FIRST LINES 
O F T H E 
PRACTICE of PHYSIC. 
B Y 
William cullen, m.d. 
Profeflbr of the Practice of Phyfic in the Univerfity of Edinburgh; 
Firft Phyfician to his Majefty for Scotland; 
Fellow of the Royal College of Phyficians of Edinburgh, 
of the Royal Societies of London, of Edinburgh, &c. &e. 
FOURTH EDITION, 
Corrected and Enlarged. 
VOL. II. 
ED INBURGH: 
Printed forC. ELLIOT, Edinburgh; 
And T. CADELL, London. 
M.DCC.LXXXIV. CONTENTS. 
PARTI. B O O K II. 
CHAPTER XII. 
Page 
Of the Rheumatism . 9 
CHAP. XIII. 
Of the Toothach, or Odontalgia . 38 
CHAP. XIV. 
Of the Gout . » yi 
BOOK III. 
Of Exanthemata, or Eruptive Fe- 
vers . . 123 
a 2 CHAP. IV 
CONTENTS. 
Page 
CHAP. I. 
Of the Small-pox . . 126 
CHAP. II. 
Of the Chicken-pox . . 171 
CHAP. III. 
Of the Measles . . 173 
CHAP. IV. 
Of the Scarlet Fever . 187 
CHAP. V. 
Of the Plague . . 200 
Sed. I. Of the Phenomena of the 
Plague . . 200 
Sedl. H. Of the Prevention of the 
Plague . . .205 
Sect. Ill. Of the Cure of the Plague 216 
CHAP. CONTENTS. 
V 
Page 
CHAP. VI. 
Of Erysipelas, or St Anthony's Fire 222 
CHAP. VII. 
Of the Miliary Fever . 235 
CHAP. VIII. 
Of the remaining Exanthemata : 
Urticaria, Pemphigus, and Aph- 
tha . . . 252 
BOOK IV. 
Of Hemorrhagies . . 256 
CHAP. I. 
in general , 256 
SeSt. I. Of the Phenomena of Hemor* 
rhagy ... 259 
Sedl. II. Of the Proximate Caufe of 
Hemorrhagy » . 263 
SecSt. VI 
CONTENTS. 
Page 
Sedt. III. Of the Remote Caufes of He- 
morrhagy . . 294 
Se6t. IV. Of the Cure of Hemorrhagy 298 
CHAP. IL 
Of the Epistaxis, or Hemorrhagy of 
the Nofe . . 320 
CHAP. III. 
Of the Hemoptysis, or Hemorrhagy 
from the Lungs . . 336 
Sedl. I. Of the Phenomena and Caufes 
of Hemoptyfis . . 336 
Se&. II. Of the Cure of Hemoptyfs 350 
CHAP. IV. 
Of the Phthisis Pulmonalis, or 
Confumption of the Lungs . 356 
SecSl. I. Of the Phenomena and Caufes 
of the Phthifs Pulmonalis . 356 
* Se6t. II. Of the Cure of Phthifs 403 
1 CHAP. CONTENTS. 
VII 
Page 
CHAP. V. 
Of the Hemorrhois, or of the Hemor~ 
rhoidal Swelling and Flux 424 
SedL I. Of the Phenomena and Caufes 
of the Hemorrhois . 424 
Sedl. IL Of the Cure of Hemorrhoidal 
dffeElions . , 441 . FIRST LINES 
OF THE 
PRACTICE of PHYSIC. 
PARTI. B O O K II. 
CHAP. XIL 
Of the Rheumatism. 
CCCCXXXIII. 
this difeafe there are two fpecies, 
the one named the Acute, the other 
the Chronic rheumatifm. 
Vol. II. 
B 
CCCCXXXIV. 10 
PRACTICE 
cccCxxxiv. 
It is the Acute Rheumatifm which efpe- 
cially belongs to this place, as from its 
caufes, fymptoms, and methods of cure, 
it will appear to to be a fpecies of phleg- 
mafia or inflammation. 
ccccxxxv. 
This difeafe is frequent in cold, and 
more uncommon in warm, climates. It 
appears moft frequently in autumn and 
fpring, lefs frequently in winter when the 
cold is confiderable and conftant, and very 
feldom during the heat of fummer. It 
may occur, however, at any feafon, if vi- 
ciffitudes of heat and cold be for the time 
frequent. 
CCCCXXXVI. 
The acute rheumatifm generally arifes 
from OF PHYSIC. 
11 
from the application of cold to the body 
when any way unufually warm; or when 
one part of the body is expofed to cold 
whilft the other parts are kept warm; or 
laftly, when the application of the cold is 
long continued, as it is when wet or moift 
clothes are applied to any part of the body. 
CCCCXXXVIL 
Thefe caufes may affetft perfons of all 
ages; but the rheumatifm feldom appears 
in either very young or in elderly perfons, 
and moft commonly occurs from the age 
of puberty to that of thirty-five years. 
CCCCXXXVIII. 
Thefe caufes (CCCCXXXVI.) may alfo 
affect perfons of any conftitution ; but 
they moft commonly affect thofe of a fan- 
guine temperament. 
B 2 
CCCCXXX1X. PRACTICE 
12 
CCCCXXXIX. 
This difeafe is particularly diftinguifhed 
by pains affecting the joints, for the moft 
part the joints alone, but ibmetimes affect- 
ing alfo the mufcular parts. Very often 
the pains fhoot along the courfe of the 
mufcles, from one joint to another, and are 
always much increafed by the action of 
the mufcles belonging to the joint or 
joints affected. 
CCCCXL. 
The larger joints are moft frequently 
affected; fuch as the hip-joint, and knees of 
the lower, and the Ihoulders and elbows 
of the upper, extremities. The ankles and 
wrifes arealfo frequently affedled; but the 
fmaller joints, fuch as thole of the toes or 
fingers, feldom fuller. 
CCCCXLI. OF PHYSIC. 
13 
CCCCXLI. 
This difeafe, although fometimes coii'- 
fined to one part of the body only, yet very 
often afiedls many parts of it; and then it 
comes on with a cold ftage, which is im- 
mediately fucceeded by the other fymp- 
toms of pyrexia, and particularly by a fre- 
quent, full, and hard pulfe. Sometimes the 
pyrexia is formed before any pains are 
perceived; but more commonly pains are 
felt in particular parts, before any fymp- 
toms of pyrexia appear. 
CCCCXLII. 
When no pyrexia is prefent, the pain is 
Sometimes confined to one joint only; but, 
when any confiderable pyrexia is prefent, 
although the pain may be chiefly in one 
joint, yet it feldom happens but that the 
pains aflcdt feveral joints often at the very 
S3 
fame 14 
PRACTICE 
fame time, but for the moSt part Shifting 
their place, and, having abated in one joint, 
become more violent in another. They do 
not commonly remain long in the fame 
joint, but frequently Shift from one to an- 
other, and fometimes return to joints for- 
merly affedfed; and in this manner the 
difeafe often continues for a long time. 
CCCCXLIII. 
The pyrexia attending this difeafe has 
an exacerbation every evening, and is mod 
considerable during the night, when the 
pains alfo become more violent; and it is 
at the fame time that the pains fhift their 
place from one joint to another. The 
pains feem to be alfo increafed during the 
night, by the body being covered more 
clofely, and kept warmer. 
CCCCXLIV. OF PHYSIC. 
15 
CCCCXLIV. 
A joint, after having been for fome time 
affedled with pain, commonly becomes af- 
fected alfo with fome rednefs and fwelling, 
which is painful to the touch. It feldom 
happens, that a fwelling coming on does 
not alleviate the pain of the joint; but 
the fwelling does not always take off the 
pain entirely, nor fecure the joint againft a 
return of it. 
CCCCXLV. 
This difeafe is commonly attended with 
fome fweating, which occurs early in the 
courfe of the difeafe; but it is feldom free 
or copious, and feldom either relieves the 
pains or proves critical. 
B 4 
CCCCXLVL 16 
PRACTICE 
CCCCXLVI. 
In the courfe this difeafe the urine is 
high coloured, and in the beginning with- 
out fediment; but as the difeafe advances, 
and the pyrexia has more confiderable re- 
miflions, the urine depofits a lateritious fe- 
diment. This, however, does not prove 
entirely critical; for the difeafe often con- 
tinues long after fuch a fediment has ap- 
peared in the urine. 
CCCCXLVII. 
When blood is drawn in this difeafe, 
it always exhibits the appearance men- 
tioned CCXXXVII. 
CCCCXLVIII. 
The acute rheumatifm, though it has 
fo much of the nature of the other phleg- 
jnafiae, OF PHYSIC. 
17 
mafias, differs from all thofe hitherto 
mentioned, in this, that it is not apt 
to terminate in fuppuration. This ai- 
med: never happens in rheumatifm; but 
the difeafe fometimes produces effufions 
of a tranfparent gelatinous fluid into the 
{heaths of the tendons. If we may be al- 
lowed to fuppofe that fuch eflufions are fre- 
quent, it muft alfo happen, that the efiufed 
fluid is commonly reabforbed; for it has 
feldom happened, and never indeed to my 
obfervation, that confiderable or perma- 
nent tumours have been produced, or fuch 
as required to be opened, and to have the 
contained fluid evacuated. Such tumours, 
however, have occurred to others, and the 
opening made in them has produced ul- 
cers difficult to heal. Vide Storck. Ann. 
Med. II. 
CCCCXLIX 18 
PRACTICE 
CCCCXLIX. 
With the circumftances mentioned from 
CCCCXXX1X. to CCCCXLVIII. the dif- 
eafe often continues for feveral weeks. 
It feldom, however, proves fatal; and it 
rarely happens that the pyrexia continues 
to be confiderable for more than two or 
three weeks. While the pyrexia abates in 
its violence, if the pains of the joints con- 
tinue, they are lefs violent, more limited 
in their place, being confined commonly 
to one or a few joints only, and are lefs 
ready to change their place. 
CCCCL. 
When the pyrexia attending rheuma- 
tifm has entirely ceafed ; when the fwell- 
ing, and particularly the rednefs of the 
joints, are entirely gone ; but when pains 
ftill continue to affedl certain joints, 
which OF PHYSIC. 
19 
which remain diff, which feel uneafy 
upon motion, or upon changes of weather, 
the difeafe is named the Chronic Rheuma- 
tifm, as it very often continues for a long 
time. As the chronic is commonly the 
fequel of the acute rheumatifm, 1 think it 
proper to treat of the former alfo in this 
place. 
CCCCLI. 
The limits between the acute and chro- 
nic rheumatifm are not always exactly 
marked. 
When the pains are dill ready to fhift 
their place; when they are efpecially fevere 
in the night-time; when, at the fame 
time, they are attended with fome degree 
of pyrexia, and with fome fwelling, and ef- 
pecially with fome rednefs of the joints; the 
difeafe is to be confidered as dill partaking 
the nature of the acute rheumatifm. 
But, 20 
PRACTICE 
But, when there is no degree of pyrexia 
remaining; when the pained joints are 
without rednefs ; when they are cold and 
Iliff; when they cannot eafily be made to 
fweat; or when, while a free and warm 
fweat is brought out on the reft of the 
body, it is only clammy and cold on the 
pained joints ; and when, efpecially, the 
pains of thefe joints are increafed by cold, 
and relieved by heat applied to them; the 
cafe is to be confidered as that of a purely 
chronic rheumatifm. 
CCCCLII. 
The chronic rheumatifm may affect 
different joints; but is efpecially ready to 
affect thofe joints which are furroundcd 
with many mufcles, and thofe of which 
the mufcles are employed in the moft con- 
ftant and vigorous exertions. Such is the 
cafe of the vertebras of the loins, the af- 
fection OF PHYSIC. 
21 
fe&ion of which is named Lumbago; or 
that of the hip-joint, when the difeafe is 
named Ifchias, or Sciatica. 
CCCCLIII. 
Violent ftrains and fpafms occurring on 
fudden and fomewhat violent exertions, 
bring on rheumatic afFeddions, which at 
firft partake of the acute, but very foon 
change into the nature of the chronic 
rheumatifm. 
CCCCLIV. 
I have thus delivered the hiftory of 
rheumatifm; and fuppofe, that, from what 
has been faid, the remote caufes, the diag- 
nofis, and prognofis of the difeafe, may be 
underftood. The diftin&ion of the rheu- 
matic pains from thofe refembling them, 
which occur in the fyphilis and fcurvy, 
will 22 
PRACTICE. 
will be obvious, either from the feat of 
thofe pains, or from the concomitant 
fymptoms peculiar to thefe difeafes. The 
diftindlion of rheumatifm from gout will 
be more fully underflood from what is to 
be delivered in the following chapter. 
CCCCLV. 
With refpecl to the proximate caufe of 
rheumatifm, there have been various opi- 
nions. It has been imputed to a peculiar 
acrimony; of which, however, in or- 
dinary cafes, I can find no evidence; 
and, from the confideration of the remote 
caufes, the fymptoms, and cure of the 
difeafe, I think the fuppofition very im- 
probable. 
The caufe of an Ifchias Nervofa affigned 
by Cotunnius, appears to me hypothe- 
tical, and is not fupported by either the 
phenomena or method of cure. That, 
however, OF PHYSIC. 
23 
however, a difeafe of a rheumatic nature 
may be occafioned by an acrid matter ap- 
plied to the nerves, is evident from the 
toothach, a rheumatic aftedtion generally 
ariling from a carious tooth. 
That pains refembling thofe of rheu- 
matifm, may arife from deep-fea ted fup- 
purations, we know from fome cafes de- 
pending on fuch a caufe, and which, in 
their fymptoms, refemble the lumbago or 
ifchias. I believe, however, that, by a 
proper attention, thefe cafes depending on 
fuppuration, may be commonly diftin- 
guifhed from the genuine cafes of lumba- 
go and ifchias ; and, from what is.faid in 
CCCCXLVIII. I judge it to be at leaft 
improbable, that a genuine lumbago or 
ifchias does ever end in fuppuration. 
CCCCLVI. 
The proximate caufe of rheumatifm 
has 24 
PRACTICE. 
has been by many fuppofed to be a lentor 
of the fluids obftru&ing the veflels of the 
part; but the fame confideration as in 
CCXLI. i, 2, 3, 4, and 5, will apply 
equally here for rejecting the fuppofition 
of a lentor- 
CCCCLVII. 
While I cannot, therefore, find either 
evidence or reafon for fuppofing that the 
rheumatifm depends upon any change in 
the Rate of the fluids, I muft conclude 
that the proximate caufe of acute rheuma- 
tifm, is commonly the fame with that of 
other inflammations not depending upon 
a direct ftimulus. 
CCCCLVIH, 
In the cafe of rheumatifm I fuppofc, 
that the moft common remote caufe of it, 
that OF PHYSIC. 
25 
fliat is, cold applied, operates efpecially on 
the veffels of the joints, from thefe being 
lefs covered by a cellular texture than thofe 
of the intermediate parts of the limbs. I 
fuppofe further, that the application of 
cold produces a conftridlion of the extreme 
veffels on the furface, and at the fame time 
an increafe of tone or phlogiftic diathefis 
in the courfe of them, from which arifes 
an increafed impetus of the blood, and, 
at the fame time, a refiftance to the free 
paffage of it, and confequently inflam- 
mation and pain. Further, I fuppofe, 
that the refiftance formed excites the vis 
medicatrix to a further increafe of the 
impetus of the blood; and, to fupport 
this, a cold ftage arifes, a fpafm is formed, 
and a pyrexia and phlogiftic diathefis are 
produced in the whole fyftem. 
c 
Vol. II. 
CCCCLIX. 26 
PRACTICE 
CCCCLIX. 
According to this explanation, the cauie 
of acute rheumatifm appears to be exactly 
analogous to that of the inflammations de- 
pending on an increafed afflux of blood to 
a part while it is expofed to the a&ion of 
cold. 
But there feems to be alfo, in the cafe of 
rheumatifm, a peculiar affedfflon of the 
fibres of the mufcles. Thefe fibres feem 
to be under fome degree of rigidity, and 
therefore lefs eafily admit of motion; and 
are pained upon the exertions of it. 
It is alfo an affedtion of thefe fibres 
which gives an opportunity to the propa- 
gation of pains from one joint to another, 
along the courfe of the mufcles; and which 
pains are more feverely felt in the extre- 
mities of the mufcles terminating in the 
joints, becaufe, beyond thefe,.the ofcilla- 
tions are not propagated. 
This OF PHYSIC. 
27 
This affection of the mufcular fibres at- 
tending rheumatifm, feems to explain why 
(trains and fpafms produce rheumatic af- 
fections ; and, upon the whole, {hows, 
that, with an inflammatory affection of 
the fanguiferous fyftem, there is alfo in 
rheumatifm a peculiar affeCtion of the 
mufcular fibres, which has a confiderable 
{hare in producing the phenomena of the 
difeafe. 
CCCCLX. 
Having thus given my opinion of the 
proximate caufe of rheumatifm, I proceed 
to treat of the cure. 
CCCCLXI. 
Whatever difficulty may occur with re- 
fpedt to the explanation given (CCCCLVIIL 
and CCCCLIX.) this remains certain, that 
C 2 
in 28 
PRACTICE 
in acute rheumatifm, at leaft in all.thofe 
cafes which do not arife from diredt fti- 
muli, there is an inflammatory affedtion 
of the parts, and a phlogiftic diathefis in 
the whole fyftem; and upon thefe is found- 
ed the method of cure, which frequent 
experience has approved of. 
CCCCLXII. 
The cure therefore requires, in the firft 
place, an antiphlogiftic regimen, and par- 
ticularly a total abftinence from animal 
food, and from all fermented or fpirituous 
liquors ; fubftituting a vegetable or milk 
diet, and the plentiful ufe of bland diluent 
drinks. 
CCCCLXIII, 
Upon the fame principle (CCCCL.) at 
lead with perhaps the fame exception as 
above OF PHYSIC. 
29 
above, blood-letting is the chief remedy 
of acute rheumatifm. The blood ought 
to be drawn in large quantity, and the 
bleeding is to be repeated in proportion 
to the frequency, fullnefs, and hardnefs of 
the pulfe, and to the violence of the pain. 
For the moft part, large and repeated 
bleedings, during the firfl: days of the dif- 
eafe, feem to be necefiary, and according- 
ly have been very much employed; but 
to this fome bounds are to be fet; for very 
profufe bleedings occafion a flow recovery 
and, if not abfolutely effe&ual, are ready 
to produce a chronic rheumatifm. 
CCCCLXIV. 
To avoid that debility of the fyftem, 
which general bleedings are ready to occa- 
iion, the urgent fymptom of pain may be 
often relieved by topical bleedings, and, 
when any fwell.ing and rednefs 
have 
c 3  PRACTICE 
30 
have come upon a joint, the pain of it 
may be very certainly relieved by fuch 
bleedings ; but, as the continuance of the 
difeafe feems to depend more upon the 
phlogiftic diathefis of the whole fyftem, 
than upon the affection of particular parts, 
fo topical bleedings will not always fupply 
the place of the general bleedings propofed 
above. 
GCCCLXV. 
To take off the phlogiftic diathefis pre- 
vailing in this difeafe, purging may be ufe- 
ful, if procured by medicines which do not 
ftimulate the whole fy ftem, fuch as the neu- 
tral faits, and which have, in fome meafure, 
a refrigerant power. Purging, however, is 
not fo powerful as bleeding, in removing 
phlogiftic diathefis ; and, when the difeafe 
has become general and violent, frequent 
ftoqls OF PHYSIC. 
31 
itools are inconvenient, and even hurtful, 
by the motion and pain which they occafiom 
CCCCLXVI. 
In acute rheumatifm, applications to the 
.pained parts are of little fervice. Fomenta- 
tions, in the beginning of the difeafe, rather 
aggravate than relieve the pains. The ru- 
befacients and camphire are more effectual 
in relieving the pains; but generally they 
only ihift the pain from one part into an- 
other, and do little towards the cure of the 
general afiedtion. Bliftering, applied to 
the pained part, may alfo be very effectual 
in removing the pain from it; but will be 
pf little ufe, except where the pains are 
much confined to one part. 
CCCCLXVII. 
The feveral remedies mentioned from 
C 4 
(CCCCLL 32 
PRACTICE 
(CCCCLI. to CCCCLV.) moderate the vio- 
lence of the difeafe, and fometimes remove 
it entirely; but they fometimes fail in this, 
and leave the cure imperfedf. The at- 
tempting a cure by large and repeated 
bleedings, is attended with many inconveni- 
ences, (fee CXL.) ; and the moft effec- 
tual and fafe method of curing this difeafe, 
is after fome general bleedings for taking 
off, or at leaft diminifhing the phlogiftic dia- 
thefisto employ fwcating, conduced by the 
rules laid down CLXVIII. and CLXIX. 
CCCCLXVIII. 
Opiates, except where they are diredled 
to procure fweat, always prove hurtful in 
every ftage of this difeafe. 
CCCCLXIX. 
The Peruvian bark has been fuppofed a 
remedy OF PHYSIC. 
33 
remedy in fome cafes of this difeafe; but 
we have feldom found it ufeful, and, in 
fome cafes, hurtful. It appears to me to 
be fit in thofe cafes only, in which the 
phlogiftic diathefis is already much abated, 
and where, at the fame time, the exacerba- 
tions of the difeafe are manifeftly periodi- 
cal, with confiderable remifiions inter- 
pofed. 
CCCCLXX. 
Calomel, and fome other preparations 
of mercury, have been recommended 
in the acute rheumatifm; but I believe 
they are ufeful only in cafes of the chronic 
kind, or at leaft in cafes approaching to the 
nature of thefe. 
CCCCLXXI. 
Having now treated fully of the cure of 
the 34 
PRACTICE 
the acute rheumatifm, I proceed to treat of 
the cure of the chronic, which is fo fre- 
quently a fequel of the former. 
CCCCLXXII. 
The phenomena of the purely chronic 
rheumatifm, mentioned in CCCCXXXIX. 
and CCCCXL. lead me to conclude, that 
its proximate caufe is an atony, both of 
the blood-veflels and of the mufcular fibres 
of the part affeCted, together with a degree 
of rigidity, and contraction in the latter, 
fuch as frequently attend them in a Rate 
of atony. 
cccclxxiii. 
Upon this view of the proximate caufe, 
the general indication of cure muft be to 
reflore the activity and vigour of the vital 
principle in the part; and the remedies 
for OF PHYSIC. 
35 
for this difeafe, which experience has ap- 
proved of, are chiefly fuch as are mani- 
feflly fuited to the indication propofed. 
CCCCLXXIV. 
Thefe remedies are either external or in- 
ternal. 
The external are the fupporting the heat 
of the part, by keeping it conftantly co- 
vered with flannel; the increafing the heat 
of the part by external heat, applied 
cither in a dry or in a humid form; the 
diligent ufe of the flefh-brufh, or other 
means of friCtion; the application of electri- 
city in fparks or {hocks; the application of 
cold water by affiifion or immerflon; the 
application of eflential oils of the moft 
warm and penetrating kind; the appli- 
cation of fait brine; and, laftly, the em- 
ployment of exercife, either of the part 
itfelf, fo far as it can eaflly bear it; or of 
the 36 
PRACTICE 
the whole body by riding, or other mode 
of geftation. 
CCCCLXXV. 
The internal remedies are, i. Large 
doles of eflential oil drawn from relinous 
fubftances, fuch as turpentine; 2. Sub- 
ftances containing fuch oils, as guaiac; 
3. Volatile alkaline faits; 4. Thefe, or other 
medicines diredied to procure fweat, 
(GLXIX.); and, laftly, calomel, or other 
preparation of mercury, in fmall dofes, 
continued for fome time. 
CCCCLXXVL 
Thefe (CCCCLXIII, CCCCLXIV.) are 
the remedies fuccefsfully employed in 
the purely chronic rheumatifm; and there 
are ftill others recommended, as bleeding, 
general and topical, burning, bliftering, 
and OF PHYSIC. 
37 
and iflues ; but thefe appear to me to be 
chiefly, perhaps only, ufeful when the difl- 
eafe ftill partakes of the nature of acute 
rheumatifin. 
CHAP. 38 
PRACTICE 
CHAP. XIII. 
Of the Toothach or Odontalgia. 
CCCCLXXVIL 
T Have formerly confidered this difeafe 
as a fpecies of Rheumatifm, to be treat- 
ed upon the fame principles as thofe de- 
livered in the preceding chapter; but 
now, from more attentive confideration, I 
am led to conlider the toothach as a diftindl 
difeafe. Whilft the moft of what has been 
delivered in the laft chapter proceeds upon 
the OF PHYSIC. 
39 
the fuppofition that the rheumatifm de- 
pends upon a certain ftate of the blood- 
veflels and of the motion of the blood in 
them, without this being produced by the 
irritation of any acrid matter applied; I 
judge, that in the toothach, though there 
dre often the fame circumftances in the 
ftate of the blood-veflels as in the cafes of 
rheumatifm, thefe circumftances in tooth- 
ach always arife from the application of an 
acrid matter to the nerves of the teeth. 
CCCCLXXVIIL 
This difeafe is often no other than a 
pain felt in a particular tooth, without any 
inflammatory affedion being at the fame 
time communicated to the neighbouring 
parts. This, however, is rarely the cafe; 
and for the moft part, together with the 
pain of the tooth, there is fome degree of 
pain and of inflammatory affedion com- 
municated  PRACTICE 
40 
municated to the neighbouring parts, fome- 
times to the whole of thofe on the fame 
fide of the head with the affected tooth. 
CCCCLXXIX. 
This inflammatory affecflion feems to 
me to be always an affection of mufcles, 
and of the membranous parts connected 
with thefe, without any tendency to fup- 
puration; and fuch an affection, as is excited 
by cold in fimilar parts elfewhere. It is 
from thefe circumftances that I conclude 
the affection to be of the rheumatic kind. 
CCCCLXXX. 
It is poHible that the mufcles and 
membranes of the jaw may be affected by 
the fame caufes which produce the rheu- 
matifm in other parts; and it is alfo po£- 
fible, that a rheumatic diathefis at firft 
pro- 0 F PHYSIC. 
41 
produced by irritation, may fubfift in the 
mufcles and membranes of the jaw, fo that 
the inflammatory affedlion may be renew- 
ed by certain caufes without any new ap- 
plication of acrid matter: but I am per- 
fuaded that either of thefe occurrences are 
very rare, and I have never been able to 
afcertain any cafes of toothach to be of 
thefe kinds. I confider it, therefore, as high- 
ly probable that this rheumatic affection of 
the jaws which we name toothach, is al- 
ways dependent upon fome immediate 
application of acrid matter to the nerves 
of the teeth. 
CCCCLXXXI. 
It is however to be obferved, that this 
application of acrid matter does not always 
excite a pain in the tooth itfelf, or an in- 
flammatory affection of the neighbouring 
parts; but that it very often operates by 
Vol. II. 
D 
produ- 42 
PRACTICE 
producing a diathefis only; fo that cold ap- 
plied to the neighbouring parts does excite 
both a pain in the tooth, and an inflam- 
matory affection of the neighbouring parts 
which did not appear before. 
There feem to be alfo certain dates of 
the body, which operate upon the fame 
diathefis, fo as to produce toothach. Such 
feems to be the cafe of pregnant women, 
who are more liable to toothach than other 
women. There are probably alfo fome cafes 
of increafed irritability which render per- 
fons more fubjedt to toothach. Thus wo- 
men are more liable to the difeafe than 
men, and particularly women liable to hy- 
fteric affedlions. 
CCCCLXXXII. 
The acrid matter producing this difeafc 
feems to be generated firft in the hard 
fubftances of the teeth, and as it often ap- 
pears OF PHYSIC. 
43 
pears fir ft upon the external furface of 
thefe, it might be fufpedled to arife from 
the application of external matters to the 
teeth: but as the production of this acri- 
mony is often begun in the internal cavity 
of the teeth, where the operation of external 
matters cannot be fufpecled, and as even 
when it begins upon the external parts of the 
teeth, the operation of the caufe is at firft in 
a fmall portion of the teeth only, that it isdif- 
ficult to fuppofe that any matter externally 
applied could act in fuch a partial manner; 
fo it is prefumed that the acrid matter occa- 
fioning the toothach is produced by fome 
vice originating in the fubftance of the tooth 
itfelf. When it begins upon the external 
furface, it is on the enamel; but upon the 
internal furface, it mu ft be in the bony 
part. From what caufes it arifes in either 
of thefe fubftances, I do not at ail know; 
but I fufpeCt that it often arifes from fome 
more general fault in rhe fluids of the 
D 2 
body. 44 
PRACTICE 
body. The frequent ufe of mercury, efpe- 
daily when thrown much upon the mouth, 
and the ftate of the fluids in feurvy, feem 
both of them to give a difpofttion to a 
caries in the teeth ; and it is poflible that 
fome other acrimonious ftates of the fluids 
may have the fame effect. 
CCCCLXXXIH. 
A caries in feme part of the teeth, whe- 
ther arifing upon their internal furface or 
upon their external proceeding fo far as to 
reach the nerves in the cavity of the teeth, 
is pretty manifeftly the caufe of toothach, 
and of the firft attacks of it; but when 
the cavity of the teeth has been opened, 
fo that the external air or other matters 
can reach that cavity, thefe are often the 
exciting caufes of toothach, and ferve to 
prove in general, that acrid matters applied 
to the nerves occafion the difeafe. 
CCCCLXXXIV. OF PHYSIC. 
45 
CCCCLXXXIV. 
What is the nature of the matter pro- 
duced in the caries of the teeth, I do not 
underhand, nor have I found any proper 
corrector of it; but I prefume it to be of 
the putrid kind, as it often taints the breath 
with a fetid odour. 
CCCCLXXXV. 
Jn the cure of this difeafe, a long 
experience has fhown, that the extraction 
of the carious tooth proves the moil ef- 
fectual, and very often the only effectual, 
remedy of the difeafe. But as in fome cafes 
this extraction is not proper, and as in 
many cafes it is obftinately avoided, other 
means of curing the difeafe, or at leaft of 
relieving the pain, have been fought for 
gnd much praCtifed. 
D 3 
CCCCLXXXVL 46 
PRACTICE 
CCCCLXXXVI. 
Among thefe remedies, thofe are like- 
ly to be the moft effectual which en- 
tirely deftroy the affedted nerve, or at leaft 
fo much of it, as is expofed to the adtion 
of the acrid matter in the tooth. When 
an opening is made into the cavity of the 
tooth, the nerve of it may be deftroyed 
moft certainly by the adtual cautery; and 
it may alfo poflibly be done by the appli- 
cation of potential cauftics, either of the 
alkaline or acid kind. 
CCCCLXXXVII. 
When thefe remedies cannot be ren- 
dered effectual, relief may often be ob- 
tained by diminifhing thefenfibility of the 
nerve affedted, by the application of 
opium, or of the more acrid aromatic oils, 
diredtly to the nerve in the tooth. It ap- 
pears OF PHYSIC. 
47 
pears alfo that the fenfibility of the affec- 
ted nerve may often be for fome time 
diminifhed by the external application of 
opium to the extremities of thofe nerves in 
the fkin, which are branches of the fame 
fifth pair of nerves with thofe of the teeth. 
CCCCLXXXVIII. 
When the difeafe conlifts entirely in a 
pain of the nerve of the tooth, without any 
conhderable affedion communicated to 
the neighbouring parts, the remedies al- 
ready mentioned are thofe efpecially to be 
employed; but when the difeafe coniifts 
very much in an inflammatory affedion 
of the mufcles and membranes of the jaw, 
and when at the fame time there is little 
or no accefs for the abovementioned re- 
medies to the affeded nerve, other mea- 
fures are to be employed for relieving the 
difeafe. 
D 4 
CCCCLXXXIX. 48 
PRACTICE 
CCCCLXXXIX. 
If the difeafe be attended with any ge- 
neral phlogiflic diathefis of the fyftem, or 
with any confiderable degree of pyrexia, a 
general bleeding may be ufeful in relieving 
the difeafe: but thefe circumftances occur 
very rarely, and the difeafe is for the 
moft part a purely topical afiedlion, in 
which, as I obferved before, a general 
bleeding is of very little fervice. As 
this difeafe, however, is a topical inflam- 
mation, it might be fuppofed that to- 
pical bleedings would be very ufeful, 
and fometimes they are fo; but it is fel- 
dom that their effects are either con- 
fiderable or permanent. The reafons of 
this I take to be, that the difeafe does 
not confift in an aflfedtion of the blood- 
veffels alone, as in the ordinary cafes 
of rheumatifm ; but in a peculiar af- 
fection of the fibres both of the paufclc? 
and O F P H Y S I C. 
49 
and of the veffels of the part induced by 
irritation. The inefficacy of topical bleed- 
ings is with me a proof of the difeafe 
being of the latter kind. 
CCCCXC. 
The remedies therefore neceffiary to 
give relief in this difeafe, are thofe which 
take off the fpafm of the veffels, and efpe- 
cially of the mufcles and membranes af- 
feded. Such are bliftering, brought as near 
to the part affeded as can be conveniently 
done; and fuch are alfo increafed excre- 
tions excited in the neighbouring parts, as 
of the faliva and mucus of the mouth by 
the ufe of acrid mafticatories. It is often 
fufficient, to excite a ftrong fenfation in 
the neighbouring parts; as by eau de luce, 
ipirit of lavender, or Hungary water, 
fnuffed up the noftrils; or by the vitriolic 
lethcr properly applied to the cheek. It is 
upon 50 
PRACTICE 
upon the fame footing that I fuppofe 
brandy or other ardent fpirit held in the 
mouth is often of fervice. 
CCCCXCI. 
There are cafes of toothach in which it 
does not appear that the difeafe arifes from 
an acrid matter immediately applied to 
the nerve of a tooth; but from the exter- 
nal application of cold, or fome other 
caufes immediately applied to the mufcles 
and membranes of the jaw; and which 
therefore feem to require fome remedies 
different from thofe abovementioned. But 
in all fuch cafes, it is to be fufpecled, that 
the effects of cold or of other fuch caufes are 
owing to a diathefis produced by an acrid 
matter applied to the nerve of a tooth, and 
continuing in fome meafure to adt there; 
and we have accordingly often found, that 
the adtion of thofe external caufes were 
tQ OF PHYSIC. 
51 
to be obviated only by the extraction of 
the tooth from which the diathefis had 
arifen. 
CHAP. XIV. 
Of the Gout. 
CCCCXCIL 
THE Gout, not only as it occurs in 
different perfons, but even as it oc- 
curs in the fame perfon at different times, 
is a difeafe of fuch various appearance, 
that it is difficult to render the hiftory of it 
complete and exaCl, or to give a character 
of 52 
PRACTICE 
of it that will univerfally apply. How- 
ever, I fhall endeavour to defcribe the dif- 
eafe as it moft commonly appears, and to 
mark the varieties of it as well as I can. 
From fuch a hiftory I expedt that a ge- 
neral character may be given; and fuch I 
think is the following, as given in the laft 
edition of our Nofology : 
Gen. XXIII. PODAGRA. 
Morbus hasreditarius, oriens fine caufa 
externa evidente, fed prseunte plerumque 
ventriculi affedtione infolita; pyrexia; do- 
lor ad articulum et plerumque pedis pollici, 
certe pedum et manuum jundluris, potifli- 
mum infeflus; per intervalla revcrtens, et 
fcpe cum ventriculi et internarum partium 
affedionibus alternans,. 
CCCCXCIII. 
The Gout is generally a hereditary dif- 
eafe; OF PHYSIC. 
53 
eafe; but feme perfons, without hereditary 
difpofition, feem to acquire it; and, in 
fome, a hereditary difpofition may be coun- 
teracted by various caufes. Thefe circum- 
ftances may feem to give exceptions to our 
general pofition; but the fads diredly 
fupporting it are very numerous. 
CCCCXCIV. 
This difeafe attacks efpecially the male 
fex; but it fometimes, though more rarely, 
attacks alfo the female. The females liable 
to it are thofe of the more robuft and full 
habits; and it very often happens to fuch 
long before the menftrual evacuation has 
ceafed. I have found it occurring in feve- 
ral females, whofc menftrual evacuations 
were more abundant than ufual. 
ccccxcv. 
This difeafe feldom attacks Eunuchs; 
and, 54 
PRACTICE 
and, when it does, they feem to be thole 
who happen to be of a robuft habit, to 
lead an indolent life, and to live very full. 
CCCCXCVI. 
The gout attacks efpecially men of robuft 
and large bodies, men of large heads, of 
full and corpulent habits, and men whofe 
{kins are covered with a thicker rete muco- 
Jumy which gives a coarfer furface. 
CCCCXCVH. 
If, with the ancients, we might afcer- 
tain, by certain terms, the temperaments of 
men, 1 would fay, that the gout attacks efpe- 
cially men of a cholerico-fangiiine tempera- 
ment, and that it very feldom attacks the 
purely fanguine or melancholic. It is, 
however, very difficult to treat this matter 
with due precifion. 
ccccxcvin. OF PHYSIC. 
55 
CCCCXCVIII. 
The gout feldom attacks perfons em- 
ployed in conftant bodily labour, or per- 
fons who live much upon vegetable ali- 
ment. It is alfo faid to be lefs frequent 
among - thofe people who make no ufe 
of wine or other fermented liquors. 
CCCCXCIX. 
The gout does not commonly attack men, 
till after the age of five and thirty; and ge- 
nerally not till a (till later period. There 
are indeed inftances of the gout occurring 
more early; but thefe are few in 
fon of the numbers which agree with what 
we have given as the general rule* When 
the difeafe docs appear early in life, it feems 
to be in thofe in whom the hereditary dif- 
pofition is very ftrong, and to whom the 
remote caufes to be hereafter mentioned. 
have 56 
PRACTICE 
have been applied in a confiderable de- 
gree. 
D. 
As the gout is a hereditary difeafe, and 
affects efpecially men of a particular habit, 
its remote caufes may be confidered as 
predifponent and occafional. 
DI. 
The predifponent caufe, fo far as expref- 
fed by external appearances, or by the ge- 
neral temperament we have already mark- 
ed ; and phyficians have been very confi- 
dent in afligning the occafiona! caufes; 
but, in a difeafe depending fo much upon 
a predifpofition, the afligning occafional 
caufes muft be uncertain; as, in the pre- 
difpofed, the occafional caufes may not al- 
ways appear, and in perfons not predif- 
pofed OF PHYSIC. 
57 
pofed, they may appear without effect. 
This uhcertainty muft particularly affect 
the cafe of the gout; but I lhall offer 
what appears to me molt probable on the 
fubjedt. 
DIE 
The occafional caufes of the gout feem 
to be of two kinds. FirR, thofe which 
induce a plethoric Rate of the body. Se- 
condly, thofe which, in plethoric habits, 
induce a Rate of debility. 
Dill. 
Of the fir ft kind are a fedentary indolent 
manner of life, a full diet of animal food, 
and the large ufe of wine or of other fer- 
mented liquors. Thefe circumRances com- 
monly precede the difeafe; and if there 
fhould be any doubt of their power of 
Vol. II. 
E 
pro« 58 
PRACTICE 
producing it, the fad, however, will be 
rendered fufficiently probable by what has 
been obferved in CCCCXCVIII. 
DIV. 
Of the fecond kind of occafional caufes 
which induce debility are, excefs in ve- 
nery; intemperance in the ufe of intoxi- 
cating liquors; indigeftion, produced ei- 
ther by the quantity or quality of aliments; 
much application to ftudy or bufinefs ; 
night - watching ; exceffive evacuations; 
the ceafing of ufual labour; the fudden 
change from a very full to a very fpare 
diet; the large ufe of acids and acefcents ; 
and, laftly, cold applied to the lower ex- 
tremities. 
DV. 
The firft (DHL) feem. to ad by in- 
creafing O F P H Y S I C. 
59 
creaflng the predifpofltion. The laft (DIV.) 
are commonly the exciting caufes, both of 
the firfl. attacks, and of the repetitions of 
the difeafe. 
DVI. 
It is an inflammatory affection of fome 
of the joints which efpecially conftitutes 
what we call a paroxyfm of the gout. This 
fometimes comes on fuddenly without any 
warning, but is generally preceded by fe- 
veral fymptoms; fuch as the ceaflng of a 
fweating which the feet had been com- 
monly affected with before; an unufual 
coldnefs of the feet and legs ; a frequent 
numbnefs, alternating with a fenfe of 
prickling along the whole of the lower ex- 
tremities; frequent cramps of the mufcles 
of the legs; and an unufual turgcfcence 
of the veins. 
E 2 
DVII. 60 
PRACTICE 
DVII. 
While thefe fymptoms take place in the 
lower extremities, the whole body is af- 
fecded with fome degree of torpor and lan- 
guor, and the fundlions of the ftomach in 
particular are more or lefs difturbed. The 
appetite is diminiflied, and flatulency, or 
other fymptoms of indigeftion, are felt. 
Thefe fymptoms, and thofe of DVI. take 
place for feveral' days, fometimes for a 
week or two, before a paroxyfm comes 
on : but commonly, upon the day imme- 
diately preceding it, the appetite becomes 
greater than ufrtal. 
DVIIL 
The circumftances of paroxyfms are the 
following. They come on moft commonly 
in the fpring, and fooner or later accord- 
ing. as the vernal heat fucceeds fooner or 
later OF PHYSIC. 
61 
later to the winter's cold; and perhaps 
fooner or later alio according as the body 
may happen to be more or lefs expofed to 
vicifiitudes of heat and cold. 
DIX. 
The attacks are ibmetimes felt firft in 
the evening, but more commonly about 
two or three o'clock of the morning. The 
paroxyfm begins with a pain affeAing one 
foot, moft commonly in the ball or firft 
joint of the great toe, but fometimes in 
other parts of the foot. With the coming 
on of this pain, there is commonly more 
or lefs of a cold fhivering, which, as the 
pain increafes, gradually ceafes, and is 
fucceeded by a hot ftage of pyrexia, which 
continues for the fame time with the pain 
itfelf. From the firft attack, the pain be- 
comes by degrees more violent, and con- 
tinues in this ftate with great reftleflhefs 
E 3 
of 62 
PRACTICE 
of the whole body, till next midnight, 
after which it gradually remits ; and, after 
it has continued for twenty-four hours 
from the commencement of the firft at- 
tack, it commonly ceafes very entirely, 
and, with the coming on of a gentle 
fweat, allows the patient to fall afleep. The 
patient, upon coming out of this fleep in 
the morning, finds the pained part affect- 
ed with fome rednefs and fwelling, which, 
after having continued for fome days, 
gradually abate. 
DX. 
When a paroxyfm has thus come on, 
although the violent pain after twenty-four 
hours be confiderably abated, the patient 
is not entirely relieved from it. For fome 
days he has every evening a return of 
more confiderable pain and pyrexia, and 
[ which continue with more or lefs violence 
til! OF PHYSIC. 
63 
till morning. After continuing in this 
manner for feveral days, the difeafe fome- 
times goes entirely off, not to return till 
after a long interval. 
DXL 
When the difeafe, after having thus re- 
mained for fome time in a joint, ceafes 
very entirely, it generally leaves the perfon 
in very perfect health, enjoying greater 
eafe and alacrity in the fundlions of both 
body and mind, than he had for a long 
time before experienced. 
DXII. 
At the beginning of the difeafe, the re- 
turns of it are fometimes only once in three 
or four years; but, after fome time, the 
intervals become fliorter, and the attacks 
become annual ; afterwards they come 
E 4 
twice 64 
PRACTICE 
twice each year, and at length recur fevc- 
ral times during the whole courfe of au- 
tumn, winter, and fpring ; and as it hap- 
pens that, when the fits are frequent, the 
paroxyfms become alfo longer, fo, in the 
advanced ftate of the difeafe, the patient 
is hardly ever tolerably free from it, ex- 
cept perhaps for two or three months in 
fummer. 
DXIII. 
The progrefs of the difeafe is alfo marked 
by the parts which it affefts, At firft, it 
commonly affects one foot only, after- 
wards every paroxyfm affects both feet, 
the one after the other; and, as the difeafe 
continues to recur, it not only affects both 
feet at once, but after having ceafed in the 
foot which was fecondly attacked, returns 
again into the foot ffrft affeeffed, and per- 
haps a fecond time alfo into the other. Its 
changes OF PHYSIC. 
65 
changes of place are not only from one 
foot to the other, but alfo from the feet 
into other joints, efpecially thofe of the 
upper and lower extremities ; fo that there 
is hardly a joint of the body that is not, 
on one occafion or other, affected. It fome- 
times affeCts two different joints at the 
fame time, but more commonly it is fe- 
vere in a fingle joint only, and paifes fuc- 
ceffively from one joint to another; fo 
that the patient's affliction is often pro- 
tracted for a long time. 
DXIV. 
When the difeafe has often returned, 
and the paroxyfms have become very fre- 
quent, the pains are commonly lefs vio- 
lent than they were at firft ; but the pa- 
tient is more affected with ficknefs, and 
the other fymptoms of the atonic gout, 
which fhall be hereafter mentioned. 
DXV. 66 
PRACTICE 
DXV. 
After the firft paroxyfms of the difeafe, 
the joints which have been affedled arc 
entirely reftored to their former fupplenefs 
and ftrength; but after the difeafe has re- 
curred very often, the joints affefled do 
neither fo fuddenly nor fo entirely recover 
their former (late, but continue weak and 
fliff, and thefe effects at length proceed to 
fuch a degree ; that the joints lofe their 
motion altogether. 
DXVI. 
In many perfons, but not in all, after the 
difeafe has frequently recurred, concre- 
tions of a chalky nature are formed upon 
the outfide of the joints, and for the moft 
part immediately under the ikin. The 
matter feems to be depofited at firft in a 
fluid form, but afterwards becomes dry 
and OF PHYSIC. 
67 
and firm. In their dry ftate, thefe con- 
cretions are a friable earthy fubftance, very 
entirely foluble in acids. After they have 
been formed, they contribute, with other 
circumftances, to deftroy the motion of 
the joint. 
DXVII. 
In moft perfons who have laboured un- 
der the gout for many years, a nephritic 
affection comes on, and difcovers itfelf by 
all the fymptoms which ufually attend cal- 
culous concretions in the kidneys, and 
which we (hall have occalion to defcribe 
in another place. All that is necelfary to 
be obferved here is, that the nephritic af- 
fection alternates with paroxyfms of the 
gout, and that the two affe&ions, the 
nephritic and the gouty, are hardly ever 
prefent at the fame time. This alfo may 
be obferved, that children of gouty or 
nephritic 68 
PRACTICE 
nephritic parents, commonly inherit one 
or other of thefe difeafes; but which ever 
may have been the principal difeafe of the 
parent, fome of the children have the one, 
and fome the other. In. fome of them, 
the nephritic affection occurs alone, with- 
out any''gout fupervening; and this hap- 
pens to be frequently the cafe of thef emale 
offspring of gouty parents. 
DXVIII. 
In the whole of the hiftory already 
given, I have defcribed the moft common 
form of the difeafe, and which therefore, 
however diverlified in the manner I have 
faid, may be ftill called the regular ftate 
of the gout. Upon occaiion, however, the 
difeafe affumes different appearances ; but, 
as I fuppofe the difeafe to depend always 
upon a certain diathefis or difpofition of 
the fyftem; fo every appearance which we 
can OF PHYSIC. 
69 
can perceive to depend upon that fame dif- 
pofition, I ftill conflder as a fymptom and 
cafe of the gout. The principal circum- 
ftance in what we term the Regular Gout, 
is the inflammatory affection of the joints; 
and, whatever fymptoms we can perceive 
to be connected with, or to depend upon, 
the difpofition which produces that inflam- 
matory affe&ion, but without its taking 
place, or being prefent at the fame time, 
we name the Irregular Gout. 
DXIX. 
Of fuch irregular gout there are three 
different ftates, which I name the 
the and the mifplaced gout. 
DXX. 
The atonic ftate is when the gouty dia- 
thefis prevails in the fyftem, but, from 
certain 70 
PRACTICE 
certain caufes, does not produce the in- 
flammatory affedion of the joints. In this 
cafe, the morbid fymptoms which appear 
are chiefly affedions of the ftomach; fuch 
as lofs of appetite, indigeftion, and its 
various circumftances of ficknefs, naufea, 
vomiting, flatulency, acid erudations, and 
pains in the region of the ftomach. Thefe 
fymptoms are frequently accompanied with 
pains and cramps in feveral parts of the 
trunk, and the upper extremities of the 
body, which are relieved by the difcharge 
of wind from the ftomach. Together 
with thefe affections of the ftomach, there 
commonly occurs a coftivenefs ; but fome- 
times a loofenefs with colic-pains. Thefe 
affedions of the alimentary canal are often 
attended with all the fymptoms of hypo- 
chondriacs ; as dejedion of mind, a con- 
ftant and anxious attention to the flighteft 
feelings, an imaginary aggravation of thefe, 
and an apprehenfion of danger from them. 
In OF PHYSIC., 
71 
In the fame atonic gout, the vifcera of 
the thorax alfo are fometimes affedled, and 
palpitations, faintings, and afthma, occur. 
In the head alfo occur, headachs, gid- 
dinefs, apopledic and paralytic affections. 
DXXI. 
When the feveral fymptoms now men- 
tioned, occur in habits having the marks 
of a gouty difpofition, this may be fuf- 
peCted to have laid the foundation of them; 
and efpecially when either, in fuch habits, 
a manifeft tendency to the inflammatory 
affeCtion has formerly appeared; or when 
the fymptoms mentioned are intermixed 
with, and are relieved by, fome degree 
of the inflammatory gout. In fuch cafes 
there can be no doubt of confldering the 
whole as a flate of the gout. 
DXXII. 72 
PRACTICE 
DXXIL 
Another ftate of the difeafe I name the 
retrocedent gout. This occurs when an in- 
flammatory ftate of the joints has, in the 
ufual manner, come on, but which, with- 
out arifing to the ordinary degree of pain 
and inflammation, or, at leaft, without 
thefe continuing for the ufual time, and re- 
ceding gradually in the ufual manner, they 
fuddenly and entirely ceafe, while fome 
internal part becomes affected. The in- 
ternal part moft commonly affedled is the 
ftomach, which is then affected with an- 
xiety, flcknefs, vomiting, or violent pain; 
but fometimes the internal part is the 
heart, which gives occafion to a fyncope; 
fometimes it is the lungs which are affect- 
ed with afthma; and fometimes it is the 
head, giving occafion to apoplexy or palfy. 
In all thefe cafes, there can be no doubt 
of the fymptoms being all a part of the 
fame OF PHYSIC. 
73 
fame difeafe, however different the affec- 
tion may feem to be in the parts which it 
attacks. 
dxxiii. 
The third Rate of irregular gout, which 
we name the mif is when the gouty 
diatheiis, inftead of producing the inflam- 
matory affection of the joints, produces an 
inflammatory affection of fome internal 
part, and which appears from the fame 
fymptoms that attend the inflammation of 
thofe parts ariflng from other caufes. 
Whether the gouty diatheiis does ever 
produce fiich inflammation of the internal 
parts, without having firft produced it in 
the joints, or if the inflammation of the 
internal part be always a tranflation from 
the joints previoufly affedted, I dare not 
determine; but, even-fuppoiing the latter 
to b6 always the cafe, I think the difference 
Vol. II. 
F 
of 74 
PRACTICE 
of the affection of the internal part muft 
ftill diftinguilh the mifplaced from what 
I have named the Retrocedent Gout. 
DXXLV. 
What internal parts may be affected by 
the mifplaced gout, I cannot precifely fay, 
becaufe I have never met with any cafes of 
the mifplaced gout in my practice; and I 
find no cafes of it diflinctly marked by 
practical writers, except that of a pneu- 
monic inflammation. 
DXXV. 
There are two cafes of a tranflated gout; 
the one of which is an affection of the 
neck of the bladder, producing pain, ftran- 
gury, and a catarrhus veflese : The other 
is an affection of the replum, fometimes by 
pain alone in that part, and fometimes by 
1132- OF PHYSIC* 
75 
hemorrhoidal fwellings there. In gouty 
perfons, I have known fuch affections al- 
ternate with inflammatory affections of 
the joints: But whether to refer thofe af- 
fections to the retrocedent, or to the mid- 
placed gout, I will not prefume to deter- 
mine* 
DXXVI. 
From the hiltory which I have now de- 
livered of the gout, I think it may be dif- 
cerned under all its various appearances. 
It is, however, commonly fuppofed, that 
there are cafes in which it may be difficult 
to diftinguiffi gout from rheumatifm, and 
it is poffible there may be fuch cafes; but, 
for the moft part, the two difeafes may be 
diftinguifhed with great certainty by ob- 
ferving the predifpofition, the antecedents, 
the parts affedted, the recurrences of the 
difeafe, and its connexion with the other 
F 2 
parts 76 
PRACTICE 
parts of the fyftem; which circumftances, 
for the moft part, appear very differently 
in the two difeafes. 
DXXVIL 
With refpedl to the gout, our next bufi- 
nefs is to inveftigate its proximate caufe; 
which muft be a difficult talk, and I at* 
tempt it with fome diffidence. 
dxxviii. 
Upon this fubjeft, the opinion which 
has generally prevailed is, that the gout 
depends upon a certain morbific matter, 
always prefent in the body; and that this 
matter, by certain caufes, thrown upon the 
joints or other parts, produces the feveral 
phenomena of the difeafe. 
DXXIX. OF PHYSIC. 
77 
DXXIX. 
This doctrine, however ancient and ge- 
neral, appears to me very doubtful; for, 
Firft, there is no direct evidence of any 
morbific matter being prefent in perfons 
difpofed to the gout. There are no ex- 
periments or obfervations which fliow that 
the blood, or other humours of gouty per- 
fons, are in any refpecft different from 
thofe of other perfons. Previous to at- 
tacks of the gout, there appear no marks 
of any morbid ftate of the fluids; for the 
difeafe generally attacks thofe perfons who 
have enjoyed the molt perfect health, and 
appear to be in that ftate when the difeafe 
comes on. At a certain period of the dif- 
eafe, a peculiar matter indeed appears in 
gouty perfons, (DXVI.); but this, which 
does not appear in every inftance, and 
which appears only after the difeafe has 
fubfifted for a long time, feems manifeftly 
F 3 
t® 78 
PRACTICE 
to be the effect, not the caufe, of the difeafe, 
Further, though there be certain acrids 
which, taken into the body, feein to ex- 
cite the gout, (DIV.) it is probable that 
thefe acrids operate otherwife in exciting 
the difeafe, than by affording the material 
caufe of it. In general, therefore, there is 
no proof of any morbific matter being the 
caufe of the gout. 
Secondly, The fuppofitions concerning 
the particular nature of the matter pro- 
ducing the gout, have been fo various and 
fo contradictory to each other, as to allow 
us to conclude, that there is truly no proof 
of the exiflence of any of them. With 
refpeCt to many of thefe fuppofitions, they 
are fo inconfifient with chemical philofo- 
phy, and with the laws of the animal occo- 
nomy, that they mull be entirely rejected. 
Thirdly, The fuppofition of a morbific 
matter being the caufe of the gout, is not 
confident with the phenomena of the dif- 
eafe, OF PHYSIC. 
79 
eafe, particularly with its frequent and 
fudden tranflations from one part to an- 
other. 
Fourthly, The fuppofition is further ren- 
dered improbable by this, that, if a mor- 
bific matter did exift, its operation fhould 
be fimilar in the feveral parts which it at- 
tacks ; whereas it feems to be very differ- 
ent, being ftimulant, and exciting inflam- 
mation in the joints, but fedative and 
deftroying the tone in ftomach: Which, 
upon the fuppofition of particular matter 
adding in both cafes, is not to be explained 
by any difference in the part affected. 
Fifthly, Some facts, alleged in proof of 
a morbific matter, are not fufliciently con- 
firmed, fuch as thofe which would prove 
the difeafe to be contagious. There is, 
however, no proper evidence of this, the 
fafts given being not only few, but excep- 
tionable ; and the negative obfervations are 
innumerable. 
F 4 
Sixthly, 80 
PRACTICE 
Sixthly, Some arguments brought in 
favour of a morbific matter, are founded 
upon a miftaken explanation. The dif- 
eafe has been fuppofed to depend upon a 
morbific matter, becaufe it is hereditary. 
But the inference is not juft ; for moft 
hereditary difeafes do not depend upon 
any morbific matter, but upon a parti- 
cular conformation of the ftrucfture of the 
body, tranfmitted from the parent to the 
offspring ; and this laft appears to be par- 
ticularly the cafe in the gout. It may be 
alfo obferved, that hereditary difeafes, de- 
pending upon a morbific matter, always 
appear much more early in life than the 
gout commonly does. 
Seventhly, The fuppofition of a mor- 
bific matter being the caufe of the gout, 
has been hitherto ufelefs, as it has not 
fuggefted any fuccefsful method of cure. 
Particular fuppofitions have often corrupt- 
ed the practice, and have frequently led 
from OF PHYSIC. 
81 
from thofe views which might be ufeful, 
and from that practice which experience 
had approved. Further, though the fup- 
pofition of a morbific matter has been ge- 
nerally received, it has been as generally 
in practice. When the gout 
has affected the ftomach, nobody thinks 
of correcting the matter fuppofed to be 
prefent there, but merely of reftoring the 
tone of the moving fibres. 
Eighthly, The fuppofition of a morbific 
matter is quite fuperfluous; for it ex- 
plains nothing, without fuppofing that 
matter to produce a change in the date of 
the moving powers ; and a change in the 
ftate of the moving powers, produced 
by other caufes, explains every circum- 
ftance, without the fuppofition of a mor- 
bific matter; and, to this purpofe, it 
may be obferved, that many of the 
caufes (DIV.) exciting the gout, do not 
operate 82 
PRACTICE 
operate upon the ftate of the fluids, but 
diredlly and folcly upon that of the mo- 
ving powers. 
Laftly, The fuppofition of a morbific 
matter is alfo fuperfluous; becaufe, without 
any fiich fuppofition, I think the difeafe 
can be explained in a manner more con- 
fiftent with its phenomena, with the laws 
of the animal oeconomy, and with the me- 
thod of cure which experience has appro- 
ved. 
I now proceed to give this explanation ; 
but, before entering upon it, I muft pre- 
mife fome general obfervations. 
DXXX. 
The firft obfervation is, that the gout is 
a difeafe of the whole fyftem, or depends 
upon a certain general conformation and 
Rate of the body; which manifeftly appears 
from the fafts mentioned from CCCCXCIV. 
to OF PHYSIC. 
83 
to CCCCXCVII. But the general ftate of 
the fyftem depends chiefly upon the ftate 
of its primary moving powers; and there- 
fore the gout may be fuppofed to be chiefly 
an affection of thefe. 
DXXXI. 
My fecond obfervation is, that the gout 
is manifeftly an affection of the nervous 
fyftem; in which the primary moving 
powers of the whole fyftem are lodged. 
The occasional or exciting caufes (DIV.) 
are almoft all fuch as act diredlly upon the 
nerves and nervous fyftem; and the greater 
part of the fymptoms of the atonic or re- 
trocedent gout are manifeftly affections of 
the fame fyftem. (DXX. and DXX1L) 
This leads us to feek for an explanation of 
the whole of the difeafe in the laws of the 
nervous fyftem, and particularly in the 
changes 84 
'PRACTICE 
changes which may happen in the balanc-c 
of its feveral parts. 
DXXXIL 
My third obfervation is, that the fto- 
mach, which has fo univerfal a confent 
with the reft of the fyftem, is the internal 
part that is the moft frequently, and often 
very conflderably, afledled by the gout. 
The paroxyfms of the difeafe are com- 
monly preceded by an affection of the 
ftomach (DVII.); many of the exciting 
caufes (DIV.) act firft upon the ftomach; 
and the fymptoms of the atonic and re- 
trocedent gout (DXX. DXXII.) are moft 
commonly and chiefly affedtions of the 
fame organ. This obfervation leads us 
to remark, that there is a balance fub- 
flfting between the ftate of the internal 
and that of the external parts; and, in 
particular, that the ftate of the ftomach is 
con* O F PHYSIC. 
85 
Connected with that of the external parts, 
(XLIV.) fo that the Hate of tone in 
the one may be communicated to the 
other. 
DXXXIIL 
Thefe obfervations being premifed, I 
fliall now offer the following pathology of 
the gout. 
In fome perfons there is a certain vigo- 
rous and plethoric Rate of the fyftem. 
(CCCCXCVI.) which, at a certain period 
of life, is liable to a lofs of tone in the ex- 
tremities (CCCCXCIX. DVL). This is in 
fome meafure communicated to the whole 
fyftem, but appears more efpecially in the 
functions of the ftomach (DVIL). When 
this lofs of tone occurs while the energy of 
the brain ftill retains its vigour, the visme- 
dicatrix natural is excited to reftore the tone 
of the parts ; and accomplifhes it by ex- 
citing 86 
PRACTICE 
citing an inflammatory affedlion in fome 
part of the extremities. When this has 
fub fitted for fome days, the tone of the 
extremities, and of the whole fyftem, are 
reftored, and the patient returns to his 
ordinary flatc of health (DXL). 
DXXXIV. 
This is the courfe of things, in the ordi- 
nary form of the difeafe, which we name 
the regular gout; but there are circum- 
ftances of the body, in which this courfe 
is interrupted or varied. Thus when the 
atony (DVL DVII.) has taken place, 
if the re-a&ion (DIX.) do not fucceed, 
the atony continues in the ftorhach, or 
perhaps in other internal parts, and pro- 
duces that (late which we have, for rea- 
ions now obvious, named the atonic gout. 
DXXXV. OF PHYSIC. 
87 
DXXXV. 
A fecond cafe of variation in the courfe 
of the gout is, when, to the atony, the re- 
adlion and inflammation have to a certain 
degree fucceeded, but, from caufes either 
internal or external, the tone of the extre- 
mities, and perhaps of the whole fyftem, is 
weakened; fo that the inflammatory Rate, 
before it had either proceeded to the de- 
gree, or continued for the time, requifite 
for reftoring the tone of the fyftem, fud- 
denly and entirely ceafes. Hence the flo- 
mach, and other internal parts, relapfe 
into the ftate of atony; and perhaps have 
this increafed by the atony communicated 
from the extremities: All which appears 
in what we have termed the retrocedent 
gout. 
DXXXVI. 
A third cafe of variation from the ordi- 
nary 88 
PRACTICE 
nary courfe of the gout, is, when, to the 
atony ufually preceding, an inflammatory 
re-aclion fully fucceeds : But has its ufual 
determination to the joints by fome cir- 
cumftances prevented ; and is therefore di- 
rected to an internal part, where it pro- 
duces an inflammatory afteClion, and that 
ftate of things which we have named the 
mifplaced gout. 
DXXXVII 
We have thus offered an explanation o£ 
the circumftances of the fyftem in the fe- 
veral Rates of the gout; and this explanation 
we fuppofc to be confident with the phe- 
nomena of the difeafe, and with the laws 
of the animal oeconomy. There are indeed, 
with refpedt to the theory of the difeafe, 
feveral queftions which might be put; to 
which we have not given any anfwer. But, 
tho' perhaps we could give an anfwer to 
many OF PHYSIC. 
89 
many of thefe queftions, it does not here 
appear necellary; as at prefent we intend 
Only to eftablifh fuch general facts with 
regard to this difeafe, as may lay a founda- 
tion for the cure of it, fo far as experience 
has enabled us to profecute it. Proceed- 
ing, therefore, upon the feveral parts of 
the pathology given, as fo many matters of 
fact, I fhall now conlider what may be at- 
tempted towards the cure of the difeafe. 
DXXXVIII. 
In entering upon this, I mull obferve, 
in the firft place, that a cure has been 
commonly thought impoflible; and we 
acknowledge it to be very probable, that 
the gout, as a difeafe of the whole habit, 
and very often depending upon original 
conformation, cannot be cured by medi- 
cines, the effects of which are always 
very tranfitory, and feldom extend to 
Vol. II. 
G 
the 90 
PRACTICE 
the producing any coniiderable change of 
the whole habit. 
DXXXIX. 
It would perhaps have been happy for 
gouty perfons, if this opinion had been 
implicitly received by them ; as it would 
have prevented their having been fo often 
the dupes of felf-intereded pretenders, 
who have either amufed them with inert 
medicines, or have raftily employed thofe 
of the mod pernicious tendency. I am 
much difpofed to believe the impoffibility 
of a cure of the gout by medicines; and 
more certainly dill incline to think, that 
whatever may be the poffible power of 
medicines, yet no medicine for curing the 
gout has hitherto been found. Although 
almod every age has prcfented a new re- 
medy, yet all hitherto offered have very 
foon O F PHYSIC. 
91 
foon been either negledled as ufelefs, or 
condemned as pernicious. 
DXL. 
Though unwilling to admit the power 
of medicines, yet I contend, that a great 
deal can be done towards the cure of the 
gout by a regimen: And from what has 
been obferved (CCCCXCVIIL), I am firmly 
perfuaded, that any man who, early 'in 
life, will enter upon the confiant practice 
of bodily labour, and of abfiinence from 
animal food, will be preferved entirely 
from the difeafe. 
Whether there be any other means of 
radically curing the gout, I am not ready 
to determine. There are hiftories of cafes 
of the gout, in which it is faid, that by 
great emotions of mind, by wounds, and 
by other accidents, the fymptoms have 
been fuddenly relieved, and never again 
G 2 
rc- 92 
PRACTICE 
returned; but how far thefe accidental 
cures might be imitated by art, or would 
fucceed in other cafes, is at leaft extremely 
uncertain. 
DXLI. 
The practices proper and necefiary in 
the treatment of the gout, are toconfidered 
under two heads: As they are to be 
employed in the intervals of paroxyfms; 
As during the time of thefe. 
DXLII. 
In the intervals of paroxyfms, the indi- 
cations are, to prevent the return of pa- 
roxyfins, or at leaft to render them left fre- 
quent, and more moderate. During the 
time of paroxyfms, the indications are, to- 
moderate the violence, and fhorten the du- 
ration O F P H Y S I C. 
93 
ration of them as much as can be done 
with fafety. 
DXLIII. 
It has been already obferved, that the 
gout may be entirely prevented by con- 
ftant bodily exercife, and by a low diet; and 
I am of opinion, that this prevention may 
take place even in perfons who have a he- 
reditary difpofition to the difeafe. I muft 
add here, that, even when the difpofition 
has difcovered itfelf by fever al paroxyfms 
of inflammatory gout, I am perfuaded that 
labour and abftinence will abfolutely pre- 
vent any returns of it for the reft of life. 
Thefe, therefore, are the means of anfwering 
the firft indication to be purfued in the in- 
tervals of paroxyfms; and I muft here offer 
fome remarks upon the proper ufe of thefe 
remedies. 
G 3 
DXLIV. 94 
PRACTICE 
DXLIV. 
Exercife, in perfons difpofed to the gout, 
is directed to two purpofes: One of thefe is 
the ftrengthening of the tone of the extreme 
veffels; and the other, the guarding againfl 
a plethoric Rate. For the former, if ex- 
ercife be employed early in life, and before 
intemperance has weakened the body, a 
very moderate degree of it will anfwer the 
purpofe; and for the latter, if abftinence 
be at the fame time obferved, little exercife. 
will be neceffary, 
DXLV. 
With rcfpccl to cxcrcife, this in general 
is to be obferved, that it fhould never be 
violent; for, if violent, it cannot be long 
continued, and mutt always endanger the 
bringing on an atony in proportion to the 
violence of the preceding exercife. 
DXLVI OF PHYSIC. 
95 
DXLVI. 
It is alfo to be obferved, that the exer- 
cife of geftation, though confiderable and 
conftant, if it be entirely without bodily 
exercife, will not anfwer the purpofe in pre- 
venting the gout. For this end, therefore, 
the exercife mutt be in feme meafure that 
of the body ; and muft be moderate, but 
at the fame time conftant, and continued 
through life. 
DXLVII. 
In every cafe and circumftance of the 
gout in which the patient retains the ufe 
of his limbs, bodily exercife, in the in- 
tervals of paroxyfms, will always be ufe- 
ful; and, in the beginnings of the difeafe, 
when the difpofition to it is not yet ftrong, 
exercife may prevent a paroxyfm which 
otherwife might have come on. In more 
G 4 
advanced 96 
PRACTICE 
advanced flates of the difeafe, however, 
when there is fome difpofition to a pa- 
roxyfm, much walking will bring it on ; 
either as it weakens the tone of the lower 
extremities, or as it excites an inflamma- 
tory difpofition in them; and it is pro- 
bable, that in the fame manner ftrains or 
contufions often bring on a paroxyfm of 
the gout. 
DXLVIII. 
Abftinence, the other part of our regi- 
men (DXL.) for preventing the gout, is 
of more difficult application. If an abfti- 
nence from animal-food be entered upon 
early in life, while the vigour of the fy- 
Item is yet entire, we have no doubt of its 
being both fafe and effectual; but, if the 
motive for this dietffiall not have occur- 
red till the conftitution ffiall have been 
broken by intemperance, or by the de- 
cline OF PHYSIC. 
97 
cline of life, a low diet may then endanger 
the bringing on an atonic ftate. 
DXLIX. 
Further, if a low diet be entered upon 
only in the decline of life, and be at the 
fame time a very great change in the for- 
mer manner of living, the withdrawing of 
an accuftomed ftimulus of the fyftem may 
readily throw this into an atonic ftate. 
DL. 
The fafety of an abftemious courfe may 
be greater or lefs according to the manage- 
ment of it. It is animal-food which es- 
pecially difpofes to the plethoric and in- 
flammatory ftate, and that food is to be 
therefore efpecially avoided; but, on the 
other hand, it is vegetable aliment of the 
loweft quality that is in danger of weak- 
ening 98 
PRACTICE 
ening the fyftem too much, by not afford- 
ing fufficient nourifhment; and more par- 
ticularly, of weakening the tone of the 
ftomach by its acefcency. It is therefore 
a diet of a middle nature that is to be 
chofen ; and milk is precifely of this kind, 
as containing both animal and vegetable 
matter. 
As approaching to the nature of milk, 
and as being a vegetable matter contain- 
ing the greateft portion of nourifhment, 
the farinaceous feeds are next to be chofen 
and are the food moft proper to be joined 
with milk. 
DLL 
With refpedl to drink, fermented liquors 
are ufeful only when they are joined with 
animal-food, and that by their acefcency; 
and their ftimulus is only neceflary from 
cuftom. When, therefore, animal-food is 
to OF PHYSIC. 
99 
to be avoided, fermented liquors are un- 
neceffary; and, by increafing the acefcency 
of vegetables, thefe liquors may be hurt- 
ful. The ftimulus of fermented or fpi- 
rituous liquors, is not neceffary to the 
young and vigorous; and, when much 
employed, impairs the tone of the fyftem, 
Thefe liquors, therefore, are to be avoided, 
except fo far as cuftom and the declining 
Hate of the fyftem may have rendered 
them neceffary. For preventing or mode- 
rating the regular gout, water is the only 
proper drink. 
DLII. 
With refpedl to an abflemious courfe, 
it has been fuppofed, that an abftinence 
from animal-food and fermented liquors, 
or the living upon milk and farinacea alone 
for the fpace of one year, might be fuffi- 
cient for a radical cure of the gout: and 
it 100 
PRACTICE 
it is poflible that, at a certain period of 
life, in certain circumftances of the con- 
ftitution, fuch a meafure might anfwer 
the purpofe. But this is very doubtful; 
and it is more probable that the abftinence 
muft, in a great meafure, be continued, 
and the milk diet be perliiled in, for the 
reft of life. It is well known, that feveral 
perfons who had entered on an abflemious 
courfe, and had been thereby delivered 
from the gout, have, however, upon re- 
turning to their former manner of full 
Jiving, had the difeafe return upon them 
with as much violence as before, or in a 
more irregular and more dangerous form. 
DLIII. 
It has been alleged, that, for prevent- 
ing the return of the gout, blood-letting, 
or fcarifications of the feet, frequently re* 
peated, and at ftated times, may be prac- 
tifed OF PHYSIC. 
101 
tifed with advantage; but of this I have 
had no experience. 
DLIV. 
Exercife and abftinence are the means of 
avoiding the plethoric ftate which gives the 
difpofition to the gout, and are therefore 
the means propofed for preventing paro- 
xyfms, or at leaft for rendering them lefs 
frequent, and more moderate. But many 
circumftandes prevent the fteadinefs ne« 
ceflary in purfuing thefe meafures; and 
therefore, in fuch cafes, unlefs great care 
be taken to avoid the exciting caufes, the 
difeafe may frequently return; and, in 
many cafes, the preventing of paroxyfms 
is chiefly to be obtained by avoiding thofe 
exciting caufes enumerated in DIV. The 
conduct neceflary for avoiding them, will 
be fufliciently obvious to perfons acquaint- 
ed with the doctrines of the Hygieine, 
which PRACTICE 
102 
which I fuppofe to have been delivered in 
another place. 
DLV. 
A due attention in avoiding thofe feveral 
caufes, (Dill, DIV.) will certainly pre- 
vent fits of the gout; and the taking 
care that the exciting caufes be never ap- 
plied in a great degree, will certainly ren- 
der fits more moderate when they do come 
on. But, upon the whole, it will appear, 
that a ftridt attention to the whole con- 
duct of life, is in this matter necelfary; 
and therefore, when the predifpofition has 
taken place, it will be extremely difficult 
to avoid the difeafe. 
DLVI. 
I am indeed firmly perfuaded, that, by 
obviating the predifpofition, and by avoid- 
ing OF PHYSIC. 
103 
ing the exciting caufes, the gout may be 
entirely prevented: But as the meafures 
neceiTary for this purpofe will, in moft 
Cafe's, be purfued with difficulty, and even 
with reluctance, men have been very de- 
firous to find a medicine which might an- 
fwer the purpofe without any reftraint on 
their manner of living. To gratify this 
defire, phyficians have propofed, and, to 
take advantage of it, empirics have feigned, 
many remedies, as we have already ob- 
ferved. Of what nature feveral of thefe 
remedies have been, I cannot certainly fay; 
but, of thofe which are unknown, we con- 
clude, from their having been only of 
temporary fame, and from their having 
focn fallen into neglect, that they have 
been either inert or pernicious, and there- 
fore I make no inquiry after them; and 
lhall now remark only upon one or two 
known remedies for the gout which have 
been lately in vogue. 
DLVIL 104 
PRACTICE 
DLVII. 
One of thefe is what has been named in 
England the Portland Powder. This is 
not a new medicine, but is mentioned by 
Galen, and, with fome little variation 
in its compofition, has been mentioned by 
the writers of almoft every age fince that 
time. It appears to have been at times in 
fafhion, and to have again fallen into neg- 
left ; and I think that this laft has been 
owing to its having been fourtd to be, in 
many inftances, pernicious. In every in- 
ftance which I have known of its exhibi- 
tion for the length of time prefcribed, the 
perfons who had taken it were indeed 
afterwards free from any inflammatory 
afleftion of the joints : but they were af- 
fefted with many fymptoms of the atonic 
gout; and all, foon after finifliing their 
courfe of the medicine, have been attacked 
with OF PHYSIC. 
105 
With apoplexy, afthma, or dropfy, which 
proved fatal. 
DLVIII. 
Another remedy which has had the ap- 
pearance of preventing the gout, is an al- 
kali in various forms, fuch as the fixed 
alkali both mild and cauftic, lime-water, 
foap, and ab forbent earths. Since it be- 
came common to exhibit thefe medicines 
in nephritic and calculous cafes, it has 
often happened that they were given to 
thofe who were at the fame time fubjedl 
to the gout; and it has been obferved* 
that, under the ufe of thefe medicines, 
gouty ptrfons have been longer free from 
the fits of their difeafe. That, however, 
the ufe of thefe medicines has entirely 
prevented the returns of gout, I do not 
know ; becaufe I never puflied the ufe of 
thofe medicines for a long time, being 
apprehenfive that the long continued ufe 
Vol. II. 
H 
of 106 
PRACTICE 
of'them might produce a hurtful change 
in the ftate of the fluids. 
DLIX. 
With refpeft to preventing the gout, I 
have only one other remark to offer. As 
the preventing the gout depends very much 
on fupporting the tone of the ftomach, and 
avoiding indigeftion ; fo coflivenefs, by 
eccafioning this, is very hurtful to gouty 
perfons. It is therefore neceffary for fuch 
perfons to prevent or remove coflivenefs, 
and, by a laxative medicine, when need- 
ful; but it is at the fame time proper, that 
the medicine employed fhould be fuch as 
may keep the belly regular, without much 
purging. Aloetics, rhubarb, magnefia 
alba, or flowers of fulphur, may be em- 
ployed, as the one or the other may hap- 
pen to be beft fuited to particular perfons. 
DLX. OF PHYSIC. 
107 
DLX. 
Thefe are the feveral meafures (from 
DXLII. to DLIX.) to be purfued in the 
intervals of the paroxyfms; and we are 
next to mention the meafures proper du- 
ring the time of them. 
DLXI. 
As during the times of paroxyfms the 
body is in a feverifh ftate, no irritation 
fhould then be added to it; and every part, 
therefore, of the antiphlogiftic regimen, 
(CXXX. to CXXXIII.) except the appli- 
cation of cold, ought to be ftridlly ob- 
ferved. 
Another exception to the general rule 
may occur when the tone of the ftomach 
is weak, and when the patient has been 
before much accuftomed to the ufe of 
ftrong drink; for then it may be allowable, 
H 2 
and 108 
PRACTICE 
and even neceflary, to give forne animal- 
food, and a little wine. 
DLXII. 
That no irritation is to be added to the 
fyftem during the paroxyfms of gout, ex- 
cept in the cafes mentioned, is entirely 
agreed upon among phyficians : But it is 
a more difficult matter to determine whe- 
ther, during the time of paroxyfms, any 
meafures may be purfued to moderate the 
violence of readlion and of inflammation. 
Dr Sydenham has given it as his opinion, 
that the more violent the inflammation 
and pain, the paroxyfms will be the {hot- 
ter, as well as the interval between the 
prefent and next paroxyfm longer: and, if 
this opinion be admitted as juft, it will 
forbid the ufe of any remedies which 
might moderate the inflammation; which 
is, to a certain degree, undoubtedly ne- 
ceflary OF PHYSIC. 
109 
ceffary for the health of the body. On 
the other hand, acute pain prefles for re- 
lief, and, although a certain degree of in- 
flammation may feem abfolutely neceflary, 
it is not certain but that a moderate degree 
of it may anfwer the purpofe: And it is 
even probable, that, in many cafes, the 
violence of inflammation may weaken the 
tone of the parts, and thereby invite a re- 
turn of paroxyfms. It feems to me to be 
in this way, that, as the difeafe advances, 
the paroxyfms become more frequent. 
DLXIIL 
From thefe laft confiderations, it feems 
probable, that, during the time of paro- 
xyfins, feme meafures may be taken to 
moderate the violence of the inflammation 
and pain ; and particularly, that in firfl: 
paroxyfms, and in the young and vigo- 
rous, blood-letting at the arm may be prac- 
tifed 
H 3 110 
PRACTICE 
tifed with advantage: But I am perfuaded, 
that this practice cannot be repeated often 
with fafety; becaufe blood-letting not only 
weakens the tone of the fyflem, but may 
alfo contribute to produce plethora. I be- 
lieve, however, that bleeding by leeches 
on the foot, and upon the inflamed part, 
may be pradlifed, and repeated with greater 
fafety; and I have known inftances of its 
having been pracffifed with fafety, to mo- 
derate and fhorten paroxyfms : but how 
far it may be carried, we have not had 
experience enough to determine. 
DLXIV. 
Befides blood-letting, and the antiphlo- 
giflic regimen, it has been propofed to 
employ remedies for moderating the in- 
flammatory fpafm of the part affected, fuch 
as warm bathing, and emollient poultices. 
Thefe have fometimes been employed with 
advantage OF PHYSIC. 
111 
advantage and fafety; but, at other times, 
have been found to give occafion to a re- 
troceflion of the gout. 
DLXV. 
Bliftering is a very effectual means of 
relieving and difcufling a paroxyfm of the 
gout; but has alfo frequently had the ef- 
fect of rendering it retrocedent. 
DLXVI. 
The flinging with nettles I confider as 
analogous to bliftering; and I think it 
probable that it would be attended with 
the fame danger. 
DLXVII. 
The burning with moxa, or other fub- 
flances, I confider as a remedy of the fame 
H 4 
kind, 112 
PRACTICE 
kind. I have had indeed no evidence of 
this proving hurtful; but neither have I 
had any proper evidence of its having pro- 
ved a radical cure. 
DLXVIII. 
Camphire, and fome aromatic oils, 
have the power of allaying the pain, and 
of removing the inflammation from the 
part affeded: but thefe remedies com- 
monly make the inflammation only fliift 
from one part to another, and therefore 
with the hazard of its falling upon a part 
where it may be more dangerous; and they 
have fometimes rendered the gout retro- 
cedent. 
DLXIX. 
From thefe refledions (DLXIV. et feq.) 
it will appear, that feme danger muft at- 
tend OF PHYSIC. 
113 
tend every external application to the parts 
afledled, during a paroxyfm; and that 
therefore the common practice of commit- 
ting the perfon to patience and flannel 
alone, is eftablifhed upon the belt foum 
dation. 
DLXX. 
Opiates give the moft certain relief from 
pain; but, when given in the beginning 
of gouty paroxyfms, occafion thefe to re- 
turn with greater violence. When, how- 
ever, the paroxyfms fliall have abated in 
their violence, but ftill continue to return, 
fo as to occafion painful and reftlefs nights, 
opiates may be then given with fafety and 
advantage, efpecially in the cafe of perfons 
advanced in life, and who have been often 
affected with the difeafe. 
DLXXI. 114 
PRACTICE 
DLXXL 
When, after paroxyfms have ceafed, 
fome fwelling and ftiffnefs fhall remain in 
the joints, thefe fymptoms are to be dif* 
cuffed by the diligent ufe of the flefh-brufh. 
DLXXII. 
Purging, immediately after a paroxyfm, 
will be always employed with the hazard 
of bringing it on again. 
DLXXIIL 
I have now finifhed what has occurred 
to be laid upon the means of preventing 
and curing the regular gout; and fhall 
now confider its management when it has 
become irregular, of which, as I have ob- 
ferved above, there are three different 
cafes. 
DLXXIV. OF PHYSIC. 
115 
DLXXIV. 
In the firft cafe, which I have named 
the Atonic Gout, the cure is to be accom- 
plifhed by carefully avoiding all debili- 
tating caufes; and by employing, at the 
fame time, the means of ftrengthening the 
fyftem in general, ancj the ftomach in par- 
ticular. 
DLXXV. 
For the avoiding debilitating caufes, I 
muft refer to the dodlrines of the Hygi- 
enic, as in DLIV. 
DLXXVI. 
For ftrengthening the fyftem in gene- 
ral, I muft recommend frequent exercife 
on horfeback, and moderate walking. Cold 
bathing alfo may anfwer the purpofe, and 
may 116 
PRACTICE 
may bp fafely employed, if it appear to be 
powerful in ftimulating the fyftem, and be 
not applied when the extremities are threat- 
ened with any pain. 
For fupporting the tone of the fyftem in 
general, when threatened with atonicg out, 
fome animal food ought to be employed, 
and the more acefcent vegetables ought to 
be avoided. In the fame cafe, fome wine 
alfo may be neceifary; but it Ihould be in 
moderate quantity, and of the leaft acefcent 
kinds; and, if every kind of wine fhall 
be found to increafe the acidity of the fto- 
mach, ardent fpirits and water muft be 
employed. 
DLXXVII. 
For ftrengthening the ftomach, bitters 
and the Peruvian bark may be employed ; 
but care muft be taken that they be not 
con* OF PHYSIC. 
117 
conftantly employed for any great length 
of time. Compare DLVII. 
I 
The moft effectual medicine for ftrength- 
ening the ftomach is iron, which may be 
employed under various preparations; 
but, to me, the beft appears to be the ruft 
in fine powder, which may be given in 
very large dofes. 
For fupporting the tone of the ftomach, 
aromatics may be employed ; but fliould 
be ufed with caution, as the frequent and 
large ufe of them may have an oppofite ef- 
fect; and they fliould therefore be given 
only in compliance with former habits, or 
for palliating prefent fymptoms. 
When the ftomach happens to be liable 
to indigeftion, gentle vomits may be fre- 
quently given; and proper laxatives fliould 
be always employed to obviate, or to re- 
move, coftivenefs. 
DLXXVIII. 118 
PRACTICE 
DLXXVIII. 
In the atonic gout, or in perfons liable 
to it, to guard againft *cold is efpecially 
necelfary; and the mod certain means of 
doing this, is by repairing to a warm cli- 
mate during the winter-feafon. 
DLXXIX. 
In the more violent cafes of the atonic 
gout, bliftering the lower extremities may- 
be ufeful; but that remedy fhould be 
avoided when any pain threatens the ex- 
tremities. In perfons liable to the atonic 
gout, iflues may be eftablifhed in the ex- 
tremities, as, in fome meafure, a fupple- 
ment to the difeafe. 
DLXXXrf 
A fecond cafe of the irregular gout, is 
that OF PHYSIC. 
119 
that which I have named the Retrocedent. 
When this affects the ftomach and inte- 
ftines, relief is to be inftantly attempted 
by the free ufe of ftrong wines, joined 
with aromatics, and given warm; or if thefe 
fliall not prove powerful enough, ardent fpi- 
rits mull be employed, and are to be given 
in a large dofe. In moderate attacks, ardent 
fpirits impregnated with garlic, or with 
afa foetida, may be employed; or, even 
without the ardent fpirits, afolution of afa 
foetida with the volatile alkali may anfwer 
the purpofe. Opiates are often an effec- 
tual remedy, and may be joined with aro- 
matics, as in the Electuarium Thebaicum; 
or they may be ufefally joined with volatile 
alkali and camphire. Mufk has likewife 
proved ufeful in this difeafe. 
When the affection of the ftomach is 
accompanied with vomiting, this may be 
encouraged, by taking draughts of warm 
wine, at firft with water, and afterwards 
with- 120 
PRACTICE 
without it; having at length recourfe, if 
necellary, to feme of the remedies above 
mentioned, and particularly the opiates. 
In like manner, if the inteftines be af- 
fected with diarrhoea, this is to be at firft 
encouraged, by taking plentifully of weak 
broth ; and when this lhall have been done 
fufficiently4 the tumult is to quieted by 
opiates. 
DLXXXI. 
When the retrocedent gout fhall affect 
the lungs, and produce afthma, this is to 
be cured by opiates, by antifpafmodics, 
and, perhaps, by buffering on the breaft 
or back. 
DLXXXII. 
When the gout, leaving the extremities, 
fliall afteft the head and produce pain, 
vertigo. OF PHYSIC. 
121 
vertigo, apoplexy, cr palfy, our refourccsare 
very precarious. The moft probable means 
of relief is, bliflering the head; and if the 
gout fliall have receded very entirely from 
the extremities, blifters may be applied to 
thefe alfo. Together with thefe blifterings, 
aromatics, and the volatile alkali, may be 
thrown into the ftomach. 
DLXXXIII. 
The third cafe of the irregular gout is 
what I have named the Mifplaced, that is, 
when the inflammatory affection of the gout, 
inftead of falling upon tire extremities, falls 
upon fome internal part. In this cafe, the 
difeafe is to be treated by blood-letting, 
and by fuch other remedies as would be 
proper in an idiopathic inflammation of 
the fame parts. 
Vol. II. 
I 
DLXXX1V. 122 
PRACTICE 
DLXXX1V. 
"Whether the tranflation fo frequently 
made from the extremities to the kidneys, 
is to be confidered as an inftance of the 
mifplaced gout, feems, as we have faid be- 
fore, uncertain: but I am difpofed to think 
it fomething different; and therefore am of 
opinion, that, in the Nephralgia Calculofa 
produced upon this occafion, the remedies 
of inflammation are to be employed no 
farther than they may be otherwife fome- 
times neceffary in that difeafe, arifing 
from other caufes than the gout. 
BOOK BOOK HI. 
Of EXANTHEMATA, or 
ERUPTIVE FEVERS. 
DLXXXV. 
THE difeafes comprehended under this 
title, which make the third Order of 
Pyrexiae in our Nofology, are in general 
fuch as do not arife but upon occafion of 
a fpecific contagion applied, which firft 
produces fever, and afterwards an eruption 
upon the furface of the body; and which 
dif- 
I 2 124 
PRACTICE 
difeafes, for the moft part, affect perfons 
but once in the courfe of their lives. 
DLXXXVJ. 
Whether the character of the Order may 
be thus limited, or if the Order may be 
allowed to comprehend alfo the eruptive 
fevers produced by a matter generated in 
the body itfelf, and likewife thofe cafes of 
eruption which do not depend .upon con- 
tagion, or upon a matter generated before 
the fever, but upon a matter generated in 
the courfe of the fever, I am not ready to 
determine. Of the difeafes enumerated 
by the Nofologifls as Exanthemata. there 
are certainly three different kinds, which 
may be diftinguiflied by the circum fiances 
mentioned in this and the preceding para- 
graph. Of the firfl kind are the Small-pox, 
the Chicken-pox, the Meafles, the Scarlet 
Fever, and the Plague. Of the fecond kind 
fcems 'OF PHYSIC. 
125 
feems to be the Eryfipelas; and of the 
third kind I judge the Miliaria and Pe- 
techia to be. But as I am not fufficiently 
confident in the facts which fhould fupport 
thefe diftindlions, or which would enable 
us to apply them in all cafes; I go on in this 
book to treat of almoft all the exanthe- 
mata enumerated by preceding Nofologifts, 
with only fome difference in the arrange- 
ment from what it was in my former edi- 
tions. 
I 3 
CHAP. 126 
PRACTICE 
CHAP. I. 
Of the Sm a ll-pox. 
DLXXXVII. 
THE fmall-pox is a difeafe ariiingfrom 
a contagion of a ipecific nature, 
which firft produces a fever, and, on the 
third or fourth day thereof, produces an 
eruption of fmall red pimples. Thefe are 
afterwards formed into puftles, containing 
a matter, which, in the courfe of eight 
days from the time of the eruption, is 
changed OF PHYSIC. 
127 
changed into pus. After this, the matter 
dries, and falls off in crufts. 
DLXXXVIIL 
This is a general idea of the difeafe; 
but there are two particular forms or va- 
rieties of it, well known under the appel- 
lations of the Di/linfl and which 
require to be ipecially defcribed. 
DLXXXIX. 
In the former, or the diftincft fmall-pox, 
the eruptive fever is moderate, and ap- 
pears to be evidently of the inflammatory 
kind, or what we name a Synocha. It ge- 
nerally comes on about mid-day, with 
fome fymptoms of a cold ftage, and 
commonly with a confiderable languor 
and drowfinefs. A hot ftage is foon 
formed, and becomes more confiderable on 
I 4 
the 128 
PRACTICE 
the fecond and third days. During this 
courfe, children are liable to frequent Hart- 
ings from their {lumbers; and adults, if 
they are kept a-bed, are difpofcd to much 
fweating. On the third day, children are 
fometimes affedted with one or two epi- 
leptic fits. Towards the end of the third 
day, the eruption commonly appears, and 
gradually increafes during the fourth; ap- 
pearing firft upon the face, and fuccefiively 
on the inferior parts, fo as to be completed 
over the whole body on the fifth day. 
From the third day, the fever abates; 
and againft the fifth, it entirely ceafes. The 
eruption appears firft in fmall red fpots, hard- 
ly eminent, but by degrees rifing into pim- 
ples. Thefe are generally upon the face in 
fmallnumber; but, even when more nume- 
rous, they arc feparate and diftindt from one 
another. On the fifth or fixth day, a fmall 
veficle, containing an almofl colourlefs or 
whey-coloured fluid, appears upon the top 
o OF PHYSIC. 
129 
of each pimple. For two days, thefe ve- 
licles increafe in breadth only, and there is 
a fmall hollow pit in their middle; fo that 
it is only againft the eighth day that they 
are raifed into fpheroidical puftules. 
Thefe veficles or puftules, from their 
firft formation, continue to be furrounded 
with an exactly circular inflamed margin, 
which, when the puftules are numerous, 
diffufes fome inflammation over the neigh- 
bouring ficin, fo as to give fomewhat of a 
damafk rofe colour to the fpaces between 
the puftules. As the puftules increafe in 
fize, if they be numerous on the face, 
againft the eighth day the whole of the 
face becomes confiderably fwelled; and, 
in particular, the eye-lids are fo much 
fwelled as entirely to fhut the eyes. 
As the difeafe thus proceeds, the matter 
in the puftules becomes by degrees more 
opaque and white, and at length of a yel- 
lowifh colour. On the eleventh day, the 
fwelling 130 
PRACTICE 
fwelling of the face is abated, and tlid 
puftules feem quite full. On the top of 
each a darker fpot appears; and at this 
place the puftule, on the eleventh day, or 
foon after, is fpontaneoufly broken, and a 
portion of the matter oozes out; in confe- 
quence of which, the puftule is fhrivelled, 
and fubfides; while the matter oozing out 
dries, and forms a cruft upon its furface* 
Sometimes a little only of the matter oozes 
out; and what remains in the puftule be- 
CQmes thick, and even hard. After fome 
days, both the crufts and the hardened 
puftules fall off, leaving the ikin which 
they covered of a brown red colour; and 
it is only after many days that the ikin 
in thefe places refumes its natural colour. 
In fome cafes, where the matter of the pu- 
ftules has been more liquid, the crufts 
formed by it are later infalling off, and the 
part they covered fuffers fome defquama- 
tion, which leaves in it a fmall pit or hollow. 
This OF PHYSIC. 
131 
This is the courfe of things on the face; 
and fucceflively, the puftules on the reft of 
the body take the fame. The matter of 
the puftules, on the arms and hands, is 
frequently abforbed; fo that, at the height 
of the difeafe, thefe puftules appear as 
empty veficles. On the tenth and ele- 
venth days, as the fwelling of the face fub- 
iides, a fwelling arifes in the hands and 
feet; but which, again, fubiides, as the 
puftules come to maturity. 
When the puftules on the face are nu- 
merous, fome degree of pyrexia appears on 
the tenth and eleventh days, but difappears 
again after the puftules are fully ripened; 
or perhaps remains in a very flight degree 
till the puftules on the feet have finifhed 
their courfe. It is feldom that in the 
diftincft fmall-pox the fever continues 
longer. 
When the puftules on the face are nu- 
merous, fome uneafinefs in the throat, with 
a 132 
TRACTICE 
a hoarfcnefs of the voice, comes on upon 
the iixth or feventh day, and a thin liquid 
is poured out from the mouth Thefe 
fymptoms increafe with the fwelling of 
the face ; and the liquids of the mouth 
and throat becoming thicker, are more 
difficultly thrown out. There is, at the 
fame time, fome difficulty of fwallowing; 
fo that liquids taken in to be fwallowed 
are frequently rejected, or thrown out by 
the nofe. But all thefe affedlions of the 
fauces abate as the fwelling of the face 
fubfides. 
DXC. 
In the other form of fmall-pox, or what 
is called the Confluent, the courfe of the 
difeafe is, in general, the fame with that 
we have defcribed; but the fymptoms of 
every ftage are more violent, and feveral of 
the circumftances are different. 
In OF PHYSIC. 
133 
In particular, the eruptive fever is more 
violent. The pulfe is more frequent and 
more contradied, approaching to that flate 
of pulfe which is found in the typhus. 
The coma is more conliderable, and there 
is frequently a delirium. Vomiting, alfo, 
is a common fymptom, efpecially at the 
coming on of the difeafe. In very young 
infants, epileptic fits are fometimes fre- 
quent on the firft days of the difeafe, and 
fometimes prove fatal before any eruption 
appears; or they ulher in a very confluent 
and putrid fmall-pox. 
DXCI. 
The eruption appears more early on the 
third day, and it is frequently preceded or 
accompanied with an eryfipelatous efflo- 
refcence. Sometimes the eruption appears 
in clufters, like that of the mealies. When 
the eruption is completed, the pimples are 
always 134 
PRACTICE 
always more numerous upon the face, and 
at the fame time fmaller and lefs eminent. 
After the eruption, the fever fuffers fome 
remiffion, but never goes off entirely; and, 
after the fifth or fixth day, it again in- 
creafes, and continues confiderable through 
the remaining courfe of the difeafe. 
The vcficles formed on the tops of the 
pimples appear fooner; and while they in- 
creafe in breadth, do not retain a circular, 
but are every way of an irregular figure. 
Many of them run into one another, info- 
much that very often the face is covered ra- 
ther with one veficle than with a number 
of puftules. The veficles, fo far as they are 
any ways feparated, do not arife to a fphe- 
roidical form, but remain flat, and fome- 
times the whole of the face is of an even 
furface When the puftules are in any 
meafure feparated, their circumference is 
not bounded by an inflamed margin, and 
the OF PHYSIC. 
135 
the part of the fkin that is free from puf- 
tules is commonly pale and flaccid. 
The liquor that is in the puftules changes 
from a clear to an opaque appearance, and 
becomes whitilh or brownifli, but never 
acquires the yellow colour and thick con»- 
fiftence that appear in the diftintft fmall- 
pox. 
DXCII. 
The fwelling of the face which attends 
the diftindl fmall-pox, when they are 
numerous, and almoft then only, always 
attends the confluent, comes on more early, 
and arifes to a greater degree; but abates 
on the tenth day, and on the eleventh ftill 
more. At this time the puftules or ve- 
ficles break, and fhrivelling pour out a li- 
quor that is formed into brown or black 
crufts, which do not fall off for many days 
Thofc of the face, in falling off, 
leave 136 
PRACTICE 
leave the parts they cover fubjecl to a de- 
fquamation, which pretty certainly pro- 
duces pittings. 
On the other parts of the body, the 
puftules of the confluent fmall-pox are 
more diftincl than upon the face, but ne- 
ver acquire the fame maturity and conflu- 
ence of pus as in the properly diftindt 
kind. • 
The falivation which, only fometimes, 
attends the diftindl fmall-pox, very con- 
stantly attends the confluent; and both the 
falivation and the afl'eclion of the fauces 
above-mentioned, are, efpecially in adults, 
in a higher degree. In infants, a diar- 
rhoea comes frequently in place of the fa- 
livation. 
In the confluent fmall-pox, there is of- 
ten a confidcrable putrefcency of the fluids, 
as appears from petechise, from ferous ve- 
ficles, under which the fkin fliows a dif- 
pofition to gangrene, and from bloody 
urine O F P H Y S I C. 
137 
urine or other all which 
fymptoms frequently accompany this dif- 
eafe. 
In the confluent fmall-pox, the fever, 
which had only fuffered a remiflion from 
the time of eruption to that of maturation, 
is often, at or immediately after this pe- 
riod, renewed with confiderable violence. 
This is what has been called the Secondary 
Fever; and is, in different cafes, of various 
duration and event. 
DXCI1I. 
We have thus endeavoured to defcribe 
the various circumftances of the fmall- 
pox ; and from the difference of thefe cir- 
cumftances, the event of the difeafe may- 
be determined. The whole of the prog- 
nofis may be nearly comprifed in the fol- 
lowing proportions. 
The more exactly the difeafe retains the 
Vol. II. 
K 
form 138 
PRACTICE 
form of the diftinft kind, it is the fafer; 
and the more completely the difeafe takes 
the form of the confluent kind, it is the 
more dangerous. 
It is only when the diftinft kind fhows 
a great number of puftules on the face, or 
otherwife, by fever or putrefcency, ap- 
proaches to the circumftances of the con- 
fluent, that it is attended with any danger. 
In the confluent fmall-pox there is al- 
ways danger; and this is always more 
confiderable and certain, according as the 
fever is more violent and permanent, and 
efpecially as the marks and fymptoms of 
putrefcency are more evident. 
When the putrid difpofltion is very great, 
the difeafe fometimes proves fatal before 
the eighth day ; but in moft cafes it is 
on the eleventh that death happens, and 
fometimes it is put ofF till the fourteenth 
or feventeenth day. 
Though the fmall-pox fhould not be 
mime- OF PHYSIC. 
139 
immediately fatal, the more violent kinds 
are often followed by a morbid ftate of the 
body, of various kind and event. Thefe 
confequences, as I judge, may be imputed 
fometimes to an acrid matter produced by 
the preceding difeafe, and depofited in dif- 
ferent parts; and fometimes to an inflam- 
matory diathefis produced, and determined 
to particular parts of the body. 
DXC1V. 
It is, I think, agreed among practi- 
tioners, that, in the different cafes of fmall- 
pox, the difference chiefly depends upon 
the appearance of diflindl or confluent; 
and, from the above defcription of thefe 
kinds, it will appear, that they chiefly 
differ in the period of the eruption, in the 
number of puflules produced, in the form 
of the puflules, in the flate of the matter 
contained in them, in the continuance of 
K 2 
the  PRACTICE 
140 
the fever, and laftly in the danger of the 
difeafe. 
DXCV. 
Upon inquiring into the caufes of thefe 
differences, we might readily fufpccl, that 
they depended upon a difference of the 
contagion producing the difeafe. This, 
however, is not probable: for there are 
innumerable inftances of the contagion, 
arifing from a perfon labouring under the 
fmall-pox of the diftindl kind, producing 
the confluent ; and, on the contrary. 
Since the practice of inoculation became 
frequent, we have known the fame vario- 
lous matter produce in one perfon the di- 
flinct, and in another the confluent fmall- 
pox. It is therefore highly probable, that 
the difference of the fmall-pox does not 
depend upon any difference of the conta- 
gion, but upon fome difference in the 
ftate OF PHYSIC. 
141 
ftate of the perfons to whom it is applied, 
or in the ftate of certain circumftances 
concurring with the application of the 
contagion. 
DXCVI. 
To find out wherein the difference in 
the ftate of the perfons to whom the con- 
tagion of the fmall-pox is applied confifts, 
I obferve, that the difference between the 
diftintft and confluent fmall-pox confifts 
efpecially in the number of puftules pro- 
duced ; which, in the diftintft, are generally 
few ; in the confluent, always many. If, 
therefore, we fliall be able to difcover what, 
in the ftate of different perfons, can give 
occafion to more or fewer puftules, we 
Ihall probably be able to account for all 
the other differences of the diftindl and 
confluent fmall-pox. 
K3 
DXCVIL 142 
PRACTICE 
DXCVIL 
It is evident, that the contagion of the 
fmall-pox is a ferment with refpedt to the 
human fluids, and affimilates a great part 
of them to its own nature; and it is pro- 
bable, that the quantity thus afhmilated, 
is, in proportion to the bulk of their feve- 
ral bodies, nearly the fame in different 
perfons. This quantity paffes again out 
of the body, partly by infenfible perfpira- 
tion, and partly by being depofited in 
puftules; but'if the quantities generated 
be nearly equal, the quantities palling out 
of the body by the two ways mentioned 
are very unequal in different perfons; 
and, therefore, if we can explain the caufes 
which determine more to pafs by the one 
way than by the other, we may thereby 
difcover the caufes wrhich give occafion to 
more puftules in one perlon than in ano- 
ther. 
DXCVIII. OF PHYSIC. 
143 
DXCVIII. 
The caufes which determine more of the 
variolous matter to pafs by perfpiration, 
or to form puftules, are probably certain 
circumftances of the fkin, that determine 
more or lefs of the variolous matter to flick 
in it, or to pafs freely through it. 
DXCIX. 
The circumftance of the fkin, which 
feems to determine the variolous matter to 
flick in it, is a certain ftate of inflamma- 
tion, depending much upon the heat of it: 
Thus we have many inftances of parts of 
the body, from being more heated, having 
a greater number of puftules than other 
parts. In the prefent practice of inoculation, 
in which few puftules arc produced, much 
feems to be owing to the care that is taken 
to keep the fkin cool. Parts covered with 
K 4 
plafters, 144 
PRACTICE 
plafters, efpecially with thofe of a ftimulant 
kind, have more puftules than other parts. 
Further, certain circumftances, fuch as 
adult age, and full living, determining to 
a phlogiftic diathefis, feem to produce a 
greater number of puftules ; while the 
contrary circumftances have contrary ef- 
fects. 
DC. 
It is therefore probable, that an inflam- 
matory ftate of the whole fyftem, and 
more particularly of the fkin, gives occa- 
iion to agreater number of puftules: and the 
caufes of this may likewife produce moft 
of the other circumftances of the confluent 
fmall-pox; fuch as the period of eruption; 
the continuance of the fever; the eflufion 
of a more putrefcent matter, and lefs fit 
to be converted into pus; and, what arifes 
from O F PHYSIC. 
145 
from thence, the form and other circum- 
ftances of the puflules. 
DCI. 
Having thus attempted to account for 
the chief difference which occurs in the 
hate of the fmall-pox, we fhall now try 
the truth of our dodtrine, by its applica- 
tion to practice. 
DCII. 
In confidering the practice, we view it 
firft, in general, as fuited to render the 
difeafe more generally benign and fafe, 
and this by the practice of inoculation. 
DCIII. 
It is not neceffary here to defcribe the 
operation of inoculating; and what we 
name 146 
PRACTICE 
name the practice of inoculation, compre- 
hends all the feveral meafures which pre- 
cede or follow that operation, and are fup- 
pofed to produce its falutary effects. 
Thefe meafures are chiefly the follow- 
ing. 
1. The choofing for the fubjecl of ino- 
culation perfons otherwife free from dif- 
eafe, and not liable, from their age or 
other circumftances, to any incidental dif- 
eafe. 
2. The choofing a perfon at the time 
of life moft favourable to a mild difeafe. 
3. The choofing for the practice a fea- 
fon the moft conducive to the mildnefs of 
the difeafe. 
4. The preparing the perfon to be ino- 
culated, by abftinence from animal-food 
for fome time before inoculation. 
5. The preparing the perfon by courfes 
of mercurial and antimonial medicines. 
6. The taking care, at the time of ino- 
culation, OF PHYSIC. 
147 
culation, to avoid cold, intemperance, fear 
or other circumftances which might ag- 
gravate the future difeafe. 
7. After thefe preparations and precau- 
tions, the chooling a fit matter to be em- 
ployed in inoculation, by taking it from a 
perfon of a found conftitution, and free 
from any difeafe or fufpicion of it; by 
taking it from a perfon who has had the 
fmall-pox of the mod benign kind; and, 
laftly, by taking the matter from fuch per- 
fons, as foon as it has appeared in the 
pudules, either in the part inoculated, or 
on other parts of the body. 
8. The introducing, by inoculation, 
but a fmall portion of the contagious 
matter. 
9. After inoculation, the continuing the 
vegetable diet, as well as the employment 
of mercurial and antimonial medicines; 
and, at the fame time, frequently employ- 
ing purgatives. 
io. Both 148 
PRACTICE 
10. Both before and after inoculation, 
taking care to avoid external heat, either 
from the fun, artificial fires, warm cham- 
bers, much clothing, or being much in 
bed; and, on the contrary, expofing the 
perfon to a free and cool air. 
11. Upon the appearance of the eruptive 
fever, the rendering that moderate by the 
employment of purgatives ; by the ufe of 
cooling and antifeptic acids; and efpe- 
cially, by expofing the perfon frequently 
to a cool and even a cold air, at the fame 
time giving freely of cold drink. 
12. After the eruption, the continuing 
the application of cold air, and the ufe of 
purgatives, during the courfe of the dif- 
eafe, till the puftules are fully ripened. 
DCIV. 
Thefe are the meafures propofed and 
practifed in the lateft and moft improved 
ftate OF PHYSIC. 
149 
Hate of inoculation ; and the advantages 
obtained by the whole of the practice, or 
at leaft by molt of the meafures above- 
mentioned, are now afcertained by a long 
experience to amount to this, That, in 
in ninety-nine cafes of the hundred, ino- 
culation gives a diftind: fmall-pox only, 
and that alfo very generally of the mildeft 
form: but it will ftill be ufeful, for the 
proper conduct of inoculation, to confider 
the importance and utility of the feveral 
meafures above-mentioned, that we may 
thereby more exactly determine upon what 
the advantages of inoculation more cer- 
tainly depend. 
DCV, 
As the common infection may often 
feize perfons labouring under another dif- 
eafe, which may render the fmall-pox 
more violent, it is obvious that inoculation 
muft 150 
PRACTICE 
muft have a great advantage, by avoid* 
ing fuch concurrence. But, as the avoid- 
ing fiich concurrence may often, in the 
mean while, leave perfons expofed to the 
common infection, it merits inquiry, 
whether every difeafed ftate fhould reftrain 
from the practice of inoculation, or what 
are the particular difeafes that fhould do 
fo. This is not yet fufficiently afcertained 
by obfervation ; and we have frequently 
remarked, that the fault-pox have often 
occurred with a difeafed ftate of the body, 
without being thereby rendered more vio- 
lent. In particular, we have obferved, 
that a fcrophulous habit, or even the pre- 
fence of fcrophula, did not render the 
fmall-pox more violent; and we have ob- 
ferved alfo, that feveral difeafes of the fkin 
are equally innocent. I am of opinion, 
that they are the difeafes of the febrile 
kind, or ailments ready to induce or ag- 
gravate a febrile ftate, that efpecially give 
the OF PHYSIC. 
151 
the concurrence which is moft dangerous 
with the fmall-pox. I dare not attempt 
any general rules ; but I am difpofed to 
maintain, that, though a perfon be in a 
difeafed ftate, if that ftate be of uncertain 
nature and effeift, and at the fame time the 
fmall-pox be exceedingly rife, fo as to 
render it extremely difficult to guard 
againft the common infection, it will al- 
ways be fafer to give the fmall-pox by ino- 
culation, than to leave the perfon to take 
them by the common infection. 
DCVL 
Though inoculation has been pradlifed 
with fafety upon perfons of all ages ; yet, 
from what has actually occurred in the 
cafes of common infection, and from feve- 
ral other confiderations, there is reafon to 
conclude, that adults are more liable to a 
violent difeafe than perfons of younger 
years. 152 
PRACTICE 
years. At the fame time, it is-obferved, 
that children, in the time of their firft den- 
tition, are liable, from this irritation, to 
have the fmall-pox rendered more violent; 
and that infants, before the time of den- 
tition, upon receiving the contagion of the 
fmall-pox, are liable to be affedled with 
epileptic fits, which frequently prove fa- 
tal. It is, therefore, upon the whole, evi- 
dent, that, though circumftances may ad- 
mit, and even render inoculation at any 
age proper ; yet, for the moft part, it will 
be ftill more advifeable to choofe perfons 
at an age, after the firft dentition is over, 
and before the time of puberty. 
DCVIL 
Though inoculation has been pracftifed 
with fafety at every feafon of the year; 
yet, as it is certain that the cold of winter 
may increafe the inflammatory, and the 
heats OF PHYSIC. 
153 
heats of fummer increafe the putrefcent 
ftate of the fmall-pox, it is highly probable 
that inoculation may have fome advantage, 
from avoiding the extremes either of heat 
or cold. 
DCVIII. 
Although the original temperament and 
confutations of men are not to be rea- 
dily changed; it is fufficiently certain, 
that the conditions of the human body 
may, by various caufes, in many refpecfls 
be occafionally very much changed: and 
therefore, as the ufe of animal food may 
increafe both the inflammatory and pu- 
trefcent ftate of the human body, fo it 
muft render perfons, on receiving the con- 
tagion of the fmall-pox, lefs fecure againft 
a violent difeafe; and, therefore, inocu- 
lation may derive fome advantage from 
abftinence from animal food for fome time 
Vol. II. 
L 
before 154 
PRACTICE 
before the inoculation is performed: but 
I am of opinion, that a longer time than 
that ufually prefcribed may be often necef- 
fary; and I am perfuaded, that the Scot- 
tifli mothers who avoid giving their chil- 
dren animal food till they are paft the 
fmall-pox, render this difeafe in them of a 
milder kind. 
DCIX. 
I cannot deny that mercurial and anti- 
monial medicines may have fome effect 
in determining to a more free perfpiration, 
and therefore may be of fome ufe in pre- 
paring a perfon for the fmall-pox ; but 
there are many obfervations which ren- 
der me doubtful as to their effect. The 
quantity cf both thefe medicines, parti- 
cularly of the antimony, commonly em- 
ployed, is too inconfiderable to produce 
any effect It is true, that the mercurials 
have OF PHYSIC. 
155 
have often been employed more freely; 
but even their falutary e Heels have not been 
' evident, and their mifchievous effects 
have fometimes appeared. I doubt, there- 
fore, upon the whole, if inoculation de- 
rives any advantage from thefe pretended 
preparatory courfes of medicines. 
DCX. 
As it has been often obferved, in the cafe 
of almoft all contagions, that cold, intem- 
perance, fear, and fome other circumftan- 
ces, concurring with the application of the 
contagion, have greatly aggravated the fu- 
ture difeafe, fo it muft be the fame in the 
cafe of the fmall-pox ; and it is undoubt- 
ed, that inoculation muft derive a great, 
and perhaps its principal, advantage, from 
avoiding the concurrences above men- 
tioned, 
L 2 
next 156 
PRACTICE 
DCXL 
It has been commonly fuppofed, that 
inoculation has derived fome advantage 
from the choice of the matter employed in 
it; but, from what has been obferved in 
DXCV. it muft appear very doubtful 
if any choice be neceffary, or can be of 
any benefit, in determining the ftate of the 
difcafe. 
DCXIL 
It has been fuppofed by Tome, that ino- 
culation has an advantage, by introducing 
a fmall portion only of the contagious mat- 
ter: But this refts upon an uncertain foun- 
dation. It is not known what quantity is 
introduced by the common infection, and 
it may be a fmall quantity only. Although 
it were larger than that thrown in by ino- 
culation, it is not afcertained that the cir- 
cum- OF PHYSIC. 
157 
cumftance of quantity would have any ef- 
fecft. A certain quantity of ferment may 
be neceflary to excite fermentation in a 
given mafs; but, that quantity given, the 
fermentation and aflimilation are extended 
to the whole mafs; and we do not find 
that a greater quantity than is juft necef- 
fary, either increafes the atftivity of the 
fermentation, or more certainly fecures 
the aflimilation of the whole. In the cafe 
of the fmall-pox, a confiderable difference 
in the quantity of contagious matter intro- 
duced, has not difcovered any efled in mo- 
difying the difeafe. 
DCXIIL 
Purging has the effedl of diminifhing 
the activity of the fanguiferous fyftem, 
and of obviating its inflammatory ftate. 
It is therefore probable, that the frequent 
ufe of cooling purgatives is a practice at- 
tending 
L 3 158 
PRACTICE 
tending inoculation which may be of con- 
fiderable advantage; and, probably, it i$ 
alfo ufeful by diminifhing the determina- 
tion to the fkin. It appears to me, that 
mercurials and antimonials, as they are 
commonly managed, are ufeful only as 
they make a part of the purging courfe. 
DCXIV. 
It is probable, that the Rate of the fmall- 
pox depends very much upon the ftate of 
the eruptive fever, and particularly upon 
moderating the inflammatory ftate of the 
fkin ; and, therefore, it is probable, that 
the meafures taken for moderating the 
eruptive fever and inflammatory ftate of 
the fkin, afford the greateft improvement 
which has been made in the practice of 
inoculation. The tendency of purging, 
and the ufe of acids, for this purpofe, is 
fufliciently obvious; and upon the fame 
groundss OF PHYSIC. 
159 
grounds, we ffiould fuppofe, that blood- 
letting might be ufeful; but probably 
this has been omitted, for the fame rea- 
fon that perhaps might have led to the 
omiffion of other remedies alfo, which is, 
that we have found a more powerful and 
effectual one in the application of cold air, 
and the ufe of cold drink. Whatever 
doubts or difficulties our theory might 
prefent to us on this fubjedl, they may be 
entirely negledted, as the practice of In- 
doftan had long ago, and the practice of 
this country has lately by a large and re- 
peated experience, afcertained the fafety 
and efficacy of this remedy • and as it may 
and can be more certainly employed with 
the practice of inoculation, than it can be 
in cafes of common infection, it muft give 
a lingular advantage to the former. 
1-4 
DCXV. 160 
PRACTICE 
DCXV. 
After the eruption, when a few pimples 
only, have appeared on the face, the con- 
tinuing the application of cold air, and the 
employment of purgatives, has indeed been 
the practice of many inoculators: but, I 
think, thefe practices cannot be faid to give 
any peculiar advantages to inoculation; 
for when the Hate of the eruption is de- 
termined, when the number of puftules 
is very fmall, and the fever has entirely 
ceafed, I hold the fafety of the difeafe to 
be abfolutely afcertained, and the further 
ufe of remedies entirely fuperfluous. In 
fuch cafes, I judge the ufe of purgatives 
to be not only unneceflary, but that they 
may be often hurtful. 
DCXVI. 
I have thus confidered the feveral cir- 
cumftances and practices accompanying 
ino- OF PHYSIC. 
161 
inoculation, and have endeavoured to af- 
certain the utility and importance of each. 
Upon the whole, I hope I have fufficiently 
afcertained the general utility and great ad- 
vantage of this practice, efpecially confiding 
in this, that if certain precautions, prepa- 
rations, and remedies, are of importance, 
all of them can be employed with more 
certainty in the practice of inoculation, 
than in the cafe of common infection. 
It remains now that I fhould offer fome 
remarks on the conduct of the fmall-pox, 
as received by infeddion, or even when, after 
inoculation, the fymptoms fliall prove vio- 
lent. The latter fometimes happens, al- 
though every precaution and remedy have 
been employed. The caufe of this is not 
well known; but it appears to me to be 
commonly owing to a difpofition of the 
fluids to putrefcency. But, however this 
may be, it will appear, that, not only in 
the cafe of common infeddion, but even in 
that 162 
PRACTICE 
that of inoculation, there may be occafion 
for ftudying the conduct of this difeafe, 
in all its poflible varying circumftances. 
dcxvii. 
When, from the prevailing of fmall- 
pox as an epidemic, and more efpecially 
when it is known that a pcrfon not for- 
merly affedied with the difeafe has been 
expofed to the infection, if fuch perfon 
fhould be feized with the fymptoms of 
fever, there can be little doubt of its being 
an attack of the fmall-pox ; and therefore 
he is to be treated in every refpedt, as if 
the difeafe had been received by inocula- 
tion. He is to be freely expofed to a cool 
air, to be purged, and to have cooling 
acids given liberally. 
DCXVIII. 
If thefe meafures moderate the fever, 
no- OF PHYSIC. 
163 
nothing more is necefTary: But if the na- 
ture of the fever attacking a perfon be un- 
certain ; or, if with fufpicions of the fmall- 
pox, the fymptoms of the fever be violent; 
or even if, knowing the difeafe to be fmall- 
pox, the meafures mentioned DXCVII. 
fhall not moderate the fever fufficiently ; it 
will be proper to let fome blood; and this 
will be more efpecially proper, if the per- 
fon be an adult, of a plethoric habit, and 
accuftomed to full living. 
DCXIX, 
In the fame circumftances, we judge it 
will be always proper to give a vomit, as 
ufeful in the commencement of all fevers, 
and more efpecially in this, where a de- 
termination to the ftomach appears from 
pain and fpontaneous vomiting. 
DCXXo 164 
PRACTICE 
DCXX. 
It frequently happens, efpecially in in- 
fants, that, during the eruptive fever of the 
fmall-pox, convulfions occur. Of thefe, 
if only one or two fits appear on the 
evening preceding the eruption, they give 
a favourable prognoftic of a mild difeafe, 
and require no remedy; but if they occur 
more early, and be violent and frequently 
repeated, they are very dangerous, and re- 
quire a fpeedy remedy. For this purpofe, 
bleeding is hardly ever of fervice; bliftering 
always comes too late; and the only re- 
medy I have found effedual, is an opiate 
given in a large dofe. x 
DCXXL 
Thefe are the remedies neceflary during 
the eruptive fever; and if, upon the erup- 
tion, the pimples upon the face be very few 
and OF PHYSIC. 
165 
and diftincSt, the difeafe is no further of any 
danger, requires no remedies, and the pur- 
gatives, Which, as has been laid before, are 
by fome practitioners continued, prove of- 
ten hurtful. 
But when, upon the eruption, the pim- 
ples on the face are very numerous; when 
they are not diftinCt; and efpecially when, 
upon the fifth day, the fever does not fuf- 
fer a confiderable remifiion; the difeafe will 
ftill require a great deal of attention. 
DCXXII. 
If, after the eruption, the fever fhall 
continue; the avoiding heat, and the con- 
tinuing to expofe the body to a cool air, 
will ftill be proper. If the fever be con- 
fiderabk, with a full and hard pulfe, in an 
adult perfon, a bleeding will be necelfary; 
and, more certainly, a cooling purgative. 
It is, however, feldom that a repetition of 
the 166 
PRACTICE 
the bleeding will be proper, as a lofs of 
ftrength does ufually come on very foon; 
but the repetition of a purgative, or the 
frequent ufe of laxative glyfters, is com- 
monly ufeful. 
DCXXIII. 
When a lofs of ftrength, with other 
marks of a putrefcent tendency of the 
fluids, appears, it will be neceflary to ex- 
hibit the Peruvian bark in fubftance, and 
in large quantity. In the fame cafe, the 
free ufe of acids, and of nitre, is ufeful; 
and it is commonly proper alfo to give 
wine very freely. 
DCXXIV. 
From the fifth day of the difeafe, on- 
ward through the whole courfe of it, it is 
proper to give an opiate once or twice a- 
day, or PHYSIC. 
167 
day; taking care, at the fame time, to ob- 
viate coflivenefs, by purgatives, or laxative 
glyflers. 
DCXXV. 
In a violent difeafe, from the eighth to 
the eleventh day, it is proper to lay on 
bliflers fucceffively on different parts of the 
body, and that without regard to the parts 
being covered with puflules. 
DCXXVI. 
If, in this difeafe, the tumour of the fau- 
ces be confiderable ; the deglutition diffi- 
cult ; the faliva and mucus vifcid, and with 
difficulty thrown out; it will be proper to 
apply bliflers to the external fauces, and 
to employ diligently detergent gargles. 
DCXXVII. 168 
PRACTICE 
DCXXVIL 
During the whole courfe of the difeafe,* 
when any confiderable fever is prefent, the 
frequent exhibition of antimonial medi- 
cines, in naufeating dofes, has been found 
ufeful; and thefe, for the moft part, fuffi- 
ciently anfwer the purpofe of purgatives. 
DCXXVIII. 
The remedies mentioned from DCXXIL 
to DCXXVI. arc thofe frequently necef- 
fary, from the fifth day, till the fup- 
puration is finifhed. But as, after that 
period, the fever is fometimes continued 
and increafed; or, as fometimes, when, 
after there has been little or no fever be- 
fore, a fever now arifes, and continues with 
confiderable danger; this is what is called 
the Secondary Fever, and requires particu- 
lar treatment. 
DCXXIX. OF PHYSIC. 
169 
DCXXIX. 
When the fecondary fever follows the 
'diftind fmall-pox, and the pulfe is full and 
hard, the cafe is to be treated as an inflam- 
matory afledion, by bleeding and purging. 
But, if the fecondary fever follow the con- 
fluent fmall-pox, and be a continuance or 
exacerbation of the fever which had fub- 
flfted before, it is to be confldered as of 
the putrid kind; and in that cafe, bleeding 
is improper. Some purging may be ne- 
ceflary; but the remedies to be chiefly de- 
pended on, are the Peruvian bark and 
acids. 
When the fecondary fever firft appears, 
whether it is after a diftind or a confluent 
fmall-pox, it will be ufeful to exhibit an 
antimonial emetic in naufeating dofes, but 
in fuch manner as to produce fome vo- 
miting. 
M 
Vol, II. 
DCXXX. 170 
PRACTICE 
DCXXX. 
For avoiding the pits which frequently 
follw the fmall-pox, many different mea- 
fures have been propofed; but none of 
them appear to be fufficiently certain. 
CHAP. OF PHYSIC 
171 
CHAP. II. 
Of the Chicken-pox. 
DCXXXI. 
THIS diTeaTe Teems to depend upon a 
Tpecific contagion, and to affect per- 
fons but once in their lives. It is hardly 
ever attended with any danger; but as it 
Teems frequently to have given occafion to 
the Tuppofition of a perfon's having the 
Tmall-pox twice, it is proper to ftudy this 
M 2 
diTeafe, 172 
PRACTICE 
difeafe, and to diftinguifh it from the ge- 
nuine fmall-pox. 
DCXXXII. 
This may be generally done by attend- 
ing to the following circumftances. 
The eruption of the chicken-pox comes 
on with very little fever preceding it, or 
with fever of no determined duration. 
The pimples of the chicken-pox, more 
quickly than thofe of the fmall-pox, are 
formed into little veficles or puftules. 
The matter in thefe puftules remains 
fluid, and never acquires the colour or 
confiflence of the pus which appears in the 
puftules of the fmall-pox. 
The puftules of the chicken-pox are al- 
ways in three or four days from their firft 
appearance, formed into crufts. 
See Dr Heberden in Med. Tran fa ft. 
Vol. I. art. xvii. 
CHAP. OF PHYSIC. 
173 
CHAP. III. 
Of the Measles, 
DCXXXIII. 
r I "'HIS difeafe alfo depends upon a fpe- 
cific contagion, and affe&s perfons 
but once in their lives. 
DCXXXIV. 
it occurs moft frequently in children; 
but no age is exempted from it, if the 
M 3 
pet- 174 
PRACTICE 
perfons have not been fubjcclcd to it be-* 
fore.. 
DCXXXV. 
It commonly appears as an epidemic, 
firft in the month of January, and ceafes 
foon after the fummer folftice; but various 
accidents, introducing the contagion, may 
produce the difeafe at other times of the 
year. 
DCXXXVI. 
The difeafe always begins with a cold 
ftage, which is foon followed by a hot, 
with the ordinary fymptoms of thirft, heat, 
anorexia, anxiety, fickncfs, and vomiting; 
and thefe are more or lefs confiderable in 
different cafes. Sometimes from the be- 
ginning, the fever is fharp and violent; 
often, for the firft two days, it is obfcui e 
and OF PHYSIC. 
175 
and inconfiderable, but always becomes 
violent before the eruption, which ufually 
happens upon the fourth day. 
DCXXXVII. 
This eruptive fever, from its commence- 
ment, is always attended with hoarfenefs, 
with a frequent hoarfe dry cough, and fre- 
quently with fome difficulty of breathing. 
At the fame time, the eye-lids are fome- 
what fwelled, the eyes are a little inflamed, 
and pour out tears ; and, together with 
thefe fymptoms, there is a coryza, and 
frequent fneezing. For the moft part, a 
conftant drowfinefs attends the beginning 
of this difeafe. 
DCXXXVIII. 
The eruption, as we have faid, common-* 
ly appears upon the fourth day, firfl: on 
M 4 
the 176 
PRACTICE 
the face, and fuccettively on the lower 
parts of the body. It difcovers itfelf Hrft 
in fmall red points; but, foon after, a 
number of thefe appear in clutters, which 
do not arife into vifible pimples, but by 
the touch are found to be a little promi- 
nent. This the cafe on the face; but 
on other parts of the body, the promi- 
nence, or roughnefs, is hardly to be per- 
ceived. On the face the eruption retains 
its rednefs, or has that increafed for two 
days : but, on the third, the vivid rednefs 
is changed to a brownilli red; and, in a 
day or two more, the eruption entirely 
difappears, while a meally defquamation 
takes place. During the whole time of 
the eruption, the face is fomewhat turgid, 
but feldom confiderably fwelled. 
DCXXXIX. 
Sometimes, after the eruption has ap- 
peared, OF PHYSIC. 
177 
peared, the fever ceafes entirely: but this 
is feldom the cafe ; and more commonly 
the fever continues, or is increafed after 
the eruption, and does not ceafe till after 
the defquamation. Even then the fever 
does not always ceafe, but continues with 
various duration and effect. 
DCXL. 
Though the fever happen to ceafe upon 
the eruption's taking place, it is common 
for the cough to continue till after 
the defquamation, and fometimes much 
longer. 
In all cafes, while the fever continues, 
the cough alfo continues, generally with 
an increafe of the difficulty of breathing; 
and both of thefe fymptoms fometimes 
arife to a degree that denotes a pneumonic 
affedion. This may arife at any period 
of the difeafe ; but very often it does not 
come 178 
PRACTICE 
come on till after the defquamation of the 
eruption. 
After the fame period, alfo, a diarrhoea 
frequently comes on, and continues for 
fome time. 
DCXLL 
It is common for the mealies, even 
when they have not been of a violent kind, 
to be fucceeded by inflammatory affec- 
tions, particularly ophthalmia and phthir 
fls. 
DCXLIL 
If the blood be drawn from a vein du- 
ring the mealies, with the circumftances 
necclfary to favour the feparation of the 
gluten, this always appears feparated, and 
lying on the furface of the cralfamentum, 
as in inflammatory difeafes. 
DCXLIIL OF PHYSIC. 
179 
DCXLIII. 
For the molt part the meafles, even 
when violent, are without any putrid ten- 
dency ; but in fome cafes fuch a tendency 
appears, both in the courfe of the difeafe, 
and efpecially after the ordinary courfe of 
it is finifhed. See Dr Watfon, in London 
Med, Obfervations, Vol. IV. art. xi. 
DCXLIV. 
From what is delivered (fromDCXXXVIL 
to DCXLIL) it will appear, that the mea- 
lies are diftinguifhed by a catarrhal af- 
fection, and by an inflammatory diathelis 
to a confiderable degree; and therefore 
the danger attending them arifes chiefly 
from the coining on of a pneumonic in- 
flammation. 
PCXLV, 180 
PRACTICE 
DCXLV. 
From this confideration it will be ob* 
vious, that the remedies efpecially necef- 
fary, are thofe which may obviate and 
diminifh the inflammatory diathefis ; and 
therefore, in a particular manner, blood- 
letting. This remedy may be employed 
at any time in the courfe of the difeafe, or 
after its ordinary courfe is finiflied. It is 
to be employed more or lefs according to 
the urgency of the fymptoms of fever, 
cough, and dyfpnoea; and generally may 
be employed very freely. But, as the 
fymptoms of pneumonic inflammation fel- 
dom come on during the eruptive fever; 
and, as this fever is fometimes violent im- 
mediately before the eruption, though a 
fufliciently mild difeafe be to follow; fo 
bleeding is feldom very neceflary during 
the eruptive fever, and may often be re- 
fer v cd OF PHYSIC. 
181 
ferved for the periods of greater danger 
which are perhaps to enfue. 
DCXLVI. 
In all cafes of mealies, where there are 
no marks of putrefcency, and where there 
is no reafon, from the known nature of the 
epidemic, to apprehend putrefcency, bleed- 
ing is the remedy to be depended upon: 
but alfiftance may alfo be obtained from 
cooling purgatives; and particularly from 
bliftering on the lides, or between the 
ihoulders. 
DCXLVIL 
% 
The dry cough may be alleviated by the 
large ufe of demulcent pectorals, mucila- 
ginous, oily, or fweet. It may, however, 
be obferved, with refpedt to thefe demul- 
cents, that they are not fo powerful in in- 
volving 182 
PRACTICE 
volving and correcting the acrimony of 
the mafs of blood as has been imagined; 
and that their chief operation is by ber 
fmearing the fauces, and thereby defend- 
ing them from the irritation of acrids, 
either arifing from the lungs, or diftilling 
from the head. 
DCXLVIII. 
For moderating and quieting the cough 
in this difeafe, opiates certainly prove the 
mofl effectual means, whenever they can 
be fafely employed. In the mealies, in 
which an inflammatory flate prevails in a 
confiderable degree, opiates may be fup- 
pofed to be inadmiflible; and, in thofe 
cafes in which a high degree of pyrexia and 
dyfpnoea fhow either the prefence, or at 
leafl: the danger, of pneumonic inflamma- 
tion, I think that opiates might be very 
hurtful. In cafes, however, in which the 
dyfpncea OF PHYSIC. 
183 
dyfpncea is not confiderable, and where 
bleeding, to obviate or abate the inflam- 
matory ftate, has been duly employed, 
I 
and where the cough and watchfulnefs are 
the urgent fymptoms, I think that opiates 
may be fafely exhibited, and with great 
advantage. I think, further, that, in all 
the exanthemata, there is an acrimony dif- 
fufed over the fyftem, which gives a con- 
fiderable irritation; and, for obviating the 
effe&s of this, opiates are ufeful, and al- 
ways proper, when no particular contra- 
indication prevails. 
DCXLIX. 
When the defquamation of the meafles 
is finifhed, though there fhould then be 
no diforder remaining, phyficians have 
thought it neceffary to purge the patient 
feveral times, with a view to draw off the 
dregs of this difeafe. that is, a portion of 
the 184 
PRACTICE 
the morbific matter which is fuppofed td 
remain long in the body. I cannot reject 
this fuppofition; but, at the fame time, 
cannot believe, that the remains of the 
morbific matter, diffufed over the whole 
mafs of blood, can be entirely drawn off 
by purging; and it appears to me, that, 
to avoid the confequences of the mealies, it 
is not the drawing off the morbific matter 
which we need to fludy, fo much as the 
obviating and removing the inflammatory 
flate of the fyftem which had been in- 
duced by the difeafe. With this laft viewj 
indeed, purging may (fill be a proper re- 
medy ; but bleeding, in proportion to the 
fymptoms of inflammatory difpofition, is 
yet more fo. 
DCL. 
From our late experience of the benefit 
of cold ail in the eruptive fever of the 
fmall- OF PHYSIC. 
185 
fmall-pox, feme phylicians have been of ) 
opinion, that the practice might be trans- 
ferred to the mealies; but we have not yet 
had trials Sufficient to afeertain this. There | 
is no doubt that external heat may be very 
hurtful in the mealies, as in molt other 
inflammatory difeafes ; and therefore the 
body ought to be kept in a moderate tem- 
perature during the whole courfe of the 
mealies ; but how far, at any period of 
the difeafe, cold air may be applied with 
Safety, we are yet uncertain. Analogy, 
though So often the refource of phyfleians, 
is, in general, fallacious; and further, tho' 
the analogy with the fmall-pox might lead 
to the application of cold air during the 
eruptive fever of the meafles, the analogy 
with catarrh Seems tobeagainfl: the practice. 
After the eruption had appeared upon the 
fkin, we have had many inftances of cold 
air making it difappear, and thereby pro- 
ducing much diforder in the fyflem ; and 
Vol. II. 
N 
have 186 
PRACTICE 
have alfo had frequent examples of fuel! 
diforder being removed by reiloring the 
heat of the body, and thereby again bring- 
ing forth the eruption. 
CHAP. OF PHYSIC. 
187 
CHAP. IV. 
Of the Scarlet Fever. 
DCLI. 
TT may be doubted if the fcarlet fever be 
a difeafe fpecifically different from the 
cynanche maligna above defcribed. The 
latter is almoft always attended with a 
fcarlet eruption ; and, in all the inftances 
I have feen of what may be called the 
fcarlet fever, the difeafe, in almoft every 
perfon affected, has been attended with an 
ulcerous fore throat. 
N 2 
DCLIL 188 
PRACTICE 
DCL1I. 
This view of the matter may create 
fome doubt; but I am flill of opinion, 
that there is a fcarlet fever which is a 
difeafe fpecihcally different from the cy- 
nanchc maligna. 
Dodtor Sydenham has defcribed a fcarlet 
fever, which he had feen prevailing as an 
epidemic, with all the circumftances of the 
fever and eruption, without its being ac- 
companied with any affeciionof the throat; 
at leaft he does not take notice of any fuch 
affedlion, which fuch an accurate obferver 
could not fail to have done, if any fuch 
fymptom, as we have commonly feen ma- 
king a principal part of the difeafe, had 
attended thofe cafes which he had obferved. 
Several other writers have defcribed the 
fcarlet fever in the fame manner, and I 
know phylicians who have feen the dif- 
eafe in that form ; fo that there can be 
no OF PHYSIC. 
189 
no doubt of there being a fcarlet fever not 
necelfarily connected with an ulcerous 
fore throat, and therefore a difeafe different 
from the cynanche maligna. 
DCLIII. 
But, further, although in all the inftan- 
ces of fcarlet fever which I have feen, (and 
in the courfe of forty years I have feen it 
fix or feven times prevailing as an epidemic 
in Scotland), the difeafe, in almoft all the 
perfons affected, was attended with an ul- 
cerous fore throat, or was what Sauvages 
names the Scarlatina Anginofa; and al- 
though, in fome infiances, the ulcers of the 
throat were of a putrid and gangrenous 
kind, and at the fame time the difeafe in 
all its fymptoms refembled very exactly 
the cynanche maligna; yet, I am ftill per- 
fuaded, that not only the fcarlatina of 
Sydenham, but that even the fcarlatina 
N 3 
anginofa 190 
PRACTICE 
anginofa of Sauvages, is a different dif- 
eafe from the cynanche maligna; and I 
have formed this opinion from the follow- 
ing confiderations. 
DCLIV. 
ifl, There is a fcarlet fever entirely free 
from any affection of the throat, which 
fometimes prevails as an epidemic; and 
therefore there is a fpecific contagion pro- 
ducing a fcarlet eruption without any de- 
termination to the throat. 
idly, The Scarlatina, which, from its 
matter being generally determined to the 
throat, may be properly termed Anginofa, 
has, in many cafes of the fame epidemic, 
been without any affection of the throat; 
and therefore the contagion may be fup- 
pofed to be more efpecially determined to 
produce the eruption only. 
Though in all the epidemics that 
I OF PHYSIC. 
191 
I could allege to be thofe of the fcarlatina 
anginofa, there have been fome cafes which, 
in the nature of the ulcers, and in other 
circumftances, exaAly reiembled the cafes 
of the cynanche maligna ; yet I have as 
conftantly remarked, that thefe cafes have 
not been above one or two in a hundred, 
while the reft have all of them been with 
ulcers of a benign kind, and with cir- 
cumftances hereafter to bedefcribed, fome- 
what different from thofe of the cynanche 
maligna. 
y On the other hand, as I have two 
or three times feen the cynanche maligna 
epidemically prevailing; fo, among the per- 
fons affeAed, I have feen inftances of cafes 
as mild as thofe of the fcarlatina anginofa 
ufually are: but here the proportion was 
reverted; and thefe mild cafes were not 
one fifth of the whole, while the reft were 
of the putrid and malignant kind. 
Lafily-t It applies to the fame purpofe to 
N 4 192 
PRACTICE 
obferve, that, of the cynanche maligna* 
mod of the inftances terminate fatally; 
while, on the other hand, that is the event 
of very few of the cafes of the fcarlatina 
anginofa. 
DCLV; 
From thefe confiderations, though it 
may appear that there is fome affinity be- 
tween the cynanche maligna and fcarla- 
tina anginofa, it will ftill remain probable 
that the two difeafes are fpecifically dif- 
ferent. 1 have been at fome pains to eRa- 
bliffi this opinion: for, from all my ex- 
perience, I find, that thofe two difeafes re- 
quire a different treatment; and 1 there- 
fore now proceed to mention more parti- 
cularly the circumftances of the fcarlatina 
anginofa. 
DCLVI, OF PHYSIC. 
193 
DCLVL 
This difeafe commonly appears about 
the beginning of winter, and continues 
throughout that feafon. It comes on with 
fome cold fhivering, and other fymptoms 
of the fever which ufually introduces the 
other exanthemata. But here there is no 
cough, nor the other catarrhal fymptoms 
which attend the mealies; nor is there that 
anxiety and vomiting which commonly in- 
troduce the confluent fmall-pox, and which 
more certainly introduce the Cynanche 
Maligna. 
Early in the difeafe, fome uneafinefs is 
felt in the throat; and frequently the de- 
glutition is difficult, generally more fo than 
in the Cynanche Maligna. Upon looking 
into the fauces, a rednefs and fwelling ap- 
pear in colour and bulk approaching to 
the Rate of thefe fymptoms in the Cynan- 
che Tonlillaris; but, in the Scarlatina, 
cher® 194 
PRACTICE 
there is always more or lefs of Houghs, 
which feldorn appear in the Cynanche 
Tonfillaris; and the Houghs are commonly 
whiter than thofe in the Cynanche Ma- 
ligna. , 
While thefe appearances are difcovered 
in the fauces, upon the third or fourth day 
a fcarlet eruption appears on the fkin, in 
the fame form as defcribed in (CCCX1V.) 
This eruption is commonly more confi- 
derable and universal than in the Cynan- 
che; but it feldorn produces a remiffion 
of the the fever. The eruption for the 
moft part remains till the the third or 
fourth day after its firft appearance; but 
then goes off, ending in a meally defqua- 
mation. At this time the fever ufually 
fubfides ; and, generally, at the fame time, 
fon e degree of fweat comes on. 
The Houghs on the fauces, which ap- 
peared early in the difeafe, continue for 
fome days; but then falling off, difcover 
the OF PHYSIC. 
195 
the fwelling abated, and an nicer formed 
on one or both tonfils fhowing a laudable 
pus; and foon after the fever has fubfided, 
thefe ulcers heal up entirely. For the molt 
part this difeafe has much lefs of coryza 
attending it than the Cynanche Maligna; 
and, when there is a coryza attending the 
Scarlatina, the matter difcharged is lefs 
acrid, and has not the fetid fmell which 
it has in the other difeafe. 
In the Scarlatina, when the eruption has 
entirely difappeared, it frequently hap- 
pens, that, in a few days after, the whole 
body is affected with an anafarcous fwell- 
ing ; which, however, in a few days more, 
gradually fubfides. 
We have thus defcribed the moft com- 
mon circumftances of the Scarlatina Angi- 
nofa; and have only to add, that, during 
the time of its being epidemic, and efpe- 
cially upon its firfl fetting in, there are 
always a few cafes in which the cir- 
cum« 196 
PRACTICE 
cumflances of the difeafe approach very 
nearly to thofe of the Cynanche Maligna; 
and it is only in thefe infiances that the 
difeafe is attended with any danger. 
DCLV1I. 
With refpecl the cure of this difeafe, 
when the fymptoms of it are nearly the 
fame with thofe of the Cynanche Maligna, 
it requires exactly the fame treatment as 
directed in (CCCXVII.) 
DCLV1II. 
When the fcarlet fever appears, without 
any affection of the throat, the treatment 
of it is very fimple, and is delivered by Dr 
Sydenham. An antiphlogiftic regimen is 
commonly all that is requifite; avoiding, on 
one hand, the application of cold air; anxl, 
Qli the other, any increafe of external heat. 
DCL1X, OF PHYSIC. 
197 
DCLIX. 
In the ordinary date of the Scarlatina 
Anginofa, the fame treatment is, in mod 
cafes, fudicient; but as here the fever is 
commonly more confiderable, and there is 
likewife an affedron of the throat, fome 
remedies may be often neceffary. 
DCLX. 
"When there is a pretty high degree of 
fever with a full pulfe, and a confiderable 
fwelling of the tonfils, bleeding is very 
proper, efpecially in adults; and it has been 
frequently pracdifed with advantage: but 
as, even in the Cynanche Tonfillaris, much 
bleeding is feldom necelfary, (CCCV.); fo, 
in the Scarlatina, when the flate of the fe- 
ver and the appearances of the fauces ren- 
der the nature of the difeafe ambiguous, 
bleeding may be omitted; and, if not alto- 
gether 198 
PRACTICE 
gether avoided, it fhould at leaft not 
be large, and ought not to be repeated. 
DCLXI. 
Vomiting, and efpecially naufeating do- 
fes of emetics, notwithftanding the in- 
flamed ftate of the fauces, have been found 
very ufeful in this difeafe. An open belly 
is proper in every form of this difeafe; 
and when the naufeating dofes of emetics 
operate a little downwards, they are mote 
ferviceable. 
DCLXII. 
In every form of the Scarlatina Angi- 
nofa, through the whole courfe of it, de- 
tergent gargles fliould be employed, and 
more or lefs as the quantity of doughs 
and the vifcid mucus in the fauces may 
feem to require. 
DCLXIII. OF PHYSIC. 
199 
DCLXII1. 
Even in the milder Rates of the Scarla- 
tina Anginofa, it has been common with 
practitioners to exhibit the Peruvian bark 
through the whole courfe of the difeafe; 
but we are affured, by much experience, 
that in fuch cafes it may be lafely omit- 
ted, though in cafes any ways ambiguous 
it may not be prudent to neglect this re- 
medy. 
DCLXIV. 
The anafarcous (welling, which fre- 
quently follows the Scarlatina Anginofa, 
feldom requires any remedy; and, at leaft, 
the purgatives fo much inculcated, and fo 
commonly exhibited, foon take off the-ana- 
farca. 
CHAP. 200 
PRACTICE 
CHAP. V. 
Of the Plague. 
sect. I. 
Of the Phenomena cf the Plague. 
DCLXV. 
THE Plague is a difeafe which always 
arifesfrom contagion; which affects 
many perfons about the fame time; proves 
fatal to great numbers; generally produ- 
ces OF PHYSIC. 
201 
ces fever; and, in moft perfons, is attend- 
ed with buboes or carbuncles. 
DCLXVI. 
Thefe are the circumftances which taken 
together give the character of the difeafe; 
but it is accompanied with many fymp- 
toms almoft peculiar to itfelf, that, in diffe- 
rent perfons are greatly diverfified in num- 
ber and degree, and fhould be particularly 
ftudiedi I would wilh to lay a foundation 
for this; but think it unfit for a perfon 
who has never feen the difeafe to attempt 
its particular hiftory. For this, therefore, 
I muft refer to the authors who have 
written on the fubjedl; but allowing thofe 
only to be confulted, who have themfelves 
feen and treated the difeafe in all its diffe-* 
rent forms* 
o 
Vol. II. 
DCLXVII. 202 
PRACTICE 
DCLXVII. 
From the accounts of fuch authors, it 
appears to me, that the circumftances 
which particularly diflinguilh this difeafe, 
and efpecially the more violent and dan- 
gerous Rates of it, are, 
j/?, The great lofs of ftrength in the 
animal fundlions, which often appears ear- 
ly in the difeafe. 
The ftupor, giddinefs, and con- 
fequent daggering, which refembles drun- 
kcnnefs, or the head-ach, and various de- 
lirium ; which are all of them fymptoms 
denoting a great diforder in the fundlions 
of the brain. 
;///)', The anxiety, palpitation, fyncope, 
and efpecially the weaknefs and irregularity 
of the pulfc, which denote a confiderable 
difturbance in the adlion of the heart. 
The naufea and vomiting, parti- 
cularly the vomiting of bile, which fhows 
an accumulation of vitiated bile in the gall- 
bladder OF PHYSIC. 
203 
bladder and biliary dudts, and from 
thence derived into the inteftines and fto- 
mach ; all of which fymptoms I fuppofe 
to denote a confiderable fpafm, and lofs of 
tone, in the extreme vefl'els on the furface 
of the body. ; 
$thly.) The buboes or carbuncles, which 
denote an acrimony prevailing in the 
fluids. And, 
Lafily, The petechias, hemorrhagies, and 
colliquative diarrhoea, which denote a pu- 
trefcent tendency prevailing to a great de- 
gree in the mafs of blood. 
DCLXVI1I. 
From the confideration of all thefe fymp- 
toms, it appears, that the plague is efpe- 
cially diftinguilhed by a fpecific contagion, 
often fuddenly producing the moft confide- 
rable fymptoms of debility in the nervous 
fyflem or moving powers, as well as of 
a general putrcfcency in the fluids ; and it 
O 2 
is PRACTICE 
204 
is from the confideration of thefe circum- 
ftances as the proximate caufe, that I think 
both the prevention and cure of the plague 
muft be directed. 
DCLXIX. 
If this difeafe fliould revifit the northern 
parts of Europe, it is probable, that, at 
the time, there will be no phyfician then 
alive, who, at the firft appearance of the 
difeafe, can be guided by his former expe- 
rience, but muft be inftrudted by his ftudy 
of the writers on this fubject, and by ana- 
logy. It is, therefore, I hope, allowable 
for me, upon the fame grounds, to offer 
here my opinion with refpedt to both the 
prevention and cure of this difeafe. 
This paragraph was written before I had 
any notice of the plague of Mofcow anno 
17715 but I think it will hill apply to 
the OF PHYSIC. 
205 
the cafe of Great Britain and of may other 
northern dates. 
SECT. H. 
Of the Prevention of the Plague. 
DCLXX. 
With refpeft to the prevention: As 
we are firmly perfuaded that the difeafe 
never arifes in the northern parts of Europe, 
but in confequence of its being imported 
from fome other country; fo the firft mea- 
fure neceflary, is the magiftrate's taking 
care to prevent the importation : and this 
may generally be done by a due attention 
o 3 
to 206 
PRACTICE 
to bills of health, and to the proper per- 
formance of quarantains. 
DCLXXL 
With rcfpect to the latter, we are per- 
fuaded, that the quarantain of perfons may 
fafely be much lefs than forty days ; and, 
if this were allowed, the execution of the 
quarantain ■would be more exadi and cer- 
tain, as the temptation to break it would 
be in a great meafure removed. 
DCLXXII. 
With refpect to the quarantain of goods; 
it cannot be perfect, unlefs the fufpected 
goods be unpacked and duly ventilated, 
as well as the other means employed for 
correcting the infeftion they may carry; 
and, if all this were properly done, it is 
probable that the time commonly prefer!- 
bed O F P H Y S I C. 
207 
bed for the quarantain of goods might alfo 
be fliortened. 
DCLXXIII. 
A fecond meafure, in the way of pre- 
vention, becomes requifite, when an in- 
fection has reached and prevailed in any 
place, to prevent that infection from 
spreading into other places. This can be 
done only by preventing the inhabitants, 
or the goods of any infedted place, from 
going out of it, till they have undergone 
a proper quarantain. 
DCLXXIV. 
The third meafure for prevention, to be 
employed with great care, is to hinder the 
infection from fpreading among the in- 
habitants of the place in which it has ari- 
fen. The meafures neceflary for this are 
O 4 
to 208 
PRACTICE 
to be directed by the dodtrine laid down 
in LXXXII. ; and from that doctrine 
we infer, that all perfons who can avoid 
any near communication with infected 
perfons, or goods, may efcape the infec- 
tion. 
DCLXXV. 
For avoiding fiicli communication, a 
great deal may be done by the maglftrate, 
i. By allowing as many of the inhabitants 
as are free from the infection, and not 
neceflary to the fervice of the place, to go 
put of it. 2. By prohibiting all affem- 
blies, or unneceflary intercourfe, of the 
people. 3. By taking care that neceflary 
communications be performed without 
contact. 4. By making fuch arrange- 
ments and proviflons as may render it eafy 
for the families remaining, to flint them- 
felyes up in their own houfes. 5. By al- 
lowing OF PHYSIC. 
209 
lowing perfons to quit houfes in which an 
infection appears, upon condition that they 
go into lazarettos. 9. By ventilating and 
purifying, or deftroying at the public 
expence, all infected goods. Laftly, By 
avoiding hofpitals, and providing fepa- 
rate apartments for infedled perfons. 
The execution of thefe mcafures will re- 
* 
quire great authority, and much vigilance 
and attention, on the part of themagiftrate; 
but it is not our province to enter into 
any detail on this fubject of the public 
police. 
DCLXXVI, 
The fourth and laft part of the bufinefs 
of prevention, refpedls the conduct of 
perfons neceflarily remaining in infected 
places, efpecially of thofe obliged to have 
fome communication with perfons infeded. 
DCLXXVII. 210 
PRACTICE 
DCLXXVII. 
Of thofe obliged to remain in infected 
places, but not obliged to have any near 
communication with the fick, they may 
be preferved from the contagion by avoid- 
ing all near communication with other 
perfons, or their goods ; and, it is pro- 
bable, that a fmall diftance will anfwer the 
purpofe, if, at the fame time, there be no 
ftream of air to carry the effluvia of per- 
fons, or goods, to fome diftance. 
DCLXXVIIL 
For thofe who are neceflarily obliged to 
have a near communication with the lick, 
it is proper to let them know, that fome of 
the moft powerful contagions do not ope- 
rate, but when the bodies of men expofed 
to the contagion are in certain circum- 
ftances which render them more liable to 
be OF PHYSIC. 
211 
be affected by it, or when certain caufes 
concur to excite the power of it; and there- 
fore, by avoiding thefe circumftances and 
caufes, they may often efcape infection. 
DCLXXIX. 
The bodies of men are efpecially liable 
to be affected by contagions, when they are 
any ways confiderably weakened by want 
of food, and even by a fcanty diet or one 
of little nourifhment; by intemperance in 
drinking, which, when the ftupor of in- 
toxication is over, leaves the body in a 
weakened date ; by excefs in venery ; by 
great fatigue; or by any conliderable eva- 
cuation. 
DCLXXX. 
The caufes which, concurring with con- 
tagion, 212 
PRACTICE 
tagion, render it more certainly adlive, are 
cold, fear, and full living. 
The feveral means, therefore, of avoid- 
ing or guarding againfl the adtion of cold 
(XCIV. to XGVI.) are to be carefully 
ftudied. 
DCLXXXI. 
Againft fear the mind is to be fortified 
as well as poftlble, by infpiring a favour- 
able idea of the power of prefcrvative 
means ; by deftroying the opinion of the 
incurable nature of the difeafe ; by occu- 
pying mens minds with bufinefs or labour; 
and by avoiding all objects of fear, as fu- 
nerals, pafling bells, and any notice of the 
death of particular friends. 
DCLXXXIL 
A full diet of animal-food increafes the 
irritability OF PHYSIC. 
213 
irritability of the body, and favours the 
operation of contagion; and indigeflion, 
whether from the quantity or quality of 
food, has the fame effect, 
DCLXXXIII. 
Belides giving attention tp obviate the 
feveral circumftances (DCX. DCLXXIX. 
to DCLXXXII.) which favour the opera- 
tion of contagion, it is probable that fome 
means may be employed for ftrengthening 
the bodies of men, and thereby enabling 
them to refill contagion. 
For this purpofe, it is probable, that the 
moderate ufe of wine, or of fpirituous li- 
quors, may have a good effect. 
' It is probable alfo, that exercife, when it 
can be employed, if fo moderate as to be 
neither heating nor fatiguing to the body, 
may be employed with advantage. 
Perfons who have tried cold bathing, 
and commonly feel invigorating effects 
from 214 
PRACTICE 
from it, if they are any ways fecure againft 
having already received infedion, may 
poflibly be enabled to relift it by the ufe 
of the cold bath. 
It is probable, that fome medicines alfo 
may be ufeful in enabling men to relift 
infection : but amongft thefe I can hardly 
admit the numerous alcxipharmics for- 
merly propofed ; or, at leaft, very few of 
them, and thofe only of tonic power. 
Amongft thefe laft we reckon the Peruvian 
bark; and it is perhaps the moft effectual. 
If any thing is to be expecfted from anti- 
feptics, I think camphire, whether inter- 
nally or externally employed, is one of the 
moft promiling. 
Every perfon is to be indulged in the 
ufe of any means of prefervation of which 
he has conceived a good opinion, whether 
it be a charm or a medicine, if the latter 
be not-direcily hurtful. 
Whether ilfues be ufeful in preferving 
from, or in moderating the c fleets of, con- 
tagion, OF PHYSIC. 
215 
tagion, I cannot determine from the ob- 
fervations I have yet read. 
DCLXXX1V. 
As neither the atmofphere in general, 
nor any confiderable portion of it, is 
tainted or impregnated with the matter of 
contagions ; fo the lighting of fires over 
a great part of the infedled city, or other 
general fumigations in the open air, are of 
no ufe for preventing the difeafe, and may 
perhaps be hurtful. 
DCLXXXV. 
It would probably contribute much to 
check the progrefs of infection, if the poor 
were enjoined to make a frequent change 
of cloathing, and were fuitably provided 
for that purpofe; and if they were, at the 
fame time, induced to make a frequent 
ventilation of their houfes and furniture. 
SECT. 216 
PRACTICE 
SECT. III. 
Of the Cure of the Plague* 
DCLXXXVL 
In* the cure of the plague, the indica- 
tions are the fame as thofe of fever in ge- 
neral, (CXXVL); but here they are not 
all equally neceflary and important. 
DCLXXXVIL 
The meafures for moderating the vio- 
lence of reaction, which operate by 
minifhing the action of the heart and ar- 
teries OF PHYSIC. 
217 
teries (CXXVIIL), have feldom any place 
here, excepting fo far as the antiphlogiftic re- 
gimen is generally proper. Some phyficians, 
indeed, have recommended bleeding; and 
there may occur cafes in which bleeding 
may be ufeful; but, for the mod part, it 
is unneceffary, and in many cafes it might 
be very hurtful. 
Purging has alfo been recommended; 
and, in fome degree, it may be ufeful in 
drawing off the bile, or other putrefeent 
matters frequently prefentin the inteftines; 
but a large evacuation this way may cer- 
tainly be hurtful. 
DCLXXXVIII. 
The moderating the violence of reaction, 
lb far as it can be done by taking off the 
fpafm of the extreme veffels (CLI.) is a 
meafure of the utmoft neceffity in the 
cure of the plague ; and the whole of the 
Vol. IL 
P 
means 218 
PRACTICE 
means (CLII. to CC.) fuited to this indica- 
tion are extremely proper. 
DCLXXXIX. 
The giving an emetic at the very firft 
approach of thedifeafe, would probably be 
of great fervice; and it is likely, that at 
fome other periods of the difeafe emetics 
might be ufeful, both by evacuating bile 
abundant in the alimentary canal, and by 
taking off the fpafm of the extreme veffels. 
DCXC. 
From fome principles with refpeft to 
fever in general, and with refpeci to the 
plague in particular, I am of opinion, that, 
after the exhibition of the firft vomit, the 
body fhould be difpofed to fweat; which 
ought to be raifed to a moderate degree 
only, but continued for at lead twenty- 
four OF PHYSIC. 
219 
four hours, or longer if the patient bear 
it ealily. 
DCXCL 
This fweating fliould be excited and con- 
duced agreeably to the rules laid down 
in CLXVI11.) It is to be promoted by 
the plentiful ufe of diluents, rendered more 
grateful by vegetable acids, or more po wer- 
ful by being impregnated with fome por- 
tion of neutral faits. 
DCXCII. 
To Support the patient under the conti- 
nuance of the fweat, a little weak broth, 
acidulated with juice of lemons, may be 
given frequently; and fometimes a little 
wine, if the heat of the body be not con- 
fiderable. 
p 2 
DCXCIII. 220 
PRACTICE 
DCXCI1I. 
If fudorific medicines are judged to be 
neceflary, opiates are the moft effectual 
and fafe: but they fhould not be combined 
with aromatics; and probably may be 
more effectual, if joined with a portion of 
emetics, and of neutral faits. 
DCXCIV. 
If, notwithftanding the ufe of emetics 
and fudorifics, the difeafe fhould flill con- 
tinue, the cure muft depend upon the 
employment of means for obviating de- 
bility and putrefcency; and, for this pur- 
pofe, the various remedies propofed above 
(from CCI. to CCXXVI1), may all be 
adminiflcred, bur efpecially the tonics; and 
of thefe the chief are cold drink and the 
Peruvian bark. 
DCXCV. O F PH YSI C. 
221 
DCXCV. 
In the cure of the plague, fome attention 
is due to the management of bilboes and 
carbuncles ; but we do not touch this, as 
it belongs to the province of furgery. 
P 3 
CHAP. 222 
PRACTICE 
CHAP. VI. 
Of Erysipelas, or St Anthony'sFire, 
DCXCVI, 
IN (CCLXXIV ) I mentioned the diftinc- 
tion w hich 1 propofed to make betv\ een the 
difeafes to be named the Erythema and the 
Eryfipelas; and from thence it will appear, 
that Eryfipelas, as an Frythema following 
fever, may have its place here. 
DCXCVIL 
I fuppofe the eryfipelas to depend on 
a OF PHYSIC. 
223 
a matter generated within the body, and 
which, analogous to the other cafes of ex- 
anthemata, is, in confequence of fever, 
thrown out upon the furface of the body. 
I own it may be difficult to apply this to 
every particular cafe of eryfipelas; but I 
take the cafe in which it is generally fup- 
pofed to apply, that of the eryfipelas of the 
face; which I (ball therefore confider here. 
DCCVIII. 
The Eryfipelas of the face comes on 
with a cold {hivering, and other fymptoms 
of pyrexia. The hot llage of this is fre- 
quently attended with a confufion of head, 
and fome degree of delirium; and almoft 
always with drowfineis, or perhaps coma. 
The pulfe is always frequent, and com- 
monly full and hard. 
P4 
DCCIX 224 
PRACTICE 
DCXCIX. 
When thefe fymptoms have continued 
for one, two, or at mod three days, there 
appears, on fome part of the face, a red- 
nefs, fuchas that defcribed in(CCLXXV.) 
as the appearance of Erythema. This 
rednefs, at firft, is of no great extent; but 
gradually fpreads from the part it firft oc- 
cupied to the other parts of the face, com- 
monly till it has affected the whole; and 
frequently from the face it fpreads over 
the hairy fcalp, or defeends on fome part 
of the neck. As the rednefs fpreads, it 
commonly difappears, or at lead: decreafes, 
in the parts it had before occupied. All the 
parts upon which the rednefs appears are, at 
the fame time, affected with fome fwelling, 
which continues for fome time after the 
rednefs has abated. The whole face be- 
comes confiderably turgid; and the eye- 
lids OF PHYSIC. 
225 
lids are often fo much fwelled, as entirely 
to flint up the eyes. 
DCC. 
When the rednefs and fwelling have 
proceeded for fome time, there commonly 
arife, fooner or later, blitters of a larger or 
fmaller fize, on feveral parts of the face. 
Thefe contain a thin yellowifh or almoft co- 
lourlefs liquor,which fooner or later runs out. 
The fur face of the fkin, in the blittered places, 
fometimes becomes livid and blackifli; but 
this livor feldom goes deeper than the fur- 
face, or difcovers any degree of gangrene 
affecting the ikin. On the parts of the 
face not affected with blitters, the cuticle 
fuffers, towards the end of the difeafe, a 
confiderable d efquamation. 
Sometimes the tumour of the eye-lids 
ends in a fuppuration. 
DCCL 226 
PRACTICE 
DCCI. 
The inflammation coming upon the 
face does not produce any remiflion of the 
fever which had before prevailed; and 
fometimes the fever increafes with the in- 
creafing and fpreading inflammation. 
DCCIL 
The inflammation ufually continues for 
eight or ten days ; and, for the fame time, 
the fever and fymptoms attending it alfo 
continue. 
DCCIIL 
In the progrefs of the inflammation the 
delirium and coma attending it fometimes 
go on increaflng, and the patient dies apo- 
ple<fl:ic on the feventh, ninth, or eleventh 
day of the difeafe. In fuch cafes, it has 
been OF PHYSIC. 
227 
been commonly fuppofed that the difeafe 
is tranflated from the external to the in- 
ternal parts. But I have not feen any in- 
itance in which it did not appear to me, 
that the affection of the brain was merely 
a communication of the external affection, 
as this continued increafing at the fame 
time with the internal. 
DCCIV. 
When the fatal event does not take 
place, the inflammation, after having af- 
fected a part, commonly the whole of the 
face, and perhaps the other external parts 
of the head, ceafes. With the inflamma- 
tion, the fever alfo ceafes; and, without 
any evident crifis, the patient returns to 
his ordinary Hate of health. 
DCCV. 228 
PRACTICE 
DCCV. 
This difeafe is not commonly contagi- 
ous; but as it may arife from an acrid 
matter externally applied, fo it is poflible 
that the difeafe may fometimes be com- 
municated from one perfon to another. 
Perfons who have once laboured under 
this difeafe are liable to returns of it. 
DCCVI. 
The event of this difeafe may be fore- 
feen from the ftate of the fymptoms which 
denote more or lefs affedlion of the brain. 
If neither delirium nor coma come on, 
the difeafe is fcldom attended with any 
danger; but when thele fymptoms appear 
early in the difeafe, and are in a confider- 
able degree, the utmoft danger is to be 
apprehended. 
DCCV1I. OF PHYSIC. 
229 
DCCVII. 
As this difeafe often arifes in the part, at 
the fame time with the coming on of the 
pyrexia; as I have known it, with all its 
fymptoms, arife from an acrimony applied 
to the part; as it is commonly attended 
with a full, and frequently a hard pulfe; 
as the blood drawn in this difeafe fhows 
the fame cruft upon its furface, that ap- 
pears in the phlegmafiae; and, laftly, as 
the fwelling of the eye-lids, in this difeafe, 
frequently ends in a fuppuration; fo, from 
thefe confiderations, it feems doubtful if 
this difeafe be properly, in Nofology, fe- 
parated from the Phlegmaliae. At any 
rate, I take the difeafe I have defcribed to 
be what phylicians have named the Ery- 
fipelas Phlegmonodes, and that it par- 
takes a great deal of the nature of the Phleg- 
mafias. 
DCCVIIL PRACTICE 
230 
DCCV1II. 
Upon this conclusion, the Eryfipelas of 
the face is to be cured very much in the 
fame manner as phlegmonic inflamma- 
tions, by blood-letting, cooling purgatives, 
and by employing every part of the anti- 
phlogiflic regimen ; and our experience 
has confirmed the fitnefs of this method of 
cure. 
DCCIX. 
The evacuations of blood-letting and 
purging, are to be employed more or lefs 
according to the urgency of fymptoms, 
particularly thofe of the pyrexia, and of 
thofe which mark an affection of the brain. 
As the pyrexia continues, and often in- 
creafes vith the inflammation of the face; 
fo the evacuations mentioned may be em- 
ployed OF PHYSIC. 
231 
ployed at any time in the courfe of the 
dileafe. 
DCCX. 
In this, as in other difeafes of the head, 
it is proper to put the patient, as often as 
he can eafily bear it, into lomewliat of an 
erect pollute. 
DCCXI. 
As in this difeafe there is always an ex- 
ternal affeftion, and as in many inflanccs 
there is no other ; fo various external ap- 
plications to the part affedted have been 
propofed ; but al molt all of them are of 
doubtful effect. The narcotic, refrigerant, 
and allringent applications, are fufpedled 
of difpofing to gangrene ; fpiricuous appli- 
cations feem to increafe the inflammation; 
and all oily or watery applications feem to 
occa- 232 
PRACTICE 
occafion its fpreading. The application 
that feems moft fafe, and which is now 
mod commonly employed, is that of a dry 
mealy powder frequently fptinklcd upon 
the inflamed parts. 
DCCXII. 
An Eryfipelas Phlegmonodes frequently 
appears on other parts of the body, beiide 
the face; and fuch other eryfipelatous in- 
flammations frequently end in fuppuration. 
Thefe cafes are feldom dangerous. At co- 
ming on, they are fometimes attended 
with drowfinefs, and even with fome de- 
lirium ; but this rarely happens ; and 
thefe fymptoms do not continue after the 
inflammation is formed. I have never 
feen an inftance of the tranllation of this 
inflammation from the limbs to an inter- 
nal part; and though thefe inflammations 
of the limbs be attended with pyrexia, 
they OF PHYSIC. 
233 
they feldom require the fame evacuations 
as the erylipelas of the face. At firft they 
are to be treated by dry mealy applica- 
tions only; and all humid applications, 
as fomentations, or poultices, are not to 
be applied, till, by the continuance of die 
difeafe, by the increafe of fwelling, or by 
a throbbing felt in the part, it appears 
that the dileafe is proceeding to fuppura- 
tion. 
DCCXIIL 
We have hitherto confidered eryfipelas 
as in a great meafure of a phlegmonic na- 
ture ; and, agreeably to that opinion, we 
have propofed our method of cure. But 
it is probable, that an eryfipelas is fome- 
timcs attended with, or is a fymptom of, a 
putrid fever ; and, in fuch cafes, the eva- 
cuations propofed above may be impro- 
per, 
Vol. 11.  PRACTICE 
234 
per, and the ufe of the Peruvian bark may 
be neceflary ; but 1 cannot be explicit 
upon this fubject, as fuch putrid cafes have 
not come under my obfervation. 
CHAP. OF PHYSIC. 
235 
CHAP. VII. 
Of the Miliary Fever. 
DCCXIV. 
THIS difeafe is laid to have been un- 
known to the ancients, and that it 
appeared, for the firft time, in Saxony, 
about the middle of the laft century. It is 
faid to have fpread from thence into all 
the other parts of Europe ; and, fince the 
period mentioned, to have appeared in 
many countries in which it had never ap- 
peared before. 
DCCXV. PRACTICE 
236 
DCCXV. 
From the time of its having been firft 
particularly obferved, it has been defcri- 
bed and treated of by many different wri- 
ters; and by all of them, till very lately, 
has been confidered as a peculiar idiopathic 
difeafe. 
It is faid to have been conftantly at- 
tended with peculiar fymptoms. It comes 
on with a cold Rage, which is often conli- 
derable. The hot ftage, which fucceeds, 
is attended with great anxiety, and fre- 
quent fighing. The heat of the body be- 
comes great, and foon produces profufe 
fweating ; preceded, however, by a fenfe 
of pricking, as of pin-points, in the fkin; 
and the fweat is of a peculiarly rank and 
difagreeable odour. The eruption appears 
fooner or later in different perfons, but 
at no determined period of the dileafe. It 
feldom or never appears on the face; but 
dif- OF PHYSIC. 
237 
difcovers itfelf firft upon the neck and 
breaft, and from thence often fpreads over 
the whole body. 
DCCXVI. 
The eruption named Miliary is faid to 
be of two kinds, the one-named the Red, 
the other the White Miliary. The for- 
mer, which in Englifh is ftricHy named a 
Rafh, is commonly allowed to be a fymp- 
tomatic affection ; and as the latter is the 
only one that has any pretenlions to be 
confidered as an idiopathic difeafe, it is 
this alone that I ihall more particularly 
defcribe and treat of in the prefent chap- 
ter. 
DCCXVIL 
What then is called the White Miliary 
eruption, appears at firil like the red, in 
very 238 
PRACTICE 
very fmall red pimples, for the moft part 
diftind, but fometimes cindered together. 
Their flight prominence is diftinguilhed 
better by the finger than by the eye. Soon 
after the appearance of this eruption, and 
at lead: on the fecond day, a fmall veficle 
appears upon the top of each pimple. At 
firft the veficle is whey-coloured; but foon 
becomes white, and ftands out like a little 
globule on the top of the pimple. In two 
or three days, thefe globules break, or are 
rubbed off; and are fucceeded by fmall 
crufts, which foon after fall off in fmall 
fcales. While one fet of pimples takes 
this courfe, another fet fucceeds ; fo that 
the difeafe often continues upon the fkin 
for many days together. Sometimes when 
one crop of this eruption has difappeared, 
another, after fome interval, is produced. 
And it has been further obferved, that in 
fbme perfons there is fuch a tendency to 
this difeafe, that they have been affedted 
with OF PHYSIC. 
239 
with it feveral times in the courfe of their 
lives. 
DCCXVIIL 
This difeafe is faid to affeft both texes, 
and perfons of all ages and conftitutions ; 
but it has been obterved, at all times, to af- 
fedt efpecially, and moft frequently, lying- 
in women. 
DCCXIX. 
This difeafe is often accompanied with 
violent fymptoms, and has frequently 
proved fatal. The fymptoms attending it, 
are, however, very various. They are, in 
one or other inftance, all the feveral fymp- 
toms attending febrile difeafes ; but I 
cannot find that any fymptom or con- 
courfe of fymptoms are fteadily the fame 
in different perfons, fo as to furnifh any 
0.4 
ipecifis 240 
PRACTICE 
fpecific character to the difeafe. When 
the difeafe is violent, the molt common 
fymptoms are phrenitic, comatofe, and 
convulfive affections, whi. h are alfo fymp- 
toms of all fevers treated by a very warm 
regimen. 
DCCXX. 
While there is fuch a variety of fymp- 
toms appearing in this difeafe, it is nor to 
be expected that any one particular method 
of cure can be propofed : and according- 
ly we find, in different writers, different 
methods and remedies prefcribed; fre- 
quent difputes about the moft proper; and 
thofe received and praclifed by fome, op- 
pofed and rejected by others. 
DCCXXI. 
I have thus given an account of what I 
have OF PHYSIC. 
241 
have found delivered by authors who have 
considered the white miliary fever as an 
idiopathic difeate ; but, now, after having 
often obterved the difeate, 1 muft fay that 
I doubt much if it ever be fuch an idio- 
pathic as has been teppofed, and I fuf- 
pect that there is much fallacy in what 
has been written on the fubjeCt. 
DCCXXII. 
It teems to me very improbable, that 
this Ihould have been really a new elite- 
eafe when it was firft confidcred as fuch* 
There appear to me very clear traces of it 
in authors who wrote long before that 
period ; and, though there were nor, we 
know that the defcriptions of the ancients 
were inaccurate and imperfect, particularly 
with refpect to cutaneous affections; whilft 
we know alio very well, that thole affec- 
tions which ufuaily appeared as fympto- 
matic 242 
PRACTICE 
matic only, were commonly negle&ed, of 
confounded together under a general ap- 
pellation. 
DCCXXIII. 
The antecedent fymptoms of 
fighing, and pricking of the fkin, which 
have been fpoken of as peculiar to this 
difeafe, are, however, common to many 
others; and, perhaps, to all thofe in which 
fweatings are forced out by a warm regi- 
men. 
Of the fymptoms faid to be concomi- 
tant of this eruption, there are none which 
can be faid to be conftant and peculiar but 
that of fweating. This, indeed, always 
precedes and accompanies the eruption; 
and, while the miliary eruption attends 
many different difeafes, it never, however, 
appears in any of thefe, but after fweat- 
ing ; and, in perfons labouring under 
thefe O F PHYSIC. 
243 
thefe difeafes, it does not appear, if fweat- 
ing be avoided. It is therefore probable, 
that the eruption is the effect of fweating; 
and that it is the produce of a matter, not 
I 
before prevailing in the mafs of blood, 
but generated, under particular circum- 
ftances, in the fkin itfelf. That it depends 
upon particular circumftances of the Ikin, 
appears further from hence, that the erup- 
tion feldom or never appears upon the face, 
although it affects the whole of the body 
belides ; that it comes upon thofe places 
efpecially which are more clofely covered; 
and that it can be brought out upon par- 
ticular parts by external applications. 
DCCXXIV. 
It is to be obferved, that this eruptive 
difeafe differs from the other exanthemata 
in many circumftances ; in its not being 
contagious, and therefore never epidemic ; 
that 244 
PRACTICE 
that the eruption appears at no determined 
period of the difeafe; that the eruption 
has no determined duration; that fuccef- 
five eruptions frequently appear in the 
courfe of the fame fever ; and that fuch 
eruptions frequently recur in the courfe of 
the fame perfon's life. 
All thefe circumftances render it ex- 
tremely probable, that, in the miliary fever, 
the morbific matter is not a fubfifting con- 
tagion communicated to the blood, and 
thence, in confequence of fever and aflimi- 
lation, thrown out upon the furface of the 
body; but a matter occafionally produced 
in the Ikin itfelf, by fweating. 
DCCXXV. 
This conclufion is further rendered pro- 
bable from hence, that, while the miliary 
eruption has no peculiar fymptoms, or 
con- OF PHYSIC. 
245 
concourfe of fymptoms, belonging to it; 
yet, upon occaiion, it accompanies almoft 
all febrile difeafes, whether inflammatory 
or putrid, if thefe happen to be attended 
with fweating ; and from thence it may 
be prefumed, that the miliary eruption is 
a fymptomatic affection only, produced in 
the manner we have faid. 
DCCXXVI. 
But, as this fymptomatic affection does 
not always accompany every in (lance of 
fweating, it may be proper to inquire, 
what are the circumflances which Special- 
ly determine this eruption to appear ? To 
this, however, I can give no full and pro- 
per anfwer. I cannot fay that there is any 
one circumflance which in all cafes gives 
occafion to this eruption ; nor can I fay 
what different caufes may, in different 
cafes, give occalion to it. There is only 
one 246 
PRACTICE 
one obfervation I can offer to the purpofc 
of this inquiry; and it is, that, of the per- 
fons fweating under febrile difeafes, thofe 
are efpecially liable to the miliary erup- 
tion, who have been prevjoufly weakened 
by large evacuations, particularly of blood. 
This will explain why it happens to lying- 
in women more frequently than to any 
other perfons; and to confirm this expla- 
nation, I have remarked, that the eruption 
happened to women not in childbed, but 
who had been much fubjedled to a fre- 
quent and copious menftruation, and to an 
almoft conftant fluor albus. I have alfo 
had occafion to obferve it happen to men 
in fevers, after wounds from which they 
had fuffered a great lofs of blood. 
Further, that this eruption is produced 
by a certain ftate of debility, will appear 
probable, from its often occurring in fe- 
vers of the putrid kind, which are always 
attended with great debility. It is true, 
that OF PHYSIC. 
247 
that it alfo fometimes attends inflamma- 
tory difeafes, when it cannot be accounted 
for in the fame manner; but I believe it 
will be found to attend efpecially thofe in- 
flammatory difeafes in which the fweats 
have been long protraCled or frequently 
repeated, and which have thereby produ- 
ced a debility, and perhaps a debilitating 
putrid diathefis. 
DCCXXVIL 
It appears fo clearly to me that this erup- 
tion is always a fymptomatic and factitious 
that I am perfuaded it may be 
in moft cafes prevented merely by avoid- 
ing fweats. Spontaneous fweatings, in the 
beginning of difeafes, are very rarely cri- 
tical ; all fweatings, not evidently critical, 
Ihould be prevented ; and the promoting 
them, by increafing external heat, is com- 
monly very pernicious. Even critical 
fweats 248 
PRACTICE 
fweats fhould hardly be encouraged by 
fuch means. If, therefore, fpontaneous 
fweats arife, they are to be checked by the 
coolnefs of the chamber ; by the lightnefs 
and loofenefs of the bed-clothes ; by the 
perfons laying out their hands and arms, 
and by their taking cold drink : and, by 
thefe precautions, 1 think I have frequently 
prevented miliary eruptions, which were 
otherwife likely to have appeared, parti- 
cularly in lying-in women. 
DCCXXVIIL 
But it may happen, when thefe precau- 
tions have been neglected, or from other 
circumftances, that a miliary eruption does 
actually appear ; and the queftion will 
then be put, how the cafe is to be treated? 
It is a queftion ot confequence, becaufe I 
believe that the matter here generated is 
often of a virulent kind ; it is frequently 
the OF PHYSIC. 
249 
the offspring of putrefcency; and, when, 
treated by increaling the external heat of 
the body, it feems to acquire a virulence 
which produces thofe fymptoms men- 
tioned in (DGCX1X.), and proves cer- 
tainly fatal. 
It has been an unhappy opinion with 
moft phyiicians, that eruptive difeafes were 
ready to be hurt by cold; and that it was 
therefore necelfary to cover up the body 
very clofely, fo as thereby to increafe the 
external heat. We now know that this is 
a miftaken opinion; that increaling the 
external heat of the body is very generally 
mifehievous; and that feveral eruptions 
not only admit, but require the application 
of cold air. We are now perfuaded, that 
the practice which formerly prevailed, in 
the cafe of miliary eruptions, of covering 
up the body clofe, and both by external 
means, and internal remedies, encouraging 
the fweatings which accompany this erup- 
tion, 
Vol. II. 
R 250 
PRACTICE 
tion, was highly pernicious, and common- 
ly fatal. I am therefore of opinion, even 
when a miliary eruption has appeared, that 
in all cafes where the fweating is not ma- 
nifeflly critical, we fhould employ all the 
feveral means of flopping it that are men- 
tioned above ; and I have fometimes had 
occafion to obferve, that even the admif- 
iion of cool air was fafe and ufeful. 
DCCXXIX. 
This is, in general, the treatment of mi- 
liary eruptions ; but, at the fame time, the 
remedies fuited to the primary difeafe are 
to be employed; and therefore, when the 
eruption happens to accompany inflamma- 
tory affedlions, and when the fulnefs and 
hardnefs of the pulfe or other fymptoms 
fhow an inflammatory ftate prelent, the 
cafe is to be treated by bloodletting, pur- 
ging, and other antiphlogiftic remedies. 
Upon OF PHYSIC. 
251 
Upon the other hand, when the miliary 
eruption attends difeafes in which debility 
and putrefcency prevail, it will be proper 
to avoid all evacuations, and employ tonic 
and antifeptic remedies, particularly the 
Peruvian bark, cold drink, and cold air. 
I (hall conclude this fubjeCt with men- 
tioning, that the venerable octogenarian 
practitioner, de Fifcher, when treating of 
this fubject, in laying down the indications 
of cure, has given this as one of them: 
' Excretionis peripheries non primariam 
* habere rationem.' 
R 2 
CHAP. 252 
PRACTICE 
H A P. VIII . 
Of the Remaining Exanthemata: 
URTICARIA, PEMPHIGUS, AND APHTHA. 
DCCXXX. 
7 B "TIE Nettle Rafli is a name applied to 
two different difeafes. The one is 
the chronic eruption defcribed by Dr He- 
berden in the Medical Tranfadlions, Vol. I. 
art. xvii. which, as not being a febrile dis- 
order, does not belong to this place. The 
other is the Urticaria of our Synopfis, which, 
as taken into every fyftem of Nofology as 
one OF PHYSIC. 
253 
one of the Exanthemata Febrilia, is pro- 
perly to be treated of here. 
DCCXXXI. 
I have never obferved this difeafe as con- 
tagious and epidemic; and the few fpora- 
dic cafes of it which have occurred to me, 
have feldom taken the regular courfe de- 
fcribed by authors. At the fame time, as 
the accounts of different authors are not 
very uniform, and hardly confident, I can- 
not enter further into the confideration of 
this fubjccl ; and I hope it is not very ne- 
ceffary, as on all hands it is agreed to be 
a mild difeafe, and fuch as feldom requires 
the ufe of remedies. It is generally fuffi- 
cient to obferve an antiphlogiftic regimen, 
and to keep the patient in a temperature 
that is neither hot nor cold. 
B3 
DCCXXXII. 254 
PRACTICE 
DCCXXXII. 
The Pemphigus, or Veficular Fever, is a 
rare and uncommon difeafe, and very few 
inftances of it are recorded in the writings 
of phyficians. As 1 have never had occa- 
fion to fee it, it would be improper for me 
to treat of it, and I do not choofe to repeat 
after others, while the difeafe has yet been 
litjle obferved, and its charader does not 
feem to be exactly afcertainech Vid. Adda 
Helvetica, vol. ii. p. 260. Synopf. Nofolog. 
vol. ii. p. 149. 
DCCXXXIIL 
The Aphtha, or Thrufli, is a difeafe better 
known; and, as it commonly appears in 
infants, it is fo well underftood as not to 
need our treating of it here. As an idio- 
pathic difeafe, affecting adults, I have not 
feen it in this country : but it feems to be 
more OF PHYSIC. 
255 
more frequent in Holland $ and, therefore, 
for the dudy of it, I refer to Dr Boerhaave, 
and his commentator Van Swieten, whofe 
works are in every body's hands. 
DCCXXXIV. 
The Petechia has been, by all our Nofo- 
logifts, enumerated amongfl the exanthe- 
mata ; but as, according to the opinion of 
mod phyficians, it is very judly held to 
be always a fymptomatic affection only, I 
cannot give it a place here. 
R 4 
BOOK BOOK IV. 
OF HEMORRHAGIES. 
CHAP. I. 
Of Hemorrhagy in general. 
DCCXXXV. 
IN eftablifliing aclafs or order of difeafes, 
under the title of Nofo- 
logifts have employed the fingle circum- 
ftance of an effufion of red blood, as the 
character OF PHYSIC. 
257 
character of fuch a clafs or order. By this 
means, they have affociated difeafes which 
in their nature are very different; but, in 
every methodical diftribution, fuch arbi- 
trary and unnatural alfociations fhould be 
avoided as much as pofhble. Further, by 
that management Nofclogifts have fuppref- 
fed or loft fight of an eftablifhed and well- 
founded diftindion of hemorrhagies into 
Active and Paflive. 
DCCXXXVI. 
It is my delign to reftore this diftinc- 
tion ; and 1 {hall therefore here, under the 
title of Hemorrhagies, comprehend thofe 
only which have been commonly called 
Active, that is, thofe attended with fome 
degree of pyrexia ; which feem always to 
depend upon an increafed impetus of the 
Iplood in the velTels pouring it out, and 
which 258 
PRACTICE 
which chiefly arife from an internal caufe. 
In this I follow Dr Hoflman, who joins 
the active hemorrhagies with the febrile 
difeafes; and have accordingly eftablifhed 
thefe hemorrhagies as an order in the clafs 
of Pyrexia?. From this order I exclude all 
thofe effiifions of red blood that are owing 
entirely to external violence; and all thofe 
which, though arifing from internal caufes, 
are, however, not attended with pyrexia, 
and which feem to be owing to a putrid 
fluidity of the blood, to the weaknefs or 
to the erofion of the veflels, rather than to 
any increafed impetus of the blood in 
them. 
DCCXXXVII. 
Before proceeding to treat of tliofe pro- 
per hemorrhagies which form an order in 
our Noiology, I fhall treat of active hemor- 
rhagy in general; and indeed the feveral 
genera O F PHYSIC. 
259 
genera and fpecies to be treated of parti- 
cularly afterwards, have fo many circum- 
ftances in common with one another, that 
the general coniideration to be now offered 
will prove both proper and ufeful. 
SECT. I. 
Of the Phenomena 
DCCXXXV1II. 
The phenomena of hemorrhagy are 
generally the following. 
Hemorrhagies happen efpecially in ple- 
thoric habits, and to perfons of a fanguinc 
temperament. They appear moft com- 
monly in the fpring, or in the beginning 
of ftimmer. 
for fome time, longer or fliorter in dif- 
ferent 260 
PRACTICE 
ferent cafes, before the blood flows, there 
are fome fymptoms of fulnefs and tenfion 
about the parts from whence the blood is 
to iiTue. In fuch parts as fall under our 
view, there are fome rednefs, fwelling, and 
fenfe of heat or of itching; and in the 
internal parts, from which blood is to flow, 
there is a fenfe of weight and heat; and, 
in both cafes, various pains are often felt 
in the neighbouring parts. 
DCCXXXIX. 
When thefe fymptoms have fubfifted for 
fome time, fome degree of a cold ftage of 
pyrexia comes on, and a hot ftage is form- 
ed; during which, the blood flows of a 
florid colour, in a greater or lefler quan- 
tity, and continues to flow for a longer or 
fliorter time; but commonly, after fome 
time, the effulion fpontaneoufly ceafes, and 
together with it the pyrexia alfo. 
DCCXL. OF PHYSIC. 
261 
DCCXL. 
During the hot ftage which precedes an 
hemorrhagy, the pulfe is frequent, quick, 
full, and often hard; but, as the blood 
flows, the pulfe becomes fofter and lefe 
frequent. 
DCCXLI. 
In hemorrhagies, blood drawn from a 
vein, does, upon its concreting, commonly 
fliow the gluten feparated, or a cruft 
formed, as in the cafes of Phlegmafise. 
DCCXLII. 
Hemorrhagies, from internal caufes, 
having once happened, are apt, after a cer- 
tain interval, to return; in fome cafes very 
often, and frequently at Rated periods. 
DCCXLIIL 262 
PRACTICE 
DCCXLIII. 
Thefe are, in general, the phenomena of 
hemorrhagy; and if in fome cafes all of 
them be not exquifitely marked, or if per- 
haps fome of them do not at all appear, 
it imports only, that, in different cafes, the 
fyftem is more or lefs generally rflccled ; 
and that, in fome cafes, there are purely 
topical hemorrhagies, as there are purely 
topical inflammations. 
SECT. OF PHYSIC. 
263 
SECT. II. 
Of the Proximate Cause o/'Hemorrhagy, 
DCCXLIV. 
The pathology of hemorrhagy feems to 
be fufficiently obvious. Some inequality 
in the diftribution of the blood, occalions 
a congeftion in particular parts of the fan- 
guiferous fyftem; that is, a greater quantity 
of blood is poured into certain vefiels than 
their natural capacity is iuitcd to receive. 
Thefe veffels become, thereby, preternatu- 
rally diflended ; and this diftention, pro- 
ving a ftimuhis to them, excites their ac- 
tion to a greater degree than ufual, which, 
pufh- 264 
PRACTICE 
pufhing the blood with unufual force in- 
to the extremities of thefe veffels, opens 
them by anailomofis, or rupture ; and, if 
thefe extremities be loofely fituated on ex- 
ternal furfaces, or on the internal furfaces 
of certain cavities that open outwardly, a 
quantity of blood flows out of the body. 
DCCXLV. 
This reafoning will, in fome meafurej 
explain the production of hemorrhagy. 
But it appears to me, that, in mod cafes, 
there are fome other circumftances that 
concur to produce it: for it is probable, 
that, in confequence of congeftion, a fenfe 
of refiftance arifes, and excites the action 
of the Vis Medicatrix Naturae ; the exer- 
tions of which are ufually made by the 
formation of a cold ftage of pyrexia, indu- 
cing a more vigorous adion of the veflels; 
and the concurrence of this exertion more 
cfiec* OF PHYSIC. 
265 
effectually opens the extremities, and occa- 
flons the flowing out of the blood. 
DCCXLVI. 
What has been delivered in the two pre- 
ceding paragraphs, fcems to explain the 
whole phenomena of hemorrhagy, except 
the circumftance of its frequent recurrence, 
which I apprehend may be explained in 
the following manner. The congeflion 
and confequent irritation being taken ofF 
by the flowing of the blood ; this, there- 
fore, foon after, fpontaneoufly ceafes; but, 
at the fame time, the internal caufes which 
had before produced the unequal diftribu- 
tion of the blood, commonly remain, and 
muft now operate the more readily, as the 
over-ftretched and relaxed veflels of the 
part will more ealily admit of a congeflion 
of blood in them, and, confequently, pro- 
duce 
Vol. II. 
S 266 
PRACTICE 
duce the fame feries of phenomena as be- 
fore. 
DCCXLVII. 
This may fufliciently explain the ordi- 
nary return of hemorrhagy : but there is 
ftill another circumftance, which, as com- 
monly concurring, is to be taken notice of; 
and that is, the general plethoric hate of 
the fyftem, which renders every caufe of 
unequal diftribution of more confiderable 
effect. Though hemorrhagy may often 
depend upon the ftate of tne veffels of a 
particular part being favourable to a con- 
geftion's being formed in them ; yet, in 
order to that hate's producing its effect, it 
is neceffary that the whole fyftem fhould 
be at leaft in its natural plethoric condi- 
tion ; and, if this fhould be in any degree 
increafed tyeyond wrhat is natural, it will 
ftill more certainly determine the effects 
of OF PHYSIC. 
267 
of topical confciir ation to take place. T he 
return of hemorrhagy, therefore, will be 
more certainly occafioned, if the fyftem 
becomes preternaturally plethoric ; but 
hemorrhagy has always a tendency to in- 
creafe the plethoric ftate of the f) item, 
and, conl'equently, to occaflon its own re- 
turn. 
DCCXLVIII. 
To fhew that hemorrhagy does contri- 
bute to produce or increafe the plethoric 
ftate of the fyftem, it is only neceflary to 
obferve, that the quantity of ferous fluids 
being given, the ftate of the excretions de- 
pends upon a certain balance between the 
force of the larger arteries propelling the 
blood, and the refiftanceof the excretories: 
but the force of the arteries depends upon 
their fulnefs and diftention, chiefly given 
to them by the quantity of red globules and 
S 2 
gluten, 268 
PRACTICE 
gluten, which are, for the greateft part, con- 
fined to the red arteries; and therefore, the 
Jpoliatwn made by an hemorrhagy, being 
chiefly of red globules and gluten, the ef- 
fufion of blood mull leave the red arteries 
more empty and weak. In confequence of 
the weaker adlion of the red arteries, the 
excretions are in proportion diminifhed; 
and, therefore, the ingefta continuing the 
fame, more fluids will be accumulated in 
the larger veflels. It is by this means that 
the lofs of blood by hemorrhagies, whether 
artificial or fpontaneous, if vrithin certain 
bounds, is commonly fo foon recovered : 
but, as the diminution of the excretions, 
from a lefs quantity of fluid being impelled 
into the excretories, gives occafion to thefe 
veflels to fall into a contradied ftate; fo, if 
this fliall continue long, thefe veflels will 
become more rigid, and will not yield to 
the fame impelling force as before. Al- 
though the arteries, therefore, by new 
blood OF PHYSIC. 
269 
blood collected in them, {hall have reco- 
vered their former fulnefs, tenfion, and 
force, yet this force will not be in balance 
with the refiftance of the more rigid ex- 
crctories, fo as to reftore the former {late 
of excretion ; and, confequently, a further 
accumulation will take place in the arteries, 
and an increafe of their plethoric (late be 
thereby induced. In this manner, we per- 
ceive more clearly, that hemorrhagy, as 
producing a more plethoric flate of the 
fyftem, has a tendency to occalion its own 
recurrence with greater violence ; and, as 
the renewal and further accumulation of 
blood require a determinate time, fo, 
in the feveral repetitions of hemorrhagy, 
that time will be nearly the fame; and 
therefore the returns of hemorrhagy will 
be commonly at Rated periods, as has been 
obferved frequently to happen. 
8 3 
DCCXLIX. 270 
PRACTICE 
DCCXLIX. 
I have thus explained the nature of he- 
morrhagy in general, as depending upon 
fomc inequality in the diftribution of the 
blood, occafioning a congeftion of it in 
particular parts of the fanguiferous fyftem. 
It is indeed probable, that, in moft per- 
fons, the feveral parts of the fanguiferous 
fyftem are in balance with one another; 
and that the denfity, and confequently the 
refinance, in the feveral veflels, is in pro- 
portion to the quantity of blood which 
each fhould receive ; from whence it fre- 
quently happens, that no inequality in the 
diftribution of the blood takes place in the 
courfe of a long life. If, however, we con- 
fider that the fanguiferous fyftem is con- 
ftantly in a plethoric ftate, that is, that 
the vefiels are conftantly diftended beyond 
that fize which they would be of, if free 
from any diftending force, we fiiall be 
fatif- OF PHYSIC. 
271 
fatisfied that this hate may be readily 
changed. For as, on the one hand, the 
veflels are elaftic, fo as to be under a con- 
ftant tendency to contraCi upon the with- 
drawing of any part of the ditlending force; 
and, on the other hand, are not fo rigid 
but that, by an increafe of the impetus of 
the blood in them, they may be more than 
ordinarily di (tended ; fo we can eafilv un- 
derhand how, in moft perfons, caufes of 
an increafed contraction or diflention may 
arife in one part or other of the fyflem, or 
that an unequal diftribution may take 
place ; and how, in an exquifitely di (tended 
or plethoric fyftem, a fmall inequality in 
the diftribution of the blood may form 
thofe congeftions which give occafion to 
hemorrhagy. 
DCCL. 
In this manner I endeavour to explain 
S 4 
how 272 
PRACTICE 
how hemorrhagy may be occafioned at any 
period of life, or in any part of the body: 
but hemorrhagies happen in certain parts 
more frequently than in others, and at cer- 
tain periods of life more readily than at 
others ; and therefore, in delivering the 
general doctrine of hemorrhagy, it may be 
required that I fhould explain thofe cir- 
cumflances which produce the fpecialities 
mentioned; and I fhall now attempt it. 
DCCLI. 
The human body, from being of a fmall 
bulk at its fir ft formation, grows after- 
wards to a conliderable fize. This increafe 
of bulk confills, in a great meafure, in the 
increafe of the quantity of fluids, and a 
proportional enlargement of the contain- 
ing veflels. But, at the fame time, the 
quantity of folid matter is alfo gradually 
increafed ; and, in whatever manner we 
may OF PHYSIC. 
273 
may fuppofe this to be done, it is probable 
that the progrefs, in the whole of the 
growth of animal bodies, depends upon 
the extenfion of the arterial fyftem; and 
fuch is the conftitution of the fanguiferous 
fyftem, that the motion of the blood in the 
arteries has a conftant tendency to extend 
them in every dimenfion. 
DCCLII. 
As the ftate of the animal-fol id is, at the 
firft formation of the body, very lax and 
yielding; fo the extenfion of the fyftem 
proceeds, at firft, very faft: but, as the ex- 
tenfion gives occafion to the appofition of 
more .matter to the folid parts, thefe are, 
in proportion to their extenfion, conftantly 
acquiring a greater denfity, and therefore 
giving more refiftance to their further ex- 
tenfion and growth. Accordingly, we ob- 
serve, that as the growth of the body ad- 
• vances, 274 
PRACTICE 
vances, its increafe in any given time, be- 
comes proportionally lefs and lefs, till at 
length it ceafes altogether. 
DCCLIIL 
This is the general idea of the growth of 
the human body, till it attain the utmoft 
bulk which it is capable of acquiring; but, 
it is to be remarked, that this growth does 
not proceed equally in every part of the 
body, it being requifite for the oeconomy 
of the fyftem, that certain parts fliould be 
firft evolved, and fhould alfo acquire their 
full bulk fooner than others. This appears 
particularly with refpeft to the head, the 
parts of which appear to be firft evolved, 
and fooneft to acquire their full fize. 
DCCLIV. 
To favour this unequal growth, it is pre- 
fumed, OF PHYSIC. 
275 
fumed, that the dimenfions or the laxity of 
the veffels of the head, or that the direction 
of the force of the blood, are adapted to the 
purpofe; and from what has been faid in 
(DCCLIL), it will alfo certainly follow, that 
as the veffels of the head grow fafteft, and 
fooneft acquire their full fize, fo they will 
fooneft alfo acquire that denfity which will 
prevent their further extenfion. While, 
however, the force of the heart, and the 
quantity of the fluids, with refpecl to the 
whole fyftem, remain the fame, the dif- 
tending and extending powers will be di- 
rected to fuch parts as have not yet acqui- 
red the fame denfity and dimenfions as 
thofe firfl: evolved ; and thus the diftending 
and extending powers will proceed to ope- 
rate till every part of the fyftem, in refpecl 
of denfity and refiftance, fhall have been 
brought to be in balance with every other, 
and till the whole be in balance with the 
force of the heart, io that there can be no 
further 276 
PRACTICE 
further growth in any particular part, un- 
Jefs fome preternatural circumnance fhall 
happen to arife. 
DCCLV. 
In this procefs of the growth of the bo- 
dy, as it feems in general to depend upon 
,a certain balance between the force of the 
heart, or diflending power, and the refin- 
ance of the folids ; fo it will appear, that? 
while the folids remain very lax and yield- 
ing, fome occaflonal increafe of the dif- 
tending power may arife without produ- 
cing any very perceptible diforder in the 
fyflem. But, it will alfo appear, that, in 
proportion as the diflending power and re- 
finance of the folids come to be more near- 
ly in exadl balance with one another, fo 
any increafe of the didending power will 
more readily produce a rupture of veflels, 
which do not eafily yield to extenfion. 
DCCLVI. OF PHYSIC. 
277 
DCCLVI. 
From all this, it mu ft follow, that the 
effects of any unufually plethoric ftate of 
the fyftem, will be different according as 
this ihall occur at different periods of the 
growth of the body. Accordingly, it is evi- 
dent, that if the plethoric ftate arifes while 
the head is yet growing, and while the de- 
termination of the blood is ftill more to 
the head than to the other parts, the in- 
creafed quantity of the blood will be efpe- 
cially determined to the head; and as there 
alfo, at the fame time, the balance between, 
thediftending and extending powers is moft 
nearly adjufted, fo the determination of 
the blood will moft readily produce in that 
part a rupture of the veffels, or an hemor- 
rhagy. Hence it is, that hemorrhagies 
of the nofe fo frequently happen in young 
. perfons ; and in thefe more readily, as they 
approach nearer to their acme, or full 
growth; 278 
PRACTICE 
growth ; or, it may be faid, perhaps more 
properly, as they approach nearer to the age 
of puberty, when, perhaps, in both fexes, 
but efpecially in the female, a new deter- 
mination arifes in the fyllem. 
DCCLVIL 
The determination of agreater quantity of 
blood to the veifels of the head, might be 
fuppofed to occafion a rupture of veifels in 
other parts of the head, as well as in the 
nofe: but fuch a rupture does not com- 
monly happen ; becaufe in the nofe, there 
is, for the purpofe of fenfe, a conliderable 
net-work of blood veifels expanded on the 
internal furface of the noftrils, and covered 
only with thin and weak teguments. From 
this circumftance it is, that upon any in- 
creafed impetus of the blood in the veifels 
of the head, thofe of the nofe are mod ea- 
fily broken; and the effulion from the nofe 
taking OF PHYSIC. 
279 
taking place, it not only relieves the other ex- 
tremities of the external carotid, to which 
the arteries of the nofe chiefly belong, but 
relieves alfo, in a great meafure, the fyftena 
of the internal carotid. For, from the in- 
ternal carotid, certain branches are fent to 
the nofe, are fpread out on its internal 
furface, and probably inofculated with the 
extremities of the external carotid: fo 
that, whichfoever of the extremities are 
broken, the vis derivation! s of Haller will 
take place ; the effufion will relieve the 
whole fanguiferous fyftem of the head ; 
and the fame eflulion will alfo commonly 
prevent an hemorrhagy happening at the 
fame time in any other part of the body. 
DCCLVIII. 
From thefe principles, it will appear why 
hemorrhagies of the nofe, fo frequent be- 
fore the period of puberty, or of the acme, 
feldom 280 
PRACTICE 
feldom happen after thefe periods : and J 
muft obferve further, that although they 
fhould occur, they would not afford any 
objection to my doctrine, as fuch hemor- 
rhagies might be imputed to a peculiar laxi- 
ty of the velfels of the nofe, and perhaps 
to a habit acquired with refpect to thefe 
velfels, while the balance of the fyftem 
might be otherwife duly adjulted. 
DCCLIX. 
When the procefs of the growth of the 
body goes on regularly, and the balance of 
the fyftem is properly adjuRed to the gra- 
dual growth of the whole, as well as to the 
fucceflive growth of the feveral parts, even 
a plethoric Rate does not produce any he-, 
morrhagy, or at lead: any after that of the 
nofe : but if, while the plethoric Rate con- 
tinues, any inequality fliall alfo fubfiR in 
any of the parts of the fyRem, congeRions, 
hemorrhagic O F PH Y S I C. 
281 
hemorrhagic or inflammatory, may be ftill 
readily formed. 
DCCLX. 
In general, it may be obferved, that, 
when the feveral parts of the fyftem of the 
aorta have attained their full growth, and 
are duly balanced with one another, if then 
any confiderable degree of plethora remain 
or arife, the nicety of the balance will be 
between the fyftems of the aorta and pul- 
monary artery, or between the veflels of 
the lungs and thofe of all the reft of the 
body. And although the lefler capacity of 
the veflels of the lungs is commonly com- 
penfated by the greater velocity of the 
blood in them ; yet, if this velocity be not 
always adjufted to theneceflary compenfa- 
tion, it is probable that a plethoric ftate of 
the whole body will always be efpecially 
felt in the lungs $ and, therefore, that an 
VOL. II. 
T 
hemor- 282 
PRACTICE 
hemorrhagy, as the effect of a general ple- 
thora, may be frequently occafioned in 
the lungs, even though there be no fault 
in their conformation. 
DCCLXI. 
In fome cafes, perhaps, an hemorrhagy 
from the lungs, or an hemoptyiis, does arife 
from the general plethoric Rate of the 
body; but an hemoptyiis more frequently 
does, and may be expe&ed to happen, from 
a faulty proportion between the capacity 
of the lungs and that of the reft of the 
body. 
DCCLXII. 
When fuch a difproportion takes place, 
it will be evident, that an hemoptyiis will 
efpecially happen about the time that the 
body is approaching to its acme; that is, 
when OF PHYSIC. 
283 
when the fyftem of the aorta has arrived 
at its utmoft extenfion and reliftance, and 
when, therefore, the plethoric Rate of the 
whole muR efpecially affect the lungs. 
DCCLXIII. 
Accordingly, it lias been conftantly ob- 
ferved, that the hemopty fis efpecially oc- 
curs about the time of the body's arriving 
at its acme'; but I muft remark alfo, that the 
hemorrhagy may occur fooner or later, ac- 
cording as the balance between the velTels 
of the lungs, and thofe of the fyftem of the 
aorta, happens to be more or lefs exadly ad- 
jured to one another; and it may there- 
fore often occur much later than the pe- 
riod mentioned, when that balance, though 
not quite even, is however not fo ill ad- 
jufted, but that fome other concurring 
caufes are neceffary to give it effect. 
T 2 
DCCLXIV. 284 
PRACTICE 
DCCLXIV. 
It was anciently remarked by Hippocra- 
tes, and has been confirmed by modern 
obfervation, that the hemoptyfis generally 
occurs in perfons between the age of fifteen 
and that of five-and-thirty ; that it may 
happen at any time between thefe two pe- 
riods ; but that it feldom happens before 
the former, or after the latter; and it may 
be proper here to inquire into the reafon 
of thefe two limitations. 
DCCLXV. 
With refpe6l to the firft, the rea- 
fon of it has been already explained in 
(DCCLXII. and DCCLXIIL). 
With refpedl to the fecond limitation, I 
expedl: that the reafon of it will be under- 
ftood from the following confiderations. 
I OF PHYSIC. 
285 
It has been already obferved, that the ex- 
tenfion and growth of the body require the 
plethoric Rate of the arterial fyftem; and 
nature has provided for this, partly by the 
conftitution of the blood being fuch, that 
a great portion of it is unfit to pafs into 
the exhalants and excretories ; partly by 
giving a certain denfity and refiftance to 
the feveral exhalants and excretories thro' 
which the fluids might pafs out of the red 
arteries; and partly, but efpecially, by a 
refiftance in the veins to the free paflage of 
the blood into them from the arteries. 
DCCLXVI. 
With refpecft to this laft and chief cir- 
cumftance, it appears from the experi- 
ments of Sir Clifton Wintringham, in his 
Experimental that the propor- 
tional denlity of the coats of the veins to 
that of the coats of the arteries, is greater in 
T3 
young 286 
PRACTICE 
young than in old animals : From which 
it may be prefumed, that the reliftance to 
the paflage of the blood from the arte- 
ries into the veins, is greater in young ani- 
mals than in old; and, while this reliftance 
continues, the plethoric ftate of the arte- 
ries muft be conftantly continued and fup- 
As however the denfity of the coats 
of the veflels, confifting chiefly of a cellular 
texture, is increafed by preflure; fo, in pro- 
portion as the coats of the arteries are more 
expofed to preflure by diftention than thofe 
of the veins, the former, in the progrefs of 
the growth of the body, muftincreafe much 
more in denfity than the latter; and,there- 
fore, the coats of the arteries, in rcfpecl of 
denfity and reliftance, muft come, in time, 
not only to be in balance with thofe of 
the veins, but to prevail over them: a fact 
which is fufliciently proved by the experi- 
ments of the above-mentioned ingenious 
author. 
By OF PHYSIC. 
287 
By thefe means, the proportional quan- 
tities of blood in the arteries arid veins 
muft change in the courfe of life. In 
younger animals, the quantity of blood 
in the arteries muft be proportionally 
greater than in old ones ; but, by the in- 
creaiing denfity of the arteries, the quan- 
tity of blood in them muft be continually 
diminifhing, and that in the veins be 
proportionally increaling, fo as at length 
to be in a proportionally greater quantity 
than that in the arteries. When this change 
happens in the proportional quantities of 
the blood in the arteries and veins, it muft be 
evident that the plethoric ftate of the arte- 
ries will be in a great meafure taken off; 
and, therefore, that the arterial hemorrhagy 
is no longer likely to happen; but that, if 
a general plethoric ftate afterwards take 
place in the fyftem, it muft efpecially ap- 
pear in the veins. 
t4 
dcclxvil 288 
PRACTICE 
DCCLXVII. 
The change I have mentioned to hap- 
pen in the date of the arterial and venous 
fyftems, is properly fuppofed to take place 
in rhe human body about the age of thirty- 
five, when it is manifeft that the vigour of 
the body, which depends fo much upon the 
fullnefs and tenfion of the arterial fyftem, 
no longer increafes ; and therefore it is, 
that the fame age is the period, after which 
the arterial hemorrhagy, hemopty fis, hardly 
ever appears. It is true,there are inftances of 
the hemoptyfis happening at a later period; 
but it is for the reafons given (DCCLVIII.) 
which fhow that an hemorrhagy may hap- 
pen at any period of life, from accidental 
caufes forming congeftions, independent of 
the ftate of the balance of the fyftem at 
that particular period* 
pccLxvin, OF PHYSIC. 
289 
DCCLXVIIL 
I have faid, (DCCLXVL), that if, after 
the age of thirty-five, a general and preter- 
natural plethoric ftate occur, it muft efpe- 
cially appear in the venous fyftem ; and I 
muft now obferve, that this venous ple- 
thora may alfo give occafion to hemor- 
rhagy. 
DCCLXIX. 
If a plethoric ftate of the venous fyftem 
take place, it is to be prefumed, that it will 
efpecially and in the firft place affect the 
fyftem of the vena portarum, in which the 
motion of the venous blood is more flow 
than elfewhere; in which the motion of 
the blood is little affifted by external com- 
preffion; and in which, from the want of 
valves in the veins that form the vena 
portarum, the motion of the blood is little 
aflifted 290 
PRACTICE 
affifted by the compreilion that is applied; 
while, from the fame want of valves in 
thofe veins, the blood is more ready to re- 
gurgitate in them. Whether any regurgi- 
tation of the blood can produce an action 
in the veins, and which inverted, or di- 
rected towards their extremities, can force 
thefe, and occafion hemorrhagy, may per- 
haps be difputed: but it appears to me that 
an hemorrhagy, produced by a plethoric 
Rate of the veins, may be explained in ano- 
ther and more probable manner. If the 
blood be accumulated in the veins, from 
any interruption of its proper courfe, that 
accumulation muft refill the free paflage 
of the blood from the arteries into the 
veins. This again, muft produce fome con- 
geftion in the extremities of the red arte- 
ries, and therefore fome increafcd adlion 
in them, which muft be determined with 
more than ufual force, both upon the ex- 
tremities of the arteries, and upon the ex- 
halants OF PHYSIC. 
291 
halants proceeding from them ; and this 
force may occafion an effufion of bloody 
either by anaflomofis, or rupture. 
DCCLXX. 
In this manner I apprehend the hemor-» 
rhoidal flux is to be explained, fo far as it 
depends upon the flate of the whole fyflem. 
It appears mofl commonly to proceed from 
the extremities of the hemorrhoidal veflels, 
which, being the mofl dependent and diflant 
branches of thofe veins that form the 
vena portarum, are therefore the mofl 
readily affefled by every accumulation of 
blood in that fyflem of veins, and confe- 
quently by any general plethora in the 
venous fyflem. 
DCCLXXI. 
It is here to be obferved, that I have 
fpoken 292 
PRACTICE 
fpoken of this hemorrhagy as proceeding 
from the hemorrhoidal veffels only, as in- 
deed it molt commonly does ; but it will 
be readily underftood, that the fame accu- 
mulation and refiftance to the venous blood 
may, from various caufes, affect many of 
the extremities of the vena portarum, which 
lie very fuperficially upon the internal 
furface of the alimentary canal, and give 
occafion to what has been called the Mor- 
bus .Niger or Melina, 
DCCLXXIL 
Another part, in which an unufually ple- 
thoric ftate of the veins may have particu- 
lar effects, and occafion hemorrhagy, is the 
head. In this, the venous fyftem is of a 
peculiar conformation, and fuch as feems 
intended by nature to give there a flower 
motion to the venous blood. If, therefore, 
the plethoric flate of the venous fyftem in 
general, OF PHYSIC. 
293 
general, which Teems to increafe as life ad- 
vances, fliould at length increafe to a great 
degree, it may very readily affedt the ve- 
nous veflels of the head, and produce there 
fuch a refinance to the arterial blood, as 
to determine this to be poured out from 
the nofe, or into the cavity of the cranium. 
The fpecial effect of the latter effufion will 
be, to produce the difeafe termed Apoplexy; 
and which, therefore, is properly named 
by Dodtor Hoffman, Hemorrbagia Ce- 
rebri : and the explanation of its caufe, 
which I have now given, explains well 
why it happens efpecially to men of large 
heads and fhort necks, and to men in the 
decline of life, when the powers promoting 
the motion of the blood are much weak- 
ened. 
DCCLXXI1I. 
I have thus attempted to give the hiftory 
of 294 
PRACTICE 
of the plethoric and hemorrhagic Rates of 
the human body, as they occur at the dif- 
ferent periods of life; and hope I have 
thereby explained, not only the nature of 
hemorrhagy in general, but alfo of the 
particular hemorrhagies which moft com- 
monly appear, and as they occur fuccef- 
fively at the different periods of life. 
SECT. III. 
Of the Remote Causes 
DCCLXX1V. 
In the explanation hitherto given, I have 
specially confidered the predifpofition to 
liemor- OF PHYSIC. 
295 
hcmorrhagy ; but it is proper alfo, and 
even neceflary, to take notice of the occa- 
fional caufes, which not only concur with 
the predifponent, in exciting hemorrhagy, 
but may alfo fometimes be the foie caufes 
of it. 
DCCLXXV. 
Thefe occafional caufes are, 
i. External heat, which, by rarefying 
the blood, produces or increafes the plethoric 
ftate of the body; and the fame heat, as 
giving a ftimulus to the whole fyftem, mutt 
urge any particular determinations before 
eftablifhed, Rill further, or may urge to 
excefs any inequality, otherwife innocent; 
fo that, in either way, external heat may 
immediately excite hemorrhagies, to which 
there was a predifpofition, or may form 
congeRions where there were none before, 
and thereby occafion hemorrhagy. 
2. A 296 
PRACTICE 
2. A confiderable and fudden diminu- 
tion of the weight of the atmofphere, which 
feems to occafion the fame effects as 
heat, by producing alfo an expanfion of 
the blood. 
3. Whatever increafes the force of the 
circulation, and thereby the velocity of the 
blood, may operate in the fame manner as 
heat, in urging not only previous deter- 
minations with violence, but alfo in urging 
to excefs inequalities, otherwife innocent. 
All violent exercife, therefore, and efpe- 
cially all violent efforts, which, not only 
by a larger and longer infpiration, but alfo 
by the fimultaneous action of many muf- 
cles interrupting the free motion of the 
blood, impel it with unufual force into 
the extreme veffels more generally, and, 
according to the different poftures of the 
body, and mode of the effort, into certain 
veffels more particularly. 
Among the caufes increaling the force 
of OF PHYSIC. 
297 
of the circulation, anger and other violent 
active paflions are to be reckoned. 
4. The violent exercife of particular 
parts of the body. If thefe are already 
affected with congeftions, or liable to them, 
filch exercife may be conildered as a fti- 
mulus applied to the veflels of that parti- 
cular part. Thus, any violent exercife of 
refpiration may excite hemoptyfis, or occa- 
fion its return. 
5. The poftures of the body increaling 
determinations, or ligatures occafioning 
accumulations of the blood in particular 
parts of the body. 
6. A determination into certain veflels 
rendered habitual by the frequent repeti- 
tion of hemorrhagy from them. , 
7. Cold, externally applied, as changing 
the diftribution of the blood, and deter- 
mining it in greater quantity into the in- 
ternal parts. 
Vol. II. 
U 
SECT, 298 
PRACTICE 
SECT. IV. 
Of the Cure of Hemorrhagy. 
DCCLXXVI. 
Having thus confidered the proximate 
and remote caufes of hemorrhagy in gene- 
ral, cur next bufinefs is, to treat of the cure 
of the difeafe in the fame manner. 
In entering upon this fubjeft, the firft 
queftion which prefents itfelf, is, Whether 
the cure of hemorrhagies ought to be at- 
tempted by art, or if they Ihould be left 
to the conduct of nature ? 
DCCLXXVII. OF PHYSIC. 
299 
DCCLXXVII. 
The latter opinion was the favourite doc- 
trine of the celebrated Dr Stahl, and his 
followers. They that the hu- 
man body is much difpofed to a plethoric 
ftate; and, confequently, to many dis- 
orders which nature endeavours to obviate 
and relieve by exciting hemorrhagy: that 
this, therefore, is often neceflary to the 
balance and health of the fyftem : that it 
is accordingly to be generally encouraged, 
fometimes folicited, and is not to be 
fuppreffcd, unlefs when it goes to great 
excefs, or happens in parts in which it may 
be dangerous* 
DCCLXXVIII. 
Much of this dodlrine may be admitted. 
The human body, upon many occafions, 
becomes preternaturally plethoric ; and 
the 
U 2 300 
PRACTICE 
the dangerous confequences which might 
from thence be apprehended, feem to be 
obviated by an hemorrhagy taking place: 
and, further, the neceftity of hemorrhagy 
often appears from hence, that the fup- 
preflion of it feems to occafion many dis- 
orders. 
All this feems to be juft; but, in the 
conclufion drawn from it there is a fal- 
lacy. 
DCCLXXIX. 
It appears to me certain, that hemor- 
rhagy,' either upon its firft attack, or upon 
its after recurrence, is never neceftary to 
the health of the body, excepting upon the 
iuppofit on, that the plethoric Rate which 
feern to require the evacuation, cannot be 
otherwife prevented or removed ; and as 
I imagine it poflible by other means to 
prevent or remove a plethoric Plate, fo I 
do OF PHYSIC. 
301 
do not think that hemorrhagy is, in ail 
cafes, neceffary. In general, I am of opi- 
nion that hemorrhagy is to be avoided, 
i . Becaufe it dqes not always happen in 
parts where it is fafe. 
2. Becaufe often, while it does relieve a 
plethoric ftate, it may, at the fame time, 
induce a very dangerous difeafe. 
3. Becaufe it may often go to excefs, 
and either endanger life, or induce a dan- 
gerous infirmity. 
And, laftly, Becaufe it has a tendency to 
increafe the plethoric flate it was meant to 
relieve; to occafion its own recurrence, 
(DCCXXI.); and thereby to induce a ha- 
bit, which, if left to the precarious and 
unequal operation of nature, may, from 
the frequent errors of this, be attended 
with much danger. 
u 3 
DCCLXXX. 302 
PRACTICE 
DCCLXXX. 
It is further to be confidered, that he- 
morrhagies do not always arife from the 
neceflities of the fyftem, but often proceed 
from incidental caufes. It appears to me, 
that all hemorrhagies of the latter kind 
may be immediately fupprelfed, and the 
repetition of them, as it induces a plethora, 
and a habit not otherwife neceflary, may 
be prevented with great advantage. 
DCCLXXXL 
Upon the whole of this fubject, I con- 
clude, that every preternatural hemorrhagy, 
or, in other words, every one except that 
of the pienfes in females, is to be avoided, 
and cfpecially the returns of it prevented; 
and I therefore now proceed to mention, 
how hemorrhagy, and its recurrences, may, 
and Ihould be prevented. 
DCCLXXXII. OF PHYSIC. 
303 
DCCLXXXII. 
From the principles delivered above, it 
will immediately appear, that the preven- 
tion, either of the firft attacks, or of the 
returns of hemorrhagy, will chiefly, and 
in the firft place, depend upon the prevent- 
ing or removing any confiderable degree of 
a plethoric ftate which may happen to pre- 
vail in the body. It is true, that, where 
the hemorrhagy depends upon the parti- 
cular conformation of certain parts, rather 
than upon the general plethoric ftate of 
the whole ; the meafures for removing or 
preventing the latter, may not always be 
fuflicient for preventing hemorrhagy : but 
at the fame time it muft be evident, that 
determinations, inconfequence of the con- 
formation of particular parts, will always 
be urged more or lefs, in proportion to the 
greater or lefler degree of the plethoric 
ftate of the whole fyftem ; and, therefore, 
U 4 
that, 304 
PRACTICE 
that, even in the cafes depending upon 
particular conformation, the preventing or 
removing an unufually plethoric Rate, will 
always be a chief means of preventing he- 
inorrhagy. It is further to be attended 
to, that there may be feveral inequalities 
in the balance of the fyftem, which may 
have little or no effect unlefs when the 
fyftem becomes preternaturally plethoric ; 
and, therefore, that, in all cafes, the pre- 
venting or removing of the plethoric ftate 
of the fyftem, will be a chief means of pre- 
venting the firfl: attacks, or the returns of 
hemorrhagy. It now, therefore, remains 
to explain, how the plethoric ftate of the 
fyftem is to be prevented or removed. 
DCCLXXXHI. 
The fluids of the human body are in 
continual wafte by the excretions, but are 
commonly replaced by the aliments taken 
in; OF PHYSIC. 
305 
in; and if the quantity of aliments in 
any meafure exceed that of the excretions, 
an increafe of the quantity of the fluids of 
the body, or, in other words, a plethoric 
Rate, mu ft neceflarily arife. This, to a 
certain degree, is requifite for the growth 
of the body : but, even then, if the pro- 
portion of the aliments to the excretions, 
be greater than is fuited to the growth of 
the body, and more certainly ftill, if, after 
the growth is completed, when an equality 
between the ingejla and the excreta fliould 
be eftablifhed, the difproportion ftill con- 
tinue, a preternaturally-plethoric ftate mu ft 
arife. In both cafes, it is evident, that the 
plethora muft be prevented or corrctfted 
by adjufting theingefta and excreta to each 
other; which generally may be done, ei- 
ther by diminifliing the ingefta, or by in- 
creafing the excreta. The former may 
be eftecled by the management of diet, 
the 306 
PRACTICE 
the latter by the management of exer- 
cife. 
DCCLXXXIV. 
The ingefta may be diminifhed, either 
by giving aliment in lefs quantity than 
ufual, or by giving aliments of a lefs nu- 
tritious quality ; that is, aliments of a fub- 
ftance, which, under the fame bulk and 
weight, contain lefs of a matter capable of 
being converted into animal fluids, and 
more of a matter ready to pafs off by the 
excretions, and confequently lefs of a 
matter to be retained and accumulated in 
the veffels. 
The choice of aliments fuited to thefe 
purpofes, mufl be left to be directed by the 
dodrines of the Materia Medica. 
DCCLXXXV. OF PHYSIC. 
307 
DCCLXXXV. 
The increafing of the excreta, and there- 
by diminifhing the plethoric date of the 
fydem, is to be obtained by increafing the 
exercife of the body ; and generally for ad- 
jufting the balance between the ingefta and 
excreta, and thereby obviating the plethoric 
date, it is neceflary that exercife, in a due 
meafure, be very condantly employed, 
DCCLXXXVI. 
The obferving abftinence, am} the em- 
ployment of exercife, for obviating or re- 
moving the plethoric ftate of the body, 
were formerly confidered pretty fully, 
when treating of the gout, (DXLVIII. 
to DLII.); fo that the lefs is necettary to 
be faid here : and it is now only requifite 
to obferve, that the fame doubts, as in cafes 
of the gout, do not occur here with regard 
to 308 
PRACTICE 
to the fafety of thofe meafures, which, in 
a plethoric ftate of the body difpofing to 
hemorrhagy, are always admiilible and 
proper. Here, however, it is to be obfer- 
ved, that fame choice in the mode of exer- 
cife is neccflary, and that it fhould be dif- 
ferent according to the particular determi- 
nations which may happen to prevail in 
the fyftem. In general, in the cafe of ple- 
thora difpofing to hemorrhagy, bodily ex- 
ercife will always be hazardous, and gefta- 
tion more commonly fafe. 
DCCLXXXVII. 
Artificial evaluations may be employed 
to dimini fh the plethoric ftate of the body; 
and when, at any time, it has become con- 
fiderable, and immediately threatens a dif- 
eafe, thefe evacuations fhould be made to 
the quantity that the fymptoms fcem to re- 
quire. But it is conftantly to be attended 
to, OF PHYSIC. 
309 
to, that blood-lettings are improperly em- 
ployed to prevent a plethora, as they have 
a tendency to increafe it (DCCXXT.); and 
as they require to be often repeated, and 
are thereby apt to induce a habit which 
may be attended with much danger. 
DCCLXXXVIIL 
While a plethora, and thereby the pre- 
difpofition tohemorrhagy, is avoided, or re- 
moved, the other meafures nccefTary for 
preventing the occurrence of this, are thofe 
for avoiding the remote caufes. Thefe have 
been enumerated in (DCCLXXV.); and 
the means of avoiding them, fo far as within 
our power, are fufficiently obvious. 
DCCLXXXIX. 
Having thus mentioned the means of 
preventing either the firfl attacks, or the re- 
currence  PRACTICE 
310 
currence of hemorrhagy ; I muft next fay 
how it is to be managed when it has actu- 
ally come on. 
DCCXC. 
When an hemorrhagy has come on which 
appears to have arifen from a preternatu- 
rally plethoric (late, or from fome change 
in the balance of the fanguiferous fyftem, 
no meafures are to be immediately taken 
for fupprefling it; as we may expert, that, 
when the quantity of blood neceflary for 
the relief of the fyftem is poured out, the 
effufion will fpontaneoufly ceafe. 
DCCXCI. 
In many cafes, however, it may be fuf- 
peCled, that the quantity of blood poured 
out, is not exatftly in proportion to the ne- 
ceflities of thefyftem, cither for relieving a 
general OF PHYSIC. 
311 
general plethora or a particular congeflion, 
but that it is often to a greater quantity than 
thefe require. This we fuppofe to happen 
in confequence of an inflammatory dia- 
thefls prevailing, and of a febrile fpafm be- 
ing formed; and therefore it is in many 
cafes proper, as well as for the moft part 
fafe, to moderate the evacuation, and, when 
it threatens to go to excefs, to fupprefs it 
altogether. 
DCCXCII. 
An hemorrhagy may be moderated by 
avoiding any irritation that might concur 
to increafe it; fo that every part of the an- 
tiphlogiftic regimen is to be obferved ; in 
particular external heat, both as it ratifies 
the fluids, and ftimulates the folids, is to 
be carefully avoided : and, it is probable, 
that in all cafes an hemorrhagy may be 
fafely 312 
PRACTICE 
fafely moderated by cool air applied, and 
cold drink exhibited. 
DCCXCIIL 
A fecond means for the fame purpofe, is, 
the ufe of refrigerant medicines, and parti- 
cularly of acids and nitre. 
DCCXCIV. 
A third means which has been frequently 
employed, is that of blood-letting. Thd 
propriety of this pratflice may be doubt- 
ful, as the quantity of blood poured out by 
the hemorrhagy, may be fuppofed to an* 
fwer the purpofe of an evacuation in any 
other way; and I am ready to allow, that 
the practice has been often fuperfluous, and 
fometimes hurtful, by making a greater 
evacuation than was neceflary or fafe. At 
the fame time, I apprehend it is not for the 
mere OF PHYSIC. 
313 
mere purpofe of evacuating, that blood- 
letting is to be pradiifed in the cure of he- 
morrhagy; but that it is further neceflary 
for taking off the inflammatory diathefls 
which prevails, and the febrile fpafm that 
has been formed. Accordingly, in the cafe 
of hemorrhagy, when the pulfe is not only 
frequent, but quick and full, and does not 
become fofter or flower upon the flowing 
of the blood, and that the effufion is pro- 
fufe, and threatens to continue fo, it appears 
to me, that blood-letting may be neceflary, 
and I have often found it ufeful. It feems 
probable alfo, that the particular circum- 
ftances of venefedtion may render it more 
powerful for taking off the tenfion and in- 
flammatory irritation of the fyftem, than 
any gradual flow from an artery. 
DCCXCV. 
That a fpafm of the extreme veffels has 
Vol. IL 
X 
9 314 
PRACTICE 
a fhare in fupporting hemorrhagy, appears 
to me probable from hence, that blittering 
has been often found ufeful in moderating 
and fupprefling the difeafe. 
DCCXCVL 
Do emetics and vomiting contribute to 
the cure of hemorrhagy? See Dr Bryan 
Robinson on the virtues and power of 
medicines. 
DCCXCVII. 
When an hemorrhagy is very profufe, 
andfeems to endanger life, or even threatens 
to induce a dangerous infirmity, it is agreed 
on all hands, that it is to be immediately 
fupprefled by every means in our power ; 
and particularly, that, befides the means 
above mentioned for moderating the dif- 
eafe, aftringents, internal or external where 
the OF PHYSIC. 
315 
the latter can be applied, are to be employed 
for fupprelhng it. 
DCCXCVIII. 
The internal aftringents are either vege- 
table or foflil. 
The vegetable aftringents are feldom 
very powerful in the cure of any hemor- 
rhagica, except thofe of the alimentary ca- 
nal 
The foflil aftringents are more power- 
ful ; but fome choice amongft the diffe- 
rent kinds may be proper. 
The chalybeates, fo frequently employed, 
do not appear to me to be very powerful. 
The preparations of lead are certainly 
more fo, but are otherwife of fo pernicious 
a quality, that they fhould not be employed 
except in cafes of the utmoft danger. The 
Tindhira Sarurnina, or Antiphthifica, as it 
has been called, appears to be of little effi- 
cacy; 
X 2 316 
PRACTICE 
cacy; but whether from thefmall portion of 
lead which it contains, or from the ftate 
in which the lead is in it, I am uncertain. 
The foffil aftringent that appears to me 
the moft powerful, and at the fame time 
the moft fafe, is alum. 
DCCXCIX. 
External aftringents, when they can be 
applied, are more effectual than the inter- 
nal. The choice of thefe is left to the fur- 
geons. 
DCQC. 
The moft powerful of all aftringents ap- 
pears to me to be cold, which may be em- 
ployed, either by applying cold water to 
the furface of the body, or by throwing it 
into the internal parts. 
DCCCI. OF PHYSIC. 
317 
DCCCL 
For fupprefling hemorrhagies, many fu- 
perftitious remedies and charms have been 
recommended, and pretended to have been 
employed with fuccefs. The feeming fuc- 
cefs of thefe, however, has been generally 
owing to the by-(landers miftaking a fpon- 
taneous ceafing of the hemorrhagy for the 
effedl of the remedy. At the fame time, I 
believe, that thofe remedies may have been 
fometimes ufeful, by impreHing the mind 
with horror, awe, or dread. 
DCCCII. 
Upon occafion of profufe hemorrhagies, 
opiates havp been employed with advan- 
tage ; and, when the fulnefs and inflam- 
matory diathefis of the fyftem have been 
previoufly taken off by the hemorrhagy 
X 3 
itfelfj 318 
PRACTICE 
itfeif, or by blood-letting, 1 think opiates 
may be employed with faiety. 
Dcccni. 
For reftraining hemorrhagy, ligatures 
have been applied upon the limbs, in the 
view of retarding the return of the venous 
blood from the extremities ; but they ap- 
pear to me to be of uncertain and ambi- 
guous ufe. 
DCCCIV. 
In the cafe of profufe hemorrhagies, no 
pains are to be taken to prevent a Deli- 
quium Animi, or fainting, as the happen- 
ing of this is often rhe moft certain means 
of Hopping the hemorrhagy. 
DCCCV. OF PHYSIC. 
319 
DCCCV. 
Having thus delivered the general doc- 
trine of hemorrhagy, I proceed to confider 
the particular cafes of it. It may perhaps 
be remarked, that I have marked fewer of 
thefe than are commonly enumerated by 
the nofologifts ; but my reafons for differ- 
ing from thefe authors, muft be left to a 
nofological difcuflion, to be entered into 
elfewhere more properly than here. 
X 4 
CHAP. 320 
PRACTICE 
CHAP. n. 
Of the Epistaxis, or Hemorrhagy 
of the Nose. 
DCCCVI. 
THE ftate of the veflels upon the in- 
ternal furface of the nofe being 
fuch as already mentioned (DCCLVIL), 
renders an hemorrhagy from that, more 
frequent than from any other part of the 
body. 
DCCCVII. OF PHYSIC. 
321 
DCCCV1L 
The blood commonly flows from one 
noftril only, and probably becaufe an he* 
morrhagy from one veflel relieves the con* 
geftion in all the neighbouring veflels. 
The blood flowing from both noftrils at 
the fame time, fliows commonly a more 
confiderable difeafe. 
DCCCVIIL 
This hemorrhagy happens to perfons of 
every eonftitution and temperament, but 
moft frequently to thofe of a plethoric ha- 
bit, and fanguine temperament. It hap- 
pens to both fexes, but moft frequently to 
the male. 
DCCCIX. 
This hemorrhagy may occur at any time 
of 322 
PRACTICE 
of life; but moft commonly happens to 
young perfons, owing to the ftate of the 
balance of the fyftem peculiar to that age, 
as mentioned in (DCCLVL) 
DCCCX. 
Although generally it happens to perfons 
before they have arrived at their full 
growth, and more rarely afterwards; yet 
fometimes it happens to perfons after their 
acme, and during the Rate of manhood: 
and it muR be imputed to an un- 
ufually plethoric Rate of the fyRem ; to an 
habitual determination of the blood to the 
veffels of the nofe; or to the particular 
weaknefs of thefe. 
DCCCXI 
In all thefe cafes the difeafe may be con- 
fidered as an hemorrhagy purely arterial, 
and OF PHYSIC. 
323 
and depending upon an arterial plethora; 
but it fometimes occurs in the decline of 
life, when probably it depends upon and 
may be confldered as a mark of a venous 
plethora of the veflels of the head. See 
(DCCLXX11.) 
DCCCXII. 
This hemorrhagy happens alfb at any 
period of life, in certain febrile difeafes, 
which are altogether or partly of an in- 
flammatory nature, and which (how a par- 
ticular determination of the blood to the 
veflels of the head. Thefe difeafes often 
admit of a folution by this hemorrhagy, 
when it may be properly termed critical. 
DCCCXIII. 
The difeafe fometimes comes on with- 
out any previous fymptoms; particularly, 
when 324 
PRACTICE 
when fome external violence has a fliare in. 
producing it. But, when it proceeds en- 
tirely from an internal caufe, it is com- 
monly preceded by headachs, rednefs of 
the eyes, a florid colour of the face, an un- 
ufual pulfation in the temples, a fenfe of 
fulnefs about the nofe, and an itching of 
the noflrils. A bound belly, pale urine, 
coldnefs of the feet, and cold fliivering over 
the whole body, are alfo fometimes among 
the fymptoms that precede the difeafe. 
DCCCXIV. 
From the weaknefs of the veffels of the 
nofe, the blood often flows from them with- 
out any confiderable effort of the whole fyf- 
tem, and therefore without any obfervable 
febrile diforder ; which, however, in many 
cafes, is, in all its circumflances, very dis- 
cernible. 
DCCCXVe OF PHYSIC. 
325 
DCCCXV. 
An hemorrhagy of the nofe happening 
to young perfons, is, and may generally be, 
confidered as a flight difeafc of little confe- 
quence, and hardly requiring any remedy. 
But, even in young perfons, when it recurs 
very frequently, and is very copious, it will 
require particular attention, as it is to be 
confidered as a mark of arterial plethora; 
and, as frequently returning, it may in- 
creafe the plethoric ftate_; which, in a more 
advanced flage of life, may give the blood 
a determination to parts from which the 
hemorrhagy would be more dangerous. 
All this will more particularly require at- 
tention, according as the marks of plethora, 
and of particular congeftion, preceding the 
hemorrhagy, are mote confiderable; and 
as the flowing of the blood is attended with 
a more confiderable degree of febrile dif- 
erder. 
DCCCXVL 326 
PRACTICE 
DCCCXVL 
When the epiflaxis happens to perfons 
after their acme, returning frequently, and 
flowing copioufly, it is always to be confi- 
dered as a dangerous difeafe, and as more 
certainly threatening the confequences men- 
tioned in the laft paragraph. 
DCCCXVII. 
When this hemorrhagy happens in the 
decline of life, it may be confidered as in 
itfelf very falutary : but at the fame time, 
it is to be confidered as a mark of a very 
dang rous ftate of the fyftem ; that is, as 
a mark of a very ftrong tendency to a ve- 
nous plethora in the veffels of the head: 
and I have accordingly obferved it often 
followed by apoplexy, palfy, or fuch like 
difeafes. 
DCCCXVIII. OF PHYSIC. 
327 
DCCCXVIIL 
When an hemorrhagy from the nofe 
happens in febrile difeafes, as mentioned in 
(DCCCXIL), and is in pretty large quan- 
tity, it may be confidered as critical and 
falutary ; but it is very apt to be profufe, 
and even in this way dangerous. 
It upon fome occafions occurs during 
the eruptive fever of feveral exanthemata, 
and is in fuch cafes fometimes falutary; 
but, if thefe exanthemata be accompanied 
with any putrid tendency, this hemorrhagy, 
like artificial blood-lettings, may have very 
bad efle*ds. 
DCCCXIX. 
Having thus explained the feveral cir- 
cumftances of epiftaxis, I proceed to con- 
fider the management and cure of it. I ufe 
the expreflion of management, becaufe it has 
been PRACTICE 
328 
been ufually thought to require no cure$ 
but that nature fhould be allowed to throw 
out blood in this way very frequently ; 
and as often as it appears to arife from in- 
ternal caufes, that is, from a ftate of the 
fyftem fuppofed to require fuch evacua- 
tion. 
DCCCXX. 
I am however of opinion, for the reafons 
given in (DCCLXXIX.), that this difeafe is 
very feldom to be left to the conduct of 
nature; and that in all cafes it fhould be 
moderated by keeping the patient in cool 
air ; by giving cold drink; by keeping the 
body and head eredl; by avoiding any 
blowing of the nofe, fpeaking, or other ir- 
ritation: and, when the blood has flowed 
for feme time, without fhowing any ten- 
dency to ceafe, a profufe bleeding is to be 
prevented by meafures employed to flop it, 
fuch OF PHYSIC. 
329 
fuch as prefiingthe noftril from which the 
blood flows, wafliing the face with cold 
water, or applying this to other parts of the 
body. 
DCCCXXI. 
Even in the cafe of young perfons where 
the difeafe is leaft hazardous, and even in 
the fir ft attacks, I judge fuch meafures to be 
proper : but they will be ftill more proper 
if the difeafe frequently recurs without 
any external violence ; if the returns fhall 
happen to perfons of a habit difpofed to 
be plethoric; and, more particularly, if the 
marks of a plethoric ftate appear in the pre- 
cedent fymptoms. (DCCCXIII.). 
DCCCXXII. 
Even in young perfons, if the bleeding 
be very profufe and long continued, and 
Vol. II. 
Y 
more 330 
PRACTICE 
more efpecially if the pulfe become weak 
and the face pale, I apprehend it will be 
proper to fupprefs the hemorrhagy by every 
means in our power. See DCCXCV1I. 
and following paragraphs. 
DCCCXXIII. 
Further, in the fame cafe of young perfons, 
when the returns of this hemorrhagy become 
frequent, and efpecially with the marks of a 
plethoric habit, I think it necelfary to employ 
fuch a regimen as may prevent a plethoric 
Hate, (DCCLXXXlil.- DCCLXXXVII.). 
At the fame time, care fhould be taken to 
avoid all circumftances which may deter- 
mine the blood more fully to the veffels of 
the head, or prevent its free return from 
them ; and, by keeping an open belly, to 
make fome derivation from them. 
DCCCXXIV, OF PHYSIC. 
331 
DCCCXXIV. 
In adult perfons, liable to frequent 
returns of/ the epiftaxis, the whole of 
the meafures propofed (DCCCXXlIi ), 
are more certainly and freely to be em- 
ployed. When, with the circumftances 
mentioned in DCCCXIII. the tendency to 
a profufe hemorrhagy appears, a bleeding 
at the arm may be proper, even in young 
perfons ; but, in the cafe of adults, it will 
be ftill more allowable, and even necelfary. 
DCCCXXV. 
In perfons of any age liable to frequent 
returns of this hemorrhagy, when the mea- 
fures propofed in DCCCXVII. tefeq. {hall 
have been neglected, or, from peculiar cir- 
cumftancesin the balance of the fyftem, fhall 
have proved ineffectual, and the fymptoms 
threatening hemorrhagy (DCCCXXXV III.) 
Ya 
fljall  PRACTICE 
332 
fliall appear, it will then be proper, by blood- 
letting, cooling purgatives, and every part 
of the antiphlogiftic regimen, to prevent the 
hemorrhagy, or at leaft to prevent its be- 
ing profufe when it does happen. 
DCCCXXVL 
In the circumftances juft now mentioned 
(DCCCXXV.), the meafures propofed are 
proper, and even neceffary ; but it ihould 
at the fame time be obferved, that thefe 
arepradtifed with much lefs advantage than 
thofe pointed out in DCCCXXIV. : be- 
caufe, though thofe fuggefted here may 
prevent the coming on of the hemorrhagy 
for the prefent, they certainly however 
difpofe to the return of that plethoric ftate 
which required their being ufed, and there 
can be no proper fecurity againft returns 
of the difeafe, but by purfuing the means 
propofed in DCCCXXIII. 
Dcccxxvir. OF PHYSIC. 
333 
DCCCXXVIL 
When the hemorrhagy of the nofe hap- 
pens to perfons approaching to their full 
growth, and when its returns have been 
preceded by the fymptoms DCCCXIII. it 
may be fuppofed, that, if the returns can 
be prevented by the mcafures propofed in 
DCCCXXV. thefe may be fafely em- 
ployed ; as the plethoric Rate induced will 
be rendered fafe, by the change which is 
foon to take place in the balance of the fyf- 
tem. This, however, cannot be admitted; 
as the evacuations praftifed upon this plan 
will have all the confequences which, I have 
already obferved, may follow the recurrence 
of the hemorrhagy itfelf. 
DCCCXXVIIL 
When the hemorrhagy of the nofe {hall 
be found to make its returns at nearly 
Y3 
Hated 334 
PRACTICE 
ftated periods, the meafures for preventing 
it (DCCCXXV.) may be pra6tifed with 
greater certainty ; and, upon every repe- 
tition of blood-letting, by dimini£hing the 
quantity taken away, its tendency to in- 
duce a plethora may be in fome meafure 
avoided. When, indeed, the repetition of 
evacuations is truly unavoidable, the dimi- 
nilhing them upon every repetition is pro- 
perly pradlifed : but it is a practice of nice 
and precarious management, and fhould by 
no means be trufted to, fo far as to fuper- 
fede the meafures propofed in DCCCXXV. 
wherever thefe can be admitted. 
DCCCXXIX. 
When the hemorrhagy of the nofe 
happens in confequence of a venous ple- 
thora in the veflels of the head, as in 
DCCLXXII. the flowing of the blood 
pretty largely may be allowed, efpecially 
wheq OF PHYSIC. 
335 
when it happens after the fuppreflion or 
ceafing of the menftrual or hemorrhoidal 
flux. But, though the flowing of the blood 
is, on its firft occurring, to be allowed, 
there is nothing more proper than guard- 
ing againfl its returns. This is to be done 
not only by the meafures propofed in 
DCCLXXX1II etfeq. but, as the effects ofa 
plethoric ftate of the veflels of the head are 
very uncertain, fo, upon any appearance of 
it, and efpecially upon any threatening of 
hemorrhagy, the plethora is to be removed, 
and the hemorrhagy to be obviated imme- 
diately by proper evacuations ; as blood- 
letting, purging, and iflues, or by reftoring 
fupprefled evacuations, where this can be 
done. 
CHAP. 336 
PRACTICE 
CHAP. III. 
Of the Hemoptysis, or Hemorrhagy 
from the Lungs. 
SECT. I. 
Of tbeV henomen a 
DCCCXXX. 
w HEN, after fome affection of the 
breaft, blood is thrown out from 
the mouth, and is brought out with more 
or lefs of coughing, there can be no doubt 
that OF PH Y S I C. 
337 
that it comes from the lungs; and this ge- 
nerally afcertains the difeafe of which I 
am now to treat. But there are cafes in 
which the fource of the blood fpit out is 
uncertain; and therefore, fome other con- 
fiderations to be mentioned hereafter, are 
often neceflary to afcertain the exiftence of 
an hemoptyfis. 
DCCGXXXI. 
The blood-veffels of the lungs are more 
numerous than thofe of any other part of 
the body of the fame bulk. Thefe veffels, 
of the larged fize, as they arife from the 
heart, are more immediately than in any 
other part fubdivided into veffels of the 
fmalleft fize; and thefe fmall veffels fpread 
out near to the internal furfaces of the 
bronchial cavities, are iituated in a loofe 
cellular texture, and covered by a tender 
membrane only : fo that, conlidering how 
readily 338 
PRACTICE 
readily and frequently thefe veflels arc 
gorged with blood, we may underftand 
why an hemorrhagy from them is, next to 
that of the nofe, the moft frequent of any; 
and particularly, why any violent fhock 
given to the whole body fo readily occa- 
fions an hemoptyfis. 
DCCCXXXII. 
An hemoptyfis may be occafioned by 
external violence, at any period of life; and 
I have explained above (DCCLX ), why 
in adult perfons, while the arterial ple- 
thora ftill prevails in the fyftem, that is, 
from the age of fixteen to that of five-and- 
thirty, an hemopty(is may at any time be 
produced, merely by a plethoric Hate of 
the lungs. 
DCCCXXX1II. O F P H Y S I C. 
339 
DCCCXXXIII. 
But it has been alfo obferved above, 
(DCCLX1.), that an hemoptyfis more fre- 
quently arifes from a faulty proportion 
between the capacity of the veffels of the 
lungs and that of thofe of the reft of the 
body. Accordingly it is often a heredi- 
tary difeafe, which implies a peculiar and 
faulty conformation. And the dif afealfo 
happens efpecially to perfons whodifeover 
the fmaller capacity of their lungs, by the 
narrownefs of their cheft, and by the pro- 
minency of their Ihoulders; which laft is 
a mark of their having been long liable to 
$ difficult refpiration. 
DCCCXXXIV. 
With thefe circumftances alfo the dif- 
cafe happens efpecially to perfons of a fan- 
guine temperament; in whom particularly, 
the 340 
PRACTICE 
the arterial plethora prevails. It happens 
likewife to perfons of a (lender delicate 
make, of which a long neck is a mark; to 
perfons of much fenfibility, and irritabi- 
lity, and therefore of quick parts, whole 
bodies are generally of a delicate ftruclure; 
to perfons who have been formerly liable 
to frequent hemorrhagies of the nofe ; to 
perfons who have buffered a fuppreflion of 
any hemorrhagy they had formerly been 
liable to, the moft frequent inftance of 
which is in females who have buffered a 
bupprellion of their menftrual flux ; and, 
laftly, to perfons who have buffered the am- 
putation of any considerable limb. 
DCCCXXXV. 
Ill moft of thebe cafes (DCCCXXXIV.), 
the difeafe happens efpecially to perfons 
about the time of their coming to their 
full OF PHYSIC. 
341 
full growth, or foon after it, and this for 
the reafons fully fet forth above. 
DCCCXXXVI. 
From all that has been faid from 
DCCCXXXI. to DCCCXXXV. the pre- 
difponent caufe of hemoptyfis will be Suf- 
ficiently underftood, and the difeafe may 
happen from the mere-circumllance of the 
predifponent caufe arifing to a confider- 
able degree. In the predifpofed, however, 
it is often brought on by the concurrence 
of various occasional and exciting caufes. 
One of thefe, and perhaps a frequent one, 
is external heat; which, even when in no 
great degree, will bring on the difeafe in 
fpring, and the beginning of fummer, 
while the heat rarities the blood more than 
it relaxes the folids which had been before 
contracted by the cold of winter. Ano- 
ther exciting caufe is a fudden diminution 
of  PRACTICE 
342 
of the weight of the atmofphere, efpecially 
when concurring with any effort in bodily 
exercife. This effort, too, alone, may of- 
ten, in the predifpofed, be the exciting 
caufe ; and, more particularly, any vio- 
lent exercife of refpiration. In fhort, in 
the predifpofed, any degree of external 
violence alfo may bring on the difeafe. 
DCCCXXXVII. 
Occafioned by one or other of thefe 
caufes (DCCCXXXVI.), the difeafe comes 
on with a fenfe of weight and anxiety in 
the cheft, fome unealinefs in breathing, 
fome pain of the bread or other parts of 
the thorax, and fome fenfe of heat under 
the fternum; and very often, before the 
difeafe appears, a faltilh tafle is perceived 
in the mouth. 
DCCCXXXVIII. OF PHYSIC. 
343 
DCCCXXXV1IL 
Immediately before the appearance of 
blood, a degree of irritation is felt at the 
top of the larynx. To relieve this, a hawk- 
ing is made, which brings up a little blood, 
of a florid colour, and fomewhat frothy. 
The irritation returns ; and, in the lame 
manner, more blood of a like kind is 
brought up, with fome noife in the wind- 
pipe, as of air palling through a fluid. 
DCCCXXXIX. 
This is commonly the manner in which 
the hemoptyfls begins ; but lometimes at 
the very firft the blood comes up by 
coughing, or at leaft fomewhat of cough- 
ing accompanies the hawking juft now 
mentioned. 
DCCCXL. 344 
P R A C T 1 C E 
DCCCXL. 
The blood iffuing is fometimes at firfl 
in very fmall quantity, and foon difappears 
altogether: but, in other cafes, efpecially 
when it repeatedly occurs, it is in greater 
quantity, and frequently continues to ap- 
pear at times for feveral days together. 
It is fometimes profufe; but rarely in fuch 
quantity as either by its excefs, or by its 
fudden fuffocation, to prove immediately 
mortal. It commonly cither ceafes fpon- 
taneoufly, or is flopped by the remedies 
employed. 
DCCCXLI. 
When blood is thrown out from the 
mouth, it is not always cafy to determine 
from what internal part it proceeds; whe- 
ther from the internal fur face of the mouth 
itfelf, from the fauces, or adjoining cavi- 
ties OF PHYSIC. 
345 
ties of the nofe, from the ftomach, or from 
the lungs. It is, however, very neceffary 
to diftinguilh the different cafes; and, in 
molt inftances, it may be done by attend- 
ing to the following confiderations. 
DCCCXLII. 
When the blood fpit out, proceeds from 
fome part of the internal iurface of the 
mouth itfelf, it comes out without any 
hawking or coughing ; and generally, up- 
on infpedlion, the particular fource of it 
becomes evident. 
DCCCXLIII. 
When blood proceeds from the fauces, 
or adjoining cavities of the nofe, jt may be 
brought out by hawking, andfometimes by 
coughing, in the manner we have defcribed 
in DCCCXXXVIL and DCCCXXXIX.; 
Vol. II. 
2 
fo 346 
PRACTICE 
fo that, in this way, a doubt may arife 
concerning its real fource. A patient of- 
ten lays hold of thele circumftances to 
pleafe himfelf with the opinion of its co- 
ming from the fauces, and he may be al- 
lowed1 to do fo : but a phyfician cannot 
readily be deceived, if he conlider, that a 
bleeding from the fauces is more rare than 
one from the lungs ; that the former fel- 
dom happens but to perfons who have 
been before liable either to an hemorrhagy 
of the nofe, or to fome evident caufe of 
erofion ; and, in moft cafes, by looking 
into the fauces, the diflillation of the blood, 
if it comes from thence, will be perceived. 
DCCCXLIV. 
When blood proceeds from the lungs, 
the manner in which it is brought up will 
commonly fhow from whence it comes : 
but, independent of that, there are many 
circum- OF PHYSIC. 
347 
tircumftances which may concur to point 
it out, fuch as the period of life, the habit 
of body, and other marks of a predifpofition 
(DCCCXXXIII - DCCCXXXV.) ; and, 
together with thefe, the occafional caufes 
(DCCCXXXVI.) having been immediately 
before applied* 
DCCCXLV. 
When vomiting accompanies the throw- 
ing out of blood from the mouth, as vo- 
miting and coughing often mutually ex- 
cite each other; fo they may be frequently 
joined, and render it doubtful, whether 
the blood thrown out proceeds from the 
lungs or from the ftomach. We may 
however generally decide, by considering, 
that blood does not fo frequently proceed 
from the Stomach as from the lungs: that 
blood proceeding from the Stomach com- 
monly appears in greater quantity, than 
Z 2 
when 348 
PRACTICE 
when it proceeds from the lungs: that the! 
blood proceeding from the lungs is ufually 
of a florid colour, and mixed with a little 
frothy mucus only ; whereas the blood 
from the ftomach is commonly of a darker 
colour, more grumous, and mixed with 
the other contents of the ftomach : that 
the coughing or vomiting, according as the 
onfe or the other firft arifes in the cafes in 
which they are afterwards joined, may 
fometimes point out the fource of the 
blood; and, laftly, that much may be 
learned from the circumftances and fymp- 
toms which have preceded the hemor- 
rhagy. 
Thofe which precede the hemoptyfis, 
enumerated in DCCCXXXVI1. are moft of 
them evident marks of an affection of the 
lungs. And, on the other hand, the he- 
matemefis, or ifluing of blood from the 
ftomach, has alfo its peculiar fymptoms 
and circumftances preceding it; as, for 
inftance, OF PHYSIC. 
349 
inftance, fome morbid affection of this 
organ, or at lead fome pain, anxiety, and 
fenfe of weight, referred difcinclly to the 
region of the ftomach. To all this may 
be added, that the vomiting of blood hap- 
pens more frequently to females than to 
males ; and to the former, in confequence 
of a fuppreflion of their menftrual flux : 
and, by attending to all thefe conlide- 
rations (DCCCXLII.-DCCCXLV.), the 
prefence of the hemoptyfls may commonly 
be fufficiently afcertained. 
Z 3 
SECT. 350 
PRACTICE 
SECT. II. 
Of the Cure of Hemoptysis. 
DCCCXLVI. 
This difeafe is fometimes attended with 
little danger; as, when it happens to fe- 
males in confequence of a fuppreflion of 
the menfes ; when, without any marks of 
a predifpofition, it arifes from external 
violence; or when, from whatever caufe 
arifing, it leaves behind it no cough, 
dyfp- OF PHYSIC. 
351 
dyfpnoea, cr other afFedlion of the lungs. 
Even in fuch cafes, however, a danger 
may arife from too large an wound being 
made in the velTels of the lungs ; from a 
quantity of red blood being left to flag- 
nate in the cavity of the bronchia ; and 
particularly, from any determination of 
the blood being made into the veflels of 
the lungs, which, by renewing the hemor- 
rhagy, may have dangerous confequences. 
In every infiance therefore of hemoptyfis, 
the effufion is to be moderated by the fe- 
veral means mentioned (DCCXC1I, to 
DCCXCV). 
DCCCXLVII. 
Thefe meafures are efpecially neceflary 
when the hemoptylis arifes in confequence 
of predifpofition; and in all cafes where 
there is the appearance of a large effufion, 
or where the hemorrhagy frequently re- 
turns, 
1 4 352 
PRACTICE 
turns, the effufion is not only to be mode- 
rated, but to be entirely flopped, and the 
returns of it prevented by every means in 
our power. See DCCXGV1L and follow* 
ing. 
DCCCXLVIII. 
To flop an liemoptyfis, or prevent the 
returns of it, two medicines have been fre- 
quently employed; neither of which I can 
approve of. Thefe are, chalybeates, and 
the Peruvian bark. As both of them con- 
tribute to increafe the phlogiftic diathefis 
of the fyflem, they can hardly be fafe in 
any cafe of adlive hemorrhagy, and I have 
frequently found them hurtful. 
DCCCXLIX. 
As the hemoptyfis which happens in 
confequence of prechfpofition, is always 
attended OF PHYSIC. 
353 
attended with a phlogiftic diathefis; and, 
as the bad confequences of the difeafe are 
efpecially to be apprehended from the con- 
tinuance of that diathefis; fo this is to be 
induftrioully taken off by blood-letting, in 
greater or fmaller quantity, and more or 
Jefs frequently repeated, according as the 
fymptoms fhall direct. At the fame time, 
cooling purgatives are to be employed, 
and every part of the antiphlogiftic regi- 
men is to be ftriclly enjoined. The refri- 
gerants may alfo be adminiftered; taking 
care, however, that the acids, and more 
efpecially the nitre, do not excite cough- 
ing. 
DCCCL. 
From what was obferved in DCCXCV. 
it will appear, that bliftering upon the 
bread or back may be a remedy of he- 
paopty/is, when it is prefent; and that if- 
fues 354 
PRACTICE 
fues in the fame places may be ufeful in 
preventing the recurrence of it when it 
has ceafed. 
DCCCLL 
The avoiding of motion is generally a 
proper part of the antiphlogiftic regimen; 
and, in the hemoptyfis, nothing is more 
necelfary than avoiding bodily exercife: 
but fome kinds of geftation, as failing, 
and travelling in an eafy carriage on 
fmooth roads, have often proved a re- 
medy. 
DCCCLIL 
Such is the treatment I can propofe for 
the hemoptyfis, confidered merely as an 
hemorrhagy: But when, in fpite of all our 
precautions, it continues to recur, it is often 
followed by an ulceration of the lungs, and 
a OF PHYSIC. 
355 
a phthilis pulmonalis. This, therefore, I 
muft now proceed to conlider; but, as it 
arifes alfo from other cauies belides the he- 
moptyfis, it mull be treated of with a more 
general view. 
CHAP. 356 
PRACTICE 
CHAP. IV. 
Of the Phthisis Pulmonalis, or 
Consumption of the Lungs. 
SECT. I. 
Of the Phenomena and Causes of Phthisis 
Pulmonalis. 
DCCCLIII. 
r A 5HE Phthifis Pulmonalis I would de- 
fine to be, An expectoration of pus or 
purulent matter from the lungs, attended 
with a hectic fever. 
As O F P H Y S I C, 
357 
As this is the principal fpecies of phthifis, 
I fhall frequently in this chapter employ 
the general term of phthifis, though flriCtly 
meaning the phthifis pulmonalis. 
DCCCLIV. 
I have met with fome infiances of an 
expectoration of purulent matter, conti- 
nuing for many years, accompanied with 
very few fymptoms of heCtic, and at lead 
without any hedtic exquifitely formed: 
but, in none of thefe inftances, were the 
perfons fo entirely free from fymptoms of 
hectic, as to form any exception to the ge- 
neral definition. 
DCCCLV. 
In every inftance of an expectoration of 
pus, I prefbme there is an ulceration of 
the lungs. The late Mr de Haen is the 
only 358 
PRACTICE 
only author that I know of who has ad- 
vanced another opinion, and has fuppofed, 
that pus may be formed in the blood-vef- 
fels, and be from thence poured into the 
bronchise. Admitting his fact, I have at- 
tempted an explanation of the appearance 
of pus without ulceration in CCCXLIX.: 
but, after all, I cannot help fufpeRing the 
accuracy of his obfervations; muR entirely 
reject his explanation of them ; muft how- 
ever allow, that we Rill want facts to fup- 
port the explanation I have offered; and 
doubt much if it will apply to any cafe of 
phthifis. For thefe reafons I Rill conclude, 
agreeably to the faith of all other diffec- 
tions, and the opinions of all phyiicians, that 
the fymptoms mentioned in our definition 
depend always upon an ulceration formed 
in the lungs. 
DCCCLVI. OF PHYSIC. 
359 
DCCCLVI. 
It has fometimes happened, that a ca- 
tarrh was attended with an expectoration 
of a matter fo much refembling pus, that 
phyficians have been often uncertain whe- 
ther it was mucus or pus, and therefore 
whether the difeafe was a catarrh or a 
phthifis. It is often of confequence to de- 
termine thefe queftions; and it appears to 
me that it may be generally done, with fuf- 
ficient certainty, from the following confi- 
derations, of which each particular is not 
always fingly decifive, but when they are 
taken together can hardly deceive us. 
i. From the colour of the matter; as mu- 
cus is naturally tranfparent, and pus al- 
ways opake. When mucus becomes opake, 
as it fometimes does, it becomes white, 
yellow, or greenilh; but the laft men- 
tioned colour is hardly ever fo remarkable 
in mucus as in pus. 
2. From 360 
PRACTICE 
2. From the confidence; as mucus is 
more vifcid, and coherent, and pus lefs fix 
and may be faid to be more friable. When 
mucus is thrown into water, it is not rea- 
dily diffufed. but remains united in uni- 
form and circular mafles : but pus, in the 
fame circumftances, though not readily dif- 
fufed, does not remain fo uniformly uni- 
ted, and by a little agitation is broken in- 
to ragged fragments. 
3. From the odour; which is feldom per- 
ceived in mucus, but frequently in pus. 
It has been propofed to try the odour of 
the matter expectorated, by throwing it 
upon live coals : but in fuch a trial both 
mucus and pus give otlt a difagreeable 
fmell, and it is not eafy to diftinguifli be- 
tween them. 
4. From the fpecific gravity compared 
with water; and, indeed, it is ufual for the 
mucus of the lungs to fwim on the furface 
of water, and for pus to link in it. But in 
this OF PHYSIC. 
361 
this we may fometimes be deceived ; as 
pus which has entangled a great deal of 
air may fwim, and mucus that is free from 
air may link. 
5. From the mixture which is difcernible 
in the matter brought up: for if a yellow 
or greenilh matter appears furrounded with 
a quantity of tranfparent or lefs opake and 
lefs coloured matter, the more ftrongly co- 
loured matter may be generally conlldered 
as pus ; as it is not eafy to underhand how 
one portion of the mucus of the lungs can 
be very conliderably changed, while the 
reft of it is very little fo, or remains in its 
ordinary ftate. 
6. From the admixture of certain fub- 
ftances with the matter thrown out from 
the lungs. To this purpofe we are in- 
formed by the experiments of the late Mr 
Charles Darwin : a. That the vitriolic acid 
diflblves both mucus and pus, but moll 
readily the former: That, if water be added 
Vol. II. 
A a 
t© 362 
PRACTICE 
to fuch a folution of mucus, this is fepa- 
rated, and either fwims on the furface, or, 
divided into flocculi, is fiifpended in the li- 
quor; whereas, when water is added to a like 
folution of pus, this falls to the bottom, or 
by agitation is diflu fed fo as to exhibit an 
uniformly turbid liquor, b. That a folu- 
tion of the cauflic fixed alkali, after fome 
time, diflblves mucus, and generally pus ; 
and, if water be added to fuch folutions, the 
pus is precipitated, but the mucus is not. 
From fuch experiments it is fuppofed, that 
pus and mucus may be certainly diftin- 
guifhed from each other. 
7. From the expectoration's being at- 
tended with a hectic fever. A catarrh, or 
expectoration of mucus, is often attended 
with fever ; but never, fo far as 1 have ob- 
ferved, with fuch a fever as I am prefently 
to defcribe as a hectic. This, in my opi- 
nion, is the moft certain mark of a puru- 
lent Rate in ibme part of the body ; and if 
others OF PHYSIC. 
363 
others have thought differently, I am per- 
fuaded that it has been owing to this, that, 
prefumingupon the mortal nature of a con- 
firmed or purulent phthilis, they have con- 
lidered every cafe in which a recovery hap- 
pened, as a catarrh only: but, that they 
may have been miftaken in this, fliall be 
fhown hereafter. 
DCCCLVII. 
Having thus confidered the firft part of 
the character of the phrhifis pulmonalis as 
a mark of an ulceration of the lungs ; and 
having juft now faid, that the other part of 
the character, that is, the hecftic fever, is a 
mark or indication of the fame thing ; it is 
proper now to confider this here, as 1 had 
with that view omitted it before (LXX1V.). 
A a 2 
DCCCLVIII, 364 
PRACTICE 
DCCCLV11I. 
A heciic fever has the form of a remit- 
tent, which has exacerbations twice every 
day. The firft of thefe occurs about noon, 
fometimes a little fooner or later ; aqd a 
flight remiffion of it happens about five af- 
ternoon. This laft is foon fucceeded by an- 
other exacerbation, gradually increafing till 
after midnight: but after two o'clock of the 
morning, a remiffion takes place, which be- 
comes more and more confiderable as the 
morning advances. The exacerbations are 
frequently attended with fome degree of 
cold fhivering; or at leaft, the patient is 
exceedingly fenfible to any coolnefs of the 
air, feeks external heat, and often complains 
of a fenfe of cold, when, to the thermome- 
ter, his fkin is preternaturally warm. Of 
thefe exacerbations, that of the evening is 
always the moft confiderable. 
DCCCLIX. OF PHYSIC. 
365 
DCCCLIX* 
It has commonly been given as a part 
of the character of a hetflic fever, that an 
exacerbation of it commonly appears after 
the taking food 5 and it is true that dinner, 
which is taken at noon or after it, does 
feem to occafion fome exacerbation. But 
this muft not make us judge the mid-day 
exacerbation to be the effect of eating only; 
for I have often obferved it to come on an 
hour before noon, and often fome hours 
before dinner; which, in this country at 
prefent, is not taken till fome time after 
noon. It is indeed to be obferved, that in 
ahnoft every perfon, the taking food occa- 
fions fome degree of fever: but I am per- 
fuaded this would not appear fo coniider- 
able in a hediic, were it not that an exacer- 
bation of fever is prefent from another 
caufe; and accordingly, the taking food in 
the morning has hardly any fenfible effcdl. 
A a 3 
DCCCLX. 366 
PRACTICE 
DCCCLX. 
I have thus defcribed the general form 
of he&ic fever ; but many circumftances 
attending it, are further to be taken notice 
of. 
The fever I have defcribed does not com- 
monly fubfift long, till the evening exacer- 
bations become attended with fweatings; 
which continue to recur, and to prove more 
and more profufe, through the whole courfe 
of the difeafe. * 
Almoft from the firft appearance .of the 
heftic, the urine is high-coloured, and de- 
pofits a copious branny red fediment, 
which hardly ever falls clofe to the bottom 
of the veflel. 
In the hectic, the appetite for food is ge- 
nerally lefs impaired than in any other kind 
of fever. 
The thirft is feldom confiderable; the 
ptouth is commonly moift ; and as the dif- 
eafe OF PHYSIC. 
367 
eafe advances, the tongue becomes free from 
all fur, appears very clean; and in the ad- 
vanced Rages of the difeafe, the tongue nd 
fauces appear to be fomewhat inflamed, 
and become more or lefs covered with 
aphthae. 
As the difeafe advances, the red veflels 
of the adnata of the eye difappear, and the 
whole of the adnata becomes of a pearly 
white. 
The face is commonly pale; but, during 
the exacerbations, a florid red, and an al- 
moft circumfcribed fpot, appear on each 
cheek. 
For fome time, in the courfe of a hec- 
tic, the belly is bound ; but, in the advan- 
ced ftages of it, a diarrhoea almoft alwtys 
comes on, and continues to recur frequent- 
ly during the reft of the difeafe, alternating 
in fome meafure with the fweatings men- 
tioned 
The difeafe is always attended with a 
A a 4 
de* 368 
PRACTICE 
debility, which gradually increafes during 
the courfe of it. 
During the fame courfe an emaciation 
takes place, and goes to a greater degree 
than in almoft any other cafe. 
The falling off of the hairs, and the 
adunque form of the nails, are alfo fymp- 
toms of the want of nourilhment. 
Towards the end of the difeafe, the feet 
are often affedled with oedeinatous fwell- 
ings. 
The exacerbations of the fever are feldom 
attended with any headach, and fcarcely 
ever with delirium. 
The fenfes and judgment commonly re- 
main entire to the very end of the difeafe; 
and the mind, for the moft part, is confi- 
dent and full of hope. 
Somedays beforedeath, adelirium comes 
qn5 and commonly continues to the end. 
DCCCLXI. OF PHYSIC. 
369 
DCCCLXL 
The hectic fever now defcribed (DCCCL VIII, 
DCCCLX.) as accompanying a purulent 
ftate of the lungs, is perhaps the cafe in 
which it moft frequently appears : but I 
have never feen it in any cafe, when there 
was not evidently,or when I had not ground 
to fuppofe, there was a permanent puru- 
lency or ulceration in fome external or in- 
ternal part. It was for this reafon that in 
LXXIV. I concluded it to be a fympto- 
matic fever only. Indeed, it appears to 
me to be always the effect of an acrimony 
abforbed from abfceifes or ulcers, although 
it is not equally the effect of every fort of 
acrimony ; for the fcorbutic and cancerous 
kinds often fubfift long in the body with- 
out producing a hedlic. What is the pre- 
cife ftate of the acrimony producing this 
I cannot determine, but it feeins to be 
that of a vitiated purulency. 
DCCCLXIL 370 
PRACTICE 
DCCCLXII. 
However this may be, it appears, that 
the hectic's depending in general upon an 
acrimony, explains its peculiar circum- 
ftances. The febrile Rate feems to be 
chiefly an exacerbation of that frequency 
of the pulfe, which occurs twice every day 
to perfons in health, and may be produced 
by acrimony alone. Thefe exacerbations, 
indeed, do not happen without the proper 
circumftances of pyrexia; but the fpafm of 
the extreme veflels in a hedlic does not feem 
to be fo confiderable as in other fevers : 
and hence the Rate of fweat and urine 
which appears fo early and fo conftantly in 
hectics. Upon the fame fuppofition of an 
acrimony corrupting the fluids, and debili- 
tating the moving powers, I think that 
X 
moft of the other fymptoms may alfo be 
explained. 
DCCCLXIII. OF PHYSIC. 
371 
DCCCLXIIL 
Having thus confidered the charaCteri- 
ftical fymptoms and chief part of the proxi- 
mate caufe of the phthifis pulmonalis, I 
proceed to obferve, that an ulcer of the 
lungs, and its concomitant circumftance of 
hedlic fever, may arife from different pre- 
vious affections of the lungs: all of which 
however may, in my opinion, be referred 
to five heads; that is, I. To an hemopty fis; 
2. To a fuppuration of the lungs in con- 
fequence of pneumonia ; 3. To catarrh ; 
4. To aflhma; or, 5. To a tubercle. 
Thefe feveral affeCtions, as caufes of ul- 
cers, fliall now be confidered in the order 
mentioned. 
DCCCLXIV. 
It has been commonly iuppofed, that an 
hemoptyfis was naturally, and almoft ne- 
ceflarily 372 
PRACTICE 
ceftarily, followed by an ulcer of the lungs; 
but I will prefume to fay, that, in general, 
this is a miftake; for there have been 
many inftances of hemoptyiis occafioned 
by external violence, without being fol- 
lowed by any ulcer of the lungs ; and there 
have alfo been many inftances of hemop- 
tyiis from an internal caufe, without any 
confequent ulceration. And this too has 
been the cafe, not only when the hemop- 
tyiis happened to young perfons, and re- 
curred for feveral times, but when it has 
often recurred during the courfe of a long 
life. It is indeed eafy to conceive, that a 
rupture of the veftels of the lungs, like 
that of the veftels of the nofe, may be of- 
ten healed, as the furgeons fpeak, by the 
firft intention. It is probable therefore, 
that it is an hemoptyiis in particular cir- 
cumftances only, which is neceftarily fol- 
lowed by an ulcer ; but what thefe cir- 
cumftances are, it is difficulty determine. 
It OF PHYSIC. 
373 
It is poflible, that merely the degree of 
rupture, or frequently repeated rupture 
preventing the wound from healing by the 
firft intention, may occafion an ulcer ; or 
it is poflible that red blood eflufed, and 
not brought up entirely by coughing, may, 
by ftagnating in the bronchiae, become 
acrid, and erode the parts. Thefe how- 
ever are but fuppofitions, not fupported by 
any clear evidence. And, if we confider 
that thofe cafes of hemoptyfis which fol- 
low the predifpofition (DCCCXXXI1.- 
DCCCXXXV.) are thofe efpecially which 
end in phthifis, we fliall be led to fufpect 
•that there are fome other circumftances 
which concur here to determine the con- 
fequence of hemoptyfis, as I fliall here- 
after endeavour to ihow. 
DCCCLXV. 
Any fuppofition, however, which we can 
make 374 
PRACTICE 
make with refpecl to the innocence of an 
hemoptyfis, muft not fuperfede the mea- 
fures propofed above for its cure : both 
becaufe we cannot certainly forefee what 
may be the confequences of fuch an acci- 
dent, and becaufe themeafures above fug- 
gefted are fafe; for, upon every fuppofition, 
it is a diathefis phlogiftica that may urge 
on every bad confequence to be appre- 
hended. 
DCCCLXVI. 
The fccond caufe of an ulceration of 
the lungs, to be confidered, is a fuppura- 
tioii formed in confequence of pneumo- 
nia. 
DCCCLXVII. 
Trom the fymptoms mentioned ill 
DCCCLVIII.-DCCLIX, it may with rea- 
fon OF PHYSIC. 
375 
fon be concluded, that an abfcefs, or, as it 
is called, a is formed in fome part 
of the pleura, and moft frequently in that 
portion of it inverting the lungs. Here 
purulent matter frequently remains for 
fome time, as if inclofed in a cyft : but 
commonly it is not long before it comes 
to be either abforbed, and transferred to 
fome other part of the body; or that it 
breaks through into the cavity of the lungs, 
or into that of the thorax. In the latter 
cafe, it produces the difeafe called empyema; 
but it is only when the matter is poured 
into the cavity of the bronchia?, that it 
properly conftitutes the phthifis pulmonalis. 
In the cafe of empyema, the chief circum- 
ftances of a phthifis are indeed alfo prefent; 
but I fhall here confider that cafe only in 
which the abfcefs of the lungs gives occa- 
lion to a purulent expe&oration. 
DCCCLXV1II. 376 
PRACTICE 
DCCCLXVIIL 
An abfccfs of the lungs, in confequence 
of pneumonia, is not always followed by 
a phthifis : for fomctimes a hedtic fever is 
not formed ; the matter poured into the 
bronchia: is a proper and benign pus, 
which is frequently coughed up very rea- 
dily, and fpit out: and, though this puru- 
lent expectoration fhould continue for fome 
time, yet if a hedlic does not come on, the 
ulcer foon heals, and every morbid fymp- 
tom difappears. This has happened fo fre- 
quently, that we may conclude, that nei- 
ther the accefs of the air, nor the conftant 
motion of the lungs, will prevent an ulcer 
of thefe parts from healing, if the matter 
of it be well-conditioned. An abfcefs of 
the lungs, therefore, does not necefl'arily 
produce the phthifis pulmonalis ; and if it 
be followed by fuch a difeafe, it muft be 
in confequence of particular circumftances 
which OF PHYSIC. 
377 
which corrupt the purulent matter pro- 
duced, render it unfuitable to the healing 
of the ulcer, and at the fame time make it 
afford an acrimony, which, being abforbed, 
produces a heCtic and its confequences; 
DCCCLXIX. 
The corruption of the matter of fuch 
abfceffes may be owing to feveral caufes; 
as, i. That the matter effufed during the 
inflammation, had not been a pure ferum 
fit to be converted into a laudable pus, but 
had been united with other matters which 
prevented that, and gave a confiderable 
acrimony to the whole i Or, 2. That the 
matter effufed, and converted into pus, 
either merely by a long flagnation in a vo- 
mica, or by its connexion with an em- 
pyema, had been fo corrupted as to be- 
come unfit for the purpofe of pus, in the 
healing of the ulcer. Thefe feem to be 
Vol. II. 
B b 
poflible 378 
PRACTICE 
poffiblc caufes of the corruption of matter 
in abfceffes, fo as to make it the occafion 
of a phthifis in perfons otherwife found ; 
but it is probable, that a pneumonic abfcefs 
docs cfpccially produce phthifis when it 
happens to perfons previoufly difpofed to 
that difeafe, and therefore only as it con- 
curs with foine other caufes of it. 
DCCCLXX. 
The third caufe fuppofed to produce 
phthifis, is a catarrh; which in many cafes 
feems, in length of time, to have the ex- 
pectoration of mucus proper to it, gra- 
dually changed into an expectoration of 
pus; and at the fame time, by the addi- 
tion of a hedtic fever, the difeafe, which 
was at firft a pure catarrh, is converted in- 
to a phthilis. This fuppofltion, however, 
is not eafily to be admitted. The catarrh 
is properly an affedlion, of the mucous 
glands OF PHYSIC. 
379 
glands of the trachea and bronchise, ana- 
logous to the coryza, and lefs violent kinds 
of cynanche tonlillaris, which very feldom 
terminate in fuppuration. And although 
a catarrh Ihould be difpofed to fuch termi- 
nation, yet the ulcer produced might rea- 
dily heal up, as it does in the cafe of a cy- 
nanche tonlillaris; and therefore Ihould 
not-produce a phthilis. 
DCCCLXXI. 
Further, the catarrh, as purely the effect 
of cold, is generally a mild difeafe, as well 
as of fliort duration; and of the numerous 
inftances of it, thereareatmoft butvery.few 
cafes which can be faid to have ended in 
phthilis. In all thofe cafes in which this 
feems to have happened, it is to me pro- 
bable, that the perfons affected were pecu- 
liarly predifpofed to phthilis. And the 
beginning of phthilis fo often refembles a 
Bb 2 
catarrh, 380 
PRACTICE 
catarrh, that the former may have been 
miftakcn for the latter. Befides, to increafe 
the fallacy, it often happens that the appli- 
cation of cold, which is the moft frequent 
caufe of catarrh, is alfo frequently the ex- 
citing caufe of the cough which proves the 
beginning of phthifis. 
DCCCLXXII. 
It is to me, therefore, probable, that a 
catarrh is very feldom the foundation of 
phthifis ; but I would not pofitively affert 
that it never is fo: for it is poffible that 
the cafes of a more violent catarrh may 
have joined with them a pneumonic affec- 
tion, which may. end in a fuppuration ; or 
it may happen that a long continued ca- 
tarrh, by the violent agitation of the lungs 
in coughing, will produce fome of thofe 
tubercles which are prefently to be men- 
tioned O F PHYSIC. 
381 
tioned as the molt frequent caufe of phthi- 
iis. 
DCCCLXXII1. 
It muft be particularly obferved here, 
that nothing faid in DCCCLXXIl. fhould 
allow us to negledt any appearance of ca- 
tarrh, as is too frequently done; for it may 
be either the beginning of a phthifis, which 
is miftaken for a genuine catarrh, or that 
even as a catarrh continuing long, it may 
produce a phthifis, as in DCCCLXXIl. 
DCCCLXXIV. 
Many phyficians have fuppofed an acri- 
mony of the fluids eroding fome of the 
veflels of the lungs, to be a frequent caufe 
of ulceration and phthifls. But this appears 
to me to be a mere fuppofition : for, in any 
©f the inftances of the production of phthi- 
fia 
Bb 3 382 
PRACTICE 
fis which I have feen, there was no evidence 
of any acrimony of the blood capable of 
eroding the veflels. It is true, indeed, that 
in many cafes an acrimony fubfifting in 
fome part of the fluids, is the caufe of the 
difeafe; but it is at the fame time pro- 
bable, that this acrimony operates by pro- 
ducing tubercles, rather than by any di- 
reft erofion. 
DCCCLXXV. 
It has been mentioned in DCCCLXIII. 
that an afthma may be confidered as one 
of the caufes of phthifis ; and by afthma 
I mean, that fpecies of it which has been 
commonlynamed theSpafmodic. Thisdif- 
eafe frequently fubfifts very long without 
producing any other, and may have its own 
peculiar fatal termination, as fhall be ex- 
plained hereafter. But 1 have feen it fre- 
quently end in phthifis ; and in fuch cafes 
I or PHYSIC. 
383 
I fuppofe it to operate in the manner above 
alledged of catarrh, that is, by producing- 
tubercles, and their confluences, which 
fhall be prefently mentioned. 
DCCCLXXVI. 
I come now to confider the fifth head 
of the caufes of phthifis, and which I ap- 
prehend to be the moft frequent of any. 
This I havefaid, in general, to be tubercles; 
by which term are meant, certain fmall 
tumours, which have the appearance of in- 
durated glands. Diffcdions have fre- 
quently ihown fuch tubercles formed in 
the lungs ; and although at iirft indolent, 
yet at length they become inflamed, and 
are thereby changed into little abfcefTes, 
or vomicae, which breaking, and pouring 
their matter into the branching, give a pu- 
rulent expedoration, and thus lay the 
foundation of phthifis. 
B b 4 
DCCCLXXVII. 384 
PRACTICE 
DCCCLXXVIL 
Though the matter expectorated upon 
thefe occafions has the appearance of pus, 
it is feldom that of a laudable kind ; and, 
as the ulcers do not readily heal, but are 
attended with a hedtic fever, for the moft 
part ending fatally, I prefume that the mat- 
ter of the ulcers is imbued with a pecu- 
liarly noxious acrimony, which prevents 
their healing, and produces a phthifis in all 
its circumftances, as mentioned above. 
PCCCLXXVIIL 
It is very probable that the acrimony 
which thus difcovers itfelf in the ulcers, 
cxifted before and produced the tubercles 
fhemfelves ; and it is to this acrimony that 
we mutt trace up the caufe of the phthifis 
following thefe tubercles. This acrimony 
is 
< * OF PHYSIC. 
385 
is probably, in different cafes, of different 
kinds; and it will not be eafy to determine 
its varieties : but to a certain length 1 lhall 
attempt it. 
DCCCLXXIX. 
In one cafe, and that, too, a very fre- 
quent one, of phthifis, it appears, that the 
noxious acrimony is of the fame kind with 
that which prevails in the fcrophula. This 
may be concluded from obferving, that a 
phthifis, at its ufual periods, frequently at- 
tacks perfons born of fcrophulous parents; 
that is, of parents who had been affected 
with fcrophula in their younger years : 
that very often, when the phthifis appears, 
there occur at the fame time fome lym- 
phatic tumours in the external parts ; and 
very often I have found the tabes mefen- 
terica, which is a fcrophulous affeftion, 
joined with the phthifis pulmonalis. To 
all 386 
PRACTICE 
all this I would add, that, even when no 
fcrophulous affection has either manifeftly 
preceded or accompanied a phthilis, this 
laft however molt commonly affedts per- 
fons of a habit refembling the fcrophulous; 
that is, perfons of a fanguine, or of a 
fanguineo-melancholic temperament, who 
have very fine Ikins, rofy complexions, 
large veins, foft flefh, and thick upper-lip : 
and further, that in fuch perfons the phthi- 
fis comes on in the fame manner that it 
does in perfons having tubercles, as (hall 
be immediately explained. 
DCCCLXXX. 
Another fpecies of acrimony producing 
tubercles of the lungs, and thereby phthi- 
fis, may be faid to be the exanthematic. It 
is well known, that the fmall-pox fome- 
times, and more frequently the mealies, lay 
the foundation of phthilis. It is probable 
alfo, OF PHYSIC. 
387 
alfo, that other exanthemata have the fame 
effect j and from the phenomena of the dif- 
eafe, and the diffe&ions of perfons who have 
died of it, it is probable, that all the exan- 
themata may occafion a phthifis, by afford- 
ing a matter which in the firft place pro- 
duces tubercles. 
DCCCLXXXL 
Another acrimony, which Teems Tome- 
times to produce phthifis, is the fiphylitic: 
but whether Tuch an acrimony produces 
phthifis in any other perfons than the pre- 
vioufly difpofed, does not appear to me cer- 
tain. 
DCCCLXXXIL 
What other fpecies of acrimony, fiich as 
from fcurvy, from pus abforbed from other 
parts of the body, from fupprefled erup- 
tionsf 388 
PRACTICE 
tions, or from other fources, may alfo pro- 
duce tubercles and phthifis, I caYmot now 
decide, but muft leave to be determined by 
thofe who have had experience of fuch 
cafes. 
DCCCLXXXIII. 
There is one peculiar cafe of phthifis, 
which from my own experience I can take 
notice of. This is the cafe of phthifis from 
a calcareous matter formed in the lungs, 
and coughed up, frequently with a little 
blood, fometimes with mucus only, and 
fometimes with pus. How this matter is 
generated, or in what precife part of the 
lungs it is feated, I acknowledge myfelf 
ignorant. In three cafes of this kind which 
have occurred to me, there was at the 
fame time no appearance of ftony or ear- 
thy concretions in any other part of the 
body. In one of thefe cafes, an exquiiitely 
formed OF PHYSIC. 
389 
formed phthifis came on, and proved mor- 
tal : while in the other two, the fymptoms 
of phthifis were never fully formed ; and 
after fome time, merely by a milk diet and 
avoiding irritation, the patients entirely re- 
covered. 
DCCCLXXXIV. 
Another foundation for phthifis, analo- 
gous, as I judge, to that of tubercles, is that 
which occurs to certain artificers whofe 
employments keep them almoft conftantly 
expofed to duft; fuch as ftone-cutters, mil- 
lers, flax-drefiers, and fome others. I have 
not obferved in this country many inftances 
of phthifis which could be referred to this 
caufe; but, from Ramazzini, Mor- 
gagni, and fome other writers, we muft 
conclude fuch cafes to be more frequent in 
the fouthern parts of Europe. 
DCCCLXXXV. 390 
PRACTICE 
DCCCLXXXV. 
Befides thofe now mentioned, there are 
probably fome other caufes producing tu- 
bercles, which have not yet been afcertained 
by obfervation; and it is likely, that in the 
Hate of tubercles there is a variety not yet 
accounted for: but all this muft be left to 
future obfervation and inquiry. 
DGCCLXXXVI. 
It has been frequently fuppofed by phy- 
sicians, that the phthilis is a contagious dif- 
eafe ; and I dare not affert that it never is 
fuch : but in many hundred inftances of 
the difeafe which I have feen, there has 
been hardly one which to me could appear 
to have arifen from contagion. It is pof- 
fible, that in warmer climates the effects of 
contagion may be more difcernible. 
After having faid that a phthifis arifes 
from Of PHYSIC. 
391 
from tubercles more frequently than from 
any other caufe, and after having attempted 
to aflign the variety of thefe, I now pro- 
ceed to mention the peculiar circumftances 
and fymptoms which ufually accompany 
the coming on of the difeafe from tu- 
bercles. 
DCCCLXXXVII. 
A tuberculous and purulent date of the 
lungs has been obferved in very young 
children, and in fome others at feveral dif- 
ferent periods before the age of puberty 
and full growth; but inftances of this kind 
are rare : and the attack of phthifis, which 
we have reafon to impute to tubercles, 
ufually happens at the fame period which 
I have afligned for the coming on of the 
hemoptyiis. 
DCCCLXXXV1II. 392 
PRACTICE 
DCCCLXXXVIII. 
The phthifls from tubercles does alfo ge- 
nerally aflccl the fame habits as the hemop- 
tyfls, that is, perfons of a flender make, of 
long necks, narrow cherts, and prominent 
fhoulders : but very frequently the per- 
fons liable to tubercles have lefs of the flo- 
rid countenance, and of the other marks of 
an exquifitely fanguine temperament, than 
the perfons liable to hemoptyfls. 
DCCCLXXXIX. 
This difeafe, arifing from tubercles, ufu- 
ally commences with a flight and fhort 
cough, which becomes habitual, is often 
little remarked by thofe a fleet cd, and fome- 
times fo little as to be abfolutely denied by 
them. At the fame time their breathing 
becomes eafily hurried by any bodily mo- 
tion, their body grows leaner, and they be- 
come OF PHYSIC. 
393 
come languid and indolent. This flate 
fometimes continues for a year, or even for 
two years, without the perfons making any 
complaint of it, excepting only that they 
are affected by cold more readily than 
ufual, which frequently increafes their 
cough, and produces fome catarrh. This, 
again, however, is fometimes relieved; is 
fuppofed to have arifen from cold alone; 
and therefore gives no alarm either to the 
patient or to his friends, nor leads them to 
take any precautions. 
DCCCXC. 
Upon one or other of thefe occasions of 
catching cold, as we commonly fpeak, the 
cough becomes more conliderable; is par- 
ticularly troublefome upon the patient's ly- 
ing down at night, and in this ftate con- 
tinues longer than is ufual in the cafe of a 
limple catarrh. This is more efpecially to 
Vol.IL 
Cc 
call 394 
PRACTICE 
call for attention, if the increafe and con- 
tinuance of cough come on duringthe fum- 
mer feafon. 
DCCCXCI. 
The cough which comes on as in 
DCCCLXXX1X. is very often for a long 
time without any expectoration; but when, 
from repeatedly catching cold, it becomes 
more conftant, it is then at the fame time 
attended with fome expectoration, which 
is molt confiderable in the mornings. The 
matter of this expectoration becomes by 
degrees more copious, more vifcid, and 
more opake; at length of a yellow or 
greenifh colour, and of a purulent appear- 
ance. The whole of the matter, however, 
is not always at once entirely changed in 
this manner ; but, while one part of it re- 
tains the ufual form of niucus, another fuf- 
fers the changes now defcribed. 
DCCCXCIb OF PHYSIC. 
395 
DCCCXCII. 
When the cough increafes, and conti- 
nues very frequent through the night, and 
when the matter expectorated undergoes the 
changes I have mentioned, the breathing 
at the lime time becomes more difficult, 
and the emaciation and weaknefs go on al- 
fo increaling. In the female fex, as the dif- 
eafe advances, and fometimes early in its 
progrefs, the menfes ceafe to flow ; and 
this cirCumftance is to be confidered as 
commonly the efleCt, although the fex 
themfelves are ready to believe it the foie 
caufe, of the difeafe. 
DCCCXCIII. 
When the cough comes on as in 
DCCCLXXXIX. the pulfe is often natu- 
ral, and for fome time after continues to 
be fo; but the fymptoms have feldom fub- 
fifted 
C C 2 396 
PRACTICE 
iifted long before the pulfe becomes fre- 
quent, and fometimes to a conliderable de- 
gree, without much of the other fymptoms 
of fever. At length, however, evening ex- 
acerbations become remarkable; and by de- 
grees the fever ailumes the exquifite form 
of hedic, as defcribed in DCCCLVI1I.- 
DGCCLX. ' 
DCCCXC1V. 
It is feldom that the cough, expectoration, 
and fever, go on increafing, in the manner 
now defcribed, without fome pain being 
felt in fome part of the thorax. It is ufu- 
ally and moft frequently felt at firft under 
the fternum, and that efpecially, or almoft 
only, upon occafion of coughing : but very 
often, and that too early, in the courfe of 
the difeafe, a pain is felt on one fide, fome- 
times very conftantly, and fo as to prevent 
the perfon from lying eafily upon that fide; 
but OF PHYSIC. 
397 
but at other times the pain is felt only upon 
a full infpiration, or upon coughing. Even 
when no pain is felt, it generally happens 
that phthifical perfons cannot lie eafily on 
fome one of their iides without having 
their difficulty of breathing increafed, and 
their cough excited. 
DCCCXCV. 
The phthilis begins, and fometimes pro- 
ceeds to its fatal iffiue,in the manner defcri- 
bed from DCCCLXXXIX. to DCCCXCV. 
without any appearance of hemoptylis. 
Such cafes are, indeed, rare; but it is very 
common for the difeafe to advance far, and 
even to an evident purulency and hecftic 
Hate, without any appearance of blood in 
the fpitting : fo that it may be affirmed, 
the difeafe is frequently not founded in he- 
moptyfis. At the fame time, we mull al- 
low, not only that it fometimes begins with 
Ccs 
an 398 
PRACTICE 
an hemoptyfis, as is faid in DCCCLXIV.; 
but further, that it feldom happens that in 
the progrcfs of the difeafe more or lefs of 
an hemoptyfis does not appear. Some 
degree of blood-fpitting does, indeed, 
appear fometimes in the date mentioned 
DCCCLXXX1X. DCCCXCI1I. but more 
commonly in the more advanced flages of 
the difeafe only, and particularly upon 
the firft appearance of purulency. How- 
ever this may be, it is feldom, in the phthi- 
fis from tubercles, that the hemoptyfis is 
confiderable, or requires any remedies dif- 
ferent from thofe which are otherwife ne- 
ceffary for the ftate of the tubercles. 
DCCCXCVL 
I have now defcribed a fucccflion of 
fymptoms which, in different cafes, occupy 
more or lefs time. In this climate they 
very often take up fome years, the fymp- 
toms 0 F ,P H Y S I C. 
399 
toms appearing efpecially in the winter 
and fpring; commonly becoming eafier, 
and fometimes almoftdifappearing, during 
the fummer : but returning again in win- 
ter, they at length, after two or three years, 
prove fatal, towards the end of fpring or 
beginning of fummer. 
DCCCXCVII. 
In this difeafe, the prognofis is for the 
moil part unfavourable. Of thofe affected 
with it, the greater number die; but there 
are alfo many of them who recover entirely, 
after having been in very unpromiling cir- 
cumftances. What are, however, the cir- 
cumftances more certainly determining to 
a happy or to a fatal event, I have not yet 
been able to afcertain. 
C c 4 
DCCCXCVIIL 400 
PRACTICE 
DCCCXCVIIT. 
The following aphorifnas are the refill t of 
mv observations. 
J 
A phthifis pulmonalis from hemoptyfis, 
is more frequently recovered than one from 
tubercles. 
An hemoptyfis not only is not always 
followed by a phthifis, as we have faid 
above (DCCCLXIV.) ; but even when 
followed by an ulceration, the ulceration 
is fometimes attended with little of hedlic, 
and frequently admits of being foon heal- 
ed. Even when the hemoptyfis and ulcer- 
ation have happened to be repeated, there 
are inftances of perfons recovering entirely 
after feveral fuch repetitions. 
A phthifis from a Suppuration in confe- 
quence of pneumonic inflammation, is that 
which moil rarely occurs in this climate ; 
and a phthifis does not always follow fuch 
Suppuration, when the abfcefs formed 
fcon OF PHYSIC. 
401 
foon breaks and difcharges a laudable pus: 
but, if the abfcefs continue long fhut up, 
and till after a confidcrable degree of bee- 
tic has been formed, a phthifis is then pro- 
duced, equally dangerous, as that front 
other caufes. 
A phthifis from tubercles has, I think, 
been recovered : but it is of all others the 
moft dangerous ; and, when arifing from a 
hereditary taint, is almoft certainly fa- 
tal. 
The danger of a phthifis, from whatever 
caufe it may have arifen, is moft certainly 
to be judged of by the degree to which the 
hedic and its confcquences have arrived. 
From a certain degree of emaciation, debi- 
lity, profufe fweating, and diarrhoea, no 
perfon recovers. 
A mania coming on, has been found to 
remove all the fymptoms, and fometimes 
has entirely cured the difeafe; but, in other 
cafes. 402 
PRACTICE 
cafes, upon the going off of the mania, the 
phthifis has recurred, and proved fatal. 
The pregnancy of women has often re- 
tarded the progrefs of a phthifis; but com- 
monly it is only till after delivery, when 
the fymptoms of phthifis return with vio- 
lence, and foon prove fatal. 
SECT, OF PHYSIC. 
403 
SECT. IL 
Of the Cure of Phthisis. 
DCCCXCIX. 
From what has been juft now faid, it 
will readily appear, that the cure of the 
phthifis pulmonalis muft be exceedingly 
difficult; and that even the utmoft care 
and attention in the employment of reme- 
dies, have feldom fucceeded. It may be 
doubtful whether this failure is to be im- 
puted to the imperfection of our art, or to 
the abfolutely incurable nature of the dif-* 
eafe. 404 
PRACTICE 
eafe. I am extremely averfe in any caffe 
to admit of the latter fuppofition, and can 
always readily allow of the former; but, 
in the mean time, muft mention here, what 
has been attempted towards either curing 
or moderating the violence of this dif- 
eafe. 
DCCCC. 
It muft be obvious, that according to the 
different circumftances of this difeafe, the 
method of cure muft be different. Our 
firft attention fhould be employed in watch- 
ing the approach of the difeafe, and pre- 
venting its proceeding to an incurable 
ftate. 
In all perfons of a phthifical habit, and 
efpecially in thofe born of phthifical pa- 
rents, the flighted: fymptoms of the ap- 
proach of phthifis, at the phthifical period 
of life, ought to be attended to. 
DCCCCI. OF PHYSIC. 
405 
DCCCCI. 
When an hemopty fis occurs, though it 
be not always followed with ulceration 
and phthifis, thefe however are always 
to be apprehended ; and every precaution 
is to be taken againft them. This is efpe- 
cially to be done by employing every 
means of moderating the hemorrhagy, 
and of preventing its return, directed in 
DCCCXCI1. et feq.; and thefe precautions 
ought to be continued for feveral years af- 
ter the occurrence of the hemoptyfis. 
DCGCCII. 
The phthifis which follows a fuppuration 
from pneumonic inflammation, can only 
be prevented with certainty, by obtaining 
a refolution of fuch inflammation. What 
may be attempted towards the cure of an 
abfcefs 406 
PRACTICE 
abfeefs and ulcer which have taken place, 
I fhall fpeak of hereafter. 
DCCCCI1I. 
I have faid, it is doubtful if a genuine 
catarrh ever produces a phthiiis; but have 
allowed that it poffibly may : and both 
upon this account, and upon account of 
the ambiguity which may arife, "whether 
the appearing catarrh be a primary dif- 
eafe, or the effect of a tubercle, I confider 
it as of confequence to cure a catarrh as 
foon as poffible after its firft appearance. 
More efpecially when it (hall linger, and 
continue for fome time, or Ihall, after fome 
intermiffion, frequently return, the cure 
of it fhould be diligently attempted. The 
meafures requifite for this purpofe Ihall 
be mentioned afterwards, when we come 
to treat of catarrh as a primary difeafe; 
but, in the mean time, the means necef- 
fary OF PHYSIC. 
407 
fary for preventing its producing a phthi- 
fis (hall be mentioned immediately, as they 
are the fame with thofe 1 fhall point out 
as neceflary for preventing a phthifis from 
tubercles. 
DCCCCIV. 
The preventing of a phthifis from afthma 
muft be, by curing, if poflible, the afthma, 
or at leaft by moderating it as much as 
may be done : and as it is probable that 
afthma occalions phthifis, by producing 
tubercles, the meafures neceflary for pre- 
venting phthifis from afthma, will be the 
fame with thofe necefiary in the cafe of 
tubercles, which 1 am now about to men- 
tion. 
DCCCCV. 
I confider tubercles as by much the moft 
fre- 408 
PRACTICE 
frequent caufe of phthifis ; and even in 
many cafes where this feeins to depend 
upon hemoptyfis, catarrh, or afthma, it 
does however truly arife from tubercles. 
It is upon this fubjed, therefore, that I 
dliall have occafion to treat of the mea- 
fures moil commonly requifite for curing 
phthifis. 
DCCCCVI. 
When, in a perfon born of phthifical 
parents, of a phthifical habit, at the 
phthifical period of life, the fymptoms 
(DCCCLXXX1X.) in the fpring, or begin- 
ning of fummer, fliall appear in the Highteft 
degree, we may prefume that a tubercle, 
or tubercles, either have been formed, or 
are forming in the lungs ; and therefore, 
that every means we can devife for pre- 
venting their formation, or for procuring 
their refolution, fiiould be employed im- 
mediately, O F. P H Y S I C. 
409 
mediately, even although the patient him- 
lelf ihould overlook or neglect the fymp- 
toms, as imputing them to accidental 
cold. 
DCCCCVIL 
This is certainly the general indication; 
but how it may be executed, I cannot rea- 
dily fay. I do not know that, at any time, 
phyficians have propofed any remedy ca- 
pable of preventing the formation of tu- 
bercles, or of refolving them when formed. 
The analogy of fcrophula, gives no allift- 
ance in this matter. In fcrophula the reme- 
dies that are feemingly of mod power are, 
fea-water, or certain mineral waters ; but 
thefe have generally proved hurtful in the 
cafe of tubercles of the lungs. I have 
known feveral inftances of mercury very 
fully employed for certain difeafes, in per- 
fons who were fuppofed at the time to 
VOL. II. 
Dd 
have. 410 
PRACTICE 
have tubercles formed, or forming, in their 
lungs ; but though the mercury proved a 
cure for thofe other difeafes, it was of no 
fcrvicc in preventing phthifis, and in fome 
cafes feemed to hurry it on. 
DCCCCVI1L 
Such appears to me to be the prefent 
Rate of our art, with refpedt to the cure of 
tubercles; but I do notdefpair of a remedy 
for the purpofe being found hereafter. In 
the mean time, all that at prefent feems to 
be within the reach of our art, is to take 
the meafures proper for avoiding the in- 
flammation of tubercles. It is probable 
that tubercles may fubfift long without 
producing any diforder: and 1 am difpofed 
to think, that nature fometimes refolves 
and difeufles tubercles which have been 
formed; but that nature does this only 
when the tubercles remain in an unin- 
flamed OF PHYSIC. 
411 
flamed flate ; and therefore, that the mea- 
fures neceflary to be taken, are chiefly 
thofe for avoiding the inflammation of the 
tubercles. 
DCCCCIX. 
The inflammation of a tubercle of the 
lungs is to be avoided upon the general 
plan of avoiding inflammation, by blood- 
letting, and by an antiphlogiftic regimen; 
the chief part of which, in this cafe, is the 
ufe of a low diet. This fuppofes a total 
abftinence from animal-food, and the ufing 
of vegetable food almoft alone : but it has 
been found, that it is not neceflary for the 
patient to be confined to vegetables of the 
weakeft nourilhment, it being fufficient 
that the farinacea be employed, and toge- 
ther with thefe, milk. 
D d 2 
DCCCCX, 412 
PRACTICE 
DCCCCX. 
Milk has been generally confidered as 
the chief remedy in phthifis, and in the 
cafe of every tendency to it; but whe- 
ther from its peculiar qualities, or from its 
being of a lower quality, with refpedt to 
nourifhmcnt, than any food entirely ani- 
mal, is not certainly determined. The 
choice and adminiftration of milk will be 
properly diredied, by confidering the na- 
ture of the milk of the feveral animals 
from which it maybe taken, and the par- 
ticular ftate of the patient with refpect to 
the period and circumftances of the dif- 
eafe, and to the habits of his ftomach with 
refpecl to milk. 
DCCCCXI. 
A fecond means of preventing the in- 
flammation of the tubercles of the lungs, 
is. OF PHYSIC. 
413 
is, by avoiding any particular irritation of 
the affeded part, which may arife from 
any violent exercife of refpiration; from 
any confiderable degree of bodily exercife; 
from any petition of the body which 
ftraitens the capacity of the thorax ; and, 
laftly, from cold applied to the furface of 
the body, which determines the blood in 
greater quantity to the internal parts, and 
particularly to the lungs. 
DCCCCXII. 
From the laft-mentioned confidefation, 
the application of cold in general, and 
therefore the winter-feafon, in cold cli- 
mates, as diminifliing the cutaneous per- 
fpiration, is to be avoided ; but more par- 
ticularly, that application of cold is to be 
fhunned that may fupprefs perfpiration, to 
the degree of occafioning a catarrh, which 
confifts in an inflammatory determination 
D d 3 
to 414 
PRACTICE 
to the lungs, and may therefore moft cer- 
tainly produce an inflammation of the tu- 
bercles there. 
By confldering, that the avoiding heat is 
a part of the antiphlogiftic regimen above 
recommended, and by comparing this with 
what has been juft now faid refpecfting the 
avoiding cold, the proper choice of cli- 
mates and feafons for phthiflcal patients 
will be readily underftood. 
DCCCCXI1I. 
A third means of avoiding the inflam- 
mation of the tubercles of the lungs con- 
lifts, in diminifhing the determination of 
the blood to the lungs, by fupporting and 
increaflng the determination to the furface 
of the body ; which is to be chiefly and 
moft fafely done by warm cloathing, and 
thefrequent ufeof theexercifesofgeftation. 
DCCCCXIV. OF PHYSIC. 
416 
DCCCCXIV. 
Every mode of geftation has been found 
of ufe in phthifical cafes ; but riding on 
horfeback, as being accompanied with a 
great deal of bodily exercife, is lefs fafe in 
perfons liable to an hemoptyfis. Travel- 
ling in a carriage, unlefs upon very fmooth 
roads, may al Co be of doubtful effedl; and 
all the modes of geftation that are em- 
ployed on land, may fall Ihort of the ef- 
fects expected from them, becaufe they 
cannot be rendered lufficienrly conftant; 
and therefore it is that failing, of all other 
modes of geftation, is the moft effectual in 
pneumonic cafes, as being both the fmooth - 
eft and moft conftann 
It has been imagined, that fome benefit 
is derived from the ftate of the atmofphere 
upon the fea: but I cannot find that any 
impregnation of this which can be fuppo- 
fed to take place, can be of fervice to phthi- 
fical 
D d 4 416 
PRACTICE 
fical perfons. It is however probable, that 
frequently fome benefit may be derived 
from the more moderate temperature and 
greater purity of the air upon the fea. 
DCCCCXV. 
In order to take off any inflammatory 
determination of the blood into the veffels 
of the lungs, blifters applied to fome part 
of the thorax may often be of fervice ; and 
for the fame purpofe, as well as for mode- 
rating the general inflammatory (late of 
the body, iffues of various kinds may be 
employed with advantage. 
DCCCCXVI. 
• The feveral meafures to be purfued in 
the cafe of what is properly called an Inci- 
pient Phthifis, have now been mentioned ; 
but they have feldom been employed in 
fuch Of PHYSIC. 
417 
fuch cafes in due time, and have therefore, 
perhaps, feldom proved effectual. It has 
more commonly happened, that after fome 
time, an inflammation has come upon 
the tubercle, and an abfcefs has been form- 
ed, which opening into the cavity of the 
bronchiae, has produced an ulcer, and a 
confirmed phthifis. 
dccccxvii. 
In this Rate of matters, fome new indi- 
cations different from the former may be 
fuppoled to arife; and indications for pre- 
venting abforption, for preventing the ef- 
fects of the abforbed matter upon the 
blood, and for healing the ulcer, have 
been actually propofed. I cannot find, 
however, that any of the means propofed 
for executing thefe indications, are either 
probable or have proved effectual. If, upon 
fome occafions, they have appeared to be 
ufeful, 418 
PRACTICE 
ufeful, it has been probably by anfwering 
fome other intention. 
While no antidote againft the poifon 
which efpecially operates here, feems to 
have been as yet found out, it appears to 
me, that too great a degree of inflammation 
has agrcatfhare in preventing the healing of 
the ulcer which occurs; and fuch inflamma- 
tion is certainly what has a great ihare in 
urging on its fatal confequences. The only 
practice, therefore, which I can venture to 
propofe, is the fame in the ulcerated as in 
the crude ftate of a tubercle; that is, the 
employment of means for moderating in- 
flammation, which have been already men- 
tioned (DCCCCIX. etfeq.}. 
DCCCCXV1IL 
The balfamics, whether natural or arti- 
ficial, which have been fo commonly ad- 
vifed in cafes of phthifis, appear to me to 
have OF PHYSIC. 
419 
have been propofed upon no fuffleient 
grounds, and to have proved commonly 
hurtful. The reiinous and acrid fubflance 
of myrrh, lately recommended, has not ap- 
peared to me to be of any fervice, and in 
fome cafes to have proved hurtful. 
DCCCCX1X. 
Mercury, fo often ufeful in healing ul- 
cers, has been fpecioufly enough propofed 
in this difeafe ; but whether that it be not 
adapted to the particular nature of the ul- 
cers of the lungs occurring in phthifis, or 
that it proved hurtful becaufe it cannot 
have effect, without exciting fuch an in- 
flammatory flate of the whole fyftem, as, 
in a hedlic ftate, muft prove very hurtful, 
I cannot determine. Upon many trials 
which I have feen made, it has proved of 
no fervice, and commonly has appeared to 
be manifeftly pernicious. 
DCCCCXX, 420 
PRACTICE 
DCCCCXX. 
The Peruvian bark has been recommend- 
ed for feveral purpofcs in phthifical cafes ; 
and is faid, upon fome occafions to have 
been ufeful; but I have feldom found it 
to be fo: and as by its tonic power it in- 
creafes the phlogiflic diathefis of the fyf- 
tem, I have frequently found it hurtful. 
In fome cafes, where the morning remif- 
fions of the fever were confiderable, and 
the noon exacerbations well marked, I have 
obferved the Peruvian bark given in large 
quantities, with the effedl of flopping thefe 
exacerbations, and at the fame time of re- 
lieving the whole of the phthifical fymp- 
toms : but in the cafes in which I obferved 
this, the fever {bowed a conflant tendency 
to recur; and at length the phthifical fymp- 
toms alfo returned, and proved quickly fa- 
tal. 
DCCCCXXL OF PHYSIC. 
421 
DCCCCXXL 
Acids of all kinds, as antifeptic and re- 
frigerant, are ufeful in cafes of phthifis ; 
but the native acid of vegetables is more 
ufeful than the foffil acids, as it can be gi- 
ven in much larger quantities, and may 
alfo be given more fafely than vinegar, be- 
ing lefs liable to excite coughing. 
DCCCCXXII. 
Though our art can do fo little towards 
the cure of this difeafe, we muft, however, 
palliate the uneafy fymptoms of it as well 
as we can. The fymptoms efpecially ur- 
gent, are the cough and diarrhoea. The 
cough may be in fome meafure relieved by 
demulcents, (DCCCLXXIIL); but therelief 
obtained by thefe is imperfcdt and tranfj- 
tory, and very often the ilomachis difturb- 
ed by the quantity of oily, mucilaginous, 
and 422 
practice 
and fweet fubllances, which are on thefe 
occafions taken into it. 
pccccxxin. 
The only certain means of relieving the 
cough, is by employing opiates. Thefe, 
indeed, certainly increafe the phlogiftic 
diathefis of the fyftem; but commonly 
they do not fo much harm in this way, as 
they do fervice by quieting the cough, 
and giving fleep. They are fuppofed to 
be hurtful by checking expectoration: but 
they do it for a fliort time only ; and, af- 
ter a found deep, the expectoration in the 
morning is more eafy than ufual. In the 
advanced (late of the difeafe, opiates feem 
to increafe the fweatings that occur ; but 
they compenfate this, by the eafe they af- 
ford in a difeafe which cannot be cured. 
dccccxxiv. OF PHYSIC. 
423 
DCCCCXX1V. 
The diarrhoea which happens in the ad- 
vanced Hate of this difeafe, is to be pal- 
liated by moderate aftringents, mucilages, 
apd opiates. 
Rhubarb, fo commonly prefcribed in 
every diarrhoea, and all other purgatives, 
are extremely pernicious in the colliquative 
diarrhoea of hedlics. 
* Frefh fubacid fruits, fuppofed to be al- 
ways laxative, are often, in the diarrhoea 
of hectics, by their antifeptic quality, very 
ufeful. 
CHAP. 424 
PRACTICE 
CHAP. V. 
Of the Hemorrhois; or, Of the He- 
morrhoidal Swelling and Flux. 
SECT. I. 
Of the Phenomena and C a u s e s of the 
HemOrrhoi s; 
DCCCXXV. 
A Discharge of blood from fmall tu- 
-*■ A. mours on the verge of the anus, is 
the fymptom which generally conftitutes 
the Hemorrhois; or, as it is vulgarly called, 
the OF PHYSIC. 
425 
the Hemorrhoidal Flux. But a difcharge 
of blood from within the anus, when the 
blood is of a florid colour, fliowing it to 
have come from no great diftance, is alfo 
confidered as the fame difeafe ; and phyfi- 
cians have agreed in making two cafes or 
varieties of it, under the names of Exter- 
nal and Internal Hemorrhois. 
DCCCCXXVI. 
In both cafes it is fuppofed that the flow 
of blood is from tumours previoufly formed, 
which are named Hemorrhoids, or Piles; 
and it frequently happens, that the tu- 
mours exift without any difcharge of blood • 
in which cafe, however, they are fuppofed 
to be a part of the fame difeafe, and are 
named Hemorrhoides Cascaz, or Blind 
Piles. 
Vol. II. 
Ee 
DCCCCXXVII* 426 
PRACTICE 
DCCCCXXVII. 
Thefe tumours, as they appear without 
the anus, are fometimes feparate, round, 
and prominent, on the verge of the anus ; 
but frequently the tumour is only one tu- 
mid ring, forming, as it were, the anus 
puffied without the body. 
DCCCCXXVIII. 
Thefe tumours, and the difcharge of 
blood from them, fometimes come on as 
an affection purely topical, and without 
any previous difordcr in other parts of the 
body : but it frequently happens, even 
before the tumours are formed, and more 
efpecially before the blood flows, that va- 
rious diforders are felt in different parts 
of the body, as headach, vertigo, ftupor, 
difficulty of breathing, ficknefs, colic- 
pains, pain of the back and loins and 
often. OF PHYSIC. 
427 
often, together with more or fewer of 
thefe fymptoms, there occurs a confider- 
able degree of pyrexia. 
The coming on of the difeafe with thefe 
fymptoms, is ufually attended withafenfe 
of fullnefs, heat, itching, and pain in and 
about the anus. 
Sometimes the difeafe is preceded by a 
difeharge of ferous matter from the anus: 
and fometimes this ferous difeharge, ac- 
companied with fome fwelling, feems to be 
in place of the difeharge of blood, and to 
relieve thofe diforders of the fyftem which 
we have mentioned. This ferous difeharge, 
therefore, has been named the Hemorrhois 
Alba. 
DCCCCXXIX. 
In the hemorrhois, the quantity of blood 
difcharged is different upon different occa- 
fions. Sometimes the blood flows only 
E e 2 
upon 428 
PRACTICE 
upon the perfon's going to ftool; and com- 
monly, in larger or lefler quantity, follows 
the difcharge of the faeces, in other cafes, 
the blood flows without any difcharge of 
faeces ; and then, generally, it is after ha- 
ving been preceded by the diforders above- 
mentioned, when it is alfo commonly in 
larger quantity. This difcharge of blood 
is often very conflderable ; and, by the re- 
petition, it is often fo great, as we could 
hardly fuppofe the body to bear but with 
the hazard of life. Indeed, though rarely, 
it has been fo great as to prove fuddenly 
fatal. Thefe conflderable difcharges occur 
efpecially to perfons who have been fre- 
quently liable to the difeafe. They often 
induce great debility; and frequently a 
leucophlegmatia, or dropfy, which proves 
fatal. 
The tumours and difcharges of blood in 
this difeafe, often recur at exadlly Rated 
periods. 
DCCCCXXX. OF PHYSIC. 
429 
DCCCCXXX. 
It often happens, in the decline of life, 
that the hemorrhoidal flux, formerly fre- 
quent, ceafes to flow; and, upon that 
event, it generally happens that the per- 
fons are afledted with apoplexy or palfy. 
DCCCCXXXI. 
Sometimes hemorrhoidal tumours are 
affedled with coniiderable inflammation; 
which, ending in fuppuration, gives occa- 
fion to the formation of fiftulous ulcers in 
thofe parts. 
DCCCCXXXII. 
The hemorrhoidal tumours have been 
often confidered as varicous tumours, or 
xlilatations of veins ; and it is true, that in 
fome cafes varicous dilatations have appear- 
ed 
E e 3  PRACTICE 
430 
ed upon difledion. Thefe, however, do 
not always appear ; and 1 prefume it is 
not the ordinary cafe, but that the tumours 
are formed by an effufion of blood into the 
cellular texture of the inteftine near to its 
extremity. Thefe tumours, when 
recently formed, frequently contain fluid 
blood ; but, after they have remained for 
fome time, they arc commonly of a firmer 
fub fiance. 
DCCCCXXXIil. 
From a confideration of their caufes, to 
be hereafter mentioned, it is fufficiently 
probable, that hemorrhoidal tumours are 
produced by fpinc interruption of the free 
return of blood from the veins of the 
lower extremity of the redum; and it is 
pofiiblc, that a confidcrable accumulation 
of blood in thefe veins, may occasion a 
rupture of their extremities, and thus pro- 
duce Of PHYSIC. 
431 
duce the hemorrhagy or tumours I have 
mentioned. But, confidering that the he- 
morrhagy occurring here, is often preceded 
by pain, inflammation, and a febrile ftate, 
as well as by many other fymptoms which 
ihow a connection between the topical affec- 
tion and the ftate of the whole fyftem, it 
feems probable that the interruption of 
the venous blood, which we have fuppofed 
to take place, operates in the manner ex- 
plained inDCCLXIX.; and therefore, that 
the difcharge of blood here is commonly 
from arteries. 
DCCCCXXXIV. 
Some phyficians have been of opinion, 
that a difference in the nature oi the he- 
morrhois, and of its effects upon the fy- 
ftem, might arife from the difference of 
the hemorrhoidal veffels from which the 
blood iffued. But it appears to me, that 
Ee 4 
hardly 432 
PRACTICE 
hardly in any cafe we can diftinguifli the 
velfcls from which the blood flows; and 
that the frequent inofculations, of both 
the arteries and veins which belong to 
the lower extremity of the return, will 
render the effects of the hemorrhagy near- 
ly the fame, from whichfoever of thefe 
veflels the blood proceed. 
DCCCCXXXV. 
In DCCLX1X. I have endeavoured to 
explain the manner in which a certain 
Rate of the fanguiferous fyftem might give 
occafion to an hemorrhoidal flux; and I 
have no doubt, that this flux may be pro- 
duced in that manner. I cannot, however, 
by any means admit that the difeafe is fo 
often produced in that manner, or that, on 
its firfl appearance, it is lb frequently a 
fyftematic afiecflion, as the Stahlians have 
imagined, and would have us to believe. Ic 
occurs OF PHYSIC. 
433 
occurs in many perfons before the period 
of life at which the venous plethora takes 
place ; it happens to females, in whom a 
venous plethora, determined to the hemor- 
rhoidal vefTels, cannot be fuppofed; and 
it happens to both fexes, and to perfons of 
all ages, from caufes which do not affect 
the fyftem, and are inanifeftly fuited to 
produce a topical affection only. 
DCCCCXXXVL 
Thefe caufes of a topical affe&ion are, in 
the fir it place, the frequent voiding of hard 
and bulky faeces, which, not only by their 
long flagnation in the rectum, but Spe- 
cially when voided, mutt prefs upon the 
veins of the anus, and interrupt the courfe 
of the blood in them. It is for this rea- 
fon that the difeafe happens fo often to 
perlons of a flow and bound belly. 
DCCCCXXXVIL 434 
PRACTICE 
DCCCCXXXVII, 
From the caufes juft now mentioned, 
the difeafe happens efpecially to perfons 
liable to fome degree of a prolapfus ani. 
Almoft every perfon in voiding feces has 
the internal coat of the return more or 
Icfs protruded without the body; and this 
will be to a greater or leffer degree, accor- 
ding as the hardncfs and bulk of the feces 
occafion a greater or leffer effort or pref- 
fure upon the anus. While the gut is thus 
pu filed out, it often happens, that the 
fphinder ani is contracted before the gut 
is replaced; and, in confequence thereof, 
a ftrong conftriction is made, which pre- 
venting the fallen-out gut from being re- 
placed, and at the fame time preventing 
the return of blood from it, occafions its 
being confiderably fwellcd, and its form- 
ing a tumid ring round the anus. 
DCCCCXXXV1IL o F P H Y S I C. 
435 
DCCCCXXXVIII. 
Upon the fphinfler's being a little re- 
laxed, as it is immediately after its ftrong 
contraction, the fallen-out portion of the 
gut is commonly again taken within the 
body; but, by the frequent repetition of 
Rich an accident, the fize and fullnefs of 
the ring formed by the fallen-out gut, is 
much increafed. It is therefore more flow- 
ly and difficultly replaced; and in this 
conffils the chief uneafmefs of hemorrhoi- 
dal perfons. 
DCCCCXXXIX. 
As the internal edge of the ring men- 
tioned, is neceflarily divided by clefts, the 
whole often affumes the appearance of a 
number of diflind fwellings ; and it alfo 
frequently happens, that feme portions of 
it 436 
PRACTICE 
it more confiderably fwelled than others, 
become more protuberant, and form thofe 
fmall tumours more ftriCtly called Hemor- 
rhoids, or Piles. 
DCCCCXL. 
From confidering that the prefiure of 
feces, and other caufes interrupting the 
return of venous blood from the lower ex- 
tremity of the reftum, may operate a good 
deal higher up in the gut than that extre- 
mity, it may be eafily underftood that tu- 
mours may be formed within the anus; 
and probably it alfo happens, that fome of 
the tumours formed without the anus, as in 
DCCCCXXXIX. may continue when taken 
within the body, even be increafed by 
the caufes juft now mentioned. It is thus 
that I 'would explain the production of in- 
ternal piles, which, on account of their 
fituation and bulk, are not protruded on 
the OF PHYSIC. 
437 
the perfon's going to ftool, and are often, 
therefore, more painful. The fame inter- 
nal piles are more efpecially painful, when 
affedled by the hemorrhagic effort defcri- 
bed in DCCXLV. and DCCLXIX. 
DCCCCXLI. 
The production of piles is particularly 
illultrated by this, that pregnant women 
are frequently affeCted with them. This 
is to be accounted for, partly from the 
preffure of the uterus upon the rectum, 
and partly from the coftive habit to which 
pregnant women are ufually liable. I have 
known many inftances of piles occurring 
for the fir ft time during the ftate of preg- 
nancy ; and there are few women that 
have born children who are afterwards 
entirely free from piles. The Stahlians 
have commonly afierted, that the male fex 
is more frequently affeCted with this dif- 
eafe 438 
PRACTICE. 
eafe than the female; but in this country 
I have conflantly found it otherwife. 
DCCCXLII. 
It is commonly fuppofed, that the fre- 
quent ufe of purgatives, efpccially of thofe 
of the more acrid kind, and more particu- 
larly of aloetics, is apt to produce the he- 
morrhoidal affection ; and as thefe purga- 
tives ftimulate chiefly the great guts, it 
feems fufficiently probable that they may 
excite this difeafe. 
DCCCCXLlli. 
I have now mentioned feveral can Fes 
which may produce the hemorrhoidal tu- 
mours and flux as a topical affecflion only; 
but muft obferve farther, that although 
the difeafe appears firfl: as a purely topical 
affedtion, it may, by frequent repetition, 
become habitual, and therefore may be- 
come OF PHYSIC. 
439 
come connected with the whole fyflem, in 
the manner already explained, with refpecl 
to hemorrhagy in general, in DCCXLVI1I. 
DCCCCXLIV. 
The dodlrine now referred to, will, it is 
apprehended, apply very fully to the cafe of 
the hemorrhoidal flux; and will the more 
readily apply, from the perfon who has been 
once affected being much expofed to a re- 
newal of the caufes which firfl occalioned 
the difeafe; and from many perfons being 
much expofed to a congeflion in the he- 
morrhoidal veflels, in confequenCe of their 
being often in an eredl pofition of the 
body, and in an exercife which pufhes the 
blood into the depending veflels, while at 
the fame time the effects of thefe circum- 
ilances are much favoured by the abun- 
dance and laxity of the cellular texture 
about the redlum. 
DCCCCXLV. 440 
PRACTICE 
DCCCCXLV. 
It is thus that the hemorrhoidal flux is 
fo often artificially rendered an habitual 
and fyflematic affeCtion ; and 1 am perfua- 
ded, that it is this which has given occa- 
iion to the Stahlians to confider the difeafe 
as almofl univerfally fuch. 
DCCCCXLVI. 
It is to be particularly obferved here, 
that when the hemorrhoidal difeafe has 
either been originally, or has become, in 
the manner juft now explained, a fyftema- 
tic affection, it then acquires a particular 
connexion with the ftomach, fo that cer- 
tain affections there excite the hemorrhoi- 
dal difeafe, and certain ftates of the hemor- 
rhoidal affeClion excite diforders of the fto- 
mach. 
It is perhaps owing to this connection, 
that the gout fometimes affects the re&um. 
See DXXV. 
SECT. OF PHYSIC. 
441 
SECT. n. 
Of the Cure of Hemorrhoidal Affections. 
DCCCCXLVIL 
Almost at all times it has been an 
opinion amongft phyficians, and from 
them fpread amongft the people, that the 
hemorrhoidal flux is a falutary evacua- 
tion, which prevents many difeafes that 
would otherwife have happened ; and that 
it even contributes to give long life. This 
opinion, in later times, has been efpecially 
Vol. IL 
Ff 
men- 442 
PRACTICE 
mentained by Dr Stahl, and his followers ; 
and has had a great deal of influence upon 
the practice of phyfic in Germany. 
DCCCCXLVIII. 
The queftion arifes with refpecft to he- 
morrhagy in general, and indeed it has been 
extended fo far by the Stahl ians. I have 
accordingly confidered it as a general que- 
ftion, (DCCLXVH.-DCCLXXX.), but 
it has been more efpecially agitated with 
regard to the difeafe now under our confl- 
deration : And as to this, although I am 
clearly of opinion, that the hemorrhois 
may take place in confequence of the 
general ftate of the fyftem, DCCLXIX. 
or, what is ftill more frequent, that by re- 
petition it may become connected with that 
general ftate DCCCCXLIII. and in either 
cafe cannot be fupprefled without great 
caution; I muft beg leave, notwithftanding 
beg OF PHYSIC. 
443 
this, to maintain, that the firft is a rare cafe, 
that generally the difeafe firft appears as an 
affection purely topical (DCCCCXXXV. 
DCCCCXLIL), and that the allowing it 
to become habitual is never proper. It is 
a nafty difagreeable difeafe, ready to go to 
excefs, and to be thereby very hurtful, as 
well as fometimes fatal. At belt it is liable 
to accidents, and thereby to unhappy con- 
fequences. 1 am therefore of opinion, that 
not only the firft approaches of the difeafe 
are to be guarded againft, but even that 
when it has taken place for fome time> 
from whatever caufe it may have pro- 
ceeded, the flux is always to be moderated, 
and the neceffity of it, if poifible, fuper- 
feded. 
DCCCCXLIX. 
Having delivered thefe general rules, I 
proceed to mention more particularly, how 
Ff 2 
the 444 
PRACTICE 
the difeafe is to be treated, acccording to 
the different circumftances under which it 
may appear. 
When we can manifeftly difcern the firft 
appearance of the difeafe to arife from 
caufes acting upon the part only, the ftridl- 
eft attention fliould be employed in guard- 
ing againft the renewal of thefe caufes. 
DCCCCL. 
One of the moft frequent of the remote 
caufes of the hemorrhoidal affection, is a 
flow and bound belly, (DCCCCXXXVI.): 
and this is to be conftantly obviated by a 
proper diet, which each individual's own 
experience muft direct ; or, if the manage- 
ment of diet be not effectual, the belly 
muft be kept regular by fuch medicines 
as may prove gently laxative, without 
irritating the rectum. In moft cafes it will 
be OF PHYSIC. 
445 
be of advantage to acquire a habit with re- 
ipecl to time, and to obferve it exadlly. 
DCCCCLI. 
Another caufe of hemorrhois to be efpeci- 
ally attended to, is the prolapfus or protru- 
fion of the anus, which is apt to happen on 
aperfon'shavingaftool,(DCCCCXXXVII.) 
If it fliall occur to any conliderable degree, 
and at the fame time be not ealily and im- 
mediately replaced, it moft certainly pro- 
duces piles, orincreafes them when other- 
wife produced. Perfons therefore liable to 
this prolapfus, fhould, upon their having 
been at ftool, take great pains to have the 
gut immediately replaced, by lying down 
in a horizontal pofture, and preffing gently 
upon the anus, till the reduction fliall be 
completely obtained. 
Ff3 
DCCCCLII. 446 
PRACTICE 
DCCCCLII. 
When the prolapfus of which I fpeak, 
is occafioned only by voiding hard and 
bulky feces, it fhould be obviated by the 
means mentioned in DCt CCL. and may 
be thereby avoided. But in fome perfons 
it is owing to a laxity of the rectum; in 
which cafe it is often moft confiderable 
upon occafion of a loofc (tool: and then the 
difeafe is to be treated by aftringents, as 
well as by proper artifices for preventing 
the falling down of the gut. 
DCCCCLIIL 
Thefe are the means to be employed 
upon the firft approaches of the hemor- 
rhoidal affection; and when from neglcft it 
fhall have frequently recurred, and has be- 
come in fome meafure eftablifhed, they are 
no lefs proper. In the latter cafe, however, 
fome OF PHYSIC. 
447 
ibme other means are alfo neceflary. It is 
particularly proper to guard againft a ple- 
thoric ftate of the body ; confequently, to 
avoid a fedentary life, a full diet, and par- 
ticularly intemperance in the ufe of ftrong 
liquor, which, as I fhould have obferved 
before, is, in all cafes of hemorrhagy, of the 
greateft influence in increafing the difpofi- 
tion to the difeafe. 
DCCCCLIV. 
I need hardly repeat here, that exercife 
of all kinds mutt be a chief means of ob- 
viating and removing a plethoric date of 
the body; but upon occaflon of the he- 
morrhoidal flux immediately approaching, 
both walking and riding, as increafing the 
determination of the blood into the hemor- 
rhoidal veflels, are to be avoided. At other 
times, when no fuch determination has 
Ff4 
been 448 
PRACTICE 
been already formed, thofe modes of exer- 
cife may be very properly employed. 
DCCCCLV. 
Cold bathing is another remedy that may 
be employed to obviate plethora, and pre- 
vent hemorrhagy; but it is to be ufed with 
caution. When the hemorrhoidal flux is 
approaching, it may be dangerous to turn 
it fuddenly afide by cold bathing: but 
during the intervals of the difeafe, this re- 
medy may be employed with advantage; 
and in perfons liable to a prolapfus ani, 
the frequent waffling of the anus with cold 
water may be very ufeful. 
DCCCCLVI. 
Tliefe are the means for preventing the 
recurrence of the hemorrhoidal flux; and 
in all cafes, when it is not immediately 
ap- O F P H Y S I C. 
449 
approaching, they are to be employech 
When it has actually come on, means are 
to be employed for moderating it as much 
as poffible, by the perfons lying in a hori- 
zontal polition upon a hard bed; by avoid- 
ing exercife in an eredl pollute ; by uling 
a cool diet; by avoiding external heat; and 
by obviating the irritation of hardened 
faeces by the ufe of proper laxatives, 
(DCCCCL.). From what has been faid 
above, as to the being careful not to in- 
creafe the determination of the blood into 
the hemorrhoidal velfels, the propriety of 
thefe meafures mull fufEciently appear ; 
and if they were not fo generally neglected, 
many perfons would efcape the great 
trouble, and the various bad confequences 
which fo frequently refult from this dif- 
eafe. 
DCCCCLVII. 450 
PRACTICE 
DCCCCLVIL 
With refpe6t to the further cure of this 
difetfe, it is almoSt in two cafes only, that 
hemorrhoidal perfons call for the afliSt- 
ance of the phyfician. The one is when 
the affection is accompanied with much 
pain ; and of this there are two cafes, ac- 
cording as the pain happens to attend the 
external or the internal piles. 
DCCCLV1IL 
The pain of the external piles arifes espe- 
cially when a conflderableprotrufion of the 
rectum has happened; and when, conti- 
nuing unreduced, it is Strangled by the con- 
ftridion of the fphinder; while, at the 
fame time, no bleeding happens, to take 
off the Swelling of the protruded portion 
of the inteStine. Sometimes an inflamma- 
tion Supervenes, and greatly aggravates the 
pain. OF PHYSIC. 
451 
pain. To relieve the pain in this cafe, 
emollient fomentations and poultices are 
fometimes of fervice ; but a more effectual 
relief is to be obtained by applying leeches 
to the tumid parts. 
DCCCCLIX. 
The other cafe in which hemorrhoidal 
perfons leek aifiitance, is that of excelTive 
bleeding. Upon the opinion fo generally- 
received of this difcharge being falutary, 
and from the obfervation that upon the 
difcharge occurring perfons have fome- 
times found relief from various diforders, 
rhe molt part of perfons liable to it are 
ready to let it go too far ; and indeed the 
Stahlians will not allow it to be a difeafe, 
unlefs when it has actually gone to excels. 
I am, however, well perfuaded, that this 
flux ought always to be cured as foon as 
poflible. 
DCCCCLX. 452 
PRACTICE 
DCCCCLX. 
When the difeafe occurs as a purely to- 
pical affection, there can be no doubt of 
the propriety of this rule; and, even when 
it has occurred as a critical difcharge in the 
cafe of a particular difeafe, yet when this 
difeafe fliall have been entirely cured and 
removed, the preventing any return of the 
hemorrhois feems to be both fafe and pro- 
per. 
DCCCCLXI. 
It is only when the difeafe arifes from a 
plethoric Rate of the body, and from a (tag- 
nation of blood in the hypochondriac 
region, or when, though originally topical, 
the difeafe, by frequent repetition, has be- 
come habitual, and has thereby acquired a 
connection with the whole fyftem, that 
any doubt can arife as to the fafety of 
curing OF PHYSIC. 
453 
curing it entirely. Even in thefe cafes, 
however, I apprehend it will be always 
proper to moderate the bleeding; lefl by 
its continuance or repetition, the plethoric 
Rate of the body, and the particular de- 
termination of the blood into the hemor- 
rhoidal veflels,be increafed, and the recur- 
rence of the difeafe, with all its inconve- 
niences and danger, be too much favoured. 
DCCCCLXII. 
Further, even in the cafes Rated, 
(DCCCCLXL), in fo far as the plethoric 
Rate of the body, and the tendency to that 
Rate, can be obviated and removed, this is 
always to be diligently attempted ; and if 
it can be executed with fuccefs, the flux 
may be entirely fupprefled. 
DCCCCLXIIL 454 
PRACTICE 
DCCCCLX1IL 
The Stahlian opinion, that the hemor- 
rhoidal flux is only in excefs when it oc- 
cafions great debility, or a leucophlegma- 
tia, is by no means juft; and it appears to 
me, that the fmalleft approach towards 
producing either of thefe, fhould be con- 
fidered as an excefs, which ought to be 
prevented from going farther. 
DCCCCLXIV. 
In all cafes therefore of excefs, or of 
any approach towards it, and particularly 
when the difeafe depends upon a prolapfus 
ani (DCCCLL), I am of opinion that 
aftringents, both internal and external, 
may be fafely and properly employed; not 
indeed to induce an immediate and total 
fuppreflion, but to moderate the hemor- 
rhagy, and by degrees to fupprefs it alto- 
gether, OF PHYSIC. 
455 
gether, while at the fame time meafures 
are taken for removing the neceflity of 
its recurrence. 
DCCCCLXV. 
When the circumftances (DCCCXLVL) 
marking a connection between the hemor- 
rhoidal affedtion and the date of the fto- 
mach occur, the meafures neceffary are the 
fame as in the cafe of atonic gout. 
The End of the Second Volume.