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, 
®f the Royal Societies of London, of Edinburgh, &c. &c. 
FOURTH EDITION, 
Corrected and Enlarged. 
VOL. III. 
EDI NBURGH: 
Printed for C. ELLIOT, Edinburgh; 
And T. CADELL, London. 
M.DCC.LXXXIV. CONTENTS. 
PART I. BOOK IV. 
"CHAP. VI. 
Of the Menorrhagia, or the Immo- 
derate Flow of the Menfes - 9 
CHAP. VII. 
Of the Leucorrhoea, Fluor Albusy or 
Whites * 24 
CHAP. VIII. 
Of the Amenorrhoea, or Interruption 
of the Menftrual Flux - 32 
A 2 CHAP. 
» X. X ..... / IV 
CONTENTS. 
CHAP. IX. 
Hemorrhagies 49 
Sed. L Of the hematemesis, or Vo- 
miting of Blood - - 51 
Se6E II. Of the hematuria, or the 
Voiding of Blood from the Urinary 
Faffage - 67 
BO O K V. 
Of Profluvia, or Fluxes with Py- 
rexia • - - 81 
c ?;A 'V'/.V. r i 
- C H A P. I. 
Of the Catarrh - "83 
.IIIV A A I' 3 
3. C H A P. II. .1 
Of the Dysentery - - - 101 
1 - CHAP. CONTENTS. 
V 
PART II. 
OF NEUROSES, OR NERVOUS , 
DISEASES - - I3i 
BOOK I, 
Of Comata, or of the Loss of 
Voluntary Motions - 124 
CHAP I. 
Of Apoplexy - - 126 
CHAP. II. 
Of Palsy - - 17° 
S . .( A 3 BOOK VI 
CONTENTS. 
BOOK IL 
Of Adynamite, or Diseases con- 
sisting in a Weakness or Loss 
of Motion in either the Vi- 
tal or Natural Functions 197 
CHAP. I. 
Syncope, or Fainting - 197 
■ 
CHAP. II. 
Q/" Dyspepsia, or Indigejlion - 217 
CHAP. III. 
or the Hypo- 
chondriac commonly called 
Vapours or Low Spirits - 249 
CHAP. CONTENTS. 
VII 
BOOK III. 
Of Spasmodic Affections with- 
out Fever - - 274 
Sect. I. 
Of the Spafnodic Affections of the Ani- 
mal Functions - 277 
CHAP. I. 
QfTETANUS - - 282 
CHAP. II. 
OfEPILEPSX - - 313 
CHAP. III. 
Of the Ghorea, or Dance of St Vitus 366 
CHAP. VIII 
contents; 
Sect.IL 
Of the Spofmodic Affections of the Vital 
Functions - - 2 72 
CHAP. IV *. 
Of the Palpitation of the Heart 372 
CHAP. V. 
Q/'DysPnoe a, or Difficult Breathing 381 
C H A P. VI. 
Of Asthma - - 387 
CHAP. VII. 
Of the Chincough, or Hoooping-Cougb 411 
* Though I have thought it proper to divide this book 
into fe&ions, I think it neceffary, for the convenience of 
references, to number the chapters from the beginning. FIRST LINES 
O F T H E 
PRACTICE of PHYSIC. 
PARTI. B O O K IV. 
CHAP. VI. 
Of the Menorrhagia, 
OR THE 
Immoderate Flow of the Menses. 
DCCCCLXVI. 
BLOOD difcharged from the vagina 
may proceed from different fources 
in the internal parts: but 1 here mean 
Vol. III. 
B 
to 10 
PRACTICE 
to treat of thofc difcharges only, in which 
the blood may be prefumed to flow from 
the fame fources that the menfes in their 
natural flate proceed from; and which dif- 
charges alone, are thofe properly compre- 
hended under the prefent title. The title 
of Metrorrhagia, or hemorrhagia uteri, might 
comprehend a great deal more. 
DCCCCLXVII. 
The menorrhagia may be confidered as 
of two kinds ; either as it happens to preg- 
nant and lying-in women, or as it happens 
to women neither pregnant nor having re- 
cently born children. The firft kind, as 
connected with the circumftances of preg- 
nancy and child-bearing, (which are not to 
be treated of in the prefent courfe), I am 
not to confider here, but {hall confine my- 
felf to the fecond kind of menorrhagia 
only. 
DCCCCLXVIII. OF PHYSIC. 
11 
DCCCCLXVIII. 
The flow of the menfes is conlidered as 
immoderate, when it recurs more fre- 
quently, when it continues longer, or 
when during the ordinary continuance it 
is more abundant, than is ufual with the 
fame perfon at other times. 
DCCCCLXIX. 
As the moft part of women are liable to 
fome inequality with refpedt to the period, 
the duration, and the quantity of their 
menfes ; fo it is not every inequality in 
thefe refpedls that is to be confidered as a 
difeafe; but only thofe deviations, which 
are exceflive in degree, which are perma- 
nent, and which induce a manifeft ftate of 
debility. 
B 2 
DCCCCLXX. PRACTICE 
12 
DCCCCLXX. 
The eircumftances (DCCCCLXVI1L 
DCCCCLX1X.) are thofe which chiefly 
conftitute the menorrhagia : but it is pro- 
per to obferve, that although I allow the 
frequency, duration, and quantity of the 
menfes to be judged of by what isufualwith 
the fame individual at other times; yet there 
is, hi thefe particulars, fo much uniformity 
obfervable in the whole of the fex, that in 
any individual in whom there occurs a con- 
fiderable deviation from the common mea- 
fure, fuch a deviation, if conftantly recur- 
ring, may be confidered as at leaft ap- 
proaching to a morbid ftate, and as requi- 
ring moft of the precautions which I fhall 
hereafter mention as neceflary to be at- 
tended to by thofe who are actually in 
fuch a ftate. 
DCCCCLXXL OF PHYSIC. 
13 
DCCCCLXXI. 
However we may determine with refpedl 
to the circumftances DCCCCLXV1II. 
DCCCCLXIX. it mutt ftill be allowed, 
that the immoderate flow of the menfes is 
efpecially to be determined by thofefymp- 
toms affedting other fundlions of the body, 
which accompany and follow thedifcharge. 
When a larger flow than ufual of the 
menfes has been preceded by headach,gid- 
dinefs, or dyfpnoea, and has been ufhered 
in by a cold ftage, and is attended with 
much pain of the back and loins, with a 
frequent pulfe, heat and third:, it may then 
be confidered as preternaturally large. 
PCCCCLXXII. 
When, in confequence of the circum- 
ftances DCCCCLXVIII.-DCCCCLXXI. 
and the repetition of thefe, the face be- 
comes 
B3 14 
PRACTICE 
comes pale; the pulfe grows weak; an un- 
ufual debility is felt in exercife ; the brea- 
thing is hurried by moderate exercife; 
when, alfo, the back becomes pained from 
any continuance in an erect pofture; when 
the extremities become frequently cold; 
and when in the evening the feet appear 
affected with oedematous fweliing; we may 
from thefe fymptoms certainly conclude, 
that the flow of the menfes has been im- 
moderate, and has already induced a dan-? 
gerous ftate of debility. 
DCCCCLXXIII. 
The debility thus induced, does often 
difcover itfelf alfo by affections of the fto- 
mach, as anorexia and other fymptoms of 
dyfpepfia; by a palpitation of the heart, 
and frequent faintings ; by a weaknefs of 
mind liable to flrong emotions from flight 
caufes, efpecially when fuddenly prefented, 
DCCcCLXXIV. OF PHYSIC. 
15 
DCCCCLXXIV. 
- - ■ ' ' ' ' z 
That flow of the menfes, which is at- 
tended with barrennefs in married women, 
may be generally considered as immode- 
rate and morbid. 
DCCCCLXXV. 
Generally, alfo, that How of the men- 
fes may be confidered as immoderate, 
which is preceded and followed by a leu- 
corrhoea. 
DCCCCLXXVI. 
I treat of menorrhagia here as an active 
hemorrhagy, becaufe I confider inenftrua- 
tion, in its natural Rate, to be always of 
that kind; and although there Ihould be 
cafes of menorrhagia which might be con- 
fidered as purely paffive, it appears to me 
B4 
that 16 
PRACTICE 
that they cannot be fo properly treated of 
in any other place. 
DCCCCLXXVIL 
The menorrhagia (DCCCCLXVIII.tf 
has for its proximate caufe, either the he- 
morrhagic effort of the uterine veffels pre- 
ternaturally increafed, or a preternatural 
laxity of the extremities of the uterine ar- 
teries, the hemorrhagic effort remaining as 
in the natural date. 
DCCCCLXXVIII. 
The remote caufes of the menorrhagia 
may be, iy?, Thofe which increafe the ple- 
thoric ftate of the uterine veffels ; fuch as 
a full and nourilhing diet, much ftrong 
liquor, and frequent intoxication. idly, 
Thofe which determine the blood more 
copiouily and forcibly into the uterine vef- 
fels ; OF PHYSIC. 
17 
fels; as violent (trainings of the whole 
body ; violent (hocks of the whole body 
from falls ; violent ftrokes or contufions 
on the lower belly ; violent exercife, parti- 
cularly in dancing ; and violent paffions 
of the mind. ydly, Thofe which particu- 
larly irritate the veffels of the uterus ; as 
excefs in venery; the exercife of venery in 
the time of menftruation ; a coftive habit, 
giving occafion to violent (training at (tool; 
and cold applied to the feet. Ajhly, Thofe 
which have forcibly overftrained the ex- 
tremities of the uterine velfels; as frequent 
abortions ; frequent child-bearing with- 
out nurfing; and difficult tedious labours. 
Or, lajlly, Thofe which induce a general 
laxity; as living much in warm chambers, 
and drinking much of warm enervating 
liquors, fuch as tea and coffee. 
DCCCCLXXIX. 18 
PRACTICE 
DCCCCLXXIX. 
The effects of the menorrhagia are pointed 
out in DCCCCLXXII. DCCCCLXXIII. 
where I have mentioned the feveral fymp- 
toms accompanying the difeafe, and from 
thefe the confequences to be apprehended 
will alfo readily appear. 
DCCCCLXXX. 
The treatment and cure of the menor- 
rhagia muft be different, according to the 
different caufes of the difeafe. 
In all cafes, the firft attention ought to 
be given to avoiding the remote caufes, 
whenever that can be done; and by that 
means the difeafe may be often entirely 
avoided. 
When the remote caufes cannot be avoid- 
ed, or when the avoiding them has been 
negledled, and therefore a copious men- 
ftruation OF PHYSIC. 
19 
ftruation has come on, it fhould be mode- 
rated as much as poflible, by abftaining 
from all exercife, either at the coming on 
or during the continuance of the menftru- 
ation ; by avoiding even an erect poflure 
as much as poflible; by ffiunning external 
heat, and therefore warm chambers and 
foft beds; by ufing a light and cool diet; 
by taking cold drink, at leaft as far as 
former habits will allow; by avoiding ve- 
nery; by obviating coftivenefs, or remo- 
ving it by laxatives that give little ftimu- 
lus. 
The fex are commonly negligent, either 
in avoiding the remote caufes, or in mode- 
rating the firft beginnings of this difeafe. 
It is by fuch neglect that it fo frequently 
becomes violent, and of difficult cure ; and 
the frequent repetition of a copious men- 
ftruation, may be confidered as a caufe of 
great laxity in the extreme veflels of the 
uterus. 
DCCCCLXXXI. 20 
PRACTICE 
DCCCCLXXXI. 
When the coming on of the menftrua- 
tion has been preceded by fome diforder 
in other parts of the body, and is accom- 
panied with pains of the back, refembling 
parturient pains, together with febrile 
Symptoms, and when at the fame time the 
flow feems to be copious, then a bleeding 
at the arm may be proper, but it is not 
often neceflary ; and it will in moft cafes 
be fufficient to employ, with great atten- 
tion and diligence, thofe means for mode- 
rating the difcharge which have been men- 
tioned in the laft paragraph. 
DCCCCLXXXIL 
When the immoderate flow of the men- 
fes fliall feem to be owing to a laxity of 
the veflels of the uterus, as may be con- 
cluded from the general debility and laxity 
of OF PHYSIC. 
21 
of the perfon's habit; from the remote 
caufes that have occafioned the difeafe 
(DCCCCLXXVIIL) ; from the abfence of 
the fymptoms which denote increafed adlion 
in the velfelsofthe uterus (DCCCCLXXI.); 
from the frequent recurrence of the dif- 
eafe ; and particularly from this, that in 
the intervals of menftrnation the perfon is 
liable to a leucorrhoea ; then in fuch cafe 
the difeafe is to be treated, not only by- 
employing all the means mentioned in 
DCCCCLXXX* for moderating the he- 
morrhagy, but alfo by avoiding all ir- 
ritation, every irritation having the greater 
effect in proportion as the veffels have 
been more lax and yielding. If, in fuch a 
cafe of laxity, it fhall appear that fome de- 
gree of irritation concurs, opiates may be 
employed to moderate the difcharge; but 
in ufing thefe, much caution is requilite. 
If, notwithftanding thefe meafures ha- 
ving PRACTICE 
22 
ving been taken, the difcharge fhall prove 
very large, aftringents both external and 
internal may be employed. In fuch cafes, 
may fmall dofes of emetics be of fervice ? 
DCCCCLXXIII. 
When the menorrhagia depends on the 
laxity of the uterine veffels, it will be pro- 
per, in the intervals of menftruation, to 
employ tonic remedies ; as cold bathing 
and chalybeates. The exercifes of gefta- 
tion, alfo, may be very ufeful, both for 
ftrengthening the whole fyftem, and for 
taking off the determination of the blood 
to the internal parts. 
DCCCCLXXIV. 
The remedies mentioned in thefe two laft 
paragraphs, may be employed in all cafes 
of OF PHYSIC. 
23 
of menorrhagia, from whatever caufe it 
may have proceeded, if the difeafe fhall 
have already induced aconliderable degree 
of debility in the body. 
CHAP. 24 
PRACTICE 
CHAP. VII. 
Of the Leucorrhoea, Fluor Albus. 
or Whites. 
DCCCCLXXXV. 
EVERY ferous or puriform difcharge 
from the vagina, may be, and has been 
Comprehended under one or other of the 
appellations 1 have prefixed to this chapter. 
Such difcharges, however, may be various; 
and may proceed from various fources, not 
yet well afcertained: but I confine myfelf 
here to treat of that difcharge alone which 
may OF PHYSIC. 
25 
be prefumed to proceed from the fame vef- 
fels, which, in their natural Rate, pour out 
the menfes. 
DCCCCLXXXVI. 
I conclude a difcharge from the vagina 
to be of this kind;* i. From its happening 
to women who are fubject to an immode- 
rate flow of the menfeSj and liable to this 
from caufes weakening the veflels of the 
uterus. 2. From its appearing chiefly, 
and often only, a little before, as well as 
immediately after, the flow of the menfes. 
3. From the flow of the menfes being di- 
minilhed, in proportion as the leucorrhcea 
is increafed. 4. From the leucorrhcea 
continuing after the menfes have entirely 
ceafed, and -with fome appearance of its 
obfcrving a periodical recurrence. 5. From 
the leucorrhcea being accompanied with the 
efleas of the menorrhagia (DCCCCLXXII. 
Vol. III. 
C 
DQCCCLXXIII.) 26 
PRACTICE 
DCCCCLXXI11.) 6. From the difcharge 
having been neither preceded by, nor ac- 
companied with, fymptoms of any topical 
affections of the uterus. 7. From the leu- 
corrhoea not having appeared foon after 
communication with a perfon who might 
be fufpe&ed of communicating infection, 
and from the firfl appearance of the difeafe 
not being accompanied with any inflam- 
matory affection of the pudenda. 
DCCCCLXXXVIL 
The appearance of the matter difcharged 
in the leucorrhoea, is very various with re- 
fpcel to confiftence and colour ; but from 
thefe appearances, it is not always poffible 
to determine concerning its nature, or 
the particular fource from whence it pro- 
ceeds. 
DCCCCLXXXVIH. OF PHYSIC* 
27 
DCCCCLXXXVI1I. 
The leucorrhoea, of which I am to treat, 
as ascertained by the feveral circumftances 
(DCCCCLXXXVI.) feems to proceed from 
the fame caufes as that fpecies of menor- 
rhagia which I fiippofe to arife from the 
laxity of the extreme veflels of the uterus. 
It accordingly often follows or accompa- 
nies fuch a menorrhagia ; but though the 
leucorrhoea depends chiefly upon the laxity 
mentioned, it may have proceeded from 
irritations inducing that laxity, and feems 
to be always increafed by any irritations 
applied to the uterus. 
DCCCCLXXXIX. 
Some authors have alleged that a va- 
riety of circumftances in other parts of the 
body may have a (hare in bringing on and 
in continuing this affedion of the uterus 
C 2 
now 28 
PRACTICE 
now under confideration: but I cannot 
difeover the reality of thofe caufes; and it 
feemstome, that this leucorrhoea, excepting 
in fo far as it depends upon a general debi- 
lity of the fyftem, is always primarily an 
affection of the uterus; and the affections 
of other parts of the body which may hap- 
pen to accompany it, are for the moft part 
to be confidered as effects, rather than as 
caufes. 
DCCCCXC. 
The effects o£ the leucorrhoea are much 
the fame with thofe of menorrhagia; in- 
ducing a general debility, and, in particu- 
lar, a debility in the functions of the fto- 
mach. If, however, the leucorrhoea be 
moderate, and be not accompanied with 
any confiderable degree of menorrhagia, 
it may often continue long without in- 
ducing any great degree of debility, and 
it OF PHYSIC. 
29 
it is only when the difcharge has been very 
copious as well as conftant, that its effects 
in that way are very remarkable. 
DCCCCXCI. 
But, even when its effects upon the 
whole body are not very confiderable, it 
may ftill be fuppofed to weaken the geni- 
tal fyftem; and it feems fufficiently pro- 
bable that this difcharge may often have a 
lhare in occafioning barrennefs. 
DCCCCXCII. 
The matter difcharged in the leucor- 
rhoea, is at firft generally mild : but after 
fome continuance of the difeafe, it fome- 
times becomes acrid ; and by irritating, or 
perhaps eroding, the furfaces over which 
c 3 
it 30 
PRACTICE 
it pafles, induces various painful dis- 
orders. 
DCCCCXCIIL 
As I have fuppofed that the leucorrhoea 
proceeds from the fame caufes as that fpe- 
cies of menorrhagia which is chiefly owing 
to a laxity of the uterine veflels, it mutt 
be treated, and the cure attempted, by the 
fame means as delivered inDCCCCLXXXII. 
for the cure of menorrhagia, and with lefs 
referve in refpedl of the ufe of aftrin- 
gents. 
DCCCCXCIV. 
As the leucorrhoea generally depends 
upon a great lofs of tone in the veflels of 
the uterus, the difeafe has been relieved, 
and fometimes cured, by certain ftimulant 
medicines, which are commonly deter- 
mined O F P H Y S I C. 
31 
mined to the urinary paffages, and from 
the vicinity of thefe are often communi- 
cated to the uterus. Such, for example, 
are cantharides, turpentine, and other bal- 
fams of a fimilar nature. 
C 4 
CHAP. 32 
PRACTICE 
C H A P. VIII. 
OF the Amenorrhoea, or Interrupt 
TION OF THE MENSTRUAL FLUX. • 
DCCCCXCV. 
Whatever, in a fyftem of metho- 
dical nofology, may be the fitted 
place for the amenorrhoea, it cannot be 
improper to treat of it here as an object 
of practice, immediately after having con- 
fidered the menorrhagia. 
Dccccxcyi. OF PHYSIC. 
33 
DCCCCXCVI. 
The interruption of the menftrual flux 
is to be confidered as of two different 
kinds ; the one being when the menfes do 
not begin to flow at that period of life at 
which they ufually appear; and the other 
being that when, after they have repeatedly 
taken place for fome time, they do, from 
other caufes than conception, ceafe to re- 
turn at their ufual periods : The former 
of thefe cafes is named the and 
the latter the fupprejjion of the menfes. 
DCCCCXCVII. 
As the flowing of the inenfes depends 
upon the force of the uterine arteries im- 
pelling the blood into their extremities, 
and opening thefe fo as to pour out red 
blood; fo the interruption of the men- 
ftrual flux mu ft depend, either upon the 
want 34 
PRACTICE 
want of due force in the action of the ute- 
rine arteries, or upon fome preternatural 
refiftance in their extremities. The for- 
mer I fuppofe to be the moft ufual caufe 
of retention, the latter the moft common 
caufe of fuppreffion ; and of each of thefe 
I lhall now treat more particularly. 
DCCCCXCVIII. 
The retention of the menfes, the emanfw 
merjium of Latin writers, is not to be con- 
fidered as a difeafe merely from the men- 
fes not flowing at that period which is 
ufual with moft other women. This pe- 
riod is fo different in different women, 
that no time can be precifely afligned as 
proper to the fex in general. In this cli- 
mate, the menfes ufually appear about the 
age of fourteen ; but in many they appear 
more early, and in many not till the flx- 
teenth year: in which laft cafe it is,often 
with- O F P H Y S I C. 
35 
without any diforder being thereby occa- 
fioned. It is not therefore from the age 
of the perfon, that the retention is to be 
confidered as a difeafe ; and it is only to 
be confidered as fuch, when, about the 
time the inenfes ufually appear, feme dif- 
orders arife in other parts of the body 
which may be imputed to their retention; 
being fuch as, when arifing at this period, 
are known from experience to be removed 
by the flowing of the inenfes. 
DCCCCXCIX. 
Thefe diforders are, a fluggiflmefs, and 
frequent fenfe of laflitude and debility, 
with various fymptoms of dyfpepfia ; and 
fometimes with a preternatural appetite. 
At the fame time the face lofes its vivid 
% 
colour, becomes pale, and fometimes of a 
yellowifh hue ; the whole body becomes 
pale and flaccid; and the feet, and perhaps 
alfo 36 
PRACTICE 
alfo a great part of the body, become af- 
fected with oedematous fwelling. The 
breathing is hurried by any quick or la- 
borious motion of the body, and the heart 
is liable to palpitation and fyncope. A 
head-ach fometimes occurs; but more 
certainly pains of the back, loins, and 
haunches. 
M, 
Thefe fymptoms, when occurring in a 
high degree, conftitute the chlor&fis of au- 
thors, hardly ever appearing feparate from 
the retention of the menfes ; and, attend- 
ing to thefe fymptoms, the caufe of this 
retention may, I think, be perceived.. 
Thefe fymptoms manifeftly fliow a con- 
iiderable laxity and flaccidity of the whole 
fyftem; and, therefore, give reafon to con- 
clude, that the retention of the menfes ac- 
companying them, is owing to a weaker 
adiion OF PHYSIC. 
37 
action of the veffels of the uterus ; which 
therefore do not impel the blood into their 
extremities, with a force fufficient to open 
thefe, and pour out blood by them. 
MI. 
How it happens that at a certain period 
of life a flaccidity of the fydem arifeS in 
young women not originally affected with 
any fuch weaknefs or laxity, and of which, 
but a little time before, they had given no 
indication, may be difficult to explain; but 
I would attempt it in this way. 
As a certain date of the ovaria in fe~ 
males, prepares and difpofes them to the 
exercife of venery, about the very period at 
which the menfes fird appear, it is to be 
prefumed that the date of the ovaria and 
that of the uterine velfels are in fome mea-* 
fure connected together ; and as generally 
fymptoms of a change in the date of the 
former 38 
PRACTICE 
former appear before thofe of the latter, 
it may be inferred, that the ftate of the 
ovaria has a great fhare in exciting the ac- 
tion of the uterine veffels, and producing 
the menftrual flux. But, analogous to what 
happens in the male fex, it may be pre- 
fumed, that in females a certain ftate of 
the genitals is neceffary to give tone and 
tenfion to the whole fyftem ; and there- 
fore that, if the ftimulus ariflng from the 
genitals be wanting, the whole fyftem may 
fall into a torpid and flaccid ftate, and from 
thence the chlorofls and retention of the 
menfes may arife. 
MIL 
It appears to me, therefore, that the re- 
tention of the menfes is to be referred to a 
certain date or affection of the ovaria : but 
what is precifely the nature of this affec- 
tion, or what are the caufes of it, I will 
not OF PHYSIC. 
39 
not pretend to explain ; nor can I explain 
in what manner that primary caufe of re- 
tention is to be removed. In this, there- 
fore, as in many other cafes, where we 
cannot afllgn the proximate caufe of dif- 
eafes, our indications of cure mull be 
formed for obviating and removing the 
morbid effects or fymptoms which appear. 
Mill. 
The effects, as has been laid in M. 
conlift in a general flaccidity of the fyf- 
tem, and confequently in a weaker action 
of the veflels of the uterus ; fo that this 
debility may be confidered as the more 
immediate caufe of the retention. This, 
therefore, is to be cured by reftoring the 
tone of the fyflem in general, and by ex- 
citing the adion of the uterine veflels in 
particular. 
M1V. 40 
PRACTICE 
MIV. 
The tone of the fyftem in general is to 
be reftored by exercife, and, in the begin- 
ning of the difeafe, by cold bathing. At 
the fame time, tonic medicines may be 
employed; and of thefe the chalybeates 
have been chiefly recommendedi 
MV. 
The action of the veilels of the uterus 
may be excited: 
i ft, By determining the blood into them 
more copioufly; which is to be done by 
determining the blood into the dcfccnding 
aorta, by purging, by the exercife of 
walking, by friction, and by warm ba- 
thing of the lower extremities. It is alfo 
probable that the blood may be determi- 
ned more copioufly into the hypogaflric 
arteries which go to the uterus, by a 
com- O F P H Y S I C. 
41 
Compreffion of the iliacs ; but the trials of 
this kind hitherto made have feldom fuc- 
ceeded. 
MVI. 
2dly, The action of the uterine veflels 
may be excited by ftimulants applied to 
them. Thus thofe purgatives which par- 
ticularly ftimulate the inteftinum rectum, 
may alfo prove ftimulant to the uterine 
veflels connected with thofe of the return* 
The exercife of venery certainly proves a 
ftimulus to the veflels of the uterus; and 
therefore may be ufeful when, with pro- 
priety, it can be employed. The various 
medicines recommended as ftimulants of the 
uterine veflels, under the title of Emmena- 
gogues, have never appeared to me to be ef- 
fectual ; and I cannot perceive that any of 
them are poflefled of a fpecific power in 
this refpect. Mercury, as an univerfal fti- 
mulant, 
Vol. III. 
D 42 
PRACTICE 
mulant, may act upon the uterus, but can- 
not be very fafely employed in chlorotic 
perfons. One of the molt powerful means 
of exciting the adtion of the veflels in every 
part of the fyftem is, the electrical fliock; 
and it has often been employed with fuc- 
cefs for exciting the veflels of the uterus. 
MVII. 
The remedies (Mill. MVL) now 
mentioned, are thofe adapted to the re- 
tention of the menfes ; and I am next to 
confider the cafe of JuppreJJion. In enter- 
ing upon this, I mult obferve, that every 
interruption of the flux, after it has once 
taken place, is not to be confidered as a 
cafe of fuppreflion. For the flux, upon 
its firft appearance, is not always immedi- 
ately eftablifhed in its regular courfe; and 
therefore, if an interruption happen foon 
after the firft appearance, or even in the 
courfe O F P H Y S I C. 
43 
courfe of the firft, or perhaps fecond year 
after, it may often be confidered as a cafe 
of retention, efpecially when the difeafe 
appears with the fymptoms peculiar to that 
date. 
MVI1I. 
Thofe which may be properly confidered 
as cafes of fuppreffion, are fuch as occur 
after the flux has been for fome time efla- 
bliflied in its regular courfe, and in which 
the interruption cannot be referred to the 
caufes of retention (MIL Mill.) but muft 
be imputed to fome refiftance in the extre- 
mities of the veflels of the uterus. Accord- 
ingly, we often find the fuppreffion induced 
by cold, fear, and other caufes which may 
produce a conftridiion of thefe extreme vef- 
fels. Some phyficians have fuppofed an ob- 
ftrudling lentor of the fluids to occafion 
D 2 
the  PRACTICE 
44 
the refiftance now mentioned : but this 
is purely hypothetical, without any pro- 
per evidence of the faCt; and it is befides, 
from other coniiderations, improbable. 
MIX. 
There are indeed fome cafes of fuppref- 
fion that feem to depend upon a general 
debility of the fyrtem, and confequently 
of the veffels of the uterus. But in fuch 
cafes, the fuppreffion always appears as 
fymptomatic of other affections, and is 
therefore not to be confidered here. 
MX. 
The idiopathic cafes of fuppreffion 
(MVI1I.) leldom continue long without 
being attended with various fymptoms or 
diforders in different parts of the body; 
very commonly arifing from the blood 
which O F P H Y S I C. 
45 
which fhould have paifed by the uterus, 
being determined more copioufly into 
other parts, and very often with fuch force 
as to producehemorrhagies in thefe. Hence 
hemorrhagies from the nofe, lungs, ftomach, 
and other parts, have appeared in confe- 
quence of fuppreffed menfes. Befides 
thefe, there are commonly hyfteric and 
dyfpeptic fymptoms produced by the fame 
caufe; and frequently colic pains, with a 
bound belly. 
MXI. 
In the idiopathic cafes of fuppreffion, 
(MVI1I.) the indication of cure is to re- 
move the conftridtion affecting the extreme 
veffels of the uterus ; and for this purpofe, 
the chief remedy is warm bathing applied 
to the region of the uterus. This, 
however, is not always effectual, and I 
do not know of any other remedy 
»3 
adapted 46 
PRACTICE 
adapted to the indication. Befides this, 
we have perhaps no other means of re- 
moving the conftridlion in fault, but 
that of increaiing the action and force of 
the veffels of the uterus, fb as thereby to 
overcome the reliftance or conflridlion of 
their extremities. This therefore is to be 
attempted by the fame remedies in the cafe 
of fuppreflion, as thofe prefcribed in the 
afes of retention (MIV.-MV1.) The 
tonics, however, and cold bathing (MIV.) 
feem to be lefs properly adapted to the 
cafes of fuppreffion, and have appeared to 
me of ambiguous effect. 
MXIL 
It commonly happens in the cafes of 
fuppreffion, that though the menfes do not 
flow at their ufual periods, .there are often 
at thofe periods fome marks of an effort 
having a tendency to produce the dif- 
charge. ■OF PHYSIC. 
47 
charge. It is therefore at thofe times efpe- 
cially. when the efforts of the fyftem are 
concurring, that we ought to employ the 
remedies for curing a fuppreffion; and it is 
commonly fruitlefs to employ them at 
other times, unlefs they be fuch as require 
fome continuance in their ufe to produce 
their effects. 
MXIII. 
Nearly flmilar to the cafes of fuppreffion, 
are thofe cafes in which the menfes flow 
after longer intervals and in leffer quan- 
tity than ufual; and when thefe cafes are 
attended with the diforders in the fyftem 
(MX.) they are to be cured by the fame re- 
medies as the cafes of entire fuppreffion, 
MXIV. 
It may be proper in this place to take 
D4 
notice 48 
PRACTICE 
notice of the dyfmenorrhea, or cafes of 
menftruation in which the menfes feem to 
flow with difficulty, and are accompanied 
with much pain in the back, loins, and 
lower belly. We impute this diforder 
partly to fome weaker action of the veflels 
of the uterus, and partly, perhaps more 
efpecially, to a fpafm of its extreme veflels. 
We have commonly found the difeafe re- 
lieved by employing fome of the remedies 
of fuppreffion immediately before the ap- 
proach of the period, and at the fame time 
employing opiates. 
CHAP. OF PHYSIC. 
49 
CHAP. IX. 
Of Symptomatic Hemorrhagies. 
MXV. 
I Have thought it very improper in this 
work, to treat of thofe morbid affec- 
tions that are almoft always fymptomatic 
of other more primary difeafes ; and this 
for feveral reafons, particularly becaufe it 
introduces a great deal of confuiion in di- 
recting practice, and leads phyficians to em- 
ploy palliative meafures only. I fliall here, 
Jxowever, deviate a little from my general 
plan, PRACTICE 
50 
plan, to make fome reflections upon fymp- 
tomatic hemorrhagies. 
MXVI. 
The hemorrhagies of this kind that efpe- 
cially deferve our notice, are the Hemate- 
metis, or Vomiting of Blood; and the He- 
maturia, or the Voiding of Blood from the 
urinary paffage. Upon thefe I am here to 
make fome remarks; becaufe, though they 
are very generally fymptomatic, it is pof- 
tible they may be fometimes primary and 
idiopathic affections ; and becaufe they 
have been treated of as primary difeafes in 
almoft every fyftem of the practice of 
phytic. 
SECT. OF PHYSIC. 
51 
SECT. I. 
Of the Hematemesis, or Vomiting of Blood* 
MXVIL 
I have faid above (in DCCCXLV.) in 
what manner blood thrown out from the 
mouth may be known to proceed from the 
ftomach, and not from the lungs: but it 
may be proper here to fay more particu- 
larly, that this may be certainly known, 
when the blood is brought up manifeflly 
by vomiting without any coughing; when 
this vomiting has been preceded by fome 
fenfe 52 
PRACTICE 
fenfe of weight, anxiety, and pain, in the 
region of the ftoinach ; when the blood 
brought up is of a black and grumous ap- 
pearance, and when it is manifeftly mixed 
with other contents of the ftomach; we can 
feldom have any doubt of the fource from 
whence the blood proceeds, and there- 
fore of the exiftence of the difeafe we treat 
of. 
MXVIII. 
We mutt allow it to be poffible that a 
plethoric (late of the body from general 
caufes may be accompanied with caufes of 
a peculiar determination and afflux of 
blood to the ftomach, fo as to dccafion an 
hemorrhagy there, and thence a vomiting 
of blood ; and in fuch a cafe this appear- 
ance might be confidered as a primary dif- 
eafe. But the hiftory of difeafes in the 
records of phyfic, afford little foundation 
for O F P H Y S I C. 
53 
for fuch a fuppofition ; and on the con- 
trary, the whole of the inftances of a vo- 
miting of blood which have been recorded, 
are pretty manifeftly fymptomatic of a 
more primary affection. 
Of fuch fymptomatic vomitings of 
blood, the chief inftances are the follow- 
ing. 
MXIX. 
One of the moft frequent is that which 
appears in confequence of a fuppreflion of 
an evacuation of blood which had been for 
fbme time before eftablifhed in another 
part of the body, particularly that of the 
menftrual flux in women. 
MXX. 
There are inftances of a vomiting of 
blood happening from the retention of the 
menfes;  PRACTICE 
54 
menfes : but fuch inftances are very un- 
common, as a retention of the menfes 
rarely happens in confequence of, or even 
with, a plethoric ftate of the body; and 
as rarely does it produce that, or the he- 
morrhagy in queftion. 
There are inftances of a vomiting of 
blood happening to pregnant women; that 
might therefore alfo be imputed to the 
fuppreflion of the menfes, which happens 
to women in that ftate. There have in- 
deed been more inftances of this than of 
the former cafe ; but the latter are ftill 
very rare : for although the blood which 
ufed to flow monthly before impregnation 
is, upon this taking place, retained, it is 
commonly fo entirely employed in dilating 
the uterine veflels, and in the growth of 
the foetus, that it. is feldom found to pro- 
duce a plethoric ftate of the body, requi- 
ring a vicarious outlet. 
The vomiting of blood, therefore, that 
is OF PHYSIC. 
55 
is vicarious of the menftrual flux, is that 
which commonly and almoft only hap- 
pens upon a fuppreffion of that flux, after 
it had been for fpme time eftablilhed. 
MXXI. 
When fuch a fuppreffion happens, it 
may be fuppofed to operate by inducing a 
plethoric Rate of the whole body, and 
thereby occaiioning hemorrhagy from other 
parts of it; and hemorrhagies from many 
different parts of the body have been ob- 
ferved by phyficians as occurring in con- 
fequence of the fuppreffion we ipeak of. 
It is however the great variety of fuch he- 
morrhagies, that leads me to think, that 
with the plethoric Rate of the whole body 
there muR be always fome peculiar cir- 
cumftances in the part from which the 
blood flows, that determines its afflux to 
that particular, often Angularly odd, part; 
and 56 
PRACTICE 
and therefore, that fuch hemorrhagies may 
from thefe circumftances occur without 
any confiderable plethora at the fame time 
prevailing in the whole fyftem. 
MXXII. 
It is to be obferved, that if we are to 
expert an hemorrhagy in confequence of a 
fuppreflion of the menfes inducing a ple- 
thoric ftate of the fyftem, we Ihould ex- 
pert efpecially an hemoptyfis, or hemor- 
rhagy from the lungs, as a plethora might 
be expected to fliow its effects efpecially 
there ; and accordingly, upon occafion of 
fupprefled menfes, that hemorrhagy occurs 
more frequently than any other : but even 
this, when it does happen, neither in its 
circumftances nor its confequences, leads 
us to fuppofe, that at the fame time any 
confiderable or dangerous plethora prevails 
in the body. 
mxxiii. OF PHYSIC. 
57 
MXXIII. 
Thefeconfiderations in MXXI. MXXIL 
will, I apprehend, apply to our prefent 
fubjecl; and I would therefore allege, 
that a hematemefis may perhaps de- 
pend upon particular circumftances of the 
ftomach determining an afflux of blood to 
that organ, and may therefore occur with- 
out any confiderable or dangerous plethora 
prevailing in the fyftem. What are the 
circumftances of the ftomach, which, upon, 
the occafion mentioned, may determine an 
afflux of blood to it, I cannot certainly or 
clearly explain; but prefume that it depends 
upon the connexion and confent which 
we know to fubfift between the uterus and 
the whole of the alimentary canal, and efpe- 
cially that principal part of it the fto- 
mach. 
Vol. III. 
E 
MXXIV, PRACTICE 
58 
MXXIV. 
From thefe reflections we may, 1 think, 
draw the following concluiions. 
I. That the hematemefis we fpeak of is 
hardly ever a dangerous difeafe. 
II. That it will hardly ever require the 
remedies fuited to the cure of aCtive hemor- 
rhagy ; and at leafl: that it will require thefe 
only in thofe unufual cafes in which there 
appear ftrong marks of a general plethora, 
and in which the vomiting of blood ap- 
pears to be confiderably active, very pro- 
fufe, and frequently recurring. 
III. That a vomiting of blood from 
fupprefled menfes, ought feldom to pre- 
vent the ufe of thefe remedies of ame- 
norrhoea, which might be improper in 
the cafe of an aCtive idiopathic hemor- 
rhagy. 
MXXV. OF PHYSIC. 
59 
MXXV. 
Another cafe of fymptomatic hemate- 
mefis quite analogous to that already men- 
tioned, is the hematemefis following, and 
feemingly depending upon, the fuppreflion 
of an hemorrhoidal flux, which had been 
eftabliflied and frequent for fome time be- 
fore. 
This may perhaps be explained by agene- 
ral plethoric ftate induced by fuch afuppref- 
fion, and indeed fome degree of a plethoric 
ftate muft in fuch a cafe be fuppofed to take 
place : but that fuppofition alone will not 
explain the whole of the cafe; for a general 
plethora would lead us to expert an he- 
moptylis (MXXII.) rather than an hema- 
temefis ; and there is therefore fomething 
ftill wanting, as in the former cafe, to ex- 
plain the particular determination to the 
ftomach. 
Whether fuch an explanation can be 
E 2 
got 60 
PRACTICE 
got from the connection between the dif- 
ferent parts of the fanguiferous veffels of 
the alimentary canal, or from the connec- 
tion of the whole of thefe veffels with the 
vena portarum, I lhall not venture to de- 
termine. But in the mean time I imagine, 
that the explanation required is rather to 
be obtained from that connection of the 
flomach with the hemorrhoidal affection 
that I have taken notice of in DCCCCXLVI. 
MXXVI. 
However we may explain the hematemefis 
occafioned by a fuppreilion of the hemor- 
rhois, the considerations in MXXI. MXXII. 
will apply here as in the analogous cafe of 
hematemefis from fupprefled menfes ; and 
will therefore allow us alfo to conclude 
here, that the difeafe we now treat of will 
feldom be dangerous, and will feldom re- 
quire OF PHYSIC. 
61 
quire the fame remedies that idiopathic 
and adlive hemorrhagy does. 
MXXVII. 
The cafes of hematemefis already men- 
tioned, may be properly fuppofed to be 
hemorrhagies of the arterial kind ; but 
it is probable that the ftomach is alfo 
liable to hemorrhagies of the venous kind. 
(DCCLXVIIL) 
In the records of phyfic there are many 
inftances of vomitings of blood, which 
were accompanied with a tumefied fpleen, 
which had comprefied the vas breve, and. 
thereby prevented the free return of ve- 
nous blood from the ftomach. How fuch an 
interruption of the venous blood may oc- 
cafion an hemorrhagy from either the extre- 
mities of the veins themfelves, or from the 
extremities of their correfpondent arteries, 
we have explained above in DCCLXIX. 
E 3 
and 62 
PRACTICE 
and the hiftories of tumefied fpleens com- 
prefling the vafa brevia afford an exceb- 
lent illuftration and confirmation of our 
dodlrine on that fubjeeb, and render it 
fufficiently probable that vomitings of 
blood often arife from fuch a caufe. 
MXXVIII. 
It is alfo poffible, that an obftruiffion of 
the liver refilling the free motion of the 
blood in the vena portarum, may fomc- 
times interrupt the free return of the ve- 
nous blood from the veffels of the fto- 
mach, and thereby occafion a vomiting of 
blood ; but the inftances of this are nei- 
ther fo frequent nor fo clearly explained as 
thofe of the former cafe. 
MXXIX. 
Defitle thcfe cafes depending on the Hate 
of OF PHYSIC. 
63 
of the liver or fpleen, it is very probable 
'that other hemorrhagies of the flomach 
are frequently of the venous kind. 
The difeafe named by Sauvages Melaena, 
and by other writers commonly termed the 
Morbus Niger, (DCCLXXII.) confiding in 
an evacuation either by vomiting or by 
ftool, and fometimes in both ways of a 
black and grumous blood, can hardly be 
otherwife occafioned, than by a venous he- 
morrhagy from fome part of the internal 
furface of the alimentary canal. 
It is, indeed, pofhble, that the bile may 
fometimes put on a black and vifcid ap- 
pearance, and give a real foundation for 
the apellationof an Atra Bills : but it is cer- 
tain, that inftances of this are very rare; 
and it is highly probable, that what gave 
occafion to the notion of an atra bilis 
among the ancients, was truly the appear- 
ance of blood poured into the alimentary 
canal in the manner I have mentioned; 
E 4 
anj 64 
PRACTICE 
and which appearance, we know, the blood 
always puts on when it has ftagnated there 
for any length of time. I fuppofe it is 
now generally thought, that Boerhaave's 
notion of fuch a matter exifting in the 
mafs of blood, is without any founda- 
tion ; whilft, by difledtions in modern 
times, it appears very clearly, that the mor- 
bus niger prefenting fuch an appearance 
of blood, always depends upon the effulion 
and ftagnation I have mentioned. 
MXXX. 
From this account of the melaena it will 
appear, that vomitings of blood may arife 
in confequence of blood being poured out 
in the manner 1 have mentioned, either 
into the cavity of the ftomach itfelf, or into 
the fuperior portions of the inteftines, 
from whence matters often pafs into the 
ftomach. 
MXXXI. OF PHYSIC. 
65 
MXXXI. 
Both in the cafe of the melsena, and in 
the analogous cafes from affections of the 
fpleen or liver, it will appear, that the vo- 
mitings of blood occurring muft be con- 
iidered as fymptomatic affections, not at all 
to be treated as a primary aCtive hernor- 
rhagy, but by remedies, if any fuch be 
known, that may refol ve the primary ob- 
ftrudtions. 
MXXXIL 
I believe I have now mentioned almoft 
the whole of the caufes producing a he- 
matemefis ; and certainly the caufes men- 
tioned, are thofe which moft commonly 
give occalion to that fymptom. PoiTibly, 
however, there may be fome other caufes 
of it, fuch as that lingular one mentioned 
by Sauvage of an aneurifm of the aorta 
burft- 66 
PRACTICE 
burning into the ftomach : and it is pof- 
fible, that fome difeafes of other contigu- 
ous parts, which have become clofely ad- 
hering to the ftomach, may fometimes, by 
a rupture into the cavity of the ftomach, 
pour blood into it, which is afterwards re- 
jected by vomiting. It is poftible alfo, that 
abfceffes and ulcerations of the ftomach 
itfelf, may fometimes pour blood into its 
cavity to be thrown up by vomiting. 
I did not think it neceftary, among the 
fymptomatic vomitings of blood, to enu- 
merate thofe from external violence, nor, 
what is analogous to it, that which arifes 
from violent draining to vomit; which laft, 
however, is much more rare than might be 
expected. In either of thefe cafes the nature 
of the difeafe cannot be doubtful, and the 
management of it will be readily underftood 
from what has been delivered above with 
refpedl to moderating and reftraining he- 
jnorrhagy in general. 
SECT, OF PHYSIC. 
67 
SECT. II. 
Of the Hematuria, or the Voiding of Blood from 
the Urinary Paffage, 
mxxxiil 
It is alleged, that an hematuria has oc- 
cured without any other fymptom of an af- 
fection of the kidneys or urinary paflages 
being prefent at the fame time; and as 
this happened to plethoric perfons, and re- 
curred at fixed periods, fuch a cafe has 
been fuppofed to be an inftance of idiopa- 
thic hematuria, and of the nature of thofe 
adive 68 
PRACTICE 
active hemorrhagies I have treated of be- 
fore. 
MXXXIV. 
I cannot pofitively deny the exiftence of 
fuch a cafe; but muft obferve, that there 
are very few inftances of fuch upon the re- 
cords of phyfic ; that none have ever oc- 
curred to my obfervation, or to that of 
my friends ; and that the obfervations ad- 
duced may be fallacious, as I have fre- 
quently obferved an hematuria without 
fymptoms of other affection of the kidney 
or urinary paflages being, for the time, 
prefent; whilft, however, fits of a nephral- 
gia calculofa having, before or foon after, 
happened, rendered it to me fufiiciently 
probable, that the hematuria was owing to 
a wound made by a (tone prefent in fome 
part of the urinary pafiages. 
MXXV. OF PHYSIC. 
69 
MXXXV. 
The exiftence of an idiopathic hematu- 
turia is further improbable, as a general 
plethora is more likely to produce an he- 
moptyiis (MXXIL), and as we do not well 
know of any circumftances which might 
determine more particularly to the kidneys. 
An idiopathic hematuria, therefore, muft 
certainly be a rare occurrence; and in- 
ftances of fymptomatic affections of the 
fame kind are very frequent. 
MXXXVI. 
One of the mofl frequent is, that hema- 
turia which attends the nephralgia calculo- 
fa, and feems manifeftly to be owing to a 
ftone wounding the internal furface of the 
pelvis of the kidney or of the ureter. In 
fuch cafes, the blood difcharged with the 
urine is fometimes of a pretty florid co- 
lour,  PRACTICE 
70 
lour, but for the moft part is of a dark 
hue : the whole of it is fometimes diffufed 
or diffolved, and therefore entirely fuf- 
pended in the urine; but if it is in any 
large quantity, a portion of it is depofited 
to the bottom of the velfel containing the 
voided blood and urine. On different oc- 
cafions, the blood voided puts on different 
appearances. If the blood poured out in 
the kidney has happened to ftagnate for 
fome time in the ureters or bladder, it is 
fometimes coagulated, and the coagulated 
part is afterwards broken down into a gru- 
mous mafs of a black or dark colour, and 
therefore gives the fame colour to the urine 
voided; or if the quantity of broken down 
blood is fmall, it gives only a brownifh. 
urine refembling coffee. It fometimes 
alfo happens, that the blood ftagnating 
and coagulating in the ureters, takes the 
form of thefe veffels, and is therefore 
voided under the appearance of a worm; 
and Of physic. 
71 
and if the coagulated blood happens to 
have, as it may fometimes have, the glu- 
ten feparated from the red globules, thefe 
worm-like appearances have their external 
furface whitifh, and the whole feemingly 
forming a tube containing a red liquor. 
I have fometimes obferved the blood which 
had feemingly been coagulated in the ure- 
ter, come away in an almoft dry ftate, re- 
fembling the half-burnt wick of a candle. 
MXXXVII. 
Thefe are the feveral appearances of the 
blood voided in the hematuria calculofa, 
when it proceeds efpecially fromthekidneys 
or ureter, and many of the fame appear- 
ances are obferved when the blood proceeds 
only from the bladder when a (tone is lodged 
there; but the attending fymptoms will 
commonly point out the different feat of the 
difeafe. 
In one cafe, when a quantity of blood 
from  PRACTICE 
72 
from the kidney or ureter is coagulated 
in the bladder, and is therefore difficultly 
thrown out from this, the pain and uneafi- 
nefs on fuch an occafion may appear chief- 
ly to be in the bladder, though it contains 
no (tone; but the antecedent fymptoms 
will commonly difcover the nature of the 
difeafe* 
MXXXVIII. 
In any of the cafes of the hematuria 
calculofa it will hardly be neceffary to em- 
ploy the remedies fuited to an adiive he- 
morrhagy. It will be proper only to em- 
ploy the regimen fit for moderating hemor- 
rhagy in general, and particularly here to 
avoid every thing or circumftance that might 
irritate the kidneys or ureters. Of fuch cafes 
of irritation there is none more frequent or 
more confiderable than the prefence of har- 
dened faeces in the colon ; and thefe there- 
fore O F P H Y 6 I C. 
73 
fore are to be frequently removed, by thq 
frequent ufe of gentle laxatives. 
MXXX1X. 
The hematuria calculofa may be pro- 
perly confidered as a cafe of the hematuria 
violenta : and therefore I fubjoin to that 
the other infiances of hematuria from ex- 
ternal violence ; fuch as that from exter- 
nal contufion on the region of the kidney, 
and that from the violent or long conti- 
nued exercife of the mufcles incumbent 
on the kidneys. An infiance of the lat- 
ter caufe occurs efpecially in riding. 
MXL. 
It may alfo be confidered as a cafe of 
the hematuria violenta, when the difeafe 
occurs in confequence of the taking in of 
certain acrid fubftances, which pafs again 
Vol. III. 
F 
efpe- 74 
PRACTICE 
efpecially by the urinary paflages; and, 
by inflaming and fwelling the neck of 
the bladder, bring on a rupture of the over- 
diftended blood-veffels, and give occaflon 
to a bloody urine. The moft noted in- 
ftance of this is in the effect of cantharides 
in a certain quantity, any way introduced 
into the body. And poflibly fome other 
acrids may have the fame effect. 
MXLI. 
Befide thefemoft frequent inftances of he- 
maturia, which cannot be confideredasidio- 
pathic hemorrhagies, there are fome other in- 
ftances of hematuria mentioned by authors, 
that are (till however manifeftly fymptoma- 
tic; fuch as a difcharge of blood from the 
urinary paflagcs, in confequence of a fup- 
preflion of either the menftrual or hemor- 
rhoidal flux. Thefe may be considered as 
analogous to the hematemelis produced by 
the OF PHYSIC. 
75 
die like caufes ; and the feveral reflections 
made above on that fubjedl, will, I think, 
apply here, and particularly the conclu- 
fions formed in MXX1V. Inflances, how- 
ever, of either of thefc cafes, and efpecially 
of the firfl, have been extremely rare. 
MXLII. 
Of fuch fymptomatic hematuria there is 
however one inflance deferving notice; 
and that is, when a fuppreflion of the 
hemorrhoidal flux, either by a communi- 
cation of veflels, or merely by the vicinity 
of parts, occaflons a determination of the 
blood into the veflels of the neck of the 
bladder, which in confequence of a rixis 
or anaflomoiis, pour out blood to be void- 
ed either with or without the urine. This 
cafe is what has been named the Hemorrhoi- 
des Veflcse; and with fome propriety, when 
F 2 
it 76 
PRACTICE 
it is manifeflly an evacuation vicarious of 
what had before been ufually made from 
the reftum. With refped to the manage- 
ment of the hemorrhoides veiicag I would 
apply the whole of the dodrines that I have 
delivered above, with refped to the cure 
of the proper hemorrhoidal afledlion. 
MXLIIL 
There remains ftill to be mentioned one 
other inftance of fymptomatic hematuria, 
which is that which happens in the cafe of 
confluent and putrid fmall-pox, as well as 
in feveral other inflances of putrid dif- 
cafes. The blood, in fuch cafes, may be 
prefumed to come from the kidneys; and 
1 apprehend that it comes from thence in 
conlcquence of that fluidity which is al- 
ways produced in the blood approaching 
to a putrid ftate. Such hematuria, there- 
fore, is not to be considered as a fymptom 
of O F P H Y S I C. 
77 
of any affection of the kidneys, but merely 
as a mark of the putrefcent date of the 
blood. 
MXLIV. 
Tn certain clifeafes the urine is difcharged 
of fuch a deep red colour, as to give a 
fufpicion of its being tinged by blood pre- 
fent in it; and this has given occafion to 
Sauvages, amongft the other fpecies of he- 
maturia, to mark the hematuria fpuria, 
and the hematuria lateritia ; both which, 
however, he fuppofes to be without any 
blood prefent in the urine. In many cafes 
it is of importance, in afcertaining the na- 
ture of a difeafe, to determine whether the 
red colour of urine be from blood prefent 
in it, or from a certain date of the faits 
and oils which are always in greater or 
leffer proportion conftituent parts of the 
urine ; and the queftion may be com- 
monly 
F 3 78 
PRACTICE 
monly determined by the following con-* 
fiderations. 
It has been obferved above, that when 
any considerable quantity of blood is void- 
ed with the urine, there is always a por- 
tion of it deposited at the bottom of the 
veffel containing the voided blood and 
urine; and in fuch a cafe there will be no 
doubt in attributing the colour of the 
urine floating above, to fome part of the 
blood diffufed in it. The queftion, there- 
fore, with refpecl to the prefence of blood 
in the urine can only occur when no fuch 
depofition as I have mentioned appears ; 
and when the blood that may be fuppofed 
to be prefent is diiTolved or diffufed, and 
therefore entirely fufpended in the urine. 
In this cafe the prefence of bluES may 
be commonly known, i ft, By the colour 
which blood gives, different from any urine 
without blood that I have ever feen; and I 
think a little experience will enable mo ft 
perfons OF PHYSIC. 
79 
perlons to make this diftindion. 2dly, By 
this, that the prefence of blood always di- 
minilhes thetranfparency of the urine with 
which it is mixed : and it is very feldom 
that urine, though very "high-coloured, 
lofes its tranfparency; at leaft this hardly 
ever appears, if the urine is examined when 
recently voided. 3dly, When urine has 
blood mixed with it, it tinges a piece of 
linen dipt into it w'ith a red colour, which 
the higheft-coloured urine without blood 
never does. 4thly, High-coloured urine 
without blood, upon cooling, and re- 
maining at reft in a velfel, almoft always 
depofits a lateritious fediment; and if up- 
on any occafion bloody urine fhould de- 
pofit a fediment that may be of a portion 
of formerly diffufed in it, the 
difference however may be difcerned by 
this, that the fediment depofited by urine 
without blood, upon the urine's being again 
heated, will be entirely re-diffolved, which 
F4 
will 80 
PRACTICE 
will not happen to any fediment from 
blood. Laflly, we know no date of urine 
without blood, which (hows any portion 
of it coagulable by a heat equal to that of 
boiling-water ; but blood diffufed in urine 
is ftill coagulable by fuch a heat: and by 
this teft, therefore, the prefence of blood in 
urine may be commonly afcertaincd. 
BOOK BOOK V. 
O F 
PROFLUVIA, or FLUXES, 
with Pyrexia. 
MXLV. 
PORMER nofologifts have eftablilhed 
"*■ a clafs of difeafes under the title of 
Fluxes, or Profluvia; but, as in this clafs 
they have brought together a great num- 
ber of difeafes, which have nothing in 
com-' 82 
PRACTICE 
common,excepting the (ingle circumftance 
of an increafcd difcharge of fluids, and 
which alfo are, in other refpeifts, very dif- 
ferent from one another; I have avoided 
fo improper an arrangement, and have 
diflributed mo ft of the difeafes compre- 
hended in fuch a clafs by the nofologifts, 
into places more natural and proper for 
them. I have, indeed, (till employed here 
the general title; but I confine it to fuch 
fluxes only, as are conftantly attended with 
pyrexia, and which therefore neceflarily 
belong to the clafs of difeafes of which I 
am now treating. 
Of the fluxes which may be confidered 
as being very conftantly febrile difeafes, 
there are only two, the catarrh and dyfen- 
tcry ; and of thefe therefore I now proceed 
to treat. 
CHAP, OF PHYSIC. 
83 
C H A P. I. 
Of the Catarrh. 
MXLVI. 
catarrh is an increafed excretion of 
mucus from the mucous membrane 
of the nofe, fauces, and bronchia, attend- 
ed with pyrexia. 
Practical writers and nofologifts have 
diftinguifhed the difeafe by different ap- 
pellations, according as it happens to affect 
thofe different parts of the mucous mem- 
brane ; 84 
PRACTICE 
brane, the one part more or lefs than the 
other : But I am of opinion, that the dif- 
eafe, although affeding different parts, is 
always of the fame nature, and proceeds 
from the fame caufe. Very commonly 
indeed thofe different parts are affedted at 
the fame time; and therefore there can be 
little room for the diftindion mentioned. 
The difeafe has been frequently treated 
of under the title of Tullis, or Cough ; and 
a cough, indeed, always attends the chief 
form of catarrh, that is, the increafed ex- 
cretion from the bronchia?: but a cough is 
fo often a fymptom of many other affec- 
tions, which are very different from one 
another, that it is improperly employed as 
a generic title. 
MXLVII. 
The remote caufe of catarrh is, moft 
commonly, cold applied to the body. 
This O F PHYSIC. 
85 
This application of cold producing catarrh, 
can in many cafes be diflinclly obferved ; 
and I believe it would always be fo, were 
men acquainted with, and attentive to, 
the circumflances which determine cold to 
adl upon the body. See XCIV.-XCVI. 
From the fame paragraphs we may learn 
what in fome perfons gives a predifpofi- 
tion to catarrh. 
MXLVIIL 
The difeafe, of which I am now to treat, 
generally begins with fome difficulty of 
breathing through the nofe, and with a 
fenfe of fome fulnefs flopping up that 
paffage. This is alfo often attended with 
fome dull pain and a fenfe of weight in 
the forehead, as well as fome fliffnefs in 
the motion of the eyes. Thefe feelings, 
fometimes at their very firfl beginning, and 
always foon after, are attended with the di- 
flillation 86 
PRACTICE 
flillation from the nofe, and fometimes 
from the eyes, of a thin fluid, which is often 
found to be fomewhat acrid, both by its 
tafte, and by its fretting the parts over 
which it pafles. 
MXLIX. 
Thefe fymptoms constitute the coryza 
and gravedo of medical authors, and are 
commonly attended with a fenfe of lati- 
tude over the whole body. Sometimes 
cold fhiverings are felt, at leaft the body 
is more fenfible than ufual to the coldnefs 
of the air ; and with all this the pulfe be- 
comes, efpecially in the evenings, more fre- 
quent than ordinary. 
ML. 
Thefe fymptoms feldom continue long be- 
fore they are accompanied with fomehoarfe- 
nefs, OF PHYSIC 
87 
nefs, and a fenfe of roughnefs and forenefs 
in the trachea, and with fome difficulty of 
breathing, attributed to a fenfe of ftrait- 
nefs of the cheft, and attended with a 
cough which feems to arife from fome ir- 
ritation felt at the glottis. The cough is 
generally at firft dry, occafioning pains 
about the cheft, and more efpecially in the 
breaft, Sometimes, together with thefe 
fymptoms, pains refem bling thofe of the 
rheumatifin are felt'in feveral parts of the 
body, particularly about the neck and 
head. While thefe fymptoms take place, 
the appetite is impaired, fome thirft arifes, 
and a general laffitude is felt over all the 
body. 
MLI. 
Thefe|fymptoms (MXLVIIL--ML.) mark 
the violence and height of the difeafe; 
which) however, does not commonly conti- 
nue 88 
PRACTICE 
nue long. By degrees the cough becomes 
attended with a copious excretion of mucus, 
which is at firft thin, but, gradually beco- 
ming thicker, is brought up with lefs fre- 
quent and lefs laborious coughing. The 
hoarfenefs and forenefsof the trachea like- 
wife going off, the febrile fymptoms aba- 
ting, the cough becoming lefs frequent, 
and with lefs expectoration, thedifeafe foon 
after ceafes altogether. 
MLIL 
Such is generally the courfe of this dif- 
eafe, which is commonly neither tedious 
nor dangerous ; but upon fome occafions, 
it is in both refpeds other wife. A perfon 
affedled with catarrh feems to be more 
than ufually liable to be affedied by cold 
air ; and, in that condition, if expofed to 
cold, the difeafe, which feemed to be yield- 
ing, is often brought back with greater 
violence O F P H Y S I C. 
89 
violence than before; and is rendered not 
only more tedious than otherwife it would 
have been, but alfo more dangerous by 
the fupervcning of other difeafes. 
MLIII. 
Some degree of the cynanche tonfillaris 
often accompanies the catarrh ; and, when 
the latter is aggravated by a frefh appli- 
cation of cold, the cynanche alfo becomes 
more violent and dangerous, in confe- 
quence of the cough which is prefent at 
the fame time. 
MLIV. 
When a catarrh has been occafioned by 
a violent caufe ; when it has been aggra- 
vated by improper management; and 
efpecially when it has been rendered more 
violent by frefh and repeated applications 
Vol. IIL 
G 
of 90 
PRACTICE 
of cold, it often pafles into a pneumonic 
inflammation attended with the utmoft 
danger. 
MLV. 
Unlefs, however, fuch accidents as thofe of 
MLII.-ML1V. happen, acatarrh, infound 
perfons not far advanced in life, is, 1 think, 
always a flight difeafe, and attended with 
little danger. But in perfons of a phthifi- 
cal difpofition, a catarrh may readily pro- 
duce a hemoptyfls, or perhaps form tu- 
bercles in the lungs ; and more certainly, 
in perfons who have tubercles already 
formed in the lungs, an accidental catarrh 
may occafion the inflammation of thefe 
tubercles, and in confequence produce a 
phthifis pulmonalis. 
MLVL OF PHYSIC. 
91 
ML VI. 
In elderly perfons, a catarrh fometimes 
proves a dangerous difeafe. Many perfons, 
as they advance in life, and efpecially after 
they have arrived at old age, have the 
natural mucus of the lungs poured out in 
greater quantity, and confequently requi- 
ring a frequent expetfloration. If therefore 
a catarrh happen to fuch perfons, and in- 
creafe the afflux of fluids to the lungs, 
with fome degree of inflammation, it may 
produce the peripneumonia notha, which 
in fuch cafes is very often fatal. See 
CCCLXXVL-CCCLXXXII. 
MLVIL 
The proximate caufe of catarrh feems 
to be an increafed afflux of fluids to the 
mucous membrane of the nofe, fauces, and 
bronchiae, along with fome degree of in- 
flammation 
G 2 92 
PRACTICE 
flammation affecting thefe parts. The lat-" 
ter circumftance is confirmed by this, that 
in the cafe of catarrh, the blood drawn 
from a vein, commonly exhibits the fame 
inflammatory cruit which appears in the 
cafe of phlegmafise. 
MLV1II. 
The application of cold which occafions 
a catarrh, probably operates by diminifli- 
ing the perfpiration ufually made by the 
fkin, and which is therefore determined to 
the mucous membrane of the parts above 
mentioned. As a part of the weight which 
the body daily lofes by infenfible evacua- 
tion, is owing to an exhalation from the 
lungs, there is probably a connection be- 
tween this exhalation and the cutaneous 
perfpiration, fo that the one may be in- 
creafed in proportion as the other is di- 
minilhed: and therefore we may under- 
ftand OF PHYSIC. 
93 
Hand how the diminution of cutaneous 
perfpiration, in confequence of the appli- 
cation of cold, may increafe the afflux of 
fluids to the lungs, and thereby produce 
a catarrh. 
MLIX. 
There are fome obfervations made by 
Dr James Keil which may feem to render 
this matter doubtful; but there is a fal- 
lacy in his obfervations. The evident ef- 
fects of cold in producing coryza, leave 
the matter in general without doubt; and 
there are feveral other circumftances which 
Ihow a connexion between the lungs and 
the furface of the body. 
MLX. 
Whether, from the fuppreflion of perfpi- 
ration, a catarrh be produced merely by 
GS 
an 94 
PRACTICE 
an increafed afflux of fluids, or whether 
the matter of perfpiration be at the fame 
time determined to the mucous glands, and 
there excite a particular irritation, may be 
uncertain; but the latter fuppofition is 
fufliciently probable. 
MLXL 
Although, in the cafe of a common ca- 
tarrh, which is in many inftances fporadic, 
it may be doubtful whether any morbific 
matter be applied to the mucous glands ; 
it is, however, certain, that the fymptoms 
of a catarrh, do frequently depend upon 
fuch a matter being applied to thefe glands, 
as appears from the cafe of meafles, chin- 
cough, and efpecially from the frequent 
occurrence of contagious and epidemical 
MLX1I, OF PHYSIC. 
95 
JVILXII. 
The mention of this laft leads me to ob~ 
ferve, that there are two fpecies of catarrh, 
as I have marked in my Synopfis of No- 
fology. One of thefe, as I fuppofe, is 
produced by cold alone, as has been ex- 
plained above; and the other feems ma- 
nifeftly to be produced by a fpecific con- 
tagion. 
Of fuch contagious catarrhs, I have 
pointed out in Synopfis many inftances 
occurring from the 14th century down to 
the prefent day. In all thefe inftances 
the phenomena have been much the fame; 
and the difeafe has always been particu- 
larly remarkable in this, that it has been 
the moft widely and generally fpreading 
epidemic known. It has feldom appeared 
in any one country of Europe, without 
appearing fuccefiively in every other part 
g4 
of 96 
PRACTICE 
of it; and in fome infiances, it has been 
even transferred to America, and has been 
fpread over that continent, fo far as we 
have had opportunities of being informed. 
MLXIII. 
The catarrh from contagion appears 
with nearly the fame fymptoms as thofe 
mentioned MXLVIII.-ML. Itfeemsoften 
to come on in confequence of the applica- 
tion of cold. It comes on with more cold 
fhivering than the catarrh arifing from 
cold alone, and fooner (hows febrile fymp- 
toms, and thefe likewife in a more con- 
iiderable degree. Accordingly, it more 
fpeedily runs its courfe, which is com- 
monly finifhed in a few days. It fome- 
times terminates by a fpontaneous fweat; 
and this, in fome perfons, produces a mi- 
liary eruption. It is, however, the febrile 
of this difeafe efpecially, that is fi- 
nifhed OF PHYSIC. 
97 
nifhed in a few days: for the cough, and 
other catarrhal fymptoms, do frequently 
continue longer ; and often, when they 
appear to be going off, they are renewed 
by any frelh application of cold. 
MLX1V. 
Confidering the number of perfons who 
are affedlcd with catarrh, of either the one 
fpecies or the other, and efcape from it 
quickly without any hurt, it may be al- 
lowed to be a difeafe very free from dan- 
ger : but it is not always to be confidered 
as fuch ; for in fome perfons it is accom- 
panied with pneumonic inflammation. 
In the phthifically difpofed, it often acce- 
lerates the coming on of phthifis ; and in 
elderly perfons it frequently proves fatal in 
the manner explained above, MLIV. and 
MLVI. 
MLXV. 98 
PRACTICE 
MLXV. 
The cure of catarrh is nearly the fame, 
whether it proceed from cold or contagion; 
with this difference, that in the latter cafe, 
remedies are commonly more neceffary 
than in the former. 
In the cafes of a moderate difeafe, it is 
commonly fuflicient to avoid cold, and to 
abftain from animal-food for fome days; 
or perhaps to lie a-bed, and, by taking fre- 
quently of fome mild and diluent drink a 
little warmed, to promote a very gentle 
fweat; and after thefe to take care to re- 
turn very gradually only, to the ufe of the 
free air. 
MLXVI. 
When the difeafe is more violent, not 
only the antiphlogiftic regimen mutt be 
exadly O F ' P H Y S I C. 
99 
exactly obferved, but various remedies 
alfo become neceffary. 
To take off the phlogiftic diathefis which 
always attends this difeafe, blood-letting, 
in a larger or fmaller quantity, and re- 
peated according as the fymptoms fliall 
require, is the proper remedy. 
For reftoring the determination of the 
fluids to the furface of the body, and at 
the fame time for expeding the fecretion 
of mucus in the lungs, which may take 
off the inflammation of its membrane, vo- 
miting is the moft effectual means. 
For the latter purpofe, it has been fup- 
pofed, that fquills, gum ammoniac, the 
volatile alkali, and fome other medicines, 
might be ufeful: but their efficacy has 
never appeared to me to be conflderable; 
and, if fquills have ever been very ufeful, 
it feems to have been rather by their eme- 
tic, than by their expectorant powers 
When the inflammatory affections of 
the PRACTICE 
100 
the lungs feem to be confiderable, it is pro- 
per, befides blood-letting, to apply blifters 
on fome part of the thorax. 
As a cough is often the moft trouble- 
fome circumftance of this difeafe, fo de- 
mulcents may be employed to alleviate it. 
See CCCLXXI1I. 
But, after the inflammatory fymptoms 
have much abated, if the cough fhould ftill 
continue, opiates afford the moft effetftual 
means of relieving it; and, in thecircum- 
ftances juft now mentioned, they may be 
very fafely employed. See CCCLXXV. 
After the inflammatory and febrile ftates 
of this difeafe are almoft entirely gone, the 
moft effectual means of difcuffing all re- 
mains of the catarrhal affection, is by fome 
exercife of geftation diligently employed. 
CHAP. OF PHYSIC. 
101 
CHAP. IL 
Of the Dysentery. 
MLXVII. 
THE dyfentery is a difeafe in which 
the patient has frequent ftools, ac- 
companied with much griping, and fol- 
lowed by a tenefmus. The ftools, though 
frequent, are generally in fmall quantity; 
and the matter voided is chiefly mucus, 
fometimes mixed with blood. At the 
fame 102 
PRACTICE 
fame time, the natural faeces feldom ap- 
pear ; and, when they do, it is generally 
in a compact and hardened form. 
MLXVIII. 
This difeafe occurs efpecially in fum- 
mer and autumn, at the fame time with 
autumnal intermittent and remittent fe- 
vers ; and with thefe it is fometimes com- 
bined or complicated. 
MLXIX. 
Hie difeafe comes on fometimes with 
cold fhiverings, and other fymptoms of 
pyrexia ; but more commonly the fymp- 
toms of the topical affection appear firft. 
The belly is coftive, with an unufual fla- 
tulence in the bowels. Sometimes, though 
more rarely, fome degree of diarrhoea is 
the firft appearance. In moft cafes the 
difeafe OF PHYSIC. 
103 
difeafe begins with griping, and a frequent 
inclination to go to (tool. In indulging 
this, little is voided ; but fome tenefmus 
attends it. By degrees the (tools become 
more frequent, the griping more fevere, 
and the tenefmus more confiderable. Along 
with thefe fymptoms there is a lofs of ap- 
petite ; and frequently (icknefs, naufea, 
and vomiting, alfo affecting the patient. 
At the fame time there is always more or 
lefs of pyrexia prefent, which is fometimes 
of the remittent kind, and obferves a ter- 
tian period. Sometimes the fever is mani- 
feftly inflammatory, and very often of a 
putrid kind. Thefe febrile ftates continue 
to accompany the difeafe during its whole 
courfe, efpecially when it terminates foon 
in a fatal manner. In other cafes, the fe- 
brile ftate almoft entirely difappears, while 
the proper dyfenteric fymptoms remain 
for a long time after. 
MLXX. 104 
PRACTICE 
MLXX. 
In the courfe of the difeafe, whether of 
a (hotter or longer duration, the matter 
voided by (tool is very various. Sometimes 
it is merely a mucous matter, without any 
blood, exhibiting that difeafe which Dr 
Roederer has named the morbus mucofus, 
and others the dyfenteria alba. For the 
moft part, however, the mucus difcharged 
is more or lefs mixed with blood. This 
fometimes appears only in ftreaks amongft 
the mucus; but at other times is more co- 
pious, tinging the whole of the matter dif- 
charged ; and upon fome occafions a pure 
and unmixed blood is voided in confider- 
able quantity. In other refpedls, the mat- 
ter voided is varioufly changed in colour 
and confidence, and is commonly of a 
ftrong and unufually fetid odour. It is 
probable, that fometimes a genuine pus is 
voided; and frequently a putrid fanies, 
pro- OF PHYSIC. 
105 
proceeding from gangrenous parts. There 
are very often mixed with the liquid mat- 
ter, fome films of a membranous appear- 
ance, and frequently fome fmall maffes of 
a feemingly febaceous matter. 
MLXXI. 
While the ftools Confifting of thefe va- 
rious matters are, in many inftances, ex- 
ceedingly frequent, it is feldom that natu- 
ral faeces appear in them; and when they 
do appear, it is, as I have mentioned, in 
the form of fcybala, that is, in fomewhat 
hardened, feparate balls. When thefe are 
voided, whether by the efforts of nature, 
or as folicited by art, they procure a re- 
miffion of all the fymptoms, and more 
efpecially of the frequent ftools, griping, 
and tenefmus. 
Vol. III. 
H 
MLXXIL 106 
PRACTICE 
MLXXII. 
Accompanied with thefe circumftances, 
the difeafe proceeds for a longer or afhorter 
time. When the pyrexia attending it is 
of a violent inflammatory kind, and more 
efpecially when it is of a very putrid na- 
ture, the difeafe often terminates fatally in 
a very few days, with all the marks of a 
fupervening gangrene. When the febrile 
Rate is more moderate, or difappears alto- 
gether, the difeafe is often protracted for 
* 
weeks, and even for months ; but, even 
then, after a various duration, it often ter- 
minates fatally, and generally in confe- 
quence of a return and confiderable aggra- 
vation of the inflammatory and putrid 
Rates. In fome cafes, the difeafe ceafes 
fpontaneoufly; the frequency of Rools, the 
griping, and tenefmus, gradually diminifh- 
ing, while natural Rools return. In other 
cafes, the difeafe, with moderatefymptoms, 
con- OF PHYSIC. 
107 
continues long, and ends in a diarrhoea, 
fometimes accompanied with lienteric 
fymptoms. 
MLXXIIL 
The remote caufes of this difeafe have 
been varioufly judged of. It generally 
arifes in fummer or autumn, after conli- 
derable beats have prevailed for fome time, 
and efpecially after very warm and at the 
fame time very dry ftates of the weather; 
and the difeafe is much more frequent in 
warm, than in cooler climates. It hap- 
pens, therefore, in the fame circumstances 
and feafons which conliderably affect the 
Hate of the bile in the human body ; but 
as the cholera is often without any dyfen- 
teric fymptoms, and copious difcharges of 
bile have been found to relieve the fymp- 
toms of dyfentery, it is difficult to deter- 
mine 
H 2 108 
PRACTICE 
mine what connection the difeafe has with 
the Hate of the bile. 
MLXX1V. 
It has been obferved, that the effluvia 
from very putrid animal-fubftances, rea- 
dily affect the alimentary canal; and upon 
fome occafions, they certainly produce a 
diarrhoea: but, whether they ever produce 
a genuine dyfentery, I have not been able 
to learn with certainty. 
MLXXV. 
The dyfentery does often manifeftly 
arifc from the application of cold, but the 
difeafe is always contagious ; and, by the 
propagation of fuch contagion, indepen- 
dent of cold, or other exciting caufes, it 
becomes epidemic in camps and other 
places. It is, therefore, to be doubted, if 
the OF PHYSIC. 
109 
the application of cold does ever produce 
the difeafe, unlefs where the fpecific con- 
tagion has been previously received into 
the body : And upon the whole, it is pro- 
bable, that a fpecific contagion is to be con- 
sidered as always the remote caufe of this 
difeafe. 
MLXXVI. 
Whether this contagion, like many 
others, be of a permanent nature, and only 
Ihows its effects in certain circumftances 
which render it adlive, or if it be occasion- 
ally produced, I cannot determine. Nei- 
ther, if the latter fuppofition be received, 
can I fay by what means it may be gene- 
rated. As little do we know any thing of 
its nature, considered in itfelf; or at moft 
this only, that, in common with many 
other contagions, it appears to be com- 
monly of a putrid nature, and capable of 
H 3 
in* 110 
PRACTICE 
inducing a putrefcent tendency in the hu- 
man body. This, however, does not at all 
explain its peculiar power in inducing 
thofe fymptoms which properly and eften- 
tially conftitute the difeafe of dyfentery, 
(MLXVII.) 
MLXXVIL 
Of thefe fymptoms, the proximate caufe 
is ftill obfcure. The common opinion has 
been, that the difeafe depends upon an 
acrid matter received into, or generated 
in the inteftines themfelves, exciting their 
periftaltic motion, and thereby producing 
the frequent ftools which occur in this, 
difeafe. But this fuppofition cannot be 
admitted: for, in all the inftances known 
of acrid fubftances applied to the inteftines 
and producing frequent ftools, they at the 
fame time produce copious ftools, as might 
be expected from acrid fubftances applied 
to OF PHYSIC. 
111 
to any length of the inteftines. This, 
however, is not the cafe in dyfentery; in 
which the ftools, however frequent, are 
generally in very fmall quantity, and fuch 
as may be fuppofed to proceed from the lower 
parts of the return only. Withrefpedl to the 
fuperior portions of the inteftines, and par- 
ticularly thofe of the colon, it is probable 
they are under a preternatural and consi- 
derable degree of conStridlion : For, as I 
have obferved above, the natural fasces are 
feldom voided ; and when they are, it is 
in a form which gives reafon to fuppofe, 
they have been long retained in the cells 
of the colon, and confequently that the 
colon had been affected with a preternatu- 
ral conftridion. This is confirmed by ai- 
med all the diffeclions which have been 
made of the bodies of dyfenteric patients, 
in which, when gangrene had not entirely 
deflroyed the texture and form of the parts, 
confiderable portions of the great guts 
H 4 
have 112 
PRACTICE 
have been found affected with a very con- 
fiderable conftriclion. 
MLXXVIIL 
I apprehend, therefore, that the proximate 
caufc of dyfentery, or at lead the chief 
part of the proximate caufe, confilts in a 
preternatural conftriclion of the colon, oc- 
cafioning at the fame time thofe fpafmo- 
dic efforts which are felt in fevere gripings, 
and which efforts, propagated downwards 
to the rectum, occafion there the frequent 
mucous ftools and tenefmus. But, whe- 
ther this explanation fhall be admitted or 
not, it will ftill remain certain, that hard- 
ened faeces retained in the colon are the 
caufe of the griping, frequent ftools, and 
tenefmus : for the evacuation of thefe 
faeces, whether by nature or by art, gives 
relief from the fymptoms mentioned ; and 
it will be more fully and ufefully con- 
firme4 OF PHYSIC. 
113 
firmed by this, that the moft immediate 
and fuccefsful cure of dyfentery is obtained 
by an early and conftant attention to the 
preventing the conftridion, and the fre- 
quent ftagnation of faeces in the colon. 
MLXXIX. 
In this manner I have endeavoured to 
afcertain the proximate caufe of dyfentery, 
and therefore to point out alfo the princi- 
pal part of the cure, which, from want of 
the proper view of the nature of the dif- 
eafe, feems to have been in feveral refpeds 
fluctuating and undetermined among prac- 
titioners. 
MLXXX. 
The moft eminent of our late practi- 
tioners, and of greateft experience in this 
dif- 114 
PRACTICE 
difcafe, feem to be of opinion, that the dif- 
eafe is to be cured moft effectually by pur- 
ging affiduoufly employed. The means 
may be various; but the moft gentle lax- 
atives are ufually fuflicient; and as they 
muft be frequently repeated, the moft 
gentle are the moft fafe ; the more efpeci- 
ally as an inflammatory ftate fo frequently 
accompanies the difeafe. Whatever laxa- 
tives produce an evacuation of natural 
feces, and a confequent remiflion of the 
fymptoms, will be fuflicient to effectuate 
the cure. But if gentle laxatives (hall not 
produce the evacuation now mentioned, 
feme more powerful medicines muft be 
employed: and I have found nothing 
more proper or convenient than tartar 
emetic, given in fmall dofes, and at fuch 
intervals as may determine their opera- 
tion to be chiefly by ftool. Rhubarb, 
fo frequently employed, is in feveral re- 
fpeCts OF PHYSIC. 
115 
fpecls amongft "the moft improper pur- 
gatives. 
MLXXXI. 
Vomiting has been held a principal re- 
medy in this difeafe; and may be ufefully 
employed in the beginning of it, with a 
view to both the Rate of the ftomach and 
of the fever : but it is not neceflary to re- 
peat it often; and unlefs the emetics em- 
ployed operate alfo by ftool, they are of 
little fer vice. Ipecauanha feems to poflefs no 
fpecific power; and it proves only ufeful 
when fo managed as to operate chiefly by 
ftool. 
MLXXXII. 
For relieving the conftridion of the co- 
lon, and evacuating the retained faeces, gly- 
flers may fometimes be ufeful: but they 
are 116 
PRACTICE 
are feldom fo effectual as laxatives, given 
by the mouth; and acrid glyfters, if they 
be not effectual in evacuating the colon, 
may prove hurtful by ftimulating the rec- 
tum too much. 
MLXXXIII. 
The frequent and fevere griping attend- 
ing this difeafe, leads almoft neceffarily to 
the ufe of opiates, and they are very effec- 
tual for the purpofe of relieving from the 
gripes ; but by occafioning an interrup- 
tion of the aftion of the finall guts, they 
favour the conftri&ion of the colon, and 
thereby fometimes aggravate the difeafe: 
and if at the fame time the ufe of them fu- 
perfede in any meafure the employing of 
purgatives, it commonly does much mil- 
chief ; I believe it indeed to be only the 
negledl of purging that renders the ufe of 
opiates very neceffary. 
MLXXX1V. OF PH YS1C. 
117 
MLXXXIV. 
When the gripes are both frequent and 
feyere, they may fometimes be relieved by the 
employment of a femicupium, or by a fo- 
mentation of the abdomen, continued for 
fome time. In the fame cafe, the pains 
may be relieved, and, as I think, the con- 
ftriddion of the colon may be taken off, by 
blifters applied to the lower belly. 
MLXXXV. 
At the beginning of this difeafe, when 
the fever is any way confiderable, blood- 
letting, in patients of tolerable vigour, may 
be proper and neceflary ; and, when the 
pulfe is full and hard, with other fymptoms 
of an inflammatory difpolition, blood-let- 
ting ought to be repeated. But, as the fe- 
ver attending dyfentery is often of a putrid 
kind, or does, in the courfe of the difeafe, 
be- 118 
PRACTICE 
become foon of that nature, blood-letting 
muft be employed with great caution. 
MLXXXVL 
From the account now given of the na- 
ture of this difeafe, it will be fufficiently 
obvious, that the ufe of aftringents in the 
beginning of it muft be abfolutely perni- 
cious. 
MLXXXVII. 
Whether an acrid matter be the original 
caufe of this difeafe, may be uncertain : 
but from the indigeftion and the ftagna- 
tion of fluids in the ftomach which attend 
the difeafe, it may be prefumed, that fome 
acrid matters are conftantly prefent in the 
ftomach and inteftines, and therefore that 
demulcents may be always ufefully em- 
ployed. At the fame time, from this con- 
fideration O F PH YSI C. 
119 
lideration that mild oily matters thrown 
into the inteftines in conflderable quantity 
always prove laxative, I am of opinion 
that the oleaginous demulcents are the moft 
ufeful. 
MLXXXVIII. 
As this difeafe is fo often of an inflam- 
matory or of a putrid nature, it is evident 
that the diet employed in it fhould be ve- 
getable and acefcent. Milk in its entire 
Rate is of doubtful quality in many cafes; 
but fome portion of the cream is often al-, 
lowable, and whey is always proper. 
In the firfl: ftages of the difeafe, the fweet 
and fubacid fruits are allow'able, and even 
proper. It is in the more advanced ftages 
only, that any morbid acidity feems to 
prevail in the ftomach, and to require fome 
referve in the ufe of acefcents. At the be- 
ginning of the difeafe, abforbents feem to 
be 120 
PRACTICE 
be fuperfluous; and by their aflringent 
and feptic powers they may be hurtful. 
MLXXXIX. 
When this difeafe is complicated with 
an intermittent fever, and is protracted 
from that circumftance chiefly, it is to be 
treated as an inte mittent, by adminifter- 
ing the Peruvian bark, which, however, in 
the earlier periods of the difeafe, is hardly 
to be admitted. PART IL 
O F 
NEUROSES, 
4 
OR 
NERVOUS DISEASES. 
MXC. 
IN a certain view, almoft the whole of 
the difeafes of the human body might 
be called Nervous : but there would be 
no ufe for fuch a general appellation > and, 
I 
Vol. III. 
nn 122 
PRACTICE 
on the other hand, it feems improper to 
limit the term, in the loofe inaccurate man- 
ner in which it has been hitherto applied, 
to hyfteric and hypochondriacal diforders, 
wdiich are themfelves hardly to be defined 
with fufficient precifion. 
MXCI. 
In this place I propofe to comprehend, 
under the title of Neuroses, allthofe pre- 
ternatural affedlions of fenfe or motion, 
which are without pyrexia as a part of the 
primary difeafe; and all thofe which do 
not depend upon a topical afiedlion of the 
organs, but upon a more general affection 
of the nervous fyftem, and of thofe powers 
of the fyftem upon which fenfe and mo- 
tion more cfpecially depend. 
MXCIL OF PHYSIC. 
123 
MXCIL 
Of fuch difeafes I have eftabliflied a clafs, 
under the title of Neuroses, or Nervous 
Diseases. lhefe I again diftinguifh, as 
they confift, either in the interruption and 
debility of the powers of fenfe and motion, 
or in the irregularity with which thefe 
powers are exercifed; and have accord- 
ingly arranged them under the four or- 
ders of Comata* Adynamia* Spafmi* and Ve~ 
fa?iia* to be defined as we proceed to treat 
of them more particularly. 
I 2 
BOOK .BOOK I. 
Of C O M A T A, 
OR OF THE 
LOSS OF VOLUNTARY MOTION, 
MXCIII. 
T TNDER this title are comprehended 
thofe affections which have been 
commonly called the Soporofe difeafes ; 
but they are moft properly diftinguifhed 
by their conlifting in fome interruption 
or OF PHYSIC. 
125 
or fuppreflion of the powers of feufe and 
voluntary motion, or of what are called 
the animal-functions* Thefe are indeed 
ufually fufpended in the time of natural 
Heep: but of all the difeafes to be com- 
prehended under our title, fleep, or even 
the appearance of it, is not conftantly a 
fymptom. Of fuch difeafes I can mark 
and properly explain two genera only, 
which come under the titles of Apoplexy 
and 
I 3 
CHAP. 126 
PRACTICE 
CHAP. L 
Of Apoplexy. 
MXCIV. 
is that difeafe in which the 
whole of the external and internal 
fenfes, and the whole of the voluntary mo- 
tions, are in fome degree aboliflied; while 
refpiration and the action of the heart 
continue to be performed. By its being 
an affection of the whole of the powers of 
fenfe and of voluntary motion, we d flin- 
guifli OF PHYSIC, 
127 
gulfli it from Palfy; and by its being with 
the continuance of refpiration and the ac- 
tion of the heart, it is difling uiflied from 
Syncope. I have further added to the or- 
dinary definition of apoplexy, that the abo- 
lition of the powers of fenfe and motion 
is in fome degree only; meaning by this to 
imply, that, under the title of Apoplexy, 
are here comprehended thofe difeafes 
which, as differing from it in degree only, 
cannot, with a view either to pathology 
or practice, be properly diflinguifhed from 
it: Such are the difeafes fometimes treated 
of under the names of Car us, Cataphora, 
Coma* and Letbargus. 
MXCV. 
Apoplexy, in all its different degrees, 
moft commonly affects perlons advanced 
in life, and efpecially thofe above fixty 
years of age. It moft ufually affects per- 
fons 
I 4 128 
PRACTICE 
fons of large heads and fhort necks, per* 
fons of a corpulent habit, perfons who 
have paded an indolent life and ufed a 
full diet, and efpecially thofe who have 
indulged in frequent intoxication. Men 
who have long laboured under a frequent 
and copious difcharge of blood from the 
hemorrhoidal velfels, upon either thefup- 
preflion or fpontaneous cealing of that 
difcharge, are particularly liable to be af- 
fected with apoplexy. 
MXCVI. 
This difeafe frequently comes on very 
fuddenly : but in many cafes it is preceded 
by various fymptoms, fuch as frequent 
fits of giddinefs, frequent headachs, a he- 
morrhagy from the nofe, fome tranfitory 
interruptions of feeing and hearing, fome 
falfe vifion and hearing, fome tranfitory 
degree of numbnefs or lofs of motion in 
the O F P H Y S I C. 
129 
the extremities, fome faltering of the 
tongue in fpeaking, a lofe of memory, a 
frequent drowfinefs, and frequent fits of 
incubus. 
MXCVIL 
An attention to thefe fymptoms, and to 
the predifponent circumftances (MXCV.), 
will often enable us to forefee the more 
violent attacks of this difeafe. 
MXCVIII. 
When the difeafe comes on fuddenly 
to a confiderable degree, it has been fre- 
quently obferved to have been immediately 
induced by violent exercife ; by a full and 
long-continued infpiration; by a fit of 
anger; by much external heat, efpecially 
that arifing from a crowded aflembly of 
people; by warm bathing; by intoxica- 
tion; 130 
PRACTICE 
tion; by long ftooping with the head 
down ; and by a tight ligature about the 
neck. The difeafe has been remarked to 
make its attacks inoft frequently in the 
Ipring feafon, and efpecially when the ver- 
nal heat fuddenly fucceeds to the winter 
cold. 
MXCIX. 
The fymptoms denoting the pretence of 
I 
this diteate will be fufficiently known from 
the definition given MXC1V. Although 
the whole of the body is affected with the 
lofs of fente and motion, it fometimes takes 
place more upon one fide of the body than 
the other; and, in that cate, the fide leaft 
affedled with palfy is fometimes affected 
with convulfions. In this difeafe there is 
often a ftertorous breathing ; and this has 
been faid to be a mark of the mote violent 
ftate of the diteate: but it is not always 
pre- OF PHYSIC. 
131 
prefent even in the moft complete form 
or moft violent degree of the difeafe. 
NIC. 
The proximate caufe of this difeafe may 
be, in general, whatever interrupts the 
motion of the nervous power from the 
brain to the mufcles of voluntary motion; 
or, in fo far as fenfe is afFeded, whatever 
interrupts the motion of the nervous 
power from the fentient extremities of 
the nerves to the brain. 
MCL 
Such an interruption of the motions of 
the nervous power may be occafioned, ei- 
ther by fame compreflwn of the origin of the 
nerves* or by fmething defraying the mobi- 
lity of the nervous' power. Both thefe caufes 
we mutt treat of more particularly ; and, 
firft, 132 
PRACTICE 
firfl:, of that of comprefiion, feemingly the 
mo ft frequent occafion of apoplexy, and 
perhaps the occafion of all thofe apoplexies 
arifing from internal caufes. 
MCIL 
The lofs of fenfe and motion in parti- 
cular parts of the body, may be occasioned 
by a compreffion, either of the origin of 
certain nerves only, or of the fame nerves 
in fome part of their courfe from the brain 
to the organs of fenfe and motion. Such 
cafes of partial compreffion will be more 
properly considered hereafter ; and the 
affedlion I am now to treat of being gene- 
ral, it mutt depend upon a very general 
compreffion of the origin of the nerves, 
or medullary portion of the brain ; and 
therefore, this more general compreffion 
only is to be considered here. 
MCIIL OF PHYSIC. 
133 
MCIII. 
This compreffion of the origin of the 
nerves, or medullary portion of the brain, 
may be produced in different ways; as, 
1. By external violence fracturing and 
prefling in a part of the cranium. 
2. By tumours, fometimes foft, fome- 
times bony, formed in different parts of 
the brain, or in its membranes, and be- 
coming of fuch a bulk as to comprefs the 
medullary fubftance of the brain. 
3. By the blood accumulated in the 
blood-veffels of the brain, and diftending 
them to fuch a degree as to comprefs the 
medullary portion of the fame. 
4. By fluids effufed in different parts of 
the brain, or into the cavity of the cra- 
nium, and accumulated in fuch quantity 
as to occafion the compreffion we treat 
of. 
And, as to this laft, it is to be remarked 
here3 134 
PRACTICE 
here, that the fluids eflufed may be of two 
kinds: that is, they may be either a por- 
tion of the common mafs of blood, poured 
out from red veflels; or a portion of ferum 
or colourlefs fluid, poured out chiefly by 
exhalants. 
MCIVa 
Of thefe feveral caufes of com preflion 
the firft is not to be confidered here, be- 
caufe the removing it does not belong to 
our province; and the confideration of 
the fecond may be omitted, as in moft in- 
ftances it is neither to be difcerned nor 
cured by any means yet known. The 
third and fourth caufes of compreftion, as 
they are the moft frequent, and are alfo 
moft properly the fubjeds of our art, fo 
they are thofe which deferve our particu- 
lar attention ; and we {hall therefore en- 
deavour OF PHYSIC 
135 
deavour to trace them further back in the 
fcries of caufes which may produce them. 
MCV. 
Both the Bates of over-diBention and 
of effufion, may be produced by whatever 
increafes the afflux and impetus of the 
blood in the arteries of the head ; fuch as 
violent exercife, a violent fit of anger, ex- 
ternal heat applied, or any Brong preffure 
upon the defcending aorta. 
MCVI. 
But both thefe Bates of over-diftentiori 
and of effufion, may alfo and feem to be 
more frequently produced by caufes that 
operate by preventing the free return of 
the venous blood from the veflels of the 
head to the right ventricle of the heart. 
MCV1I. 136 
PRACTICE 
MCVII. 
The venous veffels of the brain are of a 
conformation and diftribution fo peculiar, 
as lead us to believe, that Nature intended 
to retard the motion of the blood, and ac- 
cumulate it in thefe veffels; and therefore, 
even very fmall additional refiftances to 
the motion of the blood from thefe to- 
wards the right ventricle of the heart, may 
ftill more readily accumulate the blood in 
them. Such accumulation will moft rea- 
dily happen in advanced life, when the 
venous fyftem in general is in a plethoric 
ftate, and when this plethora takes place 
efpecially in the venous veffels of the brain. 
It will, in like manner, be moft apt to oc- 
cur in perfons whofe heads are large with 
refpecft to the reft of the body ; and in per- 
fons of a fhort neck, which is unfavour- 
able to the return of the venous blood 
from the head. The accumulation of 
blood OF PHYSIC. 
137 
blood in the venous veflels of the brain, 
will alfo be mofl likely to occur in perfons 
of a corpulent habit, either becaufe thefe 
may be confidered to be in a plethoric 
ftate, or becaufe obefity, by occafioning a 
compreflion of the blood-veflels in other 
parts of the body, more readily fills thofe 
of the brain, which are entirely free from 
any fuch compreflion. 
MCVIIL 
Thefe are the circumftances in the con- 
flitution of the body, which, producing a 
flower motion and return of the venous 
blood from the veflels of the head, favour 
an accumulation and diftention in them ; 
and we now proceed to mention the feve- 
ral occalional caufes, which, in every per- 
fon, may diredlly prevent the free return 
of the blood from the veflels of the head 
towards the heart. Such are, 
Vol. III. 
K 
i. Stoop- 138 
PRACTICE 
1. Stooping down with the head, or 
other fituations of the body in which the 
head is long kept in a depending ftate, and 
in which the gravity of the blood increafes 
the afflux of it by the arteries, and oppofes 
the return of it by the veins. 
2. A tight ligature about the neck, which 
compreffes the veins more ftrongly than 
the arteries. 
3. Any obftrucffion of a considerable 
number of the veins carrying the blood 
from the head, and more efpecially any 
confiderable obftrudion of the afcending 
vena cava. 
4. Any confiderable impediment of the 
free paffage of the blood from the veins 
into the right ventricle of the heart; and 
it is commonly by this, and the immediate- 
ly preceding circumftance, that polypous 
concretions in the cava, or right ventricle, 
are found to occafion apoplexy. 
5. The return of blood from the veins of 
the OF PHYSIC. 
139 
the head towards the heart, is efpecially 
interrupted by every circumftance that 
produces a more difficult tranfmiffion of 
the blood through the vefTels of the lungs. 
It is well known, that, at the end of every 
expiration, fome interruption is given to 
the free tranfmiffion of the blood through 
the lungs; and that this at the fame time 
gives an interruption to the motion of the 
blood from the veins into the right ven- 
tricle of the heart. This clearly appears 
from that regurgitation of the blood in 
the veins which occafions the alternate 
heaving and fubfiding that is perceived in 
the brain of living animals when the cra- 
nium is removed, and which is obferved 
to be fynchronous with the alternate mo- 
tions of refpiration. From this we rea- 
dily perceive, that whatever occafions a 
difficulty in the tranfmiflion of the blood 
through the lungs, mu ft alfo interrupt the 
free return of the venous blood from the 
K 2 
veflels PRACTICE 
140 
veflcls of the head; and muft therefore 
favour, and perhaps produce, an accumu- 
lation of blood, and an over-diflention in 
thefe veflels. 
It is further to be obferved, that, as a 
very full infpiration continued for any 
length of time, occafions fuch an interrup- 
tion of the free tranfmiflion of the blood 
through the lungs, as produces a fuffufion 
of face, and a manifeft turgefcence of the 
blood-veffels of the head and neck; fo 
every full and long-continued infpiration 
may occafion an accumulation of blood in 
the veflels of the head, to a very confider- 
able degree. Thus, as every ftrong exer- 
tion of the mufcular force of the body re- 
quires, and is attended with, a very full 
and long-continued infpiration, we thence 
learn why the violent exertions of mufcu- 
lar force have been fo often the immediate 
or exciting caufes of apoplexy. 
It may alfo be remarked, that corpu- 
lency OF PHYSIC. 
141 
lency and obefity feem to operate very 
much, by occafioning a more difficult 
tranfmiffion of the blood through the 
veffiels of the lungs. It appears, that in 
fat perfons, from the compreffion of the 
blood-veffels in many parts of the body, 
the veffiels of the lungs are thereby kept 
very full; fo that, upon tjie leaft increafe 
of bodily motion, which fends the blood 
fafter into the lungs, a more frequent and 
laborious refpiration becomes in fuch per- 
fons immediately neceffary. This {hows, 
that, in fuch perfons, the blood is not free- 
ly tranfmitted through the lungs; a cir- 
cumftance which, as in other inftances, 
muft give a conftant reiiftance to the re- 
turn of blood from the veffiels of the head, 
and therefore favour or occafion an accu- 
mulation of blood in them. 
Is the motion of the blood in the vef- 
fels of the head, rendered flower by ftudy, 
fare, and anxiety ? 
K 3 
MIX, 142 
PRACTICE 
MCIX. 
It is to be obferved further, that thefe 
feveral caufes (MCV.-MGVIII.) of a pre- 
ternatural fulnefs in the blood-veflels of 
the brain, may produce japoplexy in dif- 
ferent ways, according as the fulnefs takeg 
place in the arteries or in the veins. 
MCX. 
Accordingly, Jirft, the increafed afflux 
of blood into the arteries of the brain, and 
an increafed adlion in thefe, may either 
occafion a rupture of their extremities, and 
thereby an effufion of red blood producing 
compreffion; or the fame afflux and inr 
creafed action may occafion an increafed 
exhalation from their extremities, of a fe- 
rous fluid, which, if not as quickly re- 
abforbed, may foon accumulate in fuch 
quantity as to produce compreffion. 
MCXL OF PHYSIC. 
143 
MCXI. 
The plethoric ftate of the ve- 
nous veffels of the brain may operate in 
three different ways. 
1. The fulnefs of the veins may give fuch 
refiftance to the blood flowing into them 
from the arteries, as to determine the impe- 
tus of the blood to be fo much greater upon 
the extremities of the arteries as to occafion 
a rupture of thefe, and confequently an 
cffufion of red blood, or the H&morrbagia 
cerebri, which Hoffman confiders as a fre- 
quent caufe of apoplexy, and which we have 
before explained in DCCLXXII. 
2. Whilft the fame refiftance to the blood 
flowing from the arteries into the veins, 
increafes the impetus of the blood in the 
former, this may, without occafioning rup- 
ture, increafe the exhalation from their ex- 
halant extremities, and produce an effufion 
of a ferous fluid; in the fame manner as 
K 4 
fuch 144 
PRACTICE 
fuch refiftance in the veins produces hy- 
dropic effufions in other parts of the body. 
3. If we may fuppofe, as no lymphatics 
have been yet difcovered in the brain, that 
the ordinary abforbents are not prefent 
there, and that the exhaled fluids are ab- 
forbed or taken up by the extremities of 
the veins; this will Ihow ftill more clearly 
that a refiflance to the motion of the blood 
in the veins of the brain, may readily pro- 
duce an accumulation of ferous fluid in its 
cavities, and confequently a compreflipri 
producing apoplexy. 
MCXII. 
Bcfide thefe cafes of apoplexy from af- 
flux in the arteries, or refiftance in the 
veins, an efiufion of ferum may happen 
from two other caufes. The one is a re- 
laxation of the exhalants, as in other cafes 
of hydropic diathefis prevailing in the 
body; OF PHYSIC. 
145 
body; and it is not unufual for a general 
dropfy to end in apoplexy. The fecond is 
an over proportion of watery parts in the 
mafs of blood, which is therefore ready to 
run off by the exhalants, as in the cafe of 
an ifehuria renalis ; which, when it proves 
incurable, very commonly terminates in 
apoplexy. 
MCXIII. 
We have now mentioned the feveral 
caufes of apoplexy depending upon com- 
preffion; and from the whole it will ap- 
pear, that the moft frequent of all thefe 
caufes is a plethoric hate, or an accumu- 
lation and congeftion of blood in the ve-> 
nous velfels of the head, operating, accord- 
ing to its degree, in producing over-dif- 
tention or effufion. The frequent opera- 
tion of fuch a caufe will efpecially appear 
from a confideration of the predifponent 
circunv? 146 
PRACTICE 
circumftances (MXCV.), and from the 
antecedent fymptoms (MXCVL) 
MCXIV. 
From the view I have now given of the 
caufes of apoplexy arifing from compref- 
iion, it will readily appear that there is a 
foundation for the common diftindtion of 
this difeafe into the two kinds of Sanguine 
and Serous. But this diftindtion cannot 
be very ufefully applied in pradlice, as 
both kinds may often depend on the fame 
caufe, that is, a venous plethora; and there- 
fore requiring very nearly the fame me- 
thod of cure. The only diftindHon that 
can be properly made of apoplexies from 
compreflion, is perhaps the diftindlion of 
ferous apoplexy, into that depending on the 
plethora mentioned MCX1II.; and that de- 
pending upon hydropic diathefis,or an over- 
proportion of water in the blood (MCX1I.); 
the OF PHYSIC. 
147 
the former caufes giving a proper idiopa- 
thic, the latter only a fymptomatic, dif- 
eafe. 
MCXV. 
Befide the caufes now mentioned, occa- 
fioning apoplexy by compreilion, I allege 
there are other caufes producing the fame 
difeafe, by directly deftroying the mobi- 
lity of the nervous power. Such caufes 
feem to be the mephitic air arifing from 
fermenting liquors, and from many other 
fources; the fumes arifing from burning 
charcoal; the fumes of mercury, of lead, 
and of fome other metallic fubftances; 
opium, alcohol, and many other narcotic 
poifons: To all which I would add the 
power of cold, of concuflion, of electricity, 
and of certain paffions of the mind. 
MCXVL 148 
PRACTICE 
MCXVI. 
None of thefe poifons or noxious powers 
+ccm to kill by acting firft upon the or- 
gans of refpiration or upon the fanguife- 
rous fyftem; and I believe their immedi- 
ate and direct adtion to be upon the ner- 
vous power, deftroying its mobility, be- 
caufe the fame poifons fhow their power in 
deftroying the irritability of mufcles and 
of the nerves connected with them, when 
both thefe are entirely feparated from the 
i'eft of the body. 
MXCVIL 
It appears to me probable, that the apo-, 
pledlic Rate in fome degree accompanying, 
and almoft always fucceeding, an epileptic 
paroxyirn, does not depend upon compref- 
fion, but upon a certain date of immobi- 
lity of the nervous power, produced by 
cep* O T P H Y S I C. 
149 
certain circumftances in the nervous fy- 
Item itfelf, which fometimes feem to* be 
communicated from one part of the body 
to another, and at length to the brain. 
MCXVIIL 
The fame obfervation may be made with 
refpect to many inftances of hyfteric pa- 
roxyfm ; and the circumftances, both of 
epileptic and hyfteric paroxyfms, ending 
in coma, or a degree of apoplexy, lead me 
to think, that alfo the apoplexy proceeding 
from retrocedent or atonic gout is of the 
fame kind, or that it depends upon an im- 
mobility of the nervous power, rather than 
upon compreflion. 
MCXIX. 
It may indeed happen, that as the apo- 
plectic and gouty predifpofitions do often 
con- 150 
PRACTICE 
concur in the fame perfon; fo it may con- 
fequently happen, that the apoplexy co- 
ming upon gouty perfons may fometimes 
depend upon compreflion; and dilfedions 
may, accordingly, difcover that the cir- 
cumftances of fuch a caufe had preceded. 
But, in many cafes of apoplexy following 
a retrocedent or atonic gout, no fuch an- 
tecedent or concomitant circumftances, as 
commonly occur in cafes of compreffion, 
do diftindtly or clearly appear; while 
others prefent themfelves, which point 
out an affedlion of the nervous power 
alone. 
MCXX. 
With refpecft, however, to the circum- 
ftances which may appear upon the dif- 
fecftion of perfons dead of apoplexy, there 
may be fome fallacy in judging, from thofe 
circumftances, of the caufe of the difeafe. 
What- OF PHYSIC. 
151 
Whatever takes off or diminilhes the mo- 
bility of the nervous power, may very 
much retard the motion of the blood in 
the veffels of the brain; and that perhaps 
to the degree of increafing exhalation, or 
even of occafioning rupture and effufion: 
fo that, in fuch cafes, the marks of com- 
preffion may appear, upon diffedlion, tho' 
the difeafe had truly depended on caufes 
deftroying the mobility of the nervous 
power. This feems to be illuftrated and 
confirmed from what occurs in many 
cafes of epilepfy. In fome of thefe, after 
a repetition of fits, recovered from in the 
ufual manner, a fatuity is induced, which 
commonly depends upon a watery inun- 
dation of the brain : And in other cafes of 
epilepfy, when fits have been often re- 
peated without any permanent confe- 
quence, there happens at length a fatal 
paroxyfm; and upon diffe6tion it appears, 
that an effufion of blood had happened. 
This, 152 
PRACTICE 
This, I think, is to be confidered as a caufe 
of death, not as a caufe of the difeafe : for 
in fuch cafes, I fuppofe that the difeafe had 
diminifhed the action of the veffels of the 
brain, and thereby given occafion to a flag- 
nation, which produced the appearances 
mentioned. And I apprehend the fame 
reafoning will apply to the cafes of retroce- 
dent gout, which, bydeftroying the ener- 
gy of the brain, may occafion fuch a ftag- 
nation as will produce rupture, effufion* 
and death ; and in fuch a cafe, the ap- 
pearances upon diffedlion might lead us 
to think that the apoplexy had depended 
entirely upon comprefiion. 
MCXXI. 
The feveral caufes mentioned in MCXV0 
are often of fuch power as to occafion 
immediate death, and therefore have not 
commonly been taken notice of as afford- 
ing OF PHYSIC. 
153 
ing infiances of apoplexy; but, as the ope- 
ration of the whole of thefe caufes is fimi- 
lar and analogous, and as in moll inftances 
of the operation of thefe caufes an apo- 
plectic ftate is manifeftly produced, there 
can be little doubt in confidering molt of 
the inftances of their effedls as cafes of apo- 
plexy, and therefore fuch as fall properly 
under our confideration here. 
MCXXII. 
This difeafe of apoplexy is fometimes 
entirely recovered from; but more fre- 
quently it ends in death, or in a hemiple- 
gia. Even when an attack of the difeafe is 
recovered from, we generally find it dif- 
pofed to return; and the repeated attacks 
of it almoft always, fooner or later, bring 
on the events we have mentioned. 
Vol. III. 
L 
MCXXIIL 154 
PRACTICE 
MCXXIIL 
The feveral events of this difeafe, ill 
health, death, or another difeafe, may be ex- 
pected and forefeen from a confideration of 
the predifponent circumftances (MXCV.); 
of the antecedent fymptoms (MXCVI.) ; 
of the exciting caufes (MXCVIII.); of the 
violence and degree of the fymptoms when 
the difeafe has come on (MXCIV.) ; of 
the duration of the difeafe ; and of the 
effects of the remedies employed. 
MCXXIV. 
From the great danger attending this 
difeafe when it has come on (MCXXII.), 
it will readily appear, that our care fhould 
be chiefly directed to the prevention of it. 
This, I think, may be often done by avoid- 
ing the remote and exciting caufes ; and 
how this may be accompliihed, will be ob- 
vious OF PHYSIC. 
155 
Vious from the enumeration of thofe caufes 
given above (MXCVIII.) But it will alfo 
appear from what is faid above, that the 
prevention of this difeafe will efpecially 
depend upon obviating the predifponent 
caufe; which, in moft cafes, feems to be a 
plethoric flate of the blood-veffels of the 
brain. This, I think, may be obviated by 
different means ; and, in the firfl place, 
by a proper management of exercife and 
diet. 
MCXXV. 
The exercife ought to be fuch as may 
Support the perfpiration, without heating 
the body or hurrying refpiration ; and, 
therefore, commonly by forne mode of 
geflation. In perfons not liable to frequent 
fits of giddinefs, and who are accuflomed 
to riding on horfeback, this exercife is, o£ 
all others, the bed. Walking, and fome 
L 2 
other 156 
PRACTICE 
other modes of bodily exercife, may be 
employed with the reftridiions juft now 
mentioned; but in old men, and in men 
of corpulent habits, bodily exercife ought 
always to be very moderate. 
MCXXVI. 
In perfons who pretty early in life Ihow 
the predifpolition to apoplexy, it is pro- 
bable that a low diet, with a good deal of 
exercife, might entirely prevent the dif- 
eafe ; but, in perfons who are advanced in 
life before they think of taking precau- 
tions, and are at the fame time of a cor- 
pulent habit, which generally fuppofes 
their having been accuftomed to full li- 
ving, it might not be fafe to put them up- 
on a low diet: and it may be enough that 
their diet be rendered more moderate than 
ufual, efpecially with refpecl to animal- 
food; OF PHYSIC. 
157 
food ; and that, at fupper, fuch food 
fhould be abftained from altogether. 
In drinking, all heating liquors are to 
be abftained from, as much as former ha- 
bits will allow ; and the fmalleft approach 
to intoxication is to be carefully fhunned. 
For ordinary draught, fmall beer is to be 
preferred to plain water, as the latter is 
more ready to occalion coftivenefs, which 
in apoplectic habits is to be carefully 
avoided. The large ufeof tobacco, in any 
fhape, may be hurtful; and except in cafes 
where it has been accuftomed to occahon 
a copious excretion from the head, the in- 
terruption of which might not be fafe, 
the ufe of tobacco fliould be avoided; and 
even in the circumftance mentioned, where 
it may be in fome meafurc neceffary, the 
ufe of it fhould at leaft be rendered as mo- 
derate as poffible. 
L 3 
MCXXVII. 158 
PRACTICE 
MCXXVII. 
Evacuations by (tool may certainly con- 
tribute to relieve the plethoric date of the 
veffels of the head ; and, upon an appear- 
ance of any unufual turgefcence in thefe, 
purging will be very properly employed ; 
but, when no fuch turgefcence appears, the 
frequent repetition of large purging might 
weaken the body too much; and, for pre- 
venting apoplexy, it may for the mod part 
be enough to keep the belly regular, and 
rather open, by gentle laxatives. In the 
dimmer feafon, it may be ufeful to drink, 
every morning, of a gentle laxative mine- 
ral water, but never in large quantity. 
MCXXVIIL 
In the cafe of a plethoric date of the 
fydem, it might be fuppofed that blood- 
letting would be the moft effedual means 
of OF PHYSIC. 
159 
of diminifhing the plethora, and of pre- 
venting its confequences : and, when an 
attack of apoplexy is immediately threat- 
ened, blood-letting is certainly the .remedy 
to be depended upon; and blood fhould be 
taken largely, if it can be done, from the 
jugular vein, or temporal artery. But, 
when no threatening turgefcence ap- 
pears, the obviating plethora is not judi- 
cioufly attempted by blood-letting, as we 
have endeavoured to demonflrate above 
DCCLXXXVII. In doubtful circum- 
ftances, leeches applied to the temples, or 
fcarifications of the hind-head, may be 
?uore fafe than general bleedings. 
MCXXIX. 
When there are manifeft fymptoms of 
a plethoric Rate in the veflels of the head, 
a feton, or pea-iflue, near the head, may 
L 4 
be 160 
PRACTICE 
be very ufeful in obviating any turgefcence 
of the blood. 
MCXXX. 
Thefe are the means to be employed for 
preventing the apoplexy which might arife 
from a plethoric flate of the veffels of the 
brain; and if, at the fame time, great 
care is taken to avoid the exciting caufes 
(MXCVIII.), thefe means will be generally 
fuccefsful. 
In the cafes proceeding from other caufes 
(MCXV.), as their application is fo imme- 
mediately fucceeded by the difeafe, they 
hardly allow any opportunity for preven- 
tion. 
MCXXXI. 
For the Cure of apoplexies from inter- 
nal caufes, and which I fuppofe to be chiefly 
thofe O F P H Y S I C. 
161 
thofe from compreffion, the ulual violence 
and fatality of it require that the proper 
remedies be immediately and largely em- 
ployed. 
The patient is to be kept as much as 
poffible in fomewhat of an eredl pofture, 
and in cool air; and therefore neither in a 
warm chamber, nor covered with bed- 
cloaths, nor furrounded with a crowd of 
people. 
MCXXXII. 
In all cafes of a full habit, and where 
the difeafe has been preceded by marks of 
a plethoric Rate, blood-letting is to be im- 
mediately employed, and very largely. In 
my opinion, it will be moft effectual when 
the blood is taken from the jugular vein ; 
but, if that cannot be properly done, it 
may be taken from the arm. The open- 
ing of the temporal artery, wrhen a large 
branch 162 
practice: 
branch can be opened, fo as fuddenly to 
pour out a confiderable quantity of blood, 
may alfo be an effedual remedy ; but, in 
execution, it is more uncertain, and may 
be inconvenient. It may be in fome mea- 
fure fupplied, by cupping and fcarifying 
f 
on the temples or hind-head. This, in- 
deed, fliould feldom be omitted; and thefe 
fcarifications are always preferable to the 
application of leeches. 
With refped to every mode of blood- 
letting, this is to be obferved, that when 
in any cafe of apoplexy, it can be perceived 
that one fide of the body is more affeded 
with the lofs of motion than the other, 
the blood-letting, if poiTible, fhould be 
made on the fide oppofite to that moft 
affeded. 
MCXXXIII. 
Another remedy to be employed is pur- 
ging, OF PHYSIC. 
163 
ging, to be immediately attempted by acrid 
glyfters; and at the fame time, if any 
power of fwallowing remain, by draftic 
purgatives given by the mouth. Thefe, 
however, left they may excite vomiting, 
fhould be given in divided portions at pro* 
per intervals. 
MCXXXIV. 
Vomiting has been commended by Tome 
practitioners and writers: but, apprehend- 
ing that this might impel the blood with 
too much violence into the veflels of the 
head, I have never employed it. 
MCXXXV. 
Another remedy to be immediately em- 
ployed is bliftering; and I judge that this 
is more effectual when applied to the head, 
pr near to it, than when it is applied to 
the 164 
PRACTICE 
the lower extremities. This remedy I do 
not confider as a ftimulant, or capable of 
making any confiderable revulfion: but, 
applied to the head, I fuppofe it ufeful in 
taking off the hemorrhagic difpofition fo 
often prevailing there. 
MCXXXVI. 
It has been ufual with practitioners, 
together with the remedies' already men- 
tioned, to employ ftimulants of various 
kinds: but I am difpofed to think them 
generally hurtful; and they muft be fo, 
wherever the fulnefs of the velfels, and 
the impetus of the blood in thefe, is to be 
diminifhed. Upon this principle it is 
therefore agreed, that ftimulants are abfo- 
lutely improper in what is fuppofed to be 
a fanguine apoplexy; but they are com- 
monly fuppofed to be proper in the ferous. 
If, however, we be right in alleging that 
this OF PHYSIC. 
165 
this alfo commonly depends upon a ple- 
thoric ftate of the blood-velfels of the 
brain, flimulants muft be equally impro- 
per in the one cafe as in the other. 
MCXXXVII. 
It may be argued from the almoft 
univerfal employment of ftimulants, and 
fometimes with fceming advantage, that 
they may not be fo hurtful as my notions 
of the caufes of apoplexy lead me to fup- 
pofe. But this argument is, in feveral re- 
fpedts, fallacious; and particularly in this, 
that in a difeafe which, under every ma- 
nagement, often proceeds fo quickly to a 
fatal termination, the effects of remedies 
are not to be eafily afcertained. 
MCXXXVIil. 166 
PRACTICE 
MCXXXV1II. 
I have now mentioned the feveral reme- 
dies which I think adapted to the cure of 
apoplexy arifing from comprefiion, and 
fhould next proceed to treat of the cure of 
apoplexy arifing from thofe caufes that di- 
rectly deftroy the mobility of the nervous 
power. But many of thofe caufes are of- 
ten fo powerful, and thereby fo fuddenly 
fatal in their effeCts, as hardly to allow of 
time for the ufe of remedies ; and fuch 
cafes therefore have been fo feldom the 
fubjeCls of practice, that the proper reme- 
dies are not fo well afcertained as to en- 
able me to fay much of them here. 
MCXXXIX. 
When, however, the application of the 
caufes (MCXV.) is not fo powerful as 
immediately to kill, and induces only an 
apo- OF PHYSIC. 
167 
apoplectic Rate, fome efforts are to be made 
to obviate the confequences, and to recover 
the patient: and even in fome cafes where 
the caufes referred to, from the ceafing of 
the pulfe and of refpiration, and from a 
coldnefs coming upon the body, have in- 
duced an appearance of death ; yet, if 
thefe appearances have not continued long, 
there may be means of recovering the per- 
fons to life and health. I cannot, indeed, 
treat this fubject completely ; but for the 
cure of apoplexy from feveral of the caufes' 
mentioned MCXV. Ihall offer the follow- 
ing general directions. 
i. When a poifon capable of producing 
apoplexy has been recently taken into the 
ftomach, if a vomiting fpontaneoufly ari- 
fes, it is to be encouraged; or if it does not 
fpontaneoufly come on, a vomiting is to 
be immediately excited by art, in order 
that the poifon may be thrown out as 
quickly as poffible. If, however, the poi- 
fon 168 
PRACTICE 
fon has been taken into the ftomach long 
before its effects have appeared, we judge 
that, upon their appearance, the exciting 
of vomiting will be ufelefs, and may per- 
haps be hurtful. 
2. When the poifon taken into the fto- 
mach, or otherwife applied to the body, 
has already induced an apoplecftic ftate, as 
thofe caufes do commonly at the fame 
time occafion a ftagnation or flower mo- 
tion of the blood in the velfels of the brain 
and of the lungs, fo it will generally be 
proper to relieve this congeftion by taking 
fome blood from the jugular vein, or from 
the veins of the arm. 
3. Upon the fame fuppofition of a con- 
geftion in the brain or lungs, it will gene- 
rally be proper to relieve it by means of 
acrid glyftcrs producing fome evacuation 
from the inteftines. 
4. When thefe evacuations by blood- 
letting and purging have been made, the 
various O F P H Y S I C. 
169 
various flimulants which have been com- 
monly propofed in other cafes of apoplexy, 
may be employed here with more probabi- 
lity and fafety. One of the moft effectual 
means of roufing apoplectics of this kind 
feems to be throwing cold water on feve- 
ral parts of the body, or wafhing the body 
all over with it. 
5. Although the poifon producing apo- 
plexy happens to be fo powerful as very 
foon to occafion the appearances of death 
above mentioned ; yet if this ftate has not 
continued long, the patient may often be 
recoverable, and the recovery is to be at- 
tempted by the fame means that are di- 
rected to be employed for the recovery of 
drowned perfons, and which are now com- 
monly known* 
Vol. III. 
M 
CHAP.  PRACTICE 
170 
CHAP. II. 
Of Palsy. 
MCXL. 
pALSY is a difeafe confiding in a lofs of 
the power of voluntary motion, but 
affedling certain parts of the body only, 
and by this it is diftinguifhed from apo- 
plexy (MXCIV). One of the moft fre- 
quent forms of palfy is when it affects the 
whole of the mufcles on one fide of the 
body, and then the difeafe is named a 
Hemiplegia, 
MCXLL OF PHYSIC. 
171 
MCXLI. 
The lofs of the power of voluntary mo- 
tion may be owing either to a morbid af- 
fection of the mufcles or organs of mo- 
tion, by which they are rendered unfit for 
motion; or to an interruption of the influx 
of the nervous power into them, which is 
always neceffary to the motions of thofe 
that are under the power of the will. 
The difeafe, from the fir fl of thefe caufes, 
as confifting in an organic and local af- 
fection, we refer entirely to the clafs of 
local difeafes. I am here to confider 
that difeafe only which depends upon the 
interrupted influx of the nervous power ; 
and it is to this difeafe alone I would give 
the appellation of Palfy, A difeafe depend- 
ing on an interrupted influx of the ner- 
vous power, may indeed often appear as 
merely a local affeClion; but as it de- 
pends upon an affection of the moft ge- 
neral 
M 2 172 
PRACTICE 
neral powers of the fyflem, it cannot be 
properly feparated from the fyftematic 
affections. 
MCXLIL 
In palfy, the lofs of motion is often 
accompanied with a lofs of fenfe: but, as 
this is not conftantly the cafe, and as 
therefore the lofs of fenfe is not an effen- 
tial fymptom of palfy, I have not taken 
it into my definition (MCXL.); and I 
fliall not think it neceffary to take any 
further notice of it in this treatife; be- 
eaufe, in fo far as it is in any cafe a part 
of the paralytic affection, it muft depend 
upon the fame caufes, and will be cured 
alfo by the very fame remedies, as the lofs 
of motion. 
MCXLIII. OF PHYSIC. 
173 
MCXLI1I. 
The palfy then, or lofs of motion, which 
is to be treated of here, may be diftin- 
guifhed as of two kinds ; one of them de- 
pending upon an affection of the origin of 
the nerves in the brain, and the other de- 
pending upon an affection of the nerves 
in fome part of their courfe between the 
brain and the organs of motion. Of the 
latter, as appearing in a very partial affec- 
tion, I am not to fpeak particularly here ; 
I fhall only treat of the more general pa- 
ralytic affections, and efpecially of the 
hemiplegia (MCXL.). At the fame time 
I exped:, that what I fhall fay upon this 
fubject will readily apply to both the 
pathology and practice in the cafes of af- 
fections more limited. 
M 3 z 
MCXLIV. 174 
PRACTICE 
MCXL1V. 
The hemiplegia (MCXL.) ufually be- 
gins with or follows, a paroxyfm of apo- 
plexy ; and when the hemiplegia, after 
fubfifting for fome time, becomes fatal, it 
is commonly by palling again into the 
ftate of apoplexy. The relation therefore 
or affinity between the two difeafes, is fuf- 
ficiently evident; and is further ftrongly 
confirmed by this, that the hemiplegia 
comes upon perfons of the fame confuta- 
tion (MXCV.), and is preceded by the 
fame fymptoms (MXCVIII.) that have 
been taken notice of with refpecl to apo- 
plexy. 
MCXLV. 
When a fit of apoplexy has gone off, 
and there remains a date of palfy appear- 
ing as a partial afieflion only, it might 
per- OF PHYSIC. 
175 
perhaps be fuppofed that the origin of the 
nerves is in a great meafure relieved ; but 
in fo far as commonly there ftill remain 
the fymptoms of the lofs of memory, and 
of fome degree of fatuity, thefe I think 
ihow that the organ of intelledb, or the 
common origin of the nerves, is ftill con- 
fiderably affected. 
MCXLVL 
Thus, the hemiplegia, from its evident 
connexion with, and near relation to 
apoplexy, may be properly confidered as 
depending upon like caufes; and confe- 
quently either upon a compreflion pre- 
venting the flow of the nervous power 
from the brain into the organs of motion, 
or upon the application of narcotic or other 
powers (MCXV.) rendering the nervous 
power unfit to flow in the ufual and pro- 
per manner. 
M 4 
MCXLVIL 176 
PRACTICE 
MCXLVII. 
We begin with confidering the cafes 
depending upon compreffion. 
The compreffion occafioning hemiplegia 
may be of the fame kind, and of all the 
different kinds that produce apoplexy, and 
therefore either from tumour, over-diften- 
tion, or effufion. The exiftence of tu- 
mour giving compreffion, may often be 
better difcerned in the cafe of palfy than 
in that of apoplexy, as its effects often ap- 
pear at firft in a very partial affection. 
MCXLVI1I. 
The other modes of compreffion, that 
is, of over-diftention and effulion, may, 
and commonly do take place, in hemiple- 
gia ; and when they do, their operation 
here differs from that producing apoplexy, 
by OF PHYSIC. 
177 
by its effects being partial, and on one 
fide of the body only. 
It may feem difficult to conceive that 
an over-diftention can take place in the 
veffels on one fide of the brain only; but it 
may be underftood : and in the cafe of a 
palfy which is both partial and tranfitory, 
it is perhaps the only condition of the 
veffels of the brain that can be fuppofed. 
In a hemiplegia, indeed, which fubfifts for 
any length of time, there is probably al- 
ways an effufion, either fanguine or ferous: 
but it is likely that even the latter muft be 
fupported by a remaining congeftion in 
the blood-veffels. 
MCXLIX. 
That a fanguine effufion can happen 
without becoming very foon general, and 
thereby occafioning apoplexy and death, 
may alfo feem doubtful: but diffedions 
prove 178 
PRACTICE 
prove that in fact it does happen occafion- 
ing palfy only ; though it is true, that this 
more commonly depends upon an effufion 
of ferous fluid, and of this only. 
MCL. 
Can a palfy occafioned by a compref- 
fion remain, though the compreifion be 
removed ? * 
MCLL 
From what has been faid MCXLIV. it 
will be obvious, that the hemiplegia may- 
be prevented by all the feveral means pro- 
pofed MCXXV. et. feq. for the prevention 
of apoplexy. 
MCLIL 
Upon the fame grounds, the Cure of 
patfy OF PHYSIC. 
179 
palfy mull be very much the fame with 
that of apoplexy (MCXXX. and 
when palfy has begun as an apoplexy, it 
it is prefumed, that, before it is to be con- 
lidered as palfy, all thofe feveral remedies 
have been employed. Indeed, even when 
it happens that on the firft attack of the 
difeafe the apopledic Hate is not very 
complete, and that the very firft appearance 
of the difeale is as a hemiplegia, the affi- 
nity between the two difeafes (MCXL1V.) 
is fuch as to lead to the fame remedies in 
both cafes. This is certainly proper in all 
thofe cafes in which we can with much 
probability impute the difeafe to compref- 
fion ; and it is indeed feldom that a hemi- 
plegia from internal caufes comes on but 
with a conliderable affedlion of the inter- 
nal and even of the external fenfes, toge- 
ther with other marks of a compreffion of 
the origin of the nerves. 
MCLIII. 180 
PRACTICE 
MCLIIL 
Not only, however, where the difeafe 
can be imputed to compreffion, but even 
where it can be imputed to the appli- 
cation of narcotic powers, if the difeafe 
come on with the appearances mentioned 
at the end of laft paragraph, it is to be 
treated in the fame manner as an apoplexy 
by MCXXXI -MCXXXIX. 
MCLIV. 
The cure of hemiplegia, therefore, on 
its firft attack, is the fame, or very nearly 
the fame, with that of apoplexy : and. it 
feems requifite that it fhould be different 
only, i. When the difeafe has fubfifted 
for fome time; 2. When the apoplectic 
fymptoms, or thofe marking a confiderable 
compreffion of the origin of the nerves, 
are removed ; and particularly, 3. When 
there OF PHYSIC. 
181 
there are no evident marks of compreflion, 
and it is at the fame time known that nar- 
cotic powers have been applied. 
MCLV. 
In all thefe cafes, the queftion arifes, 
Whether ftimulants may be employed, or 
how far the cure may be entirely trufted 
to fuch remedies ? Upon this queftion, 
with refpecft to apoplexy, I have offered my 
opinion in MCXXXVI. And, with refpecft 
to hemiplegia, I am of opinion, that fti- 
mulants are almoft always equally dange- 
rous as in the cafes of complete apoplexy; 
and particularly, i. In all the cafes of he- 
miplegia fucceeding to a paroxyfm of com- 
plete apoplexy; 2. In all the cafes coming 
upon perfons of the temperament men- 
tioned in MXCV. and after the fame an- 
tecedents as thofe of apoplexy (MXCVL); 
and, 182 
PRACTICE 
and, 3. In all the cafes coming on with 
fymptoms of apoplexy from compreftion. 
MCLVI. 
It is, therefore, in the cafes MCLIV. 
only, that ftimulants are properly admif- 
fible : And even in the two firft of thefe 
cafes, in which a plethoric ftate of the 
blood-veffels of the brain may have brought 
on the difeafe; in which a difpofition to 
that ftate may ftill continue; and in wrhich 
even fome degree of congeftion may ftill 
remain; the ufe of ftimulants muft be an 
ambiguous remedy ; fo that perhaps it is 
in the third of thefe cafes only that fti- 
mulants are clearly indicated and admif- 
fible. 
MCLV1I. 
Thefe doubts with refpect to the ufe of 
ftimu- OF PHYSIC. 
183 
ftimulants, may perhaps be overlooked or 
difregarded by thofe who allege that fti- 
mulants have been employed with ad- 
vantage even in thofe cafes (MCLV.) in 
which I have faid they ought to be a- 
voided. 
MCLVIII. 
To compromife this contrariety of opi- 
nion, I muft obferve, that even in the cafes 
of hemiplegia depending upon compref- 
fion, although the origin of the nerves be 
fo much comprefled as to prevent fo full a 
flow of the nervous power as is neceflary 
to mufcular motion, yet it appears from 
the power of fenfe ft ill remaining, that the 
nerves are, to a certain degree, ftill per- 
vious ; and therefore it is poflible that fli- 
mulants applied, may excite the energy of 
the brain fo much, as in fome meafure to 
force open the comprefled nerves, and to 
fhow 184 
PRACTICE 
fliow fome return of motion in paralytic 
mufcles. Nay, further, it may be allowed, 
that if thefe ftimulants be fuch as aft more 
upon the nervous than upon the fangui- 
ferous fyftem, they may poflibly be em- 
ployed without any very hurtful confe- 
fequence. 
MCLIX. 
But ftill it will be obvious, that although 
certain ftimulants aft chiefly upon the ner- 
vous fyftem, yet they alfo aft always in 
fome meafure upon the fanguiferous ; fo 
that, when they happen to have the latter 
effeft in any conflderable degree, they may 
certainly do much harm; and in a difeafe 
which they do not entirely cure, the mif- 
chief arifing from them may not be dif- 
cerned. 
MLX. OF PHYSIC. 
185 
MCLX. 
Whilft the employment of ftimulants ia 
fo often an ambiguous practice, we may 
perhaps go fome length towards afcertain- 
ing the matter, by coniidering the nature 
of the feveral ftimulants which may be em- 
ployed, and fome of the circumftances of 
their adminiftration. With this view, there- 
fore, I fhall now mention the feveral fti- 
mulants that have been commonly employ- 
ed, and offer fome remarks upon their na- 
ture and ufe. 
MCLXL 
They are in the firft place to be diftin- 
guifhed as external or internal. Of the 
firft kind, we again diftinguifh them, as they 
are applied to particular parts of the body 
only, or as they are more generally ap- 
plied 
Vol. III. 
N 186 
PRACTICE 
plied to the whole fyftem. Of the firft 
kind are, 
1. The concentrated acids of vitriol or 
nitre; involved, however, in oily or unftu- 
ous fubftances, which may obviate their 
corrofive, without deftroying their ftimu- 
lant power. 
2. The volatile alkaline fpirits, efpecially 
in their cauftic ftate; but involved alfo in 
oils, for the purpofe juft now mentioned. 
3. The fame volatile fpirits are fre- 
quently employed by being held to the 
nofe, when they prove a powerful ftimulus 
I 
to the nervous fyftem ; but it is at the 
fame time probable, that they may alfo 
prove a ftrong ftimulantto the blood-veffels 
of the brain. 
4. A brine, or ftrong folution of fea- 
falt. 
5. The effential oils of aromatic plants, 
or of their parts. 
6. 'lhe OF PHYSIC. 
187 
6. The efiential oils of turpentine, or of 
other fuch refinous fubftances. 
7. The diftilled oils of amber, or of other 
bituminous foftils. 
8. The redified empyreumatic oils of 
animal or vegetable fubftances. 
9. Various vegetable acrids, particularly 
muftard. 
10. The acrid matter found in feveral in- 
feds, particularly cantharides. 
Some of thefe ftimulants may be either 
applied in fubftance, or may be diflblved 
in ardent fpirits, by which their ftimulant 
power may be increafed, or more conve- 
niently applied. 
MCLXIL 
The greater part of the fubftances now 
enumerated ihow their ftimulant power by 
inflaming the fkin of the part to which 
they are applied ; and when their applica- 
tion 188 
PRACTICE 
tion is fo long continued as to produce 
this effect, it interrupts the continuance of 
their ufe, and the inflammation of the 
part does not feem to do fo much good as 
the frequent repetition of a more moderate 
ftimulus. 
MCLXIIL 
Analogous to thefe ftimulants is the 
flinging of nettles, which has been fre- 
quently commended. 
Among the external ftimulants, the me- 
chanical one of fricftion with the naked 
hand, the flefh-brufli, or flannel, is juftly 
to be reckoned. Can the impregnation of 
the flannels to be employed, with the 
fumes of burning maftic, olibanum, &c. 
be of any fervice ? 
MCLXIV. OF PHYSIC. 
189 
MCLXIV. 
With refpedl to the whole of thefe ex- 
ternal ftimulants, it is to be obferved, that 
they affect the part to which they are ap- 
plied much more than they do the whole 
fyftem, and they are therefore indeed fafer 
in ambiguous cafes; but, for the fame rea- 
fon, they are of lefs efficacy in curing a 
general affecftion. 
MCLXV. 
The external applications which may 
be applied to affect the whole fyftem, are 
the powers of heat and cold, and of elec- 
tricity. 
Heat, as one of the moft powerful fti- 
mulants of the animal oeconomy has been 
often employed in palfies, efpecially by 
warm bathing. But as, both by ftimula- 
ting the folids and rarefying the fluids, 
N 3 
this 190 
PRACTICE 
this proves a ftrong ftimulus to thelangui- 
ferous fyftem, it is often an ambiguous re- 
medy ; and has frequently been mani- 
feftly hurtful in palfies depending upon a 
congeftion of blood in the veffels of the 
brain. The moil certain, and therefore 
the moft proper ufe of warm bathing jn 
paliies, feems to be in thofe that have been 
occahoned by the application of narcotic 
powers. Are the natural baths more ufe- 
ful by the matters with which they may 
be naturally impregnated ? 
MCLXVI. 
Cold applied to the body for any length 
of time, is always hurtful to paralytic per- 
fons; but if it be not very intenfe, nor 
the application long continued, and if at 
the fame time the body be capable of a 
brilk reaction, fuch an application of cold 
is a powerful flimulant of the whole fy- 
ftem, OF PHYSIC. 
191 
tern, and has often been ufeful in curing 
palfy. But, if the power of reaction in 
the body be weak, any application of cold 
may prove very hurtful. 
MCLXVII. 
Electricity, in a certain manner applied, 
is certainly one of the moil powerful fti- 
mulants that can be employed to aft upon 
the nervous fyftem of animals ; and there- 
fore, much has been expected from it in 
the cure of palfy. But, as it ftimulates the 
fanguiferous as well as the nervous fyftem, 
it has been often hurtful in palfics depend- 
ing upon a compreftion of the brain; and 
efpecially when it has been fo applied as to 
adl upon the veflels of the head. It is 
fafer when its operation is confined to par- 
ticular parts fomewhat remote from the 
head ; and, further, as the operation of 
cleClricity, when very ftrong, can deftroy 
N 4 
the 192 
PRACTICE 
the mobility of the nervous power, I am 
of opinion, that it is always to be employed 
with caution, and that it is only fafe when 
applied with moderate force, and when 
confined to certain parts of the body re- 
mote from the head. It is alfo my opi- 
nion, that its good effects are to be expec- 
ted from its repetition rather than from its 
force, and that it is particularly fuited to 
the cure of thofe palfies which have been 
produced by the application of narcotic 
powers. 
MCLXVIII. 
Amongft the remedies of palfy, the ufe 
of cxercife is not to be omitted. In a 
hemiplegia, bodily exercife cannot be em- 
ployed ; and in a more limited affection, if 
depending upon a compreffion of fome 
part of the brain, it would be an ambi- 
guous O F PH Y S IC. 
193 
guous remedy : but, in all cafes where the 
exercifes of geflation can be employed, 
they are proper; as, even in cafes of com- 
preflion, the ftimulus of fuch exercife is 
moderate, and therefore fafe ; and, as it 
always determines to the furface of the 
body, it is a remedy in all cafes of inter- 
nal congeftion. 
MCLXIX. 
The internal ftimulants employed in 
palfy are various, but chiefly the follow- 
ing. 
i. The volatile alkaline faits, or fpirits, 
as they are called, are very powerful and 
difluflve ftimulants, operating efpecially on 
the nervous fyftem ; and even although 
they operate on the fanguiferous, yet, if 
given in frequently repeated finall rather 
than in large dofes, their operation being 
traniitory, is tolerably fafe. 
2. The 194 
PRACTICE 
2. The vegetables of the clafs named 
Tetradynamia, are many of them power- 
ful diffufive ftimulants ; and at the fame 
time, as quickly palling out of the body, 
and therefore of tranlitory operation, they 
are often employed with fafety. As they 
commonly prove diuretic, they may in 
this way alfo be of fervice in fome cafes of 
ferous palfy. 
3. The various aromatics, whether em- 
ployed in fubftance, intindhire, or in their 
effential oils, are often powerful ftimu- 
lants ; but being more adhehve and in- 
flammatory than thofe laft mentioned, 
they are therefore in all ambiguous cafes 
lefs fafe. 
4. Some other acrid vegetables have 
been employed; but we are not well ac- 
quainted with their peculiar virtues, or 
proper ufe. 
5. Some relinous fubftances, as guaia- 
cum, and the terebinthinate fubftances, or 
their O F P H Y S I C 
195 
their eflential oils, have been, with fome 
probability, employed; but they are apt 
to become inflammatory. Decodlions of 
guaiacurn, and fome other fudorifics, have 
been directed to excite fweating by the 
application of the fumes of burning fpirit 
of wine in the laconicum, and have in that 
way been found ufeful. 
6. Many of the fetid antifpafmodic me- 
dicines have been frequently employed in 
palfy ; but I do not perceive in what man- 
ner they are adapted to the cure of this 
difeafe, and I have not obferved their good 
effects in any cafes of it. 
7. Bitters, and the Peruvian bark, have 
alfobecn employed; but with no propriety 
or advantage that I can perceive. 
MCLXX. 
With rcfpecl to the whole of thefe in- 
ternal ftimulants, it is to be obferved, that 
they 196 
PRACTICE 
they feldom prove very powerful; and 
wherever there is any doubt concerning 
the nature or ftate of the difeafe, they may 
readily do harm, and are often therefore 
of ambiguous ufe. 
BOOK BOOK IL 
Of ADYNAMIA, 
O R 
Diseases consisting in a Weakness 
or Loss of Motion in either the 
Vital or Natural Functions. 
CHAP. I. 
Of Syncope, or Fainting. 
MCLXXL 
r I is a difeafe in which the action 
* of the heart and refpiration become 
confiderably weaker than ufual,or in which 
for 198 
PRACTICE 
for a certain time thefe functions ceafe 
altogether. 
MCLXXII. 
Phyficians having obferved that this 
affection occurs in different degrees, have 
endeavoured to diftinguifh thefe by diffe- 
rent appellations ; but as it is not poffible 
to afcertain thefe different degrees with 
any precifion, fo there can be no ftricl 
propriety in employing thofe different 
names, and I fhall here comprehend the 
whole of the affections of this kind under 
the title of Syncope. 
MCLXXHI. 
This difeafe fometimes comes on fud- 
denly to a confiderable degree, but fome- 
times alfo it comes on gradually ; and in 
the latter cafe, it ufually comes on with a 
fenfe of languor, and of anxiety about the 
heart, O F P H Y S I C. 
199 
heart, accompanied at the fame time, or 
immediately after, with fome giddinefs, 
dimnefs of fight, and founding in the ears. 
Together with thefe fymptoms, the pulfe 
and refpiration become weak; and often fo 
weak, that the pulfe is fcarcely to be felt, 
or the refpiration to be perceived ; and 
fometimes thefe motions, for a certain 
time, ceafe altogether. While thefe fymp- 
toms take place, the face and whole fur- 
face of the body become pale, and more 
or lefs cold according to the degree and 
duration of the paroxyfm. Very com- 
monly, at the beginning of this, and du- 
ring its continuance, a cold fweat appears, 
and perhaps continues on the fore-head, 
as well as on fome other parts of the body. 
During the paroxyfm, the animal func- 
tions, both of fenfe and motion, are al- 
ways in fome degree impaired, and very 
often entirely fuf pended. A paroxyfm of 
fyncope is often, after fome time, fponta- 
* neoufly 200 
PRACTICE 
neoufly recovered from; and this recovery 
is generally attended with a fenfe of much 
anxiety about the heart. 
Fits of fyncope are frequently attended 
with, or end in, vomiting; and fometimes 
with convulfions, or an epileptic fit. 
MCLXXIV. 
Thefe are the phenomena in this dif- 
eafe; and from every view of the greateft 
part of them, there cannot be a doubt that 
the proximate caufe of this difeafe is a 
very weak or a total ceafmg of the action 
of the heart. But it will be a very diffi- 
cult matter to explain in what manner the 
feveral remote caufes operate in producing 
the proximate caufe. This, however, I {hall 
attempt, though with that diffidence which 
becomes me in attempting a fubjecl that 
has not hitherto been treated with much 
fuccefs. 
MCLXXIV. OF PHYSIC. 
201 
MCLXX1V. 
The remote caufes of fyncope may, in 
the firft place, be referred to two general 
heads. The one is, of thofe caufes exift- 
ing and adling in the brain, or in parts of 
the body remote from the heart, but adling 
upon it by the intervention of the brain. 
The other general head of the remote cau- 
fes of fyncope, is of thofe exifting in the 
heart itfelf, or in parts very immediately 
connecfted with it, and thereby acting 
more dircdly upon it in producing this 
difeafe. 
MCLXXV. 
In entering upon the confideration of the 
firft fet of thofe caufes (MCLXXIV.), I 
muft aflume a proportion which I fuppofe 
to be fully eftabliihcd in Phyfiology. It is 
this : Than though the mufcular fibres of 
Vol, III. 
O 
the PRACTICE 
202 
the heart be endowed with a certain de- 
gree of inherent power, they are ftill, for 
fuch adtion as is neceflary to the motion of 
the blood, very conftantly dependent upon 
a nervous power fent into them from the 
brain. At leaft this is evident, that there 
are certain powers adding primarily, and 
perhaps only in the brain, wThich influence 
and varioufly modify the afiion of the 
heart. 1 fuppofe, therefore, a force very 
conftantly during life exerted in the brain, 
with refpedft to the moving fibres of the 
heart, as well as of every part of the body: 
which force I fliall call the Energy of the 
Brain ; and which I fuppofe may be, on 
different occafions, ftronger or weaker with 
refpecl to the heart. 
MCLXXVI. 
Admitting thefe proportions, it will be 
obvious, that if I can explain in what 
man- OF PHYSIC. 
203 
manner the fir fl fet of remote caufes 
(MCLXX1V.) diminifli the energy of the 
brain, I fliall at the fame time explain in 
what manner thefe caufes occafion a fyn- 
cope. 
MCLXXVII. 
To do this, I obferve, that one of the 
moft evident of the remote caufes of fyn- 
cope is a hemorrhagy, or an evacuation of 
blood, whether fpontaneous or artificial. 
And as it is very manifeft that the energy 
of the brain depends upon a certain fulnefs 
and tenfion of its blood-veffels, for which 
nature feems to have induftrioully provided 
by fuch a conformation of thofe blood- 
velfels as retards the motion of the blood 
both in the arteries and veins of the brain; 
fo we can readily perceive, that evacuations 
of blood, by taking off the fulnefs and ten- 
fion of the blood-veffels of the brain, and 
O 2 
thereby  PRACTICE 
204 
thereby diminifhing its energy with re- 
fpect to the heart, may occafion a fyncope. 
In many perfons, a fmall evacuation of 
blood will have this effedl ; and in fuch 
cafes there is often a clear proof of the 
manner in which the caufe operates, from 
this circumftance, that the effect can be 
prevented by laying the body in a hori- 
zontal pofture ; which, by favouring the 
afflux of the blood by the arteries, and re- 
tarding the return of it by the veins, pre- 
ferves the neceffary fulnefs of the veffels of 
the brain. 
It is farther to be remarked here, that 
not only an evacuation of blood occaflons 
fyncope, but that even a change in the 
diftribution of the blood, whereby a larger 
portion of it flows into one part of the 
fyftem of blood-veffels, and confequently 
lefs into others, may occafion a fyncope. 
It is thus I explain the fyncope that rea- 
dily occurs upon the evacuation of hydro- 
pic OF PHYSIC. 
205 
pic waters, which had before filled the cavi- 
ties of the abdomen or thorax. It is thus alfo 
I explain the fyncope that fometimes hap- 
pens on blood-letting, but which does not 
happen till the ligature which had been 
employed is untied, and admits a larger 
afflux of blood into the blood-veffels of 
the arm. Both thefe cafes of fyncope 
fhow, that an evacuation of blood does 
not always occafion the difeafe by any ge- 
neral effect on the whole fyftem, but often 
merely by taking off the requifite fulnefs 
of the blood-veffels of the brain. 
MCLXXV1II. 
The operation of fome others of the re- 
mote caufes of fyncope, may be explained 
on the following principles. Whilft the 
energy of the brain is, upon different oc- 
cafions, manifeflly ftronger or weaker, it 
feems to be with this condition, that a 
O 3 
ftronger 206 
PRACTICE 
Rronger exertion of it is neceflarily fol- 
lowed by a weaker Rate of the fame. It 
feems to depend upon this law in the con- 
flitution of .the nervous power, that the 
ordinary contraction of a mufcle is always 
alternated with a relaxation of the fame ; 
that, unlefs a contraction proceeds to the 
degree of fpafm, the contracted Rate can- 
not be long continued : and it fccms to 
depend upon the fame caufe that the vo- 
luntary motions, which always require an 
unufual increafe of exertion, occafion fa- 
tigue, debility, and at length irrefiRiblc 
Reep. 
From this law, therefore, of the nervous 
power, we may underRand, why a Ridden 
and violent exertion of the energy of the 
brain is fometimes followed by Rich a di- 
minution of it as to occafion a fyncope ; 
and it is thus I fuppofe that a violent fit 
of joy produces fyncope, and even death. 
It is upon the fame principle alfo, I fup- 
pofe. OF PHYSIC. 
207 
pofe, that an exquifite pain may fometimes 
excite the energy of the brain more ftrongly 
than can be fupported, and is therefore 
followed by fuch a diminution as muft 
occafion fainting. But the effect of this 
principle appears more clearly in this, that 
a fainting readily happens upon the fud- 
den remiffion of a confiderable pain ; and 
thus I have feen a fainting occur upon the 
redudion of a painful diilocation. 
MCLXXIX. 
It Teems to be quite analogous when a 
fyncope immediately happens on the Hnifil- 
ing of any great and long-continued effort, 
whether depending on the will, or upon a 
propenfity ; and in this way a fainting 
fometimes happens to a woman on the 
bearing of a child. This may be well 
illuftrated by obferving, that in perfons 
already much weakened, even a very mo- 
derate 
O 4 208 
PRACTICE 
derate effort will fometimes occafion faint- 
ing. 
MCLXXX. 
To explain the operation of fome other 
caufes of fyncope, it may be obferved, that 
as the exertions of the energy of the brain 
are efpecially under the influence of the 
will, fo it is well known that thofe modi- 
fications of the will which are named Paf- 
fions and Emotions, have a powerful in- 
fluence on the energy of the brain in its 
actions upon the heart, either in increaflng 
or diminifhing the force of that energy. 
Thus, anger has the former, and fear the 
latter effect; and thence it may be under- 
ftood how terror often occaflons a fyncope 
fometimes of the moft violent kind, named 
Afphyxia, and fometimes death itfelf. 
MCLXXXL OF PHYSIC. 
209 
MCLXXXL 
As, from what I have juft mentioned, 
it appears, that the emotions of defire in- 
creafe, and thofe of averfion diminifh, the 
energy of the brain; fo it may be under- 
ftood, how a ftrong averfion, a horror, or 
the feeling which arifes upon the fight of 
a very difagreeable objecft, may occafion 
fainting. As an example of this, 1 have 
known more than one inftance of a per- 
fon's fainting at the fight of a fore in ano- 
ther perfon. 
MCLXXXIL 
To this head of horror and difguft, I 
refer the operation of thofe odours which 
in certain perfons occafion fyncope. It 
may be fuppofed, that thofe odours are en- 
dowed with adirecftly fedative power, and 
may thereby occafion fyncope ; but they 
are, 210 
PRACTICE 
are, many of tfyem, with refpect to other 
perfons, evidently of a contrary quality: 
and it appears to me, that thofe odours 
occafion fyncope only in thofe perfons to 
whom they are extremely difagreeable. 
MCLXXXIIL 
It is, however, very probable, that among 
the caufes of fyncope, there are fome which, 
analogous to all thofe we have already 
mentioned, act by a directly fedative 
power : and fuch may either be diffufed 
in the mafs of blood, and thereby com- 
municated to the brain, or may be only 
taken into the ftomach, which fo readily 
and frequently communicates its affections 
to the brain. 
MCLXXXIV. 
Having now enumerated, and, as I hope, 
ex- OF PHYSIC. 
211 
explained, the moil part of the remote 
caufes of fyncope, that cither operate im- 
mediately upon the brain, or whofe opera- 
ration upon other parts of the body is 
communicated to the brain, it is proper 
to obferve, that the moft part of thefe 
caufes operate upon certain perfons more 
readily and more powerfully than upon 
' others; and this circumftance, which 
may be conlidered as the predifponent 
caufe of fyncope, deferves to be inquired 
into. 
It is, in the firft place, obvious, that the 
operation of fome of thofe caufes depends 
entirely upon an idiofyncrafy in the per- 
fons upon whom they operate; which, 
however, I cannot pretend to explain. 
But, in the next place, with reipect to the 
greater part of the other caufes, their ef- 
fects feem to depend upon a temperament 
which is in one degree or other in com- 
mon to many perfons. This tempera- 
ment 212 
PRACTICE 
ment feems to conlift in a great degree 
of fenfibility and mobility, arifing from 
a Rate of debility, fometimes depending 
upon original conformation, and fome- 
times produced by accidental occurrences 
in the courfe of life. 
MCLXXXV. 
The fecond fet of the remote caufes of 
fyncope (MCLXXIV.), or thofe aCting 
direCUy upon the heart itfelf, are certain 
organic affections of the heart itfelf, or of 
the parts immediately connected with it, 
particularly the great veffels which pour 
blood into or immediately receive it from 
the cavities of the heart. Thus a dilata- 
tion or aneurifm of the heart, a polypus 
in its cavities, abfceffes or ulcerations in 
its fubftance, a clofe adherence of the pe- 
ricardium to the furface of the heart, aneu- 
rifms of the great veffels near to the heart, 
poly- O F P H Y S I C. 
213 
polypus in thefe, and oflifications in thefe 
or in the valves of the heart, are one or 
other of them conditions which, upon dif- 
fedlion, have been difcovered in thofe 
perfons who had before laboured under 
frequent fyncope. 
MCLXXXVL 
It is obvious, that thefe conditions are 
all of them, either fuch as may, upon oc- 
cafion, difturb the free and regular influx 
into, or the free egrefs of the blood from, 
the cavities of the heart; or fuch as may 
otherwife difturb its regular action, by 
fometimes interrupting it, or fometimes 
exciting it to more violent and convulfive 
adiion. The latter is what is named the 
Palpitation of the heart, and it commonly 
occurs in the fame perfons who are liable 
to fyncope. 
MCLXXXVIL 214 
PRACTICE 
MCLXXXVII. 
It is this, as I judge, that leads us to 
perceive in what manner thefe organic af- 
fections of the heart and great veffels may 
occaiion fyncope ; for it may be fuppofed, 
that the violent exertions made in palpita- 
tions may either give occaiion to an alter- 
nate great relaxation (MCLXXVIIL), or 
to a fpafmodic contraction; and in either 
way fufpend the aCtion of the heart, and 
occaiion fyncope. It feems to me probable, 
that it is a fpafmodic contraction of the 
heart that occaiions the intermiffion of the 
pulfe fo frequently accompanying palpita- 
tion and fyncope. 
MCLXXXVIII. 
Though it frequently happens that pal- 
pitation and fyncope arife, as we have faid, 
from the organic affections above men- 
tioned, OF PHYSIC. 
215 
tioned, it is proper to obferve, that thele 
difeafes, even when in a violent degree, do 
not always depend on fuch caufes acting 
dire&ly on the heart, but are often de- 
pendent on fome of thofe caufes which we 
have mentioned above as acting primarily 
on the brain. 
MCLXXXIX. 
I have thus endeavoured to give the pa- 
thology of fyncope; and of the cure I can 
treat very iliortly. 
The cafes of fyncope depending on the 
fecond fetof caufes (MCLXXlV.),andfully 
recited in MCLXXXV. I fuppofe to be 
generally incurable; as our art, fo far as I 
know, has not yet taught us to cure any 
one of thofe feveral caufes of fyncope 
(MCLXXXV.) 
The cafes of fyncope, depending on the 
firft fet of caufes (MCLXXIV.), and whole 
ope- 216 
PRACTICE 
operation I have endeavoured to explain 
in MCLXXVII. etJeq. I hold to be gene- 
rally curable, either by avoiding the fe- 
veral occafional caufes there pointed out, 
or by correcting the predifponent caufes 
(MCLXXX1V.) The latter* I think, may 
generally be done by correcting the de- 
bility or mobility of the fyftem, by the 
means which I have already had occalion 
to point out in another place. 
CHAP. OF PHYSIC. 
217 
C H A P. II. 
Of Dyspepsia, or Indigestion. 
MCXC. 
A Want of appetite, a fqueamilhnefs, 
fometimes a vomiting, fudden and 
tranfient diftentions of the ftomach, eruc- 
tations of various kinds, heartburn, pains 
in the region of the ftomach, and a bound 
belly, are fymptoms which frequently con- 
cur in the fame perfon, and therefore may 
be prefumed to depend upon one and the 
fame proximate caufe. In both views, 
Vol. III. 
p 
there- 218 
PRACTICE 
therefore they may be confidered as form- 
ing one and the fame difeafe, to which 
we have given the appellation of 
fet at the head of this chapter. 
MCXCL 
But as this difcafe is alfo frequently a 
fecondary and fympathic affection, fo the 
fymptoms above mentioned are often join- 
ed with many others; and this has given 
occafion to a very confufed and undeter- 
mined defcription of it, under the gene- 
ral title of Nervous Difeafes, or under that 
of Chronic Weaknefs. It is proper, how- 
/ 
ever, to diftinguilh, and I apprehend the 
fymptoms enumerated above are thofe ef- 
fential to the idiopathic affedlion I am now 
to treat of. 
MCXCII. OF PHYSIC. 
219 
MCXCII. 
It is indeed to be particularly obferved, 
that thefe fymptoms are often truly ac- 
companied with a certain Rate of mind 
which may be confidered as a part of the 
idiopathic affection : but I fhall take no 
further notice of this fymptom in the pre- 
fent chapter, as it will be fully and more 
properly confidered in the next, under the 
title of Hypochondriacs. 
MCXCI1L 
That there is a diftindl difeafe attended 
always with the greater part of the above 
fymptoms, is rendered very probable by 
< 
this, that all thefe feveral fymptoms may 
arife from one and the fame caufe; that 
is, from an imbecillity, lofs of tone, and 
weaker action in the mufcular fibres of the 
ftom^ch: and I conclude therefore that 
P 2 
this 220 
PRACTICE 
this imbecillity may be confidered as the 
proximate caufe of the difeafe I am to treat 
of under the name ofDyfpepfia. 
MCXCIV. 
The imbecillity of the ftomach, and the 
confequent fymptoms (MCXC.), may, 
however, frequently depend upon fome 
organic affedion of the ftomach itfelf, as 
tumour,ulcer, or feirrhofity; or upon fome 
affection of other parts of the body com- 
municated to the ftomach, as in gout, 
amenorrhoea, and fome others. In all thefe 
cafes, however, the dyfpeptic fymptoms 
are to be confidered as fecondary or fym- 
pathic affections, to be cured only by 
curing the primary difeafe. Such fecon- 
dary and fympathic cafes cannot, indeed, 
be treated of here : but, as I prefume, that 
the imbccilhty of the ftomach may often 
take place without either any organic af- 
fedion OF PHYSIC. 
221 
fecTion of this part, or any more primary 
affection in any other part of the body; 
fo I fuppofe and expedt it will appear, from 
the confideration of the remote caufes, 
that the dyfpepfia may be often an idiopa- 
thic affection, and that it is therefore pro- 
perly taken into the fyftem of methodical 
Nofology, and becomes the fubjedt of our 
confideration here. 
MCXCXV. 
There can be little doubt, that, in moft 
cafes, the weaker adfion of the mufcular 
fibres of the ftomach, is the moft frequent 
and chief caufe of the fymptoms men- 
tioned in MCXC. ; but 1 dare not main- 
tain it to be the only caufe of idiopathic 
dyfpepfia. There is, pretty certainly, a 
peculiar fluid in the ftomach of animals, 
or at leafl a peculiar quality in the fluids, 
that we know to be there, upon which the 
P3 
folu- 222 
PRACTICE 
folution of the aliments taken into the fto- 
mach chiefly depends: and it is at the fame 
time probable,that the peculiar quality of the 
diflblving or digefting fluids may be vari- 
oufly changed, or that their quantity may 
be, upon occafion, diminifhed. It is there- 
fore fuflicicntly probable, that a change 
in the quality or quantity of thefe fluids 
may produce a confiderablc difference in 
the phenomena of digeftion, and parti- 
cularly may give occafion to many of 
the morbid appearances mentioned in 
MCXC. 
MCXCVI. 
This Teems to be very well founded, 
and points out another proximate caufe of 
dyfpepfia befide that we have already af- 
figned : But, notwithftanding this, as the 
peculiar nature of the digeftive fluid, the 
changes which it may undergo, or the 
caufes O F P H Y S I C. 
223 
caufes by which it may be changed, are 
all matters fo little known, that I cannot 
found any practical doctrine upon any 
fuppofition with refpedl to them ; and as, 
at the fame time, the imbecillity of the fto- 
mach, either as canting the change in the 
digeftive fluid, or as being induced by 
that change, feems always to be prefent, 
and to have a great fliare in occafioning 
the fymptoms of indigeftion; fo I fhall flill 
confider the imbecillity of the ftomach as 
the proximate and almoft foie caufe of 
dyfpepfia. And I more readily admit of 
this manner of proceeding; as, in my 
opinion, the doctrine applies very fully 
and clearly to the explaining the whole of 
the practice which experience has efta- 
bliflied as the moft fuccefsful in this 
difeafe. 
P 4 
MCXCVIL 224 
PRACTICE 
MCXCVIL 
Confidering this, then, as the proxi- 
mate caufe of dyfpepfia, I proceed to men- 
tion the feveral remote caufes of this dif- 
eafe; as they are fuch, as, on different oc- 
cafions, feem to produce a lofs of tone in 
the mufcular fibres of the ftomach. They 
may, I think, be confidered under two 
heads. The jirft is, of thofe which a (ft di- 
retftly and immediately upon the ftomach 
itfelf: The fecond is, of thofe which aift 
upon the whole body, or particular parts 
of it, but in confequence of which the 
ftomach is chiefly or almoft only affected. 
MCXCVII1. 
Of the firfl: kind are, 
i.t Certain fedative or narcotic fub- 
ftances taken into the ftomach; fiich as 
tea, OF PHYSIC. 
225 
tea, coffee, tobacco, ardent fpirits, opium, 
bitters, aromatics, putrids, and acefcents. 
2. The large and frequent drinking of 
warm water, or of warm watery liquids. 
3. Frequent furfeit, or immoderate re- 
pletion of the ftomach. 
4. Frequent vomiting, whether fponta- 
neoufly arifing, or excited by art. 
5. Very frequent fpitting, or rejection of 
faliva. 
MCXCIX. 
Thofe caufes which act upon the whole 
body, or upon particular parts and func- 
tions of it, are, 
1. An indolent and fedentary life. 
2. Vexation of mind, and diforderly 
paffions of any kind. 
3. Intenfe ftudy, or clofe application to 
bufinefs too long continued. 
4. Excels in venery. 
5- 226 
PRACTICE 
5. Frequent intoxication; which partly 
belongs to this head, partly to the for- 
mer. 
6. The being much expofed to moift and 
cold air when without exercife. 
Though the difeafe, as proceeding from 
the laft fet of caufes, may be confidered as 
a fymptomatic affection only; yet as the 
affection of the ftomach is generally the 
firft, always the chief, and often the only 
effect which thefe caufes produce or dif- 
covcr, I think the afFetftion of the ftomach 
may be confidered as the difeafe to be at- 
tended to in practice ; and the more pro- 
perly fo, as in many cafes the general de- 
bility is only to be cured by reftoring the 
tone of the ftomach, and by remedies firft 
applied to this organ. 
MCCI. 
For the cure of this difeafe, we form three 
feve- OF PHYSIC. 
227 
feveral indications; a prefervative, a pal- 
liative, and a curative. 
Thefirjl is, to avoid or remove the re- 
mote caufes juft now enumerated. 
The fecond is, to remove thofe fymptoms 
which especially contribute to aggravate 
and continue the difeafe. And, 
The third is, to reftore the tone of the 
ftomach; that is, to correct or remove the 
proximate caufe of the difeafe. 
MCCII. 
The propriety and neceflity of the firft 
indication is fufficiently evident, as the 
continued application, or frequent repeti- 
tion of thofe caufes, rnuft continue the dif- 
eafe; may defeat the ufe of remedies; or, 
in fpite of thefe, may occafion the recur- 
rence of the difeafe. It is commonly the 
neglect of this indication which renders 
this difeafe fo frequently obftinate. How 
the 228 
PRACTICE 
the indication is to be executed, will be 
fufficiently obvious from the confideration 
of the feveral caufes : but it is proper for 
the practitioner to attend to this, that the 
execution is often exceedingly difficult, he- 
caufe it is not eafy to engage men to break 
in upon eftabliffied habits, or to renounce 
the purfuit of pleafure ; and particularly, 
to perfuade men that thefe practices are 
truly hurtful which they have often prac- 
tifed with feeming impunity. 
MCC1IL 
The fymptoms of this difeafe which 
efpecially contribute to aggravate and con- 
tinue it, and therefore require to be more 
immediately corrected or removed, are, 
firjly the crudities of the ftomach already 
produced by the difeafe, and difcovered 
by a lofs of appetite, by a fenfe of weight 
and uneafinefs in the ftomach, and parti- 
cularly OF PHYSIC. 
229 
cularly by the eruCtation of imperfectly 
digefted matters. 
Another fymptom to be immediately 
corrected, is an unufual quantity, or a 
higher degree than ufual, of acidity pre- 
fent in the flomach, difcovered by various 
diforders in digeftion, and by other effeCls 
to be mentioned afterwards. 
The thirdfymptom aggravating the dif- 
eafe, and otherwife in itfelf urgent, is co- 
ftivenefs, and therefore conftantly requi- 
ring to be relieved. 
MCCIV. 
The firjl of thefe fymptoms is to be re- 
lieved by exciting vomiting ; and the ufe 
of this remedy, therefore, ufually and pro- 
perly begins the cure of this difeafe. The 
vomiting may be excited by various means, 
more gentle or more violent. The for- 
mer may anfwer the purpofe of evacuating 
the  PRACTICE 
230 
the contents of the ftomach : but emetics, 
and vomiting, may alfo excite the ordinary 
adlion of the ftomach ; and both, by va- 
rioufly agitating the fyftem, and particu- 
larly by determining to the furface of the 
body, may contribute to remove the caufes 
of the difeafe. But thefe latter effects can 
only be obtained by the ufe of emetics of 
the more powerful kind, fuch as the anti- 
monial emetics efpecially are. 
MCCV. 
The /econd fymptom to be palliated, i« 
an excefs of acidity, either in quantity or 
quality, in the contents of the ftomach. 
In man there is a quantity of acefcent ali- 
ment almoft conftantly taken in, and, as 
I think, always undergoes an acetous fer- 
mentation in the ftomach; and it is there- 
fore, that, in the human ftomach, and in 
the ftomachs of all animals uling vegetable 
food, OF PHYSIC. 
231 
food, there is always found an acid pre- 
lent. This acid, however, is generally in- 
nocent, and occafions no diforder, unlefs 
either the quantity of it is very large, or 
the acidity proceeds to a higher degree 
than ufual. But, in either of thefe cafes, 
the acid occafions various diforders, as fla- 
tulency, eructation, heartburn, gnawing 
pains of the ftomach, irregular appetites 
and cravings, loofenefs, griping, emacia- 
tion, and debility. To obviate or remove 
thefe efleds aggravating and continuing 
the difeafe, it is not only neceffary to cor- 
rect the acid prefent in the ftomach; but, 
efpecially as this acid proves a ferment 
determining and increafing the acefcency 
of the aliments afterwards taken in, it is 
proper alfo, as foon as poflible, to correCt 
the difpofition to exceflive acidity. 
MCCVI. 232 
PRACTICE 
MCCVI. 
The acidity prefent in the ftomach may 
be corrected by the ufe of alkaline faits, 
or abforbent earths, or by fuch fubftances 
containing thefe, which can be decompofed 
by the acid of the ftomach. Of the alka- 
lines, the cauftic is more effectual than the 
mild ; and this accounts for the effects of 
lime-water. By employing abforbents, we 
avoid the excefs of alkali, which might 
fometimes take place. The abforbents are 
different, as they form a neutral more or 
lefs laxative; and hence the difference be- 
tween magnefia alba and other abforbents. 
It is to be obferved, tbatalkalines and ab- 
forbents may be employed to excefs; as, 
when employed in large quantity, they 
may deprive the animal fluids of the acid 
neccflary to their proper compofition. 
mccvii. OF PHYSIC. 
233 
MCCVII. 
The difpofition to acidity may be ob- 
viated by avoiding acefcent aliments, and 
ufing animal-food little capable of acef- 
cency. This, however, cannot be long 
continued without corrupting the ftate of 
our blood; and as vegetable food cannot be 
entirely avoided, the excefs of their acef- 
cency may in fome meafure be avoided, 
by choofing vegetable food the leaft dif- 
pofed to a vinous fermentation, fuch as 
leavened bread and well fermented liquors, 
and, inftead of frelh native acids, employ- 
ing vinegar. 
MCCVIII. 
The acid arifing from acefcent matters 
/ 
in a found date of the ftomach, does not 
proceed to any high degree, or is again 
foon involved and made to difappear: but 
Vol. III. 
Q 
this PRACTICE 
234 
this does not always happen; and a more 
copious acidity, or a higher degree of it, 
may be produced, either from a change in 
the digeftive fluids, become lefs fit to mo- 
derate fermentation and to cover acidity, 
or from their not being fupplied in due 
quantity. How the former may be occa- 
fioned, we do not well underftand; but we 
can readily perceive that the latter, per- 
haps the former alfo, may proceed from a 
weaker adtion of the mufcular fibres of the 
ftomach. In certain cafes, fedative paf- 
fions, immediately after they arife, occafion 
the appearance of acidity in the ftomach 
which did not appear before; and the ufe 
of ftimulants often corrects or obviates an 
acidity that would otherwife have appeared. 
From thefe confiderations, we conclude, 
that the production and fubfiftence of aci- 
dity in the ftomach, is to be efpecially pre- 
vented by reftoring and exciting the pro- 
per OF PHYSIC. 
235 
per acftion of it, by the feveral means to be 
mentioned hereafter. 
MCCIX* 
But it is alfo to be further obferved, that 
though there are certain powers in the fto- 
mach for preventing a too copious acidity, 
or a high degree of it, they are not how- 
ever always fufficient for preventing acef- 
cency, or for covering the acidity produced; 
and therefore, as long as vegetable fub- 
ftances remain in the ftomach, their acef- 
cency may go on and increafe. From 
hence we perceive, that a fpecial caufe of 
the excefs of acidity may be, the too long 
retention of acefcent matters in the fto- 
mach ; whether this may be from thefe 
matters being of more difficult folution, 
or from the weaknefs of the ftomach more 
flowly difcharging its contents into the 
duodenum, or from fome impediment to 
<L2 
the 236 
PRACTICE 
the free evacuation of the ftomach by the 
pylorus. The latter of thefe caufes we are 
well acquainted with, in the cafe of a fcir- 
rhous pylorus, producing commonly the 
higheft degree of acidity. In all the in- 
ftances of this fcirrhofity I have met with, 
I have found it incurable : but the firft of 
thefe caufes is to be obviated by avoiding 
fuch aliments as are of difficult folution ; 
and the fecond is to be mended by the 
feveral remedies for exciting the a&ion.of 
the ftomach, to be mentioned afterwards. 
MCCX. 
The third fymptom commonly accom- 
panying dyfpepfia, which requires to be 
immediately removed,is coftivenefs. There 
is lb much connexion between the feveral 
portions of the alimentary canal with re- 
fpecl to the periftaltic motion, that, if ac- 
celerated or retarded in any one part, the 
other O F PHYSIC. 
237 
other parts of it are commonly affected in 
the fame manner. Thus, as the brifker 
adlion of the ftomach muft accelerate the 
action of the inteftines, fo the flower action 
of the inteftines muft in fome meafure re- 
tard that of the ftomach. It is therefore 
of confequence to the proper action of the 
ftomach, that the periftaltic motion of the 
inteftihes determining their contents down- 
wards, be regularly continued; and that all 
ooftivenefs, or interruption of that determi- 
nation, be avoided. This may be done by 
the various means of exciting the aClion 
of the inteftines : but it is to be obferved 
here, that as every confiderable evacua- 
tion of the inteftines weakens their action, 
and is ready therefore to induce coftivenefs 
when the evacuation is over; fo thofe pur- 
gatives which produce a large evacuation, 
are unfit for correcting the habit of coftive- 
nefs. This, therefore, fliould be attempted 
by medicines which do no more than fo- 
licit 238 
PRACTICE 
licit the inteftines to a more ready difcharge 
of their prefent contents, without either 
hurrying their action, or increafing the ex- 
cretions made into their cavity ; either of 
which effects might produce a purging. 
There are, I think, certain medicines pecu- 
liarly proper on this occafion, as they leem 
to ftimulate efpecially the great guts, and 
to a cl little on the higher parts of the in- 
ternal canal. 
MCCXI. 
We have thus mentioned the feveral 
means of executing our fecond indication; 
and I proceed to the third, which is, as we 
have faid, the proper curative; and it is to 
reftore the tone of the ftomach, the lofs of 
which we confider as the proximate caufe 
of the difeafe, or at leaft as the chief part 
of it. The means of fatisfying this indi- 
cation we refer to two heads. One is, of 
thofe OF PHYSIC. 
239 
thofe means which operate direcftly and 
chiefly on the ftomach itfelf; and the other 
is, of thofe means which, operating upon 
the whole fyftem, have their tonic effects 
thereby communicated to the ftomach. 
MCCXIL 
The medicines which operate diredlly on 
rhe ftomach, are either ftimulants or to- 
nics. 
The ftimulants are faline or aromatic. 
The faline are acids or neutrals. 
Acids of all kinds feem to have the power 
of {Emulating the ftomach, and therefore 
often increafe appetite: but the native acids, 
as liable to fermentation, may otherwife 
do harm, and are therefore of ambiguous 
life. The acids, therefore, chiefly and fuc- 
cefsfully employed, are the vitriolic, mu- 
riatic, and the diftilled acid of vegetables, 
as 240 
PRACTICE 
as it is found in tar-water, which are all 
of them antizymics. 
The neutral faits anfwering this inten-r 
tion, are efpecially thofe which have the 
muriatic acid in their compofition, though 
it is prefumed that neutrals of all kinds 
have more or lefs of the fame virtue. 
MCCXIII. 
The aromatics, and perhaps fome other 
acrids, certainly (Emulate the ftomach, as 
they obviate the acefcency and flatulency 
of vegetable food : but their ftimulus is 
traniitory; and if frequently repeated, and 
taken in large quantities, they may hurt 
the tone of the ftomach. 
MCCXlVa 
The tonics employed to ftrengthen the 
ftomach OF PHYSIC. 
241 
ftomach are bitters, bitters and aftringents 
combined, and chalybeates. 
Bitters are undoubtedly tonic medicines, 
both with refpecft to the ftomach and the 
whole fyftem : but their long-continued 
ufe has been found to deftroy the tone of 
the ftomach, and of the whole fyftem; 
and, whether this is from the mere repeti- 
tion of their tonic operation, or from fome 
narcotic power joined with the tonic in 
them, I am uncertain. 
MCCXV. 
Bitters and aftringents combined, are, 
probably, more effectual tonics than either 
of them taken lingly ; and we fuppofe fuch 
a combination to take place in the Peruvian 
bark ; which therefore proves a powerful 
tonic, both with refpecft to the ftomach 
and to the whole fyftem. But I have fome 
ground to fufped, that the long-continued 
ufe 242 
PRACTICE 
ufe of this bark may, like bitters, deftroy 
both the tone of the ftomach and of the 
whole fyftem. 
MCCXVI. 
Chalybeates may be employed as tonics 
in various forms, and in conliderable 
quantities, with fafety. They have been 
often employed in the form of mineral 
waters, and feemingly with fuccefs : but 
whether this is owing to the chalybeate in 
the coinpofition of thefe waters, or to fome 
other circumftances attending their ufe, I 
dare not politively determine ; but the lat- 
ter opinion feems to me the more pro- 
bable. 
MCCXVII. 
The remedies which ftrengthen the 
ftomach, by being applied to the whole 
body, OF PHYSIC. 
243 
body, are, exercife and the application of 
cold. 
As exercife ftrengthens the whole body, 
it muft alfo ftrengthen the ftomach; but 
it does this alfo in a particular manner, 
by promoting perfpiration, and exciting 
the action of the veffels on the furface of 
the body, which have a particular confent 
with the mufcular fibres of the ftomach. 
This particularly explains why the exer- 
(fifes of geftation, though not the moft 
powerful in ftrengthening the whole fy- 
ftem, are, however, very powerful in 
ftrengthening the ftomach; of which we 
have a remarkable proof in the effects of 
failing. In ftrengthening the general fy- 
ftem, as fatigue muft be avoided, fo bo- 
dily exercife is of ambiguous ufe; and 
perhaps it is thereby, that riding on horfe- 
back has been fo often found to be one 
of the moft powerful means of ftrengthen- 
ing  PRACTICE 
244 
ing the ftomach, and thereby of curing 
dyfpepfia. 
MCCXVIII. 
The other general remedy of dyfpepfia, 
is the application of cold: which may be 
in two ways ; that is, either by the appli- 
cation of cold air, or of cold water. It is 
probable, that, in the atmofphere con- 
ftantly furrounding our bodies, a certain 
degree of cold, confiderably lefs than the 
temperature of our bodies themfelves, is 
neceflary to the health of the human body. 
Such a degree of cold feems to ftrengthen 
the veflels on the furface of the body, 
and therefore the mufcular fibres of the 
ftomach. But, further, it is well known, 
that if the body is in exercife fufficient to 
fupport fuch a determination to the fur- 
face, as to prevent the cold from produ- 
cing an entire conftridion of the pores; 
a OF PHYSIC. 
245 
a certain degree of cold in the atmofphere, 
with fuch exercife, will render the perfpi- 
ration more confiderable. From the fharp 
appetite that in fuch circumftances is com- 
monly produced, we can have no doubt, 
that by the application of fuch cold, the tone 
of the ftomach is confiderably ftrengthened. 
Cold air, therefore, applied with exercife, 
is a moll powerful tonic with refpedl to 
the ftomach: and this explains why, for 
that purpofe, no exercifes within doors, 
or in clofe carriages, are fo ufeful as thofe 
in the open air. 
MCCXIX. 
From the fame reafoning, we can per- 
ceive, that the application of cold water, or 
cold bathing, while it is a tonic with re- 
fpecl to the fyftem in general, and efpeci- 
ally as exciting the adion of the extreme 
veffels, muft in both refpedls be a power- 
ful 246 
PRACTICE 
ful means of ftrengthening the tone of the 
ftomach. 
MCCXX. 
Thefe are the remedies to be employed 
towards a radical cure of, idiopathic dyf- 
pepfia ; and it might be, perhaps, expected 
here, that I fhould treat alfo of the various 
cafes of the fympathic difeafe. But it will 
be obvious that this cannot be properly 
done without treating of all the difeafes of 
which the dyfpepfia is a fymptom, which 
cannot be proper in this place. It has 
been partly done already, and will be fur- 
ther treated of in the courfe of this work. 
In the mean time, it may be proper to ob- 
ferve, that there is not fo much occafion 
for diftinguilhing between the idiopathic 
and fympathic dyfpepfia, as there is in 
many other cafes of idiopathic and fympa- 
thic difeafes. For, as the fympathic cafes 
of OF PHYSIC. 
247 
of dyfpepfia are owing to a lofs of tone in 
fome other part of the fyftem, which is 
from thence communicated to the fto- 
mach ; fo the tone of the ftomach refto- 
red, may be communicated to the part 
primarily affected ; and therefore the re- 
medies of the idiopathic may be often ufe- 
fully employed, and are often the reme- 
dies chiefly employed, in fympathic dyf- 
pepfia. 
MCCXXI. 
Another part of our bufinefs here might 
be to fay, how fome other of the urgent 
fymptoms, befide thofe above mentioned, 
are to be palliated. On this fubjeft, I 
think it is enough to fay, that the fymp- 
toms chiefly requiring to be immediately 
relieved, are flatulency, heartburn, other 
kinds of pain in the region of the ftomach, 
and vomiting. 
The 248 
PRACTICE 
The dyfpeptic are ready to fuppofe that 
the whole of their dijeafe conflfts in a fla* 
tulency. In this it will be obvious that 
they are miftaken; but, although the fla- 
tulency is not to be entirely cured, but by 
mending the imbecillity of the ftomach 
by the means above mentioned ; yet the 
flatulent diftention of the ftomach may be 
/ 
relieved by carminatives, as they are call- 
ed, or medicines that produce a difcharge 
of wind from the ftomach ; fuch are the 
various antifpafmodics, of which the moft 
effectual is the vitriolic aether. 
The heartburn may be relieved by ab- 
forbents, antifpafmodics, or demulcents. 
The other pains of the ftomach may be 
fometimes relieved by carminatives, but 
moft certainly by opiates. 
Vomiting is to be cured moft efteddually 
by opiates thrown by injection into the 
anus. 
CHAP. OF PHYSIC. 
249 
CHAP. III. 
Or HYPOCHONDRIASIS, 
OR THE 
HYPOCHONDRIAC AFFECTION, 
COMMONLY CALLED 
Vapours or Low Spirits. 
MCCXXII. 
IN certain perfons there is a ftate of mind 
diftinguilhed by a concurrence of the 
following circumftances: A langour, lift* 
leffnefs, or want of refolution and activity 
Vol. III. 
K 
with 250 
PRACTICE 
with refpecl to all undertakings ; a dilpo- 
lition to ferioufnefs, fadnefs, and timidity; 
as to all future events, an apprehenlion of 
the worR or moft unhappy Rate of them; 
and therefore, often upon flight grounds, 
an apprehenlion of great evil. Such per- 
fons are particularly attentive to the Rate 
of their own health, to every the fmalleR 
change of feeling in their bodies; and 
from any unufual feeling, perhaps of the 
IlighteR kind, they apprehend great dan- 
ger, and even death itfelf. In refpedt to 
all thefe feelings and apprehenlions, there 
is commonly the moR obRinate belief and 
and perfualion. 
MCCXXIII. 
This Rate of mindis the Hypochondriacs 
of medical writers. See Linnasi Genera 
Morborum, Gen. 76. Sagari SyRema 
Symptomaticum, Clafs XIII. Gen. 5. The 
fame O F P H Y S I C. 
251 
fame ftate of mind is what has been com- 
monly called Vapours and Low Spirits. 
Though the term Vapours vsv&y be founded 
on a falfe theory, and therefore improper, 
I beg leave, for a purpofe that will imme- 
diately appear, to employ it for a little 
here. 
MCCXX1V. 
Vapours, then, or the Rate of mind de- 
fcribed above, is, like every other ftate of 
mind, connected with a certain ftate of 
the body, which muft be inquired into in 
order to its being treated as a difeafe by 
the art of phyfic. 
MCCXXV. 
This Rate of the body, however, is not 
very eafily afcertained : for we can per- 
ceive, that on different occafions it is very 
R 2 
dif-  PRACTICE 
252 
different; vapours being combined fome- 
times with dyfpepfia, fometimes with hy- 
fteria, and fometimes with melancholia, 
which are difeafes feemingly depending 
on very different Rates of the body. 
MCCXXVI. 
The combination of vapours with dyf- 
pepfia is very frequent, and in feemingly 
very different circumftances. It is, efpe- 
cially, thefe different circumftances that I 
would wifh to afcertain; and I remark, 
that they are manifeftly of two different 
kinds. Firft, as the difeafe occurs in 
young perlons of both fexes, in perfons of 
a fanguine temperament, and of a lax and 
flaccid habit. Secondly, as it occurs in 
elderly perfons of both fexes, of a melan- 
cholic temperament, and of a firm and ri- 
gid habit. 
MCCXXVII, OF PHYSIC. 
253 
MCCXXVII. 
Thefe two different cafes of the combi- 
nation of vapours and dyfpepfia, I confider 
as two diftimft difeafes, to be diftinguifhed 
chiefly by the temperament prevailing in 
the perfons affected. 
As the dyfpepfia of fanguine tempera- 
ments is often without vapours; and as the 
vapours, when joined with dyfpepfia in 
fuch temperaments, may be confidered as, 
perhaps, always a fymptom of the affec- 
tion of the ftomach ; fo to this combina- 
( 
tion of dyfpepfia and vapours, I would ftill 
apply the appellation of Dyfpepfia, and con- 
fider it as ftridly the difeafe treated of in 
the preceding chapter. 
But the combination of dyfpepfia and 
vapours in melancholic temperaments, as 
the vapours or the turn of mind peculiar 
to the temperament, nearly that defcribed 
above in MCCXXII. are elfential circum- 
flances 
R 3 254 
PRACTICE 
fiances of the difeafe ; and as this turn of 
mind is often with few, or only flight 
fymptoms of dyfpepfia, and, even though 
the latter be attending, as they feem to be 
rather the effects of the general tempera* 
ment, than of any primary or topical af- 
affeftion of the ftomach ; 1 confider this 
combination as a very different difeafe 
from the former, and would apply to it 
flridly the appellation of Hypochondriafis. 
MCCXXVIII. 
Having thus pointed out a diftin&ion 
between Dyfpepfla and Hypocondriafis, I 
(hall- now, ufing thefe terms in the ftridt 
fenfe above mentioned, make fome obfcr- 
vations which may, I think, illuftrate the 
fubjefl, and more clearly and fully efta* 
blilh the diflindlion propofed. 
MCCXXXX, OF PHYSIC. 
255 
MCCXXIX. 
The dyfpepfia often appears early in 
life, and is frequently much mended as 
life advances ; but the hypochondriacs fel- 
dom appears early in life, and more ufu- 
ally in more advanced years only ; and 
more certainly Hill, when it has once ta- 
ken place, it goes on increaling as life ad- 
vances to old age. 
This feems to be particularly well illu- 
strated, by our obferving the changes in 
the date of the mind which ufually take 
place in the courfe of life. In youth, the 
blind is cheerful, adlive, rafli, and move- 
able ; but as life advances, the mind by 
degrees becomes more ferious, flow, cau- 
tious, and fteady; till at length, in old age, 
the gloomy, timid, didrudful, and obdi- 
nate date of melancholic temperaments is 
more exquifitely formed. In producing 
thefe changes, it is true, that moral caufcs 
R 4 
have 256 
PRACTICE 
have a (hare; but it is at the fame time 
obvious, that the temperament of the body 
determines the operation of thefe moral 
caufes, fooner or later, and in a greater or 
leffer degree, to have their effects. The 
fanguine temperament retains longer the 
character of youth, while the melancholic 
temperament brings on more early the 
manners of old age. 
MCCXXX. 
Upon, the whole, it appears, that the 
fkate of the mind which attends, and efpe- 
daily diftinguifhes hypochondriafis, is the 
effect of that fame rigidity of the folids, 
torpor of the nervous power, and peculiar 
balance between the arterial and venous 
fyftems which occur in advanced life, and 
which at all times take place more or lefs 
in melancholic temperaments. If there- 
fore there be alfo fomewhat of a like date 
of O F PH YSIC. 
257 
pf mind attending that dyfpepfia which 
occurs early in life in fanguine tempe- 
raments and lax habits, it mult depend 
upon a different {fate of the body, and pro- 
bably upon a weak and moveable ftate of 
the nervous power. 
MCCXXXI. 
Agreeable to all this, in dyfpepfia, there 
is more of fpafmodic affedtion, and the 
affection of the mind (MCCXXI1.) is often 
abfent, and, when prefent, is perhaps al- 
ways of a {lighter kind : while, in hypo- 
chondriacs, the affection of the mind is 
is more conftant, and the fymptoms of 
dyfpepfia, or the affections of the ftomach, 
are often abfent, or, when prefent, are in a 
{lighter degree. 
I believe the affection of the mind is 
commonly different in the two difeafes. In 
dyfpepfia, it is often languor and timidity 
only, 258 
PRACTICE 
only, eafily difpelled ; while in hypochon- 
driacs, it is generally the gloomy and ri- 
vetted apprehenfion of evil. 
The two difeafes are alfo diftinguifhed 
by fome other circumftances. Dyfpepfia, 
as I have faid, is often a fymptomatic af- 
fection ; while hypochondriacs is, perhaps, 
always a primary and idiopathic difeafe. 
As debility may be induced by many 
different caufes, dyfpepCa is a frequent 
difeafe; while hypochondriaCs, depending 
upon a peculiar temperament, is more 
rare. 
MCCXXXII. 
Having thus endeavoured to diflinguifh 
the two difeafes, I fuppofe the peculiar na- 
ture and proximate caufe of hypochondriajis 
will be underftood ; and I proceed there- 
fore to treat of its cure. 
So far as the affections of the body, and 
parti- OF PHYSIC 
259 
particularly of the ftomach, are the fame 
here as in the cafe of dyfpepjia, the method 
of cure might be fuppofed to be alfo the 
fame; and accordingly the practice has been 
carried on with little diftindion: but I am 
perfuaded that a diftindion is often necef- 
fary. 
MCCXXXIII. 
There may be a foundation here for the 
fame prefervative indication as firft laid 
down in the cure of dyfyepfia (MCCII.); 
but I cannot treat this fubjedl fo clearly or 
fully as I could wifh, becaufe I have not 
yet had fo much opportunity of obferva- 
tion as I think neceflary to afcertain the 
remote caufes; and I can hardly make ufe 
of the obfervations of others, who have fel- 
dom or never diftinguifhed between the two 
difeafes. What, indeed, has been faid with 
refpeft to the remote caufes of melancholia, 
will 260 
PRACTICE 
will often apply to fahypochondriajis, which 
I now treat of; but the fubjed of the for- 
mer has been fo much involved in a doubt- 
ful theory, that I find it difficult to feled 
the fads that might properly and ftridly 
apply to the latter. I delay this fubjed, 
therefore, till another occafion; but in the 
mean time trufl, that what I have faid re- 
garding the nature of the difeafe, and fome 
remarks I fliall have occafion to offer in 
confidering the method of cure, may in 
fome meafure fupply my deficiency on 
this fubjed of the remote caufes. 
MCCXXXIV. 
The fecand indication laid down in ths 
cure of dyfpepfia (MCCI.) has properly 
a place here ; but it is ftill to be executed 
with fome diftindion. 
MCCXXXV. OF PHYSIC. 
261 
MCCXXXV. 
An anorexia, and accumulation of cru- 
dities in the ftomach, does not fo com- 
monly occur in hypochondriafis as in dyfl- 
pepfia ; and therefore vomiting (MCCIV.) 
is not fo often neceflary in the former as 
in the latten 
MCCXXXVI. 
The fymptom of excefs of acidity, from 
the flow evacuation of the ftomach in me- 
lancholic temperaments, often arifes to 
very high degree in hypochondriafis; and 
therefore, for the fame reafon as in MCCV. 
it is to be obviated and corretfted with the 
Utmoft care. It is upon this account that 
the feveral antacids, and the other means 
of obviating acidity, are to be employed in 
hypochondriafis, and with the fame atten- 
tions and confiderations as in MCCVI. 
and 262 
PRACTICE 
and following ; with this reflexion, how- 
ever, that the exciting the action of the 
ftomach there mentioned, is to be a little 
differently under flood, as llia.ll be hereafter 
explained. 
MCCXXXVII. 
As coftivenefs, and that commonly to a 
confiderable degree, is a very conftant at- 
tendant of hypochondriafis, fo it is equally 
hurtful as in dyfpepfia. It may be reme- 
died by the fame means in the former as 
in the latter, and they are to be employed 
with the fame reftriddions as in MCCX. 
MCCXXXVIII. 
It is efpecially with refpecl to the third 
indication laid down in the cure of dyf- 
pepfia (MCCI.) that there is a differ- 
ence of practice to be obferved in the cure 
of O F P H Y S I C. 
263 
of hypochondriacs; and that often one 
diredlly oppofite to that in the caie of dyf- 
pepfia, is to be followed. 
MCCXXXIX. 
In dyfpepHa, the chief remedies are the 
tonic medicines, which to me feem neither 
neceflary nor fafe in hypochondriacs; for 
in this there is not a lofs of tone, but a 
want of activity that is to be remedied. 
Chalybeate mineral waters have com- 
monly been employed in hypochondriaiis, 
and feemingly with fuccefs. But this is 
probably to be imputed to the amufement 
and exercife ufually accompanying the ufe 
of thefe waters, rather than to the tonic 
power of the fmall quantity of iron which 
they contain. Perhaps the elementary wa- 
ter, by favouring the excretions, may have 
a lhare in relieving the difeafe. 
MCCXL. 264 
PRACTICE 
MCCXL. 
Cold bathing is often highly ufeful to 
the dyfpeptic, and, as a general ftimulant* 
may fometimes feem ufeful to the hypo- 
chondriac ; but it is not commonly fo to 
the latter: while, on the other hand, warm 
bathing, hurtful to the dyfpeptic, is often 
extremely ufeful to the hypochondriac. 
MCCXLI. 
Another inftance of a contrary pra&ice 
neceifary in the two difeafes, and illuftra- 
ting their refpedive natures, is, that the 
drinking tea and coffee is always hurtful 
to the dyfpeptic, but is commonly extreme-4 
ly ufeful to the hypochondriac. 
MCCXLII, 
Exercife, as it ftrengthens the fyftem, 
and OF PHYSIC. 
265 
and thereby the ftomach, and more efpe- 
cially, as by increasing the perfpiration it 
excites the adlion of the ftomach, it proves 
one of the moft ufeful remedies in dyfpepfta; 
and further, as by increafing the perfpira- 
tion, it excites the activity of the ftomach, 
it likewife proves an ufeful remedy in the 
hypochondriacs. However, in the latter 
cafe, as I Shall explain prefently, it is ftill 
a more ufeful remedy by its operation upon 
the mind than by that upon the body. 
MCXLIII. 
It is now proper that we proceed to con- 
fider the moft important article of our 
practice in this difeafe, and which is, to 
confider the treatment of the mind, an af- 
fection of which fometimes attends dyf- 
peplia, but is always the chief circum- 
ftance in hypochondriacs. What I am to 
fuggeft here, will apply to both difeafe s; 
Vol. III. 
S 
but 266 
PRACTICE 
but it is the hypochondriacs that I am to 
keep mod condantly in view. 
MCCXLIV. 
The management of the mind, in hy- 
pochondriacs, is often nice and difficult. 
The firm perfuafion that generally prevails 
in fuch patients, does not allow their feel- 
ings to be treated as imaginary, nor their 
apprehenfion of danger to be confidered 
as groundlefs, though the phyfician may 
be perfuaded that it is the cafe in both 
refpefts. Such patients, therefore, are not 
to be treated either by raillery or by rea- 
foning. 
It is faid to be the manner of hypochon- 
driacs to change often their phyfician, and 
indeed they often do it confiftently: for a 
phyfician who does not admit the reality 
of the difeafe, cannot be fuppofed to take 
much pains to cure it, or to avert the dan- 
• ger OF PHYSIC. 
267 
ger of which he entertains no apprehen- 
lion. 
If in any cafe the pious fraud of a pla- 
cebo be allowable, it feems to be in treat- 
ing hypochondriacs; who, anxious for re- 
lief, are fond of medicines, and, though 
often difappointed, will ftill take every 
new drug that can be propofed to them. 
MCCXLV* 
As it is the nature of man to indulge 
every prefent emotion, fo the hypochon- 
driac cherilhes his fears, and, attentive to 
every feeling, finds in trifles light as air 
a ftrong confirmation of his apprehenfions. 
His cure therefore depends efpecially upon 
the interruption of his attention, or upon 
its being diverted to other objeds than his 
own feelings. 
MCCXLVI. 
S 2 268 
PRACTICE 
MCCXLVI. 
Whatever averfion to application of any 
kind may appear in hypochondriacs, there 
is nothing more pernicious to them than 
abfolute idlenefs, or a vacancy from all 
earneft purfuit. It is owing to wealth ad- 
mitting of indolence, and leading to the 
purfuit of tranfitory and unfatisfying 
amufements, or to that of exhaufting plea- 
fures only, that the prefent times exhibit 
to us fo many inftances of hypochon- 
drikcifm. 
The occupations of bufinefs fuitable to 
their circumftances and fituation in life, 
if neither attended with emotion, anxiety, 
nor fatigue, are always to be admitted, and 
perfifted in by hypochondriacs. But oc- 
cupations upon which a man's fortune de* 
pends, and which are always, therefore, 
objects of anxiety to melancholic men; 
and ntore particularly where fuch occu- 
pations OF PHYSIC. 
269 
pations are expofed to accidental interrup- 
tions, difappointments, and failures, it is 
from thefe that the hypochondriac is cer- 
tainly to be withdrawn. 
MCCXLVIL 
The hypochondriac who is not necef- 
farily, by circumftances or habits, engaged 
in bufinefs, is to be drawn from his atten- 
tion to his own feelings by fome amufe- 
ment. 
The various kinds of fport and hunt- 
ing, as purfued with fome ardor, and at- 
tended with exercife, if not too violent, are 
amongft the moft ufeful. 
All thofe amufements which are in the 
open air, joined with moderate exercife, 
and requiring fome dexterity, are generally 
of ufe. 
Within doors, company which engages 
attention, which is willingly yielded to, 
s 3 
und 270 
PRACTICE 
and is at the fame time of a cheerful 
kind, will be always found of great fer- 
vice. 
Play, in which fome ikill is required, 
and where the flake is not an object of 
much anxiety, if not too long protracted, 
may often be admitted. 
In dyfpeptics, however, gaming, liable 
to fudden and confiderable emotions, is 
dangerous; and the long continuance of it, 
with night-watching, is violently debilita- 
ting. But in melancholics, who commonly 
excel in ikill, and are lefs fufceptible of 
violent emotions, it is more admiifible, 
and is often the only amufement that can 
engage them. 
Muiic, to a nice ear, is a hazardous 
amufement, as long attention to it is very 
fatiguing. 
MCCXLVIIL 
t ■■ t ar ■ z- .. * » « OF PHYSIC. 
271 
MCCXLVIIL 
It frequently happens, that amufements 
of every kind are rejedled by hypochon- 
driacs ; and in that cafe, mechanical means 
of interrupting thought are the remedies 
to be fought for. 
Such is to be found in brifk exercife, 
which requires fome attention in the con- 
duct of it. 
Walking is feldom of this kind; though, 
as gratifying to the reftleffnefs of hypo- 
chondriacs, it has fometimes been found 
ufeful. 
The required interruption of thought is 
belt obtained by riding on horfeback, or 
in driving a carriage of any kind. 
The exercife of failing, except it be in 
an open boat, engaging fome attention, 
does very little fervice. 
Exercife in an eafy carriage, in the di- 
rection of which the traveller takes no 
S 4 
part,  PRACTICE 
272 
part, unlefs it be upon rough roads, or 
driven pretty quickly, and with long con- 
tinuance, is of little advantage. 
MCCXLIX. 
Whatever exercife may be employed, it 
will be moft effectual when employed in 
the purfuit of a journey ; firfl, becaufe it 
withdraws a perfon from many objects of 
uneafinefs and care which might prefent 
themfelves at home ; fecondly, as it enga- 
ges in more conftant exercife, and in a 
greater degree of it than is commonly 
taken in airings about home; and, laftly, 
as it is conftantly prefenting new objects 
which call forth a perfon's attention. 
MCCL. 
In our fyftem of Nofology we have, next 
to Hypochondriafis, placed the Chlorofis, 
be- OF PHYSIC. 
273 
becaufe I once thought it might be con- 
fidered as a genus, comprehending, befides 
the Chlorofis of Amenorrhoea, fome fpecies 
of Cachexy : but, as I cannot find this 
to be well founded, and cannot diftindlly 
point out any fuch difeafe, I now omit con- 
fidering Chlorofis as a genus here ; and, as 
a fymptom of Amenorrhoea, I have endea- 
voured before to explain it under that 
title. 
BOOK. BOOK III. 
O F 
SPASMODIC AFFECTIONS, 
without Fever. 
MCCLI. 
T JNDER this title I am to compre- 
hend all the difeafes which confift in 
motu abnormt; that is, in a preternatural 
Rate of the contra&ion and motion of the 
mufcular or moving fibres in any part of 
the body. 
MCCLII. OF PHYSIC. 
275 
MCCLII. 
It will hence appear, why, under this 
title, I have comprehended many more dif- 
eafes than Sauvages and Sagar have com- 
prehended under the title of Spafmi, or 
than Linnseus has done under the title of 
Motorii. But I expedl it will be obvious, 
that, upon this occafion, it would not be 
proper to confine our view to the affections 
of voluntary motion only ; and if thofe 
Nofologifts have introduced into the clafs 
of Spafmi, Palpitatio and Hyfteria, it will 
be, with equal propriety, that Afthma, 
Colica, and many other difeafes, are ad- 
mitted. 
MCCLIII. 
It has been hitherto the method of our 
Nofologifts to divide the Spafmi into the 
two orders of Tonici and Clonici, Spaftici 
and 276 
PRACTICE 
and Agitatorii; or, as many at prefent ufe 
the terms, into Spafms ftriCtly fo called, 
and Convulfions. I find, however, that 
many, and indeed moft of the difeafes to 
be confidered under our title of Spafmodic 
Affections, in refpeCt of Tonic or Clonic 
contraCiions, are of a mixed kind : and, 
therefore, I cannot follow the ufual gene- 
ral divifion; but have attempted another, 
by arranging the feveral Spafmodic Dif- 
eafes according as they affeCt the feveral 
functions, Animal, Vital, or Natural. 
SECT. OF PHYSIC* 
277 
SECT. I. 
Of the Spasmodic Affection s of the 
Animal Functions* 
MCCLIV. 
Agreeable to the language of the an- 
cients, the whole of the difeafes to be 
treated of in this fedion might be termed 
Spafmi; and many of the moderns continue 
to apply the term in the fame manner: 
but I think it convenient to diftinguifh. 
the terms of Spafin and Convul/ion* by ap- 
plying the former, ftridly to what has 
been called the Tonicy and the latter, to 
what 278 
PRACTICE 
what has been called the Clonic Spafm 
There is certainly a foundation for the ufe 
of thofe different terms, as there is a re- 
markable difference in the ftate of the con- 
traction of moving fibres upon different 
occafions. This I have indeed pointed out 
before in my treatife of Phyfiology, but 
muft alfo repeat it here. 
MCCLV. 
In the exercife of the feveral functions 
of the animal oeconomy, the contractions 
of the moving fibres are excited by the 
will, or by certain other caufes fpecially 
appointed by nature for exciting thofe 
contractions; and thefe other caufes I name 
the natural caufes. In a ftate of health the 
moving fibres are contracted by the power 
of the will, and by the natural caufes only. 
At the fame time the contractions pro- 
duced are in force and velocity regulated 
bv 
4 OF PHYSIC. 
279 
by the will, or by the circumftances of the 
natural caufes; and the contraCiions, whe- 
ther produced by the one or the other, are 
always foon fucceeded by a ftate of re- 
laxation, and are not repeated but when 
the power of the will or of the natural 
caufes is again applied. 
MCCLVI. 
Such are the conditions of the action of 
the moving fibres in a ftate of health; but 
in a morbid ftate, the contractions of the 
mufcles and moving fibres ordinarily de- 
pending upon the will are excited without 
the concurrence of the will, or contrary 
to what the will intends ; and in the other 
functions they are excited by the adion of 
unufual and unnatural caufes. In both 
cafes, the contractions produced may be 
in two different ftates. The one is, -when 
the contraCiions are to a more violent de- 
gree 280 
PRACTICE 
gree than is ufual in health, and are nei- 
ther fucceeded by a fpontaneous relaxation, 
nor even readily yield to an extenfion ei- 
ther from the action of antagonift mufcles, 
or from other extending powers applied. 
This ftate of contractions is what has been 
called a Tonic Spafm, and is what I fhall 
name limply and ftriCtly a Spafm. The 
other morbid ftate of contraCiions is, when 
they are fucceeded by a relaxation, but 
are immediately again repeated without 
the concurrence of the will or of the repe- 
tition of natural caufes, and are at the fame 
time commonly with refpect to velocity 
and force more violent than in a healthy 
ftate. This ftate of morbid contraction is 
what has been named a Clonic Spafm, and 
and what I fhall name fimply and ftrictly 
a Convulfion. 
In this faction I fliall follow nearly the 
ufual divifion of the fpafmodic difeafes, 
into OF PHYSIC. 
281 
into thofe confiding in Spafm, and thofe 
confiding in Convulfion; but it may not 
perhaps be in my power to follow fuch 
divifion exactly. 
Vol. III. 
T 
CHAP. 282 
PRACTICE 
CHAP. L 
Of Tetanus. 
MCCLVII. 
BOTH Nofologifts and Practical Wri- 
ters have diftinguifhed Tetanic com- 
plaints into the feveral fpecies of Tetanus* 
Opifthotonos, and Emprofthotonos; and I 
have in my Nolblogy put the Trifmus, or 
Locked Jaw, as a genus diftindt from the 
Tetanus. All this, however, I now judge 
to be improper; and am of opinion, that 
all OF PHYSIC, 
283 
all the feveral terms mentioned, denote, 
and are applicable only to, different degrees 
of one and the fame difeafe; the hiftory 
and cure of which I fhall endeavour to de- 
liver in this chapter. 
MCCLVIIt. 
Tetanic complaints from certain 
caufes, occur in every climate that we are 
acquainted with; but they occur moft fre- 
quently in the warmeft climates, and moft 
commonly in the warmeft feafons of fuch 
climates. Thefe complaints affect all ages, 
fexes, temperaments, and complexions. 
The caufes from whence they commonly 
proceed, are cold and moifture applied to 
the body while it is very warm, and efpe- 
cially the fudden viciffitudes of heat and 
cold. Or, the difeafe is produced by 
punctures, lacerations, or other lefions of 
nerves in any part of the body. There 
T 2 
are, 284 
PRACTICE 
are, probably, fome other caufes of this 
difeafe; but they are neither diftin&ly 
known, nor well afcertained. Though 
the caufes mentioned do, upon occafion, 
affect all forts of perfons, they feem how- 
ever to attack perfons of middle age more 
frequently than the older or younger, the 
male fex more frequently than the female, 
and the robuft and vigorous more fre- 
quently than the weaker. 
MCCLIX. 
If the difeafe proceed from cold, it com- 
monly comes on in a few days after the 
application of fuch cold ; but, if it arife 
from a puncture or other lefion of a nerve, 
the difeafe does not commonly come on 
for many days after the lefion has hap- 
pened, very often when there is neither 
pain nor uneafinefs remaining in the 
wounded or hurt part, and very frequent- 
ly OF PHYSIC. 
285 
ly when the wound has been entirely 
healed up. 
MCCLX. 
The difeafe fometimes comes on fud- 
denly to a violent degree, but more gene- 
rally it approaches by flow degrees to its 
violent ftate. In this cafe it comes on with 
a fenfe of ftiffiiefs in the back-part of the 
neck, which, gradually increafing, renders 
the motion of the head difficult and pain- 
ful. As the rigidity of the neck comes on 
and increafes, there is commonly at the 
fame time a fenfe of uneafinefs felt about 
the root of the tongue; which, by degrees, 
becomes a difficulty of fwallowing, and at 
length an entire interruption of it. While 
the rigidity of the neck goes on increafing, 
there arifes a pain, often violent, at the 
lower end of the fternum, and from thence 
{hooting into the back. When this pain 
T 3 
arifesj 286 
PRACTICE 
arifes, all the mufcles of the neck, and par- 
ticularly thofe of the back-part of it, are 
immediately affedted with fpafm, pulling 
the head ftrongly backwards. At the 
fame time, the mufcles that pull up the 
lower jaw, which upon the firft approaches 
of the difeafe were affected with fome 
fpaftic rigidity, are now generally affected 
with more violent fpafm, and fet the teeth 
fo clofely together that they do not admit 
of the finalleft opening. 
This is what has been named the Locked 
and is often the principal part of the 
difeafe. When the difeafe has advanced 
thus far, the pain at the bottom of the 
ilernum returns very frequently, and with 
it the fpafms of the hind-neck and lower- 
jaw, are renewed with violence and much 
pain. As the difeafe thus proceeds, a 
greater number of mufcles come to be af- 
fected with fpafms. After thofe of the 
neck, thofe along the whole of the fpine 
be- OF PHYSIC. 
287 
become affeded, bending the trunk of the 
body ftrongly backwards ; and this is 
what has been named the Opifthotonos. 
In the lower extremities, both the flexor 
and extenfor mufcles are commonly at the 
fame time afteded, and keep the limbs ri- 
gidly extended. Though the extenfors of 
the head and back are ufually the moft 
ftrongly afteded, yet the flexors, or thofe 
mufcles of the neck that pull the head for- 
ward, and the mufcles that fhould pull 
down the lower jaw, are often at the fame 
time ftrongly affected with fpafm. During 
the whole of the difeafe, the abdominal 
mufcles are violently affected with fpafm, 
fo that the belly is ftrongly retraded, and 
feels hard as a piece of board. 
At length the flexors of the head and 
trunk become fo ftrongly afteded as ro 
balance the extenfors, and to keep the 
head and trunk ftraight, and rigidly ex- 
tended, incapable of being moved in any 
T 4 
way; 288 
PRACTICE 
way; and it is to this Rate the term of Tlf- 
tanus has been ftridtly applied. At the fame 
time, the arms, little affecfted before, are 
now rigidly extended; the whole of the 
mufcles belonging to them being affected 
with fpafins, except thofe that move the 
fingers, which often to the laft retain fome 
mobility. The tongue alfo long retains its 
mobility; but at length it alfo becomes 
affecfted with fpafms, which attacking cer- 
tain of its mufcles only, often thruft it 
violently out between the teeth. 
At the height of the difeafe, every organ 
of voluntary motion feems to be affecfted ; 
and amongft the reft, the mufcles of the 
face. The forehead is drawn up into fur- 
rows ; the eyes, fometimes diftorted, are 
commonly rigid, and immoveable in their 
fockcts ; the nofe is drawn up, and the 
cheeks are drawn backwards towards the 
ears, fo that the whole countenance ex- 
preffes the moft violent grinning. Under 
thefe OF PHYSIC. 
289 
thefe univerfal fpafms, a violent convulfion 
commonly comes on, and puts an end to 
life. 
MCCLXI. 
Thefe fpafms are every where attended 
with moft violent pains. The utmoft vio- 
lence of fpafm is, however, not conflant; 
but, after fubfifting for a minute or two, 
the mufcles admit of fome remiffion of 
their contraction, although of no fuch re- 
laxation as can allow the action of their 
antagonifls. This remiffion of contraction 
gives alfo fome remiffion of pain ; but 
neither are of long duration. From time 
to time, the violent contractions and pains 
are renewed fometimes every ten or fifteen 
minutes, and that often without any evi- 
dent exciting caufe. But fuch exciting 
caufes frequently occur ; for almoft every 
attempt to motion, as attempting a change 
of 290 
PRACTICE 
of pofture, endeavouring to fwallow, and 
even to fpeak, fometimes gives occafion to 
a renewal of the fpafms over the whole 
body. 
MCCLX1I. 
The attacks of this difeafe are feldom 
attended with any fever. When the fpafms 
are general and violent, the pulfe is con- 
tracted, hurried, and irregular; and the 
refpiration is affected in like manner: but, 
during the remiflion, both the pulfe and 
refpiration ufually return to their natural 
ftate. The heat of the body is commonly 
not increafed ; frequently the face is pale, 
with a cold fweat upon it; and very often 
the extremities are cold, with a cold fweat 
over the whole body. When, however, 
the fpafms are frequent and violent, the 
pulfe is fometimes more full and frequent 
than natural; the face is flulhed, and a 
warm OF PHYSIC. 
291 
warm fweat is forced out over the whole 
body. 
MCCLXIII. 
Although fever be not a conftant atten- 
dant of this difeafe, efpecially when ariling 
from a lefion of nerves; yet, in thofe cafes 
proceeding from cold, a fever fometimes 
has fupervened, and is faid to have been 
attended with inflammatory fymptoms. 
Blood has been often drawn in this difeafe, 
but it never exhibits any inflammatory 
cruft; and all accounts feem to agree, that 
the blood drawn feems to be of a loofer 
texture than ordinary, and that it does not 
coagulate in the ufual manner. 
MCCLX1V. 
In this difeafe the head is feldom af- 
fected with delirium, or even confufion of 
thought, 292 
PRACTICE 
thought, till the laft ftage of it; when, by 
the repeated fhocks of a violent diftemper, 
every fundion of the fyftem is greatly dis- 
ordered. 
MCCLXV. 
It is no lefs extraordinary, that, in this 
violent difeafe, the natural fundlions are 
not either immediately or confiderably af- 
fected. Vomitings fometimes appear early 
in the difeafe, but commonly they are not 
continued ; and it is ufual enough for the 
appetite of hunger to remain through the 
whole courfe of the difeafe ; and what 
food happens to be taken down, feems to 
be regularly enough digefted. The excre- 
tions are fometimes affeded, but not al- 
ways. The urine is fometimes fupprelfed, 
or is voided with difficulty and pain. The 
belly is coftive: but, as we have hardly any 
accounts excepting of thofe cafes in which 
opiates OF PHYSIC. 
293 
opiates have been largely employed, it is 
uncertain whether the coftivenefs has been 
the effect of the opiates or of the difeafe. 
In feveral inftances of this difeafe, a mi- 
liary eruption has appeared upon the fkin; 
but whether this be a fymptom of the 
difeafe, or the effect of a certain treatment 
of it, is undetermined. In the mean while, 
it has not been obferved to denote either 
fafety or danger, or to have any effect in 
changing the courfe of the diftemper. 
MCCLXVI. 
This difeafe has generally proved fatal; 
and this indeed may be juftly fuppofed to 
be the confequence of its nature : but, as 
we know that, till very lately, phyficians 
were not well acquainted with a proper 
method of cure; and that, iinceamore pro- 
per method has been known and pra&ifed, 
many have recovered from this difeafe; it 
may 294 
PRACTICE 
may be therefore concluded, that the fatal 
tendency of it is not fo unavoidable as has 
been imagined. 
In j udging of the tendency of this dif- 
eafe, in particular cafes, we may remark, 
that, when arifing from lefions of the 
nerves, it is commonly more violent, and 
of more difficult cure, than when proceed- 
ing from cold ; that the difeafe which 
comes on fuddenly, and advances quickly 
to a violent degree, is always more dan- 
gerous than that which is flower in its 
progrefs. Accordingly, the difeafe often 
proves fatal before the fourth day ; and, 
when a patient has pafled this period, he 
may be fuppofed to be in greater fafety, 
and in general the difeafe is the fafer the 
longer it has continued. It is, however, 
to be particularly obferved, that, even for 
many days after the fourth, the difeafe 
continues to be dangerous; and, even after 
fome confiderable abatement of its force, 
it OF PHYSIC. 
295 
it is ready to recur again with its former 
violence and danger. It never admits of 
any fudden, or what may be called a cri- 
tical folution, but always recedes by de- 
grees only, and it is often very long be- 
fore the whole of the fymptoms difap- 
pear. 
MCCLXVII. 
From the hiflory of the difeafe now de- 
fcribed, it will be evident, that there is no 
room for diftinguifhing the tetanus, opiftho- 
tonos, and trifmus or locked jaw, as different 
fpecies of this difeafe, fince they all arife 
fir n the fame caufes, and are almoft con- 
ftantly conjoined in the fame perfon. I 
have no doubt that the emprojlbotonos be- 
longs alfo to the fame genus ; and as the 
ancients have frequently mentioned it, we 
can have no doubt of its having occurred: 
but, at the fame time, it is certainly in 
thefe 296 
PRACTICE 
thefe days a rare occurrence; and, as I 
have never feen it, nor find any hiftories 
in which this particular ftate of the fpafms 
is faid to have prevailed, I cannot mention 
the other circumftances which particularly 
attend it, and may diftinguifh it from the 
other varieties of tetanic complaints. 
MCCLXVIII. 
This difeafe has put on ftill a different 
form from any of thofe above mentioned. 
The fpafms have been fometimes confined 
to one fide of the body only, and which 
bend it ftrongly to that fide. This is what 
has been named by Sauvages the Tetanus 
and by fome late writers the 
Pleurojlhotonos. This form of the difeafe 
has certainly appeared very feldom; and, 
in any of the accounts given of it, I can- 
not find any circumftances that would lead 
me to confider it as any other than a va- 
riety OF PHYSIC. 
297 
riety of the fpecies already mentioned, or 
to take further notice of it here. 
MCCLXIX. 
The pathology of this difeafe I cannot 
in any meafure attempt ; as the Rructure 
of moving fibres, the Rate of them under 
different degrees of contraction, and parti- 
cularly the Rate of the fenforium, as va- 
rioufly determining the motion of the ner- 
vous power, are all matters very imperfect- 
ly, or not at all, known to me. In fuch a 
fituation, therefore, the endeavouring to 
give any rules of practice, upon a fcientific 
plan, appears to me vain and fruitlefs; 
and towards directing the cure of this dif- 
eafe, we muR be fatisfied with having 
learned fomething ufeful from 
confirmed by experience. 
Vol. III. 
u 
MCCLXX. 298 
PRACTICE 
MCCLXX. 
When the difeafe is known to arife from 
the lefion of a nerve in any part of the 
body, the firft, and, as I judge, the moft 
important ftep to be taken towards the 
cure, is, by every poffible means to cut off 
that part from all communication with 
the fenforium, either by cutting through 
the nerves in their courfe, or perhaps by 
deftroying, to a certain length, their af- 
fected part or 
MCCLXXI. 
When the cure of the difeafe is to be 
attempted by medicine, experience has 
taught us that opium has often proved an 
effectual remedy; but that, to render it 
fuch, it muft be given in much larger 
quantities than have been employed in any 
other cafe; and in thefe larger quantities, 
it OF PHYSIC 
299 
it may, in this difeafe, be given more fafely 
than the body has been known to bear in 
any other condition. The practice has 
been, to give the opium either in a folid 
or a liquid form, not in any very large 
dofe at once, but in moderate doles, fre- 
quently repeated, at the interval of one, 
two, three, or more hours, as the violence 
of the fymptoms feems to require. Even 
when large quantities have been given in 
this way, it appears that the opium does 
not operate here in the fame manner as in 
molt other cafes; for, though it procure 
fome remiffion cf the fpafms and pains, it 
hardly induces any Heep, or occalions that 
ftupor, intoxication, or delirium, which it 
often does in other circumftances, when 
much fmaller quantities only have been 
given. It is therefore very properly ob- 
ferved, that, in tetanic affections, as the 
opium Ihows none of thofe effects by 
which it may endanger life, there is little 
U 2 
or 300 
PRACTICE 
or no reafon for being fparing in the ex- 
hibition of it; and it may be given, pro- 
bably Ihould be given, as largely and as 
faft as the fymptoms of the difeafe may 
iecm to demand. 
It is particularly to be obferved, that 
though the firft exhibitions of the opium 
may have produced fome remiflion of the 
fymptoms, yet the effects of opium do 
not long continue in the fyftem ; and this 
difeafe being for fome time ready to recur, 
it is commonly very neceffary, by the time 
that the effects of the opium given may be 
fuppofed to be wearing off, and efpecially 
upon the leaf! appearance of a return of 
the fpafms, to repeat the exhibition of the 
opium in the fame quantities as before. 
This praffice is to be continued while the 
difeafe continues to fhow any difpolition 
to return; and it is only after the difeafe 
has already fubfifted for fome time, and 
when conliderable and long-continued re- 
miflions OF PHYSIC. 
301 
millions have taken place, that the dofes 
of the opium may be diminished, and the 
intervals of exhibiting them be more con- 
siderable. 
MCCLXXIL 
The adminiftering of opium in this 
manner, has in many cafes been fuccefs- 
ful; and probably would have been equally 
fo in many others, if the opium had not 
been too fparingly employed, either from 
the timidity of practitioners, or from its 
exhibition being prevented by that inter- 
ruption of deglutition which fo often at- 
tends this difeafe. This latter circumftance 
directs, that the medicine ffiould be imme- 
diately and largely employed upon the 
firft approach of the difeafe, before the 
deglutition becomes difficult; or that, if 
this opportunity be loft, the medicine, in 
fufficient quantity, and with due frequency, 
u 3 
fliould  PRACTICE 
302 
fhould be thrown into the body by gly- 
fter; which, however, does not feem to 
have been hitherto often pradifed. 
MCCLXXIII. 
It is highly probable, that, in this dif- 
eafe, the inteftines are affected with the 
fpafm that prevails fb much in other parts 
of the fyftem ; and, therefore, that coftive- 
nefs occurs here as a fymptom of the dif- 
eafe. It is probably alfo increafed by the 
opium, which is here fo largely employed; 
and, from whichever of thefe caufes it 
arifes, it certainly muft be held to aggra- 
vate the difeafe, and that a relaxation of 
the inteftinal canal will contribute to a 
relaxation of the fpafms elfewhere. This 
confideration directs the frequent exhibi- 
tion of laxatives while the power of deglu- 
tition remains, or the frequent exhibition 
of glyfters when it does not; and the 
g?od OF PHYSIC. 
303 
good effects of both have been frequently 
obferved. 
MCCLXXIV. 
It has been with fome probability fup- 
pofed, that the operation of opium in this 
difeafe, may be much aififted by joining 
with it fome other of the moft powerful 
antifpafmodics. The moft promising are 
mulk and camphire ; and fome practitio- 
ners have been oTopinion, that the former 
has proved very ufeful in tetanic complaints. 
But, whether it be from its not having 
been employed of a genuine kind, or in 
fufiicient quantity, the great advantage and 
propriety of its ufe are not yet clearly as- 
certained. It appears to me probable, that 
analogous to what happens with refpecft to 
opium, both mulk and camphire might be 
employed in this difeafe, in much larger 
u 4 
quan- 304 
PRACTICE 
quantities than they commonly have been 
in other cafes. 
MCCLXXV. 
Warm bathing has been commonly em- 
ployed as a remedy in this difeafe, and of- 
ten with advantage ; but, fo far as 1 know, 
it has not alone proved a cure ; and, in 
fome cafes, whether it be from the motion 
of the body here required, exciting the 
fpafms, or from the fear of the bath, which 
fome perfons were feized with, I cannot 
determine; but it is allowed, that the warm 
bath hath in fome cafes done harm, and 
even occasioned death. Partial fomenta- 
tions have been much commended, and, I 
believe, upon good grounds : And 1 have 
no doubt but that fomentations of the feet 
and legs, as we now ufually apply them in 
fevers, might, without much ftirring of 
the OF PHYSIC. 
305 
the patient, be very afliduoufly employed 
with advantage. 
MCCLXXVI. 
Unctuous applications were very fre- 
quently employed in this difeafe by the 
ancients : and fome modern practitioners 
have confidered them as very ufeful. 
Their effects, however, have not appeared 
to be confiderable ; and, as a weak auxi- 
liary only, attended with fome inconveni- 
ence, they have been very much negleCted 
by the Britilh practitioners. 
MCCLXXVII. 
Bleeding has been formerly employed 
in this difeafe; but of late it has been 
found prejudicial, excepting in a few cafes, 
where, in plethoric habits, a fever has fu- 
pervened. In general, the ftate of mens 
bodies 306 
PRACTICE 
bodies in warm climates is unfavourable 
to bloodletting : and, if we may form 
indications from the ftate of the blood 
drawn out of the veins, the ftate of this 
in tetanic difeafes would forbid bleeding 
in them. 
MCCLXXVIII. 
Bliftering, alfo, has been formerly em- 
ployed in this difeafe ; but feveral prac- 
titioners aflert, that blifters are conftantly 
hurtful, and they are now generally 
omitted. 
MCCLXXIX. 
Thefe are the practices that hitherto 
have been generally employed; but of 
late we are informed by feveral Weft- 
India pradlitioners, that in many inftances 
they have employed mercury with great 
ad- OF PHYSIC. 
307 
advantage. We are told, that it muft be 
employed early in the difeafe; that it is 
moft conveniently adminiftered by unc- 
tion, and fliould be applied in that way 
in large quantities, fo that the body may 
be foon filled with it, and a falivation 
raifed, which is to be continued till the 
fymptoms yield. Whether this method 
I 
alone be generally fuflicient for the cure 
of the difeafe, or if it may be affifted by 
the ufe of opium, and require this in a 
certain meafure to be joined with it, I 
have not yet certainly learned, 
MCCLXXX. 
I have been further informed, that the 
Tetanus, in all its different degrees, has 
been cured by giving internally the Pifle- 
laeum Barbadenfe, or, as it is vulgarly- 
called, the Barbadoes Tar. I think it proper 
to take notice of this here, although 1 am 
not 308 
PRACTICE 
not exactly informed what quantities of 
this medicine are to be given, or in what 
circumftances of the difeafe it is moft pro- 
perly to be employed. 
MCCLXXX. 
In the former edition of this work, 
among the remedies of tetanus I did not 
mention the ufe of cold bathing; becaufe, 
though I had heard of this, I was not in- 
formed of fuch frequent employment of it 
as might confirm my opinion of its ge- 
neral efiicacv; nor was I fufliciently in- 
formed of the ordinary and proper admi- 
niftration of it. But now, from the in- 
formation of many judicious practitioners 
who have frequently employed it, I can 
fay, that it is a remedy which in nume- 
rous trials has been found to be of great 
fervice in this difeafe ; and that, while the 
ufe of the ambiguous remedy of warm bath- 
ing O F P H Y S I C. 
309 
ing is entirely laid afide,the ufe ofcold bath- 
ing is over the whole of theWeft Indies com- 
monly employed. The adminiflration of it 
is fometimes by bathing the perfon in the 
fea, or more frequently by throwing cold 
water from a bafon or bucket upon the 
patient's body, and over the whole of it: 
when this is done, the body is carefully 
wiped dry, wrapped in blankets, and laid 
a-bed, and at the fame time a large dofe 
of an opiate is given. By thefe means a 
confiderable remiffion of the fymptoms is 
obtained ; but this remiffion, at firft, does 
not commonly remain long, but returning 
again in a few hours, the repetition both 
of the bathing and the opiate becomes 
neceffary. By thefe repetitions, however, 
longer intervals of eafe are obtained, and 
at length the difeafe is entirely cured ; and 
this even happens fometimes very quickly. 
I have only to add, that it does not appear 
to me, from any accounts I have yet had, 
that 310 
Practice 
that the cold bathing has beenfo frequently 
employed, or has been found fo commonly 
fuccefsful in the cafes of tetanus in con- 
fequence of wounds, as in thofe from the 
application of cold. 
MCCLXXXI. 
Before concluding this chapter, it is 
proper for me to take Ibme notice of that 
peculiar cafe of the tetanus, or trifmus, 
which attacks certain infants foon after 
their birth, and has beeii properly enough 
named the Trifmus Nafcentium. From 
the fubjedts it affects, it feems to be a 
peculiar difeafe: for thefe are infants not 
above two weeks, and commonly before 
they are nine days, old ; infomuch that, 
in countries where the difeafe is frequent, 
if children pafs the period now mentioned, 
they are confidered as fecure againft its at* 
tacks. The fymptom of it chiefly taken 
no-" OF PHYSIC. 
311 
iiotice of, is the trifmus, or locked jaw, 
which is by the vulgar improperly named 
the Falling of the Jaw. But this is not the 
only fymptom, as, for the moft part, it has 
all the fame fymptoms as the Opifthoto- 
nos and Tetanus ftriclly fo called, and 
which occur in the other varieties of teta- 
nic complaints above defcribed. Like the 
other varieties of tetanus, this is moft fre- 
quent in warm climates; but is not, like 
thofe arifing from the application of cold, 
entirely confined to fuch warm climates, as 
inftances of it have occurred in moft of the 
northern countries of Europe. In thefe lat- 
ter it feems to be more frequent in certain 
diftridls than in others; but in what man- 
ner limited, I cannot determine. It feems 
to be more frequent in Switzerland thaii 
in France. I am informed of its fre- 
quently occurring in the Highlands of 
Scotland ; but I have never met with any 
inftance of it in the low country. The 
par- 312 
PRACTICE 
particular caufes of it are not well known; 
and various conjectures have been offered ; 
but none of them are fatisfying. It is a 
difeafe that has been almoft conftantly fa- 
tal ; and this, alfo, commonly in the courfe 
of a few days. The women are fo much 
perfuaded of its inevitable fatality, that 
they feldom or never call for the affift- 
ance of our art. This has occalioned our 
being little acquainted with the hiftory of 
the difeafe, or with the effects of remedies 
in it. Analogy, however, would lead us 
to employ the fame remedies that have 
proved ufeful in the other cafes of teta- 
nus ; and the few experiments that are 
yet recorded, feem to approve of fuch a 
practice. 
CHAP. OF PHYSIC. 
313 
CHAP. II. 
Of Epilepsy. 
MCCLXXXII. 
T N what fenfe I ufe the term Convuljion* 
I have explained above in MCCLVI. 
The convulfions that affect the human 
body are in feveral refpedls various ; but 
I am to confider here only the chief and 
moil frequent form in which they appear, 
and which is in the difeafe named 
This may be defined, as confifting in con- 
vulfions 
Vol. III. 
X 314 
PRACTICE 
vulfions of the greater part of the mufcles 
of voluntary motion, attended with a lofs 
of fenfe, and ending in a Rate of infenfibi- 
lity, and fceming deep. 
MCCLXXX1II. 
The general form or principal circum- 
ftances of this difeafe, are much the fame 
in all the different perfons whom it affedts. 
It comes by fits, which often attack perfons 
feemingly in perfect health; and, after lall- 
ing for fome time, pafs off, and leave the 
perfons again in their ufual date. Thefe fits 
are fometimes preceded by certain fymp- 
toms, which, to perfons who have before 
experienced fuch a fit, may give notice of 
its approach, as we lliall hereafter explain; 
but even thefe preludes do not commonly 
occur long before the formal attack, which 
in moft cafes comes on fuddenly without 
any fuch warning. 
The OF P H Y S J C. 
315 
The peiTon attacked lofes fuddenly all 
fenfe and power of motion; fo that, if 
Handing, he falls immediately, or per- 
haps, with convuhions, is thrown, to the 
ground. In that fituation he is agitated 
with violent convuhions, varioufly moving 
his limbs and the trunk of his body. 
Commonly the limbs on one fide of the 
body, are more violently or more confider- 
ably agitated than thofe upon the other. 
In all cafes the mufcles of the face and 
eyes are much affected, exhibiting various 
and violent diftortions of the countenance. 
The tongue is often affeded, and thruft 
out of the mouth; while the mufcles of the 
lower jaw are alfo affeded ; and, (hutting 
the mouth with violence while the tongue 
is thruft out between the teeth, that is of- 
ten grievoufly wounded. 
While thefe convulfions continue, there 
is commonly at the fame time a frothy 
moifture ifluing from the mouth. Thefe 
' X 2 
con- 316 
PRACTICE 
convulfions have for fome moments fome 
remiffionsj but are fuddenly again re- 
newed with great violence. Generally, 
after no long time, the convulfions ceafe 
altogether ; and the perfon for fome time 
remains without motion, but in a ftate 
of abfolute infenfibility, and under the 
appearance of a profound deep. After 
fome continuance of this feeming deep, 
the perfon fometimes fuddenly, but for 
the moft part by degrees only, recovers his 
fenfes and power of motion ; but with- 
out any memory of what had pafled from 
his being firfl feized with the fit. During 
the convulfions, the pulfe and refpiration 
are hurried and irregular; but, when the 
convulfions ceafe, they return to their 
ufual regularity and healthy ftate. 
This is the general form of the difeafc; 
and it varies only in different perfons, or 
on different occafions in the fame perfon, 
by the phenomena mentioned being more 
er OF PHYSIC. 
317 
or lefs violent, or by their being of longer 
or fhorter duration. 
MCCLXXXIV. 
With refpeff to the proximate caufe of 
this difeafe, I might fay, that it is an affec- 
tion of the energy of the brain, which, or- 
dinarily under the diredion of the will, is 
here, without any concurrence of it, im- 
pelled by preternatural caufes. But I could 
go no further: For, as to what is the me- 
chanical condition of the brain in the or- 
dinary exertions of the will, I have no di- 
ftindl: knowledge; and therefore muft be 
alfo ignorant of the preternatural date of 
the fame energy of the brain under the 
irregular motions here produced. To form, 
therefore, the indications of a cure, from a 
knowledge of the proximate caufe of this 
difeafe, I muft not attempt; but, from a 
diligent attention to the remote caufes 
x 3 
which 318 
PRACTICE 
which firft induce and occaiionally excite 
the difeafe, I think we may often obtain 
fome ufeful directions for its cure. It 
fhall therefore be my bulinefs now, to 
point out and enumerate thefe remote 
caufes as well as I can. 
MCCLXXXV. 
The remote caufes of epilepfy may be 
conficlered as occafional or predifponent. 
There are, indeed, certain remote caufes 
which act independently of any predifpo- 
fition ; but, as we cannot always diftin- 
guifh thefe from the others, I fliall confider 
the whole under the ufual titles of Occafio- 
jial or Predifponent. 
MCCLXXXVI. 
The occafional caufes may, I think, be 
properly referred to two general heads; 
the OF PH YS I C. 
319 
thejQy? being of thofe which feem to aft by 
directly {Emulating and exciting the ener- 
gy of the brain; and the of thofe 
which feem to aft by weakening, the fame. 
With refpedl to both, for the brevity of 
exprefling a faft, without meaning to ex- 
plain the manner in which it is brought 
about, I {hall ufe the terms of Excitement 
and Collapfe. And though it be true, that 
with relpeft to fome of the caufes I am to 
mention, it may be a little uncertain whe- 
ther they aft in the one way or the other, 
that does not render it improper for us to 
mark, with refpeft to others, the mode of 
their operating, wherever we can do it 
clearly, as the doing fo may often be of 
ufe in directing our practice. 
MCCLXXXVII. 
Firft, then, of the occafional caufes ac- 
ing by excitement: They are either fuch as 
X 4 
adl 320 
PRACTICE 
adl immediately and directly upon the 
brain itfelf; or thofe which are firft applied 
to the other parts of the body, and are 
from thence communicated to the brain. 
MCCLXXXVIIL 
The caufes of excitement immediately 
and dircdlly applied to the brain, may be 
referred to the four heads of, i. Mechani- 
cal Stimulants ; 2. Chemical Stimulants ; 
3.Mental Stimulants; and, 4. The peculiar 
Stimulus of Over-diftention. 
MCCLXXXIX. 
The mechanical ftimulants may be, 
I 
wounding inftruments penetrating the 
cranium, and entering the fubftance of the 
brain ; or fplinters of a fractured cranium, 
operating in the fame manner; or fharp- 
pointed offifications, either arifing from the 
internal OF PHYSIC. 
321 
internal furface of the cranium, or formed 
in the membranes of the brain. 
MCCXC. 
The chemical ftimulants (MCCLXXX- 
VIII.) may be fluids from various caufcs 
lodged in certain parts of the brain, and 
become acrid by ftagnation or otherwife. 
MCCXCI. 
The mental irritations ading by excite- 
ment, are, all violent emotions of the active 
kind, fuch as joy and anger. The fir ft of 
thefe is manifeftly an exciting power, act- 
ing ftrongly, and immediately, on the 
energy of the brain. The fecond is ma- 
nifeftly, alfo, a power ading in the fame 
manner. But it muft be remarked, that 
it is not in this manner alone anger pro- 
duces its effects: for it ads, alfo, ftrongly 
on 322 
PRACTICE 
on the fanguiferous fyftem, and may be a 
means of giving the flimulus of over- 
diftention ; as, under a fit of anger, the 
blood is impelled into the veffels of the 
head with violence, and in a larger quan- 
tity* 
MCCXCIL 
Under the head of Mental Irritations, is 
to be mentioned, the light of perfons in a 
fit of epilepfy, which has often produced a 
fit of the like kind in the fpeclator. It 
may, indeed, be a queftion, Whether this 
effect be imputable to the horror produced 
by a light of the feemingly painful agita- 
tions of the limbs, and of the diftortions 
in the countenance of the epileptic perfon; 
or if it may be afcribed to the force of 
imitation merely ? It is poffible, that hor- 
ror may fometimes produce the effecff: 
bjit certainly much may be imputed to 
that OF PHYSIC. 
323 
that propenfity to imitation, at all times fo 
powerful and prevalent in human nature; 
and fo often operating in other cafes of 
convulfive diforders, which do not prefent 
any fpedlacle of horror. 
MCCXCIII. 
Under the fame head of Mental Irrita- 
tion, I think proper to mention as an in- 
ftance of it, the Epilepfia Simulata, or the 
Feigned Epilepfy, fo often taken notice of. 
Although this, at firft, may be entirely 
feigned, 1 have no doubt but that the re- 
petition renders it at length real. The 
hiftory of Quietifm and of Exorcifms leads 
me to this opinion ; and which receives a 
confirmation from what we know of the 
power of imagination, in renewing epi- 
leptic and hyfteric fits. 
MCCXCIV, 324 
PRACTICE 
MCCXC1V. 
I come now to the fourth head of the 
irritations applied immediately to the brain, 
and which I apprehend to be that of the 
Over-diftention of the blood-veffels inthat 
organ. That fuch a caufe operates in pro- 
ducing epilepfy, is probable from this, that 
the diffeclion of perfons dead of epilepfy, 
has commonly difcovered the marks of a 
previous congeflion in the blood-veffels of 
the brain. This, perhaps, may be fuppo- 
fed the effect of the fit which proved fatal: 
but that the congeftion was previous thereto, 
is probable from the epilepfy being fo often 
joined with headach, mania, palfy, and 
apoplexy ; all of them difeafes depending 
upon a congeftion in the veffels of the 
brain. The general opinion receives al fo 
confirmation from this circumftance, that, 
in the brain of perfons dead of epilepfy, 
there have been often found tumours and 
cf- Of PHYSIC. 
325 
effufions, which, though feemingly not fuf- 
ficient to produce thofe difeafes which de- 
pend on the compreffion of a confiderable 
portion of the brain, may, however, have 
been fufficient to comprefs fo many veffels 
as to render the others upon any occafion 
of a more than ufual turgefcence, or im- 
pulfe of the blood into the veffels of the 
brain more liable to an over-diftention. 
MCCXCV. 
Thefe alone might afford 
foundation for a probable conjedure with 
refped to the effects of over-diftention. 
But the opinion does not reft upon conjec- 
ture alone. That it is alfo founded in fad, 
appears from hence, that a plethoric ftate 
is favourable to epilepfy; and that every 
occafional turgefcence, or unufual impulfe 
of the blood into the veffels of the brain, 
fuch as a fit of anger, the heat of the fun, 
or 326 
PRACTICE 
or of a warm chamber, violent 
a forfeit, or a fit of intoxication, are fre- 
quently the immediately exciting caufes 
of epileptic fits. 
MCCXCVL 
I venture to remark further, that a. piece 
of theory may be admitted as a confirma- 
tion of this doctrine. As I have formerly 
maintained, that a certain fulnefs and ten- 
fion of the veffels of the brain, is neceflary 
to the fupport of its ordinary and conftant 
energy, in the diftribution of the nervous 
power; fo it muft be fufliciently probable, 
that an over-diftention of thefe blood- 
veffels may be a caufe of violent excite- 
ment. 
MCCXCVII. 
We have now enumerated the feveral 
re- O F P H Y S I C 
327 
remote or occafional caufes of epilepfy, 
acting by excitement, and acting immedi- 
ately upon the brain itfelf. Of the caufes 
ading by excitement, but ading upon 
other parts of the body, and from thence 
communicated to the brain, they are all 
of them impreflions producing an exqui- 
site or high degree either of pleafure or 
pain. 
Impreflions which produce neither the 
one nor the other, have hardly any fuch 
effects ; unlefs when fuch impreflions are 
in a violent degree, and then their opera- 
tion may be considered as a mode of pain. 
It is, however, to be remarked, that all 
ftrong impreflions which are fudden and 
furpriflng, or, in other words, unforefeen 
and unexpected, have frequently the effed 
of bringing on epileptic fits. 
Mccxcvni. 328 
PRACTICE 
mccxcviii. 
There are certain impreffions made upon 
different parts of the body, which as they 
often operate without producing any fen- 
fation, fo it is uncertain to what head they 
belong : but it is probable that the greater 
part of them aft by excitement, and there- 
forefall tobe mentioned here. The chief in- 
Hances are, The teething of infants; worms; 
acidity or other acrimony in the alimen- 
tary canal; calculi in the kidneys; acrid 
matter in abfceffes or ulcers; or acrimony 
diffufed in the mafs of blood, as in the 
cafe of fome contagions. 
MCCXCIX. 
Phyficians have found no difficulty in 
comprehending how direct ftimulants, of 
a certain force, may excite the action of 
the brain, and occafion epilepfy; but they 
have OF PHYSIC. 
329 
have hitherto taken little notice of certain 
caufes which manifeftly weaken the energy 
of the brain, and aft, as 1 fpeak, by col- 
lapfe. Thefe, however, have the effeft of 
exciting the aftion of the brain in fuch a 
manner as to occaiion epilepfy* I might, 
upon this fubjeft, fpeak of the vis mcdica- 
trix natura; and there is a foundation for 
the term: but, as 1 do not admit the Stah- 
lian doftrine of an adminiftering foul, I 
make ufe of the term only as expreffing a 
faft, and would not employ it with the 
view of conveying any explanation of the 
manner in which the powers of collapfe 
mechanically produce their effefts. In the 
mean time, however, I maintain, that there 
are certain powers of collapfe, which in 
effeft prove ftimulants, and produce epi* 
lepfy. 
Vol. III. 
Y 
MCCC* 330 
PRACTICE 
MCCC. 
That there are fuch powers, which may 
be termed Indirect Stimulants, I conclude 
from hence, that feveral of the caufes of 
epilepfy are fuch as frequently produce 
fyncope, which we fuppofe always to de- 
pend upon caufes weakening the energy of 
the brain (MCLXXVI.) It may give fome 
difficulty to explain, why the fame caufes 
fometimes occafion fyncope, and fometimes 
occafion the readion that appears in epi- 
lepfy ; and I ffiall not attempt to explain 
it: but this, I think, does not prevent my 
fuppofing that the operation of thefe caufes 
is by collapfe. That there are fuch caufes 
producing epilepfy, will, I think, appear 
very clearly from the particular examples 
of them I am now to mention. 
MCCCL OF PHYSIC. 
331 
MCCCI. 
The firft to be mentioned, which I fup- 
pofe to be of this kind, is hemorrhagy, 
whether fpontaneous or artificial. That 
the fame hemorrhagy which produces fyn- 
cope, often at the fame time produces epi- 
lepfy, is well known; and from many ex- 
periments and obfervations it appears, that 
hemorrhagies occurring to fuch a degree 
as to prove mortal, feldom do fo without 
firft producing epilepfy. 
MCCCII. 
Another caufe acting, as I fuppofe, by 
collapfe, and thereforefometimes producing 
fyncope and fometimes epilepfy, is terror; 
that is, the fear of fome great evil fudden- 
ly prefented. As this produces at the fame 
time a fudden and confiderable emotion, 
Y 2 
(MCLXXX.), PRACTICE 
332 
(MCLXXX.), fo it more frequently pro- 
duces epilepfy than fyncope. 
MCCC1II. 
A third caufe acting by collapfe, and 
producing epilepfy, is horror; or a flrong 
a ver lion fuddenly raifed by a very difagree- 
able fenfation, and frequently arifing from 
a fympathy with the pain or danger of 
another perfon. As horror is often a caufe 
of fyncope, there can be no doubt of its 
manner of operating in producing epi- 
lepfy ; and it may perhaps be explained 
upon this general principle, That as defire 
excites adlion and gives activity, fo aver- 
fion reftrains from action, that is, weakens 
the energy of the brain ; and, therefore, 
that the higher degrees of averfion may 
have the effects of producing fyncope or 
epilepfy. 
MCCCIV. OF PHYSIC. 
333 
MCCCIV. 
A fourth fet of the caufes of epilepfy, 
which I fuppofe alfo to act by collapfe, 
are certain odours, which occafion either 
fyncope or epilepfy; and, with refpedl to 
the former, I have given my reafons 
(MCLXXXII.) for fuppofing odours in 
that cafe to act rather as difagreeable than 
as fedative. Thefe reafons will, 1 think, alfo 
apply here; and perhaps the whole affair 
of odours might be confidered as inftances 
of the effect of horror, and therefore be- 
longing to the laft head. 
MCCCV. 
A fifth head of the caufes producing epi- 
lepfy by collapfe, is the operation of many 
fubftances confidered, and for the moft part 
properly confidered, as poifons. Many of 
thefe, before they prove mortal, occafion 
Y 3 
epi- 334 
PRACTICE 
epilepfy. This efled:, indeed, may in fome 
cafes be referred to the inflammatory ope- 
ration which they fometimes difcover in 
the ftomach and other parts of the alimen- 
tary canal; but, as the greater part of the 
vegetable poifons ihow chiefly a narcotic, 
or ftrongly fedative power, it is probably 
by this power that they produce epilepfy, 
and therefore belong to this head of the 
caufes acting by collapfe. 
MCCCVI. 
Under the head-of the remote caufes 
producing epilepfy, we muft now mention 
that peculiar one whofe operation is ac- 
companied with what is called the Aura 
Epikptica. This is a fenfation of fome- 
thing moving in fome part of the limbs 
or trunk of the body, and from thence 
creeping upwards to the head ; and when 
it arrives there, the perfon is immediately 
de- OF PHYSIC. 
335 
deprived of fenfe, and falls into an epilep- 
tic fit. This motion is defcribed by the 
perfon's feeling it fometimes as a cold va- 
pour, fometimes as a fluid gliding, and 
fometimes as the fenfe of a fmall infect 
creeping along their body; and very often 
they can give no diftinct idea of their 
fenfation, otherwife than as in general of 
fomething moving along. This fenlation 
might be fuppofed to arife from fome af- 
fection of the extremity or other part of a 
nerve adted upon by fome irritating mat- 
ter ; and that the fenfation, therefore, fol- 
lowed the courfe of fuch a nerve: but I 
have never found it following diflindly 
the courfe of any nerve; and it generally 
feems to pafs along the teguments. It has 
been found in fome inflances to arife from 
fomething prefling upon or irritating a 
particular nerve, and that fometimes in 
confequence of contufion or wound : but 
inftances of thcfe are more rare; and the 
Y 4 
more 336 
PRACTICE 
more common confequence of contufions 
and wounds is a tetanus. This latter ef- 
fect wounds produce, without giving any 
fenfation of an aura, or other kind of mo- 
tion proceeding from the wounded part to 
the head; while, on the other hand, the 
aura producing epilepfy often arifes from 
a part which had never before been af- 
fedled with wound or contulion, and in 
which part the nature of the in itation can 
feldom be difcovered. 
It is natural to imagine that this aura 
epileptica is an evidence of fonle irritation 
or diredl ftimulus acting in the part, and 
from thence communicated to the brain, 
and fliould therefore have been mentioned 
among the caufes acting by excitement; 
but the remarkable difference that occurs 
in feemingly like caufes producing tetanus, 
gives fome doubt on this fubject. 
MCCCVIL OF PHYSIC. 
337 
MCCCVII. 
Having now enumerated the occafional 
caufes of epilepfy, I proceed to confider the 
predifponent. As fo many of the above- 
mentioned caufes adt upon certain perfons, 
and not at all upon others, there muft be 
fuppofed in thofe perfons a predifpofition 
to this difeafe: But in what this predif- 
pofitidn confifts, is not to be eafily ascer- 
tained. 
MCCCVIIL 
As many of the occafional caufes arc 
weak impreflions, and are applied to moft 
perfons with little or no effect, I con- 
clude, that the perfons affeded by thofe 
caufes are more eafily moved than others; 
and therefore that, in this cafe, a certain 
mobility gives the predifpofition. It will, 
perhaps, make this matter clearer, to Ihow, 
in 338 
PRACTICE 
in the firft place, that there is a greater 
mobility of conftitution in fome perfons 
than in others. 
MCCCIX. 
This mobility appears moft clearly in 
the ftate of the mind. If a perfon is rea- 
dily elated by hope, and as readily de- 
preffed by fear, and paifes eafily and 
quickly from the one Rate to the other ; 
if he is eafily pleafed, and prone to gaiety, 
and as eafily provoked to anger, and ren- 
dered peevifh; if liable, from flight im- 
preffions, to ftrong emotions, but tenacious 
of none; this is the boyifh temperament, 
qui colligit ac ponit iram et mutatur in 
boras; this is the varium et mutabile fee mi- 
na; and, both in the boy and woman, 
every one perceives and acknowledges a 
mobility of mind. But this is neceffarily 
connected with an analogous ftate of the 
brain; OF PHYSIC. 
339 
brain; that is, with a mobility, in refpedt 
of every impreffion, and therefore liable 
to a ready alternation of excitement and 
collapfe, and of both to a conliderable 
degree. 
MCCCX. 
There is, therefore, in certain perfons, a 
mobility of conftitution, generally derived 
from the ftate of original ftamina, and 
more exquifite at a certain period of life 
than at others; but fometimes arifing 
from, and particularly modified by, oc- 
currences in the courfe of life. 
MCCCXL 
This mobility confifts in a greater de- 
gree of either fenfibility or irritability. 
Thefe conditions, indeed, phyficians con- 
fider as fo neceflarily connected, that the 
con- 340 
PRACTICE 
conftitution, with refpecft to them, may be 
confidered as one and the fame: but I am 
of opinion that they are different; and that 
mobility may fometimes depend upon an 
increafe of the one, and fometimes on that 
of the other. If an acftion excited, is, by 
repetition, rendered more eafily excited, 
and more vigoroufly performed, I confi- 
der this as an increafe of irritability only. 
I go no farther on this fubjecft here, as it 
was only neceffary to take notice of the 
cafe juft now mentioned, for the purpofe 
of explaining why epilepfy, and convul- 
fions of all kinds, by being repeated, are 
more eafily excited, readily become habi- 
tual, and are therefore of more difficult 
cure. 
mcccxii. 
However we may apply the diftin&ion 
of fallibility and irritability, it appears 
that O F P H Y S I C. 
341 
that the mobility, which is the predifpo- 
nent caufe of epilepfy, depends more par- 
ticularly upon debility, or upon a plethoric 
ftate of the body. 
MCCCXIII. 
What lhare debility, perhaps by indu- 
cing fenfibility, has in this matter, appears 
clearly from hence, that children, wo- 
men, and other perfons of manifeft debi- 
lity, are the moil frequent fubjecfls of this 
difeafe. 
MCCCXIV. 
The effects of a plethoric ftate in difpo- 
ling to this difeafe appears from hence, 
that plethoric perfons are frequently the 
fubjedls of it: that it is commonly excited, 
as I have faid above, by the caufes of 
any unufual turgefcence of the blood; 
and 342 
PRACTICE 
and that it has been frequently cured by 
diminifhing the plethoric Rate of the 
body. 
That a plethoric ftate of the body fliould 
difpofe to this difeafe, we may underftand 
from feveral considerations. i/?, Becaufe 
a plethoric ftate implies, for the moft part, 
a laxity of the folids, and therefore fome 
debility in the moving fibres. idlyy Be- 
caufe, in a plethoric ftate, the tone of the 
moving fibres depends more upon their 
tenfion, than upon their inherent power: 
and as their tenfion depends upon the 
quantity and impetus of the fluids in the 
blood-veflels, which are very changeable, 
and by many caufes frequently changed, 
fo thefe frequent changes muft give a mo- 
bility to the fyftem. Becaufe a ple- 
thoric ftate is favourable to a congeftion of 
blood in the veflels of the brain, it muft 
render thefe more readily affected by every 
general turgefcence of the blood in the 
fyftem, O F P H Y S I C. 
. ■ 
343 
fyftem, and therefore more efpecially dif- 
pofe to this difeafe. 
MCCCXV. 
There is another circumftance of the 
body difpofing to epilepfy, which I can- 
not ib well account for; and that is, the 
Rate of fleep: but whether I can ac- 
count for it or not, it appears, in fad, that 
this Rate gives the difpoiition I fpeak of; 
for, in many perfons liable to this difeafe, 
the fits happen only in the time of fleep, or 
immediately upon the perfons coming out 
of it. In a cafe related by De Haen, it ap- 
peared clearly, that the difpoiition to epi- 
lepfy depended entirely upon the ftate of 
the body in fleep. 
MCCCXVL 
Having thus confidered the whole of the 
rc- 344 
PRACTICE 
remote caufes of epilepfy, I proceed to treat 
of its cure, as I have faid it is from the 
confideration of thofe remote caufes only, 
that we can obtain any directions for our 
praCtice in this difeafe. 
I begin with obferving, that as the dif- 
eafe may be confidered as fympathic or 
idiopathic, I muft treat of thefe feparately, 
and judge it proper to begin with the 
former. 
MCCCXVII. 
When this difeafe is truly fympathic, 
and depending upon a primary affeCtion 
in fome other part of the body, fuch as 
acidity or worms in the alimentary canal, 
teething, or other fimilar caufes, it is obvi- 
ous, that fuch primary affections muft be 
removed for the cure of the epilepfy; but 
it is not our bufinefs here to fay how thefe 
primary difeafes are to be treated. 
MCCCXVIII. OF PHYSIC. 
345 
MCCCXVIIL 
There is? however, a peculiar cafe of 
fympathic epilepfy ; that is, the cafe ac- 
companied with the aura epileptic a, as de- 
fcribed in MCCCVI. in which, though we 
can perceive by the aura epileptica arifing 
from a particular part* that there is fome 
affection in that part; yet, as in many fuch 
cafes we cannot perceive of what nature 
the afteClion is, I can only offer the fol- 
lowing general directions. 
iy?, When the part can with fafety be 
entirely deftroyed, we fhould endeavour to 
do fo by cutting it out, or by deftroying it 
by the application of an aCtual or poten- 
tial cautery. 
'idly, When the part cannot be properly 
deftroyed, that we fhould endeavour to 
correct the morbid affeClion in it by bu- 
ffering, or by eftabliihing an iffue upon 
the part. 
Vol. III. 
z 
3dly. 346 
PRACTICE 
ylly. When thefe meafures cannot be 
executed, or do not fucceed, if the difeafe 
feems to proceed from the extremity of a 
particular nerve which we can eafily come 
at in its courfe, it will be proper to cut 
through that nerve, as before propofed on 
the fubjecl of tetanus. 
s When it cannot be perceived that 
the aura arifes from any precife place or 
point, fo as to direcfl to the above men- 
tioned operations ; but, at the fame time, 
we can perceive its progrefs along the 
limb; it frequently happens that the epi- 
lepfy can be prevented by a ligature ap- 
plied upon the limb, above the part from 
which the aura arifes : and this is always 
proper to be done, both becaufe the pre- 
venting a fit breaks the habit of the dif- 
eafe, and becaufe the frequent comprefllon 
renders the nerves lefs fit to propagate the 
aura. 
MCCCXIX. OF PHYSIC. 
347 
MCCCX1X. 
The cure of idiopathic epilepfy, as I 
have faid above, is to be direfted by our 
knowledge of the remote caufes. There are 
therefore two general indications to be 
formed : The firft is, to avoid the occa- 
fional caufes; and the fecond is, to remove 
or correct: the predifponent. 
This method, however, is not always 
purely palliative; as in many cafes the pre- 
difponent may be confidered as the only 
proximate caufe, fo our fecond indication 
may be often confidered as properly cu- 
rative. 
MCCCXX. 
From the enumeration given above, it 
will be manifeft, that for the moft part 
the occafional caufes, fo far as they are in 
our power, need only to be known, in or- 
der 
Z 2 348 
PRACTICE 
der to be avoided ; and the means of doing 
this will be fufficicntly obvious. I (hall 
here, therefore, offer only a few remarks. 
MCCCXXI. 
One of the mod frequent of the occa- 
fional caufes is that of over-dift ention 
(MCCCX1V), which, fo far as it depends 
upon a plethoric flate of the fyftem, I iliall 
fay hereafter how it is to be avoided. But 
as, not only in the plethoric, but in every 
moveable conftitution, occafional turgef- 
cence is a frequent means of exciting epi- 
lepfy, the avoiding therefore of fuch tur- 
gefcence is what ought to be moft con- 
ftantly the object of attention to perfons 
liable to epilepfy. 
MCCCXXII. 
Another of the moft frequent exciting 
caufes OF PHYSIC. 
349 
caufes of this difeafe are, all ftrong im- 
preflions fuddenly made upon the fenfes; 
for as fuch impreflions, in moveable con- 
flitutions, break in upon the ufual force, 
velocity, and order of the motions of the 
nervous fyftem, they thereby readily pro- 
duce epilepfy. Such impreffions therefore, 
and efpecially thole which are fuited to 
excite any emotion or pallion of the mind, 
are to be moll carefully guarded againft by 
pcrfons liable to epilepfy. 
MCCCXXIII. 
In many cafes of epilepfy, where the 
predifponent caufe cannot be corrected or 
removed, the recurrence of the difeafe can 
only be prevented by the ftrideft atten- 
tion to avoid the occafional; and as the 
difeafe is often confirmed by repetition 
and habit, fo the avoiding the frequent re- 
currence 
Z3 350 
PRACTICE 
currence of it is of the utmoft importance 
towards its cure. 
Thefe are the few remarks I have to 
offer with refpedt to the occafional caufes ; 
and muft now obferve, that, for the moft 
part, the complete, or, as it is called, the 
Radical Cure, is only to be obtained by 
removing or correcting the predifponent 
caufe. 
MCCCXXIV. 
I have faid above, that the predifpo- 
nent caufe of epilepfy is a certain mobility 
of the fenforium; and that this depends 
upon a plethoric ftate of the fyftem, or 
upon a certain ftate of debility in it. 
MCCCXXV. 
How the plethoric ftate of the fyftem 
is to be corrected, I have treated of fully 
above 
I . ' . OF PHYSIC. 
351 
above in DCCLXXXIII. et feq. and I need 
not repeat it here. It will be enough to 
fay, that it is chiefly to be done by a pro- 
per management of exercife and diet 
and, with refpeft to the latter, it is parti- 
cularly to be obferved here, that an abfte- 
mious courfe has been frequently found 
to be the moft certain means of curing 
epilepfy. 
MCCCXXVI. 
Confidering the nature of the matter 
poured out by ilfues, thefe may be fup- 
pofed to be a conftant means of obvia- 
ting the plethoric ftate of the fyftem; and 
it is, perhaps, therefore, that they have 
been fo often found ufeful in epilepfy. 
Poflibly, alfo, as an open iflue may be a 
means of determining occafional turgef- 
cences to fuch places, and therefore of di- 
verting them in fome meafure from their 
Z4 
adlion PRACTICE 
352 
action upon the brain; fo alfo, in this 
manner, iffues may be ufeful in epilepfy. 
MCCCXXVII. 
It might be fuppofed that blood-letting 
would be the moft effectual means of cor- 
recting the plethoric ftate of the fyftem; 
and fuch it certainly proves when the 
plethoric ftate has become confiderable, 
and immediately threatens morbid effects. 
It is therefore, in fuch circumftances, pro- 
per and neceffary: but as we have faid 
above, that blood-letting is not the proper 
means of obviating a recurrence of the 
plethoric ftate, and, on the contrary, is 
often the means of favouring it; fo it is 
a remedy advifeable in every circumftance 
of epilepfy. There is, however, a cafe of 
epilepfy in which there is a periodical or 
occafional recurrence of the fulnefs and 
turgefcence of the fanguiferous fyftem, 
giving OF PHYSIC. 
353 
giving occalion to a recurrence of the dif- 
eafe. In fuch cafes, when the means of 
preventing plethora have been negledled, 
or may have proved ineffectual, it is abfo- 
lutely neceffary for the practitioner to 
watch the returns of thefe turgefcences, 
and to obviate their effects by the only 
certain means of doing it, that is, by a 
large blood-letting. 
MCCCXXVIIL 
The fecond caufe of mobility which we 
have affigned, is a ftate of debility. If this 
is owing, as it frequently is, to original 
conformation, it is perhaps not poffible to 
cure it; but when it has been brought on 
in the courfe of life, it poflibly may admit 
of being mended; and, in either cafe, much 
may be done to obviate and prevent its 
effeds. 
MCCCXXIX. 354 
PRACTICE 
MCCCXXIX. 
The means of correcting debility, fo far 
as it can be done, are, The perfon's being 
much in cool air; the frequent ufe of cold 
bathing; the ufe of exercife, adapted to the 
ftrength and habits of the perfon; and, per- 
haps, the ufe of aftringent and tonic medi- 
cines. 
Thefe remedies are fuited to ftrengthen 
the inherent power of the folids or moving 
fibres : but as the ftrength of thefe de- 
pends alfo upon their tenfion, fo when de- 
bility has proceeded from inanition, the 
ftrength may be reftored, by reftoring the 
fulnefs and tenfion of the veflels by a 
nourifliing diet ; and we have had in- 
ftances of the propriety and fuccefs of fuch 
a praCtice. 
MCCCXXXX, OF PHYSIC. 
355 
MCCCXXX. 
The means of obviating the effects of 
debility, and of the mobility depending 
upon it, are the ufe of tonic and antifpaf- 
modic remedies. 
I I 
The tonics are, Fear, or fome degree of 
terror ; aftringents; certain vegetable and 
metallic tonics; and cold bathing. 
MCCCXXXI. 
That fear, or fome degree of terror, may 
be of ufe in preventing epilepfy, we have 
a remarkable proof in Boerhaave's cure of 
the epilepfy, which happened in the Or- 
phan-houfe at Haerlem. See Kauu Boer- 
haave's treatife, entitled Impetum Facicns, 
§ 406. And we have met with feveral 
other inftances of the fame. 
As the operation of horror is in many 
refpeds analogous to that of terror, feve- 
ral 356 
PRACTICE 
ral feemingly fuperftitious remedies have 
been employed for the cure of epilepfy ; 
and, if they have ever been fuccefsful, I 
think it mull be imputed to the horror 
they had infpired. 
MCCCXXXIL 
Of the aflringent medicines ufed for the 
cure of epilepfy, the moft celebrated is the 
*uijcus quercinus, which, when given in large 
quantities, may poffibly be ufeful; but I 
believe it was more efpecially fo in ancient 
times, when it was an object of fuperfli- 
tion. In the few infiances in which I have 
feen it employed, it did not prove of any 
effect. 
MCCCXXXIII. 
Among the vegetable tonics, the bitters 
are to be reckoned ; and it is by this qua- 
lity OF PHYSIC. 
357 
lity that I fuppofe the orange-tree leaves 
to have been ufeful: but they are not al- 
ways fo. 
MCCCXXXIV, 
The vegetable tonic, which from its ufe 
in analogous cafes is the moft promifing, 
is the Peruvian bark; this, upon occafion, 
has been ufeful, but has alfo often failed. 
It is efpecially adapted to thofe epilepfies 
which at certain periods, and which 
are at the fame time without the recur- 
rence of any plethoric ftate, or turgefcence 
of the blood ; and in fuch periodical cafes, 
if the bark is employed fome time before 
the expected recurrence, it may be ufeful: 
but it muft be given in large quantity, 
and as near to the time of the expected re- 
turn as poflible. 
MCCCXXXV. 358 
PRACTICE 
MCCCXXXV. 
The metallic tonics Teem to be more 
powerful than the vegetable, and a great 
variety of the former have been em- 
ployed. 
Even arfenic has been employed in the 
cure of epilepfy ; and its ufe in intermit- 
tent fevers gives an analogy in its favour. 
Preparations of tin have been formerly 
recommended in the cure of epilepfy, and 
in the cure of the analogous difeafe of hy- 
fteria; and feveral conliderations render 
the virtues of tin, with refpedil: to thefe 
difeafes, probable: but I have had no ex- 
perience of its ufe in fuch cafes. 
A much fafer metallic tonic is to be 
found in the preparations of iron; and we 
have feen fome of them employed in the 
cure of epilepfy, but have never found 
them to be effectual. This, however, I 
think, may be imputed to their not having 
been OF PHYSIC. 
359 
been always employed in the circumftances 
of the difeafe, and in the quantities of the 
medicine, that were proper and neceflary. 
MCCCXXXVI. 
Of the metallic tonics, the moft cele- 
brated and the moft frequently employed 
is copper, under various preparation. What 
preparation of it may be the moft effectual, 
I dare not determine ; but of late the cu- 
prum ammoniacum has been frequently found 
fuccefsful. 
MCCCXXXVII. 
Lately the flowers of zinc have been 
recommended by a great authority as ufe- 
ful in all convulfive diforders; but in 
cafes of epilepfy, I have not hitherto found 
that medicine ufeful. 
MCCCXXXVIII. 360 
PRACTICE 
MCCCXXXVIIL 
There have been of late fome inftances 
of the cure of epilepfy by the accidental 
ufe of mercury ; and if the late accounts 
of the cure of tetanus by this remedy are 
confirmed, it will allow us to think that 
the fame may be adapted alfo to the cure 
of certain cafes of epilepfy. 
MCCCXXXIX. 
With refpedl to the employment of any 
of the above mentioned tonics in this dif- 
eafe, it muft be obferved, that in all cafes 
where the difeafe depends upon a conftant 
or occafional plethoric date of the fyftem, 
thefe remedies are likely to be ineffectual; 
and if fuflicient evacuations are not made 
at the fame time, thefe medicines are like- 
ly to be very hurtful. 
MCCCXL, O F P H Y S I C. 
361 
MCCCXL. 
The other fet of medicines which we 
have mentioned as fuited to obviate the 
effects of the too great mobility of the fyf- 
tem, are the medicines named antifyafmo- 
dies. Of thefe there is a long lift in the 
writers on the Materia Medica, and by 
thefe authors recommended for the cure of 
epilepfy. The greater part, however, of 
thofe taken from the vegetable kingdom, 
are manifeftly inert and infignificant. Even 
the root of the wild valerian hardly fup- 
ports its credit. 
MCCCXLI. 
Certain fub fiances taken from the animal 
kingdom feem to be much more powerful: 
and of thefe the chief, and feemingly the 
moil powerful, ismufk; which, employed 
Vol. III. 
A a 
in 362 
PRACTICE 
in its genuine ftate, and in due quantity, 
has often been an effectual remedy. 
It is probable alfo, that the oleum ani- 
male, as it has been named, when in its 
pureft ftate, and exhibited at a proper time, 
may be an effectual remedy. 
MCCCXLII. 
In many difeafes, the moft powerful 
antifpafmodic is certainly opium; but the 
propriety of its ufe in epilepfy has been 
difputed among phyficians. When the 
difeafe depends upon a plethoric ftate in 
which bleeding may be neceflary, the em- 
ployment of opium is likely to be very 
hurtful; but, when there is no plethoric or 
inflammatory ftate prefent, and the difeafe 
feems to depend upon irritation or upon 
increafed irritability, opium is likely to 
prove the moft certain remedy. Whatever 
effects in this and other convulfive difor* 
ders OF PHYSIC. 
363 
ders have been attributed to the hyofeya- 
mus, muft probably be attributed to its 
poiTefiing a narcotic power fimilar to that 
of opium. 
MCCCXLIII. 
With refpeft to the ufe of antifpafmo- 
dies, it is to be obferved, that they are al- 
ways moft ufeful, and perhaps only ufeful, 
when employed at a time when epileptic 
fits are frequently recurring, or near to the 
times of the acceflion of fits which recur 
after confiderable 
MCCCXLIV. 
On the fubjecl of the cure of epilepfy, 
I have only to add, that as the difeafe in 
many cafes is continued by the power of 
habit only, and that in all cafes habit has 
a great fhare in increafing mobility, and 
Aa 2 
there-* 364 
PRACTICE 
therefore in continuing this difeafe ; fo 
the breaking in upon fuch habit, and 
changing the whole habits of the fyftem, 
is likely to be a powerful remedy in epi- 
lepfy. Accordingly, a confiderable change 
of climate, diet, and other circumftances 
in the manner of life, has often proved a 
cure of this difeafe. 
MCCCXLV. 
After treating of epilepfy, 1 might here 
treat of particular convulfions, which are 
to be diftinguilhed from epilepfy by their 
being more partial; that is, affedling cer- 
tain parts of the body only, and by their 
not being attended with a lofs of fenfe, nor 
ending in fuch a comatofe Rate as epilepfy 
always does. 
MGGCXLVL OF PHYSIC. 
365 
MCCCXLVI. 
Of Rich convulfive affedions many dif- 
ferent inftances have been obferved and 
recorded by phyficians. But many of thefe 
have been manifeftly fympathic affections, 
to be cured only by curing the primary 
difeafe upon which they depend, and there- 
fore not to be treated of here: Or, tho' they 
are fuch as cannot be referred to another 
difeafe, as many of them however have not 
any fpecific character with which they oc- 
cur in different perfons, I muft therefore 
leave them to be treated upon the general 
principles I have laid down with re (peel to 
epilepfy, or Ihall lay down with rcfpccl to 
the following convulfive diforder; which, 
as having very conftantly in different per- 
fons a peculiar character, I think necefiary 
to treat of more particularly. 
A a 3 
CHAP. 366 
PRACTICE 
CHAP. III. 
Of the Chorea or Dance of St Vitus. 
MCCCXLVII. 
r HIS difeafe affects both fexes, and 
almoft only young perfons. It ge- 
nerally happens from the age of ten to that 
of fourteen years. It comes on always be- 
fore the age of puberty, and rarely conti- 
nues beyond that period. 
MCCCXLVIIL OF PHYSIC. 
367 
MCCCXLVIII. 
It is chiefly marked by convulfive mo- 
tions, fomewhat varied in different per- 
fons, but nearly of one kind in all; affect- 
ing the leg and arm on the fame fide, and 
generally on one fide only. 
MCCCXLIX. 
Thefe convulfive motions commonly 
firft affect the leg and foot. Though the 
limb be at reft, the foot is often agitated 
by convulfive motions, turning it alter- 
nately outwards and inwards. When walk- 
ing is attempted, the affetfted leg is feldom 
lifted as ufual in walking, but is dragged 
along as if the whole limb were paralytic; 
and, when it is attempted to be lifted, this 
motion is unfteadily performed, the limb 
becoming agitated by irregular convulfive 
paotions. 
A a 4 
MCCCL. 368 
PRACTICE 
MCCCL. 
The arm of the fame fide is generally 
affected at the fame time ; and, even when 
no voluntary motion is attempted, the arm 
is frequently agitated with various convul- 
five motions. But efpecially when volun- 
tary motions are attempted, thefe are not 
properly executed, but are varioufly hur- 
ried jor interrupted by convulfive motions 
in a direction contrary to that intended. 
The moft common inffance of this is in 
the perfon's attempting to carry a cup of 
liquor to his mouth, when it is only after 
repeated efforts, interrupted by frequent 
convulfive retractions and deviations, that 
the cup can be carried to the mouth. 
MCCCLI. 
It appears to me, that the will often 
yields to the'fe convulfive motions, as to a 
pro- OF PHYSIC. 
369 
propenfity, and thereby they are often in- 
creafed, while the perfon affected feems 
pleafed with increafing the furprife and 
amufement which his motions occafion in 
the by danders. 
MCCCLII. 
In this difeafe the mind is often affected 
with fome degree of fatuity; and often 
ihows the fame varied, defultory, and 
caufelefs emotions which occur in hyfte- 
ria. 
MCCCLIII. 
Thefe are the moft common circum- 
flances of this difeafe ; but at times, and 
in different perfons, it is varied by fome 
difference in the convulfive motions, par- 
ticularly by thefe affedling the head and 
trunk of the body. As in this difeafe 
there 370 
PRACTICE 
there feem to be propenfities to motion, fo 
various fits of leaping and running occur 
in the perfons affedded; and there have 
been inftances of this difeafe, coniifting of 
fuch convulfive motions, appearing as an 
epidemic in a certain corner of the country. 
In fuch inftances, perfons of different ages 
are affected, and may feem to make an ex- 
ception to the general rule above laid down; 
but ftill the perfons are, for the moft part, 
the young of both fexes, and of the more 
manifeftly moveable conftitutions. 
MCCCLIV. 
The method of curing this difeafe has 
been variously propofed. Dr Sydenham 
propofed to cure it by alternate bleeding 
and purging. In fome plethoric habits I 
have found fome bleeding ufeful; but in 
many cafes I have found repeated evacua- 
tions, efpecially by bleeding, very hurtful. 
In OF PHYSIC. 
371 
Ill many cafes, I have found the difeafe, 
in fpite of remedies of all kinds, continue 
for many months ; but I have alfo found 
it often readily yield to tonic remedies, 
fuch as the Peruvian bark, and chaly- 
beates. 
The late Dr De Haen found feveral per- 
fons labouring under this difeafe cured by 
the application of eledricity. 
SECT. 372 
PRACTICE 
SECT. II. 
Of the SPASMODIC AFFECTIONS 
of the VITAL FUNCTIONS. 
CHAP. IV * 
Of the Palpitation of the Heart. 
MCCCLV. 
THE motion thus named is a contrac- 
tion or fyftole of the heart, that is 
performed with more rapidity, and gene- 
rally 
* Though I have thought it proper to divide this 
into fe&ions, I think it neceflary, for the convenience of 
references, to number the chapters from the beginning. O F P H Y S I C. 
373 
rally alfo with more force, than ufual; 
and when at the fame time the heart 
(trikes with more than ufual violence 
againft the infide of the ribs, producing 
often a coniiderable found. 
MCCCLVI. 
This motion, or palpitation, is occa- 
sioned by a great variety of caufes, which 
have been recited with great pains by Mr 
Senac and others, whom, however, 1 can- 
not follow in all the particulars with fuf- 
ficient difcernment, and therefore Shall 
here only attempt to refer all the feveral 
cafes of this difeafe to a few general 
heads. 
MCCLVII. 
The firft is of thofe arifing from the 
application of the ufual ftimulus to the 
heart's 374 
PRACTICE 
heart's contraction ; that is, the influx of 
the venous blood into its cavities, being 
made with more velocity, and therefore, 
in the fame time, in greater quantity than 
ufual. It feems to be in this manner that 
violent exercife occafions palpitation. 
MCCCLVIIT. 
A fecond head of the cafes of palpita- 
tion, is of thofe arifing from any refift- 
ance given to the free and entire evacua- 
tion of the ventricles of the heart. Thus 
a ligature made upon the aorta occafions 
palpitations of the moft violent kind. Si- 
milar refiftances, either in the aorta or 
pulmonary artery, may be readily imagi- 
ned ; and fuch have been often found in 
the dead bodies of perfons who, during 
life, had been much affedled with palpi- 
tations. 
To this head are to be referred all thofe 
cafes OF PHYSIC. 
375 
cafes of palpitation arifing from caufes 
producing an accumulation of blood in 
the great veflels near to the heart. 
MCCCLIX. 
A third head of the cafes of palpitation, 
is of thofe arifing from a more violent and 
rapid influx of the nervous power into the 
mufcular fibres of the heart. It is in this 
manner that I fuppofe various caufes act- 
ing in the brain, and particularly certain 
emotions of the mind, occafion palpita- 
tion. 
MCCCLX. 
A fourth head of the cafes of palpita- 
tion, is of thofe arifing from caufes produ- 
cing a weaknefs in the adtion of the heart, 
by diminifhing the energy of the brain 
with refpeft to it. That fuch caufes ope- 
rate 376 
PRACTICE 
rate in producing palpitation, I prefume 
from hence, that all the feveral caufes 
mentioned above (MCLXXV1I. et feq.\ 
as in this manner producing fyncope, do 
often produce palpitation. It is on this 
ground that thefe two difeafes are affec- 
tions frequently occurring in the fame per- 
fon, as the fame caufes may occafion the 
one or the other, according to the force 
of the caufe and mobility of the perfon 
aded upon. It feeins to be a law of the 
human oeconomy, that a degree of debili- 
ty occurring in any function, often produ- 
ces a more vigorous exertion of the fame, 
or at leaft an effort towards it, and that 
commonly in a convulfive manner. 
I apprehend it to be the convulfive ac- 
tion, frequently ending in fome degree of 
a fpafm, that gives occafion to the inter- 
mittent pulfe fo frequently accompanying 
palpitation. 
MCCCLXI. OF PHYSIC. 
377 
MCCCLXI. 
A fifth head of the cafes of palpitation 
may perhaps be of thofe ariling from a pe- 
culiar irritability or mobility of the heart. 
This, indeed, may be confidered as a 
predifponent caufe only, giving occafion 
to the action of the greater part of the 
caufes recited above. But it is proper to 
obferve, that this predifpofition is often 
the chief part of the remote caufe; info- 
much that many of the caufes producing 
palpitation would not have this effect but 
in perfons peculiarly predifpofed. This 
head, therefore, of the cafes of palpitation, 
often requires to be diftinguifhed from all 
the reft. 
MCCCLXII* 
After thus marking the feveral cafes and 
caufes of palpitation,! think it neceifary,with 
Vol. III. 
3 
B b 378 
PRACTICE 
view to the cure of this difeafe, to obferve, 
that the feveral caufes of it may be again 
reduced to two heads. The firft is, of 
thofe confifting in, or depending upon, 
certain organic affections of the heart it- 
felf, or of the great veffels immediately 
connected with it. The fecond is of thofe 
confifting in, or depending upon, certain 
affetftions fubfifting and acting in other 
parts of the body, and acting either by 
the force of the caufe, or in confequence 
of the mobility of the heart. 
MCCCLXIII. 
With refpedl to the cafes depending up- 
on the fir ft fet of caufes, I muft repeat here 
what I faid with refpedl to the like cafes of 
fyncope, that I do not know any means 
of curing them. They, indeed, admit. of 
fome palliation, firfi-, by avoiding every 
circumftance that may hurry the circula- 
tion OF PHYSIC. 
379 
tion of the blood; and, by every 
means of avoiding a plethoric ftate of the 
fyftem, or any occafional turgefcence of the 
blood. In many of thefe cafes, blood- 
letting may give a temporary relief: but in 
fo far as debility and mobility are con- 
cerned, in fuch cafes this remedy is likely 
to do harm. 
MCCCLXIV. 
With refpeCt to the cafes depending upon 
the other fet of caufes, they may be va- 
rious, and require very different meafures: 
but I can here fay in general, that thefe 
cafes may be confidered as of two kinds; 
one depending upon primary affections in 
other parts of the body, and acting by the 
force of the particular caufes; and ano- 
ther depending upon a ftate of mobility 
in the heart itfelf. In the firft of thefe, it 
is obvious, that the cure of the palpita- 
tion. 
Bbs 380 
PRACTICE 
tion muft be obtained by curing the pri- 
mary affection ; which is not to be treated 
of here In the fecond, the cure muft be 
obtained, partly by diligently avoiding the 
occafional caufes, partly and chiefly by 
correcting the mobility of the fyftem, and 
of the heart in particular; for doing which 
we have treated of the proper means elfe- 
where. 
CHAP. OF PHYSIC. 
381 
CHAP. V. 
Of 
Dyspnoea, or Difficult Breathing. 
MCCCLXV. 
''HE exercife of refpiration, and the 
-*• organs of it, have fo conftant and 
confiderable a connection with almoft the 
whole of the other functions and parts of 
the human body, that upon almoft every 
occafion of difeafe, refpiration muft be af- 
feCted. Accordingly fome difficulty and 
Bb 3 
dif- 382 
PRACTICE 
diforder in this fundlion, are in fadt fymp- 
toms very generally accompanying dif- 
<afe. 
MCCCLXVI. 
Upon this account the fymptom of dif- 
ficult breathing deferves a chief place and 
an ample confideration in the general fyf- 
tem of Pathology; but what ffiare of con- 
fideration it ought to have in a treatife of 
Practice, I find it difficult to determine. 
MCCCLXVIL 
On this fubjedt, it is, in the firft place, 
neceffary to diftinguilh between the fymp- 
tomatic and idiopathic affedlions ; that is, 
between thofe difficulties of breathing which 
are fymptoms only of a more general af- 
fection, or of a difeafe fubfifting primarily 
in other parts than the organs of refpira- 
tion, O F P H Y S I C. 
383 
tion, and that difficulty of breathing which 
depends upon a primary affection of the 
lungs themfelves. The various cafes of 
fymptomatic dyfpnoea I have taken pains 
to enumerate in my Methodical Nofology, 
and it will be obvious they are fuch as 
cannot be taken notice of here. 
MCCCLXVII. 
In my Nofology I have alfo taken pains 
to point out and enumerate the proper, or 
at leaft the greater part of the proper, idio- 
pathic cafes of dyfpnoea ; but from that 
enumeration it will, I think, readily ap- 
pear, that few, and indeed hardly any, of 
thefe cafes will admit or require much of 
our notice in this place. 
MCCCLXIX 
The Dyfpnoea Sicca, fpecies id, the 
B b 4 
Dyfp- 384 
PRACTICE 
Dyfpnoea Aerea, Jp. the Dyfpnoea 
Jp. qih, and Dyfpnoea Thoracica, 
fp. -jth, are fome of them with difficulty 
known, and are all of them difeafes which 
in my opinion do not admit of cure. All, 
therefore, that can be faid concerning them 
here is, that they may admit of fome pal- 
liation ; and this, I think, is to be obtained 
chiefly by avoiding a plethoric ftate of the 
lungs, and every circumftance that may 
hurry reipiration. 
MCCCLXX. 
Of the Dyfpnoea Extrinfeca, Jp. 8th, I 
can fay no more, but that thefe external 
caufes marked in the Nofology, and per- 
haps fome others that might have like ef- 
fects, are to be carefully avoided; or, when 
they have been applied, and their effects 
have taken place, the difeafe is to be pal- 
liated OF PHYSIC 
385 
liated by the means mentioned in the laft 
paragraph. 
MCCCLXXI. 
The other fpecies, though enumerated 
as idiopathic, can hardly be confidered as 
fuch, or as requiring to be treated of 
here. 
The Dyfpncea Catarrhalis, fp. may 
be confidered as a fpecies of catarrh, and is 
pretty certainly to be cured by the fame 
remedies as that fpecies of catarrh which 
depends rather upon the increafed afflux of 
mucus to the bronchia?, than upon any in- 
flammatory ftate in them. 
The Dyfpncea Jp. is cer- 
tainly to be confidered as a fpecies of drop- 
fy, and is to be treated by the fame reme- 
dies as the other fpecies of that difeafe. 
The Dyfpncea fp. Gtb, 
is in like manner to be confidered as a 
fymp- 386 
PRACTICE 
fymptom or local effect of the Polyfarcia, 
and is only to be cured by correcting the 
general fault of the fyftem. 
MCCCLXXII. 
From this view of thofe idiopathic cafes 
of dyfpnoea, which are perhaps all I could 
properly arrange under this title, it will 
readily appear that there is little room for 
treating of them here: but there is (till 
one cafe of difficult breathing, which has 
been properly diftinguiffied from every 
other under the title of AJlhma; and as it 
deferves our particular attention, I ffiall 
here feparately confider it. 
CHAP. OF PHYSIC. 
387 
CHAP. VI. 
Of Asthma. 
MCCCLXXIII. 
r l',HE term of Afthma has been com- 
monly applied by the vulgar, and 
even by many writers on the Practice of 
Phyiic, to every cafe of difficult breathing, 
that is, to every fpecies of Dyfpnoea. The 
Methodical Nofologifts, alfo, have diftin- 
guiffied 388 
PRACTICE 
guiffied Afthma from Dyfpnoea chiefly, 
and almoft folely, by the former being the 
fame affedlion with the latter, but in a 
higher degree. Neither of thefe applica- 
tions of the term feems to have been cor- 
retft or proper. I am of opinion, that the 
term Afthma may be moft properly ap- 
plied, and fhould be confined, to a cafe of 
difficult breathing that has peculiar fymp- 
toms, and depends upon a peculiar proxi- 
mate caufe, which I hope to affign with 
fufficient certainty. It is this difeafe I am 
now to treat of, and it is nearly what 
Pradftical Writers have generally diftin- 
guiffied from the other cafes of difficult 
breathing, by the title of Spafmodic Afth- 
ma, or of AJlbma Convulftvum; although, by 
not diftinguifhing it with fufficient accu- 
racy from the other cafes of Dyfpnoea, they 
have introduced a great deal of confufion 
into their treatifes on this fubjedt. 
MCCCLXXIV. OF PHYSIC. 
389 
MCCCLXXIV. 
The difeafe I am to treat of, or the Afth- 
ma to be ftridily fo called, is often a he- 
reditary difeafe. It feldom appears very 
early in life, and hardly till the time of 
puberty, or after it. It affects both fexes, 
but moft frequently the male. I have not 
obferved it to be more frequent in one 
kind of temperament than in another; and 
it does not feem to depend upon any ge- 
neral temperament of the whole body, but 
upon a particular conftitution of the lungs 
alone. It frequently attacks perfons of a 
full habit; but it hardly ever continues to 
be repeated for fome length of time with- 
out occafioning an emaciation of the whole 
body. 
MCCCLXXV. 
The attacks of this difeafe are generally 
in 390 
PRACTICE 
in the night-time, or towards the approach 
of night; but there are alfofome inftances 
of their coining on in the courfe of the 
day. At whatever time they come on, it 
is for themoft part fuddenly, with a fenfeof 
tightnefs and ftridlure acrofs the bread, 
and a fenfe of ftraitnefs in the lungs im- 
peding infpiration. The perfon thus at- 
tacked, if in a horizontal fituation, is im- 
mediately obliged to get into fomewhat of 
an ered: pofture, and requires a free and 
cool air. The difficulty of breathing goes 
on for fome time increafing, and both in- 
fpiration and exfpiration are performed 
flowly, and with a wheezing noife. In 
violent fits, fpeaking is difficult and un- 
eafy. There is often fome propenfity to 
coughing, but it can hardly be executed. 
MCCCLXXVI. 
Thefe fymptoms often continue for 
many OF PHYSIC. 
391 
many hours together, and particularly 
from midnight till the morning is far ad- 
vanced. Then commonly a remifiion takes 
place by degrees ; the breathing becomes 
lefs laborious and more full, fo that the 
perfon can fpeak and cough with more 
eafe; and, if the cough brings up fome 
mucus, the remifiion becomes immediately 
more confiderable, and the perfon falls in- 
to a much wiihed-for deep. 
MCCCLXXVII. 
During thefe fits the pulfe often conti- 
nues in its natural ftate; but in fome per- 
fons the fits are attended with a frequency 
of pulfe, and with fome heat and thirft, as 
marks of fome degree of fever. If urine 
be voided at the beginning of a fit, it is 
commonly in confiderable quantity, and 
with little colour or odour ; but, after the 
fit is over, the urine voided is in the ordi- 
nary 392 
PRACTICE 
nary quantity, of a high colour, and fome-* 
times depofics a fediment. In fome per- 
fons, during the fit the face is a little flufli- 
ed and turgid; but more commonly it is 
fomewhat pale and flirunk. 
MCCCLXXVIII. 
After fome fleep in the morning, the 
patient, for the reft of the day, continues 
to have more free and eafy breathing, but 
it is feldorn entirely fuch. He ftill feels 
fome tightnefs acrofs his breaft, cannot 
breathe eafily in a horizontal pofture, and 
can hardly bear any motion of his body, 
without having his breathing rendered 
more difficult and uneafy. In the after- 
noon he has an unufual flatulency of his 
ftomach, and an unufual drowfinefs; and, 
very frequently, thefe fymptoms precede 
the firft attacks of the difeafe. But, whe- 
ther thefe fymptoms appear or not, the 
diffi- OF PHYSIC. 
393 
difficulty of breathing returns towards th£ 
evening; and thenfometimes gradually in- 
creafes, till it becomes as violent as in the 
night before : or if, during the day, the 
difficulty of breathing has been moderate, 
and the perfon gets fome Heep in the firft 
part of the night, he is however waked 
about midnight, or at fome time between 
midnight and two o'clock in the morning; 
and is then fuddenly feized with a fit of 
difficult breathing, which runs the fame 
courfe as the night before* 
MCCCLXXIX. 
In this manner fits return for feveral 
nights fucceflively; but generally, after 
fome nights paffed in this way, the fits 
fuffer more confiderable remiifions. This 
efpecially happens when the remiffions are 
attended with a more copious expectora- 
tion 
Vol. III. 
Cc 394 
PRACTICE 
tion in the mornings, and that this con- 
tinues from time to time throughout the 
day. In thefe circumllances, afthmatics, 
for a long time after, have not only more 
eafy days, but enjoy alfo nights of entire 
fleep, without the recurrence of the dif- 
eafe. 
MCCCLXXX. 
When this difeafe, however, has once 
taken place in the manner above defcribed, 
it is ready to return at times for the whole 
of life after. Thefe returns, however, hap- 
pen with different circumftances in dif- 
ferent perfons. 
MCCCLXXXI. 
In fome perfons the fits are readily- 
excited by external heat, whether of the 
weather or of a warm chamber, and par- 
ticularly OF PHYSIC 
395 
ticularly by warm bathing. In fuch per- 
fons fits are more frequent in fummer, 
and particularly during the dog-days, than 
at other colder feafons. The fame perfons 
are alfo readily affedled by changes of the 
weather, efpecially by fudden changes 
made from a colder to a warmer, or, what 
is commonly the fame thing, from a hea- 
vier to a lighter atmofphere. The fame 
perfons are alfo affedled by every circum- 
ftance ftraitening the capacity of the tho- 
rax, as by any ligature made, or even by 
a plafter laid, upon it; and a like effect 
happens from any increafed bulk of the 
ftomach, either by a full meal, or by air 
collected in it. They are likewife much 
affected by exercife, or whatever elfe can 
hurry the circulation of the blood. 
MCCCLXXXII. 
As afthmatic fits feem thus to depend 
C C 2 
upon 396 
PRACTICE 
upon fome fulnefs of the veffels of the 
lungs, it is probable that an obftrudion 
of perfpiration, and the blood being lefs 
determined to the furface of the body, 
may favour an accumulation in the lungs, 
and thereby be a means of exciting afthma. 
This feems to be the cafe of thofe afthma- 
tics- who have fits moft frequently in the 
winter-feafon, and who have commonly 
more of a catarrhal afFeciion accompany- 
ing the afthma; which therefore occurs 
more frequently in winter, and more ma- 
nifeftly from the application of cold. 
MCCCLXXXI1L 
Befide thefe cafes of afthma excited by 
heat or cold, there are others, in which 
the fits are efpecially excited by powers 
applied to the nervous fyflem; as by paf- 
fions of the mind, by particular odours, 
and by irritations of fmoke and duft. 
That OF PHYSIC. 
397 
That this difeafe is an affection of the 
nervous fyftern, and depending upon a mo- 
bility of the moving fibres of the lungs, 
appears pretty clearly from its being fre- 
quently connected with other fpafmodic 
affections depending upon mobility; fuch 
as hyfteria, hypochondriacs, dyfpepfia, and 
atonic gout. 
MCCCLXXXIV. 
From the whole of the hiftory of afthma 
now delivered, I think it will readily ap- 
pear, that the proximate caufe of this dif- 
eafe is a preternatural, and in fome mea- 
fure a fpafmodic, conftridlion of the muf- 
cular fibres of the bronchia?; which not 
only prevents the dilatation of the bron- 
chia? neceffary to a free and full infpira- 
tion, but gives alfo a rigidity which pre- 
vents a full and free exfpiration. This pre- 
ternatural conftriclion, like many other 
Cc 3 
con- 398 
PRACTICE 
convulfive and fpafmodic affedlions, is rea- 
dily excited by a turgefcence of the blood, 
or other caufe of any unufual fulnefs and 
diftention of the veffels of the lungs. 
MCCCLXXXV. 
This difeafe, as coming by fits, may be 
generally diftinguilhed from moft other 
fpecies of dyfpnoea, whofe caufes being 
more conftantly applied, produce there- 
fore a more conftant difficulty of breath- 
ing. There may, however, be fome fal- 
lacy in this matter, as fome of thefe cau- 
fes may be liable to have abatements and 
intenfities, whereby the dyfpnoea produ- 
ced by them may feem to come by fits ; 
but I believe it is feldom that fuch fits 
put on the appearance of the genuine 
afthmatic fits defcribed above. Perhaps, 
however, there is ftill another cafe that 
xnay give more difficulty; and that is, 
when OF PHYSIC. 
399 
when feveral of the caufes, which we have 
affigned as caufes of feveral of the fpecies 
of difficult breathing referred to the ge- 
nus of Dyfpnoea, may have the effect of 
exciting a genuine afthmatic fit. Whe- 
ther this can happen to any but the pecu- 
liarly predifpofed to afthma, I am uncer- 
tain ; and therefore, whether, in any fuch 
cafes, the afthma may be confidered as 
fymptomatic, or if, in all fuch cafes, the 
afthma may not ftiil be confidered and 
treated as an idiopathic difeafe. 
MCCCLXXXVI. 
The afthma, though often threatening 
immediate death, feldom occasions it; and 
many perfons have lived long under this 
difeafe. In many cafes, however, it does 
prove fatal; fometimes very quickly, and 
perhaps always at length. In fome young 
perfons it has ended foon, by occafioning 
C c 4 
a 400 
PRACTICE 
a phthifis pulmonalis. After a long conti* 
nuance, it often ends in a hydrothorax; 
and commonly, by occafioning fome a- 
neurifm of the heart or great veffels, it 
thereby proves fatal. 
MCCCLXXXVII. 
As it is feldom that an afthma has been 
entirely cured, I therefore cannot propofe 
any method of cure which experience has 
approved as generally fuccefsful. But the 
difeafe admits of alleviation in feveral re- 
fpedts from the ufe of remedies ; and my 
bufinefs now (hall be chiefly to offer fome 
remarks upon the choice and ufe of the 
remedies which have been commonly em- 
ployed in cafes of afthma. 
MCCCLXXXVIII. 
As the danger of an afthmatic fit arifes 
chiefly OF PHYSIC. 
401 
chiefly from the difficult tranfmiffion of 
the blood through the veflels- of the lungs, 
threatening fuffocation ; fo the moft pro- 
bable means of obviating this feems to be 
blood-letting : and therefore, in all violent 
fits, praditioners have had recourfe to this 
remedy. In firft attacks, and efpecially 
in young and plethoric perfons, blood- 
letting may be very neceflary, and is com- 
monly allowable. But it is alfo evident, 
that, under the frequent recurrence of fits, 
blood-letting cannot be frequently repeat- 
ed without exhaufting and weakening the 
patient too much. It is further to be ob- 
i 
ferved, that blood-letting is not fo necef- 
fary as might be imagined, as the paflage 
of the blood through the lungs is not fo 
much interrupted as has been commonly 
fuppofed. This I particularly conclude 
from hence, that, inftead of the fuffufion 
of face, which is the ufual effect of fuch 
interruption, the face, in afthmatic fits, is 
often 402 
PRACTICE 
often fhrunk and pale. I conclude the 
fame alfo from this, that, in afthmatic 
fits, blood-letting does not commonly give 
fo much relief as, upon the contrary fup- 
pofition, might be expecfted. 
MCCCLXXXIX. 
As I have alleged above, that a turgef- 
cence of the blood is frequently the exci- 
ting caufe of afthmatic fits, fo it might be 
fuppofed that a plethoric ftate of the fy- 
ftem might have a great Ihare in produ- 
cing a turgefcence of the blood in the 
lungs ; and efpecially, therefore, that 
blood-letting might be a proper remedy 
in afthma. I allow it to be fo in the firft 
attacks of the difeafe : but as the difeafe, 
by continuing, generally takes off the ple- 
thoric ftate of the fyftem; fo, after the dif- 
eafe has continued for fome time, I allege 
that OF PHYSIC. 
403 
that blood-letting becomes lefs and lefs 
neceflary. 
MCCCXC. 
Upon the fuppofition of afthmatics be- 
ing in a plethoric hate, purging might be 
fuppofed to prove a remedy in this difeafe: 
but, both becaufe the fuppofition is not 
commonly well founded, and becaufe pur- 
ging is feldom found to relieve the vef- 
fels of the thorax, this remedy has not 
appeared to be well fuited to afthmatics; 
and large purging has always been found 
to do much harm. But as afthmatics are 
always hurt by the ftagnation and accu- 
mulation of matters in the alimentary ca- 
nal, fo coftivenefs muft be avoided, and 
an open belly proves ufeful. In the time 
of fits, the employment of emollient and 
moderately laxative glyfters has been found 
to give confiderable relief. 
MCCCXCL 404 
PRACTICE 
MCCCXCI. 
As a flatulency of the ftomach, and 
other fymptoms of indigeftion, are fre- 
quent attendants of afthma, and very 
troublefome to afthmatics ; fo, both for 
removing thefe fymptoms, and for taking 
off all determination to the lungs, the fre- 
quent ufe of gentle vomits is proper in 
this difeafe. In certain cafes, where a fit 
was expected to come on in the courfe of 
the night, a vomit given in the evening 
has frequently feemed to prevent it. 
MCCCXCII. 
Bliftering between the flioulders, or up- 
on the breaft, has been frequently em- 
ployed to relieve afthmatics ; but in the 
pure fpafmodic afthma we treat of here, I 
have rarely found blifters ufeful, either in 
preventing or relieving fits. 
MCCCXCIIL or PHYSIC. 
405 
MCCCXCIIL 
IHiies are certainly ufeful in obviating 
plethora; but as fuch indications feldom 
arife in cafes of afthma, fo iflues have 
been feldom found ufeful in this difeafe. 
MCCCXC1V. 
As afthmatic fits are fo frequently ex- 
cited by a turgefcence of the blood, fo the 
obviating and allaying of this by acids and 
neutral faits, feems to have been at all 
times the object of practitioners. See 
Floyer on the Afthma. ~ 
MCCCXCV. 
Although a plethoric ftate of the fyftem 
may feem to difpofe to afthma, and the 
occafional turgefcence of the blood may 
feem to be frequently the exciting caufe 
Qt 406 
PRACTICE 
of the fits; yet it is evident, that the dif- 
eafe mult have arifen chiefly from a pe- 
culiar conftitution in the moving fibres of 
the bronchiae, difpofing them upon va- 
rious occafions to fall into a fpafmodic 
conftriCtion ; and therefore, that the en- 
tire cure of the difeafe can only be ex- 
pected from the correcting of that predif- 
pofition, or from correcting the preter- 
natural mobility or irritability of the lungs 
in that refpeCt. 
MCCCXCVI. 
In cafes wherein this predifpofition de- 
pends upon original conformation, the 
cure muft be difficult, and perhaps im- 
poffible; but it may perhaps be modera- 
ted by the ufe of antifpafmodics. Upon 
this footing, various remedies of that kind 
have been commonly employed, and par- 
ticularly the fetid gums; but we have 
not OF PHYSIC. 
407 
not found them of any coniiderable effica- 
cy, and have obferved them to be fome- 
times hurtful by their heating too much. 
Some other antifpafmodics which might 
be fuppofed powerful, fuch as mufk, have 
not been properly tried. The vitriolic 
ether has been found to give relief, but 
its effects are not lading. 
MCGCXCVII. 
As in other fpafmodic affecftions, fo in 
this, the moft certain and powerful anti- 
fpafmodic is opium. I have often found 
it effectual, and generally fafe; and if 
there have arifen doubts with refpedt to 
its fafety, I believe they have arifen from 
not diftinguifliing between certain pletho- 
ric and inflammatory cafes of dyfpnoea, 
improperly named Afthma, and the ge- 
nuine fpafmodic afthma we treat of here. 
MCCCXGVIII. 408 
PRACTICE 
MCCCXCVIII. 
As in many cafes this difeafe depends 
upon a predifpofition which cannot be cor- 
rected by our art, fo in fuch cafes the pa- 
tient can only efcape the difeafe by avoid- 
ing the occafional or exciting caufes, which 
I have endeavoured to point out above. 
It is, however, difficult to give any general 
rules here, as different afthmatics have their 
different idiofyncrafies with refpedt to ex- 
ternals. Thus, one afthmatic finds him- 
felf eaiieft living in the midft of a great 
city, while another cannot breathe but in 
the free air of the country. In the latter 
cafe, however, moft afthmatics bear the 
air of a low ground, if tolerably free and 
dry, better than that of the mountain. 
MCCCXCIX. 
In diet alfo, there is fome difference to 
be OF PHYSIC. 
409 
be made with refpedl to different afthma- 
tics. None of them bear a large or full 
meal, or any food that is of flow and dif- 
ficult folution in the ftomach; but many 
of them bear animal-food of the lighter 
kinds, and in moderate quantity. The 
ufe of vegetables which readily prove fla- 
tulent, are always very hurtful. In re- 
cent afthma, and efpecially in the young 
and plethoric, a fpa re, light, and cool diet 
is proper, and commonly neceflary ; but, 
after the difeafe has continued for years, 
afthmatics commonly bear, and even re- 
quire, a tolerably full diet, though in all 
cafes a very full diet is very hurtful. 
MCCCC. 
In drinking, water, or cool watery li- 
quors, is the only fafe and fit drink for 
afthmatics ; and all liquors ready to fer- 
ment, and become flatulent, are hurtful to 
Vol. III. 
D d 
them. 410 
PRACTICE 
them. Few afthmatics can bear any kind 
of ftrong drink; and any excefs in fuch 
is always very hurtful to them. As afth- 
matics are commonly hurt by taking 'warm 
or tepid drink, fo, both upon that account, 
and upon account of the liquors weaken- 
ing the nerves of the ftomach, neither tea 
nor coffee is proper in this difeafe. 
MCCCCI. 
Afthmatics commonly bear no bodily 
motion eafily but that of the moft gentle 
kind. Riding, however, on horfeback, or 
going in a carriage, and efpecially failing, 
are very often ufeful to afthmatics. 
CHAP. OF PHYSIC. 
411 
CHAP. VII. 
Of the Chincough, or Hooping-cough. 
MCCCCII. 
THIS difeafe is commonly epidemic, 
and manifeftly contagious. It feems 
to proceed from a contagion of a fpecific 
nature, and of lingular quality. It does 
not, like moft other contagions, necefla- 
rily produce a fever; nor does it, like 
moft others, occalion any eruption, or 
produce otherwife any evident change in 
the ftate of the human fluids. It has, in 
common with the catarrhal contagion, 
and with that of the mealies, a peculiar 
Dd 2 
deter- 412 
PRACTICE 
determination to the lungs, but with par- 
ticular effects there, very different from 
thofe of the other two ; as will appear 
from the hiftory of this difeafe now to be 
delivered. 
MCCCCIII. 
This contagion, like feveral others, af- 
fects perfons but once in the courfe of 
their lives ; and therefore, neceffarily, 
children are moft commonly the fubjedts 
of this difeafe: but there are many in- 
ftances of it occurring in perfons confi- 
derably advanced in life; though it is 
probable, that the further that perfons are 
advanced in life, they are the lefs liable 
to be affected with this contagion. 
MCCCCIV. OF PHYSIC. 
413 
MCCCC1V. 
The difeafe commonly comes on with 
the ordinary fymptoms of a catarrh arifing 
from cold; and often, for many days, 
keeps entirely to that appearance; and I 
have had inftances of a difeafe which, 
though evidently arifing from the chin- 
cough contagion, never put on any other 
form than that of a common catarrh. 
This, however, feldom happens; for, 
generally, in the fecond, and at fartheft 
in the third week after the attack, the dif- 
eafe puts on its peculiar and characfteriftic 
fymptom, a convulfive cough. This is a 
cough in which the exfpiratory motions 
peculiar to coughing are made with more 
frequency, rapidity, and violence, than 
nfual. As thefe circumftances, however, 
in different inftances of coughing, are in 
very different degrees; fo no exacft limits 
can be put to determine when the cough 
D d 3 
can 414 
PRACTICE 
can be ftridlly laid, to be convulfive; and 
it is therefore efpecially by another cir- 
cumftance that the chincough is diftin- 
guifhed from every other form of cough. 
This circumftance is, when many exfpira- 
tory motions have been convulsively made, 
and thereby the air is in great quantity 
thrown out of the lungs, a full infpiration 
is neceffarily and fuddenly made; which, 
by the air rufhing in through the glottis 
with unufual velocity, gives a peculiar 
found. This found is fomewhat different 
in different cafes, but is in general called 
a Hoop ; and from it the whole of the 
difeafe is called the Hooping Cough. 
When this fonorous infpiration has hap- 
pened, the convulfive coughing is again 
renewed, and continues in the fame man- 
ner as before, till a quantity of mucus is 
thrown up from the lungs, or the con- 
tents of the ftomach are thrown up by 
vomiting. Either of thefe evacuations 
com- O F PH Y S I C. 
415 
commonly puts an end to the coughing, 
and the patient remains free from it for 
fome time after. Sometimes it is only 
after feveral alternate fits of coughing and 
hooping that expectoration or vomiting 
takes place; but it is commonly after the 
fecond coughing that thefe happen, and 
put an end to the fit. 
MCCCCV. 
When the difeafe, in this manner, has 
taken its proper form, it generally conti- 
nues for a long time after, and generally 
from one month to three ; but fometimes 
much longer, and that with very various 
circumftances. 
MCCCCVI. 
The fits of coughing return at various 
intervals, rarely obferving any exadl pe- 
riod. 
D d 4 416 
PRACTICE 
riod. They happen frequently in the 
courfe of the day, and more frequently 
flill in the courfe of the night. The pa- 
tient has commonly fome warning of their 
coming on; and, to avoid that violent and 
painful concuffion which the coughing 
gives to the whole body, he clings faft to 
any thing that is near to him, or demands 
to be held faft by any perfon that he can 
come at. 
When the fit is over, the patient fome- 
times breathes faft, and feems fatigued for 
a little after: but in many this appears 
very little ; and children are commonly fo 
entirely relieved, that they immediately 
return to their play, or what elfe they were 
occupied in before. 
MCCCCVII. 
If it happens that the fit of coughing 
ends in vomiting up the contents of the 
fto- OF PHYSIC. 
417 
ftomach, the patient is commonly imme- 
diately after feized with a ftrong craving 
and demand for food, and takes it in very 
greedily. 
mccccviii. 
At the firft coming on of this difeafe, 
the expectoration is fometimes none at all, 
or of a thin mucus only ; and while this 
continues to be the cafe, the fits of cough- 
ing are more violent, and continue longer: 
but commonly the expectoration foon be- 
comes confiderable, and a very thick mu- 
cus, often in great quantity, is thrown up; 
and as this is more readily brought up, 
the fits of coughing are of ihorter dura- 
tion. 
MCCCCIX. 
The violent fits of coughing frequently 
inter- 418 
PRACTICE 
interrupt the free tranfmifiion of the blood 
through the lungs, and thereby the free 
return of blood from the veflels of the 
head. This occafions that turgefcence and 
fuffufion of face which commonly attends 
the fits of coughing, and feems to occafion 
alfo thofe eruptions of blood from the nofe, 
and even from the eyes and ears, which 
fometimes happen in this difeafe. 
MCCCCX. 
This difeafe often takes place in the man- 
ner we have now defcribed, without any 
pyrexia attending it; but, though Syden- 
ham had feldom obferved it, we have found 
the difeafe very frequently accompanied 
with pyrexia, fometimes from the very be- 
ginning, but more frequently only after 
the difeafe had continued for fome time. 
When it does accompany the difeafe, we 
have not found it appearing under any 
regular OF PHYSIC. 
419 
regular intermittent form. It is conftantly 
in fome degree prefent; but with evident 
exacerbations towards evening, continuing 
till next morning. 
MCCCCXI. 
Another fymptom very frequently at- 
tending the chincough, is a difficulty of 
breathing; and that not only immediately 
before and after fits of coughing, but as 
conftantly prefent, though in different de- 
grees in different perfons. I have hardly 
ever feen an inftance of a fatal chincough, 
in which a confiderable degree of pyrexia 
and dyfpnoea had not been for-fome time 
conftantly prefent. 
MCCCCXII. 
When by the power of the contagion 
this difeafe has once taken place, the fits 
of 420 
PRACTICE 
of coughing are often repeated, without 
any evident exciting caufe : but, in many 
cafes, the contagion may be confidered as 
giving a predifpofition only; and the fre- 
quency of fits depends in fome meafure 
upon various exciting caufes ; fuch as, 
violent exercife ; a full meal; the having 
taken in food of difficult folution; irrita- 
tions of the lungs by duft, finoke, or dis- 
agreeable odours of a ftrong kind; and 
efpecially any confiderable emotion of the 
mind. 
MCCCCXIII. 
Such are the chief circumftances of this 
difeafe, and it is of various event; which, 
however, may be commonly forefeen by 
attending to the following confiderations. 
The younger that children are, they are in 
the greater danger from this difeafe; and of 
thofe OF PHYSIC 
421 
thofe to whom it proves fatal, there are 
many more under two years old than 
above it. 
The older that children are, they are the 
more fecure againft an unhappy event; 
and this I hold to be a very general rule, 
though I own there are many exceptions 
to it. 
Children born of phthifical and afth- 
matic parents are in the greateft danger 
from this difeafe. 
When the difeafe, beginning in the form 
of a catarrh, is attended with fever and 
difficult breathing, and with little expecto- 
ration, it often proves fatal, without taking 
on the form of the hooping cough ; but, 
in moft of fuch cafes, the coming on of 
the convulfive cough and hooping, bring- 
ing on at the fame time a more free expec- 
toration, generally removes the danger. 
When the difeafe is fully formed, if the 
fits are neither frequent nor violent, with 
mode- 422 
PRACTICE 
moderate expectoration, and the patient, 
during the intervals of the fits, is eafy, 
keeps his appetite, gets fleep, and is with- 
out fever or difficult breathing, the dif- 
eafe is attended with no danger ; and thefe 
circumftances becoming daily more fa- 
vourable, the difeafe very foon fponta- 
neoufly terminates. 
An expectoration, either very fcanty or 
very copious, is attended with danger; 
efpecially if the latter circumftance is at- 
tended with great difficulty of breathing. 
Thofe cafes in which the fits terminate 
by a vomiting, and are immediately fol- 
lowed by a craving of food, are generally 
without danger. 
A moderate hemorrhagy from the nofe 
often proves falutary, but very large he- 
morrhagies are generally very hurtful. 
This difeafe coming upon perfons under 
a bate of much debility, has very generally 
an unhappy event. 
The OF PHYSIC. 
423 
The danger of this difeafe fometimes 
arifes from the violence of the fits of cough- 
ing, occafioning apoplexy, epilepfy, or im- 
mediate fuffocation ; but thefe accidents 
are very rare, and the danger of the difeafe 
feems generally to be in proportion to the 
fever and dyfpnoea attending it. 
MCCCCXIV. 
The cure of this difeafe has been always 
confidered as difficult, whether the pur- 
pofe be to obviate its fatal tendency when 
it is violent, or merely to ffiorten the courfe 
of it when it is mild. When the conta- 
gion is recent, and continues to aft, we 
neither know how to correct, nor how to 
expel it; and therefore the difeafe necef- 
farily continues for fome time: but it is 
probable, that the contagion in this as in 
other inftances ceafes at length to aft; and 
that then the difeafe continues, as in other 
con- 424 
PRACTICE 
convulfive affecftions, by the power of ha- 
bit alone. 
MCCCCXV. 
From this view of the matter I main- 
tain, that the practice muft be different, 
and adapted to two different indications, 
according to the period of the difeafe. At 
the beginning of the difeafe, and for fome 
time after, the remedies to be employed 
muft be fuch as may obviate the violent 
effects of the difeafe, and the fatal tendency 
of it; but, after the difeafe has continued 
for fome time, and is without any violent 
fymptoms, the only remedies which can 
be required are thofe which may inter- 
rupt its courfe, and put an entire ftop to 
it fooner than it would have fpontaneoufly 
ceafed. 
MCCCCXVI. OF PHYSIC. 
425 
MCCCCXVI. 
For anfwering the firft indication. In 
plethoric fubjedts, or in others, when from 
the circumftances of the cough and fits it 
appears that the blood is difficultly tranf- 
mitted through the lungs, bloodletting is 
a neceffary remedy; and it may be even 
neceffary to repeat it, efpecially in the be- 
ginning of the difeafe : but, as fpafmodic 
affections do not commonly admit of much 
bleeding, fo it is feldom proper in the chin- 
cough to repeat this remedy often. 
MCCCCXVIL 
As coftivenefs frequently attends this 
difeafe, fo it is neceffary to obviate or re- 
move it by laxatives employed; and keep- 
ing an open belly is generally ufeful: but 
large evacuations in this way are common- 
ly hurtful. 
E e 
MCCCCXVIII. 
Vol. III. 426 
PRACTICE 
MCCCCXVIIL 
To obviate or remove the inflammatory 
determination to the lungs that fometimes 
occurs in this difeafe, bliftering is often 
ufeful, and even repeated bliftering has 
been of fervice ; but ifliies have not fo 
much effect, and fhould by no means fu- 
perfede the repeated bliftering that may 
be indicated. When blifters are proper, 
they are more effectual when applied to 
the thorax than when applied to any di- 
ftant parts. 
MCCCCXIX. 
Of all other remedies, emetics are the 
moff ufeful in this difeafe; both in gene- 
ral by interrupting the return of fpafmo- 
die affedlions, and in particular by deter- 
mining very powerfully to the furface of 
the body, and thereby taking off determi- 
nations OF PHYSIC. 
427 
nations to the lungs* For thefe purpofes, 
I think, full vomiting is frequently to be 
employed ; and in the intervals neceflary 
to be left between the times of full vomit- 
ing, naufeating dofes of the antimonial 
emetics may be ufeful. I have never found 
the J'ulphwr fo much praifed by 
Cloflius, to be a convenient medicine, on 
account of the uncertainty of its dofe; and 
the tartar emetic, employed in the manner 
directed by the late Dr Fothergill, has ap- 
peared to be more ufeful* 
MCGCCXX* 
Thefe are the remedies to be employed 
in the firft ftage of the difeafe for obviat- 
ing its fatal tendency, and putting it into 
a fafe train. But in the fecond ftage, when. 
I fuppofe the contagion has ceafed to 
and that the difeafe continues merely by 
E e 2 
the 428 
PRACTICE 
the power of habit, a different indication 
arifes, and different remedies are to be em- 
ployed. 
MCCCCXXI. 
This difeafe, which often continues for 
a long time, does not, in my opinion, con- 
tinue during the whole of that time in 
confequence of the contagion's remaining 
in the body, and continuing to aft in it. 
That the difeafe does often continue long 
after the contagion has ceafed to aft, and 
that too by the power of habit alone, ap- 
pears to me probable from hence, that ter- 
ror has frequently cured the difeafe; that 
any confiderable change in the ftate of the 
fyftem, fuch as the coming on of the fmall- 
pox, has alfo cured it; and, laftly, that it 
has been cured by antifpafmodic and to- 
nic medicines ; whilft none of all thefe 
means of cure can be fuppofed either to 
cor- O F P H Y S I C. 
429 
correct or to expel a morbific matter, 
though they are evidently fuited to change 
the ftate and habits of the nervous fy- 
Stem. 
MCCCCXXII. 
From this view we are directed to the 
indication that may be formed, and in a 
great meafure to the remedies which may 
be employed in what we fuppofe to be the 
fecond ftage of the difeafe. It may per- 
haps be alleged, that this indication of 
Shortening the courfe of the difeafe, is not 
very important or neceflary, as it fuppofes 
that the violence and danger is over, and, 
in confequence, that the difeafe will foon 
fpontaneoufly ceafe. The laft fuppofition, 
however, is not well founded; as the dif- 
eafe, like many other convulsive and fpaf- 
modic affedions, may continue for a long 
time by the power of habit alone, and by 
Ee 3 
the 430 
PRACTICE 
die repetition of paroxyfins may have hurt* 
ful effects, more efpecially as the violence 
of paroxyfins, and therefore their hurtful 
effedls, may be much aggravated by va- 
rious external caufes that may be acciden- 
tally applied. Our indication, therefore, 
is proper ; and we proceed to confider the 
feveral remedies which may be employed 
to anfwer it. 
MCCCCXXIIL 
Terror may poffibly be a powerful re- 
medy, but it is difficult to meafure the de- 
gree of it that fhall be produced ; and, as 
a flight degree of it may be ineffectual, and 
a high degree of it dangerous, I cannot 
propofe to employ it. 
MCCCCXXIV. 
The other remedies which we fuppofe 
fuited OF PHYSIC. 
331 
fuited to our fecond indication, and which 
indeed have been frequently employed in 
this difeafe, are antifpafmodics or tonics. 
Of the antifpafmodics, caftor has been 
particularly recommended by Dr Morris ; 
but in many trials we have not found it 
effectual. 
With more probability mulk has been 
employed: but whether it be from our 
not having it of a genuine kind, or not 
employing it in fufficiently large dofes, I 
cannot determine; but we have not found 
it commonly fuccefsful. Of antifpaf- 
modics, the moft certainly powerful is 
opium: and when there is no confider- 
able fever or difficulty of breathing pre- 
fent, opium has often proved ufeful in 
moderating the violence of the chincough; 
but I have not known it employed fo as 
entirely to cure the difeafe: 
If hemlock has proved a remedy in this 
difeafe, as we mutt believe from Dr But- 
ter's 332 
PRACTICE 
ter's accounts, I agree with that author* 
that it is to be confidered as an antifpaf- 
modic. Upon this fuppofition, it is a pro- 
bable remedy; and from the accounts of 
Dr Butter and fome others, it feems to 
have been often ufeful: but, in our trials, 
it has often difappointed us, perhaps from 
the preparation of it not having been al- 
ways proper; 
MCCCCXXV. 
Of the tonics, I confider the 
formerly celebrated, as of this kind; as 
alfo the bark of the mifletoe: but I have 
had no experience of either, as I have al- 
ways trufted to the Peruvian bark. I con- 
fider the ufe of this medicine as the moft 
certain means of curing the difeafe in its 
fecond ftage; and when there has been 
little fever prefent, and a fufficient quan- 
tity of the bark has been given, it has fel- 
dom OF PHYSIC. 
433 
do'm failed of foon putting an end to the 
difeafe. 
MCCCCXXVI. 
When convulfive diforders may be fup- 
pofed to continue by the force of habit 
alone, it has been found that a conlider- 
able change in the whole of the circum- 
ftances and manner of life has proved a 
cure of fuch difeafes ; and analogy has 
applied this in the cafe of the chincough 
fo far, that a change of air has been em- 
ployed, and fuppofed to be ufeful. In fe- 
veral inftances I have obferved it to be fo; 
but I have never found the effects of it 
durable, or fufficient to put an entire flop 
to the difeafe. 
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18. De morbis coeli mutatione medendis, audtore Jacobo Gregory, 
M. D. Med. Theoret. in Acad. Edin. Prof, &C. &C. Edit. altcra? 
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