FIRST LINES 
. ( 
O F T H E 
PRACTICE of PHYSIC 
B Y 
WILLIAM CULLEN, M.D. 
A NEW EDITION. 
CORRECTED, ENLARGED, 
and COMPLETED in 
FOUR VOLUMES, 
EDINBURGH: 
Printed for C. ELLIOT, Edinburgh? 
And T. CADELL, London. 
MD.CC.LXXXIV. FIRST LINES 
O F T H E 
PRACTICE of PHYSIC. 
B Y 
WILLIAM CULLEN, M. D. 
* 
Profcflor of the Praffice of Phyfic in the Univerfity of Edinburgh; 
Firft Phyfician to his Majcfty for Scotland; 
Fellow of the Royal College of Phyficians of Edinburgh, 
of the Royal Societies of London, of Edinburgh, &c. &c. 
FOURTH EDITION, 
Corrected and Enlarged. 
VOL. I. 
EDINBURGH: 
Printed for C. ELLIOT, Edinburgh; 
And T. CADELL, London. 
M.DCC.LXXXI V. CONTENTS. 
INTR 0 DUCT ION . Page i 
PART I. 
OF PYREXIA?, OR FEBRILE 
DISEASES . . 7 
BOOK I. 
Of Fevers . • 8 
CHAPTER I. 
Of the Phenomena ofV'E.xwkS . 8 
C H A P. II. 
Of the proximate Caufe ofTtwwR. . 30 
CHAP- IV 
C O. N T E N T S. 
Page 
CHAP. III. 
Of the Difference of Fevers, and its 
Caufes . , 56 
CHAP. IV. 
Of the remote Caufes : 76 
CHAP. V. 
Of the Proghofij of Fevers . 101 
CHAP. VI. 
Of the Method of Cure in Fevers . 124 
Sedt. I. Of the Cure in Continued Fe- 
vers » . 124 
Sedl, II. Of the Cure of Intermittent 
Fevers . » 203 
BOOK CONTENTS. 
V 
Page 
BOOK IL 
Of Inflammations, or Phlegma- 
SIJE . . . 211 
CHAP. L 
O/'Inflammation in general . 211 
Sedl. I. Of the Phenomena of Inf ani- 
mation . . 211 
Sedt. II. Of theproximate Caufe of In- 
flammation . . 214 
Sedl. III. Of the Terminations of In- 
flammation . . 227 
Sedl. IV. Of the remote Caufes of In- 
flammation . . 241 
Sedl. V. Of the Cure of Inflammation 244 
C H A P. VI 
CONTENTS. 
Page 
CHAP. IL 
Of Inflammation, more flrictly Cuta- 
neous . . . 254 
CHAP. III. 
Of Ophthalmia, or Inflammation of 
the Eye . . 260 
CHAP. IV. 
<yPHRENSY, or Phrenitis . 272 
C H A P. V. 
Of the Quinsy, or Cynanche . 278 
Sect. I. Of the Cynanche Tonfillaris ogg 
Sect. II. Of the Cynanche Maligna 284 
Sect. III. Of the Cynanche Trachealis 292 
Sedl. IV. Of the Cynanche Pharyn- 
gcea . . . 302 
Sect. V. Of the Cynanche Parotides a 303 
CHAP. CONTENTS. 
VII 
Page 
CHAP. VI, 
O/Pneumonic Inflammation 306 
CHAP. VII. 
Of Peripneumonia Notha, or 
Bajlard Peripneumony . 
CHAP. VIII. 
Of the Gastritis, or Inflammation of 
Stomach . . 356 
CHAP. IX. 
Of the Enteritis, or Inflammation of 
the Int fines * . 372 
CHAP. X. 
0/' the Hepatitis, or Inflammation of 
the Liver • . 376 
CHAP. VIII 
CONTENTS. 
Page 
CHAP. XI. 
Of zfo Nephritis, or Inflammation of 
the Kidneys 387 PREFACE. 
r deliver a Syftem of the Doctrines and Rules 
propet for directing the Practice of Phyfic, 
is an undertaking that appears to me to be attended 
with great difficulty; and, after an experience of 
more than forty years in that practice, as well as after 
much reading and reflexion, it was with great diffi- 
dence that I ever entered upon fuch a work. It was, 
however, what feemed to be my duty as a Profeflbr 
that induced me to make the attempt; and I was en- 
gaged in it by the fame fentiments that the illuftrious 
DrEjoerhaavehasexpreiredinthefollowing paflage of 
the Preface to his Inftitutions : Simul enim dccendo 
a 
admotui II 
PREFACE. 
admotus eram fenji, propriorum cogitatorum explica- 
tione docentem plus projicere, quam ft opus ab alio con- 
fcriptum interpretari fufcipit. Sua quippe optime in- 
iclligit, fua cuique pra ceeteris placent, unde clarior 
fere doEtrina, atque animat a plerumque Jequitur ora- 
tio. Qui vero fenfa alterius exponit, infelicius Jape- 
Tiumero eadem ajfequitur ; quumque juo quifque fenfu 
abundat, multa refutanda frequenter invenit, unde 
aravem fruflra laborem aggravai, minufque incitata, 
diEtione utitur. It is well known, that a Text-book 
is notonly extremely ufeful, but neceflary to Students 
who are to hear Le&ures : and from the fame confi- 
derations that moved Dr Boerhaave, I alfo wifhed 
to have one for myfelf; while at the fame time, 
from fome peculiar circumftances in my fituation, 
I bad fome additional inducements to undertake 
fuch a work. 
Betore I was eftablifhed as a Profcfibr of the 
Practice of Phyfic in this Univerfity, I had been em- 
ployed in giving Clinical Lectures in the Royal Infir- 
mary ; PREFACE. 
III 
mary; and upon that occafion had delivered, what, 
in my own opinion, feemed moft juft with regard 
to both the nature and the cure of the difeafes, of 
which I had occafion to treat. But I foon found, 
that my doctrines were taken notice of, as new> 
and peculiar to myfelf; and were accordingly fe- 
verely criticifed by thofe who, having long before 
been trained up in the fyftem of Boerhaave, had 
continued to think that that fyftem neither re- 
quired any change, nor admitted of any amend- 
ment. I found, at the fame time, that my doc- 
trines were frequently criticifed by perfons who 
either had not been informed of them correctly, 
or who feemed not to underftand them fully; 
and therefore, as foon as I was employed to 
teach a more complete Syftem of the Practice of 
Phyfic, I judged it neceflary to publifh a Text-book, 
not only for the benefit of my hearers, but that I 
might alfo have an opportunity of obtaining the opi- 
nion of the Public more at large, and thereby be 
enabled either to vindicate my doctrines, or be taught 
a 2 
to IV 
PREFACE. 
to correct them. Thefe were the motives for my 
attempting the Volumes I formerly publifhed; and 
now, from many years experience of their utility 
to my hearers, as well as from the favourable recep- 
tion they have met with from the Public, I am in- 
duced to give a new edition of this Work, not only, 
as I hope, more correct in many parts, but alfo more 
complete and comprehenfive in its general extent. 
At the firft publication of this Work, it was in- 
tended chiefly for the ufe of thofe Gentlemen who at- 
tended my Lectures: although, even then, for the 
reafons I have mentioned, it was rendered more 
full than Text-books commonly are ; and, in the 
repeated Editions I have fince had occafion to give, 
I have been conftantlyendeavouringto render itmore 
full and comprehenfive. In thefe refpeds, I hope 
the prefent edition will appear to be rendered more 
fit for general ufe, and better calculated to afford 
fatisfa£tion to all thofe who think they may (till re- 
ceive any inftru&ion from reading on this fubjeft. 
While PREFACE. 
V 
While I thus deliver my Work in its now more 
improved ftate, with the hopes that it may be of 
ufe to others as well as to thofe who hear my Lec- 
tures, I mult at the fame time obferve, that it pre- 
fents a fyftem which is in many refpects new; and 
therefore I apprehend it to be not only proper, but 
neceffary, that I fhould explain here upon what 
grounds, and from what confiderations, this has 
been attempted. 
In the firft place, I apprehend, that, in every 
branch of fcience with refpeft to which new fa<Sls 
are daily acquired, and thefe confequently giving 
occafion to new reflecSlions, which correct the prin- 
ciples formerly adopted, it is neceflary, from time 
to time, to reform and renew the whole fy-ftem, 
with all the additions and amendments which it has 
received and is then capable of. That at prefent 
this is requifite with regard to the Science of Me- 
dicine, will, I believe, readily occur to every per- 
fon who at all thinks for himfelf, and is acquainted 
a 3 
with VI 
PREFACE. 
with the Syftems which have hitherto prevailed. 
While, therefore, I attempt this, I think it may be 
allowable, and upon this occafion even proper, that I 
fhould offer fome remarks on the principal Syftems 
t 
of Medicine which have of late prevailed in Europe, 
and that I fhould take notice of the prefent ftate 
of Phyfic as it is influenced by thefe. Such remarks, 
I hope, may be of fome ufe to thofe who attempt to 
improve their knowledge by the reading of books. 
Whether the Practice of Phyfic fhould admit 
of reafoning, or be entirely refted upon experience, 
has long been, and may ftill be, a matter of difpute. 
I fhall not, however, at prefent enter*upon the dif- 
cuflion of this; becaufe I can venture to aflert, that, 
at almcft all times, the practice has been, and ftill 
is, with every perfon, founded, more or lefs, upon 
certain principles eftablifhed by reafoning: and 
therefore, in attempting to offer fome view of the 
prefent ftate of Phyfic, I muft give an account of 
thofe fyftems of the principles of the fcience 
which PREFACE. 
VII 
which have lately prevailed, or may be fuppofed 
ftill to prevail in Europe. 
When, after many ages of darknefs, which had 
deftroyed almoft the whole of ancient literature, 
learning was again reftored in the fifteenth cen- 
tury ; fo, from caufes which are well known, it 
was the fyftem of Galen alone that the Phyficians 
of thofe days became acquainted with ; and during 
the courfe of the fixteenth century, the ftudy of 
Phyficians was almoft folely employed in explaining 
and confirming that fyftem. Early, indeed, in the 
•fixteenth century, the noted Paracelfus had laid the 
foundation of a Chemical Syftem which was in di- 
reft oppofition to that of Galen; and, by the effi- 
cacy of the medicines employed by Paracelfus and 
his followers, their fyftem came to be received by 
many: but the fyftematic Phyficians continued 
to be chiefly Galenifts, and kept poffeflion of the 
Schools till the middle of the feventeenth century. 
It is not, however, neceflary here to enter into any 
a 4 
fur- VIII 
PREFACE. 
further detail refpefting the fate of thofe twooppo- 
fite fefts ; for the only circumftance concerning 
them, which I would with at prefent to point out, is, 
that, in the writings of both, the explanations they 
feverally attempted to give of the phaenomena of 
health or ficknefs turned very entirely upon the ftate 
of the fluids of the body. 
/ 
Such was the ftate of the feience of Phytic till 
about the middle of the feventeenth century, when 
the circulation of the blood came to be generally 
known and admitted; and when this, together with 
the difeovery of the receptacle of thechyle, andof the 
thoracic dutSl, finally exploded the Galenic fyftem. 
About the fame period, a confiderable revolution 
had taken place in the fyftem of Natural Philofophy. 
In the courfe of the feventeenth century, Galileo 
had introduced mathematical reafoning ; and Lord 
Bacon having propofed the method of induction, 
had thereby excited a difpofition to obferve fa<Hs, 
and to make experiments. Thefe new modes 
of PREFACE. 
IX 
of philofophizing, it might be fuppofed, would 
loon have had fome influence on the ftate of medi- 
cine ; but theprogrefs of this was flow. The know- 
ledge of the Circulation did indeed neceflarily lead 
to the confideration as well as to a clearer view of 
the Organic Syftem in animal bodies; which again 
led to the application of the mechanical philofophy 
towards explaining the phenomena of the animal 
oeconomy; and it was applied accordingly, and con- 
tinued, till very lately, to be the fafhionable mode 
of reafoning on the fubje€t. Such reafoning, in- 
deed, mult (till in feveral refpebls continue to be 
applied : but it would be eafy to (how, that it nei- 
ther could, nor ever can be applied to any great ex- 
tent in explaining the animal oeconomy ; and we 
muft therefore look for other circumftances which 
had a greater (hare in modelling the Syftem of Phy- 
fic. 
With this view it may be remarked, that, till the 
period juft now mentioned, every phyfician, whe- 
ther X 
PREFACE. 
ther Galenift or Chemift, had been fo much accu- 
ftomed to confider the ftate and condition of the 
fluids, both as the caufe of difeafe, and as the foun- 
dation for explaining the operation of medicines, 
that what we may term an Humoral Pathology 
(till continued to make a great part of every fyftem. 
In thefe circumftances, it was foon perceived, that 
chemiftry promifed a much better explanation than 
the Galenic or Ariftotelian philofophy had done ; 
and, therefore, while the latter was entirely laid 
afide, a chemical reafoning was every where received. 
Lord Bacon, with his ufual fagacity, had early ob- 
ferved, that chemiftry promifed a great number of 
fafls, and he thereby gave it credit; whilft the 
Corpufcularian philofophy, reftored by Gaflendi, 
readily united -with the reafonings of theChemiftsj 
and the philofophy of Des Cartes readily united with 
both. From all thefe circumftances, an Humoral, 
and chiefly a Chemical Pathology, came to prevail 
very much till the end of the laft century ; and has, 
in- PREFACE. 
XI 
indeed, continued to have a great (hare in our fy- 
ftems down to the prefent time. 
It is proper now, however, to obferve, that about 
the beginning of the prefent century, when every 
part of fcience came to be on a more improved and 
correct footing, there appeared in the writings of 
Stahl, of Hoffman, and of Boerhaave, three 
new, and confiderably different, Syftems of Phyfic; 
which have ever fince had a great fhare in dirtying the 
practice of it. In order, therefore, to give a nearer 
view of the prefent Rate of Phyfic, I fhall offer fome 
remarks upon thefe different fyftems; endeavouring 
to point out the advantages as well as the difadvan- 
tages of each, and how far they ftill prevail; or, ac- 
cording to my judgment, deferve to do fo. 
I shall begin with confidering that of Dr Stahl, 
which I think appeared firfl:, and for a long time 
after was the prevailing fyftem in Germany. 
It XII 
PREFACE. 
The chief and leading principle of this fyftem is, 
that the rational foul of man governs the whole 
oeconomy of his body. At all times, Phyficians have 
obferved, that the animal oeconomy has in itfelf a 
power or condition, by which, in many inftances, it 
refills the injuries which threaten it; and by which it 
alfo, on many occafions, corrects or removes the dif- 
orders induced, or arifing in it. This power, Phyli- 
cians very anciently attributed, under a vague idea, 
to an agent in the fyftem, which they called nature; 
and the language of a vis confervatrix et medicatrix 
natura» has continued in the fchools of medicine 
from the moft ancient times to the prefent. 
Dr Stahl has explicitly founded his fyftem on. 
the fuppofition, that the power of nature, fo much 
talked of, is entirely in the rational foul. He fup- 
pofes, that, upon many occafions, the foul a£ls inde- 
pendently of the ftate of the body; and that, without 
any phylical neceflity arifing from that ftate, the foul, 
purely in confequence of its intelligence, perceiving 
the PREFACE. 
XIII 
the tendency of noxious powers threatening, or of 
disorders anyways arifing in the fyftem, immediately 
excites fuch motions in the body as are fuited to ob- 
viate the hurtful or pernicious confequences which 
might otherwife take place. Many of my readers may 
think it was hardly neceflary for me to take notice 
of a fyftem founded upon fo fanciful a hypothefis; 
but there is often fo much feeming appearance of 
intelligence and defign in the operations of the 
animal ceconomy, that many eminent perfons, as 
Perrault in France, Nichols and Mead in England, 
Porterfield and Simfon in Scotland, and Gaubius in 
Holland, have very much countenanced the fame opi- 
nion, and it is therefore certainly entitled to fome 
regard. It is not, however, neceflary for me here 
to enter into any refutation of it. Dr Hoffman has 
done this fully, in his Comment ar ins de differentia, 
inter Hoffmanni doElrinam medico-mechanicam et C. 
E. Stahlii medico-organicam; and both Boerhaave and 
Haller, though no favourers of materialifm, have 
maintained a doctrine very oppofite to that of Stahl. 
I XIV 
PREFACE. 
In my Phyfiology I have offered fome arguments 
againft the fame ; and I fhall only add now, that 
whoever confiders what has been faid by Dr Nichols 
in his Oratio de Anima and by Dr Gaubius 
in fome parts of his Pathology, muft perceive, that 
the admitting of fuch a capricious government of 
the animal oeconomy, as thefe authors in fome in- 
ftances fuppofe, would at once lead us to reject all 
the phyfical and mechanical rcafoning we might 
employ concerning the human body. Dr Stahl him- 
felf feems to have been aware of this; and there- 
fore, in his Preface to Juncker's Thera- 
peiee Specialis, has acknowledged, that his general 
principle was not at all neceffary; which is in effeft 
faying that it is not compatible with any fyftem 
of principles that ought to govern our practice. 
Upon this footing, I might have at once rejected 
the Stahlian principle ; but it is even dangerous 
to bring any fuch principle into view: for, after all 
Dr Stahl had faid in the paffage juft, now referred 
to, I find, that, in the whole of their practice, both 
he PREFACE. 
XV 
he and his followers have been very much governed 
by their general principle. Trufting much to the 
conftant attention and wifdom of nature, they have 
propofed the Art of curing by expectation,• have 
therefore, for the raoft part, propofed only very in- 
ert and frivolous remedies; have izealoufly oppofed 
the ufe of fome of the moft efficacious, fuch as 
opium and the Perm .an bark ; and are extremely 
referved in the ufe of general remedies, fuch as 
bleeding, vomiting, &c. 
Although thefe remarks, upon a fyftem 
which may now be conGdered as exploded or ne- 
glected, may feem fuperfluous ; I have been willing 
to give thefe ftriClures on the Stahlian fyftem, that 
I might carry my remarks a little farther, and take 
this opportunity of obferving, that, in whatever man- 
ner we may explain what have been called the opera- 
tions of nature, it appears to me, that the general 
dodrine of Nature curing the fo much 
vaunted Hippocratic method of curing, has often 
had XVI 
PREFACE. 
had a very baneful influence on the practice of phy- 
fic; as either leading phyficians into, or continuing 
them in, a weak and feeble pi actice; and at the fame 
time fuperfeding or difcouraging all the attempts of 
art. Dr Huxham has properly obferved, that even in 
the hands of Sydenham it had this effect. Altho' it 
it may fometimes avoid the mifchiefs of bold and 
rath practitioners; yet it certainly produces that 
caution and timidity which have ever oppofed the 
introduction of new and efficacious remedies. The 
oppofition to chemical medicines in the fixteenth 
and feventeenth centuries, and the noted condem- 
nation of Antimony by the Medical Faculty of Pa- 
ris, are to be attributed chiefly to thofe prejudices, 
which the phyficians of France did not entirely get 
the better of for near a hundred years after; We 
may take notice of the referve it produced in Boer- 
haave, with refpeCt to the ufe of the Peruvian 
Bark. We have had lately publiffied, under the title 
of Conjlitutiones Epidemical, notes of the particular 
pradice of the late Baron Van Swieten; upon which 
the Preface. 
XVII 
the editor very properly obferves, That the ufe of 
the bark, in intermitting fevers, appears very rarely 
in that practice ; and we know very well where 
Van Swieten learned that referve. 
I might go farther, and fhowhow much the at- 
tention to the Autocrateia, allowed of, in one fhape 
or other, by every fe£t, has corrupted the practice 
among all phyficians, from Hippocrates to Stahl. 
It muft, however, be fufficiently obvious, and I fhall 
conclude the fubje<ft with obferving, that altho' the 
vis medicatrix natura muft unavoidably be received 
as a fact; yet, wherever it is admitted, it throws 
an obfeurity upon our fyftem ; and it is only where 
the impotence of our art is very manifeft and con- 
fiderable, that we ought to admit of it in practice. 
To finifh our remarks upon the Stahlian Syftem, 
I fhall Ihortly obferve, that it did not depend 
entirely upon the but alfo fuppofed a 
ftate of the body and difeafes, that admitted of 
b 
reme-s XVIII 
PREFACE. 
remedies; which, under the power and direction, 
of the foul, a€led upon the organization and mat- 
ter of the body, fo as to cure its difeafes. Upon 
this footing, the Stahlian pathology turned entirely 
upon Plethora and Cacochymy. It was with re- 
fpect to the former that they efpecially applied their 
doctrine of the Autocrateia in a very fanatical man- 
ner ; and, with refped: to the latter, they have been 
involved in a humoral pathology as much as the 
fyftematic phyficians who had gone before them, 
and with a theory fo incorre€t as not to merit now 
the fmalleft attention. After all, I ought not to dif- 
mifs the confideration of the Stahlian fyftem, with- 
out remarking, that as the followers of this fyftem 
were very intent upon obferving the method of na- 
ture, fo they were very attentive in obferving the 
phenomena of difeafes, and have given us in their 
writings many fa£ls not to be found elfewhere. 
While the doctrines of Stahl were prevailingin 
the univerfity of Halle, Dr Hoffman, a profeffbr in 
the PREFACE. 
XIX 
the fame univerfity, propofed a fyftem that was very 
different. He received into his fyftem a great deal 
of the mechanical, Cartefian, and chemical doctrines 
of the fyftems which had appeared before : but, with 
refpect to thefe, it is of no confequence to obfervein 
what manner he modified the doctrines of his prede- 
ceffors, as his improvements in thefe refpecfts were no 
ways confiderable, and no parr of them now remain ; 
and the real value of his works, beyond what I am juft 
nowgoing to mention, refts entirely on the many facfts 
they contain. The merit of Dr Hoffman and of his 
works is, that he made, or rather fuggefted, an ad- 
dition to the fyftem, which highly deferves our at- 
tention. Of this I cannot give a clearer account 
than by giving it in the author's own words. 
In his Medicina Rationalis Syftematica, Tom. III. 
§. i. chap. 4. he has given his Genealogia morbo~ 
rum ex turbato folidorum et fluidorum mechanifmo; 
and in the 47th and laft paragraph of this chap- 
ter, he fums up his doctrine in the follow- 
ing words : Ex hifce autem omnibus uberius haElenus 
b 2 
excujJiS) XX 
PREFACE. 
excujfis, per quam dilucide apparere arbitror, quod 
folus spasmus etfimplex at on i a, aquabilem, liberum, 
ac proportionatum fanguinis omnifque generis Jluidorum 
motum, quibus excretioninn fuccejfus et integritas func- 
tionum animi et corporis proxime nititur, turbando ac 
pervertendo, univerfam vitalem oeconomiam fubruant 
ac dejlruant; atquc bine univerfa pathologia longe rec- 
tius atque facilius EX VITIO MOTUUM MICROCOS- 
MICORUM IN SOLIDIS, quam EX VARUS AFFEC- 
TION i bus v it io sor u M humorum, de duci atque 
explicari pojfit, adcoque omnis generis agritudines in- 
ternee, ad PRETERNATURALES GENERIS NER- 
vosi affectiones fint referenda. Etenim lafis 
quocunque modo, vel nervis per corpus difeurrentibus, 
vel membranofs quibufvis nervojis partibus, illico mo- 
tuum anomalia, modo leviores, modo graviores fubfe- 
quuntur. Dcinde attenta obfervatio docet, motus quof- 
vis morbofos principaliter fedem figere et tyrannidem 
cxercere in nervojis corporis partibus, cujus generis 
prater onines canales, qui fy/laltico et diajlaltico motu 
pollentes, contentos fuccos tradunt, univerfum nimi- 
rum PREFACE. 
XXI 
rum intefiinorum et ventriculi ab cefophago ad anum 
canalem, totum fy/lema vaforum arterioforum, duEluum 
biliariorum, falivalium, urinariorum et fubcutanec- 
rum, Junt quoque membrana nerveo-mufculares cere- 
bri et medulla fpinalis, prafertim hac, qua dura ma- 
ter vocatur, organis fenforiis obducla, nec non tunica 
ilia ac ligamenta, qua ojfa cingunt artufque firmant. 
Nam nullus dolor, nulla in flammat io, nullus fpafmus, 
nulla mot us et fenfus impotentia, nulla febris aut hu- 
moris illius excretio, accidit, in qua non ha partes 
patiantur. Porro ctiam omnes, qua morbos gignunt 
caufa, operationem fuam potiffimum perfeiunt in par- 
ies motu et fenfu praditas, et canales ex his coagmen- 
tatos, eorum motum, et cum hoc fuidorum ewrfum, 
pervertendo; ita tamen, ut ficuti varia indolis funt, 
fic etiam varie in nerveas partes agant, iifdemquenox- 
am affricent. Demum omnia quoque eximia virtutis 
medicamenta, non tarn in partes fluidas, earum cra- 
fin ac intemperiem corrigenda, quam potius in J'olidas 
et nervofas, earundem mot us alterando ac mode- 
rando, fuam edunt operationem: de quibus tamen om- 
nibus, 
h 3 XXII 
PREFACE. 
mbits, in vulgari iifque eo recepta morborum doEtrina, 
altum efl filentium. 
It is true that Dr Willis had laid a foundation 
for this doctrine, in his Pathologia Cerebri et 
Nervorum; and Baglivi had propofed a fyftem 
of this kind in his Specimen defibra motrici et morbo- 
fa. But, in thefe writers, it was either not exten- 
fively applied to difeafes, or was ftill fo involved in 
many phyfiological errors that they had attracted little 
attention ; and Dr Hoffman was the firft who gave 
any tolerably fimple and clear fyftem on the fubjefl, 
or pointed out any extenfive application of it to the 
explanation of difeafes. 
There can be no fort of doubt that the pheno- 
mena of the animal oeconomy in health and in 
ficknefs, can only be explained by confidering the 
ftate and afteiiions of the primary moving powers 
in it. It is to me furprifing that phyficians were 
fo long of perceiving this, and I think we are there- 
fore PREFACE. 
XXIII 
fore particularly indebted toDr Hoffman for putting 
us into the proper train of investigation; and it every 
day appears that Phyficians perceive the neceffity of 
entering more and more into this inquiry. It was 
this, I think, which engaged Dr Kaaw Boerhaave 
to publifh his work intitled Imp e turn faciens; as 
well as Dr Gaubius to give the Pathology of the 
Solidum vivum. Even the Baron Van Swieten has 
upon the fame view thought it neceffary, in at leaft 
one particular, to make a very considerable change 
in the doClrine of his mafter, as he has done in his 
Commentary upon the 755th Aphorifm. Dr Haller 
has advanced this part of fcience very much by his 
experiments on irritatability and fenfibility. In 
thefe and in many other inftances, particularly in the 
writings of Mr Barthez of Montpellier, of fome 
progrefs in the ftudy of the affections of the Ner- 
vous Syftem, we muft perceive how much we are 
indebted to Dr Hoffman for his fo properly begin- 
ning it. The fubject, however, is difficult : the 
laws of the Nervous Syftem, in the various cir- 
cumftances 
b 4 XXIV 
PREFACE. 
cumftances of the animal oeconomy, are by no 
means afcertained ; and, from want of attention 
and obfervation with the view to a fyftem on this 
fubjecft, the bufinefs appears to many as an inex- 
plicable myftery. There is no wonder, therefore, 
that, on fuch a difficult fubjedt, Dr Hoffman's fy- 
ftem was imperfect and incorreft; and has had lefs 
influence on the writings and practice of Phyficians 
fince his time, than might have been expelled. He 
himfelf has not applied his fundamental docftrine 
fo extenfively as he might have done ; and he 
everywhere intermixed an Humoral Pathology as 
incorrect and hypothetical as any other. Though 
he differed from his colleague Dr Stahl in the fun- 
damental doctrines of his fyftem, it is but too evi- 
dent that he was very much infc&ed with the 
Stahlian doctrines of Plethora and Cacochymy, as may 
be obferved throughout the whole courfe of his 
work ; and particularly in his chapter De morborum 
gcnerationc ex nimia Jangu inis quantitate et humcrum. 
impuritate. 
But PREFACE. 
XXV 
But it is needlefs for me to dwell any longer 
upon the fyftem of Hoffman; and I am next to offer 
fome remarks on the Syftem of Dr Boerhaave, the 
cotemporary of both the other Syftematics, and 
who, over all Europe, and efpecially in this part of 
the world, gained higher reputation than either of 
the others. 
Dr Boerhaavc was a man of general erudition ; 
and, in applying to medicine, he had carefully Au- 
died the auxiliary branches of Anatomy, Chemiftry, 
and Botany, fo that he excelled in each. In forming 
a Syftem of Phyfic, he feems to have ftudied dili- 
gently all the feveral writings of both ancient and 
modern phyficians; and, without prejudice in favour 
of any former fyftems, he endeavoured to be a can- 
did and genuine eclectic. Poffeifed of an excel- 
lent fyftematic genius, he gave a fyftem fuperior to 
any that had ever before appeared. As in the great 
extent, and feemingly perfect, confiftency, of fyftem, 
he appeared to improve and refine upon every thing 
that XXVI 
PREFACE. 
that had beforebeen offered; and as in his Lectures 
he explained his doctrines with great clearnefs and 
elegance; be foon acquired a very high reputation, 
and his fyftem was more generally received than 
any former had been fince the time of Galen. Who- 
ever will confider the merits of Dr Boerhaave, and 
can compare his fyftem with that of former writers, 
muft acknowledge that he was very juftly efteemed, 
and gave a fyftem which was at that time defervedly 
valued. 
But, in the progrefs of an inquifitive and indu- 
ftrious age, it was not to be expelled that any fyftem 
ihould laft fo long as Boerhaave's has done. The 
elaborate Commentary of Van Swieten on Boer- 
haave's fyftem of practice, has been only finifhed a 
few years ago; and tho' this Commentator has added 
many fads, and made fome corrections, he has not, ex- 
cept in the particular mentioned above, made any im- 
provement in the general fyftem. It is evenfurprifing 
that Boerhaave himfelf, though he lived near forty 
years PREFACE. 
XXVII 
years after he had firft formed his fyftem, had 
hardly in all that time made any corrections of it 
or additions to it; the following is the moft remark- 
able. In Aphorifm 755, the words forte et nervofi, 
tam cerebri quam cerebelli cor di dejlinati inertia, did 
not appear in any edition before the fourth ; and 
what a difference of fyftem this points at, every phy- 
fician muft perceive. 
When I firft applied to the ftudy of Phyfic, I 
learned only the fyftem of Boerhaave; and even when 
I came to take aProfeflbr's chair in this Univerfity, I 
found that fyftem here in its entire and full force ; 
and as I believe it ftill fubfifts in credit elfewhere, 
and that no other fyftem of reputation has been yet 
offered to the world, I think it neceifary for me to 
point out particularly the imperfections and defi- 
ciences of the Boerhaavian fyftem, in order to fhow 
the propriety and neceffity of attempting a new 
one. 
To XXVIII 
PREFACE. 
To execute this, however, fo fully as I might, 
would lead me into a detail that can hardly be ad- 
mitted of here ; and I hope it is not neceffary, as I 
think, thatevery intelligent perfon, who has acquired 
any tolerable knowledge of the prefent ftate of our 
fcience, mull, in many inftances, perceive its 
imperfections. I fhall therefore touch only upon 
the great lines of this fyftem; and from the remarks 
I am to offer, truft that both the miftakes and defi- 
ciences which run through the whole of his works 
will appear. 
Dr Boerhaave's treatife of the difeafes of the 
fimple folid, has the appearance of being very clear 
and confident, and was certainly confidered by hint 
as a fundamental doCtrine; but, in my apprenfion, 
it is neither correct nor extenfively applicable. Not 
to mention the ufelefs, and perhaps erroneous, no- 
tion of the compofition of earth and gluten; nor his 
miftake refpeCting theftrudure of compound mem- 
branes; nor his inattention to the ftate of the cellu- 
lar PREFACE. 
XXIX 
lar texture ; all o£ them circumftances which render 
his doCtrine imperfect; I fliall infift only upon the 
whole being very little applicable to the explaining 
the phenomena of health or Acknefs. The laxity or 
rigidity of the Ample folid does, indeed, take place 
at the different periods of life, and mayperhaps, upon 
other oceafions, occur aslhe caufe of difeafe : but I 
prefume, that the ftate of the Ample folid is, upon few 
occaAons, either changeable or actually changed; 
and that, in ninety-nine cafes of anhundred, thephae- 
nomena attributed to fuch a change, do truly depend 
on the ftate of the folidum vivum ; a circumftance 
which Dr Boerhaave has hardlytaken notice of in any 
part of his works. How much this fhows the deA- 
ciency and imperfection of his fyftem, I need not 
expkiin. The learned work of Dr Gaubius, above 
referred to, as well as many other treatifes of late 
authors, point out fufficiently the defeats and im- 
perfections of Boerhaave on this fubjeci. 
After Dr Boerhaave has confidered|the difea- 
fes of the folids, he in the next place attempts to 
explain XXX 
PREFACE. 
explain the more fimple difeafes of the fluids ; and 
there, indeed, he delivers a more correct doClrine of 
acid and alkali than had been given before : But, 
after all, he has done it very imperfectly. We have, 
indeed, fince his time, acquired more knowledge 
upon the fubjeCt of digeftion; and fo much as to 
know, that a great deal more is yet neceflary to 
enable us to underftand in what manner the animal 
fluids are formed from the aliments taken in. And 
although Dr Boerhaave has fallen into no confider- 
able error with refpeCt to a morbid acidity in the 
ftomach, he could not poflibly be complete upon that 
fubjeCt; and his notion of the effects of acidity in 
the mafs of blood feems to have been entirely mifta- 
ken, and is, indeed, not confident with what he him- 
felf has delivered elfewhere. 
His doCtrine of alkali is fomewhat better found- 
ed, but is probably carried too far; and the ftate of 
alkalefcency and putrefaction, as well as all the other 
changes which can take place inthe condition of ani- 
mal PREFACE. 
XXXI 
mal fluids, are particulars yet involved in great 
obfcurity, and are therefore ftill fubjeCts of dif- 
pute. 
There is another particular, in which Boer- 
haave's doctrine conerning the -fluids appears to me 
imperfect and unfatisfaCtoryand that is, in his doc- 
trine de Glutinofo /front aneo. The caufes which he 
has afligned for it are by no means probable, and the 
actual exiftence of it is feldom to be proved. Some 
of the proofs adduced for the exiftence of the phlegm 
ma calidum, are manifeftly founded on a miftake with 
refpeCt to what has been called the inflammatory 
cruft, (fee Van Swieten's Commentary, page 96); 
and the many examples given by Boerhaave of a glu- 
tinofum appearing in the human body, /4ph. 75/ 
are all of them nothing more than inftances of col- 
lections or concretions, found, out of the courfe of 
the circulation. 
If, then, we confider the imperfection of DrBoer- 
haave's XXXII 
PREFACE. 
haave's dodlrine with refpeft to the ftate and vari- 
ous condition of the animal-fluids; and if at the fame 
time wc reflect how frequently he and his followers 
have employed the fuppofition of an acrimony or 
lentor of the fluids, as caufes of difeafe, and for 
directing the practice; we muft, as I apprehend, be 
fatisfied, that his fyftem is not only deficient and 
incomplete, but fallacious and apt to miflead. Al- 
though it cannot be denied, that the fluids of the 
human body fuffer various morbid changes; and that 
upon thefe, difeafes may primarily depend ; yet I 
tnuft beg leave to maintain, that the nature of thefe 
changes is feldom underftood, and more feldom 
ftill is it known when they have taken place : that 
our reafonings concerning them, have been, for the 
moft part, purely hypothetical; have therefore con- 
tributed nothing to improve, and have often milled, 
the pra&ice of phyfic. In this, particularly, they 
have been hurtful, that they have withdrawn our 
attention from, and prevented our ftudy of, the 
motions of the animal fyftem, upon the ftate of 
which PREFACE. 
XXXIII 
which the phenomena of difeafes do more certainly 
and generally depend. Whoever, then, {hall confi- 
der the almoft total negleCt of the ftate of the mo- 
ving powers of the animal-body, and the prevalence 
of an hypothetical humoral pathology, fo confpicu- 
ous in every part of the Boerhaavian Syftem, muft 
be convinced of its very great defeats, and perceive 
the neceffity of attempting one more correct. ' 
After giving this general view, it is not requifite 
to enter into particulars : but, I believe, there are 
very few pages of his aphorifms in which there 
does not occur fome error or defeat; although, per- 
haps, not to be imputed to the fault of Boerhaave, 
fo much as to this, that fince his time a great col- 
lection of new faCts has been acquired by obferva- 
tion and experiment. This, indeed, affords the belt 
and molt folid reafon for attempting a new fyftem : 
for when many new fadts have been acquired, it 
becomes requifite that thefe fhould be incorporated 
€ 
into XXXIV 
PREFACE. 
into a fyftem, whereby not only particular fub- 
jects may be improved, but the whole may he ren- 
dered more complete, confident, and ufeful. Every 
fyftem, indeed, muft be valuable in proportion to 
the number of fads that it embraces and compre- 
hends ; and Monf. Quefnay could not pay a higher 
compliment to the Syftem of Boerhaave, than by 
faying, that it exhibited La medicine collectives 
But here it will, perhaps, be fuggefted to me, 
that the only ufeful work, on the fubject of phyfic, 
is the making a collection of all the facts that re- 
late to the art, and therefore of all that experience 
has taught us with refpect to the cure of difeafes, 
I agree entirely in the opinion ; but doubt if it can 
ever be properly accomplifhed, without aiming at 
fome fyftem of principles, by a proper induction arid 
generalization of facts : at leaft I am perfuaded that 
it can be done not only very fafely, but moft ufefully 
in this way. This, however, muft be determined by 
a trial. I know that the late Mr Lieutaud has 
at- PREFACE. 
XXXV 
attempted a work on the plan of collecting fa&s 
without any reafoning concerning their caufes: And 
while I am endeavouring to give fome account of 
the prefent ftate of Phyfic, I cannot difmifs the 
fubject without offering fome remarks upon the 
promifing Synopjis univerja medicina, compofed by 
the firft phyfician of a learned and ingenious na- 
tion. 
In this work there are many facts and much ob- 
fervation from the Author's own experience, which 
may be ufeful to thofe who have otherwife ac- 
quired fome knowledge and difcernment; but, 
throughout the whole work, there isjiich total want 
of method, arrangement, fyftem, or decifion, that, in 
my humble opinion, it can be of little ufe, and may 
prove very preplexing to thofe who are yet to learn. 
The diftinCtion of the genera of difeafes, the drftinc- 
tion of the fpecies of each, and often even that of the 
varieties, I hold to be a neceffary foundation of every 
C 2 
plan XXXVI 
PREFACE. 
plan of Phyfic, whether Dogmatical or Empirical; 
But very little of this diftinCtion is to be found in 
the work of Mr Lieutaud; and in his preface he tells 
us, that he meant to negledl fuch arguta fedulitas. 
And indeed his method of managing his fubject muft 
certainly interrupt and retard all methodical nofo- 
logy. His arrangement of difeafes is according to 
no affinity, but that of the flighted and uninftruc- 
tive kind, the place of the body which they happen 
to affeCt. His Generalia et incerta[edis, have hardly 
any connection at all; the titles Rheumatijrnus, Hy~ 
pocbondriafis, Hydrops, follow one another. When 
he does attempt any general doctrine, it is not till 
long after he has treated of the widely fcattered par- 
ticulars. Under each particular title which he af- 
fumes, he has endeavoured to enumerate the whole 
of the fymptoms that ever appeared in a difeafe un- 
der that title ; and this without aiming at any diftinc- 
tion between the effential and accidental fymptoms, 
or marking the feveral combinations under which 
thefe fymptoms do for the moft part fteadily ap- 
pear. PREFACE. 
XXXVII 
pear. From the concurrence of accidental fymp- 
toms, the variety of the fame difeafe is frequently 
confiderable, a circumftance neceflarily perplexing 
and diffracting to young practitioners ; but it feems 
ftrange to me, that an experience of thirty years, 
in confiderable pradicei could do nothing to relieve 
Jthem. 
MrLiEUTAUD has at the fame time increafed 
the confufion that muft arife from this want of dU 
ftinClion, by his confidering as primary difeafes, 
what appear to me to be the fymptoms, effe&s, and 
fequels, of other difeafes only. Of this I think the 
JE/ius morbofus, Virum exolutio, Dolores, Stagnatio 
fanguinis, Purulentia, Tremor, Pervigilium, Raucedo, 
Suffocatio, Vomica, Empyema, Singultus, Vomitus, Dolor 
Stomachi, Tenefmus, all treated of under feparate 
titles, are examples. A general Symptomatologia 
maybe a very ufeful work, with a view to a Syftem 
of Pathology ; but, with a view to Practice with- 
out any Syftem, it muft have bad effects, as leading 
c 3 
only XXXVIII 
PREFACE. 
only to a pallatise practice, and diverting from the 
proper efforts towards obtaining a radical cure. Mr 
Lieutaud, indeed, has endeavoured to exhibit the 
fymptoms abovementioned as fo many primary dif- 
eafes: but he has feldom fucceeded in this; and, in 
delivering the practice, he commonly finds it necef- 
fary to confider them as fymptoms, and that not 
without fome theory, implied or expreffed, with re- 
fpect to their proximate caufes. His title of Do- 
lores may be taken as an example of this ; and from 
which it may be readily perceived, how far fuch 
treatifes can be really ufeful. 
In eftablifhing a proper Pathology, there is no- 
thing that has been of more fervice than the Dif- 
fection of morbid bodies. Mr Lieutaud has been 
much and moft commendably employed in this 
way, and in this Synopfis he has endeavoured to 
communicate his knowledge on the fubjecl; but, in 
in my humble opinion, he has feldom done it in a 
manner that can be ufeful. In the fame way 
that PREFACE. 
XXXIX 
that he has delivered the fymptoms of difeafes with- 
out any inftruclive arrangement; fo, on the fubject 
of the appearances after death, he has mentioned 
every morbid appearance that had ever been ob- 
ferved after the difeafe of which he is then treating : 
but thefe appearances are ftrangely huddled toge- 
ther, without any notice taken of thofe which be-' 
long to one fet of fymptoms or to another; and, with 
regard to the whole, without any attempt to diftin- 
guifh between the caufes of difeafes and the caufes 
of death ; although the want of fuch diftimflion 
is the well-known ground of fallacy upon this fub- 
je€t. I take for an example, the appearances men- 
tioned as having been obferved after dropfy. Here 
morbid appearances, found in every part of the body, 
in every cavity of it, and in every vifeus contained 
in thefe cavities, are enumerated ; but which of 
thefe morbid ftates are more frequent or more rare, 
and which had been more particularly connected 
with the different caufes, or with the different flats 
of fymptoms previoufly recited, we are not informed, 
c 4 
nor XL 
PREFACE. 
nor has he enabled us to difcover. In fhort, 
the diffettion of morbid bodies has been, and may 
be, highly ufeful; but in order to be fo, it muft be 
under a different management from what we find, 
either in this Synopfis, or even in the Hijloria 
I cannot difmifs this fubject without remarking, 
that the diffeQion of morbid bodies, is chiefly va- 
luable upon account of its leading us to difcover 
the proximate caufes of difeafes ; and the great and 
valuable work of the illuftrious Morgagni, is pro- 
perly intitled De Jedibus et causis. It may well 
feem furprifing, then, that Lieutaud fhould find 
the whole of proximate caufes atra caligine merfas ; 
and that he fhouljl never have thought of applying 
his difl'edlions towards the afcertaining at leaft 
fome of thefe. 
But let me now proceed to confider the impot- 
ent part of every practical work, and of this Sy- 
nopjis PREFACE. 
XLI 
nopfis univerfiE medicina ; that is, the method of 
curing difeafes. 
Here, again, upon the fame plan as in giving 
the hiftories of difeafe, the method of cure is deli- 
vered by enumerating the whole of the remedies that 
have ever been employed in a difeafe under the 
title prefixed; without afligning the fpecies, or the 
circumftances to which the remedies, though of a 
very different and fometimes oppofite nature, are 
peculiarly adapted. On the fubjedl of Afthma, he 
very juftly obferves that phyficians have been to 
blame in confounding, under this title, almoft all 
the fpecies of Dyfpncea; and he himfelf very properly 
confiders Afthma as a difeafe diftincSt from all the 
other cafes of Dyfpncea. Still, however, be confi- 
ders Afthma as of many different fpecies, arifing from 
many different caufes, which, till we underftand 
better, we cannot attempt to remove. Notwith- 
ftanding of all this, he proceeds to deliver a very 
general cure. Parum abejii fays he, quinfyecifici 
titufo XLII 
PREFACE. 
titulo gaudeant peEloralia, vulneraria, et incidentia ! 
But from fuch language, I receive no clear idea; nor 
can I obtain any clear dire&ion from the enumera- 
tion of his medicines. Bacca junipericgummitra- 
gacanthum vel ammoniacum, fapo, aqua picea, tere~ 
binthina,&c.qua tamen haud indifcriminatim funt ufur- 
panda, fed pro re nata, deleElu opus eJi. Very juftly 
indeed, deleElu opus eft; but here, as in many other 
inftances, he gives us no fort of affiftance. 
From his endeavours, though not always fuccefs- 
ful, to neglect all fyftem, his pra&ice is generally 
delivered in a very indecifive manner; or, what has 
the fame effed, in a way fo conditional as will ren- 
der it always difficult, and often impoffible, for a 
young pra&itioner to follow him. Let us take, for 
example, his cure of Dropfy. " The cure may be 
begun by blood-letting in certain conditions; but, 
" in others, it cannot be employed -without danger. It 
** gives relief in difficult breathing ; but, after it is 
t( praflifed, the fymptoms are aggravated, and ren- 
i( de red PREFACE. 
XLIII 
<e dered more objlinate. It is not to be concealed 
" that fome perfons have been cured by repeated 
« blood-lettings, or fpontaneous haemorrhagies; but 
" it is at the fame time known, that fuch a remedy 
t( inopportunely has in many infiances ha- 
Jlcned on the fatal event" 
In the fame manner he treats of vomiting, pur- 
ging, fweating, and the ufe of mineral waters; but 
I muft confefs, that he has no where removed any 
of my doubts or difficulties, and indeed he has 
fometimes increafed them. He fays, that hepatics, 
or aperients, fuch as the lingua cervina, herba ca- 
pillaresy 6 c. deferve commendation; but that, when 
the difeafe has arifen to a certain degree, they have 
been, for the moft party found to be ufelefs. He ob- 
ferves, that the powder of toads gi ven in wine, to the 
quantity of a fcruple or more, has fucceeded with 
feverals. 
Such are, commonly, the methods of cure deli- 
vered XLIV 
PREFACE. 
vered by Mr Lieutaud, longiori et forte felicijfima 
praxiedoElus. 
It would be tedious to enter further into that de- 
tail, which a criticifm of this immethodical and un- 
inftruflve work might lead me into; but, if the 
bounds proper for this preface did not prevent me, 
I would particularly (how that the work is far from 
being free from thofe reafonings which the author 
pretends to avoid, and would affect even to defpife. 
He ftill holds the dodirines of the concoction and 
CRITICAL EVACUATION of MORBIFIC MATTER ; 
dodlrines dependinguponfubtiletheories,and which, 
in my opinion, can in no ways be afeertained as 
matters of fadL Mr Lieutaud likewife is ftill very much 
upon the old plan of following nature, and there- 
fore gives often what I confider as a feeble and inert 
pra&ice. The humeEtantia, diluentia, demulcentia} et 
temperantia, are with him very univerfal remedies, 
and often thofe which alone are to be employed. 
The PREFACE. 
XLV 
The mention of thefe medicines might lead me 
to take notice of Mr Lieutaud's fecond volume, in 
which, ab infulfa remediorum farragine alienus, he 
promifes a great reformation upon the fubjeCt; but 
this falls fo far fhort of the idea of Britifh phyficians, 
that I need not make any remarks upon it. With 
refpeCt to his lift of fimples, or Emporetica> as he is 
pleafed to term them, an Englifh apothecary would 
fmile at it; and with refpeCt to his officinalia, I be- 
lieve they are to be found no where but in the Codex 
Me die ament ar ius of Paris; and in his Magiftralia his 
dofes are generally fuch as the moft timid practi- 
tioner of this country would hardly defeend to, and 
fuch as none of our practitioners of experience 
would depend upon. In fhort, the whole of the 
work, both with refpeCt to the theories with which 
it abounds, and to the faCts which it gives, will not, 
in my apprehenfion, bear any ferious criticifm. But 
I muft conclude ; and (ball only fay further, that 
fuch as I have reprefented it, is this work, executed 
by a man of the firft rank in the profeflion. It is in- 
deed XLVI 
PREFACE, 
deed for that reafon I have chofen it as the example 
of a work, upon the plan of giving fads only, and 
of avoiding the ftudy or even the notice of the prox- 
imate caufes of difeafes; and with what advantage 
fuch a plan is purfued, 1 fliall leave my readers to 
confider. 
In the following treatife I have followed a diffe- 
rent courfe. I have endeavoured to colled the fads 
relative to the difeafes of the human body, as fully 
as the nature of the work and the bounds neceflarily 
prefcribed to it would admit: But I have not been 
fatisfied with giving the fads, without endeavour- 
ing to apply them to the inveftigation of proximate 
caufes, and upon thefe to eftablifh a more fcientific 
and decided method of cure. In aiming at this, I 
flatter myfelf that I have avoided hypothecs, and 
what have been called theories. I have, indeed, en- 
deavoured to eftablifli many general dodrines, both 
phyfiological and pathological; but Itruft that thefe 
are only a. generalifation of fads, or conclufions 
from PREFACE. 
XLVII 
from a cautious and full induction : and if any one 
fhall refufe to admit, or diredly (hall oppofe, my 
general dodrines, he muft do it by fliowing that I 
have been deficient or miftaken in afluming and ap- 
plying fads. I have, myfelf, been jealous of my 
being fometimes imperfect in thefe refpeds ; but I 
have generally endeavoured to obviate the confe- 
quences of this, by proving, that the proximate 
caufes which I have afligned, are true in fad, as 
well as deductions from any reafoning that I may 
feem to have employed. Further, to obviate any 
dangerous fallacy in propofing a method of cure, I 
have always been anxious to fuggeft that which, to 
the beft of my judgment, appeared to be the me- 
thod approved of by experience, as much as it was 
the confequence of fyftem. 
Upon this general plan I have endeavoured to form 
a fyftemof phyficthatfhouldcomprehend the wholeof 
the fads relating to thefcience, and that will,I hope, 
colled and arrange them in better order than hasbeen 
done XLVIII 
PREFACE. 
done before, as well as point out in particular thofe 
which are ft ill wanting to eftablifh general principles. 
This which I have attempted, may, like other fy- 
ftems, hereafter fuffer a change; but I am confident 
that we are at prefent in a better train of inveftiga- 
tion than phyficians were in before the time of Dr 
Hoffman. The affeftions of the motions and mo- 
ving powers of the animal oeconomy, muft certainly 
be the leading inquiry in confidering the difeafes of 
the human body. The inquiry may be difficult; but 
it muft be attempted, or the fubjeft muft be deferr- 
ed altogether. I have, therefore, affumed the gene- 
ral principles of Hoffman, as laid down in the paf- 
fage which I have quoted above: and if I have ren- 
dered them more correft and more extenfive in their 
application; and, more particularly, if 1 have avoid- 
ed introducing the many hypothetical doftrines of 
the Humoral Pathology which disfigured both his 
and all the other fyftems which have hitherto pre- 
vailed ; I hope I fhall be excufed for attempting a 
fyftem, which upon the whole may appear new. 
Edin. Nov. 1783. PART I. 
■ 
Of PYREXIA 
O R 
FEBRILE DISEASES. 
Vol. I. 
A FIRST LINES 
OF THE 
PRACTICE of PHYSIC. 
INTRODUCTION. 
I. 
IN teaching the Practice of Physic, 
we endeavour to give inftrudlion for 
di/cerning, diftinguijhings preventings and 
curing difeafes, as they occur in particular 
perfons. 
IL 
The art of discerning and distin- 
guishing difeafes, may be belt attained 
A 2 
by 4 
PRACTICE 
by an accurate and complete obfervation 
of their phenomena, as thefe occur in con- 
courfe and in fucceifion, and by con- 
ftantly endeavouring to diftinguifh the 
peculiar and infeparable concurrence of 
fymptoms, to eftablifh a Methodical No- 
sology, or an arrangement of difeafes ac- 
cording to their genera and fpecics, found- 
ed upon obfervation alone, abft rafted from 
all reafoning. Such an arrangement I 
have attempted in another work, to which, 
in the courfe of the prefent, 1 {hall fre- 
quently refer. 
in. 
The Prevention of difeafes depends 
upon the knowledge of their remote cau- 
fes; which is partly delivered in the gene- 
ral Pathology, and partly to be delivered 
in this treatife. 
IV, OF PHYSIC. 
5 
IV. 
The Cure of difeafes is chiefly, and al- 
moft unavoidably, founded in the know- 
ledge of their proximate caufes. This re- 
quires an acquaintance with the Inftitu- 
tions of Medicine; that is, the knowledge of 
the ftruclure, action, and fundlions of the 
human body; of the feveral changes which 
it may undergo; and of the feveral powers 
by which it can be changed. Our know- 
ledge of thefe particulars, however, is ftill 
incomplete, is in many refpedls doubtful, 
and has been often involved in miflake 
and error. The dodlrine, therefore, of 
proximate caufes, founded upon that know- 
ledge, mu ft be frequently precarious and 
uncertain. It is, however, poflible for a 
judicious phyflcian to avoid what is vul- 
garly called theory, that is, all reafoning 
founded upon hypothecs, and thereby 
A 3 
many 6 
PRACTICE 
many of the errors which have formerly 
taken place in the Institutions of Medi- 
cine. It is poflible alfo for a perfon. 
who has an extenfive knowledge of the 
faCts relative to the animal oeconomy in 
health and in ficknefs, by a cautious and 
complete induction, to eftablilh many ge- 
neral principles which may guide his rea- 
foning with fafety; and while, at the fame 
time, a phylician admits as a foundation of 
practice thofe reafonings only which are 
fimple, obvious and certain, and for the 
moft part admits as proximate caufes thofe 
alone that are eftablifhed as matters of fad 
rather than as deductions of realbning, he 
may with great advantage eftablilh a fy- 
flem of practice chiefly founded on the 
dodtrine of proximate caufes. But when 
this cannot be done with Sufficient cer- 
tainty, the judicious and prudent phyiician 
will have recourfe to Experience alone; 
always, however, aware of the hitherto in- 
corn- OF PHYSIC. 
7 
complete and fallacious date of Empiri- 
cifm. 
V. 
With a ftricSt attention to thefe conlide- 
rations in the whole of the following trea- 
tife, I proceed to treat of particular difeafes 
in the order of my Methodical Nofology. 
a4 
PART PART I. 
Of PYREX I dZ, or FEBRILE 
DISEASES. 
VI. 
T)Yrexij$, or febrile difeafes, are di- 
ftinguifhed by the following appear- 
ances. After beginning with fome degree 
of cold {hivering, they fhow fome increafe 
of heat, and an increafed frequency of 
pulfe, with the interruption and diforder 
of feveral fundlions, particularly fome di- 
minution of flrength in the animal func- 
tions. 
VII. 
Of thefe PyrexisE I have formed a clafs, 
and have fubdivided it into the five or- 
ders of Fevers, Inflammations, Erup- 
tions, Hemorrhagies, and Fluxes. 
SeeSynopfisNofologise Methodical, Edit. 3. 
1780. 
BOOK BOOK I. 
Of FEVERS. 
CHAP. I. 
Of the Phenomena of Fevers. 
VIII. 
THOSE difeafes are more ftridlly called 
Fevers, which have the general fymp- 
toms of pyrexia, without having alongft with 
them any topical affection that is cflcntial 
and primary, fuch as the other orders of 
the Pyrexiae always have. 
IX. PRACTICE 
10 
IX. 
Fevers, as differing in the number and 
variety of their fymptoms, have been 
very properly confidered as of diftindt 
genera and fpecies. But we fuppofe, that 
there are certain circumflances in common 
to all the difeafcs comprehended under 
this order, which are therefore thofe effen- 
tially neceffary to, and properly conflitu- 
ting the nature of fever. It is our bufi- 
nefs efpecially, and in the firfl place, to in- 
vefligate thefe ; and I expert to find them 
as they occur in the paroxyfm, or fit, of 
an intermittent fever, as this is moft com- 
monly formed. 
The phenomena to be obferved in fucll 
a paroxyfm are the following. The per- 
fon OF PHYSIC. 
11 
fon is affected, firft, with a languor or 
fenfe of debility, a fluggifhnefs in motion, 
and fome uneafinefs in exerting it, with 
frequent yawning and flretching. At the 
fame time, the face and extremities become 
pale; the features fhrink; the bulk of every 
external part is diminifhed; and the fkin, 
over the whole body, appears conllridled, 
as if cold had been applied to it. At the 
coming on of thefe fymptoms, fome cold- 
nefs of the extremities, though little taken 
notice of by the patient, may be perceived 
by another perfon. At length, the patient 
himfelf feels a fenfation of cold, common- 
ly firft in his back, but, from thence, paf- 
fing over the whole body; and now his 
fkin feels warm to another perfon. The 
patient's fenfe of cold increafing, produces 
a tremor in all his limbs, with frequent 
fucceffions or rigors of the trunk of the 
body. When this fenfe of cold, and its 
effects, have continued for fome time, 
they PRACTICE 
12 
they become lefs violent, and are alterna-8 
ted with warm flufhings. By degrees, the 
cold goes off entirely; and a heat, greater 
than natural, prevails, and continues over 
the whole body. With this heat, the co- 
lour of the fkin returns, and a preternatu- 
ral rednefs appears, efpecially in the face, 
Whilft the heat and rednefs come on, the 
fkin is relaxed and fmoothed, but, for 
fome time, continues dry. The features of 
the face, and other parts of the body, recover 
their ufual fize, and become even more 
turgid. When the heat, rednefs, and tur- 
gefcence have increafed and continued for 
fome time, a moifture appears upon the 
forehead, and, by degrees, becomes a fweat, 
which gradually extends downwards over 
the whole body. As this fweat continues 
to flow, the heat of the body abates; the 
fweat, after continuing fome time, gradu- 
ally ceafes ; the body returns to its ufual 
tem~ O F P H Y S I C. 
13 
temperature; and moft of the fundions are 
reftored to their ordinary ftate. 
XL 
This feries of appearances gives occaflon 
to divide the paroxyfm into three different 
ftages; which are. called the Cold, the 
Hot, and the Sweating Stages, or 
Fits, 
In the courfe of thefe, confiderable chan- 
ges happen in the ftate of feveral other 
fundions, which are now to be mentioned. 
XII. 
Upon the firft approach of languor, the 
pulfe becomes fometimes flower, and al- 
ways weaker than before. As the fenfe of 
cold comes on, the pulfe becomes fmaller, 
very frequent, and often irregular. As 
the eold abates, and the heat comes on, 
the 14 
PRACTICE 
the pulfe becomes more regular, hard, and 
full; and, in thefe refpecfts, increafes till 
the fweat breaks out. As the fweat flows, 
the pulfe becomes fofter, and lefs frequent, 
till, the fweat ceafing altogether, it returns 
to its ufual ftate. 
XIII. 
The refpiration alfo fuffers fome changes. 
During the cold ftage, the refpiration is 
fmall, frequent, and anxious, and is fome- 
times attended with a cough; as the hot 
ftage comes on, the refpiration becomes 
fuller and more free; but continues ftill 
frequent and anxious, till the flowing of 
the fweat relieves the anxiety, and renders 
the breathing lefs frequent and more free. 
With the ceafing of the fweat, the breath- 
ing returns to its ordinary ftate. 
XIV, OF PHYSIC. 
15 
XIV. 
The natural fundlions alfofufter a change. 
Upon the approach of the cold ftage, the 
appetite for food ceafes, and does not re- 
turn till the paroxyfm be over, or the fweat 
has flowed for fome time. Generally, 
during the whole of the paroxyfm, there is 
not only a want of appetite, but an averfion 
from all folid, and efpecially animal food. 
As the cold ftage advances, there frequent- 
ly come on a ficknefs and naufea, which 
often increafe to a vomiting of a matter 
that is for the moft part bilious. This 
vomiting commonly puts an end to the 
cold ftage, and brings on the hot. As the 
hot ftage advances, the naufea and vomit- 
ing abate; and when the fweat breaks out, 
they generally ceafe altogether. 
XV. 16 
PRACTICE 
XV. 
A confiderable degree of thirft is com- 
monly felt during the whole courfe of the 
paroxyfm. During the cold ftage, the 
thirft feems to arife from the drinefs and 
clamminefs of the mouth and fauces; but, 
during the hot ftage, from the heat which 
then prevails over the whole body; and, 
as the fweat flows, the mouth becomes 
moifter, and the thirft, together with the 
heat, gradually abates. 
XVI. 
In the courfe of a paroxyfm, there is 
often a confiderable change in the Rate of 
the fecretions. The circumftances juft 
now mentioned (how it in the fecretion of 
the faliva and mucus of the mouth; and 
it is ftill more remarkable with refpecl to 
the OF PHYSIC. 
17 
the urine. During the cold ftage, the 
urine is almofl colourless, and without 
cloud or Sediment. In the hot flage, it 
becomes high-coloured, but is flill without 
Sediment. After the Sweat has flowed 
Sreely, the urine depofites a Sediment, com- 
monly lateritious, and continues to do So 
for Some time after the paroxyfm is over. 
XVII. 
Excepting in certain uncommon cafes 
which are attended throughout with a diar- 
rhoea, flools feldom occur till towards the 
end of a par oxy fm, when commonly a (tool 
happens, and which is generally of a loofe 
kind. 
XVIII. 
Analogous to thefe changes in the flatc 
of the Secretions, it frequently happens, 
Vol. I. 
B 
that 18 
PRACTICE 
that tumours fubfifting on the furface of 
the body, fuffer, during the cold ftage of 
fevers, a fudden and confiderable detu- 
mefcence; but generally, tho' not always, 
the tumours return to their former iize 
during the fweating ftage. In like man- 
ner, ulcers are fometimcs dried up during 
the cold ftage; and return again to dif- 
charge matter during the fweating ftage, 
or after the paroxyfm. is over. 
XIX. 
Certain changes appear alfo in fenfation 
and thought. During the cold ftage, the 
fenfibility is often greatly impaired ; but 
when the hot ftage is formed, the fenfibi- 
lity is recovered, and often conftderably 
increafed. 
XX. O B PHYSIC. 
19 
XX. 
With refpeft to the intellectual func- 
tions, when the cold flage comes on, at- 
tention and recollection become difficulty 
and continue more or lefs fo during the 
whole paroxyfm. Hence fome confufion 
of thought takes place, and often arifes to 
a delirium, which fometimes comes on at 
the beginning of the cold ftage, but more 
frequently not till the hot flage be formed. 
XXL 
It belongs alfo to this place to 
that the cold ftage fometimes comes on 
with a drowfinefs and fhipor, which often 
increafe to a degree that may be called 
comatofe, or apopledlic. 
B 2 
XXII. 20 
PRACTICE 
XXII. 
We have ftill to add, that fometimes, 
early in the cold ftage, a headach comes 
on; but which, more commonly, is not 
felt till the hot ftage be formed, and then 
is ufually attended with a throbbing of 
the temples. The headach continues till 
the fweat breaks out; but as this flows 
more freely, that gradually goes off. At 
the.fame time with the headach, there are 
commonly pains of the back, and of fome 
of the great joints ; and thefe pains have 
the fame courfe with the headach. 
XXIII. 
Thefe are nearly the whole, and are at 
leaft the chief of the phenomena which 
more conftantly appear in the paroxyfm of 
an intermittent fever; and we have pointed 
out OF PHYSIC. 
21 
outtheir ordinary concourfe and fucceflion. 
With refpefl to the wdiole of them, how- 
ever,' it is to be obferved, that, in different 
cafes, the feveral phenomena are in differ- 
ent degrees; that the feries of them is 
more or lefs complete; and that the feve- 
ral parts or Rages in the time they occupy, 
are in a different proportion to one ano* 
ther. 
XXIV. 
It is very feldom that a fever confiRs of 
a (ingle paroxyfm, Inch as we have now 
defcribed; and it more generally happens, 
after a certain length of time has elapfed 
from the ceafing of the paroxyfm, that 
the fame feries of phenomena again arifes3 
and obferves the fame courfe as before; 
and thefe Rates of Fever and Apyrexia 
often continue to alternate with one ano- 
ther for many times. In Rich cafes, the 
B 3 
length 22 
PRACTICE 
length of time from the end of one pa- 
roxyfm to the beginning of another, is 
called an Intermission; and the length 
of time from the beginning of one paro- 
xyfin to the beginning of another next fuc- 
ceeding, is called an Interval. 
XXV. 
When the difcafe confifts of a number 
of paroxyfms, it is generally to be obferved, 
that the intervals between them are nearly 
equal; but thefe intervals are of different 
lengths in different cafes. The moll ufual 
interval is that of forty-eight hours, which 
is named the Tertian period. The next 
xnoft common is that of feventy-two hours, 
and is named the Quartan period. Some 
other intervals alfo are obferved, particu- 
larly one of twenty-four hours, named 
therefore the Quotidian; and the ap- 
pearance of this is pretty frequent. But OF PHYSIC. 
23 
till other intervals longer than that of the 
quartan are extremely rare, and probably 
are only irregularities of the tertian or 
quartan periods. 
XXVI. 
The paroxyfms of pure intermittent fer- 
vors are always finilhed in lefs than twenty- 
four hours : and though it happens that 
there are fevers which confift of repeated 
paroxyfms, without any entire intermillion 
between them; yet in fuch cafes it is ob- 
ferved, that, though the hot and fweating 
Rages of the paroxyfm do not entirely 
ceafe before the twenty-four hours from 
their beginning have expired, they fuffer, 
however before, that time, a confiderabk 
abatement or Remission of their violence; 
and, at the return of the quotidian period, 
a paroxyfm is in fome ihape renewed, 
which runs the fame courfe p.s before. 
B 4 
This 24 
PRACTICE 
This conftitutcs what is called a Remit- 
tent Fever. 
XXVII. 
When in thefe remittents the remiflion 
is confiderable, and the return of a new 
paroxyfm is diftinctly marked by the fymp- 
toms of a cold llage at the beginning of it; 
fuch fevers retain ftridkly the appellation 
of Remittents. But when it happens, 
as it does in certain cafes, that the remif- 
iion is not confiderable, is perhaps without 
fweat, and that the returning paroxyfm is 
not marked by the moft ufual fymptoms 
of a cold ftage, but chiefly by the aggra- 
vation or Exacerbation of a hot ftage, 
the difeafe is called a Continued Fever. 
XXVIII. 
In fome cafes of continued fever, the 
re- O F P H Y S I C. 
25 
remiftions and exacerbations are fo incon- 
fiderable as not to be eafily obferved or' 
diftinguifhed; and this has led phyficians 
to imagine, that there is a fpecies of fever 
fubfifting for feveral days together, and 
feemingly confifting of one paroxyfm only. 
This they have called a Continent Fe- 
ver; but, in a long courfe of practice, I 
have not had an opportunity of obferving 
fuch a fever. 
XXIX. 
It is, however, to be obferved here, that 
the fevers of a continued form are to be 
diftinguifhed from one another; and that, 
while fome of a very continued form do 
Hill belong to the fection of intermittents, 
there are others which, though ftill con- 
lifting of feparate and repeated paroxyfms, 
yet, as different by their caufes and cir- 
cumftances from intermittents, are to be 
diftinguiftied 26 
PRACTICE 
diftinguifhed from the whole of thefe, and 
are more ftricily to be called and confidered 
as Continued. Such are moft of thofe 
which have been commonly fuppofed to be 
Continent; and thofe which by moft 
writers have been limply named Conti- 
nued; and which term I have employed as 
the title of a fetftion, to be diftinguifhed 
from that of Intermittent. 
I fliall here add the marks by which, in 
practice, thefe different continued fevers 
may be diftinguifhed from one another. 
Thofe fevers of a continued form, which, 
however, ftill belong the feeftion of Inter- 
mittents, may be diftinguifhed by their 
having paffed from an intermittent or re- 
mittent form, to that of a continued; by 
their fhowing fome tendency to become 
intermittent, or at leaft remittent; by their 
being known to have been occafioned by 
marfh miafmata; and, for the moft part, 
by their having but one parexyfm, or one 
exacerbation. OF PHYSIC. 
27 
exacerbation and remiffion, in the courfe 
of twenty-four hours. 
On the other hand, Continued Fevers, to 
be more ftridlly fo called, may be diftin- 
guilhed by their fhowing little tendency 
to become, intermittent or remittent in 
any part of their courfe, and efpecially af- 
ter the firft week of their continuance, by 
their being occafioned by human conta- 
gion, at leaft by other caufes than the 
marfh miafmata; and by their having 
pretty conftantly an exacerbation and re- 
miffion twice in the courfe of every twenty- 
four hours. In both cafes, the know- 
ledge of the nature of the epidemic for thq. 
time prevailing, may have a great ffiare in 
determining the nature of the particular 
fever. 
XXX. 
\Vith refpecl to the form, or Type, of 
fevers 28 
PRACTICE 
fevers, this further may be obferved, That 
the quartan, while it has the longeft inter- 
val, has, at the fame time, the longeft and 
moft violent cold ftage; but,upon the whole, 
the fhorteft paroxyfm: That the tertian 
having afhorter interval than the quartan, 
has, at the fame time, a fhorter and lefs 
violent cold ftage; but a longer paroxyfm: 
And, laftly, that the quotidian, with the 
fhorteft interval, has the leaft of a cold 
ftage; but the longeft paroxyfm. 
XXXI. 
The type of fevers is fometimes changed 
in their courfe. When this happens, it is 
generally in the following manner: Both 
tertians and quartans change into quoti- 
dians, quotidians into remittents, and thefe 
laft become often of the moft continued 
kind. In all thefe cafes, the fever has its 
paroxyfms protracted longer than ufual, 
before OF PHYSIC. 
29 
before it changes into a type of more fre- 
quent repetition. 
XXXIL 
From all this a prefumption arifes, that 
every fever confifts of repeated paroxyfms, 
differing from others chiefly in the cir- 
cumftances and repetition of the paro- 
xyfms; and, therefore, that it was allow- 
able for us to take the paroxyfm of a pure 
intermittent as an example and model of the 
whole. 
CHAP, 30 
PCACTICE 
CHAP II. 
Of the Proximate Cause of Fever. 
XXXIII. 
THE proximate caufe of fever feems 
hitherto to have eluded the refearch 
t>f phyficians ; and I fhall not pretend to 
afcertain it in a manner that may remove 
every difficulty; but I fhall endeavour to 
make an approach towards it, and fuch 
I hope, may be of ufe in conduct- 
ing the practice in this difeafe: while at 
the fame time I hope to avoid feveral er- 
rors OF PHYSIC; 
31 
tors which have formerly prevailed on this 
fubjedt. 
XXXIV 
As the hot ftage of fever is fo conflantly 
preceded by a cold ftage, we prefume that 
the latter is the caufe of the former; and, 
therefore, that the caufe of the cold Rage 
is the caufe of all that follows in the courfe 
of the paroxyfm. See Boerh. Aph. 756. 
XXXV. 
To difcover the caufe of the cold ftage 
of fevers, we may obferve, that it is always 
preceded by ftrong marks of a general de- 
bility prevailing in the fyftem. The fmall- 
nefs and weaknefs of the pulfe, the palenefs 
and coldnefs of the extreme parts, with the 
fhrinking of the whole body, fufficiently 
fhow that the action of the heart and larger 
arteries 32 
PRACTICE 
arteries is, for the time, extremely weaken-* 
ed. Together with this, the languor, in- 
activity, and debility of the animal mo- 
tions, the imperfect fenfations, the feeling 
of cold, while the body is truly warm, and 
fome other fymptoms, all fliow that the 
energy of the brain is, on this occaiion, 
greatly weakened; and I prefume, that, as 
the weaknefs of the adlion of the heart can 
hardly be imputed to any other caufe, this 
weaknefs alfo is a proof of the diminiflied 
energy of the brain. 
XXXVI. 
I {hall hereafter endeavour to (how, that 
the moft noted of the remote caufes of fe- 
ver, as contagion, miafmata, cold, and fear, 
are of a fedative nature; and therefore 
render it probable that a debility is in- 
duced. Likewife, when the paroxyfms of 
a fever have ceafed to be repeated, they 
may OF PHYSIC. 
33 
may again be renewed, and are moft com- 
monly renewed by the application of de- 
bilitating powers. And, further, the de- 
bility which fubfifh in the animal motions 
and other functions through the wrhole of 
fever, renders it pretty certain that feda- 
tive or debilitating powers have been 
plied to the body. 
XXXVII. 
It is therefore evident, that there are 
three Hates which always take place in 
fever, a Hate of debility, a Hate of cold, 
and a Rate of heat; and as thefe three 
Hates, regularly and conflantly fucceed 
each other in the order we have mentioned 
them, it is prefamed that they are in the 
feries of caufe and effedt with refpedl to 
one another. This we hold as a matter of 
fact, even although we Ihould not be able 
to explain in what manner or by what me- 
chanical 
Vol. I. 
c 34 
PRACTICE 
chanical means thefe Rates feverally pro- 
duce each other. 
xxxvm. 
How the hate of debility produces fome 
of the fymptoms of the cold ftage may 
perhaps be readily explained; but how it 
produces all of them, I cannot explain 
otherwife than by referring the matter to 
a general law of the animal-oeconomy, 
whereby it happens, that powers which 
have a tendency to hurt and deflroy the 
fyftem, often excite fuch motions as are 
fuited to obviate the effects of the noxious 
power. This is the vis medicatrix na- 
ture, fo famous in the fchools of phyfic; 
and it Teems probable, that many of the 
motions excited in fever are the effects of 
this power. 
XXXIX. OF PHYSIC. 
35 
XXXIX. 
That the increafed action of the heart 
and arteries, which takes place in the hot 
ftage of fevers, is to be confidered as an ef- 
fort of the vis medicatrix natures, has been 
long a commmon opinion among phyfi- 
cians; and I arn difpofed to affert, that 
fome part of the cold ftage may be im- 
puted to the fame power. I judge fo, 
becaufe the cold flage appears to be uni- 
verfally a means of producing the hot; 
becaufe cold, externally applied, has very 
often fimilar effects; and more certainly 
ft ill, becaufe it feerns to be in proportion 
to the degree of tremor in the cold flage, 
that the hot ftage proceeds more or lefs 
quickly to a termination of the paroxyfin, 
and to a more complete folution and 
longer intermiffion. See XXX. 
C 2 
XL 36 
PRACTICE 
XL. 
It is to be particularly obferved, that, 
during the cold ftage of fever, there feems 
to be a fpafm induced every where on the 
extremities of the arteries, and more efpe- 
cially of thofe upon the furface of the 
body. J This appears from the fuppreilion 
of all excretions, and from the fhrinking 
of the external parts: and although this 
may perhaps be imputed, in part, to the 
weaker action of the heart in propelling 
the blood into the extreme veffels; yet, as 
thefe fymptoms often continue after the 
adlion of the heart is reftored, there is rea- 
fon to believe, that it fpafmodic conftric- 
tion has taken place ; that it fubfifts for 
fome time, and fupports the hot ftage; 
for this ftage ceafes with the flowing of 
the fwcat, and the return of other excre- 
tions, which are marks of the relaxation 
of veffels formerly conftridled. Hoffman. 
Med. O F P H Y S I C. 
37 
Med. rat. Svftem. Tom. IV. P. I. SedT I, 
J 
Cap. I. art. 4. 
XLI. 
The idea of fever, then, tnay be, that a 
fpafm of the extreme veflels, however in- 
duced, proves an irritation to the heart and 
arteries; and that this continues till the 
fpafm is relaxed or overcome. There are 
many appearances which fupport this opi- 
nion ; and there is little doubt that a fpafm 
does take place, which proves an irritation 
to the heart, and therefore maybe confider- 
ed as a principal part in the proximate caufe 
of fever. It will ftill, however, remain a 
quefcion, what is the caufe of this fpafm; 
whether it be diredtly produced by the re- 
mote caufes of fever, or if it be only a part 
of the operation of the vis medicatrix nature. 
XLII. 
I am difpofcd to be of the latter opinion, 
c 3 
be- 38 
PRACTICE 
becaufe, in the firjl place, while it remains 
ftill certain that a debility lays the foun- 
dation of fever, it is not obvious in what 
manner the debility produces the fpafm, 
and, what feems to be its effect, the increa- 
fed action of the heart and arteries; and 
fecondly, becaufe, in almoft all the cafes 
in which an effort is made by the ivj- me- 
dicatrix nature?, a cold fit and a fpafm of 
the extreme veifels are almoft always the 
beginnings of fuch an effort. See Gaub. 
Pathol. Medicin. art. 750. 
XL1II. 
It is therefore that fuch a 
cold fit and fpafm at the beginning of fe- 
ver, is a part of the operation of the vis 
medicatrix; but, at the fame time, it feems 
to me probable, that, during the whole 
courfe of the fever, there is an atony fub- 
fifting in the extreme veftels, and that the 
re- O F P H ¥ S I C. 
39 
relaxation of the fpafm requires the reflo- 
ring of the tone and adion of thefe. 
XLIV. 
This it may be difficult to explain ; but 
I think it may be afcertained as a fad, 
by the conlideration of the fymptQms 
which take place with refped to the func-4 
tions of the ilomach in fevers, fuch as the 
anorexia, naufea, and vomiting, (XIV.) 
From many circumftances it is fufficient- 
ly certain, that there is a confent between 
the ftomach and furface of the body ; and 
in all cafes of the confent of diftant parts, 
it is prefumed to be by the connection of 
the nervous fyftem, and that the confent 
which appearsSssbecWeen the fentient and 
moving fibres of the one part with thofe of 
the other; is fuch, that a certain condition , 
prevailing in the one part occafions a fimi- 
lar condition in the other. 
C 4 
tn PRACTICE 
40 
In the cafe of the ftomach and furface 
of the body, the cbnfent particularly ap- 
pears by the connection which is obferved 
between the ftate of the perfpiration and 
the ftate of the appetite in healthy perfons; 
and if it may be prefumed that the appe- 
tite depends upon the ftate of tone in the 
mufcular fibres of the ftomach, it will 
follow, that the connection of appetite and 
perfpiration depends upon a confent be- 
tween the mufcular fibres of the ftomach 
and the mufcular fibres of the extreme 
veffels, or of the organ of perfpiration, on 
the furface of the body. 
It is further in proof of the connection 
between the appetite and perfpiration, and, 
at the fame time, of the circumftances on 
which it depends, that cold applied to the 
furface of the body, when it does not flop 
perfpiration, but proves a ftimulus to it, 
is always a powerful means of exciting ap- 
appetite. 
Having OF PHYSIC. 
41 
Having thus eftablifhed the connexion 
or confent mentioned, we argue, that as the 
fymptoms of anorexia, naufea, and vo- 
miting, in many cafes, manifeftly depend 
upon a ftate of debility or lofs of tone in the 
mufcular fibres of the ftomach ; fo it may 
be prefumed, that thefe fymptoms, in the 
beginning of fever, depend upon an atony 
communicated to the mufcular fibres of 
the ftomach from the mufcular fibres of 
the extreme vefiels on the furface of the 
body. 
That the debility of the ftomach which 
produces vomiting in the beginning of fe- 
vers actually depends upon an atony of the 
extreme vefiels on the furface of the body, 
appears particularly from a fact obferved 
by Dr Sydenham. In the attack of the 
plague, a vomiting happens, which pre- 
vents any medicine from remaining on the 
ftomach : and Dr Sydenham tells us, that 
in fuch cafes he could not overcome this 
vomiting 42 
PRACTICE 
vomiting but by external means applied to 
produce a fweat; that is, to excite the ac- 
tion of the veffels on the furface of the 
body. 
The* fame connection between the ftate 
of the ftomach and that of the extreme 
veffels on the furface of the body, appears 
from this alfo, that the vomiting, which 
fo frequently happens in the cold ftage of 
fevers, commonly ceafes upon the coming 
on of the hot, and very certainly upon 
any fweat's coming out, (XIV). It is indeed 
probable, that the vomiting in the cold 
ftage of fevers, is one of the means em- 
ployed by nature for reftoring the deter- 
mination to the furface of the body; and 
it is a circumftance affording proof, both 
of this, and of the general connection be- 
tween the ftomach and furface of the body, 
that emetics thrown into the ftomach, and 
operating there, in the time of the cold 
ftage, OF PHYSIC. 
43 
Rage, commonly put an end to it, and 
bring on the hot Rage. 
It alfo affords a proof of the fame con- 
nection, that cold water taken into the Ro- 
mach produces an increafe of heat on the 
furface of the body, and is very often a 
convenient and effectual means of pro- 
ducing fweat. 
From the whole we have now faid on 
this fubjecR, I think it is fufficiently pro- 
bable, that the fymptoms of anorexia, 
naufea, and vomiting, depend upon, and 
are a proof of, an atony fubfiRing in the 
extreme veffels on the furface of the body; 
and that this atony therefore, now afcer- 
taintd as a matter of fact, may be conli- 
dered as a principal circumRance in the 
proximate caufe of fever. 
XLV.  PRACTICE. 
44 
XLV. 
This atony we fuppofe to depend upon 
a diminution of the energy of the brain ; 
and that this diminution takes place in fe- 
vers, we conclude, not only from the de- 
bility prevailing in fo many of the func- 
tions of the body, mentioned above, 
(XXXV.) but particularly from fymptoms 
which are peculiar to the brain itfelf. De- 
lirium is a frequent fymptom of fever: and 
as from the phyfiology and pathology we 
learn that this fymptom commonly de- 
pends upon fome inequality in the excite- 
ment of the brain or intelledlual organ; 
we hence conclude, that, in fever, it de- 
notes fome diminution in the energy of the 
brain. Delirium, indeed, feems often to 
• 
depend upon an increafed impetus of the 
blood in the veflels of the brain, and there- 
fore attends phrenitis. It frequently .ap- 
pears OF PHYSIC, 
45 
pears alfo in the hot ftage of fevers, ac- 
companied with a headach and throbbing 
of the temples. But as the impetus of the 
blood in the veflels of the head is often 
confiderably increafed by exercife, external 
heat, paflions, and other caufes, without 
occafioning any delirium; fo, fuppofing 
that the fame impetus, in the cafe of fever, 
produces delirium, the reafon muft be, 
that, at the fame time, there is fome caufe 
which diminilhes the energy of the brain, 
and prevents a free communication be- 
tween the parts concerned in the intellec- 
tual fundlions. Upon the fame princi- 
ples alfo, I fuppofe there is another fpecies 
of delirium, depending more entirely on 
the diminilhed energy of the brain, and 
which may therefore arife when there is no 
unufual increafe of the impetus of the 
blood in the veflels of the brain. Such 
feems to be the delirium occurring at the 
beginning of the cold flage of fevers, or 
in 46 
PRACTICE 
in the hot Ilage of fuch fevers as fhow 
ftrong marks of debility in the whole 
fyftem. 
XLVL 
Upon the whole, our doctrine of fever 
is explicitly this. The remote caufes 
(XXXVI.) are certain fedative powers ap- 
plied to the nervous fyftem, which dimi- 
nifhing the energy of the brain, thereby 
produce a debility in the whole of the 
fundlions, (XXXV.) and particularly in 
the .action of the extreme veffels, (XLIII. 
XLIV.) Such, however, is, at the fame 
time, the nature of the animal oeconomy, 
(XXXVIII.) that this debility proves an 
indirect Ilimulus to the fanguiferous fy- 
ftem; whence, by the intervention of the 
•cold ftage, and fpafm connected with it, 
(XXXIX. XL.) the adlion of the heart and 
larger arteries is increafcd, (XL.) and con- 
tinues OF PHYSIC. 
47 
tinues fo (XLI.) till it has had the effect 
of reftoring the energy of the brain, of 
extending this energy to the extreme vef- 
fel», of reftoring therefore their action, 
and thereby efpecially overcoming the 
fpafm affecting them ; upon the removing 
of which, the excretion of fweat, and other 
marks of the relaxation of excretories, take 
place. 
XL VII. 
This doctrine will, as I fuppofe, ferve 
to explain not only the nature of fever in 
general, but alfo the various cafes of it 
which occur. Before proceeding, how- 
ever, to this, it may be proper to point out 
the opinions, and, as I apprehend, the 
miftakes, which have formerly prevailed on 
this liibjccl. 
XL VII. 48 
PRACTICE 
XL VIII. 
It has been fuppofed that a lentor or 
vifcidity prevailing in the mafs of blood, 
and flagnating in the extreme veffels, is 
the caufe of the cold ftage of fevers and its 
confequences. But there is no evidence 
of any fuch vifcidity previoufly fubfifting 
in the fluids; and as it is very improbable 
that fuch a Rate of them can be very 
quickly produced, fo the fuddennefs with 
which paroxyfms come on, renders it more 
likely that the phenomena depend upon 
fome caufe acting upon the nervous fy~ 
Bern, or the primary moving powers of the 
animal-oeconomy. See Van Swieten apud 
Boerh. Aph. 755. 
XLIX. 
Another opinion, which has been al- 
moft OF PHYSIC, 
49 
moft univerfally received, is, that a no- 
xious matter introduced into or generated 
in the body, is the proximate caufe of fe- 
ver ; and that the increafed action of the 
heart and arteries, which forms fo great a 
part of the difeafe, is an effort of the vis 
medicatrix natura to expel this morbific 
matter; and particularly to change or con- 
cocft it, fo as to render it either altogether 
innocent, or, at leafi, fit for being more 
eafily thrown out of the body. This doc- 
trine, however, although of as great anti- 
quity as any of the records of phyfic now 
remaining, and although it has been re- 
ceived by almoft every fchool of medicine, 
yet appears to me to reft upon a very un- 
certain foundation. There ate fevers pro- 
duced by cold, fear, and other caufes, ac- 
companied with all the effential circum- 
ftances of fever, and terminating by fweat; 
but, at the fame time, without any evi- 
dence or fufpicion of morbific matter. 
Vol. I. 
D 
There 50 
PRACTICE 
There have been fevers fuddenly cured, 
by a hemorrhagy, fo moderate as could not 
carry out any confiderable portion of a 
matter diffufed over the whole mafs of 
blood; nor can we conceive how the mor- 
bific matter could be collected or deter- 
mined to pafs ofF by fuch an outlet as in 
that cafe is opened. 
Even fuppofing a morbific matter were 
prefent, there is no explanation given in 
what manner the concoction of it is per- 
formed; nor is it fhown, that any fuch change 
does in faCt take place. In certain cafes, it 
is indeed evident, that a noxious matter is 
introduced into the body, and proves the 
caufe of fever: but, even in thefe cafes, it 
appears that the noxious matter is thrown 
out again, without having fuffered any 
change; that the fever often terminates be- 
fore the matter is expelled; and that, upon 
many occafions, without waiting the fup- 
pofed time of concodlion, the fever can be 
cured. OF PHYSIC. 
51 
cured, and that by remedies which do not 
feem to operate upon the fluids, or to pro- 
duce any evacuation. 
L. 
While we thus reafon againft the notion 
of fever being an effort of nature, for con- 
cocting and expelling a morbific matter; 
I by no means intend to deny that the 
caufe of fever frequently operates upon the 
fluids, and particularly produces a pu- 
trefcent ftate of them. I acknowledge 
that this is frequently the cafe : but, at 
the fame time, I maintain, that fuch a 
change of the fluids is not commonly the 
caufe of fever; that very often it is an effeft 
only; and that there is no reafon to be- 
lieve the termination of the fever to de- 
pend upon the expulfion of the putrid 
matter. 
D 2 
LI, 52 
PRACTICE 
LI. 
Another opinion which has prevailed, 
remains dill to be mentioned. In inter- 
mittent fevers, a great quantity of bile is 
commonly thrown out by vomiting ; and 
this is fo frequently the cafe, that many have 
fuppofed an unufual quantity of bile, and 
perhaps a peculiar quality of it, to be the 
caufe of intermittent fevers. This, how- 
ever, does not appear to be well founded. 
Vomiting, by whatever means excited, if 
often repeated, with violent draining, 
feems to be powerful in emulging the bi- 
liary duels, and commonly throws out a 
great deal of bile. This will happen efpe- 
£ially in the cafe of intermittent fevers. 
For as, in the date of debility and cold 
dage of thefe fevers, the blood is not pro- 
pelled in the ufual quantity into the ex- 
treme velfels, and particularly into thofe 
on the furface of the body, but is accu- 
mu- OF PHYSIC. 
53 
mulated in the veflels of the internal parts, 
and particularly in the vena portarum; fo 
this may occafion a more copious fecretion 
of bile. 
Thefe conflderations will, in fome mea- 
sure, account for the appearance of an un- 
ufual quantity of bile in intermittent fe- 
vers ; but the circumftance which chiefly 
occafions the appearance of bile in thefe 
cafes, is the influence of warm climates 
and feafons. Thefe feldom fail to produce 
a ftate of the human body, in which the 
bile is difpofed to pafs off, by its fecreto- 
ries, in greater quantity than ufflal; and 
perhaps alfo changed in its quality, as 
appears from the difeafe of cholera, which 
fo frequently occurs in warm feafons. At 
the fame time, this difeafe occurs often 
without fever; and we (hall hereafter ren- 
der it fufEciently probable, that intermit- 
tent fevers, for the moft part, arife from 
another caufe, that is, from marfh efflu- 
via; 
D 3 PRACTICE 
54 
via; while, on the other hand, there is no 
evidence of their arifing from the ftate of 
the bile alone. The marlh effluvia, how- 
ever, commonly operate moft powerfully 
in the fame feafon that produces the change 
and redundance of the bile; and therefore, 
conlidering the vomiting, and other cir- 
cumftancesof the intermittent fevers which 
here concur, it is not furpriiing that au- 
tumnal intermittents are fo often attended 
with effulions of bile. 
This view of the fubjedl does not lead 
us to confider the ftate of the bile as the 
caufe of intermittents, but merely as a 
circumftance accidentally concurring with 
them, from the date of the feafon in which 
they arife. What attention this requires 
in the conduct of the difeafe, I fhall con- 
fider hereafter. 
LIL 
From this view of the principal hypo- 
thefe$ OF PHYSIC. 
55 
thefes which have been hitherto maintain- 
ed with refpedt to the proximate caufe of 
fever, it will appear, that fevers do not 
strife from changes in the date of the 
fluids; but that, on the contrary, almod 
the whole of the phenomena of fe- 
vers lead us to believe that they chiefly 
depend upon changes in the date of the 
moving powers of the animal fydem. 
Though we fhould not be able to explain 
all the circumdances of the difeafe, it is at 
lead of fome advantage to be led into the 
proper train of invedigation. I have at- 
tempted to purfue it; and fhall now en- 
deavour to apply the doctrine already de- 
livered, towards explaining the diverfity 
of fevers. 
D 4 
CHAP. 56 
PRACTICE 
C H A P. III. 
Of the Difference of Fevers, anp 
its Causes. 
LIII. 
TO afcertain the difference of fevers, 
I think it neceffary to obferve, in 
the firft place, that every fever of more 
than one day's duration confifts of repeat- 
ed, and in fome meafure feparate, paro- 
xyfms; and that the difference of fevers 
takennoticeof above (fromXXV.toXXX.) 
appears to confift in the different ftate of 
paroxyfms, and in the different circum- 
ftances of their repetition. 
LIV. OF PHYSIC. 
57 
LIV. 
That fevers generally confift of diftindt, 
and in fome meafure feparately repeated, 
paroxyfms, I have alleged above to be a 
matter of fadt; but I {hall here endeavour 
to confirm it, by afligning the caufe. 
LV. 
In every fever, in which we can dif- 
tindlly obferve any number of feparate 
paroxyfms, we conftantly find that each 
paroxyfin is finilhed in lefs than twenty- 
four hours ; but as I cannot perceive any 
thing in the caufe of fevers determining to 
this, I muft prefume it to depend on fome 
general law of the animal-oeconomy. Such 
a law feems to be that which fubjedts the 
oeconomy, in many refpecls, to a diurnal 
revolution. Whether this depends upon 
the original conformation of the body, or 
upon 58 
PRACTICE 
upon certain powers conftantly applied to 
it, and inducing a habit, I cannot pofi- 
tively determine ; but the returns of fleep 
and watching, of appetites and excretions, 
and the changes which regularly occur in 
the ftate of the pulfe, fhow fufliciently, 
that in the human body a diurnal revo- 
lution takes place. 
LVI. 
It is this diurnal revolution which, I 
fuppofe, determines the duration of the 
paroxyfms of fevers; and the conftant and 
univerfal limitation of thefe paroxyfms, (as 
obferved in LV.) while no other caufe of 
it can be afligned, renders it fufhciently 
probable that their duration depends up- 
on, and is determined by, the revolution 
mentioned. And that thefe paroxyfms are 
connected with that diurnal revolution, ap- 
pears further from this, that though the 
1H"» OF PHYSIC. 
59 
intervals of paroxyfms are different in dif- 
rent cafes, yet the times of the acceffion 
of paroxyfms are generally fixed to one 
time of the day ; fo that Quotidians come 
on in the morning, Tertians at noon, and 
Quartans in the afternoon. 
LVIL 
It remains to be remarked, that as 
I 
Quartans and Tertians are apt to become 
Quotidians, thefe to pafs into the ftate of 
Remittents, and thefe laft to become Con- 
tinued ; and that, even in the Continued 
form, daily exacerbations and remiffions 
are generally to be obferved; fo all this 
fhows fo much the power of diurnal revo- 
lution, that when, in certain cafes, the 
daily exacerbations and remiffions are with 
difficulty diftinguifhed, we may ftill pre* 
fume, that the general tendency of the 
oeconomy prevails, that the difeafe ftill 
con- 60 
PRACTICE 
confifts of repeated paroxyfms, and, upon 
the whole, that there is no fuch difeafe as 
that which the fchools have called a Conti- 
nent Fever. I expect that this doeftrine will 
be confirmed by what I fliall fay hereafter 
concerning the periodical movements ob- 
ferved in continued fevers. 
LVIII. 
It being thus proved, that every fever, 
of more than one day's duration, coniifts 
of repeated paroxyfms; we, in the next 
place, remark, that the repetition of pa- 
xyfms depends upon the circumftances 
of the paroxyfms which have already 
taken place. From what was obferved in 
XXX. and XXXI. it appears, that the 
longer paroxyfms are protradled, they are 
the fooner repeated; and, therefore, that 
the caufe of the frequent repetition is to be 
fought OF PHYSIC. 
61 
fought for in the caufe of the protraction 
of paroxyfms. 
LIX. 
Agreeably to what is laid down in 
XLVI. and to the opinion of moft part 
of phyficians, I fuppofe, that, in every 
fever, there is a power applied to the body* 
which has a tendency to hurt and deftroy 
it, and produces in it certain motions 
which deviate from the natural date; and, 
at the fame time, in every fever which has 
its full courfe, I fuppofe, that, in confe- 
quence of the conftitution of the animal 
oeconomy, there are certain motions ex- 
cited, which have a tendency to obviate 
the effects of the noxious power, or to 
correct and remove them. Both thefe 
kinds of motion are confidered as confti- 
tuting the difeafe. 
But the former is perhaps flridly the 
morbid 62 
PRACTICE 
morbid ftate, while the latter is to be con- 
fidered as the operation of the vis 
trix nature of falutary tendency, and which 
I fhall hereafter call the reaction of the 
fyftem. 
LX. 
Upon the fuppofltion that thefe two 
ftates take place in every paroxyfm of fever, 
it will appear to be chiefly in the time of 
the hot ftage that the reaction operates in 
removing the morbid ftate; and therefore, 
as this operation fucceeds more or lefs 
quickly, the hot ftage of paroxyfms will 
be {hotter or longer. But as the length of 
paroxyfm depends chiefly upon the dura- 
tion of the hot ftage, fo the longer dura- 
tion of this and of paroxyfms, mu ft be 
owing either to the obftinacy of reflftance 
in the morbid ftate, or to the weaknefs of 
the falutary readion; and it is probable 
that 0 F P H Y S I C. 
63 
that fometimes the one and fometimes 
the other of thefe circumftances takes 
place. 
LXI. 
It Teems to be only by the ftate of 
the fpafm, that we can judge of the re- 
fiftance of the morbid ftate of fever: and 
with refpedt to this fpafm I obferve, that 
either the caufe exciting it may be differ- 
ent in different cafes; or, though the caufe 
Ihould be the fame in different perfons, 
the different degree of irritability in each 
may give occaiion to a greater or leffer de- 
gree of fpafm; and therefore, the reaction 
in fever being given, the continuance of 
the hot ftage, and of the whole par oxy fm, 
may be longer or ftiorter, according to the 
degree of fpafm that has been formed. 
LXIL 64 
PRACTICE 
LXII. 
One caufe of the obftinacy of fpafm in 
fevers may be clearly perceived. In in- 
flammatory difeafes, there is a diathefis 
phlogiftica prevailing in the body, and this 
diathelis we fuppofe to confift in an in- 
creafed tone of the whole arterial fyftem. 
When, therefore, this diathelis accompa- 
nies fever, as it fometimes does, it may be 
fuppofed to give occafion to the febrile 
fpafm's being formed more ftrongly, and 
thereby to produce more protracted pa- 
roxyfms. Accordingly we find, that all 
inflammatory fevers are of the continued 
kind; and that all the caufes of the dia- 
thefls phlogiftica have a tendency to change 
intermittent into continued fevers. Con- 
tinued fevers, then, being often attended 
with the diathefls phlogiftica, we conclude, 
that, in many cafes, this is the caufe of 
their continued form. 
LXIIL OF PHYSIC. 
65 
LXIII. 
In many fevers, however, there is no 
evidence of any diathefis phlogiftica being 
prefent, nor of any other caufe of more 
conliderable fpafm; and, in fuch cafes, 
therefore, we muft impute the protraction 
of paroxyfms, and the continued form of 
the fever, to the weaknefs of reaction. 
That this caufe takes place, we conclude 
from hence, that, in many cafes of fever, 
wherein the feparate paroxyfms are the 
longeft protradled, and the molt difficultly 
obferved, we find the mofl confiderable 
fymptoms of a general debility: and there- 
fore we infer, that, in fuch cafes, the 
protraCted paroxyfms, and continued form, 
depend upon a weaker reaction; owing 
either to the caufes of debility applied 
having been of a more powerful kind, or 
from circumflances of the patient's confti- 
tution favouring their operation. 
Vol. I. 
E 
LXIV. 66 
PRACTICE 
LXIV. 
Upon, thefe principles we make a ftep 
towards explaining in general, with fome 
probability, the difference of fevers ; but 
muff own, that there is much doubt and 
difficulty in applying the doctrine to par- 
ticular cafes. It applies tolerably well to 
explain the different Rates of intermittents, 
as they are more purely fuch, or as they 
approach more and more to the continued 
form: But feveral difficulties ftill remain 
with refpect to many circumftances of in- 
termittents ; and more ftill with refpedt to 
the difference of thofe continued fevers, 
which we have diftinguifhed in our Nofo- 
logy as different from intermittents, and 
as more efpecially entitled to the appella- 
tion of Continued, (fee Syn. Nof. Meth. 
P. V. Ch. I. Sedl. II.), and explained 
more fully above. 
LXV. OF PHYSIC. 
67 
LXV. 
From the view given (LXIII. and LX1V.) 
of the caufes of the protraction of paro- 
xyfms, and therefore of the form of 
continued fevers, ftriCtly fo called, it feems 
probable, that the remote caufes of thefe 
operate by occafioning either a phlogiftic 
diatheiis, or a weaker re-acftion; for we 
can obferve, that the moft obvious dif- 
ference of continued fevers depends upon 
the prevalence of one or other of thefe 
ftates. 
LXVI. 
Continued fevers have been accounted 
of great diverfity; but phyficians have not 
beenfuccefsful in marking thefe differences, 
or in reducing them to any general heads. 
The diftindlions made by the ancients are 
E 2 
not 68 
PRACTICE 
not well underflood; and, fo far as either 
they or the modern nofologifls have di- 
ftinguifhed continued fevers by a differ- 
ence of duration, their diftindlions are not 
well founded, and do not apply in fuch a 
manner as to be of any ufe. We think it 
agreeable to obfervation, and to the prin- 
ciples above laid down, (LXIII. LXIV.) 
to diflinguifh continued fevers according 
as they fhow either an inflammatory irri- 
tation, or a weaker readlion. 
LXVII. 
This diftin&ion is the fame with that of 
fevers into the Inflammatory and Ner- 
vous ; the diftintSlion at prefent moft ge- 
nerally received in Britain. To the firft, 
as a genus, I have given the name of Sy* 
nocha; to the fecond, that of Typhus; 
and, little ftudious whether thefe names 
be authorifed by the ancient ufe of the 
fame OF PHYSIC. 
69 
fame terms, I depend upon their being 
underftood by the characters annexed to 
them in our Nofology, which I apprehend 
to be founded on obfervation. 
Lxvin. 
By thefe characters I think continued 
fevers may in practice be diftinguifhed; 
and, if that be the cafe, the principles above 
laid down will be confirmed. 
LXIX. 
Befide thefe differences of continued fe- 
ver, now mentioned, I am not certain of 
having obferved any other that can be 
confidered as fundamental. But the mo ft 
common form of continued fevers, in this 
climate, feems to be a combination of thefe 
two genera; and I have therefore given 
fuch a genus a place in our Nofology, under 
E 3 
the 70 
PRACTICE 
the title of Synochus. At the fame time, 
I think that the limits between the Syno- 
chus and Typhus will be with difficulty 
affigned; and I am difpofed to believe, 
that the Synochus arifes from the fame 
caufes as the Typhus, and is therefore only 
a variety of it. 
LXX. 
The Typhus feems to be a genus com- 
prehending feveral fpecies. Thefe, how- 
ever, are not yet well afcertained by obfer- 
vation; and in the mean time we can per- 
ceive that many of the different cafes ob- 
ferved do not imply any fpecific difference, 
but feem to be merely varieties, arifing 
from a different degree of power in the 
caufe, from different circumftances of the 
climate or feafon in which they happen, 
or from different circumftances in the 
conftitution of the perfons affected. 
LXXII, OF PHYSIC. 
71 
LXXL 
Some of the effects ariling from thele 
circumllances require to be particularly 
explained. 
One is, an unufual quantity of bile ap- 
pearing in the courfe of the difeafe. This 
abundance of bile may poffibly attend 
fome continued fevers, ftridly fo called; 
but, for the reafons above explained, it 
more commonly attends intermittents, 
and, we believe, it might have been enu- 
merated (XXIX.) among the marks diftin- 
guilhing the latter kind of fevers from the 
former. But, though an unufual quantity 
of bile ihould appear with continued fe- 
vers, it is confidered in this cafe, as in 
that of intermittents, to be a coinci- 
dence only, owing to the ftate of the fea- 
fon, and producing no different fpecies or 
fundamental diftindion, but merely a va- 
riety 
E 4 72 
PRACTICE 
riety of the difeafe. I think it proper to ob- 
ferve here, that it is probable that the 
moR part of the continued fevers named 
Bilious have been truly luch as belong to 
the fedion of Intermittents. 
LXXII. 
Another effect of the circuinftances oc- 
cafionally varying the appearance of ty- 
phus, is a putrefcent Rate of the fluids. The 
ancients, and likewife the moderns, who are 
in general much difpofed to follow the for- 
mer, have diftinguiflied fevers, as putrid and 
non-putrid: but the notions of the an- 
cients, on this fubjeft, wrere not fufliciently 
correct to deferve much notice; and it is 
only of late that the matter has been more 
accurately obferved, and better explained. 
From the diflblved ftate of the blood, as 
it prefents itfelf when drawn out of the 
veins, or as it appears, from the red blood's 
being OF PHYSIC. 
73 
being difpofed to be effufed, and run off 
by various outlets, and from feveral 
other fymptoms, to be hereafter men- 
tioned, I have now no doubt, how much 
foever it has been difputed by fome in- 
genious men, that a putrefcency of the 
fluids to a certain degree does really take 
place in many cafes of fever. This pu- 
trefcency, however, often attends inter- 
mittent, as well as continued fevers, and, 
of the continued kind, both the fynochus 
and typhus, and all of them in very diffe- 
rent degrees; fo that, whatever attention 
it may deferve in practice, there is no 
fixing fuch limits to it as to admit of 
eftablifhing a fpecies under the title of 
Putrid. 
Lxxin. 
Befide differing by the circumttances al- 
ready mentioned, fevers differ alfo by their 
being 74 
PRACTICE 
being accompanied with fymptoms which 
belong to difeafes of the other orders of 
pyrexiae. This fometimes happens in fuch 
a manner, as to render it difficult to de- 
termine which of the two is the primary 
difeafe. Commonly, however, it may be 
afcertained by the knowledge of the re- 
mote caufe, and of the prevailing epide- 
mic, or by obferving the feries and fuc- 
ceffion of fymptoms. 
LXXIV. 
Moft of our fyftems of phyfic have 
marked, as a primary one, a fpecies of fever 
under the title of Hectic ; but, as it is 
defcribed, I have never feen it as a primary 
difeafe. I have conftantly found it as a 
fymptom of fome topical affedlion, moft 
commonly of an internal fuppuration; 
and as fuch it ffiall be coniidered in an- 
other place. 
LXXV. OF PHYSIC. 
75 
LXXV. 
The diftindlion of the feveral cafes of in- 
termittent fever I have not profecuted here; 
both becaufe we cannot affign the caufes 
of the differences which appear; and be- 
caufe I apprehend that the differences 
which, in fadl, occur, may be readily un- 
derftood from what is faid above, (XXV. 
XXVI. and XXVII.), and more fully 
from our Methodical Nofology, Cl. I. 
Sed. I. 
CHAP. 76 
PRACTICE 
CHAP. IV. 
Of the Remote Causes of Fever. 
LXXVI. 
AS fever has been held to confift chief- 
ly in an increafed action of the 
heart and arteries, phyficians have fup- 
pofed its remote caufes to be certain direct 
ftimulants fitted to produce this increafed 
action. In many cafes, however, there is 
no evidence of fuch ftimulants being ap- 
plied; and, in thofe in which they are ap- 
plied, they either produce only a tempo- 
rary O F P H Y S I C. 
77 
rary frequency of the pulfe, which cannot 
be confldered as a difeafe; or, if they do 
produce a permanent febrile ftate, it is by 
the intervention of a topical inflammation, 
which produces a difeafe different from 
what is ftridly called fever. (VIII.) 
LXXVIL 
That diredt ftimulants are the remote 
caufes of fever, feems farther improbable; 
becaufe the fuppofition does not account 
for the phenomena attending the acceflion 
of fevers; and becaufe other remote caufes 
can with greater certainty be afligned. 
LXXVIIL 
As fevers are fo generally epidemic, it is 
probable, that fome matter floating in the 
atmofphere, and applied to the bodies of 
men, ought to be confldered as the remote 
caufe 78 
PRACTICE 
caufe of fevers: and thefe matters prefent 
in the atmofphere, and thus acting upon 
men, may be confidered, either as Con- 
tagions, that is, effluvia, arifing directly 
or originally from the body of a man un- 
der a particular difeafe, and exciting the 
fame kind of difeafe in the body of the 
perfonto whom they are applied: ofMias- 
mata, that is, effluvia, arifing from other 
fubftances than the bodies of men, produ- 
cing a difeafe in the perfon to whom they 
are applied. 
LXXLX. 
Contagions have been fuppofed to be 
of great variety; and it is poffible this 
may be the cafe; but that they truly are 
fo, does not appear clearly from any thing 
we know at prefent. The genera and fpe- 
cies of contagious difeafes, of the clafs of 
Pyrexise, at prefent known, are in number 
not OF PHYSIC. 
79 
not very great. They chiefly belong to the 
order of Fevers, to that of Exanthemata, or 
that of Profluvia. Whether there be any 
belonging to the order of Phlegmafise, is 
doubtful; and though there fliould, it will 
not much increafe the number of contagious 
pyrexia?. Of the contagious exanthemata 
and profluvia, the number of fpecies is 
nearly afcertained; and each of them is 
fo far of a determined nature, that though 
they have now been obferved and diftin- 
guifhed for many ages, and in many dif- 
ferent parts of the world, they have been 
always found to retain the fame general 
character, and to differ only in circum- 
ftances, that may be imputed to feafon, 
climate, and other external caufes, or to 
the peculiar conftitutions of the feveral per- 
fons affected. It feems, therefore, proba- 
ble, that, in each of thefe fpecies, the con- 
tagion is of one fpecific nature; and that 
the number of contagious exanthemata or 
pro- 80 
PRACTICE 
profluvia is hardly greater than the num- 
ber of fpecies enumerated in the fyftems 
of nofology. 
LXXX. 
If, while the contagious exanthemata 
and profluvia are thus limited, we Ihould 
fuppofe the contagious pyrexias to be ftill 
of great and unlimited variety, it muft be 
with refpedl to the genera and fpecies of 
continued fevers. But if I be right in li- 
miting, as I have done, the genera of thefe 
fe vers, (LXVII. LXX.) will appear 
likely that the contagions which produce 
them are not of great variety; and this 
will be much confirmed, if we can render 
it probable that there is one principal, 
perhaps one common, fource of fuch con- 
tagions. 
LXXXI. OF PHYSIC. 
81 
LXXXI. 
To this purpofe, it is now well known, 
that the effluvia conftantly arifing from the 
living human body, if long retained in the 
fame place, without being diffufed in the 
atmofphere, acquire a lingular virulence ; 
and, in that ftate, being applied to the 
bodies of men, become the caufe of a fever 
which is highly contagious. 
The exiftence of fuch a caufe is fully 
proved by the late obfervations on jail 
and hofpital fevers; and that the fame vi- 
rulent matter may be produced in many 
other places, muft be fufficiently obvious: 
and it is probable that the contagion arifing 
in this manner is not, like many other 
contagions, permanent and conftantly ex- 
ifting; but that, in the circumftances 
mentioned, it is occafionally generated. 
At the fame time, the nature of the fevers 
Vol I. 
F 
from 82 
PRACTICE 
from thence, upon different occafions, ari- 
fing, renders it probable that the virulent 
Rate of human effluvia is the common 
caufe of them, as they differ only in a 
ftate of their fymptoms; which may be 
imputed to the circumftances of feafon, 
climate, &c. concurring with the conta- 
gion, and modifying its force. 
LXXXIL 
With refped to thefe contagions, tho' 
we have fpoken of them as of a matter 
floating in the atmoiphere, it is proper to 
obferve, that they are never found to ad: 
but when they are near to the fources from 
whence they arife; that is, either near to 
the bodies of men, from which they im- 
mediately iffue; or near to fome fubftances 
which, as having been near to the bodies 
of men, are imbued with their effluvia, 
and in which fubftances thefe effluvia are 
fome- OF PHYSIC. 
83 
fometimes retained in an active ftate for a 
very long time. 
The fubftances thus imbued with an 
active and infectious matter, may be 
called Fomites; and it appears to me pro- 
bable, that contagions, as they arife from 
fomites, are more powerful than as they 
arife immediately from the human body. 
lxxxiii. 
Miafmata are next to be conlidered, 
Thefe may arife from various fources, and 
be of different kinds ; but we know little 
of their variety, or of their feveral effects. 
We know with certainty only one fpecies 
of miafma, which can be confidered as the 
caufe of fever; and, from the univerfa- 
lity of this, it may be doubted if there be 
any other. 
F % 
LXXXIV. 84 
PRACTICE 
LXXXIV. 
The miafma, To univerfally the caufe 
of fever, is that which arifes from marfhes 
or moift ground, a<Sled upon by heat. 
So many obfervations have now been 
made with refpedl to this, in fo many dif- 
ferent regions of the earth, that there is 
neither any doubt of its being in general a 
caufe of fevers, nor of its being very uni- 
verfally the caufe of intermittent fevers, in 
all their different forms. The iimilarity 
of the climate, feafon, and foil, in the dif- 
ferent countries in which intermittents 
arife, and the fimilarity of the difeafes, 
though arifing in different regions, concur 
in proving that there is one common caufe 
of thefe difeafes, and that this is the marfh 
miafma. 
What is the particular nature of this 
miafma, we know not; nor do we cer- 
tainly OF PHYSIC. 
85 
tainly know whether or not it differs in 
kind: but it is probable that it does not; 
and that it varies only in the degree of its 
power, or perhaps as to its quantity, in a 
given Ipace. 
LXXXV. 
It has been now rendered probable, that 
the remote caufes of fevers (VI1L) are 
chiefly Contagions or Miafmata, and nei- 
ther of them of great variety. We have 
fuppofed that miafmata are the caufe of 
intermittents, and contagions the caufe of 
continued fevers, ftridtly fo named; but 
we cannot with propriety employ thefe 
general terms. For, as the caufe of con- 
tinued fevers may arife from fomites, and 
may, in fuch cafes, be called a Miafma; 
and as other miafmata alfo may produce 
contagious difeafes; it will be proper to 
diftinguilh the caufes of fevers, by ufing 
F 3 
the 86 
PRACTICE 
the terms Human or Marfh 'Effluvia, rather 
than the general ones of Contagion, or 
Miafma. 
LXXXVI. 
To render our doctrine of fever confid- 
ent and complete, it is neceffary to add 
here, that thofe remote caufes of fever, 
human and marfh effluvia, feem to be of 
a debilitating or fedative quality. They 
arife from a putrefcent matter. Their 
production is favoured, and their power 
increafed, by circumftances which favour 
putrefaction; and they often prove putre- 
factive ferments with refpect to the animal 
fluids. As putrid matter, therefore, is 
always, with refpect to animal-bodies, a 
powerful fedative, fo it can hardly be 
doubted that human and marfh effluvia 
are of the fame quality; and it is con- 
firmed by this, that the debility which is 
always OF PHYSIC. 
87 
always induced, feems to be in propor- 
tion to the other marks that appear of the 
power of thofe caufes. 
LXXXVII. 
Though we have endeavoured to fliow 
that fevers generally arife from marfh or 
human effluvia, we cannot, with any cer- 
tainty, exclude fome other remote caufes, 
which are commonly fuppofed to have at 
leaft a (hare in producing thofe difeafes. 
And I proceed, therefore, to inquire con- 
cerning thefe caufes; the fir ft of which that 
merits attention is, the power of cold 
applied to the human body. 
lxxxviii. 
The operation of cold on a living body 
is fo different in different circumftances, as 
to be of difficult explanation; it is here, 
F 4 
there- 88 
PRACTICE 
therefore, attempted with fome diffi- 
dence. 
The power of cold may be confidered as 
abfolute or relative. 
The abfolute power is that by which it 
can diminiffi the temperature of the body 
to which it is applied. And thus, if the na- 
tural temperature of the human body is, 
as we fuppofe it to be, that of 98 degrees of 
Farenheit's thermometer *; every degree 
of temperature lefs than that, may be con- 
fidered as cold with refpedl to the human 
body; and, in proportion to its degree, will 
have a tendency to diminiffi the tempera- 
ture of the body. But as the living human 
body has in itfelf a power of generating 
heat, fo it can fuftain its own proper heat 
to the degree above-mentioned, though 
fur- 
* In every inftance of our mentioning degrees of 
heat or cold, we (hall mention them by the degrees in 
Farenheit's fcale; and the expreflion of higher or 
lower (hall always be according to that fcale. OF PHYSIC. 
89 
furrounded by air or other bodies of a low- 
er temperature than itfelf; and it appears 
from obfervation, that, in this climate, air, 
or other bodies, applied to the living man, 
do not diminifh the temperature of his 
body, unlefs the temperature of the bodies 
applied be below 62 degrees. From hence 
it appears, that the abfolute power of cold 
in this climate, does not aft upon the living 
human body, unlefs the cold applied be 
below the degree juft now mentioned. 
It appears alfo, that the human body's 
being furrounded by ai r of a lower tempera- 
ture than itfelf, is neceffary to its being re- 
tained in its proper temperature of 98 de- 
grees : for, in this climate, every temperature 
of the air above 62 degrees, applied to the 
human body, though ftill of a lower tempe- 
rature than itfelf, is found to increafe the 
heat of it. And from all this it appears, 
that the abfolute power of cold with re- 
fpeft to the human body, is very different 
from 90 
PRACTICE 
from what it is with refpect to inanimate 
bodies. 
LXXXIX. 
The relative power of cold with refpedt 
to the living human body, is that power 
by which it produces a fenfation of cold in 
it; and with refpedl to this, it is agreeable 
to the general principle of fenfation, that 
the fenfation produced, is not in proportion 
to the abfolute force of impreflion, but 
according as the new impreilion is ftronger 
or weaker than that which had been ap- 
plied immediately before. Accordingly, 
with refpect to temperature, the fenfation 
produced by any degree of this, depends 
upon the temperature to which the body 
had been immediately before expofed ; fo 
that whatever is higher than this feels 
warm, and whatever is lower than it feels 
cold; and it will therefore happen that 
the O F PHYSIC. 
91 
the oppolite fenfations of heat and cold 
may on different occalions arife from the 
fame temperature, as marked by the ther- 
mometer. 
With refpedl to this, however, it is to 
be obferved, that though every change of 
temperature gives a fenfation of cold or 
heat as it is lower or higher than the tem- 
perature applied immediately before, the 
fenfation produced is, in different cafes, of 
different duration. If the temperature at 
any time applied is under 62 degrees, every 
increafe of temperature applied will give a 
fenfation of heat; but if the increafe of 
temperature does not arife to 62 degrees, 
the fenfation produced will not continue 
long, but be foon changed to a fenfation 
of cold. In like manner, any temperature, 
applied to the human body, lower than 
that of the body itfelf, gives a fenfation of 
cold; but if the temperature applied does 
not go below 62 degrees, the fenfation of 
cold 92 
PRACTICE 
cold will not continue long, but be foon 
changed to a fenfation of heat. 
It will appear hereafter, that the effects 
of the fenfation of cold will be very diffe- 
rent, according as it is more permanent or 
tranfitory. 
XC. 
Having thus explained the operation of 
cold as abfolute or relative with refpeft to 
the human body, I proceed to mention the 
general effects of cold upon it. 
i. Cold, in certain circumftances, has 
manifeftly a fedative power. It can extin- 
guifh the vital principle entirely, either in 
particular parts, or in the whole body; and 
conlidering how much the vital principle 
of animals depends upon heat, it cannot be 
doubted that the power of cold is always 
more or lefs diredlly fedative. 
This effect may be faid to take place 
from OF PHYSIC. 
93 
from every degree of abfolute cold; and, 
when the heat of the body has upon 
any occalion been preternaturally increafed, 
every lower temperature may be ufeful in 
diminifliing the activity of the fyftem; but 
it cannot diminifh the natural vigour of 
the vital principle, till the cold applied is 
under 62 degrees; nor even then will it 
have this effect, unlefs the cold applied be 
of an intenfe degree, or be applied for Ibme 
length of time to a large portion of the body. 
2. It is equally manifeft, that, in certain 
circumftances, cold proves a ftimulus to the 
living body, and particularly to the fan- 
guiferous fyftem. 
It is probable, that this effect takes place 
in every cafe in which the temperature 
applied produces a fenfation of cold; 
and this, therefore, as depending entirely 
on the relative power of cold, will be in 
proportion to the change of temperature 
that takes place. 
It 94 
PRACTICE 
It appears to me probable, that every 
change of temperature from a higher to a 
lower degree, will prove more or lefs fti- 
mulant ; excepting when the cold applied 
is fo intenfe, as immediately to extin guifh 
the vital principle in the part. 
3. Betide the fedative and ftimulant 
powers of cold, it is manifeftly alfo a power- 
ful ajlringent, caufing a contraction of the 
veffels on the furface of the body, and 
thereby producing a palenefs of the Ikin 
and.a fuppreffion of perfpiration; and it 
feems to have limilar effects when applied 
to internal parts. It is likewife probable, 
that this conftriction, as it takes place 
efpecially in confequence of the fenfibility 
of the parts to which the cold is applied, 
will in fome meafure be communicated to 
other parts of the body; and that thereby 
the application of cold proves a tonic power 
with refpect to the whole fyftem. 
Thefe effects of tonic and aftringent 
power OF PHYSIC. 
9S 
power feem to take place both from the ab- 
folute and relative power of cold; and 
therefore every application of it which 
gives a fenfation of cold, is, in its firft effect, 
both aftringent and ftimulant, though the 
former may be often prevented from be- 
ing either confiderable or permanent when 
the latter immediately takes place. 
XCI. 
It will be obvious, that thefe feveral ef- 
fects of cold cannot all take place at the 
fame time, but may in fucceilion be vari- 
oufly combined. The ftimulant power 
taking place obviates the effects, at lead 
the permanency of the effects, that might 
otherwife have arifen from the fedative 
power That the fame ftimulant power 
prevents thefe from the aftringent, I have 
faid above; but the ftimulant and tonic 
powers 96 
PRACTICE 
powers of cold are commonly, perhaps al- 
ways, conjoined. 
XCII. 
Thefe general effects of cold now pointed 
out are fometies falutary, frequently mor- 
bid ; but it is the latter only I am to con- 
flder here, and they feem to be chiefly the 
following. 
1. A general inflammatory difpofition 
of the fyftem, which is commonly accom- 
panied with Rheumatifm or other Phleg- 
maflae. 
2. The fame inflammatory difpofition 
accompanied with Catarrh. 
3. A Gangrene of particular parts. 
4. A Palfy of a Angle member. 
5. A Fever, or Fever ftricUy fo called 
(VIII.) which it often produces by its 
own power alone, but more commonly 
it is only an exciting caufe of fever by 
con- OF PHYSIC. 
97 
«oncurring with the operation of human 
or marfh effluvia. 
XCIIL 
Cold is often applied to the human body 
without producing any of thefe morbid 
effects, and it is difficult to determine in 
what circumftances it efpecially operates 
in producing them. It appears to me, that 
the morbid effects of cold depend partly 
upon certain circumftances of the cold it- 
felf, and partly on certain circumftances 
of the perfbn to whom it is applied. 
XCIV. 
The circumftances of the cold applied, 
which feem to give it effect, are, i. The 
intenfity or degree of the cold; 2. The 
length of time during which it is applied; 
3. The degree of moifture at the fame time 
G 
accom- 
Vol. I.  PRACTICE. 
98 
accompanying it; 4. Its being applied by 35 
wind or current of air; 5. Its being a vi- 
ciftitude, or fudden and confiderable change 
of temperature, from heat to cold. 
xcv: 
The circumftances of perfons rendering 
them more liable to be affedled by cold, 
feem to be, i. The weaknefs of the fyftem, 
and particularly the lelfened vigour of the 
circulation, occafioned by fading, by eva- 
cuations, by fatigue, by a laft night's de- 
bauch, by excefs in venery, by long watch- 
ing, by much ftudy, by reft immediately 
after great exercife, by Heep, and by pre- 
ceding difeafe. 2. The body, or its parts, 
being deprived of their accuftomed cover- 
ings. 3. One part of the body being ex- 
pofed to cold, while the reft is kept in its 
ufual, or a greater warmth. 
XCVI. Of PHYSIC. 
99 
XCVI. 
The power of thefe circumftances 
(XCV.) is demonftrated by the circum- 
ftances enabling perfons to refift cold. 
Thefe are a certain vigour of conftitution4 
exercife of the body, the prefence of adlive 
paflions, and the ufe of cordials. 
Betide thefe, there are other circumftan- 
ces which, by a different operation, enable 
perfons to refift cold atfting as a fenfation; 
fuch as, paffions engaging a clofe atten- 
tion to one objecft, the ufe of narcotics, and 
that ftate of the body in which fenfibility 
is greatly diminilhed, as in maniacs. To 
all which is to be added, the power of 
habit with refpecft to thofe parts of the 
body to which cold is more conftantly ap- 
plied, which both diminilhes fenfibility, 
and increafes the power of the activity 
generating heat. 
G * 
XCVIL 100 
PRACTICE 
XCVII. 
Befide cold, there are other powers 
that feem to be remote caufes of fever; 
fuch as, fear, intemperance in drinking, 
excefs in venery, and other circumftan- 
ces, which evidently weaken the fyftem. 
But whether any of thefe fedacive powers 
be alone the remote caufe of fever, or if 
they only operate either as concurring 
with the operation of marfh or human 
effluvia, or as giving an opportunity to 
the operation of cold, are queftions not to 
be pofitively anfwered: they may poflibly 
of themfelves produce fever; but rnofl fre- 
quently they operate as concurring in one or 
other of the ways above mentioned. 
XCVIII. 
Having now mentioned the chief of the 
remote caufes of fevers, it may be further 
obferved, OF PHYSIC. 
101 
oblerved, that thefe will arile more or lefs 
readily, according as miafmata and conta- 
gions are more or lefs prevailing and 
powerful, or as thefe are more or lefs fa- 
voured by the concurrence of cold and 
other fedative powers. 
CHAP, V. 
Of the Prognosis of Fevers, 
XCIX. 
AS fevtrs (by LX.) conlift of both 
morbid and falutary motions and 
fymptoms, the tendency of the difeafe 
to a happy or fatal iflue, or the prognoftic 
G 3 
in 102 
PRACTICE 
in fevers, has been eftablifhed by marking 
the prevalence of the morbid or of the falu- 
tary fymptoms; and it might be properly fo 
eftablifhed, if we could certainly diftin- 
guifh between the one and the other of 
thefe kinds of fymptoms: but the opera- 
tion of the reaction, or falutary efforts of 
nature in curing fevers, is ftill involved in 
fo much obfcurity, that I cannot explain 
the feveral fymptoms of it fo clearly as to 
apply them to the eftablifhing progno- 
ses ; and this, I think, may be done better, 
by marking the morbid fymptoms which 
ihow the tendency to death in fevers, 
e, 
This plan of the prognoftics in fevers 
muft proceed upon our knowledge of the 
caufes of death in general, and, in fevers 
inore particularly. 
The OF PHYSIC. 
103 
The caufes of death, in general, are ei- 
ther direct or indirect. 
The fir ft are thofe which directly attack 
and deftroy the vital principle, as lodged 
in the nervous fyStem; or deStroy the or- 
ganization of the brain immediately ne- 
ceffary to the adfion of that principle. 
The fecond, or the indirect caufes of 
death, are thofe which interrupt fuch func- 
tions as are neceffary to the circulation of 
the blood, and thereby neceffary to the 
due continuance and Support of the vital 
principle. 
CI. 
Of thefe general caufes, thofe which 
operate more particularly in fevers feem to 
be, The violence of reaction; which ei- 
ther, by repeated violent excitements, de- 
stroys the vital power itfelf; or, by its vio- 
lence, deftroys the organization of the 
0 4 
brain 104 
PRACTICE 
brain neceffary to the action of that power; 
or, by the fame violence, deftroys the or- 
ganization of the parts more immediately 
neceifary to the circulation of the blood. 
Secondly, The caufe of death in fevers 
may be a poifon, that is, a power capable of 
deltroying the vital principle ; and this 
poifon may be either the miafma or con- 
tagion which was the remote cafe of the 
fever, or it may be a putrid matter gene- 
rated in the courfe of the fever. In both 
cafes, the operation of fuch a power ap- 
pears either as acting chiefly on the ner- 
vous fyftem, inducing the fymptoms of 
debility; or as acting upon the fluids of 
the body, inducing a putrefcent date in 
them. 
CIL 
From all this it appears, that the fymptoms 
Ihowing the tendency to death in fevers, 
may OF PHYSIC. 
105 
may be difcovered by their being either 
the fymptoms 
Of violent reaction'. 
Of great debility; 
Or, of a ft rang tendency to put refaction in 
the fluids. 
And, upon this fuppofition, I proceed 
now to mark thofe fymptoms more parti- 
cularly. 
cm. 
The fymptoms which denote the 'violence 
of re-adliony are, i. The increafed force, 
hardnefs, and frequency, of the pulfe. 
2. The increafed heat of the body. 3. The 
fymptoms which are the marks of a gene- 
ral inflammatory diathefls, and more efpe- 
cially of a particular determination to the 
brain, lungs, or other important vifcera. 
4. The fymptoms which are the marks of 
the caufe of violent re-adion; that is, of 
a 106 
PRACTICE 
a ftrong ftimulus applied, or of a ftrong 
fpafm formed, the latter appearing in a 
confiderable fuppreflion of the excretions. 
CIV. 
The fymptoms which denote a great 
degree of debility* are, 
In the Animal Functions : I. The 
weaknefs of the voluntary motions; II. The 
irregularity of the voluntary motions, de- 
pending on their debility; III. The weak- 
nefs of fenfation; IV. The weaknefs and 
irregularity of the intellectual operations. 
In the Vital Functions: I. The 
weaknefs of the pulfe; II. The coldnefs or 
Ihrinking of the extremities ; III. The 
tendency to a deliquium anirni in an ereCl 
pofture; IV. The weaknefs of refpiration. 
In the Natural Functions : I. The 
weaknefs of the ftomach, as appearing in 
anorexia, naufea, and vomiting; II. In- 
voluntary OF PHYSIC. 
107 
voluntary excretions, depending upon a 
palfy of the fphindters ; III. Difficult de- 
glutition, depending upon a palfy of the 
mufcles of the fauces. 
CV. 
Lajlly, The fymptoms denoting the pu- 
trefcent fate of the fluids, are, 
I. With refpedl to the ftomach; the 
loathing of animal-food, naufea and vo- 
miting, great thirft, and a delire of acids. 
IL With refpedt to the fluids; I. The 
blood drawn out of the veins not co- 
agulating as ufual j8 2. Hemorrhagy from 
different parts, without marks of increafed 
impetus ; 3. Effufions under the ikin or 
cuticle, forming petechise, maculae, and 
vibices ; 4. Effufions of a yellow ferum 
under the cuticle. 
III. With refpetT to the date of the ex- 
cretions ; fetid breath, frequent loofe and 
fetid 108 
PRACTICE 
fetid (tools, high-coloured turbid urine, 
fetid fweats, and the fetor and livid co- 
lour of bliftered places. 
IV. The cadaverous fmell of the whole 
body. 
CVI. 
Thefe feveral fymptoms have very often, 
each of them fingly, a Ihare in determi- 
ning the prognoftic : but more efpecially 
by their concurrence and combination 
with one another; particularly thofe of 
debility with thofe of putrefcency. 
CVII. 
On the fubjecl of the prognoftic, it is 
proper to obferve, that many phyficians 
have been of opinion there is foinething in 
the nature of fevers which generally de- 
termines them to be of a certain duration; 
and OF PHYSIC. 
109 
and therefore that their terminations, whe- 
ther falutary or fatal, happen at certain pe- 
riods of the difeafe, rather than at others. 
Thefe periods are called the Critical 
Days ; carefully marked by Hippocrates 
and other ancient phyficians, as well as by 
many moderns of the greateft eminence 
in practice; whilft, at the fame time, many 
other moderns, of no inconfiderable au- 
thority, deny their taking place in the fe- 
vers of thefe northern regions which we 
inhabit. 
CVIII. 
I am of opinion that the doctrine of the 
ancients, and particularly that of Hippo- 
crates, on this (object, was well founded; 
and that it is applicable to the fevers of our 
climate. 
CIX. 110 
PRACTICE 
CIX. 
I am of this opinion, Becaufe I ob- 
serve that the animal oeconomy, both 
from its own conftitution, and from ha- 
bits which are ealily produced in it, is 
readily fubjecled to periodical movements. 
Secondly, Becaufe, in the difeafes of the 
human body, I obferve periodical move- 
ments to take place with great conftancy 
and exadlnefs ; as in the cafe of inter- 
mittent fevers, and many other difeafes. 
ex. 
Thefe confiderations render it probable, 
that exadt periodical movements may take 
place in continued fevers; and 1 think 
there is evidence of fuch movements ac- 
tually taking place. 
CXL OF PHYSIC. 
111 
CXI. 
The critical days, or thofe on which we 
fuppofe the termination of continued fe- 
vers efpecially to happen, are, the third* 
fifth) fieventh* ninth* eleventh* fourteenth 
/event eenth* and twentieth. We mark 
none beyond this laft ; becaufe, though 
fevers are fometimes protraded beyond 
this period, it is, however, more rarely; 
fo that there are not a fufficient number 
of obfervations to afcertain the courfe of 
them ; and further, becaufe it is probable 
that, in fevers long protraded, the move- 
ments become lefs exad and regular, and 
therefore lefs eafily obferved. 
CXIL 
That the days now mentioned are the 
critical days, feems to be proved by the 
particular fads which are found in the 
writings PRACTICE 
112 
writings of Hippocrates. From thefe facls, 
as collected from the feveral writings of that 
author by M. de Haen, it appears, that of 
one hundred and fixty- three infiances of the 
termination of fevers, which happened on 
one or other of the firfl twenty days of the 
difeafe, there are one hundred and feven, 
or more than two-thirds of the whole 
number, which happened on one or other 
of the eight days above-mentioned; that 
none happened on the fecond or thirteenth 
day; and upon the eighth, tenth, twelfth, 
fifteenth, fixteenth, eighteenth, and nine- 
teenth, there are but eighteen in fiances of 
termination, or one ninth of the whole. 
CXIII. 
As the terminations which happen on 
the feven days laft mentioned, are, upon 
the whole, few; and, upon any one of 
them, fewer than thofe which happen on 
any OF PHYSIC. 
113 
any of our fuppofed critical days; fo there 
are therefore nine days which may b© 
called Non-critical : while, on the 
other hand, the many terminations which 
happened on the feventh, fourteenth, and 
twentieth days, afford a proof both of 
cirtical days in general, and that thefe are 
the chief of them. Hereafter I fhall men- 
tion an analogy that renders the power 
of the other critical days fufficiently pro- 
bable. 
CXIV. 
It appears further, that as, of the ter- 
minations which were final and falutary, 
not a tenth part happened on the non- 
critical days; and of the terminations 
which were final and fatal, though the great- 
er number happened on the critical days, 
yet above a third of them happened on the 
non-critical; fo it would appear, that the 
H 
tendency 
Vol. I. 114 
PRACTICE 
tendency of the animal ceconomy is to 
obferve the critical days, and that it 
is by the operation of fome violent and 
irregular caufe that the courfe of things is 
fometimes turned to the non-critical. 
CXV. 
What has been faid gives fufficient 
ground for prcfumiqg, that it is the gene- 
ral tendency of the animal oeconomy to de- 
termine the periodical movements in fevers 
to be chiefly on the critical days. At the 
fame time, we mull acknowledge it to be 
a general tendency only; and that, in par- 
ticular cafes, many circumftances may oc- 
cur to difturb the regular courfe of it. 
Thus, though the chief and more remark- 
able exacerbations in continued fevers hap- 
pen on the critical days, there are truly 
exacerbations happening every day; and 
thefe, from certain caufes, may become 
con- OF PHYSIC. 
115 
confiderable and critical. Further, though 
intermittent fevers are certainly 
ftrongly determined to obferve a tertian or 
quartan period, we know there are cir- 
cumftances which prevent them from ob- 
ferving thefe periods exactly, and which 
render them either anticipating or poftpo- 
ning fo much, that the days of paroxyfms 
come to be quite changed; and it is allow- 
able to fuppofe, that the like may happen 
with refpect to the exacerbations of con- 
tinued fevers, fo as thereby to difturb the 
regular appearance of critical days. 
A particular inftance of this occurs with 
refpect to the fixth day of fevers. In the 
writings of Hippocrates, there are many 
inftances of terminations happening on the 
fixth day ; but it is not therefore reckon- 
ed among the critical days: for, of the ter- 
minations happening on that day, there is 
not one which proves finally of a falutary 
kind; the greater number are fatal; and 
H 2 
all 116 
PRACTICE 
all the reft are imperfect, and followed 
with a relapfe. All this fliows, that fome 
violent caufe had, in thefe cafes, produced 
a deviation from the ordinary courfe of na- 
ture; that the terminations on the fixth 
day are nothing more than anticipations of 
the feventh, and therefore a proof of the 
power of this laft. 
CXVI. 
The doctrine of critical days has been 
much embarraffed by fome diffonant ac- 
counts of it, which appear in the writings 
imputed to Hippocrates. But this may be 
juftly accounted for from thefe writings 
being truly the works of different perfons, 
and from the moil: genuine of them having 
fuffered many corruptions; fothat, in Ihort, 
every thing, which is inconfiftent with the 
facts above laid down, may be afcribed to 
one or other of thefe caufes. 
CXVIL OF PHYSIC. 
117 
CXVII. 
This, further, has efpecially difturbed the 
doctrine of critical days, that Hippocrates 
himfelf attempted, perhaps too haftily, to 
eftablifh general rules, and to bring the 
to a general theory, drawn from 
Pythagorean opinions concerning the 
power of numbers. It is this which feems 
to have produced the idea of odd days, and 
of a quaternary and feptenary period, doc- 
trines which appear fo often in the writings 
of Hippocrates. Thefe, however, are in- 
confiftent with the facts above laid down; 
and indeed, as Afclepiades and Celfus 
have obferved, are inconiiftent with one 
another. 
CXVIII. 
Upon the whole, therefore, it is appre- 
hended, that the critical days above align- 
ed 
H 3 118 
PRACTICE 
ed are truly the critical days of Hippo- 
crates, and may be confiftently explained 
in the following manner. 
CXIX. 
From the univerfality of tertian or quar- 
tan periods in intermittent fevers, we can- 
not doubt of there being, in the animal 
(Economy, a tendency to obferve fuch pe- 
riods ; and the critical days above men- 
tioned are confiftent with this tendency of 
the oeconomy, as all of them mark either 
tertian or quartan periods. Thefc periods, 
however, are not promifeuoufly mixed, 
but occupy conftantly their feveral portions 
in the prog refs of the difeafe; fo that, from 
the beginning to the eleventh day, a ter- 
tian period takes place; and, from the 
eleventh to the twentieth, and perhaps 
longer, a quartan period is as Readily ob- 
ferved. 
cxx. OF PHYSIC. 
119 
cxx. 
What determines the periods to be chan- 
ged about the eleventh day, we have not 
clearly perceived ; but the fact is certain : 
for there is no inftance of any termination 
on the thirteenth, that is, the tertian period 
next following the eleventh; whereas, up- 
on the fourteenth, feventeenth, and twen- 
tieth, which mark quartan periods, there 
are forty-three inftances of terminations, 
and fix only on all the intermediate days 
between thefe. 
This prevalence of a quartan period 
leaves no room for doubting that the twen- 
tieth, and not the twenty-fir ft, is the cri- 
tical day marked by Hippocrates, though 
the laft is mentioned as fuch in the common 
edition of the Aphorifms, taken from an 
erroneous manufeript, which Celfus alfo 
feems to have copied. 
H 4 
CXXL PRACTICE 
120 
CXXI. 
A confiftency with the general tendency 
of the fyftem, renders the feries of critical 
days we have mentioned, probably the true 
one; and the only remaining difficulty 
in finding what we have delivered to be 
the fame with the genuine dodirine of 
Hippocrates, is the frequent mention of 
the fourth as a critical day. 
It is true there are more inftances of ter- 
minations happening on this day than on 
fomc of thofe days we have afferted to be 
truly critical: but its inconfiftency with 
the more general tendency, and fome other 
confiderations, lead us to deny its being 
naturally a critical day; and to think, that 
the inftances of terminations, which have 
really occurred on the fourth day, are to 
be reckoned among the other irregularities 
that happen in this matter. 
CXXIL OF PHYSIC. 
121 
CXXII. 
I have thus endeavoured to fupport the 
dotftrine of critical days, chiefly upon the 
particular fadts to be found in the writings 
of Hippocrates: And although I might alfo 
produce many other teftimonies of both 
ancient and modern times; yet it muft 
be owned, that fome of thefe teftimonies 
may be fufpecfted to have arifen rather from 
a veneration of Hippocrates, than from 
accurate obfervation. 
CXXIII. 
With refpedt to the opinions of many 
moderns who deny the prevalence of criti- 
cal days, they are to be little regarded : 
for the obfervation of the courfe of conti- 
nued fevers is known to be difficult and 
fallacious ; and therefore the regularity of 
that; 122 
PRACTICE 
that courfe may have often efcaped inat- 
tentive and prejudiced obfervers. 
CXXIV. 
Our own obfervations amount to this, 
that fevers with moderate fymptoms, ge- 
nerally cafes of the fynocha, frequently 
terminate in nine days, or fooner, and very 
conftantly upon one or other of the cri- 
tical days which fall within that period : 
but it is very rare, in this climate, that 
cafes of either the typhus or fynochus ter- 
minate before the eleventh day; and, 
when they do terminate on this day, it is 
for the moft part fatally. When they are 
protracted beyond this time, I have very 
conftantly found, that their terminations 
were upon the fourteenth, feventeenth, or 
twentieth day. 
In fuch cafes, the falutary terminations 
are feldpm attended with any conliderabk 
eva- OF PHYSIC. 
123 
evacuation. A fweating frequently ap- 
pears, but is feldom confiderable; and I 
have hardly ever obferved critical and 
deciflve terminations attended with vo- 
miting, evacuations by ftool, or remarkable 
changes in the urine. The folution of the 
difeafe is chiefly to be difcerned from fome 
return of deep and appetite, the ceaflng of 
delirium, and an abatement of the fre- 
quency of the pulfe. By thefe fymptoms 
we can often mark a crifis of the difeafe; 
but it feldom happens fuddenly and entire- 
ly; and it is moft commonly from fome 
favourable fymptoms occurring upon one 
critical day, that we can announce a more 
% 
entire folution upon the next following. 
Upon the whole, I am perfuaded, that, 
if obfer various fliall be made with atten- 
tion, and without prejudice, I fhall be al- 
lowed to conclude with the words of the 
learned and fagacious Gaubius, " Fallor, ni 
" fua  PRACTICE 
124 
" fua conftiterit Hippocrati au&oritas, 
" Galeno fides, Naturte virtus et ordo." 
CHAP. VI. 
Of the Method of Cure in Fevers, 
SECT. I. 
Of the Cure of Continued Fevers. 
cxxv. 
AS it is allowed, that, in every fever 
which has its full courfe, there is an 
effort of nature of a falutary tendency, it 
might be fnppofcd that the cure of fevers 
fliould be left to the operations of nature, 
or O F P H YS I C. 
125 
or that our art fhould be only directed to 
fupport and regulate thefe operations, and 
that we fhould form our indications ac- 
cordingly. This plan, however, I cannot 
adopt, becaufe the operations of nature are 
very precarious, and not fo well underftood 
as to enable us to regulate them properly. 
It appears to me, that trufting to thefe ope- 
rations has often given occafion to a ne- 
gligent and inert practice; and there is rea- 
fon to believe, that an attention to the ope- 
rations of nature may be often fuperfeded 
by art. 
CXXVI. 
The plan which to me appears to be 
moft fuitable, is that which forms the in- 
dications of cure upon the view of ob- 
viating the tendency to death; while, at 
the fame time, the means of executing 
thefe indications are direded by a proper 
atten- 126 
PRACTICE 
attention to the proximate caufe of fe- 
vers. 
Upon this plan, in confequence of what 
has been laid down above on the fubject 
of the.prognoftic, we form three general 
indications in the cure of continued fevers.; 
and the one or other of thefe is to be em- 
ployed according as the circumftances of 
the fever (CII.) fhall direct. 
The firft therefore is, To moderate the vio- 
lence of reaction. 
The fecond is, Zb remove the caufes or 
obviate the effects of debility. And, 
The third is, To obviate or correct the ten- 
dency of the fluids to putrefaction. 
CXXVII. 
The firft indication may be anfwered, 
that is, the violence of readlion may be 
moderated, 
I. By OF PHYSIC. 
127 
1. By all thofe means which diminilh 
the action of the heart and arteries. 
2. By thofe means which take off the 
fpafm of the extreme veffels, which we 
fuppofe to be the chief caufe of violent 
readlion. 
CXXVIII. 
The action of the heart and arteries may 
be diminiflied, 
1. By avoiding or moderating thofe irri- 
tations, which, in one degree or other, are 
almoft conftantly applied to the body. 
2. By the ufe of certain fedative powers. 
3. By diminifliing the tenfion and tone 
of the arterial fyftem. 
CXXIX. 
The irritations (CXXVIIL I.) almoft 
conftantly applied, are the impreftions 
made 128 
PRACTICE 
made upon our fenfes; the exercife of the 
body and mind ; and the taking in of ali- 
ments. The avoiding thefe as much as 
poflible, or the moderating their force, 
conftitute what is rightly called the An- 
tiphlogistic Regimen, proper to be 
employed in almoft every continued fever. 
cxxx. 
The conduct of this regimen is to be 
directed by the following rules and confi- 
derations. 
i. Imprefllons on the external fenfes, 
as being ftimulant to the fyftem, and a 
chief fupport of its adlivity, Ihould be 
avoided as much as poffible; thofe efpe- 
cially of more conftant application, thofc 
of a ftronger kind, and thole which give 
pain and uneafinefs. 
No impreflion is to be more carefully 
guarded againlt than that of external heat; 
while, OF PHYSIC. 
129 
while, at the fame time, every other means 
of increafing the heat of the body is to be 
Ihunned. Both thefe precautions are to be 
obferved as foon as a hot ftage is fully 
formed, and to be attended to during its 
continuance; excepting in certain cafes, 
where a determination to fweating is ne- 
ceflary, or where the ftimulant effects of 
heat may be compenfated by circumftances 
which determine it to produce a relaxation 
and revulfion. 
2. All motion of the body is to be 
avoided, efpecially that which requires the 
exercife of its own mufcles ; and that po- 
fture of the body is to be chofen which 
employs the feweft mufcles, and which 
keeps none of them long in a ftate of con- 
traction. Speaking, as it accelerates refpira- 
tion, is particularly to be refrained from. 
It is to be obferved, that every motion 
of the body is the more ftimulant in pro- 
portion as the body is weaker. 
Vol. I. 
I 
3- The 130 
PRACTICE 
3. The exercife of the mind alfo is a fti- 
mulus to the body; fo that all impreflions 
which lead to thought, and thofe efpecially 
which may excite emotion or paflion, are 
to be carefully fhunned. 
With refpecl to avoiding impreflions of 
all kinds, an exception is to be made in 
the cafe of a delirium coming on, when 
the prefenting of accuftomed objects may 
have the effect of interrupting and divert- 
ing the irregular train of ideas then arifing 
in the mind. 
4. The prefence of recent aliment in the 
ftomach proves always a flimulus to the 
fyftem, and ought therefore to be as mo- 
derate as poflible. A total abftinence for 
fome time may be of fervice; but as this 
cannot be long continued with fafety, we 
muft avoid the ftimulus of aliment, by 
choofing that kind which gives the leaft. 
We fuppofe that alimentary matters are 
more ftimulant, according as they are more 
alkalefcent; O F PHYSIC. 
131 
alkalefcent; and this leads to avoid aft 
animal, and to ufe vegetable food only. 
As our drinks alfo may prove ftimulant, 
fo all aromatic and fpirituous liquors are 
to be avoided; and, in anfwering the pre- 
fent indication, all fermented liquors, ex- 
cepting thofe of the loweft quality, are to 
be abftained from. 
CXXXI. 
Befide thefe ftimulant powers more 
tonftantly applied, there are others which, 
although occafional only, yet, as com- 
monly accompanying fevers, muft be at- 
tended to and removed. 
One is, the fenfe of thirft, which, as a 
powerful ftimulus, ought always, in one 
way or other, to be removed. 
Another ftimulus frequently arifes from 
crudities, or corrupted humours, in the 
ftomach ; and it is to be removed by vo- 
miting, by dilution, or by the ufe of acids* 
I 2 
A 132 
PRACTICE 
A third fliumlus often arifes from the 
preternatural retention of faeces in the in- 
tellines ; and ought to be removed by fre- 
quent laxative glyflers. 
A fourth flimulus to be conftantly fu- 
fpedled in fevers, is a general acrimony of 
the fluids, as prodcued by the increafe of 
motion and heat, joined with an interrup- 
tion of the excretions. This acrimony is 
to be obviated or removed by the taking 
in of large quantities of mild antifeptic 
liquors. 
CXXXIL 
The avoiding of irritation in all thefe 
particulars, (CXXX. and CXXXI.) con- 
flitutes the antiphlogiftic regimen abfo- 
lutely neceflary for moderating the vio- 
lence of readlion; and, if I miflake not, 
is proper in aimoil every circumflance of 
continued fevers, becaufe the propriety and 
fafety OF PHYSIC. 
133 
fafety of employing ftimulants is often un- 
certain; and becaufe feveral of thofe above- 
mentioned, befide their ftimulant powers, 
have other qualities by which they may 
be hurtful. 
It appears to me, that the fuppofed 
utility of ftimulants, in certain cafes of fe- 
ver, has often arifen from a miftake in 
having afcribed to their ftimulant what 
really depended upon their antifpafmodic 
power. 
CXXXIIL 
A fecond head of the means (CXXVIII. 
2.) for moderating the violence of reaction, 
comprehends certain fedative powers, which 
may be employed to diminish the activity 
of the whole body, and particularly that 
of the fanguiferous fyftem. 
The of thefe to be mentioned is the 
application of cold. 
I 3 
Heat  PRACTICE 
134 
Heat is the chief fupport of the activity 
of the animal fyftem; which is therefore 
provided in itfelf with a power of gene- 
rating heat. But, at the fame time, we 
obferve, that this would go to excefs, 
were it not conftantly moderated by a 
cooler temperatute in the furrounding at- 
mofphere. When, therefore, that power 
of the fyftem generating heat is increafed, 
as is commonly the cafe in fevers, it is ne- 
celfary not only to avoid all means of in-r 
creating it further, but it feems proper al- 
lo to apply air of a cooler temperature ; or 
at leaft to apply it more entirely and free- 
ly, than in a ft ate of health. 
Some late experiments in the fmall-pox, 
and in continued fevers, Ihow that the 
free admitiion of cool air to the body is a 
powerful remedy in moderating the vio- 
lence of reaction; but what is the mode 
of its operation, to what circumftances of 
fever it is peculiarly adapted, or what li- 
mitatiqns OF PHYSIC. 
135 
mitations it requires, I lhall not venture 
to determine, till more particularly in- 
flrudled by further experience. 
CXXXIV. 
A fecond fedative power which may be 
employed in fevers, is that of certain me- 
dicines, known, in the writings on the 
Materia Medica, under the title of Refri- 
gerants. 
The chief of thefe are acids of all kinds, 
when fufficiently diluted; and they are, 
in feveral refpeds, remedies adapted to 
continued fevers. Thofe efpecially in ufe 
are, the Vitriolic and Vegetable; and, on 
many accounts, we prefer the latter. 
cxxxv. 
Another fet of refrigerants are, the 
Neutral Salts, formed of the vitriolic, ni- 
trous 
I 4 136 
PRACTICE 
trous, or vegetable acids; with alkalines, 
either fixed or volatile. All thefe neutrals, 
while they are diflblving in water, gene- 
rate cold ; but as that cold ceafes foon af- 
ter the folution is finifhed, and as the faits 
are generally exhibited in a diffolved ftate, 
their refrigerant power in the animal body 
does not at all depend upon their power 
of generating cold with water. The neu- 
tral chiefly employed as a refrigerant, is 
Nitre; but all the others, compounded as 
above-mentioned, partake more or lefs of 
the fame quality. 
CXXXVI. 
Betides thefe neutrals, fome metallic 
faits alfo have been employed as refrige- 
rants in fevers; and particularly the Sugar 
of Lead. But the refrigerant powers of 
this are not well afcertained ; and its dele- 
terious qualities are too well known to 
admit of its being freely ufed. 
CXXXVII. OF PHYSIC. 
137 
CXXXVII. 
Under the third general head (CXXVIII. 
3.) of the means to be employed for modera- 
ting the violence of reaction, are compre- 
hended the feveral means of diminifliing 
the tenfion, tone, and activity, of the 
fanguiferous fyftem. As the activity of 
this fyftem depends, in a great meafure, 
upon the tone, and* this again upon the 
tenfion of the veflels, given taxhem by the 
quantity of fluids they contain, it is evi- 
dent, that the diminution of the quantity 
of thefe, muft diminifli the activity of the 
fanguiferous fyftem. 
CXXXVIII. 
The quantity of fluids contained in the 
fanguiferous fyftem, may be diminiihed 
moft conveniently by the evacuations of 
blood-letting and purging. 
CXXXIX. 138 
d R A C T,I C E 
CXXXIX. 
Nothing is more evident, than that blood- 
letting is one of the moft powerful means 
of diminifliing the activity of the whole 
body, efpecially of the fanguiferous fy- 
ftem; and it muft therefore be the moft ef- 
fectual means of moderating the violence of 
readion in fevers. Taking this as a fad, 
I omit inquiring into its mode of ope- 
ration, and fhall only confider in what 
circumftances of fevers it may be moft 
properly employed. 
CXL. 
When the violence of readlion, and its 
conftant attendant, a phlogiftic diathefis, 
are fufficiently manifeft; when thefe con- 
ftitute the principal part of the difeaie, 
and may be expeded to continue through- 
out the whole of it, as in the cafes of Jy~ 
nocbai OF P H,Y S I C. 
139 
nocha; then blood-letting is the principal 
remedy, and may be employed as far as 
the fymptoms of the difeafe may feem to 
require, and the conftitution of the patient 
will bear. It is, however, to be attended 
to, that a greater evacuation than is necef- 
fary, may occafion a flower recovery, may 
render the perfon more liable to a relapfe, 
or may bring on other difeafes. 
CXLI. 
In the cafe of therefore, there is 
little doubt about the propriety of blood- 
letting : but there are other fpecies of fever, 
as the in which a violent reaction 
and phlogiftic diatheiis appear, and prevail 
during fome part of the courfe of the dif- 
eafe; while, at the fame time, thefe cir- 
cumftances do not conftitute the principal 
part of the difeafe, nor are to be expected 
to continue during the whole courfe of it; 
and, 140 
PRACTICE 
and it is well known, that, in many cafes, 
the ftate of violent reaction is to be fuc- 
ceeded, fooner or later, by a ftate of de- 
bility, from the excefs of which the dan- 
ger of the difeafe is chiefly to arife. It is, 
therefore, neceflary, that, in many cafes, 
blood-letting fliould be avoided; and even 
although, during the inflammatory ftate of 
the difeafe, it may be proper, it will be ne- 
ceflary to take care that the evacuation be 
not fo large as to increafe the ftate of de* 
bility which is to follow. 
CXLIL 
From all this it muft appear, that the 
employing blood-letting, in certain fevers, 
requires much difcernment and {kill, and 
is to be governed by the confideration of 
the following circumftances: 
i. The nature of the prevailing epide- 
mic. 
2. The OF PHYSIC. 
141 
а. The nature of the remote caufe. 
3. The feafon and climate in which the 
difeafe occurs. 
4. The degree of phlogiftic diatheiis 
prefent. 
5. The period of the difeafe. 
б. The age, vigour, and plethoric ftate 
of the patient. 
7. The patient's former difeafes and ha- 
bits of blood- letting. 
8. The appearance of the blood drawn 
out. 
9. The effects of the blood-letting that 
may have been already pradlifed. 
out. 
exLin. 
When, after the confideration of thefe 
circumftances, blood-letting is determined 
to be necelfary, it fhould be obferved, 
that it is more effectual, according as the 
blood is more fuddenly drawn off, and as 
the 142 
PRACTICE 
the body is, at the fame time, more free 
from all irritation, and, confequently, 
when in a pofture in which the feweft 
mufcles are in addion. 
CXLIV. 
Another evacuation whereby the quan- 
tity of fluids contained in the body can be 
confiderably diminiflied, is that of Pur- 
ging, 
CXLV. 
If we confider the quantity of fluids 
conftantly prefent in the cavity of the inte- 
ftines, and the quantity which may be 
drawn from the innumerable excretories 
that open into this cavity, it will be obvi- 
ous, that a very great evacuation can be 
made by purging; and, if this be done by 
a ftimulus applied to the inteftines, with- 
out OF PHYSIC. 
143 
out being at the fame time communicated 
to the reft of the body, it may, by empty- 
ing both the cavity of the inteftines, and 
the arteries which furnifh the excretions 
poured into it, induce a confiderable re- 
laxation in the whole fyftem ; and there- 
fore, purging feems to be a remedy fuited 
to moderate the violence of reaction in 
fevers. 
CXLVI. 
But it is to be obferved, that, as the 
fluid drawn from the excretories opening 
into the inteftines, is not all drawn imme- 
diately from the arteries, as a part of it is 
drawn from the mucous follicles only; and 
as what is even more immediately drawn 
from the arteries, is drawn off flowly; fo 
the evacuation will not, in proportion to 
its quantity, occafion fuch a hidden de- 
pletion of the red veffels as blood-letting 
does; 144 
PRACTICE 
does; and therefore cannot operate fo 
powerfully in taking off the phlogiftic dia- 
thefis of the fyftem. 
CXLVIL 
At the fame time, as this evacuation 
may induce a confiderable degree of debi- 
lity ; fo, in thole cafes in which a danger- 
ous date of debility is likely to occur, pur- 
ging is to be employed with a great deal 
of caution; and more efpecially as the 
due meafure of the evacuation is more 
difficult to be applied than in the cafe of 
blood-letting. 
CXLVIII. 
As we fliall prefently have occalion to 
obferve, that it is of great importance, in 
the cure of fevers, to reftore the determi- 
nation of the blood to the veflels on the fur- 
face OF PHYSIC, 
145 
face of the body; fo purging, as in fome 
meafure taking offthat determination, feems 
to be an evacuation not well adapted to the 
cure of fevers * 
CXLIX. 
If, notwithftanding thefe doubts, (CXLVL 
CXLVIL and CXLVIII.) it fliall be afferted, 
that purging, even from the exhibition of 
purgatives, has often been ufeful in fevers; 
I would beg leave to maintain, that this has 
not happened from a large evacuation; 
and, therefore, not by moderating the vio- 
lence of re-action, excepting in the cafe of 
a more purely inflammatory fever, or of 
exanthemata of an inflammatory nature. 
In other cafes of fever, I have feen a large 
evacuation by purging, of mifchievouscon- 
fequence ; and if, upon occafion, a more 
moderate evacuation has appeared to be 
ufeful, it is apprehended to have been 
Vol. I. 
K 
only 146 
PRACTICE 
only by taking off the irritation of retained 
fseces, or by evacuating corrupted humours 
which happened to be prefent in the inte- 
flines ; for both of which purpofes, fre- 
quent laxatives may be properly employed. 
CL. 
Another fet of means (CXXVIL 2.) for 
moderating the violence of reaction in fe- 
vers, are thofe fuited to take off the fpafm 
of the extreme veffels, which we believe to 
be the irritation that chiefly fupports the 
reaction. 
Though I have put here this indication 
of taking off the fpafm of the extreme vef- 
fels, as fubordinate to the general indica- 
tion of moderating the violence of reac- 
tion ; it is however to be obferved here, 
that as fever univerfally conlifts in an in- 
creafed action of the heart, either in fre- 
quency or in force, which in either cafe is 
fup- OF PHYSIC. 
147 
fupported by a fpafm of the extreme vef- 
fels, fo the indication for removing this 
is a very general one, and applicable in 
almoft evety circumflance of fever, or at 
leaft with a few exceptions, to be taken 
notice of hereafter. 
CLL 
For taking off the fpafm of the extreme 
veffels, the means to be employed are ei- 
ther internal or external. 
CLII. 
The internal means (CLI.) are, 
i. Thofe which determine the force of 
the circulation to the extreme veflels on 
the furface of the body, and, by reftor- 
ing the tone and activity of thefe veffels, 
may overcome the fpafm on their extre- 
mities. 
K 2 
o.. Thole 148 
PRACTICE 
2. Thofe medicines which have the 
power of taking off fpafm in any part of 
the fyftem, and which are known under the 
title of Antispasmodics. 
CLIII. 
Thofe remedies which are fit to deter- 
mine to the furfacee of the body, are, 
1. Diluents. 
2. Neutral Salts. 
3. Sudorifics* 
4. Emetics. 
CLIV. 
Water enters, in a large proportion, into 
the competition of all the animal fluids, 
and a large quantity of it is always dif- 
fufed through the whole of the com- 
mon mafs. Indeed, in a found ftate, 
the fluidity of the whole mafs depends 
upon O F P H Y S I C. 
149 
upon the quantity of water prefent in it. 
Water, therefore, is the proper diluent of 
our mafs of blood; and other fluids are 
diluent only in proportion to the quantity 
of water they contain. 
CLV. 
Water may be faid to be the vehicle 
of the feveral matters which ought to be 
excerned; and in a healthy ftate the ful- 
nefs of the extreme veflels, and the quan- 
tity of excretions, are nearly in proportion 
to the quantity of water prefent in the 
body. In fever, however, although the 
excretions are in fome meafure interrupt- 
ed, they continue in fuch quantity as to 
exhale the more fluid parts of the blood ; 
and while a portion of them is, at the 
fame time, necelfarily retained in the lar- 
ger veflels, the fmaller and the extreme 
veflels, both from the deficiency of 
K 3 
fluid, 150 
PRACTICE 
fluid, and their own contracted ftate, are 
lefs filled, and therefore allowed to remain 
in that condition. 
CLVI. 
To remedy this contracted Rate, nothing 
is more neceffary than a large fupply of 
water or watery fluids, taken in by drink- 
ing, or otherwife; for as any fuperfluous 
quantity of water is forced off by the 
feveral excretories, fuch a force applied, 
may be a means of dilating the extreme 
veffels, and of overcoming the fpafm af- 
fecting tReir extremities. 
CL VII. 
Accordingly the throwing in of a large 
quantity of watery fluids has been, at all 
times, a remedy much employed in fevers; 
and in no inftance more remarkably, than 
by OF PHYSIC, 
151 
by the Spanilh and Italian phyficians, in 
the ufe of what they call the Diata aquea. 
CL VIII. 
This practice confifts in taking away 
every other kind of aliment and drink, 
and in giving in divided portions every 
day, for feveral days together, fix or eight 
pounds of plain water, generally cold, but 
fometimes warm. All this, however, is to 
be done only after the difeafe has conti- 
nued for fome time, and, at leaft, for a 
f ' 
week. 
CLIX. 
A fecond means (CLIIL 2.) of determi- 
ning to the furface of the body, is by the 
ufe of neutral faits. Thefe, in a certain 
dofe, taken into the ftomach, produce, foon 
after, a fenfe of heat upon the furface 
K 4 
of 152 
PRACTICE 
of the body; and, if the body be covered 
clofe and kept warm, a fweat is readily 
brought out. The fame medicines, taken 
during the cold ftage of a fever, very often 
put an end to the cold ftage, and bring on 
the hot; and they are alfo remarkable for 
flopping the vomiting which fo frequently 
attends the cold ftage of fevers. All this 
ihows, that neutral faits have a power of 
determining the blood to the furface of the 
body, and may therefore be of ufe in 
taking off the fpafm which in fevers fub-» 
lifts there. 
CLX. 
The neutral moft commonly employed 
in fevers, is that formed of an alkali with 
the native acid of vegetables: but all the 
other neutrals have more or lefs of the 
fame virtue; and perhaps fome of them, 
particularly the ammoniacal faits, polfefs it 
in a ftronger degree. 
CLXI, OF PHYSIC. 
153 
CLXI. 
As cold water taken into the ftomach, 
often fhows the fame diaphoretic effects 
with the neutral faits, it is probable that 
the effect of the latter depends upon, 
their refrigerant powers mentioned above, 
(CXXXIV.) What is the effed of the 
neutral faits, given when they are forming 
and in a ftate of efter vefcence ? 11 is probable 
that this circumftance may increafe the 
refrigerant power of thefe faits, and may 
introduce into the body a quantity of fixed 
air; but for thefe purpofes it would feem 
proper to contrive that the whole of the ef- 
fervefcence fliould take placein the ftomach. 
CLXII. 
A third means (CLIII. 3.) of determin- 
ing to the furface of the body, and taking 
off the fpafm fubiifting there, is by the 
ufe 154 
PRACTICE 
ufe of fudorific medicines, and of fweat- 
ing. 
CLXIIL 
The propriety of this remedy has been 
t 
much difputed; and fpecious arguments 
may be adduced both for and againft the 
practice. 
In favour of the practice, it may be faid; 
1. That, in healthy perfons, in every 
cafe of increafed action of the heart and 
arteries, a fweating takes place, and is 
feemingly the means of preventing the bad 
effects of fuch increafed action. 
2. That, in fevers, their moft ufual 
folution and termination is by fpontane- 
ous fweating. 
3. That, even when excited by art, it 
has been found manifeftly ufeful, at cer- 
tain periods, and in certain fpecies of fever. 
CLX1V. OF PHYSIC. 
155 
CLXIV. 
Upon the other hand, it may be urged 
againft the practice of fweating; 
1. That as in fevers a fpontaneous fweat- 
ing does not immediately come on, fo 
there muft be in thefe fome circumftances 
different from thofe in the date of health, 
and which may therefore render it doubt- 
ful whether the fweating can be fafely 
excited by art. 
2. That, in many cafes, the practice 
has been attended with bad confequences. 
The means commonly employed have a 
tendency to produce an inflammatory 
diathefis; which, if not taken off by the 
fweat following their ufe, muft be in- 
creafed with much danger. Thus fweat- 
ing employed to prevent the acceffions of 
intermitting fevers, has often changed 
them into a continued form, which is al- 
ways dangerous. 
3. The 156 
PRACTICE 
3. The utility of the practice is further 
doubtful, becaufe fweating, when it hap- 
pens, does not always give a final deter- 
mination ; as muft be manifeft in the cafe 
of intermittents, as well as in many 
continued fevers, which are fometimes 
in the beginning attended with fweat- 
ings that do not prove final; and, on 
the contrary, whether fpontaneous or 
excited by art, feem often to aggravate the 
difeafe. 
CLXV. 
Fromthefe confiderations, it is extremely 
doubtful if the practice of fweating can 
be admitted very generally; but, at the 
fame time, it is alfo doubtful, if the failure 
of the practice, or the milchiefs faid to 
have arifen from it, have not been owing 
to the improper conduct of the practi- 
tioner. 
With OF PHYSIC. 
157 
With refpedt to this laft, it is almoft 
agreed among phyficians, 
1. That fweating has been generally 
hurtful when excited by ftimulant, heat- 
ing, and inflammatory medicines. 
2. That it has been hurtful when ex- 
cited by much external heat, and conti- 
nued with a great increafe of the heat of 
the body. 
3 That it is always hurtful when it 
does not foon relieve, but rather increafes, 
the frequency and hardnefs of the pulfe, 
the anxiety and difficulty of breathing, the 
headach, and delirium. 
4. That it is always hurtful if it be 
urged, when the fweat is not fluid, and 
when it is partial, and on the fuperior parts 
of the body only. 
CLXVI. 
In thefe cafes, it is probable, that either 
an 158 
PRACTICE 
an inflammatory diathefis is produced, 
which increafes the fpafm on the extreme 
veflels; or that, from other caufes, the 
fpafm is too much fixed to yield eafily to 
the increafed action of the heart and arte- 
ries ; and, upon either fuppofition, it mufl 
be obvious, that urging the fweat, as ready 
to produce a hurtful determination to 
fome of the internal parts, may be at- 
tended with very great danger. 
CLXVII. 
Though the doubts ftarted (CLXIV.) 
are to be attended to; and although the 
practices (CLXV.) having been found 
hurtful, are therefore to be rejected; it ftill 
remains true, 
i. That fweating has certainly been of- 
ten ufeful in preventing the acceflion of 
fevers, when the times of this have been 
certainly OF PHYSIC. 
159 
certainly forefeen, and a proper condudl 
employed. 
2. That, even after fevers have in fome 
meafure come on, fweating, when pro- 
perly employed, either at the very begin- 
ing of the difeafe, or during its approach 
and gradual formation, has often pre- 
vented their further progrefs. 
3. That, even after pyrexia? have con- 
tinued for fome time, fweating has been 
fuccefsfully employed in curing them, as 
particularly in the cafe of rheumatifm. 
4. That certain fevers, produced by a 
very powerful fedative contagion, have 
been generally treated, fo far as we yet 
know, moft fuccefsfully by fweating. 
CLXVIII. 
Thefe inftances (CLXVII.) are in favour 
of fweating, but give no general rule; and 
it mutt be left to further experience to de- 
termine 160 
PRACTICE 
termine how far any general rule can be 
eftablifhed in this matter. In the mean 
time, if the practice of fweating is to be 
attempted, we can venture to lay down 
the following rules for the conduct of it. 
1. That it fhould be excited without 
the ufe of ftimulant inflammatory medi- 
cines. 
2. That it fhould be excited with as lit- 
tle external heat, and with as little increafe 
of the heat of the body, as poflible. 
3. That, when excited, it fhould be 
continued for a due length of time, not 
lefs than twelve hours, and fometimes for 
twenty-four or forty-eight hours; always, 
however, providing that it proceeds without 
the circumftances mentioned (CLXV. 3.4.) 
4. That, for fome part of the time, and 
as long as the perfon can eafily bear, it 
fhould be carried on without admitting of 
deep. 
5. That it fhould be rendered univerfal 
over OF PHYSIC. 
161 
over the whole body; and, therefore, par- 
ticularly, that care be taken to bring the 
fweating to the lower extremities. 
6. That the practice fhould be rendered 
fafer by moderate purging, excited at the 
fame time. 
7. That it fhould not be fuddenly 
checked by cold any how applied to the 
body. 
CLXIX. 
When attention is to be given to thefe 
rules, the fweating may be excited, i. By 
warm bathing, or a fomentation of the 
lower extremities. 2. By frequent draughts 
of tepid liquors, chiefly water, rendered 
more grateful by the addition of a light 
aromatic, or more powerful by that of a 
fmall quantity of wine. 3. By giving 
fome dofes of neutral faits. 4. Moft ef- 
fectually, and perhaps moft fafely, by a 
Vol. I. 
L 
large 162 
PRACTICE 
large dofe of an opiate, joined with a por- 
tion of neutral faits, and of an emetic. 
In what cafes may cold water, thrown 
into the ftomach in large quantities, be 
employed to excite fweating? See Cels us 
Lib. III. chap. vii.-ix. 
CLXX. 
The fourth means (CLIII. i.) of determi- 
ning to the furface of the body, and there- 
by taking off the fpafm affecting the ex- 
treme veffels is by the ufe of emetics. 
CLXXI. 
Emetics, and particularly antimonial 
emetics, have been employed in the cure 
of fevers ever fince the introduction of 
chemical medicines; but, for a long time, 
they were employed by chemifts and che- 
mical practitioners only; and although 
of OF PHYSIC. 
163 
of late the ufe of them has become very 
general, their efficacy is (till difputed, and 
their manner of operating is not common- 
ly explained. 
CLXXII. 
Vomiting is, in many reipects, ufeful 
in fevers ; as it evacuates the contents of 
the ftomach ; as it emulges the biliary and 
pancreatic du€ts; as it evacuates the con- 
tents of the duodenum, and perhaps alto 
of a larger portion of the inteftines ; as it 
agitates the whole of the abdominal vifcera, 
expedes the circulation in them, and pro- 
motes their feveral fecretions; and, laftly, 
as agitating alfo the vifcera of the thorax, 
it has like effects there. All thefe feveral 
effects are, in many cafes and circumfiances 
of fever, procured with advantage; but do 
not properly fall under our view here, 
where wc are to confider only the effect of 
L 2 
vo- 164 
PRACTICE 
vomiting in determining to the furface of 
the body. 
CLXXIII. 
This effect we do not impute to the exer- 
cife of vomiting in agitating the whole 
frame; but to the particular operation of 
emetics upon the mufcular fibres of the 
ftomach, whereby they excite the action of 
the extreme arteries on the furface of the 
body, fo as thereby effectually to determine 
the blood into thefe veffels, remove the 
atony, and takeoff the fpafm affeCling them. 
CLXX1V. 
That Rich is the power of emetics, will 
appear from the feveral coniiderations men- 
tioned above (XLIV.); and, therefore, 
that they are remedies well fuited to the 
cure of fevers. 
CLXXV, OF PHYSIC. 
165 
CLXXV. 
Emetics, for that purpofe, are admini- 
ftered in two different ways : that is, either 
in fuch dofes as may excite full and repeat- 
ed vomitings; or in fuch dofes as may ex- 
cite ficknefs and naufea only, with little or 
no vomiting at all. 
CLXXVI. 
Full vomiting is beftfuited to the feveral 
purpofes mentioned CLXXIL; and is alfo 
well fuited to determine to the furface of 
the body, fo as thereby to obviate the atony 
and fpafm which lay the foundation of fe- 
ver. Thus vomiting, excited a little before 
the expelled acceilion of the paroxyfm of 
an intermittent, has been found to prevent 
the paroxyfm altogether. And it has been 
obferved alfo, that, when contagion has 
been applied to a perfon, and Hrft difco- 
vers 
L 3 166 
PRACTICE 
vers its operation, a vomit given will pre- 
vent the fever, which was otherwife to have 
been expe&ed. See Lind on Fevers and 
Infection. 
CLXXVII. 
Thefe are advantages to be obtained by 
exciting vomiting at the firfl: approach of 
fevers, or of the paroxyfms of fevers; and 
after fevers are formed, vomiting may alfo 
be employed, to take off, perhaps entirely, 
the atony and fpafm, or at- leaft to mo- 
derate thefe, fo that the fever may proceed 
more gently and fafely. 
CLXXVI1I. 
It is feldom, however, that vomiting is 
found to produce a final folution of fevers; 
and, after they are once formed, it is com- 
monly neceffary to repeat the vomiting fe- 
veral O F PH YS I C. 
167 
veral times; but this is attended with 
inconvenience, and fometimes with difad- 
vantage. The operation of full vomiting 
commonly foon ceafes, and the exercife of 
vomiting is often a debilitating power; 
and therefore, when the vomiting does 
not remove the atony and fpafm very en- 
tirely, it may give occafion to their recur- 
ring with greater force. 
CLXXIX. 
For thefe reafons, after fevers are fully 
formed, phyficians have thought proper to 
employ emetics in naufeating dofes only. 
Thefe are capable of exciting the action 6f 
the extreme veffels, and their operation is 
more permanent. At the fame time, they 
often fliow their power by exciting fome 
degree of fweat; and their operation is ren- 
dered more fafe, by their commonly pro- 
ducing fome evacuation by (tool. 
L 4 
CLXXX. 168 
PRACTICE 
CLXXX. 
Such are the advantages to be procured 
by naufeating dofes of emetics; and it only 
remains to mention, what are the medi- 
cines moft fit to be employed in that man- 
ner, what are the moft proper times for 
exhibiting, and what is the beft manner of 
adminiftering them. 
CLXXXI. 
The emetics at prefent chiefly in ufe, 
are, Ipecacuanha and Antimony. 
The former may be employed for every 
purpofe of emetics, particularly thofe 
mentioned CLXX1I. It may likewife be 
employed, either in larger or fmaller dofese 
for determining to the furface of the body; 
but, even in very fmall dofes, it fo readily 
excites vomiting, as to be with difficulty 
employed for the purpofe of naufeating 
only; OF PHYSIC. 
169 
only; and, however employed, there is 
reafon to believe, that its effects are lefs 
permanent, and lefs powerfully communi- 
cated from the ftomach to the reft of the 
fyftem, than thofe of Antimony. 
CLXXXII. 
This, therefore, is generally preferred; 
and its preparations, feemingly various, 
may all be referred to two heads : the one 
comprehending thofe in which the regu- 
line part is in a condition to be adted upon 
by acids; and therefore, on meeting with 
acids in the ftomach, becomes adlive: and 
the other comprehending thofe prepara- 
tions in which the reguline part is already 
joined with an acid, rendering it adlive. 
CLXXXIII. 
Of each kind there are great numbers, 
but 170 
PRACTICE 
but not differing effentially from one an- 
other. It will be enough for us to com- 
pare the Calx Antimonii Nitrata of the 
Edinburgh Difpenfatory with the Emetic 
Tartar of the fame. The former, as I 
judge, is nearly the fame with what is 
called James's Powder. Which of thefe 
is beft fumed to the cure of fevers, as above 
explained, feems doubtful; but it appears 
to me, that, although the former may have 
fome advantages from its flower operation, 
and may thereby feern to be more cer- 
tainly fudorific and purgative, yet the un- 
certainty of its dofe renders it inconve- 
nient, has often given occafion to the 
timid to be difappointed, and to the 
bold to do mifehief. On the other hand, 
the dofe of the Emetic Tartar can be ex- 
actly afeertained; and I think it may be 
exhibited in fuch a manner as to produce 
all the advantages of the other. 
CLXXXIV. OF PHYSIC. 
171 
CLXXXIV. 
Whichfoever of thefe preparations be 
employed, I judge the moft proper time 
for exhibiting them, to be the time of ac- 
ceffions, or a little before, when that can be 
certainly known. In continued fevers, 
the exacerbations are not always very- 
obfervable: but there is reafon to think, 
that one commonly happens about noon, 
or foon after it, and another in the even- 
ing ; and that thefe, therefore, are the moft 
proper times for exhibiting emetics. 
CLXXXV. 
With refpedt to the manner of admini- 
ftration, that of the Calx Nitrata is fimple, 
as the whole of what is judged a proper 
dofe is given at once, and no more can 
properly be given till the time of the next 
acceflion. 
The adminiftration of the Emetic Tartar 
is 172 
PRACTICE 
is different. It is to be given in fmall dofes, 
not fufficient to excite vomiting; and thefe 
dofes, after fhort intervals, are to be re- 
peated for feveral times, till (icknefs, nau- 
fea, and fome, but not much, vomiting, 
come on. The difference of this admini- 
ftration muft depend upon the dofe, and 
the length of the intervals at which it is 
given. If it be intended that the medicine 
fhould certainly operate by (tool, the dofes 
are made fmall, and the intervals long. 
On the contrary, when vomiting is proper, 
or when much purging ought to be avoid- 
ed, and therefore fome vomiting muft be 
admitted, the dofes are made larger and 
the intervals fhorter. 
CLXXXVI. 
With refpedl to both kinds of prepara- 
tions, the repetition is to be made at the 
times of acceflion, but not very often: for 
if OF PHYSIC. 
173 
if the firft exhibitions, duly managed, have 
little effect, it is feldom that the after ex- 
hibitions have much; and it fometimes 
happens that the repeated vomitings, and 
efpecially repeated purgings, do harm by 
weakening the patient. 
clxxxvii. 
The other fet of internal medicines, 
(CLII. 2.) which I fuppofe may be ufeful 
in taking off the fpafm of the extreme 
veflels, are thofe named Antifpafmodic. 
How many of thefe may be properly em- 
ployed, I am uncertain; and their mode of 
operation is involved in great obfcurity. 
It is certain, however, that opium, cam- 
phor, muik, and perhaps fome others, 
have been employed in fevers with advan- 
tage : but the circumftances in which 
they are efpecially proper and fafe, I find 
difficult to afcertain; and therefore can- 
not 174 
PRACTICE 
not venture here to lay down any general 
dodrine concerning them. 
CLXXXVIII. 
The external means (CLI.) fuited to take 
ofF the fpafm of the extreme veffels, are 
Blistering and Warm Bathing. 
CLXXXIX. 
What are the effects of Bliftering, fo 
frequently employed in fevers, is not yet 
agreed upon among phylicians; and many 
different opinions have been maintained on 
this fubject, drawn not only from reafon- 
ing, but alfo from prefumed experience. 
I muft not, however, enter into contro- 
verfy; but {hall deliver my own opinion 
in a few words. 
cxc. OF PHYSIC. 
175 
cxc. 
I am perfuaded, that the fmall quantity 
of cantharides abforbed from a bliftering 
plafter, is not fuflicient to change the con- 
fiftence of the mafs of blood ; and there- 
fore that fuch a quantity can neither do 
good, by refolving phlogiftic lentor, if it 
exifts; nor do harm, by increafing the dif- 
folution of the blood arifing from a pu- 
trid tendency in it. I therefore negledt 
entirely the effects of cantharides upon 
the fluids. 
CXCI. 
The inflammation produced by the ap- 
plication of cantharides to the ikin, af- 
fords a certain proof of their llimulant 
power: but, in many perfons, the effect 
of that ftimulus is not confiderable; in 
many, it is not communicated to the whole 
fyftem; 176 
PRACTICE 
fyftem; and, even when the effedt does 
take place in the whole fyftem, it feems to 
be taken off, very entirely, by the effu- 
fion and evacuation of ferum from the 
bliftered part. I conclude, therefore, that 
neither much good is to be expedled, nor 
much harm to be apprehended, from the 
ftimulant power of bliftering; and the 
certainty of this conclufion is eftablifhed, 
by the great benefit arifing from the pro- 
per practice of bliftering in inflammatory 
difeafes. 
CXCIL 
Much has been imputed to the evacua- 
tion occafioned by blistering: but it is ne- 
ver fo confiderable as to affect the whole 
fyftem ; and therefore can neither, by a 
fudden depletion, relax the fanguiferous 
veflels, nor, by any revulfion, affect the 
general diftribution of the fluids. 
CXCIIL OF PHYSIC. 
177 
CXCIII. 
The evacuation, however, is fo conlide- 
rable as to aflcct the neighbouring veffels ; 
and the manifeft utility of bliftering near 
the part affected, in inflammatory difeafes, 
leads me to believe, that bliftering, by de- 
riving to the flein, and producing an ef- 
fufion there, relaxes the fpafm of the 
deeper-feated veffels. I apprehend it to 
be in this manner that the tumour of a 
joint, from an effulion into the cellular 
texture under the fkin, takes off the rheu- 
matic pain affecting that joint. 
CXCIV. 
Analogous to this, it may be held, that 
the good effects of bliftering in continued 
fevers, arife from its relaxing the fpafm 
of the extreme veffels, by a communica- 
tion of the bliftcred part with the reft of 
Vol. I. 
M 
the 178 
PRACTICE 
the fkin ; and this is illuftrated by the ef- 
fed of bliftering in colic and dyfentery. 
cxcv. 
It appears to me, that bliftering may be 
employed at any period of continued fe- 
vers ; but that it will be of moft advan- 
tage in the advanced ftate of fuch fevers, 
when, the reaction being weaker, all am- 
biguity from the ftimulant power of bli- 
ftering is removed, and when it may beft 
concur with other circumftances tending 
to a final folution of the ipafim 
CXCVL 
From the view of this matter given in 
(CXCIII. andCXCIV.), it will appear, that 
the part of the body to which blifters ought 
to be applied, is indifferent, excepting up- 
on the fufpicion of topical affedion, when 
the O F P H Y S 1 C. 
179 
the bliflering ought to be made as near as 
poflible to the part affected. 
CXCVII. 
Whether Sinapisms, and other Rube- 
PACiENTiAj act in a manner analogous to 
what we have fuppofed of bliftering, may 
be doubtful; but their effects in rheuma- 
tifm, and other inflammatory ren- 
der it probable. 
CXCVIIL 
The other external means of taking off" 
the fpafm of the extreme veffels, is Warm 
Bathings This was frequently, and in va- 
rious circumftances, employed by the an- 
cients ; but till very lately has been ne- 
glected by modern phyiicians. As the 
heat of the bath ftimulates the extreme 
veffels, and, with the concurrence of moi- 
fture, 
M 2 180 
PRACTICE 
flure, alfo relaxes them, it feems to be a. 
fafe ftimulus, and well fuited to take off 
the fpafm affedling them. 
CXCIX. 
It may be applied to the whole body by 
immerfion : but this is, in many refpecls, 
inconvenient; and whether fome of the 
inconveniencies of immerfion might not 
be avoided by a vapour-bath, I have not 
learned from experience. I know, how- 
ever, from much experience, that moft of 
the purpofes of warm bathing can be ob- 
tained by a fomentation of the legs and 
feet, if properly adminiflered, and conti- 
nued for a due length of time, which ought 
not to be lefs than an hour. 
CC. 
The marks of the good effects of fuch a 
fomen- OF PHYSIC. 
181 
fomentation, are, the patient's bearing it 
eafily, its relieving delirium, and inducing 
deep. 
CCI. 
Having now confidered the feveral means 
of fatisfying the firft general indication in 
the cure of fevers, I proceed to the fecond, 
(CXXVL), which is, To remove the 
@r obviate the effeEls.* of debility- 
CCIL 
Moft of the fedative powers inducing 
debility, ceafe to adt foon after they have 
been firft applied; and, therefore, the re- 
moving them is not an objedl of our pre- 
fent indication. There is only one which 
may be fuppofed to continue to adt for a 
long time ; and that is, the contagion ap- 
plied : but we know nothing of the nature 
M 3 
of 182 
PRACTICE 
of contagion that can lead us to any mea- 
fures for removing or correcting it. We 
know only its effects as a fedative power 
inducing debility, or as a ferment indu- 
cing a tendency to putrefaction in the 
fluids. The obviating the latter will be 
confidered under our third general indica- 
tion, and the former alone is to be confi- 
dered here. 
CCIIL 
The debility induced in fevers by con- 
tagion, or other caufes, appears efpecially 
in the weaker energy of the brain ; but in 
what this confifts, or how it may be di- 
redlly reftored, we do not well know. As 
Nature, however, does, feemingly for this 
purpofe, excite the adlion of the heart and 
arteries, we afcribe the continuance of de- 
bility to the weaker readtion of the fan- 
guiferous fyftem ; fo that the means to be 
employed OF PHYSIC. 
183 
employed for obviating debility, are im- 
mediately directed to Support and in- 
creafe the action of the heart and arteries; 
and the remedies ufed are Tonics or Sti- 
mulants. 
CCIV. 
In contagious difeafes, both from the 
effects which appear, and from difledtions, 
it is known, that the tone of the heart and 
arteries is confiderably diminished; and 
that tonic remedies, therefore, are properly 
indicated. 
Thefe are to be confidered as of two 
kinds ; the firft being the power of cold, 
the fecond that of tonic medicines. 
ccv. 
The power of cold, as a tonic, I 
have mentioned above (XC.); and it is 
M 4 184 
PRACTICE 
employed, in fevers, in two ways; either 
as the cold matter is thrown into the fto- 
mach, or as it is applied to the furface of 
the body. 
CCVI. 
As it has been fliown above, that the 
tonic power of cold can be communicated 
from any one part to every other part of 
the fyftem ; fo it will readily be allowed, 
that the ftomach is a part as fit for this 
communication as any other; and that 
cold drink, taken into the ftomach, may, 
therefore, prove an ufeful tonic in fevers. 
CCVII. 
This the experience of all ages has con- 
firmed : but, at the fame time, it has been 
frequently obferved, that, in certain cir- 
cumftances, cold drink, taken into the fto- 
machj OF PHYSIC. 
185 
mach, has proved very hurtful ; and, 
therefore, that the ufe of cold drink in 
fevers requires fome limitations. What 
thefe limitations fliould be, and what are 
all the circumftances which may forbid 
the ufe of cold drink, is difficult to deter- 
mine ; but it feems clearly forbidden, in 
all cafes where a phlogiftic diathefis prevails 
in the fyftem, and more efpecially when 
there are topical affections of an inflam- 
matory nature. 
CCVIII. 
The other method of employing cold as 
a tonic, is, by applying it to the furface of 
the body. The application of cold air to 
the furface of the body, as a refrigerant 
power fit to moderate the violence of re- 
action, I have fpoken of above (CXXXIII.); 
but probably it may alfo be confidered 
here 186 
PRACTICE 
here as a tonic, and ufeful in cafes of debi- 
lity. 
CCIX. 
Not only cool air, but cold water alfo, 
may be applied to the furface of the body, 
as a refrigerant, and perhaps as a tonic. 
The ancients frequently applied it with 
advantage, to particular parts, as a tonic ; 
but it is a difcovery of modern times, that 
in the cafe of putrid fevers, attended with 
much debility, the body may be waihed 
all over with cold water. 
ccx. 
Tliis was firft praclifed at Breflaw in 
Sileiia, as appears from a diflertation, un- 
der the title of Epidemia verna quae Wra- 
tijlaviam, anno 1737, afflixit, to be found in 
the appendix to the Ada Nat, Curiof, Vol.X. 
And OFF H'Y S I C. 
187 
And from other writers we find, that the 
practice has paffed into fome of the neigh- 
bouring countries; although in this ifland, 
fo far as I know, we have hitherto had no 
experience of it. 
CCXL 
The medicines which have been em- 
ployed in fevers, as tonics, are various. If 
the Saccharum Saturni has been found 
ufeful, it is, probably, as a tonic, rather 
than as a refrigerant; and the Ens Vene- 
ris, or other preparations of iron which 
have been employed, can adl as tonics 
only. The preparations of copper, from 
their effects in epilepfy, are prefumed to 
poffefs a tonic power; but, whether their 
ufe in fevers be founded upon their tonic 
or their emetic powers, may be uncertain. 
The ufe of arfenic and of alum, in in- 
termittent fevers, feems manifeftly to de- 
pend 188 
PRACTICE 
pend upon their tonic power. And, up- 
on the whole, there may occur cafes of 
continued fevers, which may be cured by 
tonics taken from the foffil kingdom : but 
the ufe of thefe has been rare, as well as 
the effects uncertain ; and phyficians have 
employed, more commonly, the vegetable 
tonics. 
CCXII. 
A great variety of thefe has been em- 
ployed in the cure of intermittent fevers; 
but how many of them may be employed 
in continued fevers, or in what circum- 
ftances of thefe fevers, is not well afeer- 
tained; and I (hall now only confider the 
queftion with refpect to the moft celebra- 
ted of thefe tonics, the Peruvian Bark. 
CCXIIL OF PHYSIC. 
189 
CCXIII. 
This bark has been commonly confi- 
dered. as a fpecific, or as a remedy of 
which the operation was not underftood. 
But it is certainly allowable to inquire in- 
to this matter; and I apprehend it may 
be explained. 
CCXIV. 
To this purpofe it is to be remarked, 
that as, in many cafes, the effects of the 
bark are perceived foon after its being ta- 
ken into the ftomach, and before it can 
poflibly be conveyed to the mafs of blood, 
we may conclude, that its effects do not 
arife from its operating on the fluids; and 
muft, therefore, depend upon its opera- 
ting on the nerves of the ftomach, and 
being thereby communicated to the reft of 
the nervous fyftem. This operation feems 
to 190 
PRACTICE 
to be a tonic power, the bark being a re-* 
medy in many cafes of debility $ particu- 
larly in gangrene : and, as the recurrence 
of the paroxyfms of intermittent fevers 
depends upon a recurrence of atony, 
(XXXV. and XXXVI.); fo probably the 
bark, by its tonic power, prevents the re- 
currence of thefe paroxyfms; and this is 
greatly confirmed by obferving, that many 
other tonic medicines anfwer the fame 
purpofe. 
ccxv. 
If the operation of the bark may be 
thus explained, from its pofleffmg a tonic 
power, it is eafy to perceive why it is im- 
proper when a phlogiftic diathelis prevails; 
and, from the fame view, we can afcer- 
tain in what cafes of continued fever it 
may be admitted. Thefe are either after 
confiderable remiflions have appeared, 
when O F P H Y S I C. 
191 
when it may be employed to prevent the 
return of exacerbations, on the fame foot- 
ing that it is ufed in intermittent fevers ; 
or in the advanced ftate of fevers, when 
all fufpicion of an inflammatory ftate is 
removed, and a general debility prevails 
in the fyftem; and its being then employ- 
ed is fufliciently agreeable to the prefent 
practice. 
CCXVL 
With refpedl to the ufe of the bark, it 
is proper to add, that good effects are to 
be expected from it, almoft only when 
given in fubftance and in large quantity. 
CCXVII. 
Another fet of medicines to be employe 
cd for obviating debility and its effedls, 
are the diredt ftimulants (CCIII.k Thefe, 
in 192 
PRACTICE 
in fome meafure, increafe the tone of the 
moving fibres ; but they are different from 
the tonics, as more directly exciting and 
increafing the adlion of the heart and ar- 
teries. This mode of their operation ren- 
ders the ufe of them ambiguous ; and 
when an inflammatory diathefis is prefent, 
as fo often happens in the beginning of 
fevers, the effects of thefe flimulants may 
be very hurtful; but it ftlll remains pro- 
bable, that, in the advanced flate of fe- 
vers, when debility prevails, they may be 
ufeful. 
ccxvin. 
What are the flimulants that may be 
moft properly employed, I am uncertain, 
as the ufe of them in this age has been 
rare; but I am difpofed to believe that, 
of all kinds, wine is the beft. 
CCXIX. OF PHYSIC. 
193 
CCXIX. 
Wine has the advantage of being grate- 
ful to the palate and ftomach, and of ha- 
ving its ftimulant parts fo much diluted, 
that it can be conveniently given in fmall 
dozes ; fo that it may be employed with 
fufficient caution ; but it is of little fer- 
vice, unlefs taken pretty largely. 
ccxx. 
It may be fuppofed, and on good 
grounds, that wine has an operation ana- 
logous to that of opium and fome other 
narcotic medicines. It may indeed be 
faid, that we can diftin&ly mark its fti- 
mulant power only, which renders its ef- 
fects in the phrenitic delirium manifeltly 
hurtful, and, in the mild delirium, de- 
pending on debility, as remarkably ufe- 
ful. But in all this the analogy with o- 
pium 
N 
Vol. I.  PRACTICE 
194 
plum is Bill obvious; and it is probable, 
that both wine and opium are more ufe- 
ful by their fedative and antifpafmodic, 
than by their ftimulant powers. 
CCXXL 
Thefe are the means of anfwering our 
fecond general indication (CXXVI. 2.); 
and I now proceed to the third, which is 
To obviate or to correct the tendency of the 
fluids to putrefaction. 
CCXXII. 
This may be done, 
1. By avoiding any new application of 
putrid or putrefcent matter. 
2. By evacuating the putrid or putref- 
cent matter already prefent in the body. 
3. By correcting the putrid or putrefcent 
matter remaining in the body. 
4. By OF PHYSIC. 
195 
4. By fupporting the tone of the veffels, 
and thereby relifting further putrefaction, 
or obviating its effects. 
CCXXII1. 
The further application of putrid or pu- 
trefcent matter may be avoided, 
1. By removing the patient from places 
filled with corrupted air. 
2. By correcting the air from which he 
cannot be removed. 
3. By preventing the accumulation of 
the patient's own effluvia, by a conflant 
ventilation, and by a frequent change of 
bed-cloaths and body-linen. 
4. By the careful and fpeedy removal of 
all excremental matters from the patient's 
chamber. 
5. By avoiding animal food, or cor- 
recting it. 
N 2 
CCXXIV. 196 
PRACTICE 
CCXXIV. 
The putrid or putrefcent matter, alrea- 
dy prefent in the body, may be evacuated, 
partly by evacuating frequently the con- 
tents of the inteftines; and more effectual- 
ly ftill, by fupporting the excretions of 
perfpiration and urine, by the plentiful 
ufe of diluents. 
ccxxv. 
The putrid or putrefcent matter, re- 
maining in the body, may be rendered 
more mild and innocent by the ufe of 
diluents; or may be corrected by the ufe 
of antifeptics. Thefe laft are of many 
and various kinds; but which of them 
are conveniently applicable, or more par- 
ticularly fuited to the cafe of fevers, is not 
well afcertained. Thofe mod certainly 
applicable and ufeful, are, acefcent ali- 
ments, OF PHYSIC. 
197 
ments, acids of all kinds, neutral faits, 
and fixed air. 
CCXXVI. 
The progrefs of putrefaction may be 
confiderably retarded, and its effects ob- 
viated, by fuppporting the tone of the vef- 
fels : and this may be done by tonic re- 
medies; the chief of which are, Cold, and 
Peruvian Bark, both fufliciently treated of 
above. (CCV. et J eq.) 
CCXXVII. 
I have now finifhed the confideration of 
the three general indications to be formed 
in the cure of continued fevers; and have 
mentioned moft of the remedies which 
have been, upon any occalion, employed 
in this bufinefs. It was neceffary, in the 
firft place, to confider thefe indications 
N 3 
and 198 
PRACTICE 
and remedies feparately, and to explain 
the operation of the latter more generally; 
but, from what has been now delivered, 
compared with what was faid above, con- 
cerning the difference of fevers, and the 
lignification of their feveral fymptoms in 
forming the prognoftic, I expert it will not 
be difficult to affign the indication, and to 
feleCl and combine the feveral remedies 
mentioned, fo as to adapt them to the 
feveral fpecies and circumftances of con- 
tinued fevers. 
I OF PHYSIC. 
199 
I think it may be ufeful for my Readers 
to have the whole of the Cure of Con- 
tinued Fevers brought under one 
View, as in the following Table. 
In the Cure of CONTINUED FEVERS, 
The Indications are, 
I. To moderate the •violence of reaction. 
Which may be done, by 
i. Diminilhing the action of the heart and arte- 
ries, by 
A. Avoiding or moderating thofe irritations which 
are almoft conftantly applied to the body; as, 
a. The impreffions made upon our fenfcs, par- 
ticularly, 
Increafed heat, whether arifing from 
««• External heat, or, 
00- The accumulation of the heat of the 
body. 
b. The exercife of the body, 
c. The exercife of the mind, 
d. The taking in of aliment. 
N 4 
e. Par,  PRACTICE 
200 
e. Particular irritations arifmg from 
a. The fenfe of thirft, 
0. Crudities, or corrupted humours, in the 
ftomach, 
y. The preternatural retention of faeces, 
A general acrimony of the fluids. 
B. Employing certain fedative powers ; as, 
a. Cold. 
b. Refrigerants; the chief of which are, 
a. Acids of all kinds, 
0. Neutral faits, 
y. Metallic faits. 
C. Diminifhing the tenfion and tone of the arte- 
rial fyftem, by 
a. Blood-letting, 
b. Purging. 
2. Taking off the fpafm of the extreme veflels, by 
A. Internal means; which are, 
a. Thofe remedies which determine to the fur- 
face, as, 
Diluents, 
0. Neutral faits, 
y. Sudorifics, 
Emetics. 
b. Thofe remedies named antifpafmodics. 
B. Ex- OF PHYSIC. 
201 
B. External means ; as, 
a. Bliftering, 
b. Warm bathing. 
II. To remove the caufes* or obviate the 
effects* of debility, by 
i. Supporting and increafing the action of the heart 
and arteries, by 
A. Tonics, as, 
a. Cold, 
b. Tonic medicines, which are either, 
a. Foffil, as, 
aa. Saccharum faturni, &c. or, 
p. Vegetable, as, 
«a. Peruvian Bark. 
B. Stimulants, as, 
a. Aromatics, &c. 
b. Wine. 
HI. To obviate or correct the tendency of the 
fluids to putrefaction* by 
I. Avoiding the application of putrid or putrefcent 
matter, by 
A. Removing the patient from places filled with 
corrupted air. 
B. Sup- 202 
PRACTICE 
B. Correcting the air, from which he cannot be 
removed. 
C. Avoiding the accumulation of the patient's 
own effluvia, by 
a. A conftant ventilation, 
b. Frequently changing the bed-cloaths and 
body-linen. 
D. Removing carefully and fpeedilyall excremen- 
tal matters. 
E. Avoiding animal food, or correcting it. 
2. Evacuating the putrid orputrefcent matter already 
prefent in the body, by 
A. Evacuating frequently the inteftines. 
B. Supporting the excretions of perfpiration and 
urine, by 
a. Diluents, 
b. Neutral faits. 
3. Correcting the putrid or putrefcent matter re- 
maining in the body, by 
A. Diluents, 
B. Antifeptics, 
C. Fixed air. 
4. Refilling farther putrefaftion, or obviating its ef- 
fects, by 
Supporting the tone of the veflels, by 
Tonic remedies. 
SECT. OF PHYSIC. 
203 
SECT. II. 
Of the Cure of Intermittent Fevfrs. 
CCXXVIII. 
It (till remains to confider the cure of in- 
termittent fevers; and, with refpedt to 
thefe, we form alfo three general indica- 
tions. 
1. In the time of int er miffion, to prevent 
the recurrence of paroxyfms, 
2. In the time of paroxyfms, to conduit 
thefe fo as to obtain a final folution of the 
f 
difcafe. 
3. To take off certain circumfiances which 
might prevent the fulfilling of the two firjl 
indications. 
CCXXIX. PRACTICE 
204 
CCXXIX. 
The firfl: indication may be anfwered in 
two ways : 
1. By increasing the adtion of the heart 
and arteries fome time before the period 
of acceflion, and fupporting that increafed 
action till the period of the acceflion be 
over, fo as thereby to prevent the recur- 
rence of the itony and fpafm of the ex- 
treme veflels which give occafion to the 
recurrence of paroxyfms. 
2. Without increafing the adtion of the 
heart and arteries, the recurrence of paro- 
xyfms may be prevented, by fupporting the 
tone of the veflels, and thereby preventing 
atony, and the confequent fpafm. 
ccxxx. 
For thepurpofe mentioned in (CCXXIX. OF PHYSIC. 
205 
1.), the action of the heart and arteries may 
increafed; 
1. By various Stimulant remedies, inter- 
nally given, or externally applied, and that 
without exciting fweat. 
2. By the fame remedies, or others fo 
managed as to excite fweating, and to Sup- 
port that fweating till the period of accef- 
lion be for fome time paSt. 
3. By naufeating dofes of emetics, given 
about an hour before the time of accef- 
fion, thereby fupporting and increasing 
the tone and adfion of the extreme veffels. 
CCXXXI. 
The tone of the extreme veffels may be 
Supported without increasing the adlion of 
the heart and arteries, (CCXXIX. 2.), by 
various tonic medicines ; as, 
1. Aflringents alone. 
2. Bitters alone. 
3* Aftrin« PRACTICE 
206 
3. Aftringents and bitters conjoined. 
4. Aftringents and aromatics conjoined. 
5. Certain metallic tonics. 
6. Opiates- 
Laftly, An impreflion of horror. 
A good deal of exercife, and as full a diet 
as the condition of the patient's appetite 
and digeftion may allow of, will be proper 
during the time of intermiftion, and may 
be confidered as belonging to this head. 
CCXXXII. 
Of all the tonic remedies mentioned, 
(CCXXXL), the moft celebrated, and 
perhaps the moft certainly effectual, is the 
Peruvian bark, the tonic power of which 
we have endeavoured to demonftrate a- 
bove, (CCX1V.), and have, at the fame 
time, explained its ufe in continued fevers. 
The fame obfervation as made in 
(CCXVI.) is efpecially proper in the cafe 
of OF PHYSIC. 
207 
of intermittents ; and further with refpeft 
to thefe, the following obfervations or rules 
are offered here. 
1. That the bark may be employed with 
fafety at any period of intermittent fevers, 
providing that, at the fame time, there be 
neither a phlogiftic diathefis prevailing in 
the fyftem, nor any confiderable or fixed 
congeftion prefent in the abdominal vif- 
cera. 
2. The proper time for exhibiting the 
bark in intermittent fevers, is during the 
time of intermiffion ; and where intermif- 
fions are to be expected, it is to be abftain- 
ed from in the time of paroxyfms. 
3. In remittents, though no entire apy- 
rexia occurs, the Bark may be given du- 
ring the remiffions ; and it fhould be given, 
even though the remiffions be inconfider- 
able, if, from the known nature of the epi- 
demic, intermiffions or confiderable remif- 
fions are not to be foon expe&ed, and that 
great 208 
PRACTICE 
great danger is apprehended from repeat- 
ed exacerbations. 
4. In the cafe of genuine intermittents, 
while a due quantity of Bark is to be em- 
ployed, the exhibition of it ought to be 
brought as near to the time of acceflion as 
the condition of the patient's ftomach will 
allow. 
5. In general, in all cafes of intermit- 
tents, it is not fufiicient that the recur- 
rence of paroxyfms be flopped for once by 
the ufe of the bark; a relapfe is com- 
monly to be expelled, and fhould be pre- 
vented by the exhibition of the bark, re- 
peated at proper intervals. 
CCXXXIII. 
Our fecond general indication for con* 
dueling the paroxyfms of intermittent fe- 
vers, fo as to obtain a final folution of the 
difeafe, may be anfwered, 
I. By OF PHYSIC. 
209 
1. By exhibiting emetics during the time 
of the cold ftage, or at the beginning of the 
hot. 
2. By opiates given during the time of 
the hot ftage. 
CCXXXIV. 
The circumftances which may efpecially 
prevent the fulfilling of thofe two indica- 
tions, and therefore give occafion to our 
third, are, a phlogiftic diathefis prevailing 
in the fyftem, and congeftions fixed in the 
abdominal vifcera. The firft muft be re- 
moved by blood-letting and the antiphlo- 
giftic regimen; the fecond, by vomiting 
and purging. 
Where thefe meafures are not imme- 
diately effectual, I hold it fafer to attempt 
the cure of the difeafe by the means point- 
ed out in general in CCXXIX. rather 
than by thofe in article fecond of the fame* 
paragraph. 
O 
BOOK 
Vol. I. BOOK II. 
Of INFLAMMATIONS, 
or PHLEGMASIA. 
CHAP. I. 
Of Inflammation in general. 
SECT. I. 
Of the Phenomena of Inflammation. 
CCXXXV. 
VV THEN any part upon the furface of 
' ' the body is affected with unufual 
rednefs, heat, pain, and tumour, we name 
O a 
the 212 
PRACTICE 
the difeafe an Inflammation or Phlegmafia, 
Thefe fymptoms of inflammation are never 
confiderable, without the whole fyftem be- 
ing, at the fame time, affedled with py- 
rexia. 
CCXXXVI. 
As the external, fo likewife the internal 
parts may be affected with inflammation ; 
anfl we judge them to be fo, when, toge- 
ther with pyrexia, there is a fixed pain in 
any internal part, attended with fome in- 
terruption in the exercife of its functions. 
CCXXXVIL 
We judge of the prefence of inflamma- 
tion alfo from the ftate of the blood drawn 
out of the veins. When the blood, after 
cooling and concreting, fhows a portion of 
the gluten feparated from the reft of the 
mafs. OF PHYSIC. 
213 
inafs, and lying on the furface of the craf- 
famentum ; as fuch feparation happens ill 
all cafes of more evident phlegmafia; fo, 
in ambiguous cafes, we, from this appear- 
ance, joined with other fymptoms, infer 
the prefence of inflammation. At the 
fame time, it muft be obferved, that as 
feveral circumftances in blood-letting, 
may prevent this feparation of gluten 
from taking place in blood otherwife dif- 
pofed to it; fo, from the abfence of fuch 
appearance, we cannot always conclude 
againft the prefence of inflammation. 
CCXXXVIll. 
I cannot eafily give any other general 
hiftory of the phenomena of inflammation 
than what is contained in the three pre- 
ceding paragraphs ; and the variations 
which may take place in its circumftances, 
will occur to be more properly taken no- 
tice 
o 3 214 
PRACTICE 
tice of under the feveral heads of the par- 
ticular genera and fpecies to be hereafter 
mentioned. I proceed, therefore, to in- 
quire into the proximate caufe of inflam- 
mation in general. 
SECT. IL 
Of the Proximate Cause of Inflammation. 
CCXXXIX. 
The phenomena of inflammation 
(CCXXXV.) all concur in {flowing, that 
there is an increafed impetus of the blood 
in the veflels of the part afleded; and as, 
at the fame time, the action of the heart is 
not always evidently increafed, there is 
reafon OF PHYSIC. 
215 
reafon to prefume, that the increafed im- 
petus of the blood in the particular part is 
owing efpecially to the increafed action of 
the veflels of that part itfelf. 
CCXL. 
The caufe of this increafed aftion in the 
veflels of a particular part is, therefore, 
what we are to inquire after, and to con- 
fider as the proximate caufe of inflam- 
mation. 
In many cafes, we can manifeftly per- 
ceive, that inflammation arifes from the 
application of ftimulant fubftances to the 
part. When the application of fuch fti- 
mulants, therefore, is evident, we feek for 
no other caufe of inflammation; but as, 
in many cafes, fuch application is neither 
evident, nor, with any probability, to be 
fuppofed, we muft, in fuch cafes, feek for 
fome other caufe of the increafed im- 
A 
petus 
O 4 216 
PRACTICE 
petus of the blood in the veflels of the' 
part. 
CCXLI. 
Many phyflcians have fuppofed, that an 
obftrudlion of the extreme veflels, any how 
produced, may prove a caufe of inflam- 
mation ; and particularly, that this may 
arife from an obftrudion formed by a 
matter flopping up thefe veflels : but 
many difficulties attend this dodlrine. 
i. The opinion feems chiefly to have 
arifen from the appearance of the blood 
defcribed in (CCXXXVIL), when the fe- 
parated gluten was confidered as a preter- 
natural and morbid matter : but we now 
know very certainly, that this gluten is 
conflantly a conflituent part of the human 
blood; and that it is only a peculiar fepa- 
ration of the parts of the blood that hap- 
pens in confequence of inflammation, and 
fome OF PHYSIC. 
217 
Tome other circumftances, which gives oc- 
cafion to the appearance that was falfely 
Confidered as a mark of a morbid lentor 
in the blood. 
2. There are no experiments diredllyin 
proof of a preternatural lentor prevailing 
in the mafs of blood; rior is there any 
evidence of certain parts of the blood oc- 
cafionally acquiring a greater denfity and 
force of cohefion than ordinary; neither 
is there any proof of the denfer, or more 
coherent parts, being prefent in the mafs 
of blood in fuch greater proportion than 
ufual, as to occafion a dangerous fpifli- 
tude. The experiments of Dr Browne 
Langrifh on this fubjeci afford no con- 
clufion, having been made on certain 
parts of the blood feparatcd from the reft, 
without attending to the circumftances of 
blood-letting, which very much alter the 
ftate of the feparation and concretion of 
the blood drawn out of the veins. 
3' The 218 
PRACTICE 
3. The fuppofition of a preternatural 
lentor or vifcidity of the blood is not well 
founded; for it is probable, that nature 
has fpecially provided againft a Hate of 
the fluids, fo incompatible with the exer- 
cife of the moft important functions of 
the animal oeconomy. While motion con- 
tinues to prevent any feparation of parts, 
and heat continues to preferve the fluidity 
of the more vifcid, there feems to be al- 
ways fo large a proportion of water pre- 
fent as to give a fuflicient fluidity to the 
whole. I muft own that this is not abfo- 
lutely conclufive; but 1 ftill repeat it, as 
giving a probability to the general argu- 
ment* 
4. In the particular cafe of inflamma- 
tion, there are feveral circumftances which 
render it probable that the blood is then 
more fluid than ufual. 
5. I prefume that no fuch general len- 
tor, as Boerhaave and his difciples have 
fuppofecL OF PHYSIC. 
219 
fuppofed, does ever take place; becaufe if 
it did, it muft fliow more confiderable 
effects than commonly appear. 
6. Befides the fuppofition of an ob- 
ftruding lentor, phyficians have 
that an obftruftion may be formed by an 
impermeable matter of another kind, and 
that fuch an obftrudlion may alfo be 
the caufe of inflammation. This fuppofi- 
tion is what is well known in the fchools 
under the title of an error loci; but it is 
an opinion that I cannot find to be at all 
probable: for the motion of the blood in 
the extreme veflels is fo weak and flow, as 
readily to admit a retrograde courfe of it; 
and therefore, if a particle of blood fliould 
happen to enter a veflel whofe branches 
will not allow of its paflage, it will be 
moved backwards, till it meet with a vefl- 
fel fit for tranfinitting it; and the fre- 
quent ramifications and anaftomofes of the 
extreme arteries are very favourable to 
this. 220 
PRACTICE 
this. I muft own indeed, that this argu- 
ment is not abfolutely conclufive; becaufe 
I allow it to be pretty certain, that an 
error loci does actually upon occafion hap- 
pen : but, for the reafons I have given, it 
is probable that it feldom happens, and is 
therefore rarely the caufe of inflammation; 
or if it be, that it is not merely by the 
obftruclion that it produces ; as, among 
other reafons, I conclude particularly from 
the following argument. 
7. Though an obftru&ion fhould be 
fuppofed to take place, it will not be fuf- 
ficient for producing the effects, and exhi- 
biting the phenomena, that appear in in- 
flammation. The theory that has been 
commonly employed on this occafion is 
by no means fatisfying; and, in fact, it 
appears, from many obfervations and ex- 
periments, that confiderable obftrudiions' 
may be formed, and may fubfift, without 
producing the fvmptoms of inflammation. 
CCXLII. OF PHYSIC. 
221 
CCXLII. 
Obftr tuft ion, therefore, from a matter 
Hopping up the veflels, Gaub. Pathol. 249. j. 
is not to be confidered as the primary 
caufe of inflammation; but, at the fame 
time, it is fufliciently probable, that fome 
degree of obftrudlion does take place ip. 
every cafe of inflammation. The di ft en- 
tion, pain, rednefs, and tumour, attending 
inflammation, are to be explained only 
by fuppofing, that the extremities of the 
arteries do not readily tranfmit the unufual 
quantity of blood impelled into them by 
the increafed aiftion in the courfe of thefe 
veflels. Such an obftrmftion may be fup- 
pofed to happen in every cafe of an increa- 
fed impetus of the blood ; but it is pro- 
bable, that, in the cafe of inflammation, 
there is alfo a preternatural refiflance to 
the free paflage of the fluids. 
QCXLIII. 222 
PRACTICE 
CCXLIII. 
From the doctrine of fever, we are led 
to believe, that an increafed atflion of the 
heart and arteries is not fupported for any 
length of time by any other means than 
a fpafm affe&ing the extreme veflels ; and 
that the fame fpafm takes place in inflam- 
mation, feems likely, becaufe that every 
conliderable inflammation is introduced 
by a cold ftage, and is accompanied with 
that and other circumftances of pyrexia. 
It feems alfo probable, that fomething 
analogous to this occurs even in the cafe 
of thofe inflammations which appear left 
eonfiderable, and to be purely topical. 
CCXLIV. 
From all this, the nature of inflamma- 
tion may in many cafes be explained in 
the OF PHYSIC. 
223 
the following manner. Some caufes of 
inequality in the diftribution of the blood 
may throw an unufual quantity of it upon 
particular veflels, to which it muft necef- 
farily prove a ftimulus. But, further, it 
is probable, that, to relieve the congeftion, 
the vis niedicatrix nature increafes ftill more 
the aftion of thefe veflels; and which, as 
in all other febrile difeafes, it eflefts by 
the formation of a fpafm on their extremi- 
ties. 
CCXLV. 
A fpafm of the extreme arteries, /up- 
porting an increafed action in the courfe 
of them, may therefore be confidered as 
the proximate caufe of inflammation; at 
leaft, in all cafes not ariflng from diredl 
ftimuli applied; and even in this cafe the 
ftimuli may be fuppofed to produce a 
fpafm of the extreme veflels. 
CCLXVL 224 
PRACTICE 
CCXLVI. 
That, in inflammation, there is the con- 
currence of a conftri&ion of the extreme 
veflels, with an increafed action in the other 
parts of them, feenjs probable, from the 
confideration of Rheumatifm. This is a 
fpecies of inflammation which is often 
manifeftly produced, either by cold ap- 
plied to over-diftended veflels, or by cau- 
fes of an increafed impetus, and over- 
diftenfion in veflels previoufly conftritfled. 
Hence, the difeafe efpecially appears at 
feafons liable to frequent and confiderable 
viciflitudes of heat and cold. 
To this we may add, that the parts of 
the body moft frequently affedled with in- 
flammation, are thofe, expofed, both to 
over-diftcnflon, from a change in the di- 
ftribution of the fluids, and, at the fame 
|ime, to the immediate action of coldt 
HencCj OF PHYSIC. 
225 
Hence, quinfies, and pneumonic inflam- 
mations, are more frequent than any others.: 
CCXLVII. 
That a fpafm of the extreme velTels takes 
place in inflammation, is to be further 
prefumed from what is at the fame time 
the ftate of the whole arterial fyftem. In 
every confiderable inflammation, though 
arifing in one part only, an affection is 
communicated to the whole fyftem, in 
confequence of which an inflammation is 
readily produced in other parts befide that 
firft affecled. This general affecftion is 
well known among phylicians, under the 
name of the Diathesis Phlogistica. 
It appears moft commonly in perfons of 
the moft rigid fibres ; is often manifeftly 
induced by the tonic or aftringent powers 
of cold ; is increafed by all tonic and fti- 
mulant powers applied to the body; is 
Vol* L 
P 
always 226 
PRACTICE 
always attended with a hardnefs of the 
pulfe ; and is moft effectually taken off by 
the relaxing power of blood-letting. From 
thefe circumftances, it feems probable, that 
the diathefis phlogiftica confifts in an in- 
creafed tone, or contractility, and perhaps 
in an increafed contraction, of the mufcular 
fibres of the whole arterial fyftem. Such 
a ftate of the fyftem feems often to arife, 
and fubfift for fome time, without the 
apparent inflammation of any particular 
part; but fuch a ftate of the fyftem ren- 
ders it likely, that a fpafm may, at the 
fame time, readily arife in any of the ex- 
treme veffels, and a particular inflammation 
be there produced. It does, however, ap- 
pear alfo, that the general diathefis fre- 
quently arifes from inflammation begun 
in a particular part. 
CCXLIX. OF PHYSIC. 
227 
CCXLVIII. 
I have thus endeavoured, in the cafe of 
inflammation, to explain the ftate of the 
whole fyflem, as well as that of the part 
•more particularly affedted. The latter I 
have confidered as when in its firft for- 
mation ; but after it has fubfifted for 
fome time, various changes take place in 
the part affected; and of thefe I muft now 
take notice. 
SECT. III. 
Of the Terminations of Inflammation. 
CCXLIX. 
» 
If an inflammation be cured while the 
ftate and texture of the part remain entire, 
P 2 
the 228 
PRACTICE 
the difeafe is faid to be terminated by Re- 
solution. 
This happens when the previous con- 
geflion and fpafm have been in a moderate 
degree, and the increafed impetus of the 
blood has been fufficient to overcome the 
fpafm, to dilate the veffels, and to remove 
the congeflion, fb that the part is reflored 
to its ordinary and healthy flate. 
A refolution takes place alfo when the 
increafed impetus of the fluids has produ- 
ced an increafed exhalation into the ad- 
joining cellular texture, or an increafed 
excretion in fome neighbouring part, and 
has thereby relaxed the fpafm, and relie- 
ved the congeflion, in the veffels of the 
part more particularly afleded. 
Laftly, a refolution may take place, 
when the increafed impetus of the blood 
in the whole fyflem occafions an evacua- 
tion, which, though in a diflant part, may 
prove fufficient to take off the phlogiflic 
diathelis OF PHYSIC. 
229 
diathelis of the whole fyftcm, and thereby 
relieve the congeftion and fpafm of the 
particular part aflecfled by inflammation. 
CCL. 
The tumour which appears in inflam- 
mation may be imputed in part to the 
congeflion of fluids in their proper veflels ; 
but is owing chiefly to an effuflon of mat- 
ter into the adjoining cellular texture; and, 
accordingly, tumours feldom appear but 
in parts adjoining to a lax cellular texture. 
If, in this cafe, the matter effufed be only 
a larger quantity of the ordinary exhaling 
fluid, this, when the free circulation in 
the veflels is reftored, will be readily ab- 
forbed, and the ftate of the part will be- 
come the fame as before. But, if the in- 
creafed impetus of the blood in an infla- 
med part, dilate the exhalant veflels to 
fuch a degree, that they pour out an en- 
tire 
P 3 230 
PRACTICE 
tire ferum, this will not be fo readily re- 
abforbed: and, from the experiments of 
Sir John Pringle, and efpecially from thofe 
of Mr Gaber, Mijcell. Taurin. Vol. II. we 
learn, that the ferum, under ftagnation, 
may fufler a particular change, by having 
the gluten prefent in it changed into a 
white, opaque, moderately vifcid, mild 
liquor, which we name Pus. When this 
change takes place in the inflamed part, as it 
is at the fame time attended with an abate- 
ment of the rednefs, heat, and pain, which 
before diflinguiflied the inflammation, fo 
the difeafe is faid to be terminated by 
Suppuration; and an inflamed parr, 
containing a collection of pus, is called an 
Abscess. 
CCLI. 
In inflammation, the tendency of it to 
fuppuration may be difcovered, by the 
long OF PHYSIC. 
231 
long continuance of the inflammation, 
without the fymptoms of relblution ; by 
fome remiflion of the pain of diftention ; 
by the pain becoming of a throbbing kind, 
more diflindly connected with the pulfa- 
tion of the arteries ; by the pulfe of the 
arteries being fuller and fofter; and often, 
by the patient's being frequently affected 
with cold fhiverings. The period at which 
this takes place is not determined, but 
may be fometimes fooner, fometimes later. 
When the tendency is determined, the 
time neceffary to a complete fuppuration 
is different in different cafes. 
When pus is completely formed, the 
pain in the part entirely ceafes, and a 
weight is felt in it. If the collection be 
formed immediately under the fkin, the 
tumour becomes pointed, the part be- 
comes foft, and the fluctuation of the 
fluid within can commonly be perceived ; 
while, at the fame time, for the moft part, 
P 4 
tlic 232 
PRACTICE 
the rednefs of the fkin formerly prevailing 
is very much gone. 
CCLIL 
In abfcefles, while the pus is formed of 
one part of the matter which had been ei- 
fufed, the other and thinner parts are re- 
abforbed, fo that, in the abfcefs, when 
opened, a pus alone appears. This pus, 
however, is not the converted gluten 
alone: for the converfion of this being 
the effect of a particular fermentation, 
which may affect the folid fubftance of 
the part, and perhaps every folid of ani- 
mal bodies; fo it moft readily, and par- 
ticularly, affecds the cellular texture, ero- 
ding much of it, which thereby becomes 
a part of the pus. It generally happens 
alfo, that fome of the fmaller red veffels 
are eroded, and thereby fome red blood 
often appears mixed with the pus in ab- 
fcefles. OF PHYSIC. 
233 
fcefles. Upon the whole, the internal fur- 
face of an abfcefs is to be confidered as an 
ulcerated part. 
CCLIIL 
This account of fuppuration explains, 
why an abfcefs, when formed, may either 
fpread into the cellular texture of the 
neighbouring parts ; or, by eroding the 
incumbent teguments, be poured out up- 
on the furface of the body, and produce 
an open ulcer. 
CCLIV. 
We have here given the idea of an abfcefs 
as a collection of matter following inflam- 
mation ; but the term has been applied to 
every collection of matter eflufed, and 
changed by ftagnation in an inclofed 
cavity. 
The 234 
PRACTICE 
The matter of abfceffes, and of the ul- 
cers following them, is various, according 
to the nature of what is effufed, and which 
may be, 
1. A matter thinner than ferum. 
2. An entire and pure ferum. 
3. A quantity of red globules. 
4. A matter furnifhed by particular 
glands feated in the part. 
5. A mixture of matters from different 
fources, changed by peculiar fermenta- 
tion. 
It is the fecond only which affords a 
proper pus; the effuflon whereof, whether 
in fuppurating parts or ulcers, feems to be 
the peculiar effect of an inflammatory ftate 
of the veffels ; and for this reafon it is, 
that, when ulcers do not produce a proper 
pus, a circumftance always abfolutely ne- 
ceffary to their healing, we, in many cafes, 
bring the ulcers to a ftate of proper fuppu- 
ration, by the application of ftimulants ex- 
citing OF PHYSIC. 
235 
citing inflammation, fuch as balfams, mer- 
cury, copper, &c. 
CCLV. 
When the matter effufed into the cellu- 
lar texture of an inflamed part, is tainted 
with a putrid ferment, this produces, in 
the effufed matter, a flate approaching 
more or lefs to that of putrefaction. When 
this is in a moderate degree, and affeCts only 
the fluids effufed, with the fubftance of 
the cellular texture, the part is faid to be 
affected with Gangrene; but if the pu- 
trefaction affeCt alfo the veffels and mufcles 
of the part, the difeafe is faid to be a 
Sphacelus. 
CCLVI. 
A gangrene, and its confequences, may 
arife from a putrid ferment diffufed in the 
mafs 236 
PRACTICE 
mafs of blood, and poured out with the 
ferum effufed, which it operates upon 
more powerfully while the ferum is ftag- 
nant, and retained in the heat of the 
body: but it may alfo arife from the pe- 
culiar nature of the matter effufed being 
difpofed to putrefaction; as particularly 
feems to be the cafe of the red globules of 
the blood effufed in a large quantity. In 
a third manner alfo, a gangrene feems fre- 
quently to arife from the violent excite- 
ment of the inflammation deftroying the 
tone of the veffels; whereby the whole 
fluids ftagnate, and run into putrefaction, 
which taking place in any degree, destroys 
ftill further the tone of the veffels, and 
fpreads the gangrene. 
CCLVII. 
In inflammation, the tendency to gan- 
grene may be apprehended from an ex- 
treme OF PHYSIC. 
237 
treme violence of pain and heat in the in- 
flamed part, and from a great degree of 
pyrexia attending the inflammation. 
The adlual coming on of gangrene may 
be perceived, by the colour of the infla- 
med part changing from a clear to a dark 
red ; by blifters ariflng upon the part; by 
the part becoming foft, flaccid, and in- 
fenfible; and by the ceafing of all pain 
while thefe appearances take place. 
As the gangrene proceeds, the colour of 
the part becomes livid, and, by degrees, 
quite black; the heat of the part entirely 
ceafes; the foftnefs and flaccidity of the 
part increafe; it lofes its confidence, ex- 
hales a cadaverous fmell, and may then be 
confidered as affedled with fphacelus. 
CCLV1II. 
Gangrene is thus a third manner in 
which inflammation terminates : and the 
fchools 238 
PRACTICE 
fchools have commonly marked a fourth 
termination of inflammation; which is, 
by a fcirrhus, or an indolent hardnefs of 
the part formerly affedled with inflamma- 
tion. This, however, is a rare occurrence, 
and does not feem to depend fo much up- 
on the nature of inflammation, as upon 
the circumftances of the part affected. It 
is in glandular parts chiefly that fcirrho- 
fity is obferved ; and it is probably owing 
to the parts readily admitting a ftagnation 
of the fluids. I have obferved, that in- 
flammation feldom induces fcirrhus ; but 
that this more commonly arifes from other 
caufes; and when inflammation fuper- 
venes, which it is fooner or later apt to 
do, it does not fo commonly increafe as 
change the fcirrhofity into fome kind of 
abfcefs. From thefe confiderations, it does 
not feem neceflary to take any further no- 
tice of fcirrhus as a termination of inflam- 
mation. 
CCLIX. OF PHYSIC. 
239 
CCLIX. 
There are, however, fome other termi- 
nations of inflammation not commonly- 
taken notice of, but now to be men- 
tioned. 
One is, by the effufion of a portion of 
the entire mafs of blood, either by means of 
rupture or of anaftomoiis, into the adjoin- 
ing cellular texture. This happens efpe- 
cially in inflammations of the lungs, where 
the effufed matter, by comprefling the vef- 
fels, and flopping the circulation, occa- 
fions a fatal fuffocation ; and this is per- 
haps the manner in which pneumonic in- 
flammation moft commonly proves fatal. 
CCLX. 
Another kind of termination is, that of 
certain inflammations on the furface of the 
body, 240 
PRACTICE 
body, when there is poured out under the 
cuticle, a fluid, which being too grofs to 
pafs through its pores, therefore feparates 
it from the fkin, and raifes it up into the 
form of a veficle containing the effufed 
fluid ; and by which effufion the previous 
inflammation is taken off. 
CCLXI. 
Befide thefe already mentioned, I believe 
there is ftill another manner in which in-*- 
flammation terminates. When the internal 
parts are afledled with inflammation, there 
feems to have been almoft always upon their 
furface an exudation, which appears partly 
as a vifcid concretion upon their furface, 
and partly as a thin ferous fluid effufed 
into the cavities in which the inflamed 
vifcera are placed. Though we have be- 
come acquainted with thefe appearances 
only, as very conftantly accompanying 
thole OF PHYSIC. 
241 
thofe inflammations which have proved 
fatal, it is, however, probable that like 
circumftances may have attended thofe 
which were terminated by refolution, and 
may have contributed to that event. It is 
in favour of this fuppofition that there are 
inftances of pneumonic inflammation ter- 
minating in a hydrothorax. 
SECT. IV. 
Of the remote Causes 
CCLXIL 
The remote caufes of inflammation may- 
be reduced to five heads. 
i. The application of ftimulant fubftan- 
ces, among which are to be reckoned the 
action of fire, or burning. 
Vol. I. 
2. Ex- 242 
PRACTICE 
2. External violence operating mecha- 
nically in wounding, bruiling, compreffing, 
or overft retching the parts. 
3. Extraneous fubftances, lodged in any 
part of the body, irritating by their che- 
mical acrimony or mechanical form, or 
compreffing by their bulk or gravity. 
4. Cold, in a certain degree, not fuffi- 
cient immediately to produce gangrene. 
5. An increafed impetus of the blood 
determined to a particular part. 
It will not be difficult to underftand 
how thefe remote caufes, fingly, or in con- 
currence, produce the proximate caufe of 
inflammation. 
CCLXI1I. 
It does not appear, that, in different 
cafes of inflammation, there is any dif- 
ference in the ftate of the proximate caufe, 
except in the degree of it: and though 
fome OF PHYSIC. 
243 
Tome difference of inflammation may arife 
from the difference of the remote caufes, 
yet this is not neceffary to be taken notice 
of here; becaufe the different appear- 
ances which attend different inflamma- 
tions may be referred, for the moft part, 
to the difference of the part affedted, as 
will appear when we (hall confider the 
feveral genera and fpecies marked in the 
Nofology. When I come to treat of thefe, 
I (hall find a more proper occafion for 
taking notice of the different ftates of the 
proximate, or of the differences of the re- 
mote caufe, than by treating of them in 
general here. 
Q 2 
SECT, 244 
PRACTICE 
SECT. V. 
Of the Cure of Inflammation. 
CCLXIV. 
The indications of cure in inflammation 
are different, according as it may ftill be 
capable of refolution, or may have taken 
a tendency to the feveral other termina- 
tions above-mentioned. As the tendency 
to thefe terminations is not always im- 
mediately evident, it is always proper, up- 
on the fir ft appearance of inflammation, 
to attempt the cure of it by refolution. 
For this purpofe, the indications of cure 
are, 
1. To remove the remote caufes, when 
they are evident, and continue to operate. 
2. To take off the phlogiftic diathefis 
affecting OF PHYSIC. 
245 
affecting either the whole or the 
particular part. 
3. To take off the fpafmof the particular 
part, by remedies applied either to the 
whole fyftemj or to the part itfelf. 
CCLXV. 
The means of removing the remote 
caufes will readily occur, from conlidering 
the particular nature and circumftances of 
the different kinds. Acrid matters muft 
be removed, or their aCtion muft be pre- 
vented, by the application of correctors or 
demulcents. Compreffmg and overftretch- 
ing powers muft be taken away; and, 
from their feveral circumftances, the 
means of doing lb will be obvious. 
CCLXVI. 
The means of taking off the phlogiftic 
0.3 
diathefis 246 
PRACTICE 
diathefis of the fyftem are the fame with 
thofe for moderating the violence of re- 
adlion in fever, which are mentioned and 
treated of from CXXVII. to CXLIX. 
and therefore need not be repeated here. 
I only obferve, that, in the ufe of thofe re- 
medies, there is lefs occafion for any re- 
ferve than in many cafes of fever; and 
more particularly, that topical bleedings 
are here particularly indicated and proper. 
CCLXVII. 
The means of taking off the fpafm of 
the particular part are nearly the fame as 
thofe mentioned above, for taking off the 
fpafm of the extreme veffels in the cafe of 
fever, and which are treated of from 
CL. to CC. Only it is to be obfer- 
ved here, thaj: fome of thefe are here 
efpecially indicated, and that fome of 
them are to be directed more particu- 
t ' larly OF PHYSIC. 
247 
larly to the part efpecially affected; the 
management of which will be more pro- 
perly confidered when we fhall treat of 
particular inflammations. 
CCLXVIII. 
When a tendency to fuppuration 
(CCL1.) is diftinctly perceived, as we 
fuppofe it to depend upon the effufion of 
a fluid which cannot be eafily reabforbed, 
fo it becomes neceffary that this fluid be 
converted into pus, as the only natural 
means of obtaining its evacuation : and 
as the effufion is, perhaps, feldom made 
without fome rupture of the veffels, to the 
healing of which a pus is abfolutely ne- 
ceffary; fo, in the cafe of a tendency to 
fuppuration, the indication of cure al- 
ways is, to promote the production of a 
perfect pus as quickly as poffible. 
0.4 
CCLXIX. 248 
PRACTICE 
CCLXIX. 
For this purpofe, various remedies, fup- 
pofed to poflefs a fpecific power, have 
been propofed; but I can perceive no fuch 
power in any of them ; and, in my opi- 
nion, all that can be done is, to favour 
the fuppuration by fuch applications as 
may fupport a proper heat in the part, as 
by fome tenacity may confine the perfpi- 
ration of the part, and as, by an emollient 
quality, may weaken the cohefion of the 
teguments, and favour their erofion. 
CCLXX. 
As, in the cafe of certain effufions, a 
fuppuration is not only unavoidable, but 
deferable, it may be fuppofed, that moft 
of the means of refolution formerly men- 
tioned fhould be avoided ; and according- 
ly our pradice is commonly fo directed. 
But OF PHYSIC. 
249 
But as we obferve, on the one hand, that 
a certain degree of increafed impetus, or 
of the original circumftances of inflam- 
mation, is requifite to produce a proper 
fuppuration; fo it is then efpecially necef- 
iary to avoid thofe means of refolution 
that may diminilh too much the force of 
the circulation. And as, on the other 
hand, the impetus of the blood, when vio- 
lent, is found to prevent the proper fuppu- 
ration ; fo, in fuch cafes, although a ten- 
dency to fuppuration may have begun, it 
may be proper to continue thofe means of 
refolution which moderate the force of the 
circulation. 
With refpect to the opening of abfcefles, 
when completely formed, I refer to the 
writings on furgery. 
CCLXXI. 
When an inflammation has taken a ten- 
dency 250 
PRACTICE 
dency to gangrene, that event is to be pre- 
vented by every poflible means ; and thefe 
mull be different, according to the nature 
of the feveral caufes occafioning that ten- 
dency, as may be underftood from what 
has been already faid of them. After a 
gangrene has, in fome degree, taken place, 
it can be cured only by the feparation of 
the dead from the living parts. This, in 
certain circumftances, can be performed 
by the knife, and always moft properlv, 
when it can be fo done. 
In other cafes, it can be done by exciting 
a fuppuratory inflammation on the verge 
of the living part, whereby its coheflon 
with the dead may be every where broken 
off, fo that the latter may fall off by itfelf. 
While [this is doing, it is proper to pre- 
vent the further putrefaction of the part, 
and its fpreading wuder. For this purpole, 
various antifeptic applications have been 
propofed : but it appears to me, that, while 
the OF PHYSIC. 
251 
the teguments are entire, thefe applications 
can hardly have any effect; and, there- 
fore, that the fundamental procedure mull 
be to fcarify the part fo as to reach the li- 
ving fubftance, and, by the wounds made ( 
there, to excite the fuppuration required. 
By the fame incifions alfo, we give accefs 
to antifeptics, which may both prevent the 
progrefs of the putrefaction in the dead, 
and excite the inflammation neceffary on 
the verge of the living part. 
CCLXXII. 
When the gangrene proceeds from a lois 
of tone; and when this, communicated to 
the neighbouring parts, prevents that in- 
flammation which, as I have faid, is ne- 
ceflary to the feparation of the dead part 
from the living; it will be proper to ob- 
viate this lofs of tone by tonic medicines 
given internally 5 and, for this purpofe, 
the 252 
PRACTICE 
the Peruvian bark has been found to be 
efpecially effectual. That this medicine 
operates by a tonic power, I have en- 
deavoured to prove above (CCXIV.) ; and 
from what is faid in CCXV. the limi- 
tations to be obferved in employing it 
may alfo be learned. When the gangrene 
arifes from the violence of inflammation, 
the bark may not only fail of proving a 
remedy, but may do harm : and its power 
as a tonic is efpecially fuited to thofe cafes 
of gangrene which proceed from an ori- 
ginal lofs of tone, as in the cafe of palfy 
and oedema ; or to thofe cafes of inflam- 
mation where a lofs of tone takes place, 
while the original inflammatory fymptoms 
are removed. 
CCLXXI1I. 
The other terminations of inflamma- 
tion, either do not admit of any treatment, 
except OF PHYSIC. 
253 
except that of preventing them by the 
means of refolution; or they belong to a 
treatife of furgery, rather than to this 
place. 
Having thus, therefore, delivered the 
general dodlrine, I proceed now to confi- 
der the particular genera and fpecies of 
inflammation. 
It has been hinted above (CCLXIIL), 
that the difference of inflammation arifes 
chiefly from the difference of the part af- 
fecled: I have, therefore, arranged them, 
as they are cutaneous, visceral, or 
articular; and in this order they are 
now to be confidered. 
CHAP, 254 
PRACTICE 
CHAP. II. 
Of Inflammation, more strictly 
cutaneous. 
CCLXXIV. 
CUtaneous inflammations are of two 
kinds, commonly diftinguiflied by 
the names of Phlegmon and Erysipelas- 
Of the latter there are two cafes, which 
ought to be diftinguiflied by different ap- 
pellations. When the difeafe is an affec- 
tion of the ikin alone, and very little of 
the whole fyftem, or when the affetftion of 
the fyftem is only fymptomatical of the 
external inflammation, I fhall give the 
difeafe OF PHYSIC. 
255 
clifeafe the name of Erythema ; but 
when the external inflammation is an ex- 
anthema, and fymptomatical of an affec- 
tion of the whole fyftem, I fhall then name 
the difeafe Erysipelas. 
CCLXXV. 
It is the erythema only that I am to 
Confider here. 
For the diflinCtion between Erythema 
and Phlegmon, I have formerly referred to 
the characters given of them in our Nofo- 
logy. See Synopf. Nofolog. Meth. Vol. II. p. 5. 
gen. vii. fpec. 1. and 2. But I think it pro- 
per now to deliver the characters of them 
more fully and exactly here, as follows. 
A Phlegmon is an inflammatory affec- 
tion of the Ikin, with a fwelling, riling 
generally to a more conflderable eminence 
in the middle of it; of a bright red co- 
lour ; both the fwelling and colour being 
pretty 256 
PRACTICE 
pretty exactly circumfcribed; the whole 
being attended with a pain of diflention, 
often of a (founding or throbbing kind, 
and frequently ending in fuppuration. 
An Erythema, Rofe, or St Anthony's 
Fire, is an inflammatory affection of the 
(kin, with hardly any evident fwelling; 
of a mixed and not very bright red colour, 
readily difappearing upon preflure, but 
quickly returning again; the rednefs of 
no regular circumfcription, but fpreading 
unequally, and continuing almoft con- 
ftantly to fpread upon the neighbouring 
part; with a pain like to that from burn- 
ing ; producing blifters, fometimes of a 
fmall, fometimes of a larger (ize ; and al- 
ways ending in a defquamation of the 
fcarf-ikin, fometimes in gangrene. 
This fubjedl I am not to profecute here, 
as properly belonging to furgery, the bufl- 
nefs of which I am feldom to enter upon 
in this work; and (hall therefore obferve 
only OF PHYSIC. 
257 
Only as neceffary here, that the difference 
of thefe appearances feems to depend on 
the different feat of the inflammation. In 
the phlegmon, the inflammation feems to 
affect elpecially the veffels on the internal 
lurface of the fkin communicating with 
the lax fubjacent cellular texture; whence 
a more copious effufion, and that of ferum, 
convertible into pus, takes place. In the 
erythema, the inflammation feems to have 
its feat in the veffels on the external fur- 
face of the fkin, communicating with the 
rete mucofum, which does not admit of 
any effufion, but what feparates the cuticle, 
and gives occafion to the formation of a 
blifter, while the fmaller fize of the veffels 
admits only of the effufion of a thin fluid, 
very feldom convertible into pus. 
Befides thefe differences in the circum- 
Ilances of thefe two kinds of inflamma- 
tion, it is probable that they alfo differ 
with refped to their caufes. Erythema is 
Vol. I. 
R 
the 258 
PRACTICE 
the effect of all kinds of acrids externally 
applied to the ficin; and, when arifing 
from an internal caufe, it is from an acri- 
mony poured out on the furface of the 
ficin under the cuticle. In the phlegmon, 
an acrimony is not commonly evident. 
CCLXXVL 
Thefe differences in the feat and caufes of 
the phlegmon and erythema being admit- 
ted, it will be evident, that when an ery- 
thema affects any internal part, it can 
take place in thofe only whofe furfaces 
are covered with an epithelion, or mem- 
brane analogous to the cuticle. 
CCLXXVII. 
The fame diftin&ion between the feat 
and caufes of the two difeafes will, as I 
judge, readily explain what has been de- 
livered OF PHYSIC. 
259 
livered by practical writers, with refpecft 
to the cure of thefe different cutaneous 
inflammations. But I fliall not, however, 
profecute this here, for the reafon given 
above (CCLXXV.); and, for the fame rea- 
fon, fliall not fay any thing of the variety 
of external inflarhmation,that might other- 
wife be confidered here. 
R 2 
CHAP. 260 
PRACTICE 
CHAP. III. 
Of Ophthalmia, or Inflammation 
of the Eye. 
CCLXXVIII. 
THE inflammation of the eye may be 
confldered as of two kinds; accor- 
ding as it has its feat in the membranes 
of the ball of the eye, when I would name 
it Ophthalmia Membranarum; or as 
it has its feat in the febaceous glands pla- 
ced in the tarfus, or edges of the eye-lids, 
in which cafe it may be termed Ophthal- 
mia Tarsi. 
Thefe two kinds are very frequently 
combined OF PHYSIC. 
261 
combined together, as the one may rea- 
dily excite the other; but they are ftill to 
be diftinguilhed according as the one or 
the other may happen to be the primary 
affection, and properly as they often arife 
from different caufes. 
CCLXXIX. 
The inflammation of the membranes of 
the eye affects efpecially, and moft fre- 
quently, the adnata, appearing in a tur- 
gefcence of its veffels ; fo that the red vefl- 
fels which are naturally there, become not 
only increafed in fize, but there appear 
many more than did in a natural ftate. 
This turgefcence of the veffels is attended 
with pain, efpecially upon the motion of 
the ball of the eye; and this, like every 
other irritation applied to the furface of 
the eye, produces an effufion of tears from 
the lachrymal gland. 
R 3 
This 262 
PRACTICE 
This inflammation commonly, and 
chiefly, affects the adnata fpread on the 
anterior part of the bulb of the eye ; but 
ufually fpreads alfo along the continuation 
of that membrane on the infide of the pal- 
pebree; and, as that is extended on the 
tarfus palpebrarum, the excretories of the 
febaceous glands opening there are alfo 
frequently affected. When the affection 
of the adnata is confiderable, it is fre- 
quently communicated to the fubjacent 
membranes of the eye, and even to the 
retina itfelf, which thereby acquires fo 
great a fenfibility, that the flighted: impref- 
flon of light becomes painful. 
CCLXXX. 
The inflammation of the membranes of 
the eye is in different degrees, according 
as the adnata is more or lefs affedted, or 
according as the inflammation is either of 
the OF PHYSIC. 
263 
the adnata alone, or of the fubjacent 
membranes alfo; and, upon thefe dif- 
ferences, different fpecies have been efta- 
blifhed, and different appellations given to 
them. But I fhall not, however, profecute 
the confideration of thefe, being of opi- 
nion, that all the cafes of the Ophthalmia 
membranarum differ only in degree, and 
are to be cured by remedies of the fame 
kind, more or lefs employed. 
The remote cauies of Ophthalmia are 
many and various; as, 
1. External violence, by blows, contu- 
fions, and wounds, applied to the eyes; 
and even very flight impulfes applied, 
whilft the eye-lids are open, to the ball of 
the eye itfelf, are fometiines fufficient for 
the purpofe. 
2. Extraneous bodies introduced under 
the eye-lids, either of an acrid quality, as 
fmoke and other acrid vapours, or of a 
bulk fuflicient to impede the free motion 
R 4 
of  PRACTICE 
264 
of the eye-lids upon the furface of the eye- 
ball. 
3. The application of ftrong light, or 
even of a moderate light long continued. 
4. The application of much heat, and 
particularly of that with moifture. 
5. Much exercife of the eyes in viewing 
minute objects. 
6. Frequent intoxication. 
7. Irritation from other and various 
difeafes of the eyes. 
8. An acrimony prevailing in the mafs 
of blood, and depofited in the febaceous 
glands on the edges of the eye-lids. 
9. A change in the diftribution of the 
blood, whereby either a more than ufual 
quantity of blood, and with more than 
ufual force, is impelled into the veflels of 
the head, or whereby the free return of the 
venous blood from the veffels of the head 
is interrupted. 
10. A certain confent of the eyes with 
the OF PHYS I,C. 
265 
the other parts of the fyftem, whereby, 
from a certain ftate of thefe parts, either 
a fimultaneous, or an alternating affection 
of the eyes, is produced. 
CCLXXXI. 
The proximate caufe of Ophthalmia is 
not different from that of inflammation 
in general; and the different circumftances 
of Ophthalmia may be explained by the 
difference of its remote caufes, and by the 
different parts of the eye which it happens 
to affect. This may be underftood from 
what has been already faid; and I fhall now 
therefore proceed to confider the Cure. 
CCLXXXIL 
In the cure of Ophthalmia, the firft 
attention will be always due to the remo- 
ving of the remote caufes, and the various 
means 266 
PRACTICE 
means neceflary for this purpofe will be 
diredied by the confideration of thefe 
caufes enumerated above. 
The Ophthalmia membranarum requires 
the remedies proper for inflammation in 
general; and,when the deeper-featedmem- 
branes are affedled, and efpecially when a 
pyrexia is prefent, large general bleedings 
may be neceflary. But this is feldom the 
cafe; as the Ophthalmia, for the moft part, 
is an affediion purely local, accompanied 
with little or no pyrexia. General bleed- 
ings, therefore, from the arm or foot, have 
little effect upon it; and the cure is chiefly 
to be obtained by topical bleedings, that 
is, blood drawn from veffels near the in- 
flamed part; and opening the jugular vein 
or the temporal artery, may be confldered 
as in fome meafure of this kind. It is 
commonly fufficient to apply a number of 
leeches round the eye; and it is perhaps 
better ftill to draw blood from the temples, 
by O F P H Y S I C. 
267 
by cupping and fcarifying. In many cafes, 
a very effectual remedy is, that of fcarify- 
ing the internal furface of the inferior 
eye-lid; and more fo flill, is cutting the 
turgid veflels upon the adnata itfelf. 
CCLXXXIIL 
Befides blood-letting, purging, as a re- 
medy fuited to inflammation in general, 
has been confldered as peculiarly adapted 
to inflammations in any of the parts of 
the head, and therefore to Ophthalmia; 
and it is fometimes ufeful; bur, for the 
reafons given before with refpedt to general 
bleeding, purging in the cafe of Ophthal - 
mia does not prove ufeful in any degree 
in proportion to the evacuation excited. 
CCLXXXIV. 
For relaxing the fpafm in the part, and 
taking 268 
PRACTICE 
taking off the determination of the fluids 
to it, bliftering near the part has com- 
monly been found ufeful. 
CCLXXXV. 
Electrical fparks taken from the eye will 
often fuddenly difcufs the inflammation of 
the adnata; but the effect is feldom per- 
manent, and even a frequent repetition 
feldom gives an entire cure. 
CCLXXXVI. 
Ophthalmia, as an external inflamma- 
tion, admits of topical applications. All 
thofe, however, that increafe the heat and 
relax the veflels of the part, prove com- 
monly hurtful; and the admiflion of cool 
air to the eye, the proper application of 
cold water immediately to the ball of the 
eye, and the application of various cooling 
and OF PHYSIC. 
269 
and aftringent medicines, which at the 
fame time do not produce much irrita- 
tion, prove generally ufeful : even fpi- 
rituous liquors, employed in moderate 
quantity, have often been of fervice. 
CCLXXXVII. 
In the cure of Ophthalmia, much care 
is requifite to avoid all irritation, parti- 
cularly that of light; and the only fafe 
and certain means of doing this, is by con- 
fining the patient to a very dark chamber. 
CCLXXXVIIL 
Thefe are the remedies of the Ophthal- 
mia membranarum ; and in the Ophthal- 
mia tarfi, fo far as it is produced by the 
Ophthalmia membranarum, the fame re- 
medies may be necelfary. As, however, 
the Ophthalmia tarfi may often depend 
upon 270 
PRACTICE 
upon an acrimony depofited in the feba- 
ceous glands of the part, fo it may require 
various internal remedies according to the 
nature of the acrimony in fault; for which 
I mutt refer to the confideration of fcro- 
phula, fyphilis, or other difeafes with 
which this Ophthalmia may be connected : 
and when the nature of the acrimony is 
not afcertained, certain remedies, more ge- 
nerally adapted to the evacuation of acri- 
mony, fuch, for inftance, as mercury, may 
be employed. 
CCLXXXIX. 
In the Ophthalmia tarii, it almoft con- 
flantly happens, that Tome ulcerations are 
formed on the tarfus. Thefe require the 
application of mercury or copper, either 
of which may by itfelf fometimes entirely 
cure the affedion ; and thefe may even be 
ufeful OF PHYSIC. 
271 
ufeful when the difeafe depends upon a 
fault of the whole fyftem. 
CCXC. 
Both in the Ophthalmia membranarum, 
and in the Ophthalmia tarli, it is neceffary 
to obviate that gluing or flicking together 
of the eye-lids which commonly happens 
in deep; and this may be done by infi- 
nuating a little of any mild uncfluous me- 
dicine of fome tenacity between the eye- 
lids before the patient fhall go to deep. 
CHAP. 272 
PRACTICE 
CHAP. IV. 
Of Phrensy, or Phrenitis. 
CCXCI. 
THIS difeafe is an inflammation of 
the parts contained in the cavity of 
the cranium; and may affect either the 
membranes of the brain, or the fubftance 
of the brain itfelf. Nofologifts have ap- 
prehended, that thefe two cafes might be 
diftinguifhed by different fymptoms, and 
therefore by different appellations : but 
this does not feem to be confirmed by ob- 
fervation and diffeddion ; and therefore I 
fhall treat of both cafes under the title of 
Phrenfy, or Phrenitis. 
ccxc. OF PHYSIC. 
273 
CCXCII. 
An idiopathic phrenfy is a rare occur- 
rence, a fympathic more frequent; and the 
afcertaining either the one or the other is, 
upon many occaflons, difficult. Many of 
the fymptoms by which the difeafe is moft 
commonly judged to be prefent, have ap- 
peared, when, from certain conflderations, 
it was prefumed, and even from difledlion 
it appeared, that there had been no internal 
inflammation; and, on the other hand, 
diflecbons have Ihown, that the brain had 
been inflamed, when few of the peculiar 
fymptoms of phrenfy had before appeared. 
CCXCIIL 
The fymptoms by which this difeafe 
may be moft certainly known are, a vehe- 
ment pyrexia, a violent deep-feated head- 
ach, a rednefs and turgefcence of the face 
Vol. I. 
S 
and 274 
PRACTICE 
and eyes, an impatience.of light or noife, 
a conflant watching, and a delirium im- 
petuous and furious. Some nofologifts have 
thought thefe fymptoms peculiar to an in- 
flammation of the membranes, and that 
the inflammation of the fubftance of the 
brain was to be diftinguifhed by fome de- 
gree of coma attending it. It was for 
this reafon that in the Nofologyl added the 
Typhomania to the character of Phrenitis: 
but, upon farther reflection, I find no 
proper foundation for this; and, if we 
pafs from the characters above delivered, 
there will be no means of fixmg the va- 
riety that occurs. 
1 am here, as in other analagous cafes, 
of opinion, that the fymptoms above men- 
tioned of an acute inflammation, always 
mark inflammations of membranous parts; 
and that an inflammation of the paren- 
chyma or fubftance of vifeera, exhibits, at 
leaft commonly, a more chronic afleCtion. 
CCXCIV. OF PHYSIC. 
275 
CCXCIV. 
The remote caufes of phrenfy, are all 
thofe which directly ftimulate the mem- 
branes, or fubflance of the brain; and par-< 
ticularly all thofe which increafe the im- 
petus of the blood in the veflels of the 
brain. Among thefe the expofure of the 
naked head to the diredt rays of a very 
warm fun, is a frequent caufe. The paf- 
lions of the mind, and certain poifons, are 
amongft the remote caufes of phrenfy; but 
in what manner they operate, is not well 
underflood. 
ccxcv. 
The cure of phrenfy is the fame with 
that of inflammation in general ; but in 
phrenfy the moft powerful remedies are to 
be immediately employed. Large and re- 
peated blood-letting is efpecially neceflary; 
S 2 
and 276 
PRACTICE 
and the blood fliotdd be drawn from vef- 
fels as near as pofTible to the part affedled. 
The opening of the temporal artery has 
been recommended, and with fome rea- 
fon: but the practice is attended with in- 
venience; and I apprehend, that opening 
the jugular veins may provQ more effec- 
tual; but, at the fame time, it will be 
generally proper to draw blood from the 
temples by cupping and fcarifying. 
CCXCVI. 
It is probable, that purging, as it may 
operate by revulfion, may be of more ufe 
in this than in fome other inflammatory 
affections. 
For the fame purpofe of revulfion, warm 
pediluvia are a remedy ; but, at the fame 
time, fomewhat ambiguous. The taking 
off the force of the blood in the vcffels of 
the OF PHYSIC. 
277 
the head by an eredt pofture, is generally 
ufeful. 
ccxcvn. 
Shaving of the head is always proper 
and neceflary for the admiflion of other 
remedies. Bliftering is commonly ufeful 
in this difeafe, but chiefly when applied 
near to the part afledted. 
CCXCVIII. 
Every part of the antiphlogiftic regimen 
is here neceflary, and particularly the ad- 
miflion of cold air. Even cold fubftances, 
applied clofe to the head, have been found 
fafe and highly ufeful; and the application 
of fuch refrigerants as vinegar, is certainly 
proper. 
CCXCIX. 
It appears to me certain, that opiates 
s 3 
are 278 
R P A C T I C E 
are hurtful in every inflammatory ftate of 
the brain ; and it is to be obferved, that, 
from the ambiguity mentioned in CCXCII. 
the accounts of practitioners, with regard 
to the juvantia and Isedentia in this difeafe, 
are of very uncertain application. 
CHAP. V. 
Of the Quinsy, or Cynanche. 
ccc. 
THIS name is applied to every inflam- 
mation of the internal fauces; but 
thefe inflammations are different, accord- 
ing O F P H Y S I C. 
279 
ing to the part of the fauces which may 
be affected, and according to the nature 
of the inflammation. In the Nofology, 
therefore, after giving the character of the 
Cynanche as a genus, I have diftinguifhed 
five different fpecies, which rnuft here 
likewife be feparately confidered. 
SECT. I. 
Of the Cynanche Tonsillaris. 
CCCI. 
This is an inflammation of the mucous 
membrane of the fauces, affecting efpe- 
cially that congeries of mucous follicles 
which forms the tonflls, and fpreacling 
from thence along the velum and uvula, 
S 4 
fo 280 
P R1A C T I C E 
fo as frequently to affect every part of the 
mucous membrane. 
CCC1I. 
The difeafe appears by fome tumour, 
fometimes coniiderable, and by a rednefs 
of the parts ; is attended with a painful 
and difficult deglutition ; with a pain 
fometimes ffiooting into the ear; with a 
troublefome clamminefs of the mouth and 
throat; with a frequent, but difficult, ex- 
cretion of mucous; and the whole is ac- 
companied with a pyrexia. 
CCCIII. 
This fpecies of quinfy is never conta- 
gious. It terminates frequently by refolu- 
tion, fometimes by fuppuration, but hardly 
ever by gangrene; although in this difeafe 
fome doughy fpots, commonly fuppofed 
to OF PHYSIC. 
281 
to be fore-runners of gangrene, fometimes 
appear upon the fauces. 
CCCIV. 
This difeafe is commonly occafioned by 
cold externally applied, particularly about 
the neck. It aflccls efpecially the young 
and fanguine, and a difpofition to it is 
often acquired by habit; fo that from 
every considerable application of cold to 
any part of the body, this difeafe is rea- 
dily induced. It occurs efpecially in 
Ipring and autumn, when viciflitudes of 
heat and cold frequently take place. The 
inflammation and tumour are commonly 
at firft moft confiderable in one tonfil; and 
afterwards, abating in that, increafe in the 
other. 
cccv. 
In the cure of this inflammation, fome 
bleeding 282 
PRACTICE 
bleeding may be proper; but large gene- 
ral bleedings will feldom be neceflary. 
The opening of the ranular veins feems to 
be an inflgnificant remedy ; and leeches fet 
upon the external fauces are of more effi- 
cacy. 
CCCVI. 
At the beginning of the difeafe, full vo- 
miting has been frequently found to be of 
great fervice. 
CCCVII. 
This inflammation may be often re- 
lieved by moderate aftringents, and parti- 
cularly by acids applied to the inflamed 
parts. In many cafes, however, nothing 
has been found to give more relief than 
the vapour of warm water received into 
the fauces by a proper apparatus. 
CCCVIII. OF PHYSIC. 
283 
CCCVIII. 
The other remedies of this difeafe are 
rubefacient or bliftering medicines, ap- 
plied externally to the neck; and, with 
thefe, the employment of antiphlogiftic 
purgatives, as well as every part of the an- 
tiphlogiftic regimen, excepting the appli- 
cation of cold. 
CCCIX. 
This difeafe, as we have faid, often ter- 
minates by refolution, frequently accom- 
panied with fweating; which is therefore 
to be prudently favoured and encouraged. 
cccx. 
When this difeafe (hall have taken a 
tendency to fuppuration, nothing will be 
more ufeful, than the frequent taking into 
the 284 
PRACTICE 
the fauces the fleams of warm water. 
When the abfcefs is attended with much 
fwelling, if it break not fpontaneoufly, it 
fliould be opened by a lancet; and this 
does not require much caution, as even the 
inflammatory ftate may be relieved by 
fome fcarification of the tonfils. I have 
never had occafion to fee any cafe re- 
quiring bronchotomy. 
SECT. II. 
Of the Cynanche Maligna. 
CCCXL 
This is a contagious difeafe, feldom fpo- 
radic, and commonly epidemic. It attacks 
perfons of all ages, but more commonly 
thofe in a young and infant ftate. It at* 
tacks perfons of every conftitution when 
ex- O F PHYSIC. 
285 
expofed to the contagion, but moft readily 
the weak and infirm. 
CCCXIL 
This difeafe is ufually attended with a 
confiderable pyrexia; and the fymptoms of 
the acceffion of this, fuch as frequent cold 
ffiiverings, ficknefs, anxiety, and vomiting, 
are often the firft appearances of the dif- 
eafe. About the fame time, a fliflhefs is felt 
in the neck, with fome uneafinefs in the 
internal fauces, and fome hoarfenefs of the 
voice. The internal fauces, when viewed, 
appear of a deep red colour, with fome tu- 
mour ; but this laft is feldom confiderablej 
and deglutition is feldom difficult or pain- 
ful. Very foon, a number of white or 
affi-coloured fpots appear upon the in- 
flamed parts. Thefe fpots fpread and unite, 
covering almoft the whole fauces with 
thick floughs; which falling ofF, difeover 
nice- 286 
PRACTICE 
ulcerations. While thefe fymptoms pro- 
ceed in the fauces, they are generally 
attended with a coryza, which pours 
out a thin acrid and fetid matter, exco- 
riating the noftrils and lips. There is of- 
ten alfo, efpecially in infants, a frequent 
purging; and a thin acrid matter flows 
from the anus, excoriating this and the 
neighbouring parts. 
CCCXIII. 
With thcfe fymptoms, the pyrexia pro- 
ceeds with a fmall, frequent, and irregular 
pulfe; and there occurs a manifeft exacer- 
bation every evening, and foine remiflion 
in the mornings. A great debility appears 
in the animal functions; and the fenforium 
is affefted with delirium, frequently with 
coma. 
CCCXIV. OF PHYSIC. 
287 
CCCXIV. 
On the fecond day, or fometimes later, 
efflorefcences appear upon the fkin, which 
are fometimes in fmall points hardly emi- 
nent ; but, for the molt part, in patches of 
a red colour, fpreading and uniting fo as 
to cover the whole fkin. They appear firfl 
about the face and neck, and in the courfe 
of fome days fpread by degrees to the lower 
extremities. The fcarlet rednefs is often 
confiderable on the hands and extremities 
of the fingers, which feel Riff and fwelled. 
This eruption is often irregular, as to the 
time of its appearance, as to its fteadinefs, 
and as to the time of its duration. It 
ufually contines four days, and goes off 
by fome defquamation of the cuticle; but 
neither on its firfl appearance, nor on its 
defquamation, does it always produce a 
remiflion of the pyrexia, or of the other 
fymptoms. 
cccv. 288 
PRACTICE 
cccxv. 
The progrefs of the difeafe depends on 
the date of the fauces and of the pyrexia. 
When the ulcers on the fauces, by their livid 
and black colour, by the fetor of the breath, 
and by many marks of acrimony in the 
fluids, fhow a tendency to gangrene, this 
takes place to a confiderable degree; and, 
the fymptoms of a putrid fever conftantly 
increafing, the patient dies, often on the 
third day, fometimes later, but for the 
moft part before the feventh. The acri- 
mony poured out from the difeafed fauces 
mutt neceflarily, in part, pafs into the pha- 
rynx, and there fpread the infection into 
the oefophagus, and fometimes through 
the whole of the alimentary canal, propa- 
gating the putrefaction, and often exhauft- 
ing the patient by a frequent diarrhoea. 
The acrid matter poured out in the fau- 
ces being again abforbed, frequently occa- 
tions OF PHYSIC. 
289 
Hons large fwellings of the lymphatic 
glands about the neck, and fometimes to 
fuch a degree as to occaflonfuffbcation. 
It is feldom that the organs of refpira- 
tion efcape entirely unhurt, and very of- 
ten the inflammatory affection is commu- 
nicated to them. From diffedtions it ap- 
pears, that, in the Cynanche maligna, the 
larynx and trachea are often affedted in 
the fame manner as in the Cynanche tra- 
chealis; and it is probable, that, in con- 
fequence of that affection, the Cynanche 
maligna often proves fatal by fuch a hid- 
den fuffbcation as happens in the proper 
Cynanche trachealis; but there is reafon 
to fufpedt, that upon this fubject difledtors 
have not always diftinguifhed properly 
tween the two difeafes. 
CCCXVI. 
Thefe are the feveral fatal terminations 
Vol. I. 
T 
of 290 
PRACTICE 
of the Cynanche maligna; but they do not 
always take place. Sometimes the ulcers 
of the fauces are of a milder nature; and 
the fever is more moderate, as well as of a 
lefs putrid kind. And when, upon the 
appearance of the efflorefcence on the fkin, 
the fever fuffcrs a remiffion; when the ef- 
florefcence continues for three or four days, 
till it has fpread over the whole body, and 
then ends by a defquamation, giving a fur- 
ther remiffion of the fever; this often entirely 
terminates, by gentle fweats, on or before the 
feventh day; and the reft of the difeafe ter- 
minates in a few days more, by an excretion 
of floughs from the fauces, while fleep, appe- 
tite, and the other marks of health, return. 
From what is faid in this, and the pre- 
ceding paragraph, the prognoftics in this 
difeafe may be readily learned. 
CCCXVII. 
In the cure of this difeafe, its feptic 
ten- OF PHYSIC. 
291 
tendency is chiefly to be kept in view. The 
debility, with which it is attended, renders 
all evacuations by bleeding and purging 
improper, except in a few inftances where 
the debility is lefs, and the inflamma- 
tory fymptoms more confiderable. The 
fauces are to be preferved from the effects 
of the acrid matter poured out upon them, 
and are therefore to be frequently wafhed 
out by antifeptic gargles or injections; and 
the feptic tendency of the whole fyftem 
Ihould be guarded againft and corrected 
by internal antifeptics, efpecially by the 
Peruvian bark given in fubftance, from the 
beginning, and continued through the 
courfe of the difeafe. Emetics, both by 
vomiting and naufeating, prove ufeful, 
efpecially when employed early in the dif- 
eafe. When any confiderable tumour oc- 
curs, blifters applied externally will be of 
fervice, and, in any cafe, may be fit to 
moderate the internal inflammation. 
T 2 
SECT, 292 
PRACTICE 
SECT. III. 
Of the CynancHe TrachealiS. 
CCCXVIIL 
This name has been given to an in- 
flammation of the glottis, larynx, or upper 
part of the trachea, whether it affect the 
membranes of thefe parts, or the mus- 
cles adjoining. It may arife firft in thefe 
parts, and continue to fubfift in them 
alone; or it may come to affect thefe parts 
from the Cynanche tonfillaris or maligna 
fpreading into them. 
CCCXIX. 
Iii either way it has been a rare occur- 
rence, OF PHYSIC. 
293 
rence, and few inftances of it have been 
marked and recorded by phyficians. It is 
to be known by a peculiar ringing found 
of the voice, by difficult refpiration, with a 
fenfe of ftraitening about the larynx, and 
by a pyrexia attending it. 
cccxx. 
From the nature of thefe fymptoms, and 
from the diffedlion of the bodies of perfons 
who had died of this difeafe, there is no 
doubt of its being of an inflammatory 
nature. It does not, however, always run 
the courfe of inflammatory affections, but 
frequently produces fuch an obftruCtion of 
the paflage of the air, as fuffbcates, and 
thereby proves fuddenly fatal. 
CCCXXL 
If we judge rightly of the nature of this 
T 3 
difeafe, 294 
PRACTICE 
difeafe, it will be obvious, that the cure 
of it requires the moft powerful remedies 
of inflammation, to be employed upon the 
very firft appearance of the fymptoms. 
When a fuffocation is threatened, whether 
any remedies can be employed to prevent 
it, we have not had experience to deter- 
mine. 
CCCXXII. 
The accounts which books have hitherto 
given us of inflammations of the larynx, 
and the parts connected with it, amount 
to what we have now faid; and the in- 
fiances recorded have almofl all of them 
happened in adult pcrfons ; but there is a 
peculiar affection of this kind happening 
efpecially to infants, which till lately has 
been little taken notice of. Dr Home is 
the firfl: who has given any diftindl account 
of it; but, fince he wrote, feveral other 
authors OF PHYSIC. 
295 
authors have taken notice of it, (fee Mi- 
chaelis De angina polypofa five membra- 
naceay Argentorati 1778); and have given 
different opinions with regard to it. Con- 
cerning this diverlity of opinions I fhall 
not at prefent inquire; but Ihall deliver 
the hiftory and cure of this difeafe, in fo 
far as thefe have arifen from my own ob- 
fervation, from that of Dr Home, and of 
other fkillful pcrfons in this neighbour- 
hood. 
CCCXXIII. 
This difeafe feldom attacks infants till 
after they have been weaned. After this 
period, the younger they are, the more 
they are liable to it. The frequency of it 
becomes lefs as children become more ad- 
vanced ; and there are no inftances of 
children above twelve years of age being 
affected with it. It attacks children of the 
T 4 
mid- 296 
PRACTICE 
midland countries, as well as thofe who 
live near the fea. It does not appear to be 
contagious, and its attacks are freqrently 
repeated in the fame child. It is often 
manifeftly the effect of cold applied to the 
body; and therefore appears molt fre- 
quently in the winter and fpring feafons. 
It very commonly comes on with the or- 
dinary fymptoms of a catarrh ; but fome- 
times the peculiar fymptoms of the difeafe 
ffiow themfelves at the very fir ft. 
CCCXXIV. 
Thcfe peculiar fymptoms are the fol- 
lowing: A hoarfenefs, with fome fhrill- 
nefs and ringing found, both in fpeaking 
and coughing, as if the noife came from 
a brazen tube. At the fame time, there 
is a fcnfe of pain about the larynx, fome 
difficulty of refpiration, with a whizzing 
found in infpiration, as if the paffage of 
thg OF PHYSIC. 
297 
the air were ftraitened. The cough which 
attends it, is commonly dry ; and, if any 
thing be fpit up, it is a matter of a puru- 
lent appearance, and fometimes films re- 
fembling portions of a membrane. To- 
gether with thefe fymptoms, there is a 
frequency of pulfe, a reftleffnefs, and an 
uneafy fenfe of heat. When the internal 
fauces are viewed, they are fometimes 
without any appearance of inflammation; 
but frequently a rednefs, and even fwell- 
ling, appear; and fometimes in the fauces 
there is an appearance of matter like to that 
rejected by coughing. With the fymptoms 
now defcribed, and particularly with 
great difficulty of breathing, and a fenfe of 
ftrangling in the fauces, the patient is 
fometimes fuddenly taken off. 
cccxxv. 
There have been many difiedions made 
of 298 
PRACTICE 
of infants who had died of this difeafe; 
and almoft conftantly there has appeared 
a preternatural membrane lining the whole 
internal furface of the upper part of the 
trachea, and extending in the fame man- 
ner downwards into fome of its ramifica- 
tions. This preternatural membrane may- 
be eafily feparated, and fometimes has been 
found feparated in part, from the fubjacent 
proper membrane of the trachea. This 
laft is commonly found entire, that is, 
without any appearance of erofion or ulce- 
ration ; but it frequently fhows the vefti- 
ges of inflammation, and is covered by a 
matter refembling pus, like to that reject- 
ed by coughing ; and very often a matter 
of the fame kind is found in the bronchia?, 
fometimes in confiderable quantity. 
CCCXXVI. 
From the remote caufes of this difeafe; 
from OF PHYSIC. 
299 
from the catarrhal fymptoms commonly 
attending it; from the pyrexia conftantly 
prefent with it; from the fame kind of 
preternatural membrane being found in 
the trachea when the cynanche maligna 
is communicated to it; and, from the 
veftiges of inflammation on the trachea 
difeovered upon difleeftion; we muft con- 
clude, that the difeafe conflfts in an in- 
flammatory affetftion of the mucous mem- 
brane of the larynx and trachea, produ- 
cing an exudation analogous to that found 
on the furface of inflamed vifeera, and ap- 
pearing partly in a membranous cruft, and 
partly in a fluid refembling pus. 
CCCXXVII. 
Though this difeafe manifeftly conflfts 
in an inflammatory afFedion, it does not 
commonly end either in fuppuration or 
gangrene. The peculiar and troublefome 
cir- 300 
PRACTICE 
circumftance of the difeafe feems to confift, 
in a fpafm of the mufcles of the glottis, 
which, by inducing a fuffocation, prevents 
the common confequences of inflammation* 
CCCXXVIII. 
When this difeafe terminates in health, 
it is by a refolution of the inflammation, by 
a ceafing of the fpafm of the glottis, by an 
expectoration of the matter exuding from 
the trachea, and of the crufts formed there; 
and frequently it ends without any ex- 
pectoration, or at lead: with fuch only as 
attends an ordinary catarrh. 
CCCXXIX. 
When the difeafe ends fatally, it is by a 
fuffocation; feemingly, as we have faid, 
depending upon a fpafm affecting the 
glottis; but fometimes, probably, depend- 
ing OF PHYSIC. 
301 
ing upon a quantity of matter filling the 
bronchia. 
cccxxx. 
As we fuppofe the difeafe to be an in- 
flammatory aftedlion, fo we attempt the 
cure of it by the ufual remedies of in- 
flammation, and which for the moft part 
I have found effectual. Bleeding, both 
general and topical, has often given im- 
mediate relief; and, by being repeated, 
has entirely cured the difeafe. Bliftering 
alfo, near to the part afledled, has been 
found ufeful. Upon the fir ft attack of the 
difeafe, vomiting, immediately after bleed- 
ing, feems to be of confiderable ufe, and 
fometimes fuddenly removes the difeafe. 
In every ftage of the difeafe, the antiphlo- 
giftic regimen is neceflary, and particu- 
larly the frequent ufe of laxative glyfters. 
Though we fuppofe that a fpafm affecting 
the 302 
PRACTICE 
the glottis is often fatal in this difeafe, I 
have not found antifpafmodic medicines 
to be of any ufe. 
SECT. IV. 
Of the Cynanche PharyngjEA. 
CCCXXXL 
In the Cynanche tonfillaris, the in flam 
mation of the mucous membrane often 
fpreads upon the pharynx, and. into the 
beginning of the oefophagus, and thereby 
renders deglutition more difficult and un- 
eafy: but fuch a cafe does not require to 
be diftinguifhed as a different fpecies from 
tile common Cynanche tonfillaris; and 
only requires that blood-letting, and other 
remedies, OF PHYSIC. 
303 
remedies, Ihould be employed with greater 
diligence than in ordinary cafes. We 
have never feen any cafe in which the in- 
flammation began in the pharynx, or in 
which this part alone was inflamed: but 
practical writers have taken notice of fuch 
a cafe; and to them, therefore, I muft re- 
fer, both for the appearances which diftin- 
guifli it, and for the method of cure. 
SECT. V. 
Of the Cynanche Parptidjea* 
CCCXXXIL 
This is a difeafe known to the vulgar, 
and among them has got a peculiar appel- 
lation, in every country of Europe; but 
has 304 
PRACTICE 
has been little taken notice of by medical 
writers. It is often epidemic, and mani- 
feftly contagious. It comes on with the 
ufual fymptoms of pyrexia, which is foon 
after attended with a confiderable tumour 
of the external fauces and neck. This tu- 
mour appears firft as a glandular moveable 
tumour at the corner of the lower-jaw; 
but the fwelling foon becomes uniformly 
diffufed over a great part of the neck, 
fometimes on one fide only, but more 
commonly on both. The fwelling conti- 
nues to increafe till the fourth day; but 
from that period it declines, and in a few 
days more pafles off entirely. As the 
fwelling of the fauces recedes, fome tu- 
mour affects the teflicles in the male fex, 
or the breads in the female. Thefe tu- 
mours are fometimes large, hard, and 
fomewhat painful; but, in this climate, 
are feldom either very painful or of long 
continuance. The pyrexia attending this 
djfeafe OF PHYSIC. 
305 
difeafe is commonly flight, and recedes 
with the fwelling of the fauces; but fome- 
times, when the fwelling of the tefticles 
does not fucceed to that of the fauces, or 
when the one or the other has been fud- 
denly reprefled, the pyrexia becomes more 
confiderable, is often attended with deli- 
rium, and has fometimes proved fatal. 
CCCXXXIII. 
zA.s this difeafe commonly runs its courfe 
without either dangerous or troublefome 
fymptoms, fo it hardly requires any re- 
medies. An antiphlogiftic regimen, and 
avoiding cold, are all that will be com- 
monly neceflary. But when, upon the re- 
ceding of the fwellings of the tefticles in 
males, or of the breafts in females, the 
pyrexia comes to be confiderable, and 
threatens an aftecftion of the brain, it will 
be proper, by warm fomentations, to bring 
Vol. I. 
u 
back 306 
practice! 
back the fwelling; and, by vomiting, bleed- 
ing, or bliftering, to obviate the Confe- 
quences of its abfence. 
CHAP. VI. 
Of Pneumonia, or Pneumonic In- 
flammation. 
CCCXXXIV. 
UNDER this title I mean to compre- 
hend the whole of the inflamma- 
tions affecting either the vifcera of the 
thorax, or the membrane lining the interior 
furface of that cavity: for neither do our 
diagnoses ferve to afeertain exactly the feat 
of the difeafe: nor does the difference in 
the OF PHYSIC. 
307 
die feat of the difeafe exhibit any confi- 
derable variation in the ftate of the fymp- 
toms, nor lead to any difference in the 
method of cure. 
cccxxxv. 
Pneumonic inflammation, however va- 
rious in its feat, feems to me to be always 
known and diftinguiflied by the following 
fymptoms: pyrexia, difficult breathing, 
cough, and pain in fome part of the tho- 
rax. But thefe fymptoms are, on different 
occaiions, varioufly modified. 
CCCXXXVL 
The difeafe almoft always comes on with 
a cold ftage, and is accompanied with the 
other fymptoms of pyrexia; though, in 
a few inftances, the pulfe may not be more 
frequent, nor the heat of the body in- 
creafed 
U a 308 
PRACTICE 
creafed beyond what is natural. Some- 
times the pyrexia is from the beginning 
accompanied with the other fymptoms; 
but frequently it is formed for fome hours 
before the other fymptoms become confi- 
derable, and particularly before the pain 
be felt. For the moll part, the pulfe is 
frequent, full, llrong, hard, and quick; 
but, in a few inllances, efpecially in the 
advanced Hate of the difeafe, the pulfe 
is weak and foft, and at the fame time ir- 
regular. 
cccxxxvn. 
The difficulty of breathing is always pre- 
fent, and molt confiderable in infpiration; 
both becaufe the lungs do not eaffiy admit 
of a full dilatation, and becaufe the dilata- 
tion aggravates the pain attending the dif- 
eafe. The difficulty of breathing is alfo 
greater when the patient is in one pollute 
of OF PHYSIC. 
309 
of his body rather than another. It is 
I 
generally greater when he lies upon the 
fide affected; but fometimes the contrary 
happens. Very often the patient cannot 
lie eafy upon either fide, finding eafe only 
when lying on his back ; and fometimes 
he cannot breathe eafily, except when in 
fomewhat of an eredl pofture. 
CCCXXXV1II. 
A cough always attends this difeafe; but, 
in different cafes, is more or lefs urgent 
and painful. It is fometimes dry, that is, 
without any expectoration, efpecially in the 
beginning of the difeafe : but more com- 
monly it is, even from the firft, moift, and 
the matter fpit up various both in confid- 
ence and colour ; and frequently it is 
ftreaked with blood. 
U 3 
CCCXXXIX. 310 
PRACTICE 
CCCXXXIX. 
The pain attending this difeafe, is, in 
different cafes, felt in different parts of the 
thorax, but moft frequently in one fide. It 
has been faid to affecft the right fide more 
frequently than the left; but this is not 
certain; while, on the other hand, it is cer- 
tain, that the left fide has been very often 
affected. The pain is felt fometimes as if 
it were under the fternum; fometimes in 
the back between the fhoulders; and, when 
in the tides, its place has been higher or 
lower, more forward or backward : but 
the place of all others moft frequently af- 
fedlcd, is about the fixth or feventh rib, 
near the middle of its length, or a little 
more forward. The pain is often fevere 
and pungent; but fometimes more dull 
and obtufe, with a fenfe of weight rather 
than of pain. It is moft efpecially fevere 
and pungent when occupying the place laft 
men- OF PHYSIC. 
311 
mentioned. For the moft part it continues 
fixed in one place; but fometimes ihoots 
from the fide to the fcapula on one hand, 
or to the flernum and clavicle on the 
other. 
CCCXL. 
The varying Rate of fymptoms now 
mentioned does not always afcertain pre- 
cifely the feat of the difeafe. To me it 
feems probable, that the difeafe is always 
feated, or at leafl begins, in feme part of 
the pleura; taking that membrane in its 
greatefl extent, as now commonly under- 
flood ; that is, as covering not only the 
internal furface of the cavity of the tho- 
rax, but alfo as forming the mediaflinum, 
and as extended over the pericardium, and 
over the whole furface of the lungs. 
U 4 
CCCXLL 312 
PRACTICE 
CCCXLI. 
There is, therefore, little foundation for 
diftinguifhing this difeafe by different ap- 
pellations taken from the part which may 
be fuppofed to be chiefly affedled. The 
term Pleurify, might with propriety be 
applied to every cafe of the difeafe; and 
has been very improperly limited to that 
inflammation which begins in, and chiefly 
affects, the pleura cofialis. I have no doubt 
that fuch a cafe does truly occur : but, at 
the fame time, I apprehend it to be a rare 
occurrence; and that the difeafe much more 
frequently begins in, and chiefly affects, 
the pleura invefting the lungs, producing 
all the fymptoms fuppofed to belong to 
what has been called the Pleuritis vera. 
CCCXLII. 
Some phylicians have imagined, that 
there OF PHYSIC. 
313 
diere is a cafe of pneumonic inflammation 
particularly entitled to the appellation of 
Peripneumony; and that is, the cafe of an 
inflammation beginning in the parenchy- 
ma or cellular texture of the lungs, and 
having its feat chiefly there. But it feems 
to me very doubtful, if any acute inflam- 
mation of the lungs, or any difeafe which 
has been called Peripneumony, be of that 
kind. It feems probable, that every acute 
inflammation begins in membranous parts; 
and, in every difleCtion of perfons dead of 
peripneumony, the external membrane of 
the lungs, or fome part of the pleura, has 
appeared to have been confiderably af- 
fected. 
CCCXLIIL 
An inflammation of the pleura covering 
the upper furface of the diaphragm, has 
been diftinguifhed by the appellation of 
Para- 314 
PRACTICE 
as fuppofed to be attended 
with the peculiar fymptoms of delirium, 
rifus fardonicus, and other convulfive mo- 
tions : but it is certain, that an inflamma- 
tion of that portion of the pleura, and af- 
fecting alfo even the mufcular fubftance of 
the diaphragm, has often taken place with- 
out any of thefe fymptoms; and I have 
not met with either difledlions, or any 
accounts of difledtions, which fupport the 
opinion, that an inflammation of the pleura 
covering the diaphragm, is attended with 
delirium more commonly than any other 
pneumonic inflammation* 
CCCXLIV. 
With refpeut to the feat of pneumonic 
inflammation, I mu ft obferve further, that, 
although it may arife and fubfift chiefly in 
one part of the pleura only, it is however 
frequently communicated to other parts of 
the OF PHYSIC. 
315 
the fame, and commonly communicates a 
morbid affedtion through its whole ex- 
tent. 
CCCXLV. 
The remote caufe of pneumonic inflam- 
mation, is, commonly, cold applied to the 
body, obftrudting perfpiration, and deter- 
mining to the lungs; while at the fame 
time the lungs themfelves are expofed to 
the adlion of cold. Thefe circumflances 
operate efpecially, when an inflammatory 
diathefls prevails in the fyflem; and, con- 
fequently, upon perfons of the greateft vi- 
gour; in cold climates; in the winter fea- 
fon ; and particularly in the fpring, wThen 
viciflitudes of heat and cold are frequent. 
The difeafe, however, may arife in any fea- 
fon when fuch viciflitudes occur. 
Other remote caufes alfo may have a 
fliafe in this matter; fuch as every means 
of 316 
PRACTICE 
of obftrucfting, (training, or otherwife in- 
juring, the pneumonic organs. 
Pneumonic inflammation may happen to 
perfons of any age, but rarely to thofe un- 
der the age of puberty: and moft com- 
monly it affects perfons fomewhat advanced 
in life, as thofe between forty-five and 
fixty years; thofe, too, efpecially of a ro- 
buft and full habit. 
The pneumonic inflammation has been 
fometimes fo much an epidemic, as to oc- 
cafion a fufpicion of its depending upon a 
fpecific contagion ; but I have not met 
with any evidence in proof of this. See 
Morgagni de caufis et fedibus morborum, 
epift. xxi. art. 26. 
CCCXLVL 
The pneumonic, like other inflamma- 
tions, may terminate by refolution, fuppu- 
ration, or gangrene: but it has alfo a ter- 
mination OF PHYSIC. 
317 
mination peculiar to itfelf, as has been 
hinted above, (CCLIX.); and that is, when 
it is attended with an effuflon of blood in- 
to the cellular texture of the lungs, which 
foon interrupting the circulation of the 
blood through this vifcus, produces a fa- 
tal fuftocation. This, indeed, feems to be 
the moft common termination of pneumo- 
nic inflammation, when it ends fatally ; 
for, upon the diffetftion of almoft every 
perfon dead of the difeafe, it has appeared 
that fuch an effuflon had happened. 
CCCLXVIL 
From thefe diffedtions alfo we learn, 
that pneumonic inflammation commonly 
produces an exudation from the internal 
furface of the pleura; which appears partly 
as a foft vifcid cruft, often of a compacft, 
membranous form, covering every where 
the furface of the pleura, and particularly 
thofe 318 
PRACTICE 
thole parts where the lungs adhere to the 
pleura coftalis, or mediaftinum ; and this 
cruft feems always to be the cement of 
fuch adhefions. 
The fame exudation fliows itfelf, alfo, by 
a quantity of a ferous whitifli fluid, com- 
monly found in the cavity of the thorax; 
and fome exudation or efliifion is ufually 
found to have been made like wife into the 
cavity of the pericardium* 
cccxLvin. 
It feems probable, too, that a like eflu- 
lion is fometimes made into the cavity of 
the bronchia:: for, in fome perfons who 
have died after labouring under a pneumo- 
nic inflammation for a few days only, the 
bronchia: have been found filled with a 
confiderable quantity of aferous and thick- 
ifli fluid; which, I think, muft be confi- 
dered rather as the efliifion mentioned* 
having OF PHYSIC. 
319 
having had its thinner parts taken off by 
refpiration, than as a pus fo fuddeniy 
formed in the inflamed part. 
CCCXLIX. 
It is, however, not improbable, that this 
effufion, as well as that made into the ca- 
vities of the thorax and pericardium, may 
be a matter of the fame kind with that 
which, in other inflammations, is poured 
into the cellular texture of the parts in- 
flamed, and there converted into pus; but, 
in the thorax and pericardium, it does not 
always aflume that appearance, becaufe the 
cruft covering the furface prevents the ab- 
forption of the thinner part. This abforp- 
tion, however, may be compenfated in the 
bronchise by the drying of the air; 
and therefore the effufion into them may 
put on a more purulent appearance. 
In many cafes of pneumonic inflamma- 
tion. 320 
PRACTICE 
tion, when the Sputa are very copious, it 
is difficult to fuppofe that the whole of 
them proceed from the mucous follicles of 
the bronchia. It feems more probable 
that a great part of them may proceed from 
the effufed ferous fluid we have been men- 
tioning ; and this too will account for the 
fputa being fo often of a purulent appear- 
ance. Perhaps the fame thing may ac- 
count for that purulent expectoration, as 
well as that purulent matter found in the 
bronchia?, which the learned Mr de Haen 
fays he had often obferved, when there 
was no ulceration of the lungs; and this 
explanation, is at leaft more probable, than 
Mr de Haen's fuppofition of a pus formed 
in the circulating blood. 
CCCL. 
To conclude this fubjcdt, it would ap- 
pear, that the effufion into the bronchia?, 
which OF PHYSIC. 
321 
which we have mentioned, often concurs 
with the effufion of red blood in occafion- 
ing the fuffocation, which fatally termi- 
nates pneumonic inflammation; that the 
effufion of ferum alone may have this ef- 
fect ; and, that the ferum poured out in a 
certain quantity, rather than any debility 
in the powers of expectoration, is the caufe 
of that ceafing of expectoration which very 
conftantly precedes the fatal event. For, in 
many cafes, the expectoration has ceafed, 
when no other fymptoms of debility have 
appeared, and when, upon difleCtion, the 
bronchia? have been found full of liquid 
matter. Nay, it is even probable, that, in 
fome cafes, fuch an effufion may take place, 
without any fymptoms of violent inflam- 
mation; and, in other cafes, the effufion 
taking place, may feem to remove the 
fymptoms of inflammation which had ap- 
peared before, and thus account for thofe 
unexpected fatal terminations which have 
Vol. I. 
X 
fome- 322 
PRACTICE 
fometimes happened. Poflibly this efiufiori 
may account alfo for many of the pheno- 
mena of the Peripneumonia Notha. 
CCCLI. 
Pneumonic inflammation feldom termi- 
nates by refolution, without being attended 
with fome evident evacuation. An hsemor- 
rhagy from the nofe happening upon fome 
of the firfl: days of the difeafe, has fome- 
times put an end to it; and it is faid, that 
an evacuation from the hemorrhoidal veins, 
a bilious evacuation by ftool, and an eva- 
cuation of urine with a copious fediment, 
have feverally had the fame effect; but 
fuch occurrences have been rare and un- 
ufual. 
The evacuation moft frequently attend- 
ing, and feeming to have the greateft ef- 
fect in promoting refolution, is an expec- 
toration of a thick white or yellowifli mat- 
ter, OF PHYSIC. 
323 
ter, a little ftreaked with blood, copious, 
and brought up without either much or 
violent coughing. 
Very frequently the refolution of this 
difeafe is attended with, and perhaps pro- 
duced by, a fweat, which is warm, fluid, 
copious over the whole body, and attended 
with an abatement of the frequency of the 
pulfe, of the heat of the body, and of other 
febrile fymptoms. 
CCCLII. 
The prognoftics in this difeafe are form- 
ed from obferving the Rate of the principal 
fymptoms. 
A violent pyrexia is always dangerous. 
The danger, however, is chiefly denoted 
by the difficulty of breathing. When the 
patient can lie on one fide only ; when he 
can lie on neither fide, but upon his back 
only ; when he cannot breathe with tole- 
rable 
X 2 324 
PRACTICE 
rable eafe, except the trunk of his body 
be ereft ; when, even in this pofture, the 
breathing is very difficult, and attended 
with a turgefcence and fluffiing of the face, 
together with partial fweats about the head 
and neck, and an irregular pulfe; thefe 
circumftances mark the difficulty of breach- 
ing in progreffive degrees, and, confe- 
quently, in proportion, the danger of the 
difeafe. 
A frequent violent cough aggravating 
the pain, is always the fymptom of an ob- 
flinate difeafe. 
As I apprehend that the difeafe is hardly 
ever refolved, without fome expeftoration; 
fo a dry cough muft be always an unfa- 
vourable fymptom. 
As the expeftoration formerly defcribed, 
marks that the difeafe is proceeding to a 
refolution; fo an expeftoration which has 
not the conditions there mentioned, muft 
denote at leaft a doubtful ftate of the dif- 
eafe ; OF PHYSIC. 
325 
eafe; but the marks taken from the colour 
of the matter, are for the moft part falla- 
cious. 
An acute pain, very much interrupting 
infpiration, is always the mark of a violent 
difeafe; though not of one more dangerous, 
than an obtufe pain, attended with very 
difficult refpiration. 
When the pains, which at firfl: had af- 
fected one fide only, have afterwards ipread 
into the other; or when, leaving the fide 
firfl: affected, they entirely pafs into the 
other; thefe are always marks of an in- 
creafing, and therefore of a dangerous, dif- 
eafe. 
A delirium coming on during a pneu- 
monic inflammation, is conftantly a fymp- 
tom denoting much danger. 
cccliii. 
When the termination of this difeafe 
x 3 
proves 326 
PRACTICE 
proves fatal, it is on one or other of the 
days of the firft week, from the third to 
the feventh. This is the moft common 
cafe; but, in a few inftances, death has 
happened at a later period of the difeafe. 
When the difeafe is violent, but admit- 
ting of refolution, this alfo happens fre- 
quently in the courfe of the firft week ; 
but, in a more moderate ftate of the dif- 
eafe, the refolution is often delayed to the 
fecond week. 
The difeafe, on fome of the days from 
the third to the feventh, generally fuffers 
a remiflion ; which, however, may be of- 
ten fallacious, as the difeafe does fometimes 
return again with as much violence as be- 
fore, and then with great danger. 
Sometimes the difeafe difappears on the 
fecond or third day, while an eryfipelas 
makes its appearance on fome external 
part; and, if this continue fixed, the pneu- 
monic inflammation does not recur. 
CCCLIV. OF PHYSIC. 
327 
CCCLIV. 
Pneumonia, like other inflammations, 
often ends in fuppuration or gangrene. 
CCCLV. 
When a pneumonia, with fymptoms 
neither very violent nor very flight, has 
continued for many days, it is to be feared 
it will end in a fuppuration. This, how- 
ever, is not to be determined precifely by 
the number of days: for, not only after 
the fourth, but even after the tenth day, 
there have been examples of a pneumonia 
ending by a refolution ; and if the difeafe 
has fuffered fome intermiflion, and again 
recurred, there may be inflances of a re- 
folution happening at a much later period 
from the beginning of the difeafe, than 
that juft now mentioned. 
X 4 
CCCLVL 328 
PRACTICE 
CCCLVI. 
But if a moderate difeafe, in fpite of 
proper remedies employed, be protracted 
to the fourteenth day without any confi- 
derable remiffion, a fuppuration is pretty 
certainly to be expected; and it will be 
Bill more certain, if no figns of refolution 
have appeared, or if an expectoration 
which had appeared fhall have again 
ceafed, and the difficulty of breathing has 
continued or increafed, while the other 
fymptoms have rather abated. 
CCCLVIL. 
That, in a pneumonia, the effiffion is 
made, which may lay the foundation of a 
fuppuration, we conclude from the diffi- 
culty of breathing becoming greater when 
the patient is in a horizontal pofture, or 
when OF PHYSIC. 
329 
when he can lie more eafily upon the af- 
fected fide. 
CCCLVIII. 
That, in fuch cafes, a fuppuration has 
actually begun, may be concluded from 
the patient's being frequently affcdted with 
flight cold ihiverings, and with a fenfe of 
cold felt fometimes in one and fometimes 
in another part of the body. We form 
the fame conclufion alfo from the ftate of 
the pulfe, which is commonly lefs fre- 
quent and fofter, but fometimes quicker 
and fuller, than before. 
CCCLIX. 
That a fuppuration is already formed, 
may be inferred from there being a confi- 
derable remiflion of the pain which had 
before fubfifted, while, alongft with this, 
the 330 
PRACTICE 
the cough, and efpecially the dyfpnoea, 
continue, and are rather augmented. At 
the fame time, the frequency of the pulfe 
is rather increafed; the feverifli ftate fuffers 
confiderable exacerbations every evening, 
and by degrees a heedic in all its circum- 
ftances comes to be formed. 
CCCLX. 
The termination of Pneumonia by gan- 
grene, is much more rare than has been 
imagined; and, when it does occur, it is 
ufually joined with the termination by ef- 
fufion (CCCXLVL), and the fymptoms of 
the one are hardly to be diftinguifhed from 
thofe of the other. 
CCCLXI. 
The cure of pneumonic inflammation 
muft proceed upon the general plan 
(CCLXIV.): OF PHYSIC. 
331 
(CCLXIV.); but the importance of the 
part affedled, and the danger to which it is 
expofed, require that the remedies be fully, 
as well as early, employed. 
CCCLXII. 
The remedy chiefly to be depended up- 
on, is that of bleeding at the arm; which 
will be performed with moft advantage in 
the arm of the fide aftedted, but may be 
done in either arm, as may be moft con- 
venient for the patient or the furgeon. 
The quantity drawn muft be fuited to the 
violence of the difeafe, and to the vigour 
of the patient; and generally ought to be 
as large as this laft circumftance will allow. 
The remiflion of pain, and the relief of 
refpiration, during the flowing vof the 
blood, may limit the quantity to be then 
drawn; but if thefe fymptoms of relief do 
not appear, the bleeding fhould be con- 
tinued 332 
PRACTICE 
tinned till the fymptoms of a beginning 
fyncope come on. It is feldom that one 
bleeding, however large, will prove a cure 
of this difeafe: and although the pain and 
difficulty of breathing may be much re- 
lieved by the firft bleeding, thefe fymp- 
toms commonly, and after no long inter- 
val, recur; often with as much violence 
as before. In the event of fuch recur- 
rence, the bleeding is to be repeated, even 
in the courfe of the fame day, and perhaps 
to the fame quantity as before. 
Sometimes the fecond bleeding may be 
larger than the firft. There are perlons 
who, by their conftitution, are ready to 
faint even uponafmall bleeding; and, in 
fuch perfons, this may prevent the draw- 
ing fo much blood at firft as a pneumonic 
inflammation might require; but, as the 
fame perfons are frequently found to bear 
after-bleedings better than the firft, this 
allows the fecond and fubfequent bleed- 
ings OF PHYSIC. 
333 
ings to be larger, and to fuch a quantity 
as the fymptoms of the difeafe may feem to 
demand. 
CCLXIIL 
It is according to the Rate of the fymp- 
toms, that bleedings are to be repeated; 
and they will be more effectual when 
pra<ftifed in the courfe of the firft three 
days, than afterwards; but they are not to 
be omitted, although four days of the djf- 
eafe may have already elapfed. If the 
phyfician fhall not have been called in 
fooner; or if the bleedings praclifed during 
the firft days fliall not have been large 
enough, or even although thefe bleedings 
Ihall have procured fome remiflion; yet, 
upon the recurrence of the urgent fymp- 
toms, the bleeding fhould be repeated at 
any period of the difeafe, efpeeially within 
the firft fortnight; and even afterwards, if 
a 334 
PRACTICE 
a tendency to fuppuration be not evident, 
or if, after a feeming folution, the difeafe 
fhall have again returned. 
CCCLXIV. 
With refpedl to the quantity of blood 
which ought, or which with fafety may 
be taken away, no general rules can be 
delivered, as it muft be very different, ac- 
cording to the ftate of the difeafe, and the 
conftitution of the patient. In an adult 
male of tolerable ftrength, a pound of 
blood, avoirdupois, is a full bleeding. Any 
quantity above twenty ounces is a large, 
and any quantity below twelve a fmall, 
bleeding. A quantity of from four to five 
pounds, in the courfe of two or three days, 
is generally as much as fuch patients will 
fafely bear; but, if the intervals between 
the bleedings and the whole of the time du- 
ring which the bleedings have been em- 
ployed OF PHYSIC. 
335 
ployed have been long, the quantity taken 
upon the whole may be greater. 
CCCLXV. 
When a large quantity of blood has 
been already taken from the arm, and 
when it is doubtful if more can with fafe- 
ty be drawn in that manner, fome blood 
may ftill be taken by cupping and fcarify- 
ing. Such a meafure will be more parti- 
cularly proper, when the continuance or 
recurrence of pain, rather than the diffi- 
culty of breathing, becomes the urgent 
fymptom; and then the cupping and fca- 
rifying fhould be made as near to the 
pained part as can conveniently be done. 
CCCLXVL 
An expedoration takes place fometimes 
very early in this difeafe: but if, notwith- 
ftanding that, the urgent fytnptoms fhould 
mil 336 
PRACTICE 
ftill continue, the expectoration mult not 
fuperfede the bleedings mentioned; and 
during the firft days of the difeafe, its fo- 
lution is not to be trufted to the expecto- 
ration alone. It is in a more advanced 
ftage only, when the proper remedies have 
been before employed, and when the 
fymptoms have fathered a confiderable re- 
miftion, that the entire cure may be trufted 
to a copious and free expectoration* 
CCCLXVII. 
During the firft days of the difeafe, I 
have not found that bleeding flops expec- 
toration. On the contrary, I have of- 
ten obferved bleeding promote it; and it 
is in a more advanced ftage of the difeafe 
only, when the patient, by large evacua- 
tions, and the continuance of the difeafe, 
has been already exhaufted, that bleeding 
feems to flop expetfloration. It appears to 
me, OF PHYSIC. 
337 
me that even then bleeding does not flop 
expedoration fo much by weakening the 
powers of expectoration, as by favouring 
the ferous effufion into the bronchise, 
(CCCXLV1II.) and thereby preventing it. 
CCCLXVIII. 
While the bleedings we have mentioned 
fhall be employed, it will be necefTary to 
employ alfo every part of the antiphlogiftic 
regimen (CXXX-CXXXII.), and particu- 
larly to prevent the irritation which might 
arife from any increafe of heat. For this 
purpofe, it will be proper to keep the pa- 
tient out of bed, while he can bear it ea- 
fily; and, when he cannot, to cover him 
very lightly while he lies in bed. The 
temperature of his chamber ought not to 
exceed fixty degrees of Farenheit's ther- 
mometer ; and whether it may be at any 
time colder. I am uncertain. 
Vol. I. 
Y 
CCCLXIX, 338 
PRACTICE 
CCCLXIX. 
Mild and diluent drinks, moderately 
tepid, at leaft never cold, given by fmall 
portions at a time, ought to be adminiftered 
plentifully. Thefe drinks may be impreg- 
nated with vegetable acids. They may be 
properly accompanied alfo with nitre, or 
fome other neutrals; but thefe faits ihould 
be given feparately from the drink. 
It has becen alleged, that both acids and 
nitre are ready to excite coughing, and in 
fome perfons they certainly have this ef- 
fect ; but, except in perfons of a peculiar 
habit, I have not found their effects in 
exciting cough fo confiderable or trouble- 
fome as to prevent our feeking the advan- 
tages otherwife to be obtained from thefe 
medicines. 
CCCLXX. OF PHYSIC. 
339 
CCCLXX. 
Some practitioners have doubted, if 
purgatives can be fafely employed in this 
difeafe; and indeed a fpontaneous diar- 
rhoea occurring in the beginning of the 
difeafe has feldom proved ufeful: but I 
have found the moderate ufe of cooling 
laxatives generally fafe; and have always 
found it ufeful to keep the belly open by 
frequent emollient glyfters. 
CCCLXXI. 
To excite full vomiting by emetics, I 
judge to be a dangerous practice in this 
difeafe: but I have found it ufeful to ex- 
hibit naufeating dofes; and, in a fomewhat 
advanced Rate of the difeafe, I have 
found fuch dofes prove the belt means of 
promoting expedoration. 
Y 2 
CCCLXXII. 340 
PRACTICE 
CCCLXXII. 
Fomentations and poultices applied to 
the pained part have been recommended, 
and may be be ufeful ; but the application 
of them is often inconvenient, and may be 
entirely omitted for the fake of the more 
effectual remedy, bliftering. 
Very early in the difeafe, a blifter fliould 
be applied as near to the pained part as 
poflible. But, as when the irritation of a 
blifter is prefent, it renders bleeding lefs 
effectual; fo the application of the blifter 
fliould be delayed till a bleeding fhall 
have been employed. If the difeafe 
be moderate, the blifter may be applied 
immediately after the firft bleeding; but 
if the difeafe be violent, and it is prefumed 
that a fecond bleeding may be neceftary 
loon after the firft, it will then be proper 
to delay the blifter till after the fecond 
bleeding, when it may be fuppofcd that 
any OF PHYSIC. 
341 
any farther bleeding may be potlponed till 
the irritation ariting from the blitter tliall 
have ceafed. It may be frequently necef- 
fary in this difeafe to repeat the bliftering: 
and, in that cafe, the platters thould al- 
ways be applied fomewhere on the thorax; 
for, when applied to more diftant parts, 
they have little effect. The keeping the 
bliftered parrs open, and making what is 
called a perpetual blitter, has much lefs 
effect than a freth bliftering. 
CCCLXXIII. 
As this difeafe often terminates by an 
expectoration, fo various means of pro- 
moting this have been propofed: but none 
of them appear to be very effectual; and 
fome of them, being acrid flimulant fub- 
ftances, cannot be very fafe. 
The gums ufually employed feem too 
heating: fquills feem to be lefs fo ; but 
Y3 
they 342 
PRACTICE 
they are not very powerful, and fometimes 
inconvenient by the conflant naufea they 
induce. 
The volatile alkali may be of fervice as 
an expedlorant; but it fhould be referved 
for an advanced flate of the difcafe. 
Mucilaginous and oily demulcents ap- 
pear to be ufeful, by allaying that acri- 
mony of the mucus which occafions too 
frequent coughing ; and which coughing 
prevents the flagnation and thickening of 
the mucus, and thereby its becoming mild. 
The receiving into the lungs the fleams 
of warm water impregnated with vinegar, 
has often proved ufeful in promoting ex- 
pectoration. 
But, of all other remedies, the moft 
powerful for this purpofe, are antimonial 
medicines, given in naufeating dofes, as in 
CLXX1X. Of thefe, however, 1 have 
not found the kermes mineral more effica" 
clous than emetic tartar, or antimonial 
wine ; OF PHYSIC. 
343 
wine ; and the dofe of the kermes is much 
more uncertain than that of the others. 
CCCLXXIV. 
Though a fpontaneous fweating often 
proves the crifis of this difeafe, it ought 
not to be excited by art, unlcfs with much 
caution. At leaft, I have not yet found it 
either fo effectual or fafe, as fome writers 
have alleged. When, after fome remiffion 
of the fymptoms, fpontaneous fweats of a 
proper kind arife, they may be encou- 
raged ; but it ought to be without much 
heat, and without ftimulant medicines. 
If, however, the fweats be partial and 
clammy only, and a great difficulty of 
breathing hill remain, it will be very dan- 
gerous to encourage them. 
CCCLXXV, 
Phyficians have differed much in opinion 
Y 4 
with 344 
PRACTICE 
with regard to the ufe of opiates in pneu- 
monic inflammation. To me it appears, 
that, in the beginning of the difeafe, and 
before bleeding and bliftering have produ- 
ced fome remiffion of the pain, and of the 
difficulty of breathing, opiates have a very 
bad effect, by their increasing the difficult- 
ly of breathing, and other inflammatory 
fymptoms. But, in a more advanced ftate 
of the difeafe, when the difficulty of breath- 
ing has abated, and when the urgent fymp- 
tom is a cough, proving the chief caufe of 
the continuance of the pain and of the 
want of fleep, opiates may be employed 
with great advantage and fafety. The in- 
terruption of the expectoration, which they 
feem to occafion, is for a fhort time only ; 
and they feem often to promote it, as they 
occafion a flagnation of what was by fre- 
quent coughing diffipated infenfibly, and 
therefore give the appearance of what phy- 
ficians have called Conceded Matter. 
CHAP. OF PHYSIC. 
345 
CHAP. VII. 
Of the Peripneumonia Notha, or 
Bastard Peripneumony. 
CCCLXXVI. 
A Disease under this name is men- 
tioned in fome medical writings of 
the fixteenth century; but it is very doubt- 
ful if the name was then applied to the 
fame difeafe to which we now apply it. 
It appears to me, that unlefs fome of the 
cafes defcribed under the title of Catarrhus 
Suffocativus be fuppofed to have been of 
the kind I am now to treat of, there was no 
defcription 346 
PRACTICE 
defcription of this difeafe given before that 
by Sydenham, under the title I have em- 
ployed here. 
CCCLXXVIL 
After Sydenham, Boerhaave was thq fir ft 
who in a fyftem took notice of it as a di- 
ftinct difeafe; and he has defcribed it in his 
aphorifms, although with fome circum- 
ftances different from thofe in the defcrip- 
tion of Sydenham. Of late, Mr Lieutaud 
has with great confidence afferted, that Sy- 
denham and Boerhaave had, under the fame 
title, defcribed different difeafes ; and that, 
perhaps, neither of them had on this fub- 
delivered any thing but hypothecs. 
CCCLXXVIII. 
Notwithftandingthis bold affertion, I am 
humbly of opinion, and the Baron Van 
Swieten OF PHYSIC. 
347 
Swieten feems to have been of the fame, 
that Sydenham and Bocrhaave did defcribe 
under the fame title, one and the fame 
difeafe. Nay, I am further of opinion, 
that the* difeafe defcribed by Mr Lieutaud 
himfelf, is not effentially different from, 
that defcribed by both the other authors. 
Nor will the doubts of the very learned, 
but modeft Morgagni, on this fubjedl, dis- 
turb us, if we confider, that while very few 
defcribers of difeafes either have it in their 
power, or have been fufficiently attentive 
in diftinguilhing between the effential and 
accidental fymptoms of difeafe ; fo, in a 
difeafe which may have not only different, 
but a greater number of fymptoms, in one 
perfon than it has in another, we need not 
wonder that the defcriptions of the fame 
difeafe by different perlons fhould come out 
in fome refpeds different. I (hall, how- 
ever, enter no further into this controvetffy; 
but endeavour to defcribe the difeafe as 
it 348 
PRACTICE 
it has appeared to myfelf; and, as I judge, 
in the effential fymptoins, much the fame 
as it has appeared to all the other authors 
mentioned. 
CCCLXXIX. 
This difeafe appears at the fame feafons 
that other pneumonic and catarrhal affec- 
tions commonly do; that is, in autumn and 
in fpring. Like thefe difeafes, alfo, it is 
feemingly occafioned by fudden changes of 
the weather from heat to cold. It appears, 
alfo, during the prevalence of contagious 
catarrhs ; and it is frequently under the 
form of the Peripneumonia Notha, that 
thefe catarrhs prove fatal to elderly per- 
fons. 
This difeafe attacks moft commonly 
perfons fomewhat advanced in life, efpe- 
cially thofe of a full phlegmatic habit; 
thofe who have before been frequently liable 
to OF PHYSIC. 
349 
to catarrhal affections, and thofe who have 
been much addicted to the large ufe of fer- 
mented and fpirituous liquors. 
The difeafe commonly comes on with 
the fame fymptoms as other febrile dif- 
eafes; that is, with alternate chills and 
heats: and the fymptoms of pyrexia are 
fometimes fufficiently evident; but in moil 
cafes thefe are very moderate, and in fome 
hardly at all appear. With the firft attack 
of the difeafe, a cough comes on ; ufually 
accompanied with fome expectoration, and, 
in many cafes, there is a frequent throw- 
ing up of a coniiderable quantity of a vifcid 
opaque mucus. The cough often becomes 
frequent and violent; is fometimes accom- 
panied with a rending headach; and, as in 
other cafes of cough, a vomiting is fome- 
times excited by it. The face is fometimes 
fluffed, and fome giddinefs or drowflnefs 
often attends the difeafe. A difficulty of 
breathing, with a fenfe of oppreffion, or 
ftraitening 350 
PRACTICE 
ftraitening in the cheft, with fome obfeure 
pains there, and a fenfe of laflitude 
over the whole body, very conftantly at- 
tend this difeafe. The blood drawn in 
this difeafe, fhows a buffy furface, as in 
other inflammatory affections. 
The difeafe has often the appearance only 
of a more violent catarrh, and after the em- 
ployment of fome remedies is entirely re- 
lieved by a free and copious expectoration. 
In other cafes, however, the feverifli and 
catarrhal fymptoms are at firft very mode- 
rate, and even flight; but, after a few days, 
thefe fymptoms fuddenly become confi- 
derable, and put an end to the patient's 
life when the indications of danger were 
before very little evident. 
CCCLXXX. 
From the different circumftances iia 
which this difeafe appears, the pathology of 
it OF PHYSIC. 
351 
it is difficult. It is certainly often no other 
at firfl than a catarrhal affection, which, in 
eldprly perfons, is frequently attended with 
a large afflux of mucus to the lungs; audit 
was on this footing that Sydenham consi- 
dered it as only differing in degree from his 
Fcbris Hyemails. A catarrh, however, is ftridt- 
ly an affection of themucous membrane and 
follicles of the bronchise alone: but it may 
readily have, and frequently has, a degree 
of pneumonic inflammation joined to it; 
and in that cafe may prove more properly 
the peculiar difeafe we treat of here. But, 
further, as pneumonic inflammation very 
often produces an effuiion of ferum into the 
bronchiae, (CCCXLVI1I.) fo this, in elderly 
perfons, may occur in confequence of 
a flight degree of inflammation; and when 
it does happen, will give the exquifite and 
fatal cafes of the peripneumonia notha. 
CCCLXXXL 352 
PRACTICE 
CCCLXXXI. 
After this attempt to eftablifh the patho- 
logy, the method of cure in the different 
circumftances of the difeafe will not be 
difficult. 
In cafe the fever, catarrhal and pneu- 
monic fymptoms, are immediately confi- 
derable, a blood-letting will certainly be 
proper and neceffary: but, where thefe 
fymptoms are moderate, a blood-letting 
will hardly be requifite; and, when an 
effufion is to be feared, the repetition of 
blood-letting may prove extremely hurt- 
ful. 
In all cafes, the remedies chiefly to be 
depended upon, are vomiting and bli- 
ftering. Full vomiting may be frequently 
repeated, and naufeating dofes ought to 
be conftantly employed. 
Purging may perhaps be ufeful; but as 
it is feldom fo in pneumonic afletflions, 
nothing OF PHYSIC. 
353 
nothing but gentle laxatives are here ne- 
ceflary. 
In all the circumftances of this difeafe, 
the antiphlogiftic regimen is proper: cold is 
to be guarded againft ; but much external 
heat is to be as carefully avoided. 
CCCLXXXIL 
If a perfon fweats eafily, and it can be 
brought out by the ufe of mild tepid li- 
quors only, the practice may in fuch per- 
fons be tried. See Morgagni De Sed. 
Ccu/f. Epifl:, xiii. Art. 4. 
CCCLXXXIII. 
I might here, perhaps, give a feparate 
fedlion on the Carditis and Pericarditis, or 
the Inflammations of the Heart and Peri- 
cardium ; but they hardly require a par- 
ticular conflderation. An acute inflamma- 
tion 
Vol. I. 
Z 354 
PRACTICE 
tion of the pericardium is almoft always a 
part of the fame pneumonic affection I 
havre been treating of; and is not always 
diftinguifhed by any different fymptoms; 
or, if it be, does not require any different 
treatment. The fame may be faid of an 
acute inflammation of the heart itfelf; 
and when it happens that the one or other 
is difcovered by the fymptoms of palpita- 
tion or fyncope, no more will be implied 
than that the remedies of pneumonic in- 
flammation fliould be employed with 
greater diligence. 
From diffedlions, which fhow the heart 
and pericardium affected with erofions, ul- 
cerations, and abfceffes, we difcover, that 
thefe parts had been before affedted with 
inflammation ; and that in cafes where no 
fymptoms of pneumonic inflammation had 
appeared: it may therefore be alleged, 
that thofe inflammations of the heart and 
pericardium Ihould be confidered as dif- 
eafes OF PHYSIC. 
355 
eafes independent of the pneumonic. This 
indeed is juft : but the hiftory of fuch 
cafes proves, that thofe inflammations had 
been of a chronic kind, and hardly dif- 
covering themfelves by any peculiar fymp- 
toms; or, if attended with fymptoms 
marking an aftcction of the heart, thefe 
were, however, fuch as have been known 
frequently to arife from other caufes than 
inflammation. There is, therefore, upon 
upon the whole, no room for our treating 
more particularly of the inflammation of 
the heart or pericardium. 
Z 1 
CHAP. 356 
PRACTICE 
CHAP. VIII. 
Of the Gastritis, or Inflammation 
of the Stomach. 
CCC LXXXIV. 
AMONG the inflammations of the 
abdominal region, I have given a 
place in our Nofology to the Peritonitis; 
comprehending under that title, not only 
the inflammations afledling the peritonaeum 
lining the cavity of the abdomen, but alfo 
thofe affecting the extenfions of this mem- 
brane in the omentum and mefentery. It 
is not, however, propofed to treat of them 
here, OF PHYSIC. 
357 
here, becaufe it is very difficult to fay by 
what fymptoms they are always to be 
known; and farther, becaufe, when known, 
they do not require any remedies befide 
thofe of inflammation in general. I pro- 
ceed, therefore, to treat of thofe inflam- 
mations which, affedling vifcera of pecu- 
liar fundlions, both give cccafion to pecu- 
liar fymptoms, and require fome peculia- 
rities in the method of cure; and 1 fhall 
begin with the inflammation of the flo- 
mach. 
CCGLXXXV. 
The inflammation of the ftomach is of 
two kinds, Phlegmonic, or Erythematic *. 
The firfl: may be feated in what is called 
the Nervous Coat of the ftomach, or in the 
z 3 
peritonaeum 
* This is a new term ; but whoever confiders what 
is faid in CCLXXIV. will, I expeft, perceive the pro=> 
priety, and even the neceflity, of it. 358 
PRACTICE 
peritoneum invefting it. The fecond is 
always feated in the villous coat and cel- 
lular texture immediately fubjacent. 
CCCLXXXVI. 
The phlegmonic inflammation of the 
ftomach, or what has been commonly 
treated of under the title of Gaftritis, is 
known by an acute pain in fome part of 
the region of the ftomach, attended with 
pyrexia, with frequent vomiting, efpecially 
upon occaflon of any thing being taken 
down into the ftomach, and frequently 
with hickup. The pulfe is commonly fmall 
and hard; and there is a greater lofs of 
ftrength in all the fundions of the body, 
than in the cafe of almoft any other in- 
flammation. 
CCCLXXXVII. 
This inflammation may be produced by 
•various OF PHYSIC. 
359 
various caufes; as, by external contufion; 
by acrids of various kinds taken into the fto- 
mach; frequently by very cold drink, taken 
into it, while the body is very warm; and 
fometimes by over-diftention, from the 
having taken in a large quantity of food 
of difficult digeftion. All thefe may be 
confidered as external caufes; but the 
difeafe fometimes arifes alfo from in- 
ternal caufes not fo well underflood. It 
may arife from inflammations of the neigh- 
bouring parts communicated to the fto- 
mach, and is then to be conlidered as a 
fymptomatic affedtion only. It may arife 
alfo from various acrimonies generated 
within the body, either in the ftomach it- 
felf, or in other parts, and poured into the 
cavity of the ftomach. Thefe are caufes 
more diredlly applied to the ftomach; but 
there are perhaps others originating clfc- 
where, and affecting the ftomach only 
fympathetically. Such may be fuppofed to 
Z 4 
have 360 
PRACTICE 
have acted in the cafe of putrid fevers and 
exanthematic pyrexia*; in which, upon d if- 
fedlion, it has been difcovered that the fto- 
mach had been affecfted with inflammation. 
CCCLXXXVIII. 
From the fenfibility of the ftomach, and 
its communication with the reft of the fyr 
ftem, it will be obvious, that the inflam- 
mation of this organ, by whatever caufes 
produced, may be attended with fatal 
confequences. In particular, by the great 
debility which fuch an inflammation fud- 
denly produces, it may quickly prove fatal, 
without running the common courfe of 
inflammations. 
When it lafts long enough to follow the 
ordinary courfe of other inflammations, it 
may terminate by refolution, gangrene, 
or fuppuration. The fcirrholities which 
are often difcovered affecting the ftomach, 
are OF PHYSIC. 
361 
are feldom known tobe the confequences of 
inflammation. 
CCGLXXXIX. 
The tendency of this difeafe to admit of 
refolution, may be known by its having 
arifen from no violent caufe; by the moder- 
rate ftate of the fymptoms; and by a gra- 
dual remiffion of thefe, efpecially in coa- 
fequence of remedies employed in the 
courfe of the firft, or at fartheft the fe- 
pond, week of the difeafe. 
cccxc. 
The tendency to fuppuration may be 
known by the fymtoms continuing, in a 
moderate degree, for more than one or two 
weeks; and likewife by a confiderable re- 
million of the pain, while a fenfe of weight 
and an anxiety ftill remain. 
When 362 
PRACTICE. 
When an abfcefs has been formed, the 
frequency of the pulfe is at firft abated; 
but foon after, it is again increafed, with 
frequent cold ffiiverings, and with marked 
exacerbations in the afternoon and even- 
ing, followed by night-fweatings, and other 
fymptoms of hecftic fever. Thefe at length 
prove fatal, unlefs the abfcefs open into the 
cavity of the ftomach, the pus be evacuated 
by vomiting, and the ulcer foon heal. 
CCCXCI 
The tendency to gangrene may be fuf- 
pe&ed from the violence of the fymptoms 
not yielding to the remedies employed du- 
ring the firft days of the difeafe; and that 
a gangrene has already begun, may be 
known from the fudden remiffion of the 
pain, while the frequency of the pulfe 
continues, and at the fame time becomes 
weaker, OF PHYSIC. 
363 
weaker, accompanied with other marks of 
an increaling debility in the whole fyftem. 
CCCXCII. 
From the dilfe&zion of dead bodies it ap- 
pears, that the ftomach very often has been 
affected with inflammation, when the cha_ 
radteriftic fymptoms of it (CCCLXXXVI.) 
had not appeared; and therefore it is very 
difficult to lay down any general rules for 
the cure of this difeafe. 
CCCXCIIL 
It is only in the cafe of phlegmonic inflam- 
mation, as charadlerifed in CCCLXXXVI. 
that we can advife the cure or refolution to 
be attempted by large and repeated bleed- 
ings employed early in the difeafe: and 
we are not to be deterred from thefe by the 
fmallnefs of the pulfe; for, after bleeding, 
it 364 
PRACTICE 
it commonly becomes fuller and fofter. 
After bleeding, a blifter ought to be ap- 
plied to the region of the ftomach ; and the 
cure will be aftifted by fomentations of 
the whole abdomen, as well as by frequent 
emollient and laxative glyfters. 
CCCXCIV. 
In this difeafe, the irritability of the 
ftomach will not admit of any medicines 
being thrown into it; and, if any internal 
medicines can be fuppofed neceflary, they 
muft be exhibited in glyfters. The giving 
of drink may be tried; but it ought to be 
of the very mildeft kind, and in very fmall 
quantities at a time. 
cccxcv. 
Opiates, in whatever manner exhibited, 
are very hurtful during the firft days of 
the or PHYSIC. 
365 
thedifeafe; but when its violence fhall have 
abated, and when the violence of the pain 
and vomiting recur at intervals only, opi- 
ates given in glyfters may be cautioufly 
tried, and fometimes have been employed 
with advantage. 
CCCXCVI. 
A tendency to fuppuration, in this dif- 
eafe, is to be obviated by the means juft 
now propofed. After a certain duration 
of the difeafe, it cannot be prevented by 
any means whatever; and when actually 
begun, muft be left to nature; the bulinefs 
of the phylician being only to avoid all 
irritation. 
CCCXCVII. 
A tendency to gangrene can be obviated 
in no other way than by the means fug- 
gefted 366 
PRACTICE 
gefted CCCXCIIL employed early in the 
difeafe; and, when it does actually fuper- 
vene, admits of no remedy. 
CCCXCVIIL 
Ery thematic inflammations of the fto- 
mach, are more frequent than thofe of the 
phlegmonic kind. It appears, at leaft, from 
difleclions, that the ftomach has often been 
afFedted with inflammation, when neither 
pain nor pyrexia had before given any no- 
tice of it; and fuch inflammation I appre- 
hend to have been chiefly of the erythe- 
matic kind. This fpecies of inflammation 
alfo, is efpecially to be expedled from acri- 
mony of any kind thrown into the ftomach; 
and would certainly occur more frequently 
from fuch acaufe, were not the interior fur- 
face of this organ commonly defended by 
mucus exuding in large quantity from the 
numerous follicles placed immediately under 
the OF PHYSIC. 
367 
the villous coat. Upon many occafions,how- 
ever, the exudation of mucus is prevented, 
or the liquid poured out is of a lefs vifcid 
kind, fo as to be lefs fitted to defend the 
fubjacent nerves; and it is in fuch cafes 
that matters even of moderate acrimony, 
may produce an erythematic afiedion of 
the ftomach. 
CCCXCIX. 
From what has been, faid it muft ap- 
pear, that an erythematic inflammation of 
the ftomach may frequently occur; but 
will not always difcover itfelf, as it fome- 
times takes place without pyrexia, pain, or 
vomiting. 
cccc» 
There are cafes, however, in which it 
may be difcovered. The affedion of the 
ftomach 368 
PRACTICE. 
ftomach fometimes fpreads into the oefo- 
phagus, and appears in the pharynx, as 
well as on the whole internal furface of 
the mouth. When, therefore, an erythe- 
matic inflammation affects the mouth and 
fauces, and when at the fame time there 
{hall be in the ftomach an unufual fenfibi- 
lity to all acrids, with a frequent vomiting, 
there can be little doubt of the ftomach 
being affeded with the fame inflammation 
that has appeared in the fauces. Even 
when no inflammation appears in the fau- 
ces, yet if fome degree of pain be felt in 
the ftomach, if there be a want of appetite, 
an anxiety, frequent vomiting, an unufual 
fenfibility with refpedl to acrids, fome 
third, and frequency of pulfe, there will 
then be room to fufpedt an erythematic 
inflammation of the ftomach; and we 
have known fuch fymptoms, after fome 
time, difcover their caufe more clearly by 
the OF PHYSIC. 
369 
the apearance of the inflammation in the 
fauces or mouth. 
Erythematic inflammation is often dif- 
pofed to fpread from one place to another 
on the fame furface; andj in doing fo, to 
leave the place it had at firft occupied. Thus4 
fuch an inflammation has been known to 
fpread fucceflively along the whole courfe 
of the alimentary canal, occafioning in the 
inteftines diarrhoea, and in the ftomach 
vomitings; the diarrhoea ceafing when the 
vomitings came on, or the vomitings upon 
the coming on of the diarrhoea. 
CCCCI. 
When an erythematic inflammation of 
the ftomach fhall be difcovered, it is to be 
treated differently, according to the diffe- 
rence of its caufes and fymptoms. 
When it is owing to acrid maters taken 
in by the mouth, and when thefe may be 
VdL. I. 
A a 
fup- 370 
PRACTICE 
fuppofed flill prefent in the ftomach, they 
are to be waflied out by throwing in a large 
quantity of warm and mild liquids, and by 
exciting vomiting. At the fame time, if the 
nature of the acrimony and its proper cor- 
redlor be known, this fliould be thrown in; 
or if a fpecific corrector be not known, fome 
general demulcents fliould be employed. 
CCCCII. 
Thefe meafures, however, are more fuit- 
ed to prevent the inflammation, than to 
cure it after it has taken place. When 
this laft may be fuppofed to be the cafe, 
if it be attended with a fenfe of heat, with 
pain and pyrexia, according to the degree 
of thefe fymptoms the meafures propofed 
in CCCXCIII. are to be more or lefs em- 
ployed. 
CCCCI1L OF PHYSIC. 
371 
CCCCIII. 
When an erythematic inflammation of 
the ftomach has arifen from internal cau- 
fes, if pain and pyrexia accompany the dif- 
eafe, fome bleeding, in perfons not other- 
wife weakened, may be employed: but, as 
the affection often arifes in putrid difeafes, 
and in convalefcents from fever; fo in thefe 
cafes, bleeding is inadmiflible; all that can 
be done being to avoid irritation, and to 
throw into the ftomach what quantity of 
acids, and of acefcent aliments, it fliall be 
found to bear. 
In fome conditions of the body, in 
which this difeafe arifes, the Peruvian bark 
and bitters may feem to be indicated; but 
an erythematic ftate of the ftomach does 
not commonly allow of them. 
a 2 
CHAP. 372 
PRACTICE 
CHAP. IX. 
Of the Enteritis, or Inflammation 
of the Intestines. 
CCCCIV. 
THE inflammation of the inteftines5 
like that of the ftomach, may be ei- 
ther phlegmonic, or erythematic: but, on 
the fubjedl of the latter, I have nothing to 
add to what has been faid in the laft chap- 
ter ; and fliall here therefore treat of the 
phlegmonic inflammation only. 
ccccv. OF PHYSIC. 
373 
CCCCVI. 
This inflammation may be known to be 
'prefent, by a fixed pain of the abdomen, 
attended with pyrexia, coftivenefs, and vo- 
miting. Pradtical writers mention the 
pain in this cafe as felt in different parts of 
the abdomen, according to the different 
feat of the inflammation; .and fo, indeed, 
it fometimes happens; but very often the 
pain fpreads over the whole belly, and is 
felt more efpecially about the navel. 
CCCCVIi. 
The Enteritis and Gaftritis arife from like 
caufes ; but the former, more readily than 
the latter, proceeds from cold applied to 
the lower extremities, or to the belly itfel-f. 
The enteritis has likewife its own peculiar 
caufes, as fupervening upon the fpaf- 
modig 
A a 3 374 
PRACTICE 
modic colic, incarcerated hernia, and vol- 
vulus. 
CCCCVIIL 
Inflammations of the inteftines have the 
fame terminations as thofe of the ftomach; 
and, in both cafes, the feveral tendencies are 
to be difeovered by the fame fymptoms 
(CCCLXXXIX. CCCXCL) 
CCCCIX. 
The cure of the enteritis is, in general, 
the fame with that of the gaftritis 
(CCCXCIII. & feq.); but in the enteritis, 
there is commonly more accefs to the in- 
troduction of liquids, of acid, accfcent, 
and other cooling remedies, and even of 
laxatives. As, however, a vomiting fo 
frequently attends this difeafc, care mu ft 
be taken not to excite that vomiting by 
either OF PHYSIC. 
375 
either the quantity or the quality of any 
thing thrown into the ftomach. 
The fame obfervation, with refpedt to 
the ufe of opiates, is to be made here as 
in the cafe of gaftritis. 
CCCCX. 
Under the title of Enteritis, it has been 
ufual with practical writers to treat of the 
remedies proper for the colic, and its higher 
degree named Ileus; but, although it be 
true that the enteritis and colic do frequently 
accompany each other, I (till hold them 
to be diftincSt difeafes, to be often occur- 
ring feparately, and accordingly to require 
and admit of different remedies. I (hall 
therefore delay fpeaking of the remedies 
proper for the colic, till I fhall come to 
treat of this difeafe in its proper place. 
A a 4 
CCCCXI, 376 
PRACTICE 
CCCCXI. 
What might be mentioned with refpecl 
to the fuppuration or gangrene occurring 
in the enteritis, may be fufiicienly under?- 
flood from what has been faid on the fame 
fubjedl with refpecl to the gaftritis. 
CHAP. X. 
Of the Hepatitis, or Inflammation 
of the Liver. 
CCCCX1I. 
f'lT'HE inflammation of the liver feems 
to be of two kinds; the one acute, 
the other chronic. 
ccccxin. OF PHYSIC. 
377 
CCCCXIII. 
The acute is attended with pungent 
pain ; confiderable pyrexia ; a frequent, 
flrong, and hard pulfe; and high-coloured 
urine. 
CCCCX1V. 
The chronic hepatitis very often does not 
exhibit any of thefe fymptoms ; and it is 
only difcovered to have happened, by our 
finding in the liver, upon difledtion, large 
abfceffes, which are prefumed to be the 
effect of fome degree of previous inflam- 
mation. As this chronic inflammation is 
feldom to be certainly known, and there- 
fore does not lead to any determined prac- 
tice, we omit treating of it here, and fhall 
only treat of what relates tp the acute 
fpecies of the hepatitis. 
ccccxv. 378 
PRACTICE 
ccccxv. 
The acute hepatitis may be known by a 
pain more or lefs acute in the right hypo- 
chondrium, increafed by prefling upon the 
part. The pain is very often in fuch a 
part of the fide as to make it appear like 
that of a pleurify ; and frequently, like 
that too, is increafed on refpiration. The 
difeafe is, in fome inftances, alfo attended 
with a cough, which is commonly dry, 
but fometimes humid; and, when the 
pain thus refembles that of a pleurify, the 
patient cannot lie eafily except upon the 
fide affedted. 
In every kind of acute hepatitis, the pain 
is often extended to the clavicle, and to 
the top of the fhoulder. The difeafe is 
attended fometimes with hickup, and 
fometimes with vomiting. Many practical 
writers have mentioned the jaundice, or a 
yellow colour of the fkin and eyes, as a 
very OF PHYSIC. 
379 
very conftant fymptom of the hepatitis; 
but experience has Ihown, that it may of- 
ten occur without any fuch fymptom. 
CCCCXVL 
The remote caufes of hepatitis are not 
always to be difeerned, and many have 
been afligned on a very uncertain foun- 
dation. The following feem to be fre- 
quently evident. i. External violence 
from contufions or falls, and efpecially 
thofe which have occafioned a fracture of 
the cranium. 2. Certain pallions of the 
mind. 3. Violent fummer-heats. 4. Vio- 
lent exercife. 5. Intermittent and remit- 
tent fevers. 6. Cold applied externally, or 
internally; and therefore in many cafes the 
fame caufes which produce pneumonic in- 
flammation, produce hepatitis, and whence 
alfothetwo difeafes are fometiines joined to- 
gether. 7. Various folid concretions or col- 
lections 380 
PRACTICE 
legions of liquid matter, in thefubftanceof 
the liver, produced by unknown caufes. 
Laflly, The acute is often induced by a 
chronic inflammation of this vifeus. 
CCCCXVII. 
It has been fuppofed, that the hepatitis 
may be an affection either of the extremi- 
ties of the hepatic artery, or of thofe of the 
vena portarum ; but of the laft fuppofi- 
tion there is neither evidence nor proba- 
bility. 
CCCCXVUI. 
It feems probable, that the acute hepatitis 
is always an affection of the external mem- 
brane of the liver; and that the parenchy- 
inatic is of the chronic kind. The acute 
difeafe may be feated either on the convex 
or on the concave furface of the liver. In 
the former cafe, a mpre pungent pain and 
hickup 0 F P HZY SIC. 
381 
hickup may be produced, and the refpi- 
ration is more confiderably affedled. In 
the latter, there occurs lefs pain ; and a 
vomiting is produced, commonly byfome 
inflammation communicated to the flo- 
mach. The inflammation of the concave 
furface of the liver, may be readily com- 
municated to the gall-bladder and biliary 
dudls ; and this perhaps is the only cafe of 
idiopathic hepatitis attended with jaun- 
dice. 
CCCCXIX. 
The hepatitis, like other inflammations, 
may end by refolution, fuppuration, or 
gangrene ; and the tendency to the one or 
the other of thefe events, may be known 
from what has been delivered above. 
ccccxx. 382 
PRACTICE 
ccccxx. 
The refolution of hepatitis is often the 
confequence of, or is attended with, eva- 
cuations of different kinds. A hsemor- 
rhagy, fometimes from the right noftril, 
and fometimes from the hemorrhoidal 
veffels, gives a folution of the difeafe. 
Sometimes a bilious diarrhoea contributes 
to the fame event; and the refolution of 
the hepatitis, as of other inflammations, 
is attended with fweating, and with an 
evacuation of urine, depofiting a copious 
fediment. Can this difeafe be refolved by 
expectoration ? It would feem to be fome- 
times cured by an eryfipelas appearing in 
fome external part. 
CCCCXXI. 
When this difeafe has ended in iuppu- 
ration. OF PHYSIC. 
383 
ration, the pus collected may be difcharged 
by the biliary duels; or, if the fuppurated 
part does not any where adhere clofely to 
the neighbouring parts, the pus may be 
difcharged into the cavity of the abdomen: 
but if, during the firfl Rate of inflamma- 
tion, the affected part of the liver fhall 
have formed a clofe adhefion to fome of 
the neighbouring parts, the difeharge of 
the pus after fuppuration may be various, 
according to the different feat of the ab- 
feefs. When icatcd <ai the convex part of 
the liver, if the adhefion be to the perito- 
naeum lining the common teguments, the 
pus may make its way through thefe, and 
be difcharged outwardly ; or, if the adhe- 
fion fhould have been to the diaphragm, 
the pus may penetrate through this, and 
into the cavity of the thorax, or of thelungs; 
and through the latter may be difcharged 
by coughing. When the abfeefs of the 
liver is feated on its concave part, then, 
in 384 
PRACTICE 
in confequence of adhefions, the pus may 
be difeharged into the ftomach or the 
inteftines; and into thefe laft, either di- 
rectly, or by the intervention of the biliary 
ducts. 
CCCCXXII. 
The prognoftics in this difeafe are efla- 
blifhed upon the general principles relating 
to inflammation, upon the particular cir- 
cumflances of the liver, and upon the par- 
ticular ftate of its inflammation. 
The cure of this difeafe mutt proceed 
upon the general plan ; by bleeding, more 
or lefs, according to the urgency of pain 
and pyrexia; by the application of blifters; 
by fomentations, of the external parts in 
the ufual manner, and of the internal parts 
by frequent emollient glyfters ; by fre- 
quently opening the belly by means of 
gentle OF PHYSIC. 
385 
gentle laxatives, and by diluent and refri-* 
gerant remedies* 
CCCCXXIIL 
Although, in many cafes, the chronic 
hepatitis does not clearly difcover itfelf; 
yet, upon many occafions, it may perhaps 
be difcovered, or at leaft fufpected, from 
thofe caufes which might affect the liver 
(CCCXVI.) having been applied; from fome 
fulnefs and fomefenfe of weight in the right 
hypochondrium; from fome fhooting pains 
at times felt in that regiop; from fome un- 
eafinefs or pain felt upon preflure in that 
part; from fome uneafinefs from lying 
upon the left fide; and laftly, from fome 
degree of pyrexia, combined with more or 
fewer of thefe fymptoms. 
When from fome of thefe circumftances 
a chronic inflammation is to be fufpe&ed, 
it is to be treated by the fame remedies as in 
Vol. I. 
B b 
the 386 
PRACTICE 
the laft paragraph, employed more or lefs, 
as the degree of the feveral fymptoms fliall 
more diftindflly indicate. 
CCCCXXIV. 
When from either kind of inflammation 
a fuppuration of the liver has been formed, 
and the abfcefs points outwardly, the part 
muft be opened, the pus evacuated, and 
the ulcer healed according to the ordinary 
rules for cleanfing and healing fuch ab- 
fcefles and ulcers. 
ccccxxv. 
I might here confider the Splenitis, or 
inflammation of the fpleen; but it does 
not feem neceflary, becaufe the difeafc very 
feldom occurs. When it does, it may be 
readily known by the character given in 
our Nofology; and its various termination, 
as OF PHYSIC. 
387 
as well as the practice which it requires, 
may be underftood from what has been 
already faid with refpedl to the inflamma- 
tions of the other abdominal vifcera. 
C H A P. XI. 
Of the Nephritis, or the Inflam- 
mation of the Kidneys. 
CCCCXXVI. 
THIS difeafe, like other internal in- 
flammations, is always attended with 
pyrexia; and is efpecially known from the 
region of the kidney being affedted by pain, 
B b 2 
com- 388 
PRACTICE 
commonly obtufe, fometimes pungent. 
This pain is not increafed by the motion of 
the trunk of the body, fo much as a pain of 
the rheumatic kind affedling the fame re- 
gion. The pain of the nephritis may be 
often diftinguifhed by its fhooting along 
the courfe of the ureter; and is frequently 
attended with a drawing up of the tefticle, 
and with a numbnefs of the limb on the 
fide affected: although, indeed, thefe fymp- 
toms moft commonly accompany the in- 
flammation arifing from a calculus in the 
kidney or in the ureter. The nephritis is 
almoft conftantly attended with frequent 
vomiting, and often with coflivenefs and 
colic pains. Ufually the ftate of the urine 
is changed ; it is moft commonly of a deep 
red colour, is voided frequently, and in 
fmall quantity at a time. In more violent 
pafes, the urine is fometimes colourlefs. 
CCCXVL OF PHYSIC. 
389 
CCCCXXVII. 
The remote caufes of this difeafe may 
be various; as, external contufion; violent 
or long-continued riding; drains of the 
mufcles of the back incumbent on the kid- 
neys; various acrids in the courfe of the 
circulation conveyed to the kidney; and 
perhaps fome other internal caufes not yet 
well known. The moft frequent is that of 
calculous matter obflrudling the tubuli 
uriniferi, or calculi formed in the pelvis 
of the kidneys, and either flicking there, 
or fallen into the ureter. 
ccccxxvni. 
The various event of this difeafe may be 
underftood from what has been delivered 
on the fubjedl of other inflammations. 
CCCCXXIX. 390 
PRACTICE 
CCCCXXIX. 
Writers, in treating of the cure of ne- 
phritis, have commonly at the fame time 
treated of the cure of the Calculus renalis: 
but, though this may often produce ne- 
phritis, it is to be confidered as a diftindl 
and feparate difeafe; and what I have to 
offer as to the mode of treating it, muft be 
referved to its proper place. Here I iliall 
treat only of the cure of the Nephritis Vera 
or Idiopathica. 
ccccxxx. 
The cure of this proceeds upon the ge- 
neral plan, by bleeding, external fomenta- 
tion, frequent emollient glyfters, antiphlo- 
giftic purgatives, and the free ufe of mild 
and OF PHYSIC. 
391 
and demulcent liquids. The application 
of blifters is hardly admiflible; or, at leaft, 
will require great care, to avoid any con- 
fiderable abforption of the cantharides. 
CCCCXXXI. 
The Cyftitis, or inflammation of the 
bladder, is feldom a primary difeafe; and 
therefore is not to be treated of here. The 
treatment of it, fo far as neceflary to be 
explained, may be readily underftood from 
what has been already delivered. 
CCCCXXXIL 
Of the vifceral inflammations, there re- 
mains. to be confldered the inflammation 
of the Uterus ; but I omit it here, becaufe 
the 392 
P R A C T I C E, &c. 
the confideration of it cannot be feparated 
from that of the difeafes of child-bearing 
women. * 
END OF THE FIRST VOLUME. 
printed bt M A C F A R QU H A R and ELLIOT.