is usual, and, indeed, proper, at least in the first
place, 
 

151 OF PHYSIC 
place, to employ the milder, and less inflammatory purga-
tives. None have succeded with me better than the crystals.
of tartar, because this medicine may be conveniently given.
in small, but repeted, doses, to a considerable quantity;
and, under this management, it is the purgative least ready
to be rejected by vomiting, and much less so than the other
neutral salts. If a stronger purgative be required, jalap,
properly prepared, is less offensive to the palate, and sits bet-
ter upon the stomach, than most other powerful purgatives.
On many occasions of colic, nothing is more effectually pur-
gative than a large dose of calomel. Some practitioners have
attempted to remove the obstruction of the intestines by anti-
monial emetics exhibited in small doses, repeted at proper
intervals; and when these doses are not entirely rejected by
vomiting, they often prove effectual purgatives.
When every purgative has failed, the action of the in-
testines has been effectually excited by throwing cold water
on the lower extremities.
MCCCXCII.
The third means of overcoming the spasm of the intestines
in this disease, is by employing a mechanical dilatation;
and it has been frequently supposed that quicksilver, given
in large quantity, might operate in this manner. I have
not, however, found it successful; and the theory of it is,
with me, very doubtful. Some authors have mentioned the
use of gold and silver pills, or balls, swallowed down; but
I have no experience of such practices, and I cannot suppose
them a probable means of relief. 
MCCCXCIII.
Another means of mechanical dilatation, and a more pro-
bable measure, is by injecting a large quantity of warm water
by a proper syringe, which may throw it with some force,
and 

152 PRACTICE
and in a continued stream, into the rectum. Both from the
experiments reported by the late Mr. De Haen, and from
those I myself have had occasion to make, I judge this re-
medy to be one of the most powerful and effectual.
MCCCXC1V.
I have now mentioned all the several means that may be
employed for the cure of the colic, considered as a genus;
but, before I quit this subject, it may be expected that I
should take notice of some of the species which may seem to
require a particular consideration. In this view, it may be
expected that I should especially take notice of that species
named the Colic of Poitou, and particularly known in Eng-
land by the name of the Devonshire Colic.
MCCCXCV.
This species of the disease is certainly a peculiar one, both
in respect of its cause and its effects; but,as to the first,
it has been lately so much the subject of investigation, and
is so well ascertained by the learned physicians, Sir George
Baker and Dr. Hardy, that it is unnecessary for me to say
any thing of it here.
With respect to the cure of it, so far as it appears in the
form of a colic, my want of experience regarding it does not
allow me to speak with any confidence on the subject; but,
so far as I can learn from others, it appears to me, that it is
to be treated by all the several means that I have proposed
above for the cure of colic in general.
How far the peculiar effects of this disease are to be cer-
tainly foreseen and obviated, I have not properly learned;
and I must leave the matter to be determined by those who
have had sufficient experience in it.
CHAP. 

153 OF PHYSIC. 
CHAP. X.
Of The CHOLERA.
MCCCXCVI.
In this disease, a vomiting and purging concurring toge-
ther, or frequently alternating with one another, are the chief
symptoms. The matter rejected both upwards and down-
wards appears manifestly to consist chiefly of bile.
MCCCXCVII.
From this last circumstance, we conclude that the disease
depends upon an increased secretion of bile, and its copious
effusion into the alimentary canal; in which, as it irritates
and excites the motions above mentioned, we infer, that tne
bile thus effused in larger quantity is, at the same time, also
of a more acrid quality. This appears likewise from the
violent, and very painful gripings that attend the disease,
and which we can impute only to the violent spasmodic con-
tractions of the intestines that take place here. These spasms
are commonly communicated to the abdominal muscles, and
very frequently to those of the extremities
MCCCXCVIII.
In the manner now described, the disease frequently pro-
cedes with great violence till the strength of the patient is
greatly, and often suddenly, weakened, till a coldness of the
extremities, cold sweats, and faintings, shew this, and put
an end to the patient's life, sometimes in the course of one
day. In other cases the disease is less violent, continues for
PART II. V a 

154 PRACTICE.
a day or two, and then ceases by degrees; though such re-
coveries seldom happen without the assistance of remedies.
MCCCXCIX.
This disease seldom comes on with any symptoms of py-
rexia; and though, during the course of it, both the pulse
and respiration are hurried and irregular, these symptoms are
generally so entirely removed by the remedies that quiet the
spasmodic affections peculiar to the disease, as to leave no
ground for supposing that it had been accompanied by any
proper pyrexia.
MCCCC.
This is a disease attending a very warm state of the air;
and, in very warm climates, it may, perhaps, appear at any
time of the year; but, even in these climates, it is most fre-
quent during their warmest seasons; and, in temperate cli-
mates, appears only in the warm seasons. Dr. Sydenham
considered the appearances of this disease in England to be
confined to the month of August, but be himself observed it
to appear sometimes towards the end of summer, when the
season was unusually warm, and that, in proportion to the
heat, the violence of the disease was greater. Others have
observed that it appeared more early in summer, and always
sooner or later, according as the great heats sooner or later
set in.
MCCCCI.
From all these circumstances, it is, I think, very evident,
that this disease is the effect of a warm atmosphere, produc-
ing some change in the state of the bile in the human body,
and this change consisting either in its rendering the mat-
ter of the bile more acrid, so as thereby to stimulate a more
copious secretion, or merely by disposing the matter of the
bile 

155 OF PHYSIC. 
bile to pass off in larger quantity, and, under that circum-
stance, perhaps, necessarily more acrid.
MCCCCII.
It has been remarked, that, in warm climates, and seasons,
after extremely hot and dry weather, a fall of rain cooling
the atmosphere seems especially to bring on this disease;
and it is very probable that an obstructed perspiration may
have also a share in this, though it certainly happens that
the disease does appear when no change in the temperature
of the air, nor any application of cold, have been observed.
MCCCCIII.
It is possible, that in some cases, the heat of the season
may give only a predisposition, and that the disease may be
excited by certain ingesta, or other causes; but it is equally
certain that the disease has occurred without any previous
change, or error, either in diet, or in manner of life, that
could be observed.
MCCCCIV.
The Nosologists have constituted a Genus under the title
of Cholera, and under this have arranged as species, every
affection in which a vomiting and purging of any kind hap-
pened to concur. In many of these species, however, the
matter evacuated is not bilious, and though it were, the eva-
cuation does not procede from any cause in the state of the
atmosphere. In many cases, too, the vomiting which occurs
is not an essential, but merely an accidental symptom, from
the particular violence of the disease. The appellation of
Cholera, therefore, should, in my opinion, be confined to
the disease I have described above, which by its peculiar
cause, and, perhaps, also by its symptoms, is very different
from all the other species that have been associated with it.
I 

156 PRACTICE
I believe that all the other species arranged under the title
of Cholera by Sauvages, or Sagar, may be properly enough
referred to the genus of Diarrhœa, which we are to treat of
presently.
The distinction I have endeavoured to establish between
the proper Cholera, and the other diseases that have some-
times got the same appellation, will, as I judge, supersede
the question, Whether the Cholera, in temperate climates,
happens at any other season than that above assigned.
MCCCCV.
In the case of a genuine cholera, the cure of it has been
long ago established by experience.
In the beginning of the disease, the evacuation of the re-
dundant bile is to be favoured by the plentiful exhibition of
mild diluents, both given by the mouth, and injected by the
anus; and all evacuant medicines, employed in either way,
are not only superfluous, but commonly hurtful.
MCCCCVI.
When the redundant bile appears to be sufficiently washed
out, and even before that, if the spasmodic affections of the
alimentary canal become very violent, and are communicated
in a considerable degree to other parts of the body, or when
a dangerous debility seems to be induced, the irritation is to
be immediately obviated by opiates, in sufficiently large doses,
but in small bulk, and given either by the mouth or by
clyster.
MCCCCVII.
Though the patient be in this manner relieved, it fre-
quently happens, that, when the operation of the opium is
over, the disease shows a tendency to return; and, for at
least some days after the first attack, the irritability of the
intestines, 

157 OF PHYSIC. 
intestines, and their disposition to fall into painful spasmo-
dic contractions, seem to continue. In this situation, the
repetition of the opiates, for perhaps several days, may come
to be necessary; and, as the debility commonly induced by
the disease favours the disposition to spasmodic affections, it
is often useful and necessary, together with the opiates, to
employ the tonic powers of the Peruvian bark.
CHAP. XI.
Of DIARRHOEA,
OR
LOOSENESS.
MCCCCVIII.
This disease consists in evacuations by stool, more fre-
quent, and of more liquid matter, than usual. This lead-
ing and characteristic symptom is so diversified in its degree,
in its causes, and in the variety of matter evacuated, that it
is almost impossible to give any general history of the dis-
ease.
MCCCCIX.
It is to be distinguished from dysentery by not being con-
tagious, by being generally without fever, and by being
with

158 PRACTICE
with the evacuation of the natural excrements, which are,
at least for some time, retained in dysentery. The two dis-
eases have been commonly distinguished by the gripings
being more violent in the dysentery; and they are common-
ly less violent and less frequent in diarrhœa; but as they
frequently do occur in this also, and sometimes to a con-
siderable degree, so they do not afford any proper di-
stinction.
MCCCCX.
A diarrhœa is to be distinguished from Cholera, chiefly
by the difference of their causes, which, in cholera, is of
one peculiar kind, but, in diarrhœa, is prodigiously diversi-
fied, as we shall see presently. It has been common to di-
stinguish cholera, by the purging of bilious matter, in this,
being always accompanied with a vomiting of the same
kind; but it does not universally apply, as a diarrhœa is
sometimes attended with vomiting, and even of bilious
matter.
MCCCCXI.
The disease of diarrhœa, thus distinguished, is very
greatly diversified; but, in all cases, the frequency of stools
is to be imputed to a preternatural increase of the peristaltic
motion, in the whole, or at least, a considerable portion of
the intestinal canal. This increased action is in different de-
grees, is often convulsive and spasmodic, and, at any rate,
is a motus abnormis; for which reason, in the Methodical
Nosology, I have referred it to the order of Spasmi, and,
accordingly, treat of it in this place.
MCCCCXII.
Upon the same ground, as I consider, the disease named
Lientery to be the highest degree of an increased peristaltic
motion, 

159 OF PHYSIC. 
motion, I have considered it as merely a species of di-
arrhœa. The idea of a laxity of the intestinal canal being
the cause either of lientery, or other species of diarrhœa, ap-
pears to me to be without foundation, except in the single
cafe of frequent liquid stools from a palsy of the sphincter
ani.
MCCCCXIII.
The increased action of the peristaltic motion, I consider,
as always the chief part of the proximate cause of diarrhœa;
but the disease is further, and, indeed, chiefly diversified by
the different causes of this increased action, which we are
now to inquire into.
MCCCCXIV.
The several causes of the increased action of the intestines
may be referred, I think, in the first place, to two general
heads.
The first is, of the diseases of certain parts of the body,
which, either from a consent of the intestines with these
parts, or from the relation which the intestines have to the
whole system, occasion an increased action in the intestines,
without the transference of any stimulant matter from the
primary diseased part to them.
The second head of the causes of the increased action of the
intestines is, of the stimuli of various kinds, which are ap-
plied directly to the intestines themselves.
MCCCCXV.
That affections of other parts of the system may affect the
intestines without the transference of any stimulant matter,
we learn from hence, that the passions of the mind do in
some persons excite diarrhœa.
MCCCCXVI.

160 PRACTICE
MCCCCXVI.
That diseases in other parts may, in like manner affect
the intestines, appears from the dentition of infants, fre-
quently exciting diarrhœa. I believe that the gout often
affords another instance of the same kind; and, probably,
there are others, though not well ascertained.
MCCCCXVII.
The stimuli (MCCCCXIV.) which may be applied to
the intestines are of very various kinds, and are either, 1.
Matters immediately introduced by the mouth; or, 2. Mat-
ters poured into the intestines by the several excretories
opening into them; or, 3. Matters poured from certain
preternatural openings made into them in certain diseases.
MCCCCXVIII.
Of those (MCCCCXVII.) introduced by the mouth, the
first to be mentioned are the aliments commonly taken in.
These being taken in in too great quantity, often prevent
their due digestion in the stomach, and being thus sent in
their crude, and, probably, acrid state, to the intestines,
they frequently excite diarrhœa.
The same aliments, though, in proper quantity, yet
having too great a proportion, as is often the case, of saline
or saccharine matter along with them, prove stimulant to
the intestines, and excite diarrhœa.
But our aliments prove especially the causes of diarrhœa,
according as they, from their own nature, or from the weak-
ness of the stomach, are disposed to undergo an undue de-
gree of fermentation there, and thereby become stimulant to
the intestines. Thus, acescent aliments are ready to produce
diarrhœa; but whether from their having any directly pur-
gative quality, or only as mixed in an over-proportion with
the bile, is not well determined.
MCCCCXIX.

161 OF PHYSIC. 
MCCCCXIX.
Not only the acescent, but the putrescent disposition of
the aliments, is a cause of diarrhœa; and it appears, that
even the effluvia of putrid bodies, taken in, any how in
large quantity, have the same effect.
Are oils or fats, taken in as a part of our aliments, ever
the cause of diarrhœa; and, if they be, in what manner do
they operate?
MCCCCXX.
The other matters introduced by the mouth, which may
be causes of diarrhœa, are those thrown in either as medi-
cines, or poisons that have the faculty of stimulating the
alimentary canal. Thus, in the list of the Materia Medica,
we have a long catalogue of those named purgatives; and
in the list of poisons, we have many possessed of the same
quality. The former, given in a certain quantity, occasion
a temporary diarrhœa, and, given in very large doses, may
occasion it in excess, and continue it longer than usual,
producing that species of diarrhœa named a Hjpercatharsis,
MCCCCXXI.
The matters (MCCCCXVII.) 2. poured into the cavity
of the intestines, from the excretories opening into them,
and which may occasion diarrhœa, are either those from
the pancreatic or biliary duct, or those from the excretories
in the coats of the intestines themselves.
MCCCCXXII.
What changes may happen in the pancreatic juice I do
not exactly know, but I conceive them possible, and that an
acrid fluid may issue from the pancreas, even while still en-
tire in its structure; but more especially when it is in a sup-
Part II. X purated, 

162 PRACTICE
purated, schirrous, or cancerous state, a very acrid matter
may be poured out, and occasion diarrhœa.
MCCCCXXIII.
We know well, that, from the biliary ducts, the bile
may be poured out in greater quantity than usual; and there
is little doubt of its being also sometimes poured out of a
more than ordinary acrid quality. It is very probable, that,
in both ways, the bile is frequently a cause of diarrhœa.
Though I have said above that diarrhœa may be common-
ly distinguished from cholera, I must admit here, that, as
the causes producing that state of the bile which occasions
cholera, may occur in all the different possible degrees of
force, so as, on one occasion, to produce the most violent,
and distinctly marked cholera, but, upon another, to pro-
duce only the gentlest diarrhœa, which, however, will be
the same disease, only varying in degree; so I think it pro-
bable, that in warm climates, and in warm seasons, a
diarrhœa biliosa of this kind may frequently occur, not to be
always certainly distinguished from cholera.
However this may be, it is sufficiently probable, that, in
some cases, the bile, without having been acted upon by
the heat of the climate or season, may be redundant and
acrid, and be thereby a particular cause of diarroea.
MCCCCXXIV.
Beside bile from the several causes, and in the conditions
mentioned, the biliary duct may pour out pus, or other
matter, from abscesses in the liver, which may be the cause
of diarrhoea.
Practical writers take notice of a diarrhoea wherein a thin
and bloody liquid is discharged, which they suppose to have
preceded from the liver, and have therefore given the dis-
ease the name of Hepatirrhoea; but we have not met with
any 

163 OF PHYSIC. 
any instance of this kind, and, therefore, cannot properly
say any thing concerning it.
MCCCCXXV.
A second set of excretories, from which matter is poured
into the cavity of the intestines, are those from the coats of
the intestines themselves, and are either the exhalants pro-
ceding directly from the extremities of arteries, or the ex-
cretories from the mucous follicles; and both these sources
occur in prodigious number over the internal surface of the
whole intestinal canal. It is probable that it is chiefly the
effusion from these sources, which, in most instances, gives
the mattter of the liquid stools occurring in diarrhoea.
MCCCCXXVI.
The matter from both sources may be poured out in larger
quantity than usual, merely by the increased action of the
intestines, whether that be excited by the passions of the
mind (MCCCCXV.), by diseases in other parts of the system
(MCCCCXVI.), or by the various stimulants mentioned
(MCCCCXVII. and following), or the quantity of matter
poured out may be increased, not so much by the increased
action of the intestines, as by an increased afflux of fluids
from other parts of the system.
Thus, cold applied to the surface of the body, and sup-
pressing prespiration, may determine a greater quantity of
fluids to the intestines.
Thus, the urine in the ischuria renalis is sometimes de-
termined to pass off again by the intestines.
In like manner, pus or serum may be absorbed from the
cavities in which they have been stagnant, and be again
poured out into the intestines, as often happens, in par-
ticular with respect to the water of dropsies.
MCCCCXXVII. 

166 PRACTICE
MCCCCXXXIII.
Another preternatural source of matter poured into the
cavity of the intestines, is the opening of abscesses, seated
either in the coats of the intestines themselves, or in any of
the contiguous viscera, which, during an inflamed state, had
formed an adhesion with some part of the intestines. The
matter thus poured into their cavity may be various, purulent
or sanious, or both together, mixed at the same time with
more or less of blood, and in each of these states may be
a cause of diarrhœa.
MCCCCXXXIV.
Amongst the stimuli that may be directly applied to the
intestines, and which, by increasing their peristaltic motion,
may occasion diarrhoea, we must not omit to mention worms,
as having frequently that effect.
MCCCCXXXV.
We must also mention here a state of the intestines, where-
in their peristaltic motion is preternaturally increased, and
a diarrhoea produced; and that is, when they are affected
with an erysipelatous inflammation. With respect to the
existence of such a state, and its occasioning diarrhoea, see
what is said above in (CCCLXXVIII. and following.)
Whether it is to be considered as a particular and distinct
case of diarrhoea, or is always the same with some of these
produced by one or other of the causes above mentioned, I
have not been able to determine.
MCCCCXXXVI.
Lastly, by an accumulation of alimentary, or other matter,
poured into the cavity of the intestines from several of the
sources above mentioned, a diarrhoea may be especially oc-
casioned when the absorption of the lacteals, or of other ab-
sorbents, 

167 OF PHYSIC.
sorbents, is prevented, either by an obstruction of their ori-
fices, or by an obstruction of the mesenteric glands, through
which alone the absorbed fluids can be transmitted.
In one instance of this kind, when the chyle prepared in
the stomach and duodenum is not absorbed in the course of
the intestines, but passes off in considerable quantity by the
anus, the disease has been named the Morbus Cæliacus, or
simply, and more properly, Cæliaca, which, accordingly, I
have considered as a species of diarrhoea.
MCCCCXXXVII.
I have thus endeavoured to point out the various species
of disease that may come under the general appellation of
diarrhoea; and from that enumeration it will appear, that
many, and, indeed, the greater part of the cases of diarrhoea,
are to be considered as sympathic affections, and to be cured
only by curing the primary disease upon which they depend;
of which, however, I cannot properly treat here. From our
enumeration, it will also appear, that many of the cases of
diarrhoea, which may be considered as idiopathic, will not
require my saying much of them here: In many instances,
the disease is ascertained, and also the cause assigned, by the
condition of the matter evacuated, so that what is necessary
to correct or remove it will be sufficiently obvious to practi-
tioners of any knowledge. In short, I do not find that I
can offer any general plan for the cure of diarrhoea; so that
all I can propose on this subject, is to give some general re-
marks on the practice that has been commonly followed in
the cure of this disease.
MCCCCXXXVIII.
The practice in this disease has chiefly preceded upon the
supposition of an acrimony in the fluids, or of a laxity in the
simple and moving fibres of the intestines; and, the remedies
employed 

168 PRACTICE.
employed have accordingly been correctors of particular acri-
mony, general demulcents, evacuants by vomiting or purg-
ing, astringents, or opiates. Upon each of these kinds of
remedy I shall now offer some remarks.
MCCCCXXXIX.
An acid acrimony is, upon several occasions, the cause of
diarrhoea, particularly in children, and, in such cases, the
absorbent earths have been very properly employed. Their
common, however, and promiscuous use has been very in-
judicious; and where there is any putrescency they must be
hurtful.
MCCCCXL.
The cases in which there is a putrid or putrescent acri-
mony have, I think, been too seldom taken notice of, and,
therefore, the use of acids too seldom admitted. The acri-
mony to be suspected in bilious cases, is probably of the
putrescent kind.
MCCCCXLI.
The general correctors of acrimony are the mild diluents
and demulcents. The former have not been so much em-
ployed in diarrhœa as they ought; for, joined with de-
mulcents, they very much increase the effects of the latter;
and although the demulcents, both mucilaginous and oily,
may by themselves be useful, yet, without the assistance of
diluents, they can hardly be introduced in such quantity as
to answer the purpose.
MCCCCXLII.
As indigestion, and crudities present in the stomach, are
so often the cause of diarrhœa, vomiting must therefore be
frequently very useful in this disease.
In 

169 OF PHYSIC: 
In like manner, when the disease procedes, as it often
does, from obstructed perspiration, and an increased afflux of
fluids to the intestines, vomiting is perhaps the most effectual
means of restoring the determination of the fluids to the sur-
face of the body.
It is possible that vomiting may give some inversion of the
peristaltic motion, which is determined too much down-
wards in diarrhœa; so that, upon the whole, it is a remedy
which may be very generally useful in this disease.
MCCCCXLIII.
Purging has been supposed to be more universally ne-
cessary, and has been more generally practised. This, how-
ever, in my opinion, procedes, upon very mistaken notions
of the disease; and such a practice feems to me, for the most
part, superfluous and in many cases very hurtful.
It goes upon the supposition of an acrimony prefent in the
intestines, to be carried out by purging; but, if that acri-
mony has either been introduced by the mouth, or brought
into the intestines from other parts of the body, purging
can neither be a means of correcting nor of exhausting it,
and must rather have the effect of increasing its afflux, and
of aggravating its effects. From whatever source the acri-
mony which can excite a diarrhoea procedes, it may be sup-
posed sufficient to evacuate itself, so far as that can be done,
by purging; and as in cholera, so, in the same kind of
diarrhoea, it will be more proper to assist the evacuation by
diluents and demulcents, than to increase the irritation by
purgatives.
MCCCCXLIV.
If then, the use of purgatives, in diarrhœa, may be con-
sidered, even in the case of an acrimony present, as super-
fluous, there are many other cases in which they may be
Part II. Y extremely 

170 PRACTICE
extremely hurtful. If the irritability of the intestines shall,
from affections in other parts of the system, or other causes
have been already very much increased, purgatives must ne-
cessarily aggravate the disease. In the case of lientery, no
body thinks of giving a purgative; and in many cases of
diarrhœa approaching to that, they must be equally impro-
per. I have already observed, that, when diarrhœa pro-
cedes from an afflux of fluids to the intestines, whether in
too great quantity, or of an acrid quality, purgatives may
be hurtful; and whoever, therefore, considers the numerous
and various sources from which acrid matter may be poured
into the cavity of the intestines, will readily perceive, that,
in many cases of diarrhœa, purgatives may be extremely
pernicious.
There is one case in particular to be taken notice of.
When, from a general and acrid dissolution of the blood,
the serous fluids run off too copiously into the cavity of the
intestines, and excite that diarrhœa which attends the ad-
vanced state of hectic fever, and is properly called a Col-
liquative Diarrhœa. I have, in such cases, often seen pur-
gatives given with the most baneful effects.
There is still another case of diarrhœa in which purgatives
are pernicious, and that is when the disease depends, as we
have alleged it sometimes may, upon an erysipelatous in-
flammation of the intestines.
I need hardly add, that, if there be a case of diarrhœa
depending upon a laxity of the solids, purgatives cannot
there be of any service, and may do very much harm. Upon
the whole, it will, I think, appear, that the proper use of
purgatives in diarrhœa is very much limited, and that the
promiscuous use of them, which has been so common, is in-
judicious, and often pernicious. I believe the practice has
been chiefly owing to the use of purgatives in dysenteric
cases, in which they are truly useful, because, contrary to
the 

171 OF PHYSIC.
the case of diarrhœa, there is in dysentery a considerable
constriction of the intestines.
MCCCCXLV.
Another set of remedies employed in diarrhœa, are
astringents. There has been some hesitation about the em-
ployment of these in recent cases, upon the supposition that
they might occasion the retention of an acrid matter that
should be thrown out. I cannot, however, well understand,
or assign the cases in which such caution is necessary; and
I think that the power of astringents is seldom so great as to
render their use very dangerous. The only difficulty which
has occurred to me, with respect to their use, has been to
judge of the circumstances to which they are especially
adapted. It appears to me to be only in these where the
irritability of the intestines depends upon a loss of tone; and
this, I think, may occur either from the debility of the whole
system, or from causes acting on the intestines alone, all vio-
lent, or long continued spasmodic and convulsive affections of
the intestinal canal, necessarily inducing a debility there. Such
causes often take place, from violent irritation, in colic,
dysentery, cholera, and diarrhœa.
MCCCCXLVI.
The last of the remedies of diarrhoea that remain to be
mentioned are opiates. The same objections have been made
to the use of thee, in recent cases of diarrhoea, as to that of
astringents, but on no good grounds; for the effects of opi-
ates, as astringent, are never very permanent, and an evacu-
ation depending upon irritation, though it may be for some
time suspended by opiates, yet always returns very soon. It
is only by taking off irritability that opiates are useful, in
diarrhoea; and, therefore, when the disease depends upon an
increase of irritability alone, or when, though proceding
from 

172 PRACTICE
from irritation, that irritation is corrected or exhausted, opi-
ates are the most useful and certain remedy. And, though
opiates are not suited to correct or remove an irritation ap-
plied, they are often of great benefit in suspending the ef-
fects of that irritation whenever these are violent; so, upon
the whole, it will appear, that opiates may be very frequent-
ly, and with great propriety, employed in the cure of di-
arrhoea.
CHAP. XII.
Of The DIABETES.
MCCCCXLVII.
This disease consists in the voiding of an unusually large
quantity of urine.
As hardly any secretion can be increased without an in-
creased action of the vessels concerned in it, and as some in-
stances of this disease are attended with affections manifestly
spasmodic, I have had no doubt of arranging the diabetes
under the order of Spasmi.
MCCCCXLVIII.
This disease is always accompanied with a great degree
of thirst, and, therefore, with the taking in of a great quan-
tity of drink. This, in some measure, accounts for the very
extraordinary quantities of urine voided; but still, indepen-
dent of this, a peculiar disease certainly takes place, as the
quantity of urine voided does almost always excede the
whole of the liquids taken in.
MCCCCXLIX. 

173 OF PHYSIC.
MCCCCXLIX.
The urine voided in this disease is always very clear, and,
at first sight, appears entirely without any colour, but,
viewed in a certain light, it generally appears to be slightly
tinged with a yellowish green, and, in this respect, has been
very properly compared to a solution of honey in a large
proportion of water.
Examined by the taste, it is very generally found to be
more or less sweet; and many experiments that have now
been made in different instances of the disease, show clearly
that such urine contains, in considerable quantity, a saccha-
rine matter, and which appears to be very exactly of the na-
ture of common sugar.
MCCCCL.
Doctor Willis seems to me to have been the first who took
notice of the sweetness of the urine in diabetes, and almost
every physician of England since has taken notice of the
same. It is to be doubted, indeed, if there is any case of
idiopathic diabetes in which the urine is of a different kind.
Tho' neither the antients nor, in the other countries of
Europe, the moderns, till the latter were directed to it by
the English, have taken notice of the sweetness of the urine,
it does not persuade us, that, either in antient or in modern
times, the urine in diabetes was of another kind. I myself,
indeed, think I have met wish one instance of diabetes in
which the urine was perfectly insipid; and it would seem
that a like observation had occurred to Dr. Martin Lister.
I am, persuaded, however, that such instances are very rare,
and that the other is by much the more common, and, per-
haps, the almost universal. I judge, therefore, that the pre-
sence of such a saccharine matter may be considered as the
principal circumstance in idiopathic diabetes; and it gives,
at least, the only case of that disease that lean properly treat
of 

i74 PRACTICE
of here; for I am only certain, that what I am further to
mention relates to such a case.
MCCCCLI.
The antecedents of this disease, and, consequently, the
remote causes of it, have not been well ascertained. It may
be true that it frequently happens to men, who, for a long
time before, had been intemperate in drinking; that it hap-
pens to persons of a broken constitution, or who, as we often
express it, are in a cachectic state; that it sometimes follows
intermittent fevers; and that it has often occurred from ex-
cess in the drinking of mineral waters; but none of these
causes apply very generally to the cases that occur. They
are not always,nor even frequently, followed by a diabetes;
and there are many instances of diabetes which could not be
referred to any of them. In most of the cases of this disease
which I have met with, I could not refer it to any particular
cause.
MCCCCLII.
This disease commonly comes on slowly, and almost im-
perceptibly, without any previous disorder. It often arises
to a considerable degree, and subsists long, without being
accompanied with evident disorder in any particular part of
the system. The great thirst which always, and the voraci-
ous appetite which frequently occur in it, are often the only
remarkable symptoms. Under the continuance of the dis-
ease, the body is often greatly emaciated; and a great
weakness also prevails. The pulse is commonly frequent;
and an obscure fever is, for the most part, present. When
the disease proves fatal, it generally ends with a fever, in
many circumstances, particularly those of emaciation and de-
bility, resembling a hectic.
MCCCCLIII.
The proximate cause of this disease is not certainly or
clearly 

175 OF PHYSIC. 
clearly known. It seems to have been sometimes connected
with calculous affections of the kidneys; and it is possible,
that an irritation applied there, may increase the secretion
of urine. It perhaps often does so; but how it should pro-
duce the singular change that takes place in the state of the
urine, is not to be easily explained. It certainly often hap-
pens, that calculous matters are long present in the urinary
passages, without having any such effect as that of producing
diabetes in any shape.
Some have supposed that the disease occurs from a relaxed
state of ihe secretory vessels of the kidneys; and, indeed, the
dissections of persons who had died of this disease have shown
the kidneys in a very flaccid state. This, however, is pro-
bably to be considered as rather the effect, than the cause
of the disease.
That no topical affection of the kidneys has a share in
producing this disease, and that a fault in the assimilation
of the fluids is rather to be blamed, I conclude from hence,
that even the solid food taken in, increases the quantity of
the urine voided, at the same time, with an encrease of the
saccharine matter above mentioned.
MCCCCLIV.
The diabetes has been supposed to be owing to a certain
state of the bile; and it is true, that this disease has some-
times occurred in persons who were, at the same time, af-
fected with diseases of the liver; but this concurrence does
not often take place; and the diabetes frequently occurs,
separately from any affection of the liver. In twenty in-
stances of diabetes which I have seen, there was not, in any
one of them, any evident affection of the liver. 
The explanation that has been offered of the nature and
operation of the bile, in producing diabetes, is very hy-
pothetical, and nowise satisfying.
MCCCCLV.

176 PRACTICE
MCCCCLV.
As I have already said, I think it probable, that, in most
cases, the proximate cause of this disease is some fault in
the assimilatory powers, or in those employed in converting
alimentary matters into the proper animal fluids. This I
formerly hinted to Dr. Dobson, and it has been prosecuted
and published by him; but I must own, that it is a theory
embarrassed with some difficulties, which I cannot at present
very well remove.
MCCCCLVI.
The proximate cause of diabetes being so little known or
ascertained, I cannot propose any rational method of cure in
the disease. From the testimony of several authors, I be-
lieve that the disease has been cured; but I believe also,
that this has seldom happened; and when it has been cured,
I doubt much if it was effected by the several remedies, to
which these cures have been ascribed. In all the instances
of this disease which I myself have seen, and in several others
of which I have been informed, no cure of it has ever been
made in Scotland, though many instances of it have occur-
red, and in most of them, the remedies recommended by
authors have been diligently employed. I cannot, there-
fore, with any advantage, enter into a detail of these reme-
dies; and as the disease, together with its several circum-
stances, are likely to become soon the subject of diligent in-
vestigation, I avoid going farther at present, and judge it
prudent to suspend my opinion, till I shall have more ob-
servations and experiments upon which I can found.
CHAP. 

177 OF PHYSIC. 
CHAP. XIII.
OF HYSTERIA,
OR THE
HYSTERIC DISEASE,
MCCCCLVII.
The many and various symptoms which have been supposed
to belong to a disease under this appellation, render it ex-
tremely difficult to give a general character or definition of
it. It is however, proper, in all cases, to attempt some
general idea; and, therefore, by taking the most common
form, and that concurrence of symptoms by which it is
principally distinguished, I have formed a character in my
system of Methodical Nosology, and shall here endeavour to
illustrate it, by giving a more full history of the phenomena.
MCCCCLVIII.
The disease attacks in paroxysms or fits. These common-
ly begin by some pain and fulness felt in the left side of the
belly. From this a ball seems to move, with a grumbling
noise, into the other parts of the belly, and making, as it
were, various convolutions there, seems to move into the
stomach, and more distinctly still rises up to the top of the
gullet, where it remains for some time, and, by its pressure
PART II. Z upon 

178 PRACTICE
upon the larynx, gives a sense of suffocation. By the time
that the disease has proceded thus far, the patient is affected
with a stupor and insensibility, while, at the same time, the
body is agitated with various convulsions The trunk of the
body is wreathed to and fro, and the limbs are variously
agitated; commonly the convulsive motion of one arm and
hand, is that of beating, with the closed fist, upon the
breast very violently and repeatedly. This state continues
for some time, and has, in that period, some remissions and
renewals of the convulsive motions; but they at length cease,
leaving the patient in a stupid, and seemingly sleeping state.
More or less suddenly, and frequently with repeted sighing
and sobbing, together with a murmuring noise in the belly,
the patient comes out of this, and returns to the exercise of
sense and motion, but, generally, without any recollection
of the several circumstances we have here described.
MCCCCLIX.
This is the form of what is called an hysteric paroxysm, and is
the most common form; but its paroxysms are considerably
varied in different persons, and even in the same person at
different times. It differs, by having more or fewer of the
circumstances above mentioned; by these circumstances being
more or less violent; and by the different duration of the
whole fit.
Before the fit, there is sometimes a sudden, and unusually
large flow of limpid urine. At the coming on of the fit, the
stomach is sometimes affected with vomiting, the lungs with
considerable difficulty of breathing, and the heart with pal-
pitations. During the fit, the whole of the belly, and par-
ticularly the navel, is drawn strongly inwards; the sphincter
ani is sometimes so firmly constricted as not to admit a small
clyster pipe; and there is, at the same time, an entire sup-
pression of urine. Such fits are, from time to time, ready to
recur; 

179 OF PHYSIC.
recur; and, during the intervals, the patients are liable to
involuntary motions, to fits of laughing, and crying, with
sudden transitions from the one to the other, while some-
times false imaginations, and some degree of delirium, also
occur.
MCCCCLX.
These affections have been supposed peculiar to the fe-
male sex; and, indeed, they most commonly appear in fe-
males; but they sometimes, though rarely, attack also the
male sex; never, however, that I have, observed, in the
same exquisite degree.
In the female sex, the disease occurs, especially from
the age of puberty to that of thirty-five years, and though
it does sometimes, yet very seldom appears before the former,
or after the latter of these periods.
At all ages, the time at which it most readily occurs is
that of the menstrual period.
The disease affects the females of the most exquisitely
sanguine and plethoric habits, and frequently affects those
of the most robust and masculine constitutions.
It affects the barren more than the breeding women, and
therefore frequently young widows.
It occurs especially in those females who are liable to the
Nymphomania; and the Nosologists have, properly enough,
marked one of the varieties of this disease, by the title of
Hysteria Libidinosa.
In the persons liable to the fits of this disease, it is readily
excited by the passions of the mind, and by every consider-
able emotion, especially those brought on by surprise.
The persons liable to this disease acquire often such a de-
gree of sensibility as to be strongly affected by every impres-
sion that comes upon them by surprise.
MCCCCLXI. 

180 PRACTICE
MCCCCLXI.
In this history, there appears to be a concurrence of sym-
ptoms and circumstances, properly marking a very particular
disease, which I think may be distinguished from all others.
It seems to me to have been improperly considered by phy-
sicians as the same with some other diseases, and particularly
with hypochondriasis. The two diseases may have some sym-
ptoms in common, but, for the most part, are considerably
different.
Spasmodic affections occur in both diseases, but neither so
frequently, nor to so great a degree, in hypochondriasis as in
hysteria.
Persons liable to hysteria are sometimes affected at the same
time with dyspepsia. They are often, however, entirely
free from it; but I believe this never happens to persons af-
fected with hypochondriasis.
These different circumstances mark some difference in the
two diseases, but they are still more certainly distinguished
by the temperament they attack, and by the time of life at
which they appear to be most exquisitely formed.
It has been generally supposed, that the two diseases dif-
fer only in respect of their appearing in different sexes; but
this is not well founded; for, although the hysteria appears
most commonly in females, the male fex are not absolutely
excluded, as we have observed above; and, although the hy-
pochondriasis may be most frequent in men, the instances of
it in the female sex are very common.
MCCCCLXII.
From all these considerations, it must, I think, appear,
that the hysteria may be very well, and properly, distin-
guished from hypochondriasis.
Further, it seems to me to have been with great impro-
priety, that almost every degree of the irregular motions of
the

181 OF PHYSIC.
the nervous system has been referred to the one or other of
these two diseases. Both are marked by a peculiarity of
temperament, as well as by certain symptoms commonly ac-
companying that; but some of these, and many others usually
marked by the name of Nervous Symptoms, may, from va-
rious causes, arise in temperaments different from that which
is peculiar to either hysteria or hypochondriasis, and without
being joined with the peculiar symptoms of either the one
or the other disease; so that the appellation of Hysteric and
Hypochondriac are very inaccurately applied to them.
Under what view these symptoms are otherwise to be consi-
dered, I am not ready to determine, but must remark, that
the appellation of Nervous Diseases, is too vague and unde-
fined to be of any useful application.
MCCCCLXIII.
Having thus endeavoured to distinguish hysteria from every
other disease, I shall now attempt its peculiar pathology.
With respect to this, I think it will, in the first place, be ob-
vious, that its paroxysms begin by a convulsive and spasmo-
dic affection of the alimentary canal, which is afterwards
communicated to the brain, and to a great part of the ner-
vous system. Although the disease appears to begin in the
alimentary canal, yet the connection which the paroxysms so
often have with the menstrual flux, and with the diseases
that depend on the state of the genitals, shows, that physi-
cians have, at all times, judged rightly in considering this
disease as an affection of the uterus, and other parts of the
genital system.
MCCCCLXIV.
With regard to this, however, I can go no farther. In
what manner the uterus, and in particular the ovaria, are af-
fected in this disease; how the affection of these is commu-
nicated 

182 PRACTICE
nicated with particular circumstances to the alimentary canal;
or how the affection of this, rising upwards, affects the brain,
so as to occasion the particular convulsions which occur in
this disease, I cannot pretend to explain.
But, although I cannot trace this disease to its first causes,
or explain the whole of the phenomena, I hope, that, with
respect to the general nature of the disease, I may form some
general conclusions, which may serve to direct, our conduct in
the cure of it.
MCCCCLXV.
Thus, from a consideration of the predisponent and occa-
sional causes, it will, I think, appear, that the chief part of
the proximate cause is a mobility of the system, depending
generally upon its plethoric state.
MCCCCLXVI.
Whether this disease ever arise from a mobility of the
system, independent of any plethoric state of it, I cannot po-
sitively determine; but, in many cases that have subsisted for
some time, it is evident that a sensibility, and consequently,
a mobility, are acquired, which often appear when neither
a general plethora can be supposed to subsist, nor an occa-
sional turgescence to have happened. However, as we have
shown above that a distension of the vessels of the brain
seems to occasion epilepsy, and that a turgescence of the
blood in the vessels of the lungs seems to produce asthma, so
analogy leads me to suppose, that a turgescence of blood in
the uterus, or in other parts of the genital system, may oc-
casion the spasmodic and convulsive motions which appear
in hysteria. It will, at the same time, be evident, that this
affection of the genitals must especially occur in plethoric
habits; and every circumstance mentioned in the history of
the disease serves to confirm this opinion as to its proximate
cause.
MCCCCLXVII. 

183 OF PHYSIC.
MCCCCLXVII.
From this view of the subject, the analogy of hysteria and
epilepsy will readily appear; and why, therefore, we are to
say that the indications of cure are the same in both.
As the indications, so the several means of answering them,
are so much the same in both diseases, that the same obser-
vations and directions, with regard to the choice and employ-
ment of these remedies, that have been delivered above on
the subject of epilepsy, will apply pretty exactly to hysteria,
and, therefore, need not be repeted here.
CHAP. XIV.
Of CANINE MADNESS,
And HYDROPHOBIA.
MCCCCLXVIII.
This disease has been so exactly and fully described in
books that are in every body's hands, that it is on no ac-
count necessary for me to give any history of it here; and,
with respect to the pathology of it, I find that I can say
nothing satisfying to myself, or that I can expect to prove so
to others. I find also, with respect to the cure of this dis-
ease, that there is no subject in which the fallacy of ex-
perience appears more strongly than in this. From the most
antient times to the present, many remedies for preventing
and curing this disease have been recommended, under the
sanction of experience, and have, perhaps, also kept their
credit for some time; but succeding times have generally,
upon the same ground of experience, destroyed that credit
entirely; 

184 PRACTICE
entirely; and most of the remedies formerly employed are
now fallen into absolute neglect. In the present age, some
new remedies have been proposed, and have experience al-
leged to vouch for their efficacy; but many doubts still re-
main with respect to that; and, though I cannot judge in
this matter from my own experience, I think it incumbent
on me to give to my pupils the best judgment I can form
with respect to the choice of the remedies at present recom-
mended.
MCCCCLXIX.
I am, in the first place, firmly persuaded, that the most
certain means of preventing the consequences of the bite, is
to cut out, or otherwise to destroy the part in which the bite
has been made. In this every body agrees, but with this
difference, that some are of opinion that it can only be ef-
fectual when it is done very soon after the wound has been
made, and they therefore neglect it when this opportunity
is missed. There have been, however, no experiments made
proper to determine this matter; and there are many consi-
derations which lead me to think, that the poison is not im-
mediately communicated to the system, and, therefore, that
this measure of destroying the part may be practised with
advantage, even many days after the bite has been given,
MCCCCLXX.
Whilst the state of our experience, with respect to several
remedies now in use, is uncertain, I cannot venture to assert
that any of these is absolutely ineffectual; but I can give it
as my opinion, that the efficacy of mercury given very
largely, and persisted in for a long time, both as a means of
preventing the disease, and of curing it when it has actually
come on, is better vouched by experience than that of any
other remedy now proposed, or commonly employed.
End of the Second Part.