FIRST LINES 
O F T H E 
PRACTICE OF PHYSIC. 
B Y 
•WILLIAM CULLEN, M.D. 
14 * 
Profeflbr of the Practice of Phyfic in the Univerfity of Edinburgh ; 
Firft Phyfician to his Majefty for Scotland; 
Fellow of the Royal College of Phyficians of Edinburgh, 
of the Royal Societies of London, of Edinburgh, &c. &c. 
VOL. IV. 
EDINBURGH: 
Printed for C. ELLIOT, 
And T. C A D E L L, London, 
M.DCC.LXXXIV. CONTENTS. 
PART II. BOOK III. 
Se<fl. III. Of the Spafmodic Affections in the 
Natural Functions • 
CHAP. VIII. 
Of the Pyrosis, or what is named in Scot- 
land the Water-Brash - 5 
CHAP. IX. 
Of the Colic - • 18 
CHAP, X. 
■ * 
Of the Cholera - - 39 
A a CHAP. IV 
CONTENTS. 
CHAP. XI. 
or Looseness - 49 
CHA P. XII. 
Of the Diabetes - - 82 
CHAP. XIII. 
Of the Hysteria, or the Hysteric 
Disease - "93 
CHAP. XIV. 
Of Canine Madness and Hydro- 
phobia - - 107 
BOOK IV. 
Of VESANLE, or of the Disor- 
ders of the Intellectual 
Functions - - 111 
CHAP. CONTENTS.. 
V 
CHAP. I. 
in general - ill 
C H A P. II. 
Of Mania, or Madness - 144 
CHAP. III. 
and other Forms of 
Infinity - 168 
PART III. 
OF CACHEXIES - 188 
BOOK L 
Of EMACIATIONS - 192 
3 BOOK VI 
CONTENTS. 
BOOK II. 
Of INTUMESCENTIA, or Gene- 
ral Swellings - 216 
CHARI. 
Of Adipose Swellings - 219 
CHAP. II. 
Swellings * 226 
CHAP. III. 
Of Watery Swellings, or Drop- 
sies - - 249 
Secft. I. Of Anafarca - 277 
Secft. II. Of the Hydrothorax,or Dropfy 
of the Breajl - 308 
Secft. CONTENTS. 
VII 
Se€L III. Of or Dropfy of the 
Lower Belly - - 321 
CHAP. IV. 
Of General Swellings, arifing 
from an increased Bulk of the 
whole fubfance of particular 
PARTS - - 33I 
Of Rachitis or Rickets - 
BOOK III. 
Of the IMPETIGINES, or depra- 
ved Habit with Affections 
of the Skin - 357 
CHAP. I. 
Of Scrophula, or the King's Evil 359 
CHAP. VIII 
CONTENTS 
CHAP. II. 
Of Siphylis, or the Nl'nlka-l Dis- 
ease - - 382 
CHAP. III. 
OfScURVY - - 412 
CHAP. IV. 
tV'jAUNDICE - - 457 FIRST LINES 
O F T H E 
PRACTICE of PHYSIC. 
PART II. 
BOOK III. SECT. III. 
Of the SPASMODIC AFFECTIONS 
in the NATURAL FUNCTIONS. 
CHAP. VIII. 
Of the Pyrosis, or what is named 
4 . 
in Scotland the Water-Brash. 
MCCCCXXVII. 
THE painful fenfations referred to the 
ftomach, and which are probably 
occafioned by real affections of this organ, 
Vol. IV. 
B 
are X 
PRACTICE 
are of different kinds. Probably they pro-*- 
cecd from affections of different natures, 
and fhould therefore be diftinguifhed by 
different appellations ; but I muft own 
that the utmoft precifion in this matter 
will be difficult. In my effay towards a 
methodical Nofology, 1 have, however, at- 
tempted it. For thofe pains that are either 
acute and pungent, or accompanied with 
a fenfe of diflention, or - with a fenfe of 
conftriction, if they are at the fame time 
not attended with any fenfe of acrimony 
or heat, I employ the appellation of Ga- 
ftrodynia. To exprefs thofe painful or 
uneafy fenfations which feem toarife from 
a fenfe of acrimony irritating the part, or 
from fuch a fenfe of heat as the applica- 
tion of acrids, whether externally or in- 
ternally applied, often gives, I employ the 
term of Cardialgia ; and by this I particu- 
larly mean to denote thofe feelings which 
are expreffed by the term Heartburn in 
the OF PHYSIC 
XI 
the Englifli language. I think the term 
Soda has been commonly employed by 
practical writers to exprefs an affedlion 
attended with feelings of the latter kind. 
MCCCCXXVIIL 
Belide the pains denoted by the terms 
Gaftrodynia, Periadynia, Cardialgia, and 
Soda, there is, I think, another painful 
fenfation different from all of thefe, which 
is named by Mr Sauvages Pyrolis Suecica; 
and his account of it is taken from Lin- 
nams, who names it Cardialgia Sputatoria. 
Under the title of Pyrolis Mr Sauvages has 
formed a genus, of which the whole of the 
fpecies, except the eighth, which he gives 
under the title of Pyrolis Suecica, are all of 
them fpecies of the Gaftrodynia or of the 
Cardialgia ; and if there is a genus to be 
formed under the title of Pyrofis, it can in 
my opinion comprehend only the fpecies I 
B 2 
have 12 
PRACTICE 
have mentioned. In this cafe, indeed, I 
own that the term is not very proper; 
but my averlion to introduce new names 
has made me continue to employ the term 
of Mr Sauvages. 
MCCCCXXIX. 
The Gaftrodynia and Cardialgia I judge 
to be for the molt part fymptomatic af- 
fections ; and therefore have given them 
no place in this work: but the Pyrofis, as 
an idiopathic difeafe, and never before 
treated of in any fyftem, I propofe to treat 
of here. 
MCCCCXXX. 
It is a difeafe frequent among people in 
lower life; but occurs alfo, though more 
rarely, in people of better condition. 
Though frequent in Scotland, it is by no 
means OF PHYSIC. 
13 
means fo frequent as Linnaeus reports it 
to be in Lapland. It appears moft com- 
monly in perfons under middle age, but 
feldom in any perfons before the of 
puberty. When it has once taken place, 
it is ready to recur occafionally for a long 
time after ; but it feldom appears in per- 
fons confiderably advanced in life. It af- 
fecls both fexes, but more frequently the 
female. It fometimes attacks piegnant 
women, and fome women only when they 
are in that condition. Of other women, 
it more frequently affedls the unmarried; 
and of the married, moft frequently the 
barren. I have had many infiances of its 
occurring in women labouring under a 
fluor alb us. 
MCCCCXXXL 
The fits of this difeafe ufually come on 
in the morning and forenoon, when the 
B3 
ftomach 14 
PRACTICE 
ftomach is empty. The firft fymptom of 
it is a pain at the pit of the ftomach, with 
a fenfe of conftridlion, as if the ftomach 
was drawn towards the back ; the pain is 
increafed by railing the body into an eredt 
pofture, and therefore the body is bended 
forward. This pain is often very fevere ; 
and, after continuing for fome time, it 
brings on an erudlation of a thin watery 
fluid in confiderable quantity. This fluid 
has fometimes an acid taftc, but is very 
often abfolutely infipid. The eradiation is 
for fome time frequently repeated; and 
does not immediately give relief to the 
pain which preceded it, but does fo at 
length, and puts an end to the fit. 
MCCCCXXXII. 
The fits of this difeafe commonly come 
on without any evident exciting caufe; 
and I have not found it Readily connec- 
ted PRACTICE 
15 
ted with any particular diet. It attacks 
perfons ufing animal food, but I think 
more frequently thofe living on milk and 
farinacea. It feems often' to be excited 
by cold applied to the lower extremities ; 
and is readily excited by any confider- 
able emotion of mind. It is often with- 
out any fymptoms of dyfpepfia. 
MCCCCXXXIII. 
The nature of this affection is not very 
obvious,; but I think it may be explain- 
ed in this manner: It feems to begin by 
a fpafm of the mufcular fibres of the fto- 
mach; which is afterwards, in a certain 
manner, communicated to the blood-vef- 
fels and exhalants, fo as to increafe the 
impetus of the fluids in thefe veflels, while 
a conftridlion takes place on their extre- 
mities. While therefore the increafed im- 
petus 
b4 16 
PRACTICE 
petus determines a greater quantity than 
ufual of fluids into thefe veflels, the con- 
ftridtion upon their extremities allows 
only the pure watery parts to be poured 
out, analogous, as 1 judge, in every re- 
fpccl, to what happens in the diabetes hy- 
ftericus. 
MCCCCXXXIV. 
The practice in this difeafe is as diffi- 
cult as the theory. The paroxyfm is only 
to be certainly relieved by opium. Other 
antifpafmodics, as vitriolic ether and vo- 
latile alkali, are fometimes of fervice, but 
not conftantly fo. Although opium and 
other antifpafmodics relieve the fits, they 
have no effedl in preventing their recur- 
rence. For this purpofe, the whole of 
the remedies of dyfpepfia have been em- 
ployed without fuccefs. Of the ufe of 
the OP PHYSIC. 
17 
the nux vomica, mentioned as a reme- 
dy by Linnseus, I have had no expe- 
dience. 
p H A P. 18 
PRACTICE 
CHAP. IX. 
Of the Colic. 
MCCCCXXXV. 
THE principal fymptom of this dil- 
eafe, is a pain felt in the lower belly. 
It is feldom fixed and pungent in one part, 
but is a painful diftention in fome 
meafure fpreading over the whole of 
the belly ; and particularly with a fenfe 
of twifting or wringing round the navel. 
At the fame time, with this pain, the navel 
and OF PHYSIC. 
19 
and teguments of the belly are frequently 
drawn inwards, and often the mufcles of 
the belly are fpafmodically contracted, and 
this in feparate portions, giving the ap- 
pearance of a bag full of round balls. 
MCCCCXXXVI. 
Such pains, in a certain degree, fome- 
times occur in cafes of diarrhoea and cho- 
lera ; but thefe are lefs violent and more 
tranfitory, and are named Gripings. It is 
only when more violent and permanent, 
and attended with coftivenefs, that they 
conftitute colic. This is alfo commonly 
attended with vomiting, which in many 
cafes is frequently repeated, efpecially when 
anything is taken down into theftomach; 
and in fuch vomitings, not only the con- 
tents of the ftomach are thrown up, but 
alfo the contents of the duodenum, and 
therefore frequently a quantity of bile. 
MCCCCXXXVII. 20 
PRACTICE 
MCCCCXXXVII. 
In fome cafes of colic, the periftal- 
tic motion is inverted through the 
whole length of the alimentary canal, in 
fuch a manner that the contents of the 
great guts, and therefore ftercoraceous 
matter, is thrown up by vomiting; and the 
lame inverlion appears ftill more clearly 
from this, that what is thrown into the 
return by glyfter is again thrown out by 
the mouth. In thefe circumftances of in- 
verlion the difeafe has been named Ileus, 
or the Iliac Paflion ; and this has been 
fuppofed to be a peculiar difeafe diftindf 
from colic; but to me it appears that the 
two difeafes are owing to the fame proxi- 
mate caufe, and have the fame fymptoms. 
only in different degree. 
MCCCCXXXVIIL OF PHYSIC. 
21 
mccccxxxviii. 
The colic is often without any pyrexia 
attending it. Sometimes, however, an in- 
flammation comes upon the part of the 
inteftine efpecially affected; and this in- 
flammation aggravates all the fymptoms of 
the difeafe, being probably what brings on 
the moft confiderable inverfion of the pe- 
riftaltic motion • and, as the ftercoraceous 
vomiting is what efpecially diftinguifhes 
the ileus, this has been confidered as al- 
ways depending on an inflammation of 
the inteftines. However, I can affirm, 
that as there are inflammations of the in- 
teftines without ftercoraceous vomiting, fo 
I have feen inftances of ftercoraceous vo- 
miting without inflammation ; and there 
is therefore no ground for diftinguiffiing 
ileus from colic, but as a higher degree of 
the fame affection. 
MCCCCXXXIX, 22 
PRACTICE 
MCCCCXXXIX. 
The fymptoms of the colic, and the dif- 
fedlions of bodies dead of this difeafe, fhow 
very clearly, that it depends upon a fpaf- 
modic conftridlion of a part of the intef- 
tines; and that this therefore is to be con- 
fidered as the proximate caufe of the dif- 
eafe. In fome of the diffeclions of perfons 
dead of this difeafe, an intus-fufception has 
been remarked to have happened; but 
whether this be conftantly the cafe in all 
the appearances of ileus, is not certainly 
determined. 
MCCCCXL. 
The colic has commonly been confidered 
as being of different fpecies, but I cannot 
follow the writers on this fubject in the 
diftindtions they have eftablifhed. So far, 
however, as a difference of the remote 
caufe OF PHYSIC. 
23 
caufe conftitutes a difference of fpecies, a 
diftindbon may perhaps be admitted; and 
accordingly in my Nofology I have marked 
feven different fpecies: but I am well per- 
fuaded, that in all thefe different fpecies 
the proximate caufe is the fame, that is, a 
fpafmodic conftridbon of a part of the in- 
teftines; and confequently, that in all thefe 
cafes the indication of cure is the fame, 
that is, to remove the conftridtion men- 
tioned. Even in the feveral fpecies named 
and Calculofa, in which the 
difeafe depends upon an obftrudbon of the 
inteftine, I am perfuaded that thefe ob- 
ftru&ions do not produce the fymptoms of 
colic, excepting in fo far as they produce 
fpafmodic conftridbons of the inteftines ; 
and therefore, that the means of cure in 
thefe cafes, fo far as they admit of cure, 
muft be obtained by the fame means which 
the general indication above mentioned 
fuggefts. 
MCCCCXLI. 24 
PRACTICE 
MCCCCXLI. 
The cure, then, of the colic univerfall y3 
is to be obtained by removing the fpafmo- 
dic conftridlions of the inteftines ; and the 
remedies fuited to this purpofe may be re- 
ferred to three general heads : 
1. The taking off the fpafm by various 
antifpafmodic powers. 
2. The exciting the action of the intef- 
tines by purgatives. 
3. The employing mechanical dilata- 
tion. 
MCCCCXLII. 
Before entering upon a more particular 
account of thefe remedies, it will be pro- 
per to obferve, that in all cafes of violent 
colic, it is advifeable to pradtife blood- 
letting ; both as it may be ufeful in ob- 
viating the inflammation which is com- 
monly OF PHYSIC. 
25 
monly to be apprehended, and even as it 
may be a means of relaxing the fpafm of 
the inteftine. This remedy may perhaps 
be improper in perfons of a weak and lax 
habit, but in all perfons of tolerable vigour 
it will be a fafe remedy; and in all cafes 
where there is the lead fufpicion of an in- 
flammation actually coming on, it will be 
abfolutely neceflary. Nay, it will even be 
proper to repeat it perhaps feveral times, 
if, with a full and hard pulfe, the appear- 
ance of the blood drawn, and the relief 
obtained by the firft bleeding, fliall autho- 
rife fuch repetition. 
MCCCCXLIII. 
The antifpafmodic powers that may be 
employed, are the application of heat in a 
dry or humid form, the application of blif- 
ters, the ufe of opium, and the ufe of mild 
oils. 
Vol. IV. 
C 
The 26 
PRACTICE 
The application of heat, in a dry formy 
has been employed by applying to the 
belly of the patient a living animal, or 
bladders filled with warm water, or bags 
of fubftances which long retain their heat; 
and all thefe have fometimes been applied 
with fuccefs ; but none of them feem to 
me fo powerful as the application of heat 
in a humid form. 
This may be employed either by the 
immerfion of a great part of the body in 
warm water, or by fomenting the belly 
with cloths wrung out of hot water. 
The immerfion has advantages from the 
application of it to a greater part of the 
body, and particularly to the lower extre- 
mities : but immerfion cannot always be 
conveniently pradiifed, and fomentation 
may have the advantage of being longer 
continued; and it may have nearly all the 
benefit of immerfion, if it be at the fame 
time OF PHYSIC. 
27 
time applied both to the belly and to the 
lower extremities. 
MCCCCXLIV. 
From confidering that the teguments of 
the lower belly have fuch a connexion 
with the inteftines, as at the fame time to 
be affected with fpafmodic contractions, 
we perceive that blifters applied to the 
belly may have the effect of taking off the 
fpafms both from the mufcles of the belly 
and from the inteftines; and accordingly, 
bliftering has often been employed in the 
colic with advantage. Analogous to this, 
rubefacients applied to the belly have been 
frequently found ufefuh 
MCCCCXLV. 
The ufe of opium in colic may feem to 
be an ambiguous remedy. Very certainly 
C 2 
it 28 
PRACTICE 
it may for fome time relieve the pain, which 
is often fo violent and urgent, that it is 
difficult to abftain from the ufe of fuch a 
remedy. At the fame time, the ufe of 
opium retards or fufpends the periftaltic 
motion fo much, as to allow the inteftines 
to fall into- conftri<Stions ; and may there- 
fore, while it relieves the pain, render the 
caufe of the difeafe more obftinate. On 
this account, and further as opium pre- 
vents the operation of purgatives fo often 
neceffary in this difeafej many practitioners 
are averfe to the ufe of it, and fome entire- 
ly reject the ufe of it as hurtful. There 
are, however, others who think they can 
employ opium in this difeafe with much 
advantage. 
In all cafes where the colic comes 
on without any previous coftivenefs, and 
arifes from cold, from paffions of the mind, 
or other caufes which operate efpecially on 
the nervous fyflem, opium proves a fafe 
and OF PHYSIC. 
29 
and certain remedy; but in cafes which 
have been preceded by long coftivenefs, or 
where the colic, though not preceded by co- 
ftivenefs, lias however continued for fome 
days without a ftool, fo that a ftagnation 
of faeces in the colon is to be fufpecfted, 
the ufe of opium is of doubtful effect. In 
fuch cafes, unlefs a ftool has been firft 
procured by medicine, opium cannot be 
employed but with fome hazard of ag- 
gravating the difeafe. However, even in 
thofe circumftances of coftivenefs, when, 
without inflammation the violence of the 
fpafm is to be fufpefted, when vomiting 
prevents the exhibition of purgatives, and 
when with all this the pain is extremely 
urgent, opium is to be employed, not only 
as an anodyne, but alfo as an antifpafmo- 
dic, neceflary to favour the operation of pur- 
gatives ; and may be fo employed, when, 
either at the fame time with the opiate, 
C 3 
or 30 
PRACTICE 
or not long after it, a purgative can be ex- 
hibited. 
Is the hyofciamus, as often fhowing, 
along with its narcotic, a purgative qua- 
lity, better fuited to this difeafe than 
opium ? 
MCCCCXLVI. 
It is feemingly on good grounds that 
feveral practitioners have recommended 
the large life of mild oils in this difeafe, 
both as antifpafmodics and as laxatives ; 
and, where the palate and ftomach could 
admit them, I have found them very life- 
ful. But, as there are few Scottifh ftomachs 
that can admit a large ufe of oils, I have 
had few opportunities of employing them. 
MCCCCXLVIL 
The fecond fet of remedies adapted to 
the OF PHYSIC. 
31 
the cure of colic, are purgatives ; which, 
by exciting the adion of the intellines, ei- 
ther above or below the obftrudled place, 
may remove the conftri£tion ; and there- 
fore thefe purgatives may be given either 
by the mouth, or thrown by glyfter into 
the anus. As the difeafe is often feated in 
the great guts; as glyfters, by having a 
more fudden operation, may give more im- 
mediate relief; and as purgatives given by 
the mouth are ready to be rejected by vo- 
miting ; fo it is common, and indeed pro- 
per, to attempt curing the colic in the firft 
place by glyfters. Thefe may at firft be 
of the mildeft kind, conlifting of a large 
bulk of water, with fome quantity of a 
mild oil; and fuch are fometimes fuffi- 
ciently efficacious : however, they are not 
always fo ; and it is commonly neceflary 
to render them more powerfully ftimulant 
by the addition of neutral faits, of which 
the moft powerful is the' common or ma- 
rine 
C z|. 32 
PRACTICE 
rine fait. If thefe faline glyflers, as fome- 
times happens, are rendered again too 
quickly, and on this account or otherwife 
are found ineffectual, it may be proper, in- 
Head of thefe faits, to add to the glyflers 
an infufion of fenna, or of fome other pur- 
gative that can be extracted by water. The 
antimonial wine may be fometimes em- 
ployed in glyflers with advantage. Hardly 
any glyflers are more effectual than thofe 
made of turpentine properly prepared. 
When all other injections are found inef- 
fectual, recourfe is to be had to the injec- 
tion of tobacco-fmoke ; and, when even 
this fails, recourfe is to be had to the me- 
chanical dilatation to be mentioned here- 
after. 
MCCCCXLVIII. 
As glyflers often fail altogether in re- 
lieving this difeafe, and as even when they 
give OF PHYSIC. 
33 
give fome relief they are often imperfect 
in producing a complete cure; fo it is ge- 
nerally proper, and often neceflary, to at- 
tempt a more entire and certain cure by 
purgatives given by the mouth. The more 
powerful of thefe, or, as they are called, 
the Draftic Purgatives, may be fometimes 
neceflary ; but their ufe is to be avoided, 
both becaufe they are apt to be rejected 
by vomiting, and becaufe when they do 
not fucceed in removing the obftrtuftion 
they are ready to induce an inflammation. 
Upon this account it is ufual, and indeed 
proper, at leaft in the firft place, to employ 
the milder and lefs inflammatory purga- 
tives. None have fucceeded with me 
better than the cryftals of tartar, becaufe 
this medicine may be conveniently given 
in fmall but repeated dofes, to a confider- 
able quantity ; and under this manage- 
ment it is the purgative leaft ready to be 
rejected 34 
PRACTICE 
rejected by vomiting, and much lefs fo 
than the other neutral faits. If a flronger 
purgative be required, jalap, properly pre- 
pared, is lefs offenfive to the palate, and 
fits better upon the ftomach, than moft 
other powerful purgatives. On many oc- 
cafions of colic, nothing is more effectually 
purgative than a large dofe of calomel. 
Some practitioners have attempted to re- 
move the obftruCtion of the inteftines 
by antimonial emetics exhibited in fmall 
dofes, repeated at proper intervals ; and 
when thefe dofes are not entirely rejected 
by vomiting, they often prove effectual 
purgatives. 
When every purgative has failed, the 
action of the inteftines has been effectually 
excited by throwing cold water on the 
lower extremities. 
MCCCCXLIX. OF PHYSIC. 
35 
MCCCCXLIX. 
The third means of overcoming the 
fpafm of the inteftines in this difeafe, is 
by employing a mechanical dilatation; 
and it has been frequently fuppofed that 
quickfilver given in large quantity, might 
operate in this manner. I have not, how- 
ever, found it fuccefsful; and the theory 
of it is with me very doubtful. Some au- 
thors have mentioned the ufe of gold and 
iilver pills, or balls, fwallowed down; but 
I have no experience of fuch practices, and 
I cannot fuppofe them a probable means 
of relief. 
MCCCCL, 
Another means of mechanical dilatation, 
and a more probable meafure, is by injec- 
ting a large quantity of warm water by 
proper fyringe, which may throw it 
with 36 
PRACTICE 
with fome force, and in a continued ftream, 
into the rectum. Both from the experi- 
ments reported by the late Mr de Haen, 
and from thofe I myfelf have had occafion 
to make, I judge this remedy to be one of 
the moft powerful and effectual. 
MCCCCLI. 
I have now mentioned all the fever al 
means that may be employed for the cure 
of the colic, confidered as a genus ; but 
before I quit this fubjedd, it may be ex- 
pected that I Ihould take notice of fome 
of the fpecies which may feem to require 
a particular confideration. In this view it 
may be expeded that I fhould efpecially 
take notice of that fpecies named the Colic 
of Poitou, and particularly known in Eng- 
land by the name of the Devonfhire Co- 
lic. 
MCCCCLII. OF PHYSIC. 
37 
MCCCCLII. 
This fpecies of the difeafe is certainly a 
peculiar one, both in refpedl of its caufe 
and its effedls ; but, as to the firft, it has 
been lately fo much the fubjedl of invefti- 
gation, and is fo well afcertained by the 
learned phylicians Sir George Baker and 
Dr Hardy, that it is unneceffary for me to 
fay any thing of it here. 
With refpedl to the cure of it, fo far as 
it appears in the form of a colic, my want 
of experience concerning it does not allow 
me to fpeak with any confidence on the 
fubject; but, fo far as I can learn from 
others, it appears to me, that it is to be 
treated by all the feveral means that I have 
propofed above for the cure of colic in ge- 
neral. 
How far the peculiar effects of this dif- 
eafe are to be certainly forefeen and ob- 
viated, I have not properly learned ; and I 
muft 38 
PRACTICE 
muft leave the matter to be determined by 
thofe who have had fufficient experience 
in it. 
C I I A P. OF PHYSIC 
39 
CHAP. X. 
Of the Cholera. 
MCCCCLIIL 
IN this difeafe, a vomiting and purging 
concurring together, or frequently al- 
ternating with one another, are the chief 
fymptoms. The matter rejected both up- 
wards and downwards appears manifeftly 
to confift chiefly of bile, 
MCCCCLIV. 40 
PRACTICE 
MCCCCLIV. 
From this laft circumflance I conclude, 
that the difeafe depends upon an increafed 
fecretion of bile, and its copious effufion 
into the alimentary canal; and, as in this 
it irritates and excites the motions above- 
mentioned, I infer, that the bile thus ef- 
fufed in larger quantity is at the fame 
time alfo of a more acrid quality. This 
appears likewife from the violent and very 
painful gripings that attend the difeafe, 
and which we can impute only to the vio- 
lent fpafmodic contractions of the intef- 
tines that take place here. Thefe fpafms 
are commonly communicated to the ab- 
dominal mufcles, and very frequently to 
thofe of the extremities. 
MCCCCLV. 
In the manner now defcribed, the dif- 
eafe OF PHYSIC. 
41 
cafe frequently proceeds with great vio- 
lence, till the ftrength of the patient is 
greatly, and often fuddenly, weakened; 
while a coldnefs of the extremities, cold 
fweats, and faintings coming on, an end 
is put to the patient's life, fometimes in 
the courfe of one day. In other cafes the 
difeafe is lefs violent, continues for a day 
or two, and then ceafes by degrees ; tho' 
fuch recoveries feldom happen without 
the affiftance of remedies. 
MCCCCLVL 
The attacks of this difeafe are fclHom 
accompanied with any fymptoms of py- 
rexia ; and though, during the courfe 
of it, both the pulfe and refpiration are 
hurried and irregular, yet thefc fymp- 
toms are generally fo entirely removed 
by the remedies that quiet the fpaf- 
modic affedions peculiar to the difeafe, as 
to leave no ground for fuppofing that it 
Vol. IV. 
D 
liatj. 42 
PRACTICE 
had been accompanied by any proper py- 
rexia. 
MCCCCLVII. 
This is a difeafe attending a very warns 
ftate of the air; and, in very warm cli- 
mates, it may perhaps appear at any time 
of the year; but even in fuch climates it 
is moft frequent during their warm eft fea- 
fons; and in temperate climates, it ap- 
pears only in the warm feafons. Dr Sy- 
denham confidered the appearances of 
this difeafe in England to be confined to 
the month of Auguft; but he himfelf ob- 
ferved it to appear fometimes towards the 
end of fummer, when the feafon was un- 
ufually warm; and that in proportion to 
the heat, the violence of the difeafe was 
greater. Others have obferved that it 
appeared more early in fummer, and al- 
ways OF PHYSIC. 
43 
ways fooner or later, according as the great 
heats fooner or later fet in. 
MCCCCLVin. 
From all thefe circumftances, it is, I 
think, very evident, that this difeafe is 
the effect of a warm atmofphere, produ- 
cing fome change in the date of the bile 
in the human body ; and the change may 
coniift either in the matter of the bile 
being rendered more acrid, and thereby 
fitted to excite a more copious fecretion; 
or, in the fame matter its being prepa- 
red to pafs off in larger quantity than 
ufual. f 
MCCCCLIX. 
It has been remarked, that in warm cli- 
mates and feafons, after extremely hot and 
dry weather, a fall of rain cooling the at- 
moiphere 
D.2 44 
PRACTICE 
mofphere feems efpecially to bring on this, 
difeafe; and it is very probable that an 
obflrudled perfpiration may have alfo a 
fhare in this, though it is alfo certain 
that the difeafe does appear when no 
change in the temperature of the air, nor 
any application of cold, have been obfer- 
ved. 
MCCCCLX. 
It is poffible that, in fome cafes, the 
heat of the feafon may give only a predif- 
polition, and that the difeafe may be ex- 
cited by certain ingefta or other caufes; 
but it is equally certain that the difeafe 
has occurred without any previous change 
or error, either in diet, or in the manner 
of life, that could be obferved. 
MCCCCLXI. OF PHYSIC. 
45 
MCCCCLXI. 
The Nofologifts have conftituted a Ge- 
nus under the title of Cholera, and under 
this have arranged as fpecies every affec- 
tion in which a vomiting and purging of 
any kind happened to concur. In many 
of thefe fpecies, however, the matter eva- 
cuated is not bilious; nor does the eva- 
cuation proceed from any caufe in the 
ftate of the atmofphere. Further, in 
many of thefe fpecies alfo, the vomiting 
which occurs is not an effential, but mere- 
ly an accidental fymptom from the parti- 
cular violence of the difeafe. The appella- 
tion of Cholera therefore fhould, in my 
opinion, be confined to the difeafe I have 
defcribed above ; which by its peculiar 
caufe, and perhaps alfo by its fymptoms, 
is very different from all the other fpecies 
that have been affociated with it. I be- 
lieve that all the other fpecies arranged 
under 46 
PRACTICE 
under the title of Cholera by Sauvages or 
Sagar, may be properly enough referred 
to the genus of Diarrhoea; which we are 
to treat of in the next chapter. 
The diftindion I have endeavoured to 
eftablifh between the proper Cholera, and 
the other difeafes that have fometimes got 
the fame appellation, will, as I judge, fu- 
perfede the queftion, Whether the Chole- 
ra, in temperate climates, happens at any 
other feafon than that above afligned. 
MCCCCLXII. 
In the cafe of a genuine cholera, the 
cure of it has been long eftablifhed by- 
experience. 
In the beginning of the difeafe, the eva- 
cuation of the redundant bile is to be fa- 
voured by the plentiful exhibition of mild 
diluents, both given by the mouth and 
injected by the anus; and all evacuant 
medicines, OF PHYSIC. 
47 
medicines, employed in either way, are 
not only fuperffuous, but commonly hurt- 
ful. 
MCCCCLXIIL 
When the redundant bile appears to be 
fufficiently waflied out, and even before 
that, if the fpafmodic affections of the ali- 
mentary canal become very violent, and 
are communicated in a coniiderable de- 
gree to other parts of the body, or when 
a dangerous debility feems to be induced, 
the irritation is to be immediately obvia- 
ted by opiates, in fufficiently large dofes, 
but in fmall bulk, and given either by the 
mouth or by glyfter. 
MCCCCLXIV. 
Though the patient be in this manner 
relieved, it frequently happens, that when 
D4 
the 48 
PRACTICE 
the operation of the opium is over, the 
difeafe ftiows a tendency to return; and, 
for at leaft fome days after the firft attack, 
the'irritability of the inteftines, and their 
difpofition to fall into painful fpafmodic 
contractions, feem to continue. In this 
fituation, the repetition of the opiates, for 
perhaps feveral days, may come to be ne- 
ceffary; and as the debility commonly in- 
duced by the difeafe favours the difpoii- 
tion to fpafmodic affeCtions, it is often 
ufeful and neceflary, together with the 
opiates, to employ the tonic powers of the 
Peruvian bark. 
CHAP. OF PHYSIC. 
49 
CHAP. XI. 
Of Diarrhoea, or Looseness. 
MCCCCLXV. 
THIS difeafe conlifts in evacuations by 
ftool, more frequent and of more 
liquid matter than ufual. This leading 
and chara&eriftic fymptom is fo diverli- 
fied in its degree, in its caufes, and in the 
variety of matter evacuated, that it is al- 
moft impoffible to give any general hiftory 
of the difeafe. 
MCCGCLXVL 50 
PRACTICE 
MCCCCLXVI. 
It is to be diftinguiflied from dyfentery, 
by not being contagious; by being gene- 
rally without fever; and by being with 
the evacuation of the natural excrements, 
which are, at leaft for fome time, retained 
in dyfentery. The two difeafes have been 
commonly diftinguiflied by the gripings 
being more violent in the dyfentery; and 
they are commonly lefs violent and lefs 
frequent in diarrhoea; but as they fre- 
quently do occur in this alfo, and fome- 
times to a confiderable degree, fo they do 
not afford any proper diftin&ion. 
MCCCCLXVII. 
A diarrhoea is to be diftinguiflied from 
cholera chiefly by the difference of their 
caufes; which, in cholera, is of one pecu- 
liar kind; but in diarrhoea is prodigioufly 
diver-* OF PHYSIC. 
51 
diveriified, as we lhall fee prefently. It 
has been common to diftinguilh cholera, 
by the evacuation downwards being of bi- 
lious matter, and by this being always 
accompanied with a vomiting of the fame 
kind; but it does not univerfally apply, 
as a diarrhoea is fometimes attended with 
vomiting, and even of bilious matter. 
MCCCCLXVIII. 
The difeafe of diarrhoea, thus diftinguifh- 
ed, is very greatly diveriified; but in all 
cafes, the frequency of ftools is to be im- 
puted to a preternatural increafe of the 
periftaltic motion in the whole, or at leaft 
a confiderable portion, of the inteftinal 
canal. This increafed action is in differ- 
ent degrees, is often convulfive and fpaf- 
modic, and at any rate is a motus abnor- 
mts: for which reafon, in the Methodical 
Nofology, 1 have referred it to the order 
of 52 
PRACTICE 
of Spafmi, and accordingly treat of it in 
this place. 
MCCCCLXIX. 
Upon the fame ground, as I confider 
the difeafe named Lientery to be an in- 
creafed periftaltic motion over the whole of 
the inteftinal canal, arifingfrom a peculiar 
irritability, I have conlidered it as merely a 
fpecies of diarrhoea. The idea of a laxity 
of the inteftinal canal being the caufe ei- 
ther of lientery, or other fpecies of diar- 
rhoea,'appears to me to be without foun- 
dation, except in the (ingle cafe of fre- 
quent liquid (tools from a palfy of the 
fpbincter ani. 
MCCCCLXX. 
The increafed action of the periftaltic 
motion, I confider as always the chief part 
of O F P H Y S I C, 
53 
of the proximate caufe of diarrhoea ; but 
the difeafe is further, and indeed chiefly, 
diverfified by the different caufes of this 
increafed adion; which we are now to 
inquire into. 
MCCCCLXXI. 
The feveral caufes of the increafed ac- 
tion of the inteftines may be referred, I 
think, in the firft place, to two general 
heads. 
The firfi is, of the difeafes of certain 
parts of the body which, either from a 
confent of the inteftines with thefe parts, 
or from the relation which the inteftines 
have to the whole fyftem, occafion an in- 
creafed adion in the inteftines, without 
the transference of any ftimulant matter 
from the primary difeafed part to them. 
The fecond head of the caufes of the in- 
creafed adion of the inteftines is of the 
ftimuli 54 
PRACTICE 
ilimuli of various kinds, which are ap- 
plied diredlly to the inteflines themfelves. 
MCCCCLXXII. 
That affedlions of other parts of the fy- 
ftem may affect the inteflines without the 
transference or application of any flimu- 
lant matter, we learn from hence, that the 
paflions of the mind do in fome perfons 
excite diarrhoea. 
MCCCCLXXIIL 
That difeafes in other parts may in like 
manner affect the inteftines, appears from 
the dentition of infants frequently exci- 
ting diarrhoea. I believe that the gout 
often affords another infiance of the fame 
kind; and probably there are others alfo, 
though not well afcertained. 
MCCCCLXXIV. O F P H Y S I C, 
55 
MCCCCLXXIV. 
The ftimuli (MCCCCLXXI.) which 
may be applied to the inteftines are of 
very various kinds; and are either, 
1. Matters introduced by the mouth. 
2. Matters poured into the inteftines by 
the feveral excretories opening into them. 
3. Matters poured from certain preter- 
natural openings made into them in cer- 
tain difeafes.. 
MCCCCLXXV. 
Of thofe (MCCCCLXXI. i.) introduced 
by the mouth, the firft to be mentioned 
are the aliments commonly taken in. Too 
great a quantity of thefe taken in, often 
prevents their due digeftion in the fto- 
mach; and by being thus Cent in their 
crude, and probably acrid, date to the 
in- 56 
PRACTICE 
inteftines, they frequently excite diar- 
rhoea. 
The fame aliments, though in proper 
quantity, yet having too great a propor- 
tion, as frequently happens, of faline or 
faccharine matter along with them, prove 
ftimulant to the inteftines, and excite 
diarrhoea. 
But our aliments prove efpecially the 
caufes of diarrhoea, according as they, 
from their own nature, or from the weak- 
nefs of the ftomach, are difpofed to un- 
dergo an undue degree of fermentation 
there, and thereby become ftimulant to 
the inteftines. Thus acefcent aliments are 
ready to produce diarrhoea ; but whether 
from their having any direftly purgative 
quality, or only as mixed in an over pro- 
portion with the bile, is not well determi- 
ned. 
MCCCCLXXVI. OF PHYSIC. 
57 
MCCCCLXXVI. 
Not only the acefcent, but alfo the putref- 
cent difpofition of the aliments, feems to 
occafion a diarrhoea; and it appears that 
even the effluvia of putrid bodies, taken 
in any way in large quantity, have the fame 
effect. 
Are oils or fats, taken in as a part of 
our aliments, ever the caufe of diarrhoea ? 
and if fo, in what manner do they operate ? 
MCCCCLXXVII. 
The other matters introduced by the 
mouth, which may be caufes of diarrhoea, 
are thofe thrown in either as medicines, 
or poifons that have the faculty of (Emu- 
lating the alimentary canal. Thus, in the 
lift of the Materia Medica, we have a long 
catalogue of thofe named purgatives; and 
in the lift of poifons, we have many pof- 
fef- 
Vol. IV. 
E 58 
PRACTICE 
felled of the fame quality. The former, gi- 
ven in a certain quantity, occafion a tem- 
porary diarrhoea ; and given in very large 
dofes, may occafion it in excefs, and con- 
tinue it longer than ufual, producing that 
fpecies of diarrhoea named a Hypercathar- 
fis. 
MCCCCLXXVIII. 
The matters (MCCCCLXXIV. 2.) poured 
into the cavity of the inteftines from the 
excretories opening into them, and which 
may occafion diarrhoea, are either thofe 
from the pancreatic or biliary dudl, or 
thofe from the excretories in the coats of 
the inteftines themfelves. 
MCCCCLXXIX. 
What changes may happen in the pan- 
creatic juice, Ido not exactly know; but I 
fuppofe OF PHYSIC. 
59 
filppofe that an acrid fluid may iffue from 
the pancreas, even while ftill entire in its 
ftrudlure ; but more efpecially, when it is 
in a fuppuratedjfcirrhous, or cancerous Rate, 
that a very acrid matter may be poured 
out by the pancreatic dudl, and occalion 
diarrhoea. 
MCCCCLXXX. 
We know well, that from the biliary 
dudt the bile may be poured out in great- 
er quantity than ufual; and there is little 
doubt of its being alfo fometimes poured 
out of a more than ordinary acrid quality. 
It is very probable, that in both ways the 
bile is frequently a caufe of diarrhoea. 
Though I have faid above that diarrhoea 
may be commonly diftinguiihed from cho- 
lera, I mull admit here, that as the cau- 
fes producing that (late of the bile which 
occafions cholera, may occur in all the 
E 2 
different 60 
PRACTICE 
different poffible degrees of force, fo as, on 
one occafion, to produce the moft violent 
and dillindly marked cholera ; but, upon 
another, to produce only the gentlefl: diar- 
rhoea ; which, however, will be the fame 
difeafe, only varying in degree: So I 
think it probable, that in warm climates, 
and in warm feafons, a diarrhoea biliofa of 
this kind may frequently occur, not to be 
always certainly diftinguifhed from cho- 
lera. 
However this may be, it is fufficiently 
probable, that, in fome cafes, the bile, 
without having been adled upon by the 
heat of the climate or feafon, may be re- 
dundant and acrid, and prove therefore a 
particular caufe of diarrhoea. 
MCCCCLXXXI. 
Befide bile from the feveral caufes and: 
in the conditions mentioned, the biliary 
du€t OF PHYSIC. 
61 
duct may pour out pusj or other matter, 
from abfcefles in the liver, which may be 
the caufe of diarrhoea. 
Practical writers take notice of a diar- 
rhoea wherein a tHin and bloody liquid is 
difcharged; which they fuppofe to have 
proceeded from the liver, and have there- 
fore given the difeafe the name of Hepa- 
tirrhoea: but we have not met with any 
inllance of this kind ; and therefore can- 
not properly fay any thing concerning it- 
MCCCCLXXXII. 
A fecond fet of excretories, from which 
matter is poured into the cavity of the in- 
teflincs, are thofe from the coats of the 
inteflines themfelves; and are either the, 
exhalants proceedingly directly from the 
extremities of arteries, or the excretories 
from the mucous follicles : and boththefe 
fources occur in prodigious number over 
E3 
the 62 
PRACTICE 
the internal furface ©f the whole intefti- 
nal canal. It is probable that it is chiefly 
the eflufion from thefe fources which, in 
moft inftances, gives the matter of the li- 
quid ftools occurring in diarrhoea. 
MCCCCLXXX1II. 
The matter from both fources may be 
poured out in larger quantity than ufual, 
merely by the increafed adlion of the in- 
teftines, whether that be excited by the 
paflions of the mind (MCCCCXXIL), by 
difeafes in other parts of the fyftem 
(MCCCCLXX1. i.), or by the various fti- 
mulants mentioned MCCCCLXXV. and 
following; or the quantity of matter pour- 
ed out may be increafed, not fo much by 
the increafed action of the inteftines, as 
by an increafed afflux of fluids from other 
parts of the fyftem. 
Thus, cold applied to the furface of the 
body3 OF PHYSIC. 
63 
body, and fupprefling perfpiration, may 
determine a greater quantity of fluids to 
the inteflines. 
Thus, in the ifchuria renal'is, the urine ta- 
ken into the blood-veffels is fometimes de- 
termined to pafs off again by the inteflines. 
In like manner, pus or ferum may be 
abforbed from the cavities in which they 
have been ftagnant, and be again poured 
•out into the inteftines, as frequently hap- 
pens, in particular with refpedt to the wa- 
ter of dropfies. 
MCCCCLXXXIV. 
It is to be obferved here, that a diar- 
rhoea may be excited not only by a copious 
afflux of fluids from other parts of the fy~ 
Item, but likewife by the mere determi- 
nation of various acrid matters from the 
mafs of blood into the cavity of the inte- 
ftines. Thus it is fuppofed that the mor- 
bific 
e4 64 
PRACTICE 
bific matter of fevers is fometimes thrown 
out into the cavity of the inteftines, and 
gives a critical diarrhoea: and whether I 
do or do not admit the doctrine of critical 
evacuations, I think it is probable that the 
morbific matter of the exanthemata is fre- 
quently thrown upon the inteftines, and 
occafions diarrhoea. . 
MCCCCLXXXV. 
It is to me further probable, that the 
putrefcent matter diffufed over the mafs 
of blood in putrid difeafes, is frequently 
poured out by the exhalants into the in- 
teftines, and proves there the caufe, at lead: 
in parr, of the diarrhoea fo commonly at- 
tending thefe difeafes. 
MCCCCLXXXVL 
Upon this fubjeft of the matters pour- 
ed 
•-1 OF PHYSIC. 
65 
ed into the cavity of the inteflines, I have 
chiefly confidered them as poured out in 
unufual quantity : but it is probable that, 
for the mofl part, they are alfo changed 
in their quality, and become of a more 
acrid and ftimulant nature; upon which 
account efpecially it is, that they excite, 
or at leaf! increafe, a diarrhoea. 
MCCCCLXXXVIL 
How far, and in what manner, the ex- 
halant fluid may be changed in its nature 
and quality, we do not certainly know: 
but with refpedl to the fluid from the 
mucous excretories, we know, that, when 
poured out in unufual quantity, it is com- 
monly, at the fame time, in a more li- 
quid and acrid form; and may prove, 
therefore, confiderably irritating. 
MCCCCLXXXVIIL 66 
PRACTICE 
MCCCCLXXXVIII. 
Though the copious effufion of a more' 
liquid and acrid matter from the mucous 
excretories, be probably owing to the mat- 
ter being poured out immediately as it is 
fecreted from the blood into the mucous 
follicles, without being allowed to ftagnate 
in the latter, fo as to acquire that milder 
quality and thicker confidence we com- 
monly find in the mucus in its natural 
date ; and although we might fuppofe that 
the excretions of a thin and acrid fluid 
fhould always be the effect of every deter- 
mination to the mucous follicles, and of 
every ftimulant applied to them; yet it is 
certain, that the reverfe is fometimes the 
cafe; and that, from the mucous follicles, 
there is frequently an increafed excretion of 
a mucus, which appears in its proper form 
of a mild, vifcid, and thickifh matter. 
This commonly occurs in the cafe of dy- 
fentery; OF PHYSIC. 
67 
fentery; and it has been obferved to give 
a fpecies of diarrhoea, which has been pro- 
perly named the Diarrhea Mucofa. 
MCCCCLXXXIX. 
A third fource of matter poured into the 
cavity of the inteftines, and occasioning 
diarrhoea (MCCCCLXXIV. 3.), is from 
thofe preternatural openings produced by 
difeafes in the inteftines or neighbouring 
parts. Thus the blood-veffels on the in- 
ternal furface of the inteftines may be 
opened by erofton, rupture, or anaftomo- 
fis, and pour into the cavity their blood, 
which, either by its quantity or by its 
acrimony, whether inherent, or acquired 
by Stagnation, may Sometimes give a diar- 
rhoea evacuating bloody matter. This is 
what I think happens in that difeafe which 
Jias been called the Mebzna or Morbus Niger. 
MCCCCXC. 68 
PRACTICE 
MCCCCXC. 
Another preternatural fource of matter 
poured into the cavity of the inteftines, is 
the rupture of abfcefles feated either in the 
coats of the inteftines themfelves, or in any 
of the contiguous vifcera, which, during 
an inflamed ftate, had formed an adhefion 
with fome part of the inteftines. The 
matter thus poured into their cavity may 
be various ; purulent, or fanious, or both 
together, mixed at the fame time with 
more or lefs of blood; and in each of thefe 
ftates may be a caufe of diarrhoea. 
MCCCCXCL 
Amongft the ftimuli that may be di- 
rectly applied to the inteftines, and which, 
by increafing their periftaltic motion, may 
occafion diarrhoea, I muft not omit to 
men- OF PHYSIC. 
69 
mention worms, as having frequently that 
efteeft. 
MCCCCXCII. 
I muft alfo mention here a ftate of 
the inteftines, wherein their periftaltic mo- 
tion is preternaturally increafed, and a 
diarrhoea produced; and that is, when 
they are affedled with an erythematic in- 
flammation. With refpecft to the exiftence 
of fuch a ftate, and its occafioning diar- 
rhoea, fee what is faid above inCCCXCVIIL 
and following. Whether it is to be con- 
fldered as a particular and diftinft cafe of 
diarrhoea, or is always the fame with fome 
of thofe produced by one or ether of the 
caufes above mentioned, I have not been 
able to determine. 
MCCCCXCIII. 70 
PRACTICE 
MCCCCXCIII. 
Laftly, by an accumulation of alimen- 
tary or of other matter poured into the ca- 
vity of the inteftines from feveral of the 
fources above mentioned, a diarrhoea may 
be efpecially occafioned when the abforp- 
tion of the ladleals, or of other abforbents, 
is prevented, either by an obftrudtion of 
their orifices, or by an obftrudlion of the 
mefenteric glands, through which alone 
the abforbed fluids can be tranfmitted. 
In one inftance of this kind, when the 
chyle prepared in the ftomach and duode- 
num is not abforbed in the courfe of the 
inteftines, but pafles off* in confiderable 
quantity by the anus, the difeafe has been 
named the Morbus Cceliacus, or Amply and 
more properly Cdiaca; which according- 
ly I have confidered as a fpecies of diar- 
rhoea. 
MCCCCXC1V. O F P H Y S I C. 
71 
MCCCCXCIV. 
I have thus endeavoured to point out 
the various Species of difeafe that may 
come under the general appellation of 
Diarrhoea; and from that enumeration it 
will appear, that many, and indeed the 
greater part of the cafes of diarrhoea, are 
to be confidered as fympathic affections, 
and to be cured only by curing the pri- 
mary difeafe upon which they depend; of 
which, however, I cannot properly treat 
here. From our enumeration it will alfb 
appear, that many of the cafes of diarrhoea 
which may be confidered as idiopathic, 
will not require my faying much of them 
here. In many infiances, the difeafe is as- 
certained, and alfo the caufe affigned, by 
the condition of the matter evacuated; fo 
that what is neceffary to correct or remove 
it will be fufficiently obvious to practitio- 
ners of any knowledge. In fhort, I dfynot 
find 72 
PRACTICE 
find that I can offer any general plan for 
the cure of diarrhoea; and all that I can 
propofe to do on this fubjedl:, is to give 
fome general remarks on the practice that 
has been commonly followed in the cure 
of this difeafe. 
MCCCCXCV. 
The practice in this difeafe has chiefly- 
proceeded upon the fuppoAtion of an acri- 
mony in the fluids, or of a laxity in the 
Ample and moving flbres of the inteftines; 
and the remedies employed have accor- 
dingly been correctors of particular acri- 
mony, general demulcents, evacuants by 
vomiting or purging, aftringents, or opiates. 
Upon each of thefe kinds of remedy I fhall 
now offer fome remarks. 
MCCCCXCVI. O F P H Y S I C. 
73 
MCCCCXCVI. 
An acid acrimony is, upon feveral occa- 
lions, the caufe of diarrhoea, particularly 
in children; and in fuch cafes the abfor- 
bent earths have been very properly em- 
ployed. The common, however, and pro- 
mifcuous ufe of thefe has been very injudi- 
cious ; and where there is any putrefcency, 
they muft be hurtful. 
MCCCCXCVIL 
The cafes in which there is a putrid or 
putrefcent acrimony prevailing, have been, 
I think, too feldom taken notice of; and, 
therefore, the ufe of acids too feldom ad- 
mitted. The acrimony to be fufpedted in 
bilious cafes, is probably of the putrefcent 
kind. 
Vol. IV. 
F 
MCCCCXGVIII. 74 
PRACTICE 
MCCCCXCVIII. 
The general correctors of acrimony are 
the mild diluents and demulcents. The 
former have not been fo much employed 
in diarrhoea as they ought; for, joined 
with demulcents, they very much increafe 
the effects of the latter : and although the 
demulcents, both mucilaginous and oily, 
may by themfelves be ufeful, yet without 
the affiltance of diluents they can hardly 
be introduced in fuch quantity as to an- 
fwer the purpofe. 
MCCCCXCIX. 
As indigeftion and crudities prefent in 
the ftomach, are fo often the caufe of diar- 
rhoea, vomiting mull therefore be fre- 
quently very ufeful in this difcafe. 
In like manner, when the difeafe pro- 
ceeds, as it often does, from obflrudled per- 
fpiration, OF PHYSIC, 
75 
fpiration, and increafed afflux of fluids to 
the inteflines, vomiting is perhaps the moft 
effectual means of refloring the determi- 
nation of the fluids to the furface of the 
body. 
It is poffible alfo, that vomiting may 
give fome inverfion of the periflaltic mo- 
tion, which is determined too much down- 
wards in diarrhoea; fo that upon the whole 
it is a remedy which may be very gene- 
rally ufeful in this difeafe. 
MD. 
Purging has been fuppofed to be more 
univerfally neceffary, and has been more 
generally pradlifed. This, however, in my 
opinion, proceeds upon very miftaken no- 
tions with refpedt to thedifeafe; and fuch a 
practice feems to me for the mod part fuper- 
fluous, and in many cafes very hurtful. It 
goes upon the fuppofition of an acrimony 
F 2 
pre- 76 
PRACTICE 
prefent in the inteftines, that ought to be car- 
ried out by purging: but, if that acrimony 
has either been introduced by the mouth,or 
brought into the inteftines from other parts 
of the body, purging can neither be a means 
of correcting nor of exhaufting it; and muft 
rather have the efteCl of increafing its af- 
flux, and of aggravating its effects. From 
whatever fource the acrimony which can 
excite a diarrhoea proceeds, it may be fup- 
pofed fufhcient to evacuate itfelf, fo far as 
that can be done by purging ; and as in 
cholera, fo in the fame kind of diarrhoea, 
it will be more proper to aflift the evacua- 
tion by diluents and demulcents, than te 
increafe the irritation by purgatives. 
MDI. 
If, then, the ufe of purgatives in diar- 
rhoea may be coniidered, even when 
an acrimony is prefent, as fuperfluous, 
them OF PHYSIC. 
77 
there are many other cafes in which it 
may be extremely hurtful. If the irrita- 
bility of the inteftines fhall, from affec- 
tions in other parts of the fyftem, or other 
caufes, have been already very much in- 
creafed, purgatives muft necelTarily aggra- 
vate the difeafe. In the cafe of lientery, 
nobody thinks of giving a purgative; and 
in many cafes of diarrhoea approaching to 
that, they muft be equally improper. I 
have already obferved, that when diar- 
rhoea proceeds from an afflux of fluids to 
the inteftines, whether in too great quan- 
tity, or of an acrid quality, purgatives 
may be hurtful; and whoever, therefore, 
confiders the numerous and various four- 
ces from which acrid matter may be 
poured into the cavity of the inteftines, 
will readily perceive, that, in many cafes 
of diarrhoea, purgatives may be extremely 
pernicious. 
There is one cafe in particular to be ta- 
ken 
*3 78 
PRACTICE 
ken notice of. When, from a general and 
acrid diflblution of the blood, the ferous 
fluids run off too copioufly into the cavity 
of the inteftines, and excite that diarrhoea 
which attends the advanced ftate of hcdlic 
fever, and is properly called a Colliqua- 
tive Diarrhoea ; 1 have, in fuch cafes, often 
feen purgatives given with the moft bane- 
ful eflecls. 
There is ftill another cafe of diarrhoea 
in which purgatives are pernicious; and 
that is, when the difeafe depends, as we 
have alleged it fometimes may, upon an 
erythematic inflammation of the inte- 
ftines. 
I need hardly add, that if there be a 
cafe of diarrhoea depending upon a laxity 
of the folids, purgatives cannot there be of 
any fervice, and may do much harm. 
Upon the whole, it will, I think, appear, 
that the ufe of purgatives in diarrhoea 
is very much limited ; and that the pro- 
mif- OF PHYSIC. 
79 
mifcuous ufe of them, which has been 
fo common, is injudicious, and often per- 
nicious. I believe the practice has been 
chiefly owing to the ufe of purgatives in 
dyfenteric cafes, in which they are truly 
ufeful; becaufe, contrary to the cafe of 
diarrhoea, there is in dyfentery a conli- 
derable conftricftion of the inteftines. 
MDII. 
Another fet of remedies employed in, 
diarrhoea are aftringents. There has been 
feme helitation about the employment of 
thefe in recent cafes, upon the fuppofition 
that they might occafion the retention of 
an acrid matter that fhould be thrown out. 
I cannot, however, well underhand or 
afiign the cafes in which fuch caution is 
neceflary; and I think that the power of 
aftringents is feldom fo great as to render 
their ufe very dangerous. The only diffi- 
culty 
f4 80 
PRACTICE 
culty which has occurred to me, with re* 
IpeCt to their ufe, has been to judge of the 
circumftances to which they are efpecially 
adapted. It appears to me to be only in 
thofe where the irritability of the inte- 
ftines depends upon a lofs of tone : and 
this, I think, may occur either from the 
debility of the whole fyftem, or from cau- 
fes adiing on the inteftines alone. All 
violent or long-continued fpafmodic and. 
convulfive affedions of the inteftinal ca- 
nal neceffarily induce a debility there; and 
fuch caufes often take place, from violent 
irritation, in colic, dyfentery, cholera, and 
diarrhoea. 
MDI1L 
The laft of the remedies of diarrhoea 
that remain to be mentioned are opiates. 
The fame objections have been made to 
the ufe of thefe, in recent cafes of di ar- 
rhoea, 
> A PRACTICE 
81 
rhoea, as to that of aftringents; but on no 
good grounds : for the effect of opiates, 
as aftringent, is never very permanent; 
and an evacuation depending upon irri- 
tation, though it may be for fome time 
fufpended by opiates, yet always returns 
very foon. It is only by taking off irri- 
tability that opiates are ufeful in diar- 
rhoea ; and therefore, when the difeafe 
depends upon an increafe of irritability 
alone, or when, though proceeding from 
irritation, that irritation is corrected or 
exhaufted, opiates are the moft ufeful and. 
certain remedy. And though opiates are 
not fuited to corredl or remove an irrita- 
tion applied, they are often of great be- 
nefit in fufpendingi the effects of that ir- 
ritation whenever thefe are violent: and, 
upon the whole, it will appear, that opiates 
may be very frequently, and with great 
propriety, employed in the cure of diar- 
rhoea. 
CHAP. 
t ■  PRACTICE 
82 
CHAP. XII. 
Of the Diabetes. 
MDIV. 
THIS difeafe confifts in the voiding 
of an unufually large quantity of 
urine. 
As hardly any fecretion can be increa- 
f$d without an increafed action of the vef- 
fels concerned in it, as fome indan- 
ces of this difeafe are attended with af- 
fections manifeftly fpafmodic, 1 have had 
no doubt of arranging the diabetes under 
order of Spafmi. 
MPV, OF PHYSIC. 
83 
MDV. ' 
This difeafe is always accompanied with 
a great degree of thirft, and therefore with 
the taking in of a great quantity of drink. 
This in fome meafure accounts for the 
very extraordinary quantities of urine 
voided ; but ftill, independent of this, a 
peculiar difeafe certainly takes place, as the 
quantity of urine voided does almoft al- 
ways exceed the whole of the liquids, and 
fometimes the whole of both folids and li- 
quids, taken in. 
MDVI. 
The urine voided in this difeafe is al- 
ways very clear, and at firft fight appears 
entirely without any colour; but, viewed 
in a certain light, it generally appears to 
be flightly tinged with a yellowifh green, 
and in this refpect has been very properly 
com-  PRACTICE 
84 
compared to a folution of honey in a large 
proportion of water. 
Examined by the tafte, it is very gene- 
rally found to be more or lefs fweet; and 
many experiments that have now been 
made in different inftances of the difeafe, 
fliow clearly that fuch urine contains, in 
confiderable quantity, a faccharine matter, 
which to be very exadlly of the 
nature of common fugar, 
MDVIL 
Doctor Willis feems to me to have been, 
the firft who took notice of the fweetnefs 
of the urine in diabetes, and almoft every 
phyfician of England has lince taken notice 
of the fame. It is to be doubted, indeed, 
if there is any cafe of idiopathic diabetes 
in which the urine is of a different kind. 
Though neither the ancients, nor, in the 
other countries of Europe, the moderns, 
till OF PHYSIC. 
85 
till the latter were directed to it by the 
Englifh, have taken notice of the fweetnefs 
of the urine, it does not perfuade me, that 
either in ancient or in modern times the 
Urine in diabetes was of another kind. I 
myfelf, indeed, think I have met with one 
inftance of diabetes in which the urine was 
perfectly infipid; and it would feem that 
a like obfervation had occurred to Dr Mar- 
tin Lifter. I am perfuaded, however, that 
fuch inftances are very rare ; and that the 
other is by much the more common, and 
perhaps the almoft univerfal occurrence. 
I judge, therefore, that the prefence of fuch 
a faccharine matter may be Confidered as 
the principal circumftance in idiopathic 
diabetes; and it gives at leaft the only cafe 
of that difeafe that I can properly treat of 
here, for I am only certain that what I am 
further to mention relates to fuch a cafe. 
MDVIIL 86 
PRACTICE 
MDVIII. 
The antecedents of this difeafe, and con- 
fequently the remote caufes of it, have not 
been well afcertained. It maybe true that 
it frequently happens to men who, for a 
long time before, had been intemperate in 
drinking ; that it happens to perfons of a 
broken conflitution, or who, as we often 
exprefs it, are in a cachectic ftate; that it 
fometimes follows intermittent fevers; and 
that it has often occurred from excefs in 
the drinking of mineral waters. But none 
of thefe caufes apply very generally to the 
cafes that occur: fuch caufes are not always, 
nor even frequently, followed by a dia- 
betes ; and there are many inftances of 
diabetes which could not be referred to any 
of them. In moft of the cafes of this dif- 
eafe which I have met with, I could not 
refer it to any particular caufe. 
MDIX. 87 
OF PHYSIC. 
MDIX. 
This difeafe commonly comes on {low- 
ly, and almoft imperceptibly, without any 
previous diforder. It often arifes to a con- 
iiderable degree, and fubfifts long without 
being accompanied with evident diforder 
in any particular part of the fyftem. The 
great thirft which always, and the vora- 
cious appetite which frequently occurs in 
it, are often the only remarkablefymptoms. 
Under the continuance of the difeafe, the 
body is often greatly emaciated; and a 
great weaknefs alfo prevails. The pulfe is 
commonly frequent; and an obfcure fe- 
ver is for the moft part prefent. When 
the difeafe proves fatal, it generally ends 
with a fever, in many circumftances, par- 
ticularly thofe of emaciation and 
refembling a hedtic. 
MDX. 88 
PRACTICE 
MDX. 
The proximate caufe of this difeafe is 
not certainly or clearly known. It Teems 
to have been fometimes connected with 
calculous affedlions of the kidneys; and it 
is poflible, that an irritation applied there 
may increafe the fecretion of urine. It 
perhaps often does fo; but how it Ihould 
produce the fmgular change that takes 
place in the Hate of the urine, is not to be 
ealily explained. It certainly often hap- 
pens that calculous matters are long pre- 
fent in the urinary paftages, without ha- 
ting any fuch effect as that of producing 
diabetes in any lhape. 
Some have fuppofed that the difeafe oc- 
curs from a relaxed ftate of the fecretory 
veflels of the kidneys ; and indeed the dif- 
feeftions of perfons who had died of this 
difeafe have Ihown the kidneys in a very 
flaccid ftate. This, however, is probably 
t€> OF PHYSIC. 
89 
to be confidered as rather the effect than 
the caufe of the difeafe. 
That no topical affection of the kidneys 
has a fhare in producing this difeafe, and 
that a fault in the affimilation of the fluids 
is rather to be blamed, I conclude from 
hence, that even the folid food taken in, 
increafes the quantity of the urine voided, 
at the fame time with an increafe of the 
faccharine matter above mentioned. 
MDXL 
The diabetes has been fuppofed to be 
owing to a certain date of the bile; and it 
is true, that this difeafe has fometimes oc- 
curred in perfons who were at the fame 
time affedted with difeafes of the liver: 
but this concurrence does not often take 
place ; and the diabetes frequently occurs 
feparately from any affection of the liver. 
In twenty inftances of diabetes which I 
Vol. IV. 
G 
have 90 
PRACTICE 
have feen, there was not in any one of 
them, any evident affe&ion of the liver. 
The explanation that has been offered of 
the nature and operation of the bile, in 
producing diabetes, is very hypothetical, 
and nowife fatisfying. 
MDXII. 
As I have already faid, I think it pro- 
bable, that in moft cafes the proximate 
caufe of this difeafe is fome fault in the 
aflimilatory powers, or in thofe employed 
in converting alimentary matters into the 
proper animal fluids. This I formerly 
hinted to Dr Dobfon, and it has been pro- 
fecuted and publifhed by him; but I muft 
own, that it is a theory embarraffed with 
fome difficulties which I cannot at prefent 
very well remove. 
MDXIII. OF PHYSIC. 
91 
MDX1IL 
The proximate caufe of diabetes being 
fo little known or afcertained, I cannot 
propofe any rational method of cure in the 
difeafe. From the teftimony of feveral 
authors, I believe that the difeafe has been 
cured : but I believe alfo, that this has 
feldom happened; and when the difeafe has 
been cured, I doubt much if it was effected 
by the feveral remedies to which thefe cures 
have been afcribed. In all the inftances 
of this difeafe which I myfelf have feen, 
and in feveral others of which I have been 
informed, no cure of it has ever been made 
in Scotland, though many inftances of it 
have occurred, and in moft of them the 
remedies recommended by authors have 
been diligently employed. I cannot, there- 
fore, with any advantage, enter into a de- 
tail of thefe remedies; and as the difeafe, 
together with its feveral circumftances, 
G 2 
when  PRACTICE 
92 
when they fhall hereafter occur, is 
likely to become the fubjedt of diligent 
inveftigation, I avoid going farther at 
prefent, and judge it prudent to fufpend 
my opinion till I fhall have more obfer- 
vations and experiments upon which I can 
form it more clearly. 
CHAP. OF PHYSIC. 
93 
C H A P. XIII, 
Of the Hysteria, or the Hysteric 
Disease. 
MDXIVv 
THE many and various fymptoms 
which have been fuppofed to belong 
to a difeafe under this appellation, render 
it extremely difficult to give a general cha- 
racter or definition of it. It is, however, 
proper in all cafes to attempt fome general 
idea; and therefore, by taking the moft 
common form, and that concurrence of 
G 3 
fymp- 94 
PRACTICE 
fymptoms by which it is principally di* 
ftinguilhed, I have formed a character in 
my fyftem of Methodical Nofology, and 
iliall here endeavour to illuftrate it by 
giving a more full hiftory of the pheno- 
mena. 
MDXV. 
The difeafe attacks in paroxyfins or fits. 
Thefe commonly begin by fome pain and 
fulnefs felt in the left fide of the belly. 
From this a ball feems to move with a 
grumbling noife, into the other parts of 
the belly; and, making as it were various 
convolutions there, feems to move into the 
ftomach; and more diftin&ly ft ill rifes up 
to the top of the gullet, where it remains 
for fome time, and by its preflure upon 
the larynx gives a fenfe of fuffbcation. By 
the time that the difeafe has proceeded thus 
far, the patient is affedcd with a ftupor 
and OF PHYSIC. 
95 
and infenfibility, while at the fame time 
the body is agitated with various convul- 
fions. The trunk of the body is wreathed 
to and fro, and the limbs are varioufly 
agitated; commonly the convulfive mo- 
tion of one arm and hand, is that of beat- 
ing, with the clofed lift, upon the breaft 
very violently and repeatedly. This Rate 
continues for fome time, and has during 
that time fome remiflions and renewals of 
the convulfive motions ; but they at length 
ceafe, leaving the patient in a ftupid and 
feemingly fleeping ftate. More or lefs fud- 
denly, and frequently with repeated figh- 
ing and fobbing, together with a murmur- 
ing noife in the belly, the patient returns 
to the exercife of fenfe and motion, but 
generally without any recollection of the 
feveral circumftances that had taken place 
during the fit. 
G 4 
MDXVL 96 
PRACTICE 
MDXVI. 
This is the form of what is called an 
byfieric and is the moft common 
form ; but its paroxyfms are confiderably 
varied in different perfons,and even in the 
fame perfon at different times. It differs, 
by having more or fewer of the circum- 
ftances above mentioned; by thefe cir- 
cumffances being more or lefs violent; and 
by the different duration of the whole fit. 
Before the fit, there is fometimes a fud- 
den and unufually large flow of limpid 
urine. At the coming on of the fit, the 
ftomach is fometimes affected with vomit- 
ing, the lungs with confiderable difficulty 
of breathing, and the heart with palpita- 
tions. During the fit, the whole of the 
belly, and particularly the navel, is drawn 
ftrongly inwards; the fphindler ani is 
fometimes fo firmly conftricled as not to 
admitafmallglyfter-pipe, and there is at the 
fams OF PHYSIC. 
97 
fame time an entire fuppreflion of urine. 
Such fits are, from time to time, ready to 
recur; and during the intervals, the pa- 
tients are liable to involuntary motions, to 
fits of laughing and crying, with fudden 
tranfitions from the one to the other; while 
fometimes falfe imaginations, and fomc 
degree of delirium, alfo occur. 
MDXVII. 
Thefe affections have been fuppofed pe- 
culiar to the female fex ; and indeed they 
moft commonly appear in females : but 
they fometimes, though rarely, attack alfo 
the male fex; never, however, that I have 
obferved, in the fame exquifite degree. 
In the female fex, the difeafe occurs efpe- 
cially from the age of puberty to that of 
thirty-five years ; and though it does fome- 
times, yet very feldom appears before the 
former or after the latter of thefe periods. 
At 98 
PRACTICE 
At all ages, the time at which it moft 
readily occurs is that of the menftrual pe- 
riod. 
The difeafe more efpecially affects the 
females of the moft exquifitely fanguine 
and plethoric habits, and frequently affecfts 
thofe of the moft robuft and mafculine 
conftitutions. 
It affects the barren more than the 
breeding women, and therefore frequently 
young widows. 
It occurs efpecially in thofe females who 
are liable to the Nymphomania; and the 
Nofologifts have properly enough marked 
one of the varieties of this difeafe by the 
title of Hyjlena Libidinofa, 
In the perfons liable to the fits of this 
difeafe, it is readily excited by the paf- 
fions of the mind, and by every confider- 
able emotion, efpecially thofe brought on 
by furprife. 
The perfons liable to this difeafe ac- 
quire OF PHYSIC. 
99 
quire often fuch a degree of fenfibility, as 
to be flrongly affedled by every impreffion 
that comes upon them by furprife. 
MDXVIIL 
In this hillory, there appears to be a 
concurrence of fymptoms and circumflan- 
ces properly marking a very particular 
difeafe, which I think may be diflinguifh- 
ed from all others. It feems to me to 
have been improperly confidered by phy- 
ficians as the fame with fome other difea- 
fes, and particularly with hypochondria- 
cs. The two difeafes may have fome 
fymptoms in common, but for the moll 
part are confiderably different. 
Spafmodic affections occur in both dif- 
eafes; but neither fo frequently, nor to fo 
great a degree, in hypochondriafis as in 
hyfleria. 
Perfons liable to hyfleria are fometimes 
affected 100 
PRACTICE 
affedted at the fame time with dyfpepfia. 
They are often, however, entirely free 
from it; but I believe this never happens 
toperfons affeded with hypochondriacs. 
Thefe different circumftances mark fome 
difference in the two difeafes; but they 
are ftill more certainly diftinguifhed by 
the temperament they attack, and by the 
time of life at which they appear to be 
moft equihtely formed. 
It has been generally fuppofed, that the 
two difeafes differ only in refpect of their 
appearing iq different fexes; but this is 
not well founded : for although the hy- 
fleria appears moft commonly in females, 
the male-fex is not abfolutely free from it, 
as I have obferved above ; and although 
the hypochondriacs may be moft frequent 
in men, the inftances of it in the female" 
fex a,re very common. 
MDXIX, OF PHYSIC. 
101 
MDX1X. 
From all thefe conCderations, it muft, I 
think, appear, that the hyfteria may be 
very well, and properly, diftinguifhed 
from hypochondriacs. 
Further* it feems to me to have been 
with great impropriety, that almoft every 
degree of the irregular motions of the 
nervous fyftem has been referred to the 
one or other of thefe two difeafes. Both 
are marked by a peculiarity of tempera- 
ment, as well as by certain fymptoms 
commonly accompanying that; but fome 
of thefe, and many others ufually mark- 
ed by the name of nervous fymptoms* 
may, from various caufes, arife in tempe- 
raments different from that which is pe- 
culiar to either hyfteria or hypochondria- 
cs, and without being joined with the pe- 
culiar fymptoms of either the one or the 
other difeafe : fo that the appellations of 
Hyfteric 102 
PRACTICE 
Hyfteric and Hypochondriac are very in- 
accurately applied to them. Under what 
view thefe fymptoms are otherwife to be 
confidered, 1 am not ready to determine; 
but mull remark, that the appellation of 
Nervous Difeafes is too vague and unde- 
fined to be of any ufeful application. 
MDXX. 
Having thus endeavoured to diftinguifli 
hy fteria from every other difeafe, 1 Uiall now 
attempt its peculiar pathology. With re- 
fpecl to this, I think it will, in the firft 
place, be obvious, that its paroxyfms be- 
gin by a convullive and fpafmodic affec- 
tion of the alimentary canal, which is af- 
terwards communicated to the brain, and 
to a great part of the nervous fyftem. 
Although the difeafe appears to begin in 
the alimentary canal, yet the connection 
which the paroxyfms fo often have with 
the OF PHYSIC. 
103 
the menftrual flux, and with the difeafes 
that depend on the Rate of the genitals, 
{flows, that phyfleians have at all times 
judged rightly in confidering this difeafe 
as an affection of the uterus and other 
parts of the genital fyftem. 
MDXXI. 
With regard to this, however, I can go 
no farther. In what manner the uterus, 
and in particular the ovaria, are affected 
in this difeafe; how the affection of thefe 
is communicated with particular circum- 
ftances to the alimentary canal; or how 
the affection of this, riling upwards, af- 
fecls the brain, fo as to occafion the par- 
ticular convulfions which occur in this 
difeafe, I cannot pretend to explain. 
But although I cannot trace this difeafe 
to its firft caufes, or explain the whole of 
the phenomena; I hope, that with refpedl 
to 104 
PRACTICE 
to the general nature of the difeafe, I 
may form fome general conclufions, which 
may ferve to direct our conduct in the 
cure of it. 
MDXXII. 
Thus, from a coniideration of the pre- 
difponent and occafional caufes, it will, I 
think, appear, that the chief part of the 
proximate caufe is a mobility of the fy- 
ftem, depending generally upon its ple- 
thoric ftate. 
MDXXII1. 
Whether this difeafe ever arifes from a 
mobility of the fyftem, independent of any 
plethoric Rate of it, I cannot politively 
determine; but in many cafes that have 
fubfifted for fome time, it is evident that 
a fenfibility, and confequently a mobili- 
ty OF PHYSIC. 
105 
ty, are acquired, which often appear when 
neither a general plethora can be fuppofed 
to fubfift, nor an occafional turgefcence 
to have happened. However, as we have 
fhown above, that a diftention of the vef- 
fels of the brain feems to occafion epilep- 
fy, and that a turgefcence of the blood in 
the veffels of the lungs feems to produce 
afthma; fo analogy leads me to fuppofe, 
that a turgefcence of blood in the uterus, 
or in other parts of the genital fyftem, 
may occafion the fpafmodic and convul- 
five motions which appear in hyfteria. It 
will, at the fame time, be evident, that 
this affedlion of the genitals muff efpe- 
cially occur in plethoric habits ; and eve- 
ry circumftance mentioned in the hiftory 
of the difeafe ferves to confirm this opi- 
nion with refpeft to its proximate caufe. 
Vol. IV. 
H 
MDXXIV. 106 
PRACTICE 
MDXXIV. 
From this view of the fubjeCl, the ana- 
logy of hyfteria and epilepfy will readily 
appear; and why, therefore, I am to 
fay that the indications of cure are the 
fame in both. 
As the indications, fo the feveral means 
of anfwering them, are fo much the fame 
in both difeafes, that the fame obfervations 
and directions, with regard to the choice 
and employment of thefe remedies, that 
have been delivered above on the fubjeCt 
of epilepfy, will apply pretty exactly to 
hyfteria; and therefore not be repeated 
here. 
CHAP. O F P H Y S I C. 
107 
CHAP. XIV. 
Of Canine Madness and Hydrophobia. 
MDXXV. 
THIS difeafe has been fo exactly and 
fully defcribed in books that are in 
every body's hands, that it is on no ac- 
count necefiary for me to give any hiftory 
of it here; and with refpedl to the patho- 
logy of it, I find that I can fay nothing 
fatisfying to myfelf, or that I can expert 
to prove fo to others. I find alfo, with re- 
Ipe4l 
H 2 108 
PRACTICE 
fpcfl to the cure of this difeafe, that there 
is no fubjeft in which the fallacy of expe- 
rience appears more ftrongly than in this. 
From the moft ancient to the prefent 
times, many remedies for preventing and 
curing this difeafe have been recommend- 
ed under the fanciion of pretended ex- 
perience, and have perhaps alfo kept their 
credit for fome time: but fucceeding 
times have generally, upon the fame 
ground of experience, deftroyed that cre- 
dit entirely; and moft of the remedies 
formerly employed are now fallen into 
abfolute negleft. In the prefent age, fome 
new remedies have been propofed, and 
have experience alleged to vouch for their 
efficacy; but many doubts ftill remain 
with refpecl to this: and though I can- 
not determine in this matter from my 
own experience, 1 think it incumbent 
on me to give the beft judgment I can 
form OF PHYSIC. 
109 
form with refped to the choice of the re- 
medies at prefent recommended. 
MDXXVI. 
I am, in the firft place, firmly perfua- 
ded, that the moft certain means of pre- 
venting the confequences of the bite, is to 
cut out, or otherwife deftroy, the part in 
which the bite has been made. In this 
every body agrees; but with this differ- 
ence, that fome are of opinion that it can 
only be effedual when it is done very foon 
after the wound has been made, and they 
therefore negled it when this opportunity 
is miffed. There have been, however, no 
experiments made proper to determine this 
•matter; and there are many confidera- 
tions which lead me to think, that the 
poifon is not immediately communicated 
to the fyftem; and therefore, that this 
ineafure of deftroying the part may be 
H 3 
pradifed 110 
PRACTICE 
pra&ifed with advantage, even many days 
after the bite has been given. 
MDXXVII. 
Whilft the ftate of our experience, with 
refpeft to feveral remedies now in ufe, is 
uncertain, I cannot venture to affert that 
any of thefe is abfolutely ineffedual; but 
I can give it as my opinion, that the effi- 
cacy of mercury, given very largely, and 
perlifted in for a long time, both as a 
means of preventing the difeafe, and of 
curing it when it has actually come on, is 
better fupported by experience than that of 
any other remedy now propofed, or com- 
monly employed. 
BOOK BOOK IV. 
O F 
V E S A N I jE, 
OR OF THE 
I 
DISORDERS of the INTELLECTUAL 
FUNCTIONS. 
CHAP. I. 
Of Vesanite in general. 
MDXXVIIL 
r|'5HE Nofologifts, Sauvages and Sagar, 
-*• in a clafs of difeafes under the title 
of have comprehended the two 
H 4 
orders 112 
PRACTICE 
orders of Hallucinations s or Falfe Percep- 
tions, and of Nlorojitatss or Erroneous Ap- 
petites and Paflions ; and in like manner, 
Linneus in his clafs of Mentales, cor- 
refponding to the Vefanise ofSauvages, has 
comprehended the two orders of hnagina- 
rii and nearly the fame with the 
Ilallucinationss and Morojitatcs of that au- 
thor. This, however, from fevcral con- 
fiderations, appears to me improper; and 
I have therefore formed a clafs of Ve fan ice 
nearly the fame with the Paranoise of Vo- 
gel, excluding from it the Hallucinationes 
andMoroiitates, which I have referred to the 
Morbi Locales. Mr Vogel has done the like, 
in feparating from the Paranoias the falfe 
perceptions and erroneous appetites; and 
has thrown thefe into another clafs, to which 
he has given the title of 
MDXXI& OF PHYSIC. 
113 
MDXX1X. 
It is indeed true, that certain hallucina- 
tiones and morofitates are frequently com- 
bined with what I propofe to confider as 
ftricftly a vefania or an erroneous judge- 
ment ; and fometimes the hallucinationes 
feem to lay the foundation of, and to form 
almoft entirely, the vefania. But as moft 
part of the hallucinationes enumerated by 
the Nofologifls are affections purely topical, 
and induce no other error of judgment be- 
fide that which relates to the fingle object 
of the fenfe or particular organ affccl- 
ed; fo thefe are certainly to be fepara- 
ted from the difeafes which confift in a 
more general afFeCtion of the judgment. 
Even when the hallucinationes conflantly 
accompany or feem to induce the vefania, 
yet being fuch as arife from internal cau- 
fes, and may be prefumed to arife from 
the fame caufe as the more general affec- 
tion) PRACTICE 
114 
tion of the judgment, they are therefore 
to be conlidered as fymptoms of this only. 
In like manner I judge with refpecfl to 
the morolitates, or erroneous palfions, that 
accompany vefania; which, as confequen- 
ces of a falfe judgment, muft be conlidered 
as arifing from the fame caufes, and as 
fymptoms only, of the more general affec- 
tion. 
There is, indeed, one cafe of a morolitas 
which feems to induce a vefania, or more 
general affection of the judgment; and this 
may lead us to conlider the vefania, in this 
cafe, as a fymptom of an erroneous appetite, 
but will not afford any good reafon for com- 
prehend! ng the morofitates in general under 
the vefanias, conlidered as primary difeafes. 
The limitation, therefore, of the clafs of 
Vefanias to the lelions of our judging fa- 
culty, feems from every confideration to 
be proper. 
The particular difeafes to be compre- 
hended OF PHYSIC. 
115 
bended under this clafs, may be diftinguifh- 
ed according as they affect perfons in the 
time of waking or of fleeping. Thofe which 
affect men avrake, may again be confidered, 
as they confift in an erroneous judgment, 
to which I fhall give the appellation of 
Delirium; or as they confifl in a weaknefs 
or imperfection of judgment, which I 
fhall name Fatuity. I begin with the con- 
fideration of Delirium. 
MDXXX. 
As men differ greatly in the foundnefs 
and force of their judgment, fo it may be 
proper here toafcertain more precifely what 
error or imperfection of our judging fa- 
culty is to be confidered as morbid, and 
to admit of the appellations of Delirium 
and Fatuity. In doing this, I fhall firfl 
confider the morbid errors of judgment 
under the general appellation of Delirium, 
which 116 
PRACTICE 
which has been commonly employed to 
denote every mode of fuch error. 
MDXXXI. 
As our judgment is chiefly exercifed in 
difcerning and judging of the feveral re- 
lations of things, I apprehend that deli- 
rium may be defined to be,-In a perfon 
awake, a falfe or miftaken judgment of 
thofe relations of things, which, as occur- 
ring moft frequently in life, are thofe 
about which the generality of men form 
the fame judgment; and particularly when 
the judgment is very different from what 
the perfon himfelf had. before ufually 
formed. 
MDXXXIL 
With this miftaken judgment of rela- 
tions there is frequently joined fome falfe 
percep- OF PHYSIC. 
117 
perception of external objects, without any 
evident fault in the organs of fenfe, and 
which feems therefore to depend upon an 
internal caufe; that is, upon the imagina- 
tion arifing from a condition in the brain 
prefenting objects which are not actually 
prefent. Such falfe perceptions muft necef- 
farily occalion a delirium, or an erroneous 
judgment, which is to be confidered as the 
difeafe. 
MDXXXIIL 
Another circumftance, commonly at- 
tending delirium, is, a very unufual affo- 
ciation of ideas. As, with refpecb to moft 
of the affairs of common life, the ideas 
laid up in the memory are, in moft men, 
affociated in the fame manner; fo a very 
unufual aflbciation, in any individual, 
muft prevent his forming the ordinary 
judgment of thofe relations which are 
the 118 
PRACTICE 
the moft common foundation of aflb- 
ciation in the memory: and therefore this 
unufual and commonly hurried aflbciation 
of ideas, ufually is, and may be confidered 
as, a part of delirium* In particular it 
may be confidered as a certain mark of a 
general morbid affediion of the intellec- 
tual organs, it being an interruption or 
perverfion of the ordinary operations of 
memory, the common and neceifary 
foundation of the exercife of judge- 
ment. 
MDXXXIV. 
A third circumftance attending delirium* 
is an emotion or paffion, fometimes of the 
angry, fometimes of the timid kind ; and 
from whatever caufe in the perception or 
judgment, it is not proportioned to fuch 
caufe, either in the manner formerly cuf- 
tomary to the perfon himfelf, or in the 
man- OF PHYSIC. 
119 
manner ufual with the generality of other 
men. 
MDXXXV. 
Delirium, then, may be more fhortly de- 
fined,-In a perfon awake, a falfe judge- 
ment arifing from perceptions of ima- 
gination, or from falfe recollection, and 
commonly producing difproportionate e- 
motions. 
Such delirium is of two kinds; as it is 
combined with pyrexia and comatofe af- 
fections ; or, as it is entirely without any 
fuch combination. It is the latter cafe 
that we name Infanity', and it is this kind 
of delirium only, that 1 am to treat of 
here. 
MDXXXVI. 
Infanity may perhaps be properly 
con- 120 
PRACTICE 
confidered as a genus comprehending many 
different fpecies, each of which may de- 
ferve our attention; but before proceed- 
ing to the confideration of particular fpe- 
cies, I think it proper to attempt an in- 
veftigation of the caufe of infinity in ge- 
neral. 
MDXXXVII. 
In doing this, I fliall take it for granted, 
as demonftrated elfewhere, that although 
this difeafe fcems to be chiefly, and fome- 
times folely, an affection of the mind ; yet 
the connection between the mind and body 
in this life is fuch, that thefe affedions of 
the mind muft be confidered as depending 
upon a certain flate of our corporeal part. 
See Halleri Prim. Lin. Phyfiolog. § dlxx. 
See Boerhaavii Inft. Med. § dlxxxi. 
DCXCVI. 
MDXXXVI1I. OF PHYSIC. 
121 
MDXXXVIII, 
Admitting this proportion, I muft in 
the next place affume another, which I 
likewife fuppofe to be demonflrated elfe- 
where. This is, that the part of our body 
more immediately connected with the mind, 
and therefore more efpecially concerned 
in every affedlion of the intellectual func- 
tions, is the common origin of the nerves; 
which I ffiall, in what follows, fpeak of 
under the appellation of the Brain. 
MDXXX1X. 
Here, however, in. affuming this laft 
proportion, a very great difficulty im- 
mediately prefents itfelf. Although we 
cannot doubt that the operations of our 
intellect always depend upon certain 
motions taking place in the brain, (fee 
Gaub. Path. Med. § 523.) ; yet thefe 
motions have never been the objects of 
Vol. IV. 
I 
our 122 
PRACTICE 
our fenfes, nor have we been able to per- 
ceive that any particular part of the brain 
has more concern in the operations of our 
intelledl than any other. Neither have we 
attained any knowledge of what (hare the 
ieveral parts of the brain have in that 
operation; and therefore, in this fitua- 
tion of our fcience, it muft fye a very dif- 
ficult matter to difeover thofe Rates of the 
brain that may give occafion to the va- 
rious Rate of our intellectual func- 
tions. 
MDXL. 
It may be obferved, that the different Rate 
of the motion of the blood in the veffels of 
the brain has fome fliare in affecting the 
operations of the intellect; and phyficians, 
in Peeking for the caufes of the different 
Rates of our intellectual fundlions, have 
hardly looked further than into the Rate of 
the OF PHYSIC. 
123 
the motion of the blood, or into the condi- 
tion of the blood itfelf: but it is evident 
that the operations of the intellectual func- 
tions ordinarily go on, and are often confi- 
derably varied, without our being able to 
perceive any difference either in the mo- 
tions or in the condition of the blood. 
MDXLI. 
Upon the other hand, it is very probable 
that the ftate of the intellectual functions 
depends chiefly upon the ftate and condi- 
tion of what is termed the Nervous Power, 
or, as we fuppofe, of a fubtile very move- 
able fluid, included or inherent, in a man- 
ner we do not clearly underftand, in every 
part of the medullary fubftance of the 
brain and nerves, and whichin a living and 
healthy man is capable of being moved from 
every one part to every other of the ner- 
vous fyftem. 
I 2 
MDXLII. 124 
PRACTICE 
.MDXLII. 
With refpeCt to this power, we have 
pretty clear proof that it frequently has a 
motion from the fentient extremities of 
the nerves towards the brain, and thereby 
produces fenfation; and we have the fame 
proof, that in confequence of volition the 
nervous power has a motion from the brain 
into the mufcles or organs of motion. Accor- 
dingly, as fenfation excites our intellectual 
operations, and volition is the effeCt of thefe, 
and as the connection between fenfation 
and volition is always by the intervention 
of the brain and of intellectual operations; 
fo we can hardly doubt, that thefe latter 
depend upon certain motions, and the va- 
rious modification of thefe motions, in the 
brain. 
MDXL1IL OF PHYSIC. 
125 
MXLIII. 
To afcertain the different dates of tbefe 
motions may be very difficult; and phy- 
ficians have commonly coiffidered it to be 
fo very myfterious, that they have gene- 
rally defpaired of attaining any know- 
ledge with regard to it: but 1 conlider 
fuch abfolute defpair, and the negligence 
it infpires, to be always very blameable; 
and I ffiall now venture to go fome length 
in the inquiry, hoping that fome fteps 
made with tolerable firmnefs may enable 
us to go ftill further. 
MDXLIV. 
To this purpofe, I think it evident, 
that the nervous power, in the whole as 
well as in the feveral parts of the nervous 
fyftem, and particularly in the brain, is 
at different times in different degrees of 
I 3 
mobi- 126 
PRACTICE 
mobility and force. To thefe different 
ftates, I beg leave to apply the terms of 
Excitement and Collapfe. To that ftate 
in which the mobility and force are fuffi- 
cient for the exercife of the fundlions, or 
when thefe dates are any way preternatu- 
rally increafed, I give the name of excite- 
ment ; and to that ftate in which the mo- 
bility and force are not fufficient for the 
ordinary exercife of the fundlions, or when 
they are diminiflied from the ftate in 
which they had been before, I give the 
name of Collapfe. I beg, however, it may 
be obferved, that by thefe terms I mean 
to exprefs matters of fadl only; and 
without intending, by thefe terms, to ex- 
plain the circumftance or condition, me- 
chanical or phyfical, of the nervous power 
or fluid in thefe different ftates. 
MDXLV. OF PHYSIC. 
127 
MDXLV. 
That thefe different dates of excitement 
and collapfe take place on different occa- 
fions, mud, I think, bemanifeft from num- 
berlefs phenomena of the animal (econo- 
my : but it is efpecially to our prefent 
purpofe to obferve, that the different dates 
of excitement and collapfe, are in no in- 
dance more remarkable, than in the dif- 
ferent dates of waking and deeping. In 
the latter, when quite complete, the mo- 
tion and mobility of the nervous power, 
with refpetd to the whole of what are call- 
ed the Animal Functions, entirely ceafe, 
or, as I would exprefs it, are in a date of 
collapfe ; and are very different from the 
date of waking, which in healthy perfons 
I would call a date of general and entire 
excitement. 
U 
MDXLVI. 128 
PRACTICE 
MDXLVL 
This difference in the hates of the ner- 
vous power in fleeping and waking being 
admitted, I mud in the next place ob- 
ferve, that when thefe ftates are changed 
from the one into the other, as common- 
ly happens every day, the change is hardly 
ever made inftantaneoufly, but almoft al- 
ways by degrees, and in fome length of 
time only: and, this may be obferved 
with refpedl to both fenfe and motion. 
Thus when a perlon is falling afleep, 
the fenfibility is gradually diminifhed: fo 
that, altho' fome degree of Heep has come 
on, flight impreffions will excite fenfation, 
and bring back excitement; which the fame, 
or even ftronger impreffions, will be infuf- 
ficient to produce when the date of fleep 
has continued longer, and is, as we may 
fay, more complete. In like manner, the 
power of voluntary motion is gradually 
dimi' O F P H Y S I C. 
129 
diminifhed. In feme members it fails 
fooner than in others ; and it is feme time 
before it becomes general and conliderable 
over the whole. 
The fame gradual progrefs may be re- 
marked in a perfon's coming out of deep : 
The ears in this cafe are often awake before 
the eyes are opened or fee clearly, and the 
fenfes are often awake before the power of 
voluntary motion is recovered; and it is 
curious toobferve, that, infome cafes, fen- 
fations may be excited without producing 
the ordinary affociation of ideas. See 
Mem. de Berlin, 1752. 
MDXLVII. 
From all this, »I think it will clearly 
appear, that not only the different dates 
of excitement and collapfe can take place 
in different degrees, but that they can 
take place in different parts of the brain, 
or 130 
PRACTICE 
or at leaft with refpedt to the different 
fundlions, in different degrees. 
As I prefume that almoft every perfon has 
perceived the gradual approach of fleep- 
ing and waking, I likewife fuppofe every 
perfon has obferved, that, in fuch inter- 
mediate ftate of unequal excitement, there 
almoft always occurs more or lefs of deli- 
rium, or dreaming, if any body choofes to 
call it fo. There are in this ftate falfe 
perceptions, falle affociations, falfe judge- 
ments, and difproportionate emotions; in 
fhort, allthecircumftances by which I have 
above defined delirium. 
This clearly (hows, that delirium may 
depend, and I fhall hereafter endeavour 
to prove that it commonly does depend, 
upon fome inequality in the excitement 
of the brain; and that both thefe after- 
tions arc founded on this, that, in or- 
der to the proper exercife of our intel- 
lectual functions, the excitement muft be 
com- OF PHYSIC. 
131 
complete, and equal in every part of the 
brain. For though we cannot fay that the 
veftiges of ideas are laid up in different 
parts of the brain, or that they are in fome 
meafure diffufed over the whole, it will 
follow upon either fuppofition, that as our 
reafoning or intellectual operations always 
require the orderly and exaCt recollection 
or memory of affociated ideas; fo, if any 
part of the brain is not excited, or not ex- 
citable, that recollection cannot properly 
take place, while at the fame time other 
parts of the brain, more excited and ex- 
citable, may give falfe perceptions, affocia- 
tions, and judgments. 
MDXLV1IL 
It will ferve to illuftrate this, that the 
collapfe in deep is more or lefs complete; 
or that the Heep, as we commonly fpeak, is 
more or lefs profound : and therefore, that, 
in many cafes, though deep takes place to a 
confi* 132 
PRACTICE 
confiderable degree, yet certain imprefllons 
do ftill take effect, and excite motions, or, if 
you will, fenfations, in the brain; but which 
fenfations, upon account of the collapfed 
ftate of fo great a part of the brain, are gene- 
rally of the delirious kind, or dreams, con- 
fiding of falfe perceptions, aflbciations,and 
judgments, that would have been corrected 
if the brain had been entirely excited. 
Every one, I believe, has obferved, that 
the moft imperfedt fleeps are thofe chiefly 
attended with dreaming ; that dreams, 
therefore, moft commonly occur towards 
morning, when the complete ftate of fleepis 
pafling away; and, further, that dreams are 
moft commonly excited by ftrong andun- 
eafy impreflions made upon the body. 
I apprehend it may alfobe an illuftration 
of the fame thing, that, even in waking 
hours, we have an inftance of an unequal 
ftate of excitement in the brain producing 
delirium. Such, I think, occurs in the 
cafe OF PHYSIC. 
133 
cafe of * fever. In this, it is manifeft, 
that the energy of the brain, or its excite- 
ment, is confiderably diminiflied with re- 
fpcct to the animal fundlions: and it is 
accordingly upon this ground that I have 
explained above, in XLV. the delirium 
which fo commonly attends fever. To 
what I have there faid I fhall here only 
add, that it may ferve to confirm my 
dodlrine, that the delirium in fever comes 
on at a certain period of the difeafe only, 
and that we can commonly difcern its 
approach by a more than ufual degree of it 
appearing in the time of the patient's fal- 
ling into or coming out of fleep. It ap- 
pears therefore, that delirium, when it firft 
comes on in fever, depends upon an in- 
equality of excitement; and it can hardly 
be doubted, that the delirium which comes 
at length to prevail in the entirely weaken- 
ed ftate of fevers, depends upon the fame 
caufe prevailing in a more confiderable 
degree. 
MDXLIX. 134 
PRACTICE 
MDXLIX. 
From what has been now delivered, I hope 
it will be Sufficiently evident, that delirium 
may be, and frequently is, occasioned by 
an inequality in the excitement of the 
brain. 
How the different portions of the brain 
may at the fame time be excited or collap- 
fed in different degrees, or how the ener- 
gy of the brain may be in different degrees 
of force, with refpedl to the feveral animal, 
vital, and natural functions, I cannot pre- 
tend to explain; but it is fufficiently evi- 
dent in fa cl, that the brain may be at one 
and the fame time in different conditions 
with refpedl to thefe functions. Thus in 
inflammatory difeafes, when by a flimu- 
lus applied to the brain the force of the 
vital fundlions is preternaturally increafed, 
that of the animal is either little changed, 
or conffilerably diminiPaed. On the con- 
trary, OF PHYSIC. 
135 
trary, in many cafes of mania, the force 
of the animal fundions depending always 
on the brain, is prodigioufly increafed, 
while the date of the vital function in the 
heart is very little or not at all changed. 
I muft therefore fay again, that how dif- 
ficult foever it may be to explain the me- 
chanical or phyfical condition of the brain 
in fuch cafes, the fads are fufficient to 
fhow that there is fuch an inequality as 
may difturb our intelledual operations. 
MDL. 
I have thus endeavoured to explain the 
general caufe of Delirium : which is of two 
kinds ; according as it is with, or without, 
pyrexia. Of the firft I take no further no- 
tice here, having explained it as well as I 
could above in XLV. 
I proceed now to consider that delirium 
which properly belongs to the clafsofVe- 
faniac 136 
PRACTICE 
fanisEj and which I (hall treat of under the 
general title of Infanity. 
MDLL 
In entering upon this fubjedl, it im- 
mediately occurs, that in many inftan- 
ces of infanity, we find, upon difledlion 
after death, that peculiar circumftances 
had taken place in the general condition 
of the brain. In many cafes, it has been 
found of a drier, harder, and firmer con- 
fiftence, than what it is ufually of in per- 
fons who had not been afledled with that 
difeafe. In other cafes, it has been found in 
a more humid, foft, and flaccid ftate; and 
in the obfervations of the late Mr Meckel *, 
it has been found confiderably changed in 
its 
* Memoir, de Berlin pour 1'annee 1764. It appeared in 
many inftances of infane perfons, that the medullary fub- 
ftance of the cerebrum was drier, and of a lefs fpecific 
gravity, than in perfons who had been always of a found 
judgment. PRACTICE 
137 
Its denfity or fpecific gravity. Whether 
thefe different ftates have been obferved to 
be uniformly the fame over the whole of 
the brain, I cannot certainly learn ; and I 
fufpect the diffecftors have not always accu- 
rately inquired into this circumftance: but 
in feveral it appears that thefe 
ftates had been different in different parts 
of the brain; and inftances of this inequa- 
lity will afford a confirmation of our ge- 
neral dodlrine. 
The accurate Morgagni has obferved., 
that in maniacal perfons the medullary 
portion of the brain is unufually dry, 
hard, and firm: And this he had fo fre- 
quently obfervedj that he was difpofed to 
confider it aS generally the cafe. But in 
moft of the particular inftances which 
he has given, it appears, that, for the 
moft part, while the cerebrum was of an 
unufually hard and firm confiftence, the 
cerebellum was of its ufual foftnefs, and 
Vol. IV. 
K 
lU 138 
PRACTICE 
in many of the cafes it was unufually 
Toft and flaccid. In fome other cafesy 
Morgagni obferves, that while a part of 
the cerebrum was harder and firmer than 
ordinary, other parts of it were preterna- 
turally Soft. 
MDLIL 
Thefe observations tend to confirm our 
general doctrine: and there are others which 
I think will apply to the fame purpofe. 
Upon the diffeCtion of the bodies of 
perfons who had laboured under infani- 
ty, various organic affections have been 
difcovered in particular parts of the brain ; 
and it is Sufficiently probable, that fuch or- 
ganic affeClions might have produced a dif- 
ferent degree of excitement in the free and 
affeCted parts, and mutt have interrupted 
in Some meafure the free communication 
between the Several parts of the brain, 
and OF PHYSIC. 
139 
and in either way have occalioned infa- 
nity. 
There have occurred fo many inftances of 
this kind, that I believe phyficians are ge- 
nerally difpofed to fufpect organic lefions 
of the brain to exift in almoft every cafe 
of infanity. 
MDLIII. 
This, however, is probably a miftake: 
for we know that there have been many in- 
ftances of infanity from which the perfons 
have entirely recovered • and it is dif- 
ficult to fuppofe that any organic le- 
fions of the brain had in fuch cafe taken 
place. Such tranfitory cafes, indeed, render 
it probable, that a ftate of excitement, 
changeable by various caufcs, had been 
the caufe of fuch infiances of infanity. 
K 2 
MDLIV. 140 
PRACTICE 
MDLIV. 
It is indeed further aliened, that in- 
many inRances of infane perfons, their 
brain had been examined after death, with- 
out fliowing that any organic lefions had 
before fublifted in the brain, or findingthat 
any morbid Rate of the brain then appear- 
ed. This, no doubt, may ferve to fliow, that 
organic lefions had not been the caufe of 
the difeafe ; but it does not affure us that 
no morbid change had taken place in the 
brain : for it is probable, that the diflec- 
tors were not always aware of its being 
the general condition of hardnefs and den- 
fity, as different in different parts of the 
brain, that was to be attended to, in order 
to difcover the caufe of the preceding dif- 
eafe ; and therefore many of them had 
not with this view examined the Rate of 
the brain, as Morgagni feems carefully to 
have done. 
MDLV: OF PHYSIC. 
141 
MDLV. 
Having thus endeavoured to inveftigate 
the caufe of infinity in general, it were 
to be wifhed that I could apply the doc- 
trine to the diftinguifhing the feveral 
fpecies of it, according as they depend 
upon the different ftate and circumflances 
of the brain, and thereby to the eftablifh- 
ing of a fcientific and accurately adapted 
method of cure. Thefe purpofes, how- 
ever, appear to me to be extremely diffi- 
cult to be attained; and I cannot hope to 
execute them here. All I do is to 
make fome attempts, and offer fome re- 
flections, which further obfervation, and 
greater fagacity, may hereafter render 
more ufefuh 
MDLVI. 
The ingenious Dr Arnold has been com- 
men- 
K3 142 
PRACTICE 
mendably employed in diftinguifhing the 
different fpecies of infantry as they appear 
with refpeft to the mind ; and his labours 
may hereafter prove ufeful, when we fhall 
come to know fomething more of the dif- 
ferent ftates of the brain correfponding to 
thefe different ftates of the mind ; but at 
prefent I can make little application of his 
numerous diftinftions. It appears to me 
that he has chiefly pointed out and enu- 
merated diftinftions, that are merely va- 
rieties, which can lead to little or no va- 
riety of p raftice: and I am efpecially led 
to form the latter conclufion, becaufe thefe 
varieties appear to me to be often combi - 
ned together, and to be often changed in- 
to one another, in the fame perfon; in 
whom we muft therefore fuppofe a gene- 
ral caufe of the difeafe, which, fo far as 
it can be known, muft eftablifh the pa- 
thology, and efpecially direft the prac- 
tice. 
MDLVIL OF PHYSIC. 
143 
MDLVII. 
Tn my limited views of the different 
Hates of infanity, I muft go on to confi- 
der them under the two heads of Mania 
and Melancholia : and though I am fen- 
fible that thefe two genera do not com- 
prehend the whole of the fpecies of infa- 
nity, I am not clear in aligning the other 
fpecies, which may not be comprehended 
under thofe titles. I fhall, however, en- 
deavour, on proper occafions as I go along, 
to point them out as well as I can. 
K 4 
CHAP. 144 
PRACTICE 
CHAP. II. 
Of Mania, or Madness. 
MDLVIII. 
THE circumftances which I have men- 
tioned above in MXXXV. as confti- 
tuting delirium in general, do more Spe- 
cially belong to that kind of it which I fh.aH 
treat of here under the title of Mania. 
There is fometimes a falfe perception or 
imagination of things prefent that are not; 
but this is not a conflant, nor even a fre- 
quent, attendant of the difeafe. The falfe 
judgment, is of relations long before laid 
tip in the memory. It very often turns upon 
one OF PHYSIC. 
l45 
one iingle fubjcct: but more commonly 
the mind rambles from one fubjedt to 
another, with a'n equally falfe judgment 
concerning the mofl part of them; and as at 
the fame time there is commonly a falfe 
affociation, this increafes the confufion of 
ideas, and therefore the falfe judgments. 
What for the molt part more efpecially di- 
flinguifhes the difeafe, is a hurry of mind, 
in purfuing any thing like a train of 
thought, and in running from ope train 
of thought to another. Maniacal perfons 
are in general very irafcible : but what 
more particularly produces their angry 
emotions is, that their falfe judgments 
leading to fome action which is always 
puflied with, impetuofity and violence; 
when this is interrupted or reftrained, 
they break out into violent anger and 
furious violence againft every perfon near 
them, and upon every thing that Hands 
in the way of their impetuous will. 
The 146 
PRACTICE 
The falfe judgment often turns upon a 
miftaken opinion of fome injury fuppofed 
to have been formerly received, or now 
fuppofed to be intended : and it is remark - 
able, that fuch an opinion is often with 
refpedl to their former deareft friends and 
relations ; and therefore their refentment 
and anger is particularly directed towards 
thefe. And altho' this fhould not be the cafe, 
they commonly foon lofe that refpedt and 
regard which they formerly had for their 
friends and relations. With all thefe cir- 
cumftances, it will be readily perceived,that 
the difeafe inuft be attended very con- 
ftantly with that incoherent and abfurd 
fpeech we call raving. Further, with the 
circumftances mentioned,, there is com- 
monly joined an unufual force in all the 
voluntary motions; and an infenfibility 
or refinance of the force of all impref- 
iions, and particularly a refinance of the 
powers of deep, of cold) and even of hun- 
ger; OF PHYSIC. 
147 
ger; though indeed in many inftances a 
voracious appetite takes place. 
MDLIX. 
It appears to me, that the whole of 
thefe circumftances and fymptoms point 
out a confiderable and unufual excefs in the 
excitement of the brain, efpecially with 
refpedt to the animal fundlions; and it ap- 
pears at the fame time to be manifeflly in 
fome mcafure unequal, as it very often 
takes place with refpedt to thefe functions 
alone, while at the fame time the vital and 
natural are commonly very little changed 
from their ordinary healthy ftate. 
MDLX. 
How this excefs of excitement is pro- 
duced, it may be difficult to explain. In 
the various infiances of what Sauvages has 
named 148 
PRACTICE! 
Kame'1 the Mania and in all 
the infiances I have mentioned in my Not 
fology under the title of the Mania Corpo- 
rea, it may be fuppofed that a morbid or- 
ganic affection is produced in fome part of 
the brain ; and how that may produce an 
incrcafed or unequal excitement in certain 
parts of it, 1 have endeavoured to explain 
above in MDLII. But I mull at the fame 
time acknowledge, that fuch remote caufes 
of mania have very rarely occurred; and 
that therefore fome other caufes of the dif- 
eafe muft be fought for. 
The effects of violent emotions or paf- 
fions of the mind have more frequently 
occurred as the remote caufes of mania; 
and it is fufficiently probable that fuch 
violent emotions, as they do often imme- 
diately produce a temporary increafe of 
excitement, fo they may, upon fome oc- 
cafions of their permanent inherence or 
frequent repetition, produce a more config 
derablq OF PHYSIC, 
149 
derable and more permanent excitementj 
that is, a mania. 
With refpecl to thofe caufes of mania 
which arife in confequence of a melancho- 
lia which had previoufly long fubfifted; 
whether we confider that melancholia as a 
partial infanity, or as a long perfifting at- 
tachment to one train of thinking, it will 
be readily perceived, that in either cafe 
fuch an increafe of excitement may take 
place in fo confiderable a degree, and in 
fo large a portion of the brain, as may 
give occafion to a complete mania. 
MDLXI. 
Thefe confiderations with regard to the 
remote caufes appear to me to confirm 
fufEciently our general doctrine of in- 
creafed and unequal excitement in the 
mania which I have defcribed above; but 
I mu ft own, that I have not exhaufted 
the 150 
PRACTICE 
the fubjecft, and that there are cafes of 
mania of which I cannot affign the 
remote caufes : but, although I cannot in 
all cafes explain in what manner the ma- 
nia is produced, I prefume, from the ex- 
planation given, and efpecially from the 
fymptoms enumerated above, to conclude, 
that the difeafe defcribed above depends 
upon an increafed excitement of the brain; 
an opinion in which I am the more con- 
firmed, as I think it will point out the 
proper method of cure. At leaft I think it 
will moft clearly explain the operation of 
thofe remdies, which, fo far as I can learn 
from my own experience and that of 
others, have proved the moft fuccefsful in 
this difeafe ; and, to illuftrate this, I now 
enter upon the confideration of thefe re- 
medies, and to make fome remarks upon 
the proper manner of employing them. 
MDLXII. OF PHYSIC. 
151 
MDLXIL 
Reftraining the anger and violence of 
madmen is always neceffary for prevent- 
ing their hurting themfelves or others; 
but this reftraint is alfo to be confidered 
as a remedy. Angry pafiions are always 
rendered more violent by the indulgence 
of the impetuous motions they produce; 
and even in madmen the feeling of re- 
ftraint will fometimes prevent the efforts 
which their paffion would otherwife occa- 
fion. Reftraint, therefore, is ufeful, and 
ought to be complete; but it fhould be exe- 
cuted in the eafieft manner poftible for the 
patient, and the ftrait waiftcoat anfwers 
every purpofe better than any bther that 
has yet been thought of. The reftraining 
madmen by the force of other men, as oc- 
cafioning a conftant ftruggle and violent 
agitation, is often hurtful. Although, on 
many occafions, it may not be fafe to al- 
low 152 
PRACTICE 
low maniacs to be upon their legs or td 
walk about, it is never defirable to confine 
them to a horizontal fituation ; and when- 
ever it can be admitted, they fliould be 
more or lefs in an eredt pofture. Although 
there may be no fymptoms of any preter- 
natural fulnefs or increafed impetus of 
blood in the veffels of the brain, a hori- 
zontal pofture always increafes the fulnefs 
and tenfion of thefe veftels, and may there- 
by increafe the excitement of the 
MDLXIII.- 
The reftraint mentioned requires con- 
finement within doors, and it fhould be in 
a place which prefents as few objects of fight 
and hearing as poflible; and particularly, 
it fhould be removed from the objects that 
the patient was formerly acquainted with, as' 
thefe would more readily call up ideas and 
their various aftociations. It is for this reafon 
that OF PHYSIC. 
153 
that the confinement of madmen fhould 
hardly ever be in their ufual habitation; or 
if they are, that their apartment Ihould be 
dripped of all its former furniture. It is 
alfo for the moft part proper, that maniacs 
fhould be without the company of any of 
their former acquaintance; the appear- 
ance of whom commonly excites emotions 
that increafe the difeafe. Strangers may 
at firft be offenfive ; but in a little time 
they come to be objeds either of indiffer- 
ence or of fear, and they fhould not be 
frequently changed. 
MDLXIV. 
Fear being a paflion that diminifhes ex- 
citement, may therefore be oppofed to the 
excefs of it; and particularly to the angry 
and irafcible excitement of maniacs. Thefe 
being more fufceptible of fear than might 
be expeded, it appears to me to have been 
commonly ufeful. In moft cafes it has 
Vol. IV. 
L 
ap- 154 
PRACTICE 
appeared to me neceflary to employ a very 
conftant impreflion of fear; and therefore 
to infpire them with the awe and dread of 
fome particular perfons, efpecially of thofe 
who are to be conftantly near them. This 
awe and dread is therefore, by one means 
or other, to be acquired; in the firft place, 
by their being the authors of all the re- 
ftraints that may be occaiionally proper; 
but fometimes it may be neceflary to ac- 
quire it even by ftripes and blows. The 
former, although having the appearance of 
more feverity, are much fafer than ftrokes 
or blows about the head. Neither of them, 
however, fhould be employed further than 
feems very neceflary, and Ihould be trufted 
only to thofe whofe difcretion can be de- 
pended upon. There is one cafe in which 
they are fuperfluous; that is, when the 
inaiiiacM rage is either not fufceptible of 
fear, or incapable of remembering the ob- 
jects of it; for in fuch inftances, ftripes 
and blows would be wanton barbarity. Ill 
many OF PHYSIC. 
155 
many cafes of a moderate difeafe, it is of 
advantage that the perfons who are the 
authors of reftraint and punifliment fhould 
be upon other occafions the beftowers of 
every indulgence and gratification that is 
admifiible ; never, however, neglecting to 
employ their awe when their indulgence 
fhall have led to any abufe. 
MDLXV. 
Although in mania, no particular irrita- 
tion nor fulnefs of the fyftem feem to be 
prefent, it is plain, that the avoiding all 
irritation and means of fulnefs is proper; 
and therefore, that a diet neither Simula- 
ting nor nourilhing is commonly to be 
employed. As it may even be ufeful to 
diminish the fulnefs of the fyftem, fo both 
a low and a fpare diet is likely in molt 
cafes to be of fervice. 
L 2 
MDLXVL 156 
PRACTICE 
MDLXVI. 
Upon the fame principle, although no 
unufual fulnefs of the body be prefent, it 
may be of advantage to diminilh even its 
ordinary fulnefs by different evacuations. 
Bloodletting, in particular, might be fup- 
pofed ufeful; and in all recent cafes of 
mania it has been commonly pratftifed, 
and I think with advantage; but when the 
difeafe has fub lifted for fome time, I have 
feldom found bloodletting of fervice. In 
thofe inftances in which there is any fre- 
quency or fulnefs of pulfe, or any marks 
of an increafed impetus of the blood in 
the velfels of the head, bloodletting is a 
proper and even a neceffary remedy. Some 
praditioners, in fuch cafes, have prefer- 
red a particular manner of bloodletting, 
recommending arteriotomy, fcarifying die 
hind-head, or opening the jugular vein; 
and where any fulnefs or inflammatory 
dif- OF PHYSIC. 
157 
difpofition in the veffels of the brain, is 
to be fufpecfted, the opening of the veffels 
neareft to them is likely to be of the great- 
eft iervice. The opening, however, of either 
the temporal artery or the jugular vein 
in maniacal perfons is very often incon- 
venient; and it may generally be fuffi- 
cient to open a vein in the arm, while 
the body is kept in fomewhat of an erctft 
pofture, and fuch a quantity of blood 
drawn as nearly brings on a deliquium 
animi, which is always a pretty certain 
mark of fome diminution of the fulnefs 
and tenfion of the veffels of the brain. 
MDLXVII. 
For the fame purpofe of taking off the 
fulnefs and tenlion of thefe veffels of 
the brain, purging may be employed; and 
I can in no other view underftand the ce- 
lebrated ufe of hellebore among the an- 
cients. 
L 3 158 
PRACTICE 
dents. I cannot, however, fuppofe any 
fpecific power in hellebore ; and can by no 
means find that, at leaft the black hellebore, 
fo efficacious with us as it is faid to* have 
been at Anticyra. As coftivenefs, however, 
is commonly a very conftant and hurtful 
attendant of mania, purgatives come to 
be Sometimes very necefiary; and I have 
known fomc benefit obtained from the fre- 
quent ufe of pretty draftic purgatives. In 
this, however, I have been frequently dis- 
appointed ; and I have found more ad- 
vantage from the frequent ufe of cooling 
purgatives, particularly the foluble tartar, 
than from more draftic medicines. 
MDLXVI1I. 
Vomiting has alfo been frequently enir 
ployed in mania; and by determining 
powerfully to the furface of the body, it 
may poiTibly diminifh the fulnefs and ten- 
lioq O F P II Y S I C. 
159 
lion of the veffels, and thereby the excite- 
ment of the brain ; but I have never car- 
ried the ufe of this remedy fo far as might 
enable me to judge properly of its effects. 
Whether it may do harm by impelling the 
blood too forcibly into the veffels of the 
brain, or whether by its general agitation 
of the whole fyftem it may remove that in- 
equality of excitement which prevails in 
mania, I have not had experience enough 
•to determine. 
MDLXIX. 
Frequent (having of the head has been 
found of fervice in mania, and by promo- 
ting perfpiration it probably takes off from 
the excitement of the internal parts. This, 
however, it is likely, may be more effectual- 
ly done by bliftering, which more certainly 
takes off the excitement of fubjacent parts. 
In recent cafes it has been found ufeful by 
L 4 
indu- 160 
PRACTICE 
inducing deep; and when it has that effect, 
the repetition of it may be proper: but in 
maniacal cafes that have lafted for fome 
time, bliftering has not appeared to me to 
be of any fervice; and in fuch cafes alfo 
I have not found perpetual blifters, or any 
other form of iffue, prove ufeful. 
MDLXX. 
As heat is the principal means of firft 
exciting the nervous fyftem, and eftablifli- 
ing the nervous power and vital principle 
in animals; fo, in cafes of preternatural 
excitement, the application of cold might 
be fuppofed a proper remedy: but there are 
many inftances of maniacs who have been 
expofed for a great length of time to a con- 
fiderable degree of cold without having 
their fymptoms anywife relieved. This 
may render in general the application of 
cold a doubtful remedy ; but it is at the 
fame OF PHYSIC. 
161 
fame time certain, that maniacs have often 
been relieved, and fometimes entirely cu- 
red, by the ufe of cold bathing, efpecially 
when adminiftered in a certain manner. 
This feems to confift, in throwing the mad- 
man into the cold water by furprife; by 
detaining him in it for fome length of time; 
and, pouring water frequently upon the 
head, while the whole of the body except 
the head is immerfed in the water; and 
thus managing the whole procefs, fo as 
that, with the affiftance of fome fear, a re- 
frigerant cffedl may be produced. This, I 
can affirm, has been often ufeful; and that 
the external application of cold may be of 
fervice, we know further, from the benefit 
which has been received in fome maniacal 
cafes from the application of ice and fnow 
to the naked head, and from the applica- 
tion of the noted Clay Cap. 
Warm bathing alfohas been recommend- 
ed by fome practical writers, and in fome 
rigid 162 
PRACTICE 
rigid melancholic habits it may pofiibly 
be ufcful, or as employed in the manner 
prefcribed by fome, of immerfing the lower 
parts of the body in warm water, while 
cold water is poured upon the head and 
upper parts. Of this practice, however, I 
have had no experience; and in the com- 
mon manner of employing warm bathing 
I have found it rather hurtful to maniacs. 
MDLXXI. 
According to my fuppofition that the 
difeafe depends upon an increafed excite- 
ment of the brain, efpecially with refpedt 
to the animal fundlions, opium, fo com- 
monly powerful in inducing fleep, or a 
confiderable collapfe as to thefe fundlions, 
fhould be a powerful remedy of mania. 
That it has truly proved fuch, I believe 
from the teftimony of Bernard Huet, 
whofe practice is narrated at the end of 
Wep- OF PHYSIC. 
163 
Wepferi Hiftoria Apopledlicorum. I leave 
to my readers to ftiidy this in the work 
I have referred to, where every part of 
the practice is fully, and, as it appears 
to me, very judicioufly delivered, I 
have never indeed carried the trial fo far 
as feems to be requifite to an entire cure: 
but I have frequently employed in fome 
maniacal cafes, large dofes of opium; and 
when they had the effect of inducing deep, 
it was manifeflly with advantage. At the 
fame time, in fome cafes, from doubts, 
whether the difeafe might not depend up- 
on fome organic letions of the brain, when 
the opium would be fuperfluous ; and in 
other cafes, from doubts, whether there 
might not be fome inflammatory affection 
joined with the mania, when the opium 
would be hurtful; I have never puflied 
this remedy to the extent that might be 
peeceffary to make an entire cure. 
MDLXXII. 164 
PRACTICE 
MDLXXII. 
Camphire has been recommended as a 
remedy of mania, and there are inftances 
alleged of its having performed an entire 
cure. As it appears from the experiments 
of Beccaria that this fubftance is pofiefied 
of a fedative and narcotic virtue, thefe 
cures are not altogether improbable; but 
in feveral trials, and even in large dofes, I 
have found no benefit from it; and ex- 
cepting thofe in the Philofophical Trans- 
actions, N» 400. I have hardly met with 
any other teftimonies in its favour. 
MDLXXIII. 
I have been informed that fome maniacs 
have been cured by being compelled to 
conftant and even hard labour ; and as 
a forced attention to the conduct of any 
bodily exercife, is a very certain means of 
divert- OF PHYSIC. 
165 
diverting the mind from purfuing any 
train of thought, it is highly probable that 
fuch exercife may be ufeful in many cafes 
of mania. 
I muft conclude this fubject with obfer- 
ving, that even in feveral cafes of complete 
mania, I have known a cure take place in 
the courfe of a journey carried onforfome 
length of time. 
MDLXXIV. 
Thefe are the remedies which have been 
chiefly employed in the mania that has 
been above defcribed, and I believe they 
have been employed promifcuoufly with- 
out fuppofing that the mania was to be 
diftinguifhed into different fpecies. Indeed 
I am not ready to fay how far it is to be fo 
diftinguifhed, but I lhall offer one obfer- 
vation which may poflibly merit attention. 
It appears to me, that there are two dif- 
ferent 166 
PRACTICE 
ferent cafes of mania that are efpecially 
different according to the original tempe- 
rament of the perfons whom the difeafe 
affects. It perhaps occurs moft frequently 
in perfons of a melancholic or atrabilarian 
temperament ; but it certainly does alfo of- 
ten occur in perfons of that very oppo- 
fite temperament which phyficians have 
named the Sanguine. According as the 
difeafe happens to occur in perfons of the 
one or other of thefe temperaments, I ap- 
prehend it may be confidered as of a dif- 
ferent nature; and I believe, that accurate 
obfervation, employed upon a fufficient 
number of cafes, would difcern fome pretty 
conftant difference, either of the fymptoms, 
or at leaft of the ftate of fymptoms, in the 
two cafes. I imagine that falfe imagina- 
tions, particular averfions and refentments, 
are more fixed and heady in the melan- 
cholic than in the fanguine ; and that 
fomewhat inflammatory is more common- 
iy OF PHYSIC. 
167 
ly joined with mania in the fanguine than 
in the melancholic. If fuch difference, 
however, does truly take place, it will be 
obvious, that it may be proper to make 
fome difference alfo in the practice. I 
am of opinion, that in the mania of fan- 
guine perfons, bloodletting and other anti- 
phlogiftic meafures are more proper, and 
have been more ufeful, than in the melan- 
cholic. I likewife apprehend that cold ba- 
thing is more ufeful in the fanguine than 
in the melancholic: but I have not had 
experience enough to afcertain thefe points 
with fufficient confidence. 
I have only to add this other obfervation, 
that maniacs of the fanguine temperament 
recover more frequently and more entirely 
than thofe of the melancholic. 
C II A P. 168 
PRACTICE 
CHAP. III. 
Of Melancholy, and other Forms 
of Insanity. 
MDLXXV. 
MElancholy has been commonly 
considered as a partial infanity ; 
and as fuch it is defined in my Nofology: 
but I now entertain doubts if this be altoj 
gether proper. By a partial infanity, I un- 
derstand a falfe and mistaken judgment 
upon one particular fubject, and what re- 
lates to it; whilft, on every other fubjedt, 
the perfon affected judges as the genera- 
lity of other men do. Such cafes have 
certainly O F P H Y S I C. 
169 
certainly occurred; but I believe few in 
which the partial infanity is ftriclly limi- 
ted. In many cafes of general infanity, 
there is one fubjed of anger or fear, upon 
which the falfe judgment more particular- 
ly turns, or which is at leaft more fre- 
quently than any other the prevailing ob- 
ject of delirium: and though, from the 
inconfiftency which this principal object 
of delirium mult produce, there is there- 
fore alfo a great deal of infanity with re- 
gard to moft other objects; yet this laft 
is in very different degrees, both in dif- 
ferent perfons, and in the fame perfon at 
different times. Thus perfons confidered 
as generally infane, will, however, at 
times, and in fome cafes, pretty conftant- 
ly judge properly enough of prefent cir- 
cumftances and incidental occurrences; 
though, when thefe objeds engaging at- 
tention are not prefented, the operations 
Vol. IV. 
M 170 
PRACTICE 
of imagination may readily bring back a 
general confufion, or recall the particular 
object of the delirium. From thefe confi- 
derations, I am inclined to conclude, that 
the limits between general and partial in- 
fanity cannot always be fo exactly aflign- 
ed, as to determine when the partial affec- 
tion, is to be confidered as giving a pecu- 
liar fpecies of difeafe, different from a more 
general infanity. 
MDLXXVI. 
When infanity, neither ftricftly par- 
tial, nor entirely nor conftantly gene- 
ral, occurs in perfons of a fanguine tem- 
perament, and is attended with agreeable, 
rather than with angry or gloomy emo- 
tions, I think fuch a difeafe muft be 
confidered as different from the Mania 
defcribed above; and alfo, though partial, 
muft OF PHYSIC. 
171 
mutt be held as different from the proper 
Melancholia to be mentioned hereafter* 
MDLXXVIL 
Such a difeafe, as different from thofe 
defcribed MDL1V. requires, in my opi- 
nion, a different adminiftration of re- 
medies ; and it will be proper for me to 
take particular notice of this here. 
Although it may be neceffary to re- 
train fuch infane perfons as we have men- 
tioned MDLXXVI. from purfuing the 
objects of their falfe imagination or judge- 
ment, it will hardly be requifite to employ 
the fame force of reftraint that is neceffary 
in the impetuous and angry mania. It will 
be generally fufhcient to acquire fome awe 
over them, that may be employed, and 
fometimes even be neceffary, to check the 
rambling of their imagination, and inco- 
herency of judgment. 
M 2 
MDLXXVIII, 172 
PRACTICE 
MDLXXVIIL 
The reflraint juft now mentioned as 
neceffary will generally require the patient's 
being confined to one place, for the fake 
of excluding the objeds, and more parti- 
cularly the perfons, that might excite ideas 
connected with the chief objects of their 
delirium. At the fame time, however, if 
it can be perceived there are objects or 
perfons that can call off their attention 
from the purfuit of their own difordered 
imagination, and can fix it a little upon 
ibme others, thefe laft may be frequently 
prefented to them: and for this reafon, a 
journey, both by its having the effedl of 
interrupting all train of thought, and 
by prefenting objects engaging attention, 
may often be ufeful. In fuch cafes alfb, 
when the infanity, though more efpecially 
fixed upon one miftaken fubjeft, is not con- 
fined to this alone, but is further apt to 
ramble OF PHYSIC. 
173 
ramble over other fubjedls with incohe- 
rent ideas, I apprehend the confining or 
forcing fuch perfons to fome conftant uni- 
form labour, may prove an ufeful remedy. 
MDLXXIX. 
When fuch cafes as in MDLXXVI. oc- 
cur in fanguine temperaments, and may 
therefore approach more nearly to Phre- 
nitic Delirium ; fo, in proportion as the 
fymptoms of this tendency are more evi- 
dent and confiderable, bloodletting and 
purging will be the more proper and ne- 
cefiary. 
MDLXXX. 
To this fpecies of infanity, when occur- 
ring in fanguine temperaments, whether it 
be more or lefs partial, I apprehend that 
cold bathing is particularly adapted; while, 
M 3 
in 174 
PRACTICE 
in the partial infanity of melancholic per- 
lons, as I (hall fhow hereafter, it is hardly 
admiflible. 
MDLXXXI. 
Having thus treated of a fpecies of in- 
fanity, different, in my appreheniion, from 
both the Mania and Melancholia, I pro- 
ceed to confider what feems more properly 
to belong to this laft. 
MDLXXXII. 
The difeafe which I name Melancholia is 
very often a partial infanity only. But as 
in many infiances, though the falfe ima- 
gination or judgment feems to be with re- 
fpect to one fubjecl only ; yet it feldom 
happens that this does not produce much 
inconfiftency in the other intellectual 
operations: And as, between a very ge- 
neral and a very partial infanity, there 
are O F P H Y S I C. 
175 
are all the poffible intermediate degrees; 
fb it will be often difficult, or perhaps 
improper, to diftinguifh Melancholia by 
the character of Partial Infanity alone. If 
I miftake not, it muft be chiefly diftin- 
guifhed by its occurring in perfons of me- 
lancholic temperament, and by its being 
always attended with forne feemingly 
groundlefs, but very anxious, fear. 
MDLXXXIII. 
To explain the caufe of this, I muft ob- 
serve, that perfons of a melancholic tem- 
perament are for the moft part of a feri- 
ous thoughtful difpofition, and difpofed 
to fear and caution, rather than to hope 
and temerity. Perfons of this caft are lefs 
moveable than others by any impreflions; 
and are therefore capable of a clofer or 
more continued attention to one particular 
object, or train of thinking. They are even 
M4 
ready 176 
PRACTICE 
ready to be engaged in a conflant applica- 
tion to one fubjedt ; and are remarkably 
tenacious of whatever emotions they hap- 
pen to be affeded with. 
MDLXXX1V. 
Thefe circumftances of the melancholic 
character, feem clearly to Ihow, that per- 
sons ftrongly affedled with it rnay be rea- 
dily feized with an anxious fear; and that 
this, when much indulged, as is natural to 
fuch perfons, may eahly grow into a par- 
tial infinity. 
MDLXXXV. 
Tear and dejediion of mind, or a timid 
and defponding difpofition, may arife in 
certain dates, or upon certain occalions, 
of mere debility : and it is upon this foot- 
ing, that I fuppofe it fometimes to attend 
dyfpepfia. But in thefe cafes, 1 Relieve 
the OF PHYSIC. 
177 
the defpondent difpofition hardly ever ari- 
fes to a canfiderable degree, or proves fo 
obftinately fixed as when it occurs in per- 
fons of a melancholic temperament. In 
thefe laft, although the fear proceed from 
the fame dyfpeptic feelings as in the other 
cafe, yet it will be obvious, that the emotion 
may rife to a more considerable degree; 
that it may be more anxious, more fixed, 
and more attentive; and therefore may ex- 
hibit all the various circumftances which I 
have mentioned inMCCXXH. to take place 
in the difeafe named Hypochondriasis. 
MDLXXXVI. 
In confidering this fubjeci formerly, in 
diftinguilhing Dyipepfia from Hypochon- 
driacs, although the fymptoms affecting 
the body be very much the fame in both, 
and even thofe affecting the mind be 
fomewhat fimilar, I found no difficulty in 
di- 178 
PRACTICE 
diftinguifhing the latter difeafe, merely 
from its occurring in perfons of a melan- 
cholic temperament. But I muft now ac- 
knowledge that I am at a lofs to determine 
how in all cafes hypochondriafis and me- 
lancholia may be diftinguifhed from one 
another, whilft the fame temperament is 
common to both. 
MDLXXXVII. 
I apprehend, however, that the diftinc- 
tion may be generally afcertained in the 
following manner. 
The hypochondriacs I would confider 
as being always attended with dyfpeptic 
fymptoms: and though there may be, at 
the fame time, an anxious melancholic fear 
arifing from the feeling of thefe fymptoms; 
yet while this fear is only a miftaken judge- 
ment with refpedt to the ftate of the per- 
fon's own health, and to the danger to be 
from PRACTICE 
179 
from thence apprehended, I would ftill 
confider the difeafe as a hypochondriacs, 
and as diftincSt from the proper melan- 
cholia. But when an anxious fear and de- 
fpondency arifes from a miftaken judge- 
ment with refpeft to other circumftances 
than thofe of health, and more efpecially 
when the perfon is at the fame time with- 
out any dyfpeptic fymptoms, every one 
will readily allow this to be a difeafe 
widely different from both dyfpepfia and 
hypochondriafis ; and it is, what I would 
flridly name Melancholia. 
MDLXXXVIII. 
In this there feems little difficulty: but 
as an exquiiitely melancholic temperament 
may induce a torpor and llownefs in the ac- 
tion of the ftomach, fo it generally produces 
fome dyfpeptic fymptoms; and from thence 
there may be fome difficulty in diftinguifh- 
ing 180 
PRACTICE 
in'g fuch a cafe from hypochondriacs. But 
1 would maintain, however, that when the 
charaders of the temperament are ftrongly 
marked; and more particularly when the 
falfe imagination turns upon other fubjects 
than that of health, or when, though rela- 
tive to the perfon's own body, it is of a 
groundlefs and abfurd kind; then, not- 
withftanding the appearance of fome dyf- 
peptic fymptoms, the cafe is ftill to be con- 
fidered as that of a melancholia, rather than 
a hypochondriacs. 
MDLXXXIX. 
The difeafe of melancholia, therefore, 
manifeftly depends upon the general tem- 
perament of the body: and although, 
in many perfons, this temperament is not 
attended with any morbid affection either 
of mind or body; yet when it becomes 
exquiCtely formed, and is in a high degree, 
it OF PHYSIC. 
181 
it may become a difeafe affcRing both, and 
particularly the mind. It will therefore be 
proper to confider in what this melancho- 
lic temperament efpecially confiRs: and to 
this purpofe, it may be obferved, that in it 
there is a degree of torpor in the motion of 
the nervous power, both with refpecl to fen- 
fation and volition; that there is a gene- 
ral rigidity of the fimple folids; and that 
the balance of the fanguiferous fyftem is 
unon the fide of the veins. But all thefe 
X 
circumftances are the directly oppofite of 
thofe of the fanguine temperament; and 
✓ 
muR therefore alfo produce an oppofite 
Rate of mind. 
MDXC. 
It is this Rate of the mind, and the Hate 
of the brain correfponding to it, that is 
the chief object of our prefent coniide- 
ratioa. But what that Rate of the brain 
is 182 
PRACTICE 
is will be fuppofed to be difficult to ex- 
plain ; and it may perhaps feem raffi in 
me to attempt it. 
I will, however, venture to fay, that it is 
probable the melancholic temperament of 
mind depends upon a drier and firmer 
texture in the medullary fubftance of the 
brain ; and that this perhaps proceeds from 
a certain want of fluid in that fubftance, 
which appears from its being of a lefler fpe- 
cific gravity than ufual. That this flate of 
the brain in melancholia does actually ex- 
ifl, I conclude, fujl, from the general rigi- 
dity of the whole habit; 2M^fecondlyy from 
difleftions, ihowing fuch a flate of the 
brain to have taken place in mania, which 
is often no other than a higher degree of 
melancholia. It does not appear to me 
any wife difficult to fuppofe, that the fame 
ftate of the brain may in a moderate de- 
gree give melancholia, and in a higher 
that mania which melancholia fo often 
pafles O F P H Y S I C. 
183 
pafles into; efpecially if I fhall be al- 
lowed further to fuppofe, that either a 
greater degree of firmnefs in the fubftance 
of the brain may render it fufceptible of a 
higher degree of excitement, or that one 
portion of the brain may be liable to ac- 
quire a greater firmnefs than others, and 
confequently give occafion to that inequa- 
lity of excitement, upon which mania fo 
much depends. 
MDXCL 
I have thus endeavoured to deliver what 
appears to me moft probable with refpecl 
to the proximate caufe of melancholia; 
and although the matter fhould in fome re- 
Ipe&s remain doubtful, I am well perfua- 
ded that thefe obfervations may often be 
employed to direct our practice in this 
difeafe, as I fhall now endeavour to Ihow. 
MDXCII. 184 
PRACTICE 
MDXCII. 
In mod of the infiances of melancholia, 
the mind is to be managed very much in 
the fame manner as I have advifcd above 
with regard to hypochondriafis; but as in 
the cafe of proper melancholia, there is 
commonly a falfe imagination or judge- 
ment appearing as a partial infanity, it 
may be further neceflary in fuch cafes to 
employ fome artifices for correcting fuch 
imagination or judgment. 
MDXCI1I. 
The various remedies for relieving the 
dyfpeptic fymptoms which always attend 
hypochondriacs, will feldom be either re- 
quilite or proper in melancholia. 
There is only one of the dyfpeptic fymp- 
toms, which, though there fllould be no 
other, is very conftantly prefent in melan- 
cholia, OF PHYSIC. 
185 
cholia, and that is coftivenefs. This it is 
always proper and even necefiary to re- 
move ; and I believe it is upon this ac- 
count that the ufc of purgatives has been 
found fo often lifeful in melancholia. 
Whether there be any purgatives peculiar- 
ly proper in this cafe, I dare not pofitively 
determine; but with refpedl to the choice 
of purgatives in melancholia, I am of the 
fame opinion that I delivered above on this 
fame fubjecl with refpedl to mania. 
MDXCIV. 
With refpedl to other remedies, I judge 
that bloodletting will more feldom be pro- 
per in melancholia than in mania; but 
how far it may be in any cafe proper, muft 
be determined by the fame confiderations 
as in the cafe of mania. 
Vol. IV. 
N 
MDXCV. 186 
PRACTICE 
MDXCV. 
The cold bathing that I judged to be fo 
very ufeful in feveral cafes of infanity, is, 
I believe, in melancholia, hardly ever 
fit to be admitted; at leaft while this is 
purely a partial affection, and without 
any marks of violent excitement. On 
the contrary, upon account of the general 
rigidity prevailing in melancholia, it is 
probable that warm bathing may be often 
ufeful. 
MDXCVI. 
With refpeft to opiates which I have 
fuppofed might often be ufeful in cafes of 
mania, I believe they can feldom be pro- 
perly employed in the partial infanities of 
the melancholic, except in certain inftances 
of violent excitement, when the melancholia 
approaches nearly to the date of mania. 
MDXCVIL OF PHYSIC. 
187 
MDXCVII. 
In fuch cafes of melancholia approaching 
to a ftate of mania, a low diet may fome- 
times be neceflary; but as the employing 
a low diet almoft unavoidably leads to the 
ufe of vegetable food, and as this in every 
torpid ftate of the ftomach is ready to pro- 
duce fome dyfpeptic fymptoms, fuch vege- 
table food ought, in moderate cafes of 
melancholia, to be ufed with fome cau- 
tion. 
Though exercife, as a tonic power, is not 
proper either in hypochondriafis or melan- 
cholia ; yet, with refped to its effects upon 
the mind, it may be extremely ufeful in 
both, and in melancholia is to be employ- 
ed in the fame manner that I have advifed 
above in the cafe of hypochondriafis. 
N 2 
MDXCVIII. 188 
PRACTICE 
MDXCVIII. 
Having now delivered my dodlrine with 
refpeft to the chief forms of infanity, I 
fhould in the next place proceed to confi- 
der the other genera of Amentia and Onei- 
rodynia, which in the Nofology I have ar- 
ranged under the order of Vefaniae; but 
as I cannot pretend to throw much light 
upon thefefubjedls, and as they are feldom 
the objects of practice, I think it allowable 
for me to pafs them over at prefent; and 
the particular circumftances of this work in 
fome meafure requires that I fhould do fo. 
PART PART III. 
O F 
CACHEXIES. 
MDXCIX. 
UNder this title I propofe to eftablilh 
a clafs of difeafes, which confift in 
a depraved ftate of the whole, or of a con- 
iiderable part, of the habit of the body, 
without any primary pyrexia or neurofts 
combined with that ftate. 
n3 
MDC. 190 
PRACTICE 
MDC. 
The term Cachexy has been employed 
by Linnaeus and Sagar, as it had been 
formerly by ocher authors, for the name 
of a particular difeafe: but the difeafc 
to which thefe authors have affixed it, 
comes more properly under another ap- 
pellation ; and the term of Cachexy is 
more juftly employed by Sauvages and 
Sagar for the name of a clafs. In this I 
have followed the laft-mentioned nofolo- 
gifts, though I find it difficult to give 
fuch a character'of the clafs as will clearly 
apply to all the fpecies I have compre- 
hended under it. This difficulty would 
be ftill greater, if, in the clafs 1 have efta- 
bliflied under the title of Cachexies, I were 
to comprehend all the difeafes that thofe 
other nofologifts have done; but I am 
willing to be thought deficient rather than 
very incorrect. Thofe difficulties, how- 
ever. OF PHYSIC. 
191 
ever, which ftill remain in methodical 
nofology, imift not affect us much in a 
treatife of practice. If I can here pro- 
perly diftinguifh and defcribe the feveral 
Ipecies that truly and moil commonly 
exift, I fhall be the lefs concerned about 
the accuracy of my general claflification: 
though at the fame time this, I think, is 
always to be attempted ; and I fhall pur- 
fue it as well as I can. 
N 4 
BOOK BOOK I. 
O F 
EMACIATIONS. 
MDCI. 
EMaciation, or a conliderable dimi- 
nution of the bulk or plumpnefs of 
the whole body, is for the moft part only 
a fymptom of difeafe, and very feldpnx 
to be confidered as a primary and idiopa- 
thic affection. Upon this account, accor- 
ding to my general plan, fuch a fymptom 
might OF PHYSIC. 
193 
might perhaps have been omitted in the 
Methodical Nofology: but both the uncer- 
tainty of concluding it to be always fymp- 
tomatic, and the confiftency of fyftem, 
made me introduce into the Nofology, as 
others had done, an order under the title 
of Marcores; and this renders it requifite 
now to take fome notice of fuch difeafes. 
MDCII. 
Upon this occalion, therefore, I hope it 
may be ufeful to inveftigate the feveral 
caufes of emaciation in all the different 
cafes of difeafe, in which it appears. And 
this I attempt, as the fureft means of deter- 
mining how far it is a primary, or a 
fymptomatic affection only ; and even in 
the latter view, the inveftigation may be 
attended with fome advantage. 
MDCIII. 194 
PRACTICE 
MDC1IL 
The caufes of emaciation may, I appre- 
hend, be referred to two general heads; 
that is, either to a general deficiency of 
fluid in the veflels of the body, or to the 
particular deficiency of the oil in the cel- 
lular texture of it. Thefe caufes are fre- 
quently combined together; but it will 
be proper, in the firfl place, to confider 
them feparately. 
MDC1V. 
As a great part of the body of animals 
is made up of veflels filled with fluids, 
the bulk of the whole muft depend very 
much on the fize of thefe veflels, and the 
quantity of fluids prefent in them: and 
it will therefore be fufliciently obvious, 
that a deficiency of the fluids in thefe vef- 
fels muft, according to its degree, occa- 
fion OF PHYSIC. 
195 
(ion a proportionate diminution of the bulk 
of the whole body. This, however, will 
appear ftill more clearly, from confidering 
that in the living and found body the vef- 
fels every where feem to be preternatu- 
rally diftended by the quantity of fluids 
prefent in them; but being at the fame 
time elaftic, and conftantly endeavouring to 
contradl themfelves, they muft, on the with- 
drawing of the diftending force, or, in other 
words, upon a diminution of the quantity 
of fluids, be in proportion contracted and 
diminilhed in their fize: And it may be 
further obferved, that as each part of the 
vafcular fyftem communicates with every 
other part of it; fo every degree of dimi- 
nution of the quantity of fluid, in any one 
part, muft in proportion diminifh the bulk 
of the vafcular fyftem, and confequently 
of the whole body. 
MDCV. 196 
PRACTICE 
MDCV. 
The diminution and deficiency of the 
fluids may be occafioned by different 
caufes: fuch as, firft, by a due quantity 
of aliments not being taken in; or by the 
aliment taken in, not being of a fuflicient- 
ly nutritious quality. Of the want of a 
due quantity of aliment not being taken 
into the body, there is an inftance in the 
Atrophia laHantium Sauvagefii, Ipecies 3. 
and many other examples have occurred 
of emaciation from want of food, occafion- 
ed by poverty, and other accidental caufes. 
With refpedt to the quality of food, I 
apprehend it arifes from the want of nu- 
tritious matter in the food employed, that 
perfons living very entirely on vegetables 
are feldom of a plump and fucculent ha- 
bit. 
MDCVI. OF PHYSIC. 
197 
MDCVI. 
A fecond caufe of the deficiency of fluids 
may be, the aliments taken in, not being 
conveyed to the blood-velfels. This may 
occur from a perfon's being afle&ed with 
a frequent vomiting; which, rejecting 
the food foon after it had been taken in, 
mutt prevent the neceflary fupply of fluids 
to the blood-veflels. 
Another caufe', frequently interrupting 
the conveyance of the alimentary matter into 
the blood-veflels, is an obftrudion of the 
conglobate or lymphatic glands of the me- 
fentery, through which the chyle muft ne- 
ceflarily pafs to the thoracic dudl. Many in- 
ftances of emaciation, feemingly depending 
upon this caufe, have been obferved by 
phyficians, in perfons of all ages, but efpe- 
cially in the young. It has alfo been re- 
marked, that fuch cafes have moft fre- 
quently occurred in fcropbulous perfons, 
in 198 
PRACTICE 
in whom the mefenteric glands are com- 
monly affeded with tumour or obftruc- 
tion, and in whom, generally at the fame 
time, fcrophula appears externally. Hence 
the Tabes fcruphulofa Sy nop. Nofolog. vol. ii. 
p. 266.: And under thefe I have put as 
fynonimes Tabes glandularis, fp. to.; Ta- 
bes mefenteric a, fp. 9.; Scropbula mefen- 
terica, fp. 4.; Atrophia infantilis, fp. 13.; 
Atrophia rachitic a, fp. 8.; Tabes rachialgica* 
fp. 16. At the fame time, I have fre- 
quently found the cafe occurring in per- 
fons who did not fliow any external ap- 
pearance of fcrophula, but in whom the 
mefenteric obftrudUon was afterwards dif- 
covered by diffe&ion. Such alfo I fuppofe 
to have been the cafe, in the difeafe fre- 
quently mentioned by authors under the 
title of the Atrophia infantum. This has 
received its name from the time of life at 
'which it generally appears ; but I have 
met with inftances of it at fourteen years 
of OF PHYSIC. 
199 
of age afcertained by diffedlion. In feve- 
ral fuch cafes which I have feen, the pa- 
tients were without any fcrophulous ap- 
pearances at the time, or at any period of 
their lives before. 
In the cafe of phthilical perfons, I 
fhall hereafter mention another caufe of 
their emaciation; but it is probable that 
an obftrudiion of the mefenteric glands, 
which fo frequently happens in fuch per- 
fons, concurs very powerfully in produ- 
cing the emaciation that takes place. 
Although a fcrophulous taint may be 
the moft frequent caufe of mefenteric ob- 
flrudlions, it is fufficiently probable that 
other kinds of acrimony may produce the 
fame, and the emaciation that follows. 
It may perhaps be fuppofed, that the 
interruption of the chyle's paffing into the 
blood-veffels may be foinetimes owing to 
a fault of the abforbents on the internal 
furface of the inteftines. This, however, 
cannot 200 
PRACTICE 
cannot be readily afcertained: but the in- 
terruption of the chyle's palling into the 
blood-veffels may certainly be owing to 
a rupture of the thoracic dudt; which, 
when it does not prove foon fatal, by oc- 
calioning a hydrothorax, muft in a ihort 
time produce a general emaciation. 
MDCVII. 
A third caufe of the deficiency of the 
fluids may be a fault in the organs of di- 
geftion, as not duly converting the aliment 
into a chyle fit to form in the blood-veflels 
a proper nutritious matter. It is not, how- 
ever, eafy to afcertain the cafes of ema- 
ciation which are to be attributed to this 
caufe; but I apprehend that the emaciation 
which attends long fubfifting cafes of dyf- 
pepfia, or of hypochondriafis, is to be ex- 
plained chiefly in this way. It is this which 
I have placed in the Nofology under the 
title OF PHYSIC. 
201 
title of the Atrophia debilium ; and of 
which the Atrophia Sauv. fp. 1. 
is a proper inftance, and therefore put 
there as a fynonime. But the other titles 
of Atrophia Sauv. fp'. 15. and 
Atrophia Sauv. fp. 11. are not fo 
properly put there, as they muft be ex- 
plained in a different manner. 
MDCV1IL 
A fourth caufe of a deficiency of the 
fluids in the body, may be exceflive eva- 
cuations made from it by different out- 
lets ; and Sauvages has properly enume- 
rated the following fpecies, which we have 
put as fynonimes under the title of Atro- 
phi a inanitorum; as, Tabes nutricum* fp. 4. 
Atrophia fp. 5. Atrophia a leucor- 
rhcea, fp. 4. Atrophia ab alvi fp. 6. 
Atrophia a ptyalifmoi fp. 7. and, laftly, the 
Vol. IV. 
O 
Tabes 202 
PRACTICE 
Tabes a fanguijluxu; which, it is to be ob- 
ferved, may arife not only from fponta- 
neous hemorrhagies or accidental wounds, 
but alfo from bloodlettings in too large a 
quantity, and too frequently repeated. 
Upon this fubjedl it feems proper to 
obferve, that a meagre habit of body fre- 
quently depends upon a full perfpiration 
being conflantly kept up, though at the 
fame time a large quantity of nutritious 
aliment is regularly taken in. 
MDCIX. 
Bolides this deficiency of fluids from 
evacuations by which they are carried 
entirely out of the body, there may be a 
deficiency of fluid and emaciation in a 
J 
confiderable part of the body, by the fluids 
being drawn into one part, or collected 
into one cavity ; and of this we have an 
in- OF PHYSIC. 
203 
inAance in the Tabes a Sauv. 
fp. 5. 
MDCX. 
In the Methodical Nofology, among the 
Other fynonimes of the Atrophia inanito- 
rum I have fet down the Tabes dorfalis; 
but whether properly or not, I at prefent 
very much doubt. In the evacuation con- 
Adered as the caufe of this tabes, as the* 
quantity evacuated is never fo great as to 
account for a general deficiency of fluids 
in the body, we mult feek for another ex- 
planation of it. And whether the effects of 
the evacuation may be accounted for, either 
from the quality of the fluid evacuated, or 
from the Angularly enervating pleafure at- 
tending the evacuation, or from the eva- 
cuation's taking off the tendon of parts, 
the tention of which has a Angular power 
in fupporting the tenfion and vigour of the 
O 2 
whole 204 
PRACTICE 
whole body, I cannot pofitively determine; 
but I apprehend that upon one or other of 
thefe fuppofitions the emaciation attending 
the tabes dorfalis muft be accounted for; 
and therefore that it is to be confidered as 
an inftance of the Atrophia debi Hum, rather 
than of the Atrophia inanitorum. 
MDCXL 
A fifth caufe of a deficiency of fluids 
and of emaciations in the whole or in a 
particular part of the body, may be the 
concretion of the finall veflels, either not 
admitting of fluids, or of the fame pro- 
portion as before ; and this feems to me 
to be the cafe in the Atrophia fendis, Sauv. 
fp. 2. Or it may be a palfy of the larger 
trunks of the arteries rendering them 
unfit to propel the blood into the fmaller 
veflels ; as is frequently the cafe of para- 
lytic limbs, in which the arteries are af- 
fected OF PHYSIC. 
205 
fedled as well as the mufcles. The Atro- 
phia lateralis y Sauv. fp. 15. feems to be of 
this nature. 
MDCXII. 
A fecond general head of the caufes of 
emaciation, 1 have mentioned in MDCII. 
to be a deficiency of oil. The extent and 
quantity of the cellular texture in every 
part of the body, and therefore how con- 
fiderable a part it makes in the bulk of 
the whole, is now well known. But this 
fubftance, in different circumftances, is 
more or lefs filled with an oily matter; 
and therefore the bulk of it, and in a 
great meafure that of the whole body, 
muff be greater or lefs according as this 
fubftance is more or lefs filled in that man- 
ner. The deficiency of fluids, for a reafon 
to be immediately explained, is generally 
accompanied with a deficiency of oil: but 
o 3 
phy- 206 
practice; 
phyficians have commonly attended more 
to the latter caufc of emaciation than to the 
other, that being ufually the moft evident; 
and I fhall now endeavour to affign the 
feveral caufes of the deficiency of oil as 
it occurs upon different occafions. 
MDCX1IL 
The bufinefs of fecretion in the human 
body is in general little underftood, and 
in no inRance lefs fo than in that of the 
fecretion of oil from blood which dots not 
appear previoufly to have contained it. 
It is pofhblc, therefore, that our theory of 
the deficiency of oil may be in feveral re- 
fpecls imperfedt; but there are certain facts 
that may in the mean time apply to the 
prefent purpofe. 
MDCXIV. 
Firft, it is probable, that a deficiency of 
oil OF PHYSIC. 
207 
oil may be owing to a (late of the blood 
in animal bodies lefs fitted to afford a fe- 
cretion of oil, and confequently to fupply 
the wafte of it that is confiantly made. This 
flate of the blood muft efpecially depend 
upon the flate of the aliments taken in, as 
containing lefs of oil or oily matter. From 
many obfervations made, both with refpedl 
to the human body and to that of other 
animals, it appears pretty clearly, that the 
aliments taken in by men and domeftic 
animals, according as they contain more of 
oil, are in general more nutritious, and in. 
particular are better fitted to fill the cel- 
lular texture of their bodies with oil. I 
might illuftrate this, by a minute and par- 
ticular confideration of the difference of 
alimentary matters employed ; but it will 
be enough to give two infiances. The one 
is, that the herbaceous part of vegetables, 
does not fatten animals, fo much as the 
O J- 
4 
feeds 208 
PRACTICE 
feeds of vegetables, which manifcftly con- 
tain in any given weight a greater propor- 
tion of oil; and a fecond inftance is, that 
in general vegetable aliments do not fat- 
ten men fo much as animal food, which 
generally contains a larger proportion of 
oil. 
It will be obvious, that upon the fame 
principles a want of food, or a lefs nutri- 
tious food, may not only occafion a gene- 
ral deficiency of fluids (MDCIV.), but 
mu ft alfo afford lefs oil, to be poured into 
the cellular texture. In fuch cafes, there- 
fore, the emaciation produced, is to be at- 
tributed to both thefc general caufes. 
MDCXV. 
A fecond cafe of the deficiency of oil 
may be explained in this manner. It is 
pretty manifeft, that the oil of the blood is 
ftcreted and depofitcd in the cellular tex- 
ture O F PHYSIC. 
209 
tore in greater or letter quantity, accord- 
ing as the circulation of the blood is fa- 
lter or flower; and therefore that exercife 
which haftens the circulation of the blood 
is a frequent caufe of emaciation. Exer- 
cife produces this effect in two ways. lit, 
By increaling the perfpiration, and thereby 
carrying off a greater quantity of the nu- 
tritious matter, it leaves lefs of it to be de- 
polited in the cellular texture ; thereby 
not only preventing an accumulation of 
fluids, but, as I have faid above, cau- 
ling a general deficiency of thefe, which 
muft alfo caufe a deficiency of oil in the 
cellular texture. 2dly, It is well known, 
that the oil depofited in the cellular tex- 
ture is upon many occafions, and for va- 
rious purpofes of the ceconomy, again ab- 
forbed, and mixed or diffufed in the mafs 
of blood, to be from thence perhaps car- 
ried entirely out of the body by the feve- 
ral excretions. Now, among other pur- 
pofes  PRACTICE 
210 
pofes of the accumulation and re-abforp- 
tion of oil, this feems to be one, that the 
oil is rcquifite to the proper adtion of the 
moving fibres in every part of the body; 
and therefore that nature has provided for 
an abforption of oil to be made according 
as the action of the moving fibres may de- 
mand it. It will thus be obvious, that the 
exercife of the mufcular and moving fibres 
every where, rnuft occafion an abforption 
of oil; and confequently that fuch exercife 
not only prevents the fecretion of oil, as 
has been already faid, but may alfo caufe 
a deficiency of it, by occafioning an ab- 
forption of what had been depofited; and 
in this way, perhaps efpccially, does it 
produce emaciation. 
MDCXVI. 
A third cafe of the deficiency of oil may 
occur from the following caufe. It is 
pro- OF PHYSIC. 
211 
probable, that one purpofe of the accu- 
mulation of oil in the cellular texture of 
animals is, that it may, upon occaflon, be 
again abforbed from thence, and carried 
into the mafs of blood, for the purpofe 
of inveloping and corroding any unufual 
acrimony arifmg and exiding in the date 
of the fluids. Thus, in mod indances in 
which we can difeern an acrid date of the 
fluids, as in feurvy, cancer, fyphilis, poi- 
fons, and feveral other difeafes, we find 
at the fame time a deficiency of oil and 
an emaciation take place; which, in my 
apprehenflon, mud be attributed to the 
abforption of oil, which the prefence of 
acrimony in the body excites. 
It is not unlikely that certain poifons in- 
troduced into the body, may fubfid there; 
and, giving occaflon to an abforption of 
pil, may lay a foundation for the a 
Sauv. fp. 17. 
MDCXVII, 212 
PRACTICE 
MDCXVIL 
A fourth cafe of emaciation, and which I 
would attribute to a fudden and confider- 
able abforption of oil from the cellular 
texture, is that of fever, which fo generally 
produces emaciation. This may perhaps be 
in part attributed to the increafed perfpi- 
ration, and therefore to the general de- 
ficiency of fluids that may be fuppofed to 
take place : but whatever (hare that may 
have in producing the effedl, we can, from 
the evident ihrinking and diminution of 
the cellular fubftance, wherever it falls 
under our obfervation, certainly conclude, 
that there has been a very confiderable 
abforption of the oil which had been before 
depofited in that fubftance. This expla- 
nation is rendered the more probable 
from this, that I fuppofe the abforption 
mentioned is neceflarily made for the pur- 
pofe of inveloping or correcting an acri- 
mony, OF PHYSIC. 
213 
mony, which manifeftly does in many, 
and may be fufpecled to arife in all, cafes 
of fever. The moft remarkable inftance 
of emaciation occurring in fevers, is that 
which appears in the cafe of hedlic fevers. 
Here the emaciation may be attributed to 
the profufe fweatings that commonly at- 
tend the difeafe: but there is much rea- 
fon to believe, that an acrimony al- 
fo, is prefent in the blood; which, even 
in the beginning of the difeafe, prevents 
the fecretion and accumulation of oil; and 
in the more advanced flates of it, muft 
occafion a more confiderable abforption of 
it; which, from the fhrinking of the cel- 
lular fubftance, feems to go farther than 
in almoft any other inftance. 
Upon the fubjeft of emaciations from 
a deficiency of fluids, it may be obfer- 
ved, that every increafed evacuation ex- 
cites an abforption from other parts, and 
particularly from the cellular texture; and 
it 214 
PRACTICE 
it is therefore probable, that a deficiency 
of fluids, from increafed evacuations, pro- 
duces an emaciation, not only by the wafte 
of the fluids in the vafcular fyftem, but 
alfo by occafioning a confiderable abforp-? 
tion from the cellular texture. 
MDCXVIIL 
I have thus endeavoured to explain the 
feveral cafes and caufes of emaciation ; but 
I could not profecute the confideration of 
thcfe here in the order they are fet down 
in the Methodical Nofology. In that work 
I was engaged chiefly in arranging the 
fpecies of Sauvages; but it is my opinion 
now, that the arrangement there given, is 
erroneous, in both combining and fepara- 
ting fpecies improperly : and it feems 
to me more proper here to take notice of 
difeafes, and put them together, according 
to the affinity of their nature, rather than 
by OF PHYSIC. 
215 
by that of their external appearances. I 
doubt, if even the diftin&ion of the Tabes 
and Atrophia, attempted in the Nofology, 
will properly apply; as I think there are 
certain difeafes of the fame nature, which 
fometimes appear with, and lometimes 
without, fever. 
MDCXIX. 
After having confidered the various ca- 
fes of emaciations, I fhould perhaps treat 
of their cure : but it will readily appear, 
that the greater part of the cafes above- 
mentioned are purely fymptomatic, and 
confequently that the cure of them muft 
be that of the primary difeafes upon which 
they depend. Of thofe cafes that can any- 
wife be confidered as idiopathic, it will ap- 
pear that they are to be cured, entirely by 
removing remote caufes; the means of 
accomplidling which mutt be fuflicicndy 
obvious. 
BOOK 216 
PRACTICE 
BOOK II. 
O F 
INTUMESCENTIA 
O R 
GENERAL SWELLINGS. 
MXCXX. 
THE fwellings to be treated of in this 
place, are thofe which extend over 
the whole or a great part of the body; or 
fuch at leaft, as, though of fmall extent, 
are however of the fame nature with thofc 
that are more generally extended. 
The OF PHYSIC. 
217 
The fwellings comprehended under this 
artificial order, are hardly to be diftin- 
guifhed from one another otherwife than 
by the matter they contain or confift of: 
and in this view I have divided the order 
into four fe€tions, as the fwelling happens 
to contain, 17?, Oil; 2<7, Air; 3*/, A watery 
fluid; orj As the increafed bulk de- 
pends upon the enlargement of the whole 
lubftance of ceraint parts, and particularly 
of one or more of the abdominal vifcera.. 
Vol. IV. 
P 
CHAP. 218 
PRACTICE 
CHAP. I. 
Qf Adipose Swellings. 
MDCXXI. 
THE only difeafe to be mentioned in this 
chapter, I have, with other Nofolo- 
gifts, named Polyfarcia; and in Englifh it 
may be named Corpulency, or, more ftridl- 
ly, Obeiity; as it is placed here upon the 
common fuppofition of its depending chief- 
ly upon the increafe of oil in the cellular 
texture of the body. This corpulency, 
or obelity, is in very different degrees in 
dif- OF PHYSIC. 
219 
different perfons, and is often confiderable 
Without being confidered as a difeafe. 
There is, however, a certain degree of it, 
which will be generally allowed to be a 
difeafe; as, for example, when it renders 
perfons, from a difficult refpiration, un- 
eafy in themfelves, and, from the inabi- 
lity of exercife, unfit for difcharging the 
duties of life to others : and for that rea- 
fon I have given fuch a difeafe a place 
here. Many phyficians have confidered it 
as an object of practice, and as giving, 
even in no very high degree, a difpofition 
to many difeafes; I am of opinion that it 
ffiould be an object of practice more fre- 
quently than it has been, and therefore 
that it merits our confideration here. 
MDCXXII. 
It may perhaps be alleged, that I have 
not been fufficiently correct, in putting 
the difeafe of corpulency as an intume- 
fcentia 
P 2 220 
PRACTICE 
fcentia pinguedinofa, and therefore im- 
plying its being an increafe of the bulk of 
the body from an accumulation of oil in 
the cellular texture only. I am aware of 
this objection: and as I have already laid, 
that emaciation (MDCII.) depends ei- 
ther upon a general deficiency of fluids in 
the vafcular fyflem, or upon a deficiency 
of oil in the cellular texture ; fo I fhould 
perhaps have obfcrved farther, that the 
corpulency, or general fuinefs of the body, 
may depend upon the fuinefs of the vaf- 
cular fyflem as well as upon that of the 
cellular texture. This is true; and for 
the fame reafons I ought, perhaps, after 
Linnaeus and Sagar, to have fet down ple- 
thora as a particular difeafe, and as an in- 
ftance of morbid intumefcence. I have, 
however, avoided this, as Sauvages and 
Vogel have done; becaufe 1 apprehend 
that plethora is to be confidered as a 
Rate of temperament only, which may 
indeed difnofe to difeafe; but not as a 
dif- OF PHYSIC. 
221 
difeafe in itfelf, unlefs, in the language 
of the Stahlians, it be a plethora com- 
mota, when it produces a difeafe accom- 
panied with particular fymptoms, which 
give occaiion to its being diftinguiffied 
by a different appellation. Further, it 
appears to me, that the fymptoms wThich 
Linmeus, and more particularly thofe 
which Sagar employs in the character of 
plethora, never do occur but when the 
intumefcentia pinguedinofa has a great 
fhare in producing them. It is, however, 
very neceffary to obferve here, that ple- 
thora and obefity are generally combined 
together; and that in fome cafes of cor- 
pulency it may be difficult to determine 
which of the caufes has the greateft fhare 
in producing it It is indeed very poffible 
that a plethora may occur without great 
obefity; but I apprehend that obefity never 
happens to a confiderable degree without 
producing a plethora ad fp at turn in a great 
P3 
part PRACTICE 
222 
part of the fyftem of the aorta, and there- 
fore a plethora ad molem in the lungs, and 
in the veflels of the brain. 
MDCXXIIL 
In attempting the cure of pplyfarcia, 
I ain of opinion, that the conjunction of 
plethora and obelity, in the manner juft 
now mentioned, fhould be conftantly at- 
tended to; and when the morbid effects 
of the plethoric habit are threatened, either 
in the head or lungs, that bloodletting is 
to be praiftifed: but at the fame time it is 
to be obferved, that perfons of much obe- 
fity do not bear bloodletting well; and 
when the circumftances I have mentioned 
do not immediately require it, the prac- 
tice, upon account of obelity alone, is 
hardly ever to be employed. The fame 
remark is to be made, with refpedt to any 
other evacuations that may be propofed 
for O F P H Y S I C. 
223 
for the cure of corpulency: for without 
the other means I am to mention, they 
can give but a very imperfect relief; and, 
in fo far as they either empty or weaken 
the fyftem, they may favour the return of 
plethora, and the increafe of obefity. 
MDCXXIV. 
Polyfarcia, or corpulency, whether it 
depend upon plethora or obefity, when- 
ever it can either be confidered as a dif- 
eafe, or threatens to induce one, is to be 
cured, or the effects of it are to be obvia- 
ted, by diet and exercife. The diet mutt 
be fparing; or rather, what is more ad- 
mifiible, it muft be fuch as affords little 
nutritious matter. It muft therefore be 
chiefly, or almoft only, of vegetable mat- 
ter, and at the very utmoft of milk. Such 
a diet Ihould be employed, and generally 
ought to precede exercife: for obefity does 
P4 
not 224 
PRACTICE 
not eaffiy admit of bodily exercife ; which 
is, however, the only mode that can be 
very effectual. Such indeed, in many ca- 
fes, may feem difficult to be admitted ; but 
I am of opinion, that even the moft corpu- 
lent may be brought to bear it, by at firft 
attempting it very moderately, and increa- 
fing it by degrees very (lowly, but at the 
fame time perfifting in fuch attempts with 
great conftancy. 
MDCXXV. 
As thefe, though the only effectual mea- 
fures, are often difficult to be admitted or 
carried into execution, fome other means 
have been thought of and employed for 
reducing corpulency. Thefe, if I miftake 
not, have all been certain methods of in- 
ducing a faline date in the mafs of blood ; 
for fuch I fuppofe to be the effects of vi- 
negar and of foap, which have been pro- 
pofed. OF PHYSIC. 
225 
pofed. The latter, I believe, hardly pafies 
into the blood-veflels, without being refol - 
ved and formed into a neutral fait, with 
the acid which it meets with in the fto- 
mach. How well acrid and faline fub- 
dances are fitted to diminifh obefity, may 
appear from what has been faid above in 
MDCXV. What effects vinegar, foap, 
or other fubftances employed, have had in 
reducing corpulency, there have not pro- 
per opportunities of obferving occurred 
to me : but I am well perfuaded, that the 
inducing a faline and acrid ftate of the 
blood, may have worfe confequences, than 
the corpulency it was intended to correct; 
and that no perfon Ihould hazard thefe, 
while he may have recourfe to the more 
fafe and certain means of abftinence and 
exercife. 
CHAP. 226 
PRACTICE 
CHAP II. 
Of Flatulent Swellings, 
MDCXXVL 
THE cellular texture of the human bo- 
dy very readily admits of air, and al- 
lows the fame to pafs from any one to every 
other part of it. Hence Emphyfemata 
have often appeared from air collected in 
the cellular texture under the ikin, and in 
feveral other parts of the body. The fla- 
tulent fwellings under the lkin, have in- 
deed moft commonly appeared in confe- 
quence OF PHYSIC. 
227 
quence of air immediately introduced from 
without: but in fome instances of flatulent 
fwellings, efpecially thofe of the internal 
parts not communicating with the alimen- 
tary canal, fuch an introduction cannot be 
perceived or fuppofed; and therefore, in 
thefe cafes, fome other caufe of the pro- 
duction and collection of air muft be look- 
ed for, though it is often not to be clearly 
afcertained. 
In every folid as well as every fluid fub- 
flance which makes a part of the human 
body, there is a confiderable quantity of 
air in a fixed ftate, which may be again re- 
ftored to its elaftic flare, and feparated from 
thofe fubftances, by the power of heat, pu- 
trefaction, and perhaps other caufes : but 
which of thefe may have produced the fe- 
veral inflances of pneumatofis and flatu- 
lent fwellings that have been recorded by 
authors, I cannot pretend to afcertain.. 
Indeed, upon account of thefe difficulties, 
I 228 
PRACTICE 
I cannot proceed with any clearnefs on the 
general fubject of pneumatofis; and, there- 
fore, with regard to flatulent fwellings, I 
find it neceflary to confine myfelf to the 
confideration of thofe of the abdominal 
region alone; which I fliall now treat 
of under the general name of Tympa- 
nites. 
MDCXXVII. 
The tympanites is a fwelling of the ab- 
domen ; in which the teguments appear to 
be much ftretched by fome diftending 
power within, and equally ftretched in 
every pofture of the body. The fwelling 
does not readily yield to any preflure ; 
and in fo far as it does, very quickly re- 
covers its former ftate upon the preflure 
being removed. Being flruck, it gives a 
found like a drum, or other ftretched ani- 
mal membranes. No fluctuation within 
js OF PHYSIC. 
229 
is to be perceived: and the whole feels lefs 
weighty than might be expected from its 
bulk. The uneafinefs of the diftention is 
commonly relieved by the difcharge of air 
from the alimentary canal, either upwards 
©r downwards. 
MDCXXVIII. 
Thefe are the characters by which the 
tympanites may be diftinguifhed from the 
afcites or phyfconia ; and many experi- 
ments fhow, that the tympanites always 
depends upon a preternatural collection of 
air, fomewhere within the teguments of 
the abdomen: but the feat of the air is in 
different cafes fomewhat different; and 
this produces the different fpecies of the 
difeafe. 
One fpecies is, when the air collected, is 
entirely confined within the cavity of the 
alimentary canal, and chiefly in that of 
the 230 
PRACTICE 
the inteftines. This fpecies, therefore, is 
named the 'Tympanites intejlinalis, Sauv. fp. I. 
It is, of all others, the moft common; and 
to it efpecially belong the characters giveii 
above. 
A fecond fpecies is, when the air col- 
lected, is not entirely confined to the cavity 
of the inteftines, but is alfo prefent be- 
tween their coats ; and fuch is that which 
is named by Sauvages Tympanites entero- 
pbyfodes, Sauv. fp. 3. This has certainly 
been a rare occurrence; and has probably 
occurred only in confequence of the tym- 
panites intefiinaliSy by the air efcaping 
from the cavity of the inteftines into the 
interftices of the coats. It is, however, 
pofiible, that an erofion of the internal 
coat of the inteftines may give occafion to 
the air, fo conftantly prefent in their ca- 
vity, to efcape into the interftices of their 
coats, though in the whole of their cavity 
there has been no previous accumulation. 
A OF PHYSIC. 
231 
A third fpecies is, when the air is col- 
lected in the fac of the peritonscum, or 
what is commonly called the cavity of the 
abdomen, that is, the fpace between the 
peritonaeum and vifcera; and then the dif- 
eafe is named Tympanites abdominalis, Sauv. 
fp. 2. The exiftence of fuch a tympani- 
tes, without any tympanites intejlinalis, has 
been difputed; and it certainly has been 
a rare occurrence: but from feveral diffec- 
tions, it is unqueftionable that fuch a dif- 
eafe has fometimes truly occurred. 
A fourth fpecies of tympanites is, when 
the tympanites intejlinalis and abdomina- 
Us are joined together, or take place at 
the fame time. With refpeiSl to this, it is 
probable that the tympanites intejiinalis, is 
the primary difeafe; and the other, only 
a confequence of the air efcaping, by an 
erofion or rupture of the coats of the in- 
teftines, from the cavity of thefe, into that 
of the abdomen. It is indeed poffibie, that 
ill 232 
PRACTICE 
in confequence of erofion or rupture, the 
air which is fo conftantly prefent in the 
intertinal canal, may efcape from thence 
in fuch quantity into the cavity of the ab- 
domen, as to give a tympanites abdominalis, 
whilrt there was no previous confiderable 
Accumulation of air in the inteftinal ca- 
vity itfelf; but I have not fadls to afcer- 
tain this matter properly. 
A fifth fpecies has alfo been enumerated. 
It is when a tympanites abdominalis happens 
to be joined with the/y drops affiles', and fuch 
a difeafe therefore is named by Sauvages 
Tympanites affiticus, Sauv. fp. 4. In moft 
cafes of tympanites, indeed, fome quan- 
tity of ferum, has, upon diffedlion, been 
found in the fac of the peritonaeum • but 
that is not enough to conftitute the fpe- 
cies now mentioned; and when the collec- 
tion of ferum is more confiderable, it is 
commonly where, both from the caufes 
which have preceded, and likewife from 
the Of PHYSIC. 
233 
the fymptoms which attend, the afcites 
may be confidered as the primary difeafe; 
and therefore that this combination does 
not exhibit a proper fpecies of the tympa- 
nites. 
MDCXXIX. 
As this laft is not a proper fpecies, and 
aS Tome of the others are not only extremely 
rare, but even, when occurring, are nei- 
ther primary, nor to be eafily diftinguifh- 
ed, nor, as confidered in themfelves, admit- 
ting of any cure, I fhall here take no further 
notice of them ; confining myfelf, in what 
follows, to the confideration of the moft 
frequent cafe, and almoft the only object 
of practice, the tympanites 
MDCXXX. 
With refpedt to this, I cannot perceive 
Vol. IV. 
that 234 
PRACTICE 
that it arifes in any peculiar tempera- 
ment, or depends upon any predifpolition, 
•which can be difcerned. It occurs in ei- 
ther lex, at every age, and frequently in 
young perfons. 
MDCXXXI. 
Various remote caufes of it have been 
aligned: but many of thefe,have not com- 
monly the effect of producing this difeafe; 
and although fome of them have been 
truly antecedents of it, 1 can in few in- 
fiances difcover the manner in which they 
produce the difeafe, and therefore cannot 
certainly afcertain them to have been 
caufes of it. 
MDCXXXXIL 
The phenomena of this difeafe in its fe- 
veral ftages are the following. 
The OF PHYSIC. 
235 
The tumour of the belly fometimes 
grows very quickly to a confiderable de- 
gree, and feldom in the flow manner the 
afcites commonly comes on. In fome cafes* 
however, the tympanites comes on gradual- 
ly, and is introduced by an unufual flatu- 
lency of the flomach and inteftines, with 
frequent borborygmi, and an uncom- 
monly frequent expulfion of air upwards 
and downwards. This flate is alfo fre- 
quently attended with colic pains, efpe- 
cially felt about the navel, and upon the 
fides towards the back; but generally as the 
difeafe advances, thefe pains become lefs 
confiderable. As the difeafe advances, 
there is a pretty conftant defire to dif- 
charge air, but it is accomplifhed with dif- 
ficultly ; and when obtained, although it 
give fome relief from the fenfe of diften- 
tion, this relief is commonly tranfient and 
of Ihort duration. While the difeafe is co- 
ming on, fome inequality of tumour and 
Q^2 
tenfion 236 
PRACTICE 
tenfion may be perceived in different parts 
of the belly ; but the didention foon be- 
comes equal over the whole, and exhibits 
the phenomena mentioned in the charac- 
ter. Upon the fird coming on of the dif- 
eafe, as well as during its progrefs, the 
belly is bound, and the faeces difcharged 
are commonly hard and dry. The urine, 
at the beginning, is ufually very little 
changed in quantity or quality from 
its natural date; but as the difeafe con- 
tinues, it is commonly changed in both 
refpedts, and at length fometimes a ftran- 
gury, and even an ifchuria, comes on. 
The difeafe has feldom advanced far, be- 
fore the appetite is much impaired, and 
digedion ill performed ; and the whole 
body, except the belly, becomes confide- 
rably emaciated. Together with thefe 
fymptoms, a third and uneafy fenfe of 
heat at length come on, and a confiderable 
frequency of pulfe occurs, which conti- 
nues OF PHYSIC. 
237 
nues throughout the courfe of the dif- 
eafe. When the tumour of the belly ari- 
fes to a conliderable bulk, the breathing 
becomes very difficult, with a frequent 
dry cough. With all thefe fymptoms the 
ftrength of the patient declines; and the 
febrile fymptoms daily increaling, death 
at length enfues, fometimes probably in 
confequence of a gangrene coming upon 
the inteftines. 
MDCXXXIII. 
The tympanites is commonly of fome 
duration, and to be reckoned a chronic 
difeafe. It is very feldom quickly fatal, 
except where fuch an affection fuddenly 
arifes in fevers. To this Sauvages has 
properly given a different appellation, that 
of Meteorijmus; and I judge it may al- 
ways be confidered as a fymptomatic af- 
fection, 
Qs 238 
PRACTICE 
feftion, entirely diftincR from the tympa- 
nites we are now confidering. 
MDCXXXIV. 
The tympanites is generally a fatal dif- 
eafe, feldom admitting of cure; but what 
may be attempted in this way, I fhall try 
to point out, after I fhall have endeavour- 
ed to explain the proximate caufe, which 
alone can lay the foundation of what may 
be rationally attempted towards its cure. 
MDCXXXV. 
To afcertain the proximate caufe of 
tympanites, is fomewhat difficult. It has 
been fuppofed in many cafes, to be merely 
an uncommon quantity of air prefent in 
the alimentary canal, owing to the extri- 
cation and detachment of a greater quan- 
tity OF PHYSIC. 
239 
tity of air than ufual, from the alimentary 
matters taken in. Our vegetable aliments, I 
believe, always undergo fome degree of fer- 
mentation; and in confequence, a quan- 
tity of air is extricated and detached from 
them in the ftomach and inteftines: but it 
appears, that the mixture of the animal 
fluids which our aliments meet with in 
the alimentary canal, prevents the fame 
quantity of air from being detached from 
them that would have been in their fer- 
mentation without fiich mixture, and it is 
probable that the fame mixture contri- 
butes alfo to the reabforpcion of the air 
that had been before in fome meafure de- 
tached. The extrication, therefore, of an 
unufual quantity of air from the aliments, 
may, in certain circumftances, be fuch, 
perhaps, as to produce a tympanites; fo 
that this difeafe may depend upon a fault 
of the digeftive fluids, whereby they are 
unfit to prevent the too copious extrica- 
tion 
<u 240 
PRACTICE 
tion of air? and unfit alfo to occafion that 
reabforption of air which in found per- 
fons commonly happens. An unufual 
quantity of air in the alimentary canal, 
whether owing to the nature of the ali- 
ments taken in, qr to the fault of the di- 
geftive fluid, does certainly fometimes take 
place; and may poflibly have, and in 
fome meafure certainly has, a fliare in 
producing certain flatulent diforflers of the 
alimentary canal; but cannot be fuppofed 
to produce the tympanites, which often 
occurs when no previous diforder had ap- 
peared in the fyftem. Even in thofe cafes 
of tympanites which are attended at their 
beginning with flatulent diforders in the 
whole of the alimentary canal, as wp know 
that a firm tone of the inteflines both mo- 
derates the extrication of air, and contri- 
butes to its reabforption or ready expul- 
iion,fo the flatulent fymptoms which hap- 
pen to appear at the coming on qf a 
ty in- OF PHYSIC. 
241 
tympanites, are, in my opinion, to be re- 
ferred to a lofs of tone in the mufcular 
fibres of the inteftines, rather than to any 
fault in the digeftive fluids. 
MDCXXXVI. 
Thefe, and other confiderations, lead 
me to conclude, that the chief part of the 
proximate caufe of tympanites, is a lofs of 
tone in the mufcular fibres of the inte-r 
Bines. But further, as air of any kind 
accumulated in the cavity of the inteftines 
fhould, even by its own elafticity, find its 
way either upwards or downwards, and 
fhould alfo, by the affiftance of infpira- 
tion, be entirely thrown out of the body ; 
fo, when neither the reabforption nor the 
expulhon takes place, and the air is accu* 
mulated fo as to produce tympanites, it is 
probable that the paffage of the air along 
the courfe of the inteftines is in fome 
places  PRACTICE 
242 
places of thefe interrupted. This inter- 
ruption, however, can hardly be fuppofed 
to proceed from any other caufe than fpaf- 
modic conftriftions in certain parts of the 
canal; and I conclude, therefore, that 
fuch conftri&ions concur as part in the 
proximate caufe of tympanites. Whether 
thefe fpafmodic conftridlions are to be at- 
tributed to the remote caufe of the difeafe, 
or may be confidered as the confequence 
of fome degree of atony fir ft arifing, 1 can- 
not with certainty, and do not find it ne- 
ceffary to determine. 
MDCXXXVII. 
Having thus endeavoured to afcertain 
the proximate caufe of tympanites, I pro- 
ceed to treat of its cure; which indeed 
has feldom fucceeded, and almoft never 
but in a recent difeafe. I muft, however, 
endeavour to fay what may be reafonably 
at- O F PHYSIC. 
243 
attempted; what has commonly been at- 
tempted; and what attempts have fome- 
times fucceeded in the cure of this dif- 
eafe. 
MDCXXXVIII. 
It muft be a firft indication to evacuate 
the air accumulated in the inteftines : and 
for this purpofe it is neceffary that thole 
conftricftions, which had efpecially occali- 
oned its accumulation, and continue to in- 
terrupt its paflage along the courfe of the in- 
teftines, Ihould be removed. As thefe, how- 
ever, can hardly be removed but by exci- 
ting the periftaltic motion in the adjoining 
portions of the inteftines, purgatives have 
been commonly employed ; but it is at the 
fame time agreed, that the more gentle 
laxatives only ought to be employed, as 
the more draftic, in the overftretched and 
tenfe 244 
PRACTICE 
tenfe ftate of the inteftines, are in danger 
of bringing on inflammation. 
It is for this reafon, alfo, that glyfters 
have been frequently employed; and they 
are the more neceftary, as the faeces col- 
lected are generally found to be in a hard 
and dry ftate. Not only upon account of 
this ftate of the faeces, but, farther, when 
glyfters produce a confiderable evacuation 
of air, and thus fhow that they have foine 
effecft in relaxing the fpafms of the inte- 
ftines, they ought to be repeated very fre- 
quently. * 
MDCXXXIX. 
In order to take off the conftricftions 
of the inteftines, and with fome view alfo 
to the carminative effects of the medicines, 
various antifpafmodics have been propo- 
fed, and commonly employed ; but their 
effects are feldom confiderable, and it is 
alleged OF PHYSIC. 
245 
alleged that their heating and inflamma- 
tory powers have fometimes been hurtful. 
It is, however, always proper to join fome 
of the milder kinds with both the purga- 
tives and glyfters that are employed ; and 
it has been very properly advifed to give 
always the chief of antifpafmodics, that 
is, an opiate, after the operation of purga- 
tives is finifhed. 
MDCXL. 
In confideration of the overftretched, 
tenfe, and dry ftate of the inteftines, and 
efpecially of the fpafmodic conftridions that 
prevail, fomentations and warm bathing 
have been propofed as a remedy; and are 
faid to have been employed with advan- 
tage : but it has been remarked, that very 
warm baths have not been found fo ufeful 
as tepid baths long continued. 
MDCXLI. 246 
PRACTICE 
MDCXLI. 
Upon the fuppofition that this difeafe 
depends efpecially upon an atony of the 
alimentary canal, tonic remedies feem to 
be properly indicated. Accordingly cha- 
lybeates, and various bitters, have been em- 
ployed ; and, if any tonic, the Peruvian 
bark might probably be ufeful. 
MDCXL1L 
But as no tonic remedy is more power- 
ful than cold applied to the furface of the 
body, and cold drink thrown into the fto- 
mach; fo fuch a remedy has been thought 
of in this difcafe. Cold drink has been 
conftantly prefcribed, and cold bathing 
has been employed with advantage; and 
there have been feveral inftances of the dif- 
eafe being fuddenly and entirely cured by 
the OF PHYSIC. 
247 
the repeated application of fnow to the 
lower belly. 
MDCXLIII. 
It is hardly neceflary to remark, that, in 
the diet of tympanitic perfons, all forts of 
food ready to become flatulent in the fto- 
mach are to be avoided; and it is pro- 
bable, that the foflil acids and neutral faits, 
as antizymics, may be ufeful. 
MDCXLIV. 
In obftinate and defperate cafes of tym- 
panites, the operation of the paracentefis 
has been propofed: but it is a very doubt- 
ful remedy, and there is hardly any tefti- 
mony of its having been praclifed with 
fuccefs. It muft be obvious, that this ope- 
ration is a remedy fuited efpecially, and al- 
moft only, to the tympanites abdominalis; the 
exiftence 248 
PRACTICE 
exiftence of which, feparately from the in* 
tcflinalis, is very (Joubtful, at leaf! not eafily 
afcertained. Even if its exiftence could be 
afcertained, yet it is not very likely to be 
cured by this remedy: and how far the 
Operation might be fafe in the tympanites 
intejlinalis, is not yet determined by any 
proper experience. 
BOOK OF PHYSIC. 
249 
C H A P. Ill, 
Of Watery Swellings, or Dropsies, 
MDCXLV. 
A Preternatural collection of fe- 
rous or watery fluids, is often form- 
ed in different parts of the human body; 
and although the difeafe thence arifing be 
diftinguifhed according to the different 
parts which it occupies, yet the whole of 
fuch collections come under the general 
Vol. IV. 
R 
ap- 250 
PRACTICE 
appellation of Dropfies. At the fame time, 
although the particular inftances of fuch 
collection are to be diftinguifhed from 
each other according to the parts they oc- 
cupy, as well as by other circumftances 
attending them; yet all of them feem to 
depend upon fome general caufes, very 
much in common to the whole. Before 
proceeding, therefore, to conlider the fe- 
veral fpecies, it may be proper to endeavour 
to aflign the general caufes of dropfy. 
MDCXLVI. 
In perfons in health, a ferous or watery 
fluid feems to be conftantly poured out, 
or exhaled in vapour, into every cavity and 
interftice of the human body capable of 
receiving it; and the fame fluid, without 
remaining long or being accumulated in 
thefe fpaces, feems conftantly to be foon 
again abforbed from thence by veflels ad- 
apted OF PHYSIC. 
251 
apted to the purpofe. From this view of 
the animal (Economy, it will be obvious, 
that if the quantity poured out into any 
fpace, happens to be greater than the ab- 
forbents can at the fame time take up, an 
unufual accumulation of ferous fluid will 
be made in fuch parts; or though the quan- 
tity poured out, be not more than ufual, 
yet if the abforption be anywife inter- 
rupted or diminiihed, from this caufe alfo 
an unufual colledion of fluids may be 
occafioned. 
Thus, in general, dropfy may be impu- 
ted to an increafed eflufion, or to a dimi- 
niihed abforption; and I therefore proceed 
to inquire into the feveral caufes of thefe* 
MDCXLVIL 
An increafed effufion may happen, ei- 
ther from a preternatural increafe of the 
R 2 
ordi- 252 
PRACTICE 
ordinary exhalation, or from the rupture 
of veflels carrying, or of facs containing, 
ferous or watery fluids. 
MDCXLVIII. 
The ordinary exhalation may be increa- 
fed by various caufes, and particularly by 
an interruption given to the free return of 
the venous blood from the extreme veflels 
of the body to the right ventricle of the 
heart. This interruption feems to operate 
by refilling the free paflage of the blood 
from the arteries into the veins, thereby 
increaling the force of the arterial fluids in 
the exhalants, and confequently the quan- 
tity of fluid which they pour out. 
MDCXLIX. 
The interruption of the free return of 
the venous blood from the extreme vef- 
fels, OF PHYSIC* 
253 
fels, may be owing to certain circum- 
ftances affe&ing the courfe of the venous 
blood; very frequently, to certain condi- 
tions in the right ventricle of the heart it- 
felf, preventing it from receiving the ufual 
quantity of blood from the vena cava; or 
to obftrudlions in the vefTels of the lungs 
preventing the entire evacuation of the 
right ventricle, and thereby hindering its 
receiving the ufual quantity of blood from 
the cava. Thus, a polypus in the right 
ventricle of the heart, and the offification 
of its valves, as well as all confiderable and 
permanent obftru&ions of the lungs, have 
been found to be caufes of dropfy. 
MDCL. 
It may ferve as an illuftration of the 
operation of thefe general caufes, to re- 
mark, that the return of the venous blood 
is in fome meafure refilled when the po- 
fture 
R3 254 
PRACTICE 
fture of the body is fuch as gives occafion 
to the gravity of the blood to oppofe the 
motion of it in the veins, which takes ef- 
fedl when the force of the circulation is 
■weak; and from whence it is that an up- 
right pofture of the body produces or in- 
creafes ferous fwellings in the lower extre- 
mities. 
MDCLI. 
Not only, thofe caufes interrupting the 
motion of the venous blood more gene- 
rally, but, farther, the interruption of it in 
particular veins, may likewife have the ef- 
fect of increafing exhalation, and produ- 
cing dropfy. The moll remarkable in- 
ftance of this is, when confiderable ob- 
ftrudlions of the liver prevent the blood 
from flowing freely into it from the vena 
portarum and its numerous branches; and 
hence thefe obftrudions are a frequent 
eaufe of dropfy. 
MDCLII. OF PHYSIC. 
255 
MDCLII. 
Scirrhofities of the fpleen and other vif- 
cera, as well as the fcirrholity of the liver, 
have been confidered as caufes of dropfy; 
but the manner in which they can pro- 
duce the difeafe, I do not perceive, except 
it may be, where they happen to be near 
fome conliderable vein, by the compref- 
fion of which they may occafion fome de- 
gree of afcites; or, by comprefling the ve- 
na cava, may produce an anafarca of the 
lower extremities. It is indeed true, that 
fcirrholities of the fpleen and other vif- 
cera, have been frequently difcovered in 
the bodies of hydropic perfons: but I be- 
lieve they have been feldom found unlefs 
when fcirrhoiities of the liver were alfo 
prefent; and I am inclined to think, that 
the former have been the effects of the lat- 
ter, rather than the caufe of the dropfy: 
or 
R 4 256 
PRACTICE 
or that, if fcirrhofities of the other vifcera 
have appeared in hydropic bodies when 
that of the liver was not prefent, they muft 
have been the effects of fome of thofe 
caufes of dropfy to be hereafter mention- 
ed ; and confequently to be the accidental 
attendants, rather than the caufes, of fuch 
dropfies. 
MDCLIIL 
Even in fmaller portions of the venous 
fyftem, the interruption of the motion of 
the blood in particular veins has had the 
fame effect. Thus, a polypus formed in 
the cavity of a vein, or tumours formed 
in its coats, preventing the free paflage of 
the blood through it, have had the effect 
of producing dropfy in parts towards the 
extremity of fuch veins. 
MDCLIV. OF PHYSIC. 
257 
MDCLIV. 
But the caufe moft frequently interrupt- 
ing the motion of the blood through the 
veins is, the compreffion of tumours exift- 
ing near to them; fuch as aneurifms in the 
arteries, abfceffes, and fcirrhous or fteato- 
matous tumours in the adjoining parts. 
To this head, may be referred, the 
comprefiion of the defcending cava by the 
bulk of the uterus in pregnant women, 
and the comprefiion of the fame by the 
bulk of water in the afcites; both of which 
compreflions frequently produce ferous 
fwellings in the lower extremities. 
MDCLV. 
It may be fuppofed, that a general pre- 
ternatural plethora of the venous fyftem 
may have the effect of increafing exhala- 
tion ; and that this plethora may happen 
from 258 
PRACTICE 
from the fuppreflion of fluxes, or evacua- 
tions of blood, which had for fome time 
taken place in the body, fuch as the men- 
ilrual and hemorrhoidal fluxes. A dropfy, 
however, from fuch a caufe, has been at 
leaft a rare occurrence; and when it feems 
to have happened, I fliould fuppofe it ow- 
ing to the fame caufes as the fuppreflion 
itfelf, rather than to the plethora produced 
by it. 
MDCLVL 
One of the moft frequent caufes of an 
increafed exhalation, I apprehend to be the 
laxity of the exhalant veflels. That fuch a 
caufe may operate, appears probable from 
this, that paralytic limbs, in which fuch a 
laxity is to be fufpeCted, are frequently af- 
fected with ferous, or, as they are called, 
oedematous fwellings. 
But a much more remarkable and fre- 
quent OF PHYSIC. 
259 
quent example of its operation occurs in the 
cafe of a general debility of the fyflem, 
which is fo often attended with dropfy. 
That a general debility does induce drop- 
fy, appears fufficiently from its being fo 
commonly the confequence of powerfully 
debilitating caufes; fuch as fevers, either 
of the continued or intermittent kind, 
which have lafted long; long-continued 
and fomewhat exce(live evacuations of any 
kinds; and in ihort, almoil all difeafes 
that have been of long continuance, and 
have at the fame time induced the other 
fymptoms of a general debility. 
Among other caufes inducing a genera! 
debility of the fyftem, and thereby drop- 
fy, there is one to be mentioned as fre- 
quently occurring, and that is, intempe- 
rance in the ufe of intoxicating liquors; 
from whence it is that drunkards of all 
kinds, and efpecially dram-drinkers, are 
fo affected with this difeafe. 
MDCLVII. 260 
PRACTICE 
MDCLVIL 
That a general debility may produce a 
laxity of the exhalants, will be readily al- 
lowed ; and that by this efpecially it oc- 
cafions dropfy, I judge from hence, that 
while moft of the caufes already mentioned 
are fuited to produce dropfies of particular 
parts only, the date of general debility 
gives rife to an increafed exhalation into 
every cavity and interface of the body, 
and therefore brings on a general dif- 
eafe. Thus, we have feen effulions of a 
ferous fluid made, at the fame time, into 
the cavity of the cranium, into that of the 
thorax and of the abdomen, and like- 
wife into the cellular texture almoft over 
the whole of the body. In fuch cafes, 
the operation of a general caufe difcover- 
ed itfelf, by thefe feveral dropfies increa- 
fing in one part as they diminifhed in an- 
other, and this alternately in the different 
parts. OF PHYSIC. 
261 
parts. This combination, therefore, of 
the different fpecies of dropfy, or rather, 
as it may be termed, this univerfal dropfy, 
mu ft, I think, be referred to a general 
caufe; and in moft inftances, hardly 
any other can be thought of, but a ge- 
neral laxity of the exhalants. It is this, 
therefore, that I call the hydropic diathejis; 
which frequently operates by itfelf; and 
frequently, in fome meafure, concurring 
with other caufes, is efpecially that which 
gives them their full effedh 
This ftate of the fyftem, in its firft ap- 
pearance, feems to be what has been con- 
iidered as a particular difeafe under the 
the name of Cachexy; but in every inftance 
of it that has occurred to me, I have always 
confidered, and have always found it, to be 
the beginning of general dropfy. 
MDCLVIIL 262 
PRACTICE 
MDCLVIII. 
The feveral caufes of dropfy already 
mentioned may produce the difeafe, altho' 
there be no preternatural abundance of 
ferous or watery fluids in the blood-vef- 
fels; but it is now to be remarked, that 
a preternatural abundance of that kind 
may often give occafion to the difeafe, 
and more efpecially when fuch abundance 
concurs with the caufes above enumera- 
ted. 
One caufe of fuch preternatural abun- 
dance may be an unufual quantity of 
water taken into the body. Thus an 
unufual quantity of water, taken in by 
drinking, has fometimes occafioned a 
dropfy. Large quantities of water, it 
is true, are upon many occafions taken 
in; and being as readily thrown out again 
by ftool, urine, or perfpiration, have not 
produced any difeafe. But it is alfo cer~ OF PHYSIC. 
263 
tain, that, upon fome occafions, an unu- 
fual quantity of watery liquors taken in 
has run off by the feveral internal exha- 
lants, and produced a dropfy. This feems 
to have happened, either from the excre- 
tories not being fitted to throw out the 
fluid fo fail: as it had been taken in, or 
from the excretories having been obftruc- 
ted by accidentally concurring caufes. 
Accordingly it is faid, that the fudden 
taking in of a large quantity of very cold 
water, has produced dropfy, probably front 
the cold producing a conftridlion of the 
excretories. 
The proportion of watery fluid in the 
blood may be increafed, not only by the 
taking in a large quantity of water by 
drinking, as now mentioned, but it is 
pofilble that it may be increafed alfo by 
water taken in from the atmolphere by 
the ikin in an abforbing or imbibing 
ftate. It well known, that the fkin may 
be, 264 
PRACTICE 
be, at leaft, occaflonally in fuch a Rate; 
and it is probable, that in many cafes of 
beginning dropfy, when the circulation of 
the blood on the furface of the body is very 
languid, that the fkin may be changed 
from a perfpiring, to an imbibing, ftate; 
and thus, at leaft, the difeafe may be very 
much increafed. 
MDXCLIX. 
A fecond caufe of a preternatural abun- 
dance of watery fluids in the blood- 
veflels, may be, an interruption of the or- 
dinary watery excretions ; and according- 
ly it is alleged, that perfons much expo- 
fed to a cold and moift air are liable to 
dropfy. It is alfo faid, that an interrup- 
tion, or confiderable diminution, of the 
urinary fecretion, has produced the difl- 
eafe : and it is certain, that, in the cafe of 
an ifcburia renalis, the ferofity retained in 
the blood -veflels has been poured out into 
fome OF PHYSIC. 
265 
Tome internal cavities, and has occafioned 
dropfy. 
MDCLX. 
A third caufe, of an over-proportion of 
ferous fluid in the blood ready to run off 
by the exhalants, has been very large eva- 
cuations of blood, either fpontaneous or 
artificial. Thefe evacuations, by abftrac- 
ting a large proportion of red globules 
and gluten, which are the principal means 
of retaining ferum in the red veflels, al- 
low the ferum to run off more readily by 
the exhalants : and hence dropfies have 
been frequently the confequence of fuch 
evacuations. 
It is poflible alfo, that large and long- 
continued iflues, by abftradling a large 
proportion of gluten, may have the fame 
effect. 
An over-proportion of the ferous parts 
Vol. IV. 
S 
of 266 
PRACTICE 
of the blood, may not only be owing to 
the /puliation juft now mentioned, but 
may, I apprehend, be likewife owing to a 
fault in the digefting and affimilating 
powers in the ftomach and other organs; 
whereby they do not prepare and convert 
the aliments taken in, in fuch a manner 
as to produce from them the due propor- 
tion of red globules and gluten ; but, ftill 
continuing to fupply the watery parts, 
occafion thefe to be in an over-proportion, 
and confequently ready to run off in too 
large quantity by the exhalants. It is in 
this manner that we explain the dropfy, 
fo often attending chlorofis; which ap- 
pears always at firft by a pale colour of 
the whole body, fhowing a manifeft defi- 
ciency of red blood; which in that difeafe 
can only be attributed to an imperfeCl 
digeftion and afiimilation. 
Whether a like imperfection take place 
in what has been called a I dare 
not: OF PHYSIC. 
267 
not determine. This difeafe indeed has 
been commonly and very evidently owing 
to the general caufes of debility above 
mentioned: and it being probable that the 
general debility may affed the organs of 
digeftion and aflimilation; fo theimperfed 
ftate of thefe fundions, occafloning a de- 
ficiency of red globules and gluten, may 
often concur with the laxity of the exha- 
lants in produing dropfy. 
MDCLXL 
Thefe are the feveral caufes of increa- 
fed exhalation, which I have mentioned as 
the chief caufe of the effufion producing 
dropfy; but I have likewife obferved in 
MDCLXVII. that with the fame effed, an 
effufion may alfo be made by the rupture 
of veffels carrying watery fluids. 
In this way, a rupture of the thoracic 
dud, has given occafion to an effufion of 
S 2 
chvle 268 
PRACTICE 
chyle and lymph into the cavity of the 
thorax; and a rupture of the ladleals, has 
occafioned a like effufion into the cavity of 
the abdomen; and in either cafe, a dropfy 
has been produced. 
It is fufficiently probable that a rupture 
of lymphatics, in confequence of (trains, 
or the violent compreffion of neighbour- 
ing mufcles, has occafioned an effufion; 
which, being diffufed in the cellular tex- 
ture, has produced confiderable dropfy. 
It belongs to this head of caufes, to re- 
mark, that there are many infiances of a 
rupture or erofion of the kidneys, ureters, 
and bladder of urine ; whereby the urine 
has been poured into the cavity of the ab- 
domen, and produced an afeites. 
MDCLXII. 
Upon this fubjeft, of the rupture of 
veiTels carrying, or of veficles containing, 
watery OF PHYSIC. 
269 
watery fluids, I muft obferve, that the 
diffeClion of dead bodies has often fhown 
veficles formed upon the furface of many 
of the internal parts ; and it has been fup- 
pofed, that the rupture of fuch veficles, 
commonly named together with 
their continuing to pour out a watery 
fluid, has been frequently the caufe of 
dropfy. I cannot deny the poflibility of 
fuch a caufe, but fufpeCt the matter muft 
be explained in a different manner. 
There have been frequently found, in 
almoft every different part of animal 
bodies, collections of fpherical veficles, 
containing a watery fluid; and in many 
cafes of fuppofed dropfy, particularly in 
thofe called the preternatural encyftcd 
dropfies, the fwelling has been entirely 
owing to a collection of fuch hydatides. 
Many conjectures have been formed with 
regard to the nature and production of 
thefe veficles ; but the matter at laft 
S3 
feems PRACTICE 
270 
feems to be afccrtained. It feems to be 
certain, that each of thefe veficles has 
within it, or annexed to it, a living ani- 
mal of the worm kind; which feems to 
have the power of forming a veficle for 
the purpofe of its own oeconomy, and of 
filling it with a watery fluid drawn from 
the neighbouring parts: and this animal 
has therefore been properly named by 
late naturalifts, the T'ama bydatigena. The 
origin and oeconomy of this animal, or 
an account of the feveral parts of the 
human body which it occupies, I cannot 
profecute further here; but it was pro- 
per for me, in delivering the caufes of 
dropfy, to fay thus much of hydatides : 
and I muft conclude with obferving, I 
am well perfuaded, that moft of the in- 
ftances of preternatural encyfted drop- 
fies which have appeared in many dif- 
ferent parts of the human body, have 
been truly collections o.f fuch hydatides ; 
but 
* ' *1 OF PHYSIC. 
271 
but how the fwellings occafioned by thefe 
are to be diftinguiflied from other fpecies 
of dropfy, or how they are to be treated 
in practice, I cannot at prefent determine, 
MDCLXIII. 
After having mentioned thefe, I return to 
conflder the other general caufe of dropfy, 
which I have faid in MDCXLVI. may be 
an interruption or diminution of the ab- 
forption that Ihould take up the exha- 
led fluids from the feveral cavities and in- 
terftices of the body; the caufes of which 
interruption, however, are not eafily af- 
certained. 
MDXCLXIV. 
It feems probable, that abforption may be 
diminiflied, and even ceafe altogether, from 
a lofs of tone in the abforbent extremities 
s4 
of 272 
PRACTICE 
of the lymphatics. I cannot indeed doubt 
that a certain degree of tone or active 
power is neceffary in thefe abforbent ex- 
tremities ; and it appears probable, that the 
fame general debility which produces that 
laxity of the exhalant veffels, wherein I have 
fuppofed the hydropic diathefis to confift, 
will at the fame time occaiion a lofs of 
tone in the abforbents ; and therefore that 
a laxity of the exhalants will generally be 
accompanied with a lofs of tone in the ab- 
forbents ; and that this will have a (hare 
in the produ&ion of dropfy. Indeed it is 
probable that the diminution of abforption 
has a confiderable (hare in the matter; as 
dropfies are often cured by medicines which 
feein to operate by exciting the adlion of 
the abforbents. 
MDCLXV. 
It has been fuppofed, chat the abforption 
per- OF PHYSIC. 
273 
performed by the extremities of lympha- 
tics may be interrupted by an obftru&ion 
of thefe veffels, or at lead: of the conglo- 
bate glands through which thefe veffels 
pafs. This, however, is very doubtful. 
As the lymphatics have branches frequent- 
ly communicating with one another, it is 
not probable that the obstruction of any 
one, or even feveral of thefe, can have any 
considerable effeft in interrupting the ab- 
forption of their extremities. 
And for the fame reafon, it is as little 
probable that the obstruction of conglo- 
bate glands can have fuch an effect: at 
leaft it is only an obstruction of the glands 
of the mefentery, through which fo con- 
siderable a portion of the lymph palfes, 
that can poffibly have the effect of inter- 
rupting abforption. But even this we Should 
not readily fuppofe, there being reafon to 
believe that thefe glands, even in a con- 
siderably tumefied Slate, are not entirely 
ob-  PRACTICE 
274 
obflrudled: And accordingly I have known 
feveral inftances of the moft part of the 
mefenteric glands being conflderably tu-r 
mefied, without either interrupting the 
tranfmiflion of fluids to the blood-veflels, 
or occafionfng any dropfy. 
An hydropic fwelling, indeed, feems of- 
ten to affect the arm from a tumour of the 
axillary gland : but it feems to me doubt- 
ful, whether the tumour of the arm may 
not be owing to fome compreflion of the 
axillary vein, rather than to an obflruc- 
tion of the lymphatics# 
MDCLXVL 
A particular interruption of abforption 
may be fuppofed to take place in the brain. 
As no lymphatic veffels have yet very 
certainly been difeovered in that organ, 
it may be thought that the abforption, 
which certainly takes place there, is per- 
formed OF PHYSIC, 
275 
formed by the extremities of veins, or by 
veflels that carry the fluid direCtly into 
the veins ; fo that any impediment to the 
free motion of the blood in the veins of 
the brain, may interrupt the abforption' 
there, and occafion that accumulation of 
ferous fluid which fo frequently occurs 
from a congeflion of blood in thefe veins. 
But I give all this as a matter of conjecture 
only. 
MDCLXVIL 
Having thus explained the general cau- 
fes of dropfy, I fhould proceed, in the next 
place, to mention the feveral parts of the 
body in which ferous collections take place, 
and fo to mark the different fpecies of 
dropfy * but I do not think it necefTary 
for me to enter into any minute detail 
upon this fubjed. In many cafes, thefe 
collections are not to be afcertained by 
any 276 
PRACTICE 
any external fymptoms, and therefore can- 
not be the objects of practice ; and many 
of them, though in fome meafure difcern- 
ible, do not feem to be curable by our 
art. I the more efpecially avoid mention- 
ing very particularly the feveral fpecies, 
becaufe that has already been fufficiently 
done by Dr D. Monro, and other writers, 
in every body's hands. I muft confine 
myfelf here to the confideration of thofe 
fpecies which are the moft frequently oc- 
curring, and the moft common objects of 
our practice; which are, the Anafarca, Hy- 
drothorax, and Afcites; and of each of thefe 
I fhall treat in fo many feparate fecftions. 
SECT. OF PHYSIC. 
277 
SECT. I. 
Of Anasarca; 
MDCLXVIIL 
The Anafarca is a fwelling upon the 
furface of the body, at firft commonly 
appearing in particular parts only, but 
at length frequently appearing over the 
whole. So far as it extends, it is an uni- 
form fwelling over the whole member, 
at firft always foft, and readily receiving 
the preffure of the finger, which forms a 
hollow that remains for fome little time 
after 278 
PRACTICE 
after the prelfure is removed, but at length 
rifes again to its former fulnefs. This 
fwelling generally appears, firft, upon the 
lower extremities; and there too only in the 
evening, difappearing again in the morn- 
ing. It is ufually more confiderable as the 
perfon has been more in an eredt pofture 
during the day; but there are many in- 
flances of the exercife of walking prevent- 
ing altogether its otherwife ufual coming 
on. Although this fwelling appears at 
firft only upon the feet and about the 
ankles; yet if the caufes producing it con- 
tinue to adt, it gradually extends upwards, 
occupying the legs, thighs, and trunk of 
the body, and fometimes even the head. 
Commonly the fwelling of the lower extre- 
mities diminifhes during the night; and in 
the morning, the fwelling of the face is 
molt confiderable, which again generally 
di lappears almoft entirely in the courfe of 
the day. 
MDGLXIX. OF PHYSIC. 
279 
MDCLXIX. 
The terms of Anafarca and Leucopbleg- 
niatia have been commonly confidered as 
fynonimous; but fome authors have pro- 
pofed to confider them as denoting diftindt 
difeafes. The authors who are of this laft 
opinion employ the name of Anafarca for 
that difeafe which begins in the lower ex- 
tremities, and is from thence gradually 
extended upwards in the manner I have 
juft now defcribed; while they term Leu- 
that in which the fame kind 
of fwelling appears even at firft very ge- 
nerally over the whole body. They feem to 
think alfo, that the two difeafes proceed 
from different caufes; and that, while the 
anafarca may arife from the feveral caufes 
in MDCXLVIIL-MDCLIX. the leuco- 
phlegmatia proceeds efpecially from a de- 
ficiency of red blood, as we have mention- 
ed in MDCLX, et feq. I cannot, however, 
find 280 
PRACTICE 
And any proper foundation for this di- 
ftindion; for although in dropfles pro- 
ceeding from the caufes mentioned in 
MDCLX, et feq. the difeafe appears in 
fome cafes more immediately affeCling the 
whole body; yet that does not eftablifh a 
difference from the common cafe of ana- 
farca: for the difeafe, in all its circumftan- 
ces, comes at length to be entirely the 
fame; and in the cafes occafioned by a de- 
ficiency of red blood, I have frequently 
obferved it to come on exadily in the man- 
ner of an anafarca, as above defcribed. 
MDCLXX. 
An anafarca is evidently a preternatu- 
ral collection of ferous fluid in the cellu- 
lar texture immediately under the fkin. 
Sometimes pervading the fkin itfelf, it 
oozes out through the pores of the cu- 
ticle ; and fometimcs, too grofs to pafs by 
thefe, it raifes the cuticle in blifters. 
Some- OF PHYSIC. 
281 
Sometimes the ikin, not allowing the wa- 
ter to pervade it, is com prefled and har- 
dened, and at the fame time fo much di- 
ftended, as to give anafarcous tumours an 
unufual firmnefs. It is in thefe laft circum- 
ftances alfo that an erythematic inflam- 
mation is ready to come upon anafarcous 
fwel lings. 
MDCLXXI. 
An anafcarca may immediately arife 
from any of the feveral caufes of dropfy 
which a<ft more generally upon the fy- 
ftem: and even when other fpecies of 
dropfy, from particular circumftances, 
appear fir ft, yet whenever thefe pro- 
ceed from any caufes more generally 
aeflcling the fyftem, an anafarca fooner 
or later comes always to be joined with 
them. 
Vol. IV. 
T 
MDCLXXII. 282 
PRACTICE 
MDCLXXII. 
The manner in which this difeafe com- 
monly firfl appears, will be readily ex- 
plained by what I have faid in MDCL. 
reflecting the effects of the poflure of the 
body. Its gradual progrefs, and its af- 
fecting, after fome time, not only the 
cellular texture under the fkin, but pro- 
bably alfo much of the fame texture in the 
internal parts, will be underflood partly 
from the communication that is readily 
made between the feveral parts of the 
cellular texture; but efpecially from the 
fame general caufes of the difeafe pro- 
ducing their effeCts in every part of the 
body. It appears to me that the water of 
anafarcous fwellings is more readily com- 
municated to the cavity of the thorax, 
and to the lungs, than to the cavity of 
the abdomen, or to the vifcera contained 
in it. 
MDCLXXIII. OF PHYSIC. 
283 
MDCLXXIII. 
An anafarca is almoft always attended 
With a fcarcity of urine; and the urine 
voided, is from its fcarcity, always of a 
high colour; and from the fame caufc, 
after cooling, readily lets fall a copious 
reddifh fediment. This fcafcity of urine 
may fometimes be owing to an obffruc- 
tion of the kidneys, but probably is ge- 
nerally occafioned by the watery parts of 
the blood running off into the cellular tex- 
ture, and being thereby prevented from 
paffing in the ufual quantity to the kid- 
neys. 
The difeafe is alfo generally attended 
with an unufual degree of thirft; a cir- 
cumftance I would attribute to a like ab- 
ftradlion of fluid from the tongue and fau- 
ces, which are extremely fenfible to every 
diminution of the fluids in thefe parts. 
T 2 
MDCLXXIV; 284 
PRACTICE 
MDCLXXIV. 
The cure of anafarca is to be attempted 
upon three general indications. 
1. The removing the remote caufes of 
the difeafe. 
2. The evacuation of the ferous fluid 
already collected in the cellular texture. 
3. The reftoring the tone of the fyftem, 
the lofs of which may be confidered in 
many cafes as the proximate caufe of the 
difeafe. , . 
MDCLXXV. 
The remote caufes are very often fuch 
as had not only been applied, but had alfo 
been removed, long before the difeafe came 
on. Although, therefore, their effects re- 
main, the caufes themfelves cannot be the 
objects of practice; but if the caufes ftill 
continue to be applied, fuch as intempe- 
rance, OF PHYSIC. 
285 
rance, indolence, and feme others, they 
mutt be removed. For the moft part, the 
remote caufes are certain difeafes previous 
to the dropfy, which are to be cured by 
the remedies particularly adapted to them, 
and cannot be treated of here. The curing 
of thefe indeed may be often difficult; but 
it was proper to lay down the prefent in- 
dication, in order to ffiow, that when thefe 
remote caufes cannot be removed, the cure 
of the dropfy muft be difficult, or perhaps 
impoffible. In many cafes, therefore, the 
following indications will be to little pur- 
pofe; and particularly,? that often the exe- 
cution of the fecond will not only give 
the patient a great deal of fruitlefs trouble, 
but commonly alfo hurry on his fate. 
MDCLXXVI. 
The fecond indication for evacuating 
the collected ferum, may be fometimes 
T3 
ex- 286 
PRACTICE 
executed with advantage, and often, at leaft, 
with temporary relief. It may be perform- 
ed in two ways. Firft, by drawing off the 
water directly from the dropfical part, by 
openings made into it for that purpofe: 
Or, fecpndly, by exciting certain ferous 
excretions; in confequence of which, an 
abforption may be excited in the dropfical 
parts, and thereby the ferum abforbed and 
carried into the blood-veffels, may after- 
wards be directed to run out, or may fpon- 
taneoufly pafs out, by one or other of the 
common excretions. 
MDCLXXVII. 
In an anafarca, the openings into the 
dropfical part are commonly to be made 
in fome part of the lower extremities; and 
will be moft properly made by many fmall 
pnndtures reaching the cellular texture. 
Formerly, confiderable incilions were em- 
ploy- OF PHYSIC. 
287 
ployed for this purpofe: but as any 
wound made in dropflcal parts, which, in 
order to their healing, muft neceffarily in- 
flame and Hippurate, are liable to become 
gangrenous ; fb it is found to be much fafer 
to make the openings by fmall punctures 
only, which may heal up by the firft in- 
tention. At the fame time, even with 
refpecl to thefe pundlures, it is proper to 
obferve, that they fhould be made at fome 
diftance from one another, and that care 
fhould be taken to avoid making them in 
the moft depending parts. 
MDCLXXVIH. 
The water of anafarcous limbs may 
fometimes be drawn off by pea-iffues, made 
by cauftic a little below the knees: for as 
the great fwelling of the lower extremities 
is chiefly occafioned by the ferous fluid 
exhaled into the upper parts conftantly 
T4 
falling 288 
PRACTICE 
falling down to the lower; fo the iflues now 
mentioned, by evacuating the water from 
thefe upper parts, may very much relieve 
the whole of the difeafe. Unlefs, how- 
ever, the ifliies be put in before the dif- 
eafe is far advanced, and before the parts 
have very much loft their tone, the places 
of the iflues are ready to become affetfted 
with gangrene. 
Some practical writers have advifed the 
employment of fetons for the fame pur- 
pofe that I have propofed iflues; but I 
apprehend, that fetons will be more liable 
than iflues to the accident juft now men- 
tioned. 
MDCLXXIX. 
For the purpofe of drawing out feruna 
from anafarcous limbs, blifters have been 
applied to them, and fometimes with great 
fuccefs; but the bliftered parts are ready 
t© O F P H Y S I C. 
289 
to have a gangrene come upon them. Bu- 
ffering is therefore to be employed with 
great caution; and perhaps only in the 
circumfiances that I have mentioned above 
to be fit for the employment of iilues. 
MDCLXXX. 
Colewort-leaves applied to the fkin, rea- 
dily occafion a watery exfudation from its 
furface; and applied to the feet and legs 
afFedled with anafarca, have fometimes 
drawn off the water very copioufly, and 
with great advantage. 
Analogous, as I judge, to this, oiled filk- 
hofe put upon the feet and legs, fo as to (hut 
out all communication with the external 
air, have been found fometimes to draw a 
quantity of water from the pores of the 
fkin, and are faid in this way to have re- 
lieved anafarcous fwellings: but in feveral 
trials made, I have never found either the 
appli-  PRACTICE 
290 
application of thefe hofe, or that of the 
colewort-leaves, of much fervice. 
MDCLXXXI. 
The 2d means propofed in MDCLXXVI. 
for drawing off the water from dropfical 
places, may be the employment of eme- 
tics, purgatives, diuretics, or fudorifics. 
MDCLXXXIL 
As fpontaneous vomiting has fome- 
times excited an abforption in hydropic 
parts, and thereby drawn off the waters 
lodged in them, it is reafonable to fuppofe 
that vomiting excited by art, may have the 
fame effect; and accordingly it has been 
often pradtifed with advantage. The 
practice, however, requires that the ftrong 
antimonial emetics be employed, and that 
they O F PHYSIC. 
291 
they be repeated frequently after fliort in- 
tervals. 
MDCLXXXIII. 
Patients fubmit more readily to the 
ufe of purgatives, than to that of eme- 
tics; and indeed they commonly bear the 
former more eafily than the latter. At 
the fame time, there are no means we can 
employ to procure a copious evacuation of 
ferous fluids with greater certainty than 
the operation of purgatives; and it is upon 
thefe accounts, that purging is the evacua- 
tion which has been moft frequently, and 
perhaps with moft fuccefs, employed in 
dropfy. It has been generally found ne- 
ceflary to employ purgatives of the more 
draftic kind; which are commonly known, 
and need not be enumerated here. I be- 
lieve indeed, that the more draftic purga- 
tives are the moft effedual for exciting ab- 
forp- 292 
PRACTICE 
forption, as their ftimulus is moft readily 
communicated to the other parts of the fy- 
ftem; but of late, an opinion has prevailed, 
that fome milder purgatives may be em- 
ployed with advantage. This opinion has 
prevailed particularly with regard to the 
cryftals vulgarly called the Cream of Tar- 
tar, which in large dofes, frequently repea- 
ted, have fometimes anfwered the purpofe 
of exciting large evacuations, both by ftool 
and urine, and has thereby cured droplies. 
This medicine, however, has frequently 
failed, both in its operation and effects, 
when the draftic purgatives have been 
more fuccefsful. 
Practitioners have long ago obferved, 
that in the employment of purgatives, 
it is requilite they be repeated after as- 
fhort intervals as the patient can bear; 
probably for this reafon, that when the 
purging is not carried to the degree of 
foon exciting an abforption, the evacua- 
tion OF PHYSIC. 
293 
tion weakens the fyftem, and thereby in- 
creafes the afflux of fluids to the hydropic 
parts. 
MDCLXXXIV. 
The kidneys afford a natural outlet for 
a great part of the watery fluids contain- 
ed in the blood-veffels; and the increa- 
fing the excretion by the kidneys to a con- 
fiderable degree, is a means as likely as 
any other of exciting an abforption in 
dropfical parts. It is upon this account 
that diuretic medicines have been always 
properly employed in the cure of dropfy. 
The various diuretics that may be em- 
ployed, are enumerated in every treatife 
of the Materia Medica and of the Practice 
of Phyfic, and therefore need not be re- 
peated here. It happens, however, un- 
luckily, that none of them are of very cer- 
tain operation; neither is it well known 
why  PRACTICE 
294 
why they fometimes fucceed, and why 
they fo often fail; nor why one medicine 
fhould prove of fervice when another does 
not. It has been generally the fault of wri- 
ters upon the PraClice of Phyfic, that they 
give us infiances of cafes in which certain 
medicines have proved very efficacious, 
but negleCl to tell us in how many other 
inftances the fame have failed. 
MDCLXXXV. 
It deferves to be particularly obferved 
here, that there is hardly any diuretic more 
certainly powerful than a large quantity of 
common water taken in by drinking. I 
have indeed obferved above, in MDCLV11I. 
that a large quantity of water, or of watery 
liquors, taken in by drinking, has fome- 
times proved a caufe of dropfy ; and 
practitioners have been formerly fo much 
afraid that watery liquors taken in by 
drink- OF PHYSIC. 
295 
drinking might run off into dropfical 
places and increafe the difeafe, that they 
have generally enjoined the abftaining, as 
much as poffible, from fuch liquors. Nay, 
it has been further afferted, that by avoid- 
ing this fupply of exhalation, and by a 
total abftinence from drink, dropfies have 
been entirely cured. What conclufion is 
to be drawn from thefe fads is, however, 
very doubtful. A dropfy arifing from a 
large quantity of liquids taken in to the 
body has been a very rare occurrence; and 
there are, on the other hand, innumerable 
inftances of very large quantities of water 
having been taken in and running off again 
very quickly by ftool and urine, without 
producing any degree of dropfy. With re- 
fped to the total abftinence from drink, it 
is a pradice of the molt difficult execution; 
and therefore has been fo feldom pradifed, 
that we cannot poffibly know how far it 
might prove effedual. The pradice of gi- 
ving 296 
PRACTICE 
ving drink very fparingly, has indeed been 
often employed; but in a hundred inftan- 
ces, I have feen it carried to a great length 
without any manifeft advantage; while, on 
the contrary, the practice of giving drink 
very largely has been found not only fafe, 
but very often effectual in curing the dif- 
eafe. The ingenious and learned Dr Mill- 
man has, in my opinion, been commend- 
ably employed in reftoring the practice of 
giving large quantities of watery liquors 
for the cure of dropfy. Not only from 
the inftances he mentions from his own 
practice, and from that offeveral eminent 
phyficians in other parts of Europe, but 
alfo from many inftances in the records 
of phyfic, of the good effects of drinking 
large quantities of mineral waters in the 
cure of dropfy, I can have no doubt of the 
practice recommended by Dr Millman 
being very often extremely proper. I ap- 
prehend it to be efpecially adapted to thofe 
cafes OF PHYSIC. 
297 
'cafes in which the cure is chiefly attemp- 
ted by diuretics. It is very probable, that 
thele medicines can hardly be carried in 
any quantity to the kidneys without be- 
ing accompanied with a large portion of 
water; and the late frequent employment 
of the cryflals of tartar has often fliown, 
that the diuretic effects of that medi- 
cine are almoft only remarkable when ac- 
companied with a large quantity of wa- 
ter; and that without this, the diuretic 
effects of the medicine feldom appear. I 
flia.ll conclude this fubjecd with obferving, 
that as there are fo many cafes of drop- 
fy abfolutely incurable, the practice now- 
under confideration may often fail, yet 
in moft cafes it may be fafely tried; and 
if it appear that the water taken in paf- 
fes readily by the urinary fecretion, and 
efpecially that it increafes the urine be- 
yond the quantity of drink taken in, the 
practice may probably be continued with 
Vol. IV. 
U 
great 298 
PRACTICE 
great advantage: but, on the contrary, if 
the urine be not increaled, or be not even 
in proportion to the drink taken in, it may 
be concluded, that the water thrown in 
runs off by the exhalants, and will aug- 
ment the difeafe. 
MDCLXXXVI. 
Another fet of remedies which may be 
employed for exciting a ferous excretion, 
and thereby curing dropfy, is that of fu- 
dorifics. Such remedies, indeed, have been 
fometimes employed : but however ufeful 
they may have been thought, there are few 
accounts of their having effected a cure; 
and although I have had fome examples 
of their fuccefs, in mod inftances of their 
trial they have been ineffectual. 
Upon this fubjeCl it is proper to take 
notice of the feveral means that have been 
propofed and employed for diflipating the 
humi- OF PHYSIC. 
299 
humidity of the body; and particularly that 
of heat externally applied to the furface 
of it. Of fuch applications I have had 
no experience; and their propriety and 
utility mutt reft upon the credit of the 
authors who relate them. I fhail offer only 
this conjecture upon the fubject : That if 
fuch meafures have been truly ufeful, as 
it has feldoin been by the drawing out of 
any fenfible humidity, it has probably 
been by their reftoring the perfpiration, 
which is fo often greatly diminiflied in 
this difeafe; or, perhaps, by changing the 
ftate of the fkin, from the imbibing condi- 
tion which is alleged to take place, into 
that of perfpiring. 
MDCLXXXVII. 
When, by the feveral means now men- 
tioned, we (ball have fucceeded in evacu- 
ating the water of dropfies, there will 
U 2 
then 300 
PRACTICE 
then efpecially be occaflon for our third 
indication; which is, to reftore the tone of 
the fyftem, the lofs of which is fo often 
the caufe of the difeafe. This indication, 
indeed, may properly have place from the 
very fir ft appearance of the difeafe; and 
certain meafures adapted to this purpofe 
may, upon fuch firft appearance, be em- 
ployed with advantage. In many cafes 
of a moderate difeafe, I am perfuaded 
that they may obviate any future increafe 
of it. 
MDCLXXXVIII. 
Thus, upon what is commonly the firft 
fymptom of anafarca, that is, upon the 
appearance of what are called Oedematous 
Swellings of the feet and legs, the three 
remedies of bandaging, fridion, and ex~ 
ercife, have often been ufed with advan- 
tage. 
MDCLXXXIX. OF PHYSIC. 
301 
MDCLXXXIX. 
That fome degree of external compref- 
iion, is fuited to fupport the tone of the 
veflels, and particularly to prevent the ef- 
fects of the weight of the blood in dila- 
ting thofe of the lower extremities, muft 
be fufficiently evident; and the giving 
that compreflion by a bandage properly 
applied, has been often ufeful. In apply- 
ing fuch a bandage, care is to be taken 
that the compreflion may never be 
greater on the upper than on the lower 
part of the limb; and this, I think, can 
hardly ever be fo certainly avoided, as by 
employing a properly conftruded laced 
flocking. 
MDCXC. 
Friction is another means by which the 
3&ion of the blood-veflels may be promo* 
ted. 
V3 302 
PRA CTICE 
ted, and thereby the flagnation of fluids 
in their extremities prevented. Accor- 
dingly, the ufe of the flefh-brufh has 
often contributed to difcufs oedematous 
fwellings. It appears to me, that fric- 
tion, for the purpofes now mentioned, is 
more properly employed in the morning, 
■when the fwelling is very much gone off, 
than in the evening, when any confide- 
rable degree of it has already come on. 
1 apprehend alfo, that fridlion being 
made from below upwards only, is more 
ufeful than when made alternately up- 
wards and downwards. It has been com- 
mon, inftead of employing the flefh-brufh, 
to make the friction by warm and dry 
flannels; and this may in fome cafes be 
the moft convenient: but I cannot per- 
ceive that the impregnation of thefe flan- 
nels with certain dry fumes is of any be- 
nefit. 
MDCXCL OF PHYSIC. 
303 
MDCXCI. 
With refpedl to exercife, I muft obferve, 
that although perfons being much in an 
ere6t pofture during the day, may feem to 
increafe the fwelling which comes on at 
night; yet as the action of the mufcles has 
a great {hare in promoting the motion of 
the venous blood, fo I am certain, that as 
much exercife in walking as the patient 
can eafily bear, will often prevent that 
oedematous fwelling which much {landing, 
and even fitting, would have brought on. 
MDCXCII. 
Thefe meafures, however, although they 
may be ufeful at the coming on of a 
dropfy, whofe caufes are not very power- 
ful, will be often infufficient in a more 
violent difeafe; and fuch therefore will 
require more powerful remedies. Thefe 
u4 
are, 304 
PRACTICE 
are, exercife and tonic medicines; which, 
may be employed both during the courfe 
of the difeafe, and efpecially after the 
water has been evacuated. 
MDCXCIII. 
Exercife is fuited to aflift in every func- 
tion of the animal oeconomy, particularly 
to promote perfpiration, and thereby pre- 
vent the accumulation of watery fluids in 
the body. I apprehend alfo, that it may 
be the moft effecftual means for preventing 
the fkin from being in an imbibing flate; 
and, as has been hinted above on the fub- 
jeeft of Emaciation (MDCV1L), 1 am per- 
fuaded, that a full and large perfpiration 
will always be a means of exciting abforp- 
tion in every part of the fyftem. Exercife, 
therefore, promifes to be highly ufeful in 
dropfy ; and any mode of it may be em- 
ployed that the patient can moft conve- 
niently OF PHYSIC. 
305 
niently admit of. It fhould, however, al- 
ways be as much as he can ealily bear • and 
in anafarca, the Ihare which the exercife 
of mufcles has in promoting the motion 
of the venous blood, induces me to think 
that bodily exercife, to whatever degree the 
patient can bear it, will always be the moft 
ufeful. From fome experience alfo, I am 
perfuaded, that by exercife alone, employ- 
ed early in the difeafe, many droplies may 
be cured. 
MDCXCV. 
Betides exercife, various tonic remedies 
are properly employed to reftore the tone 
of the fyllem. The chief of thefe are, cha- 
lybeates, the Peruvian bark, and various 
bitters. Thefe are not only fuited to re- 
ftore the tone of the fyftem in general, 
but are particularly ufeful in ftrengthen- 
ing the organs of digeftion, which in 
dropfies 306 
PRACTICE 
dropfies are frequently very much weaken- 
ed : and for the fame purpofe alfo aromatics 
may be frequently joined with the tonics. 
MDCXCV. 
Cold bathing is upon many dccafions 
the moft powerful tonic we can employ; 
but at the beginning of dropfy, when the 
debility of the fyftem is confiderable, it 
can hardly be attempted with fafety. Af- 
ter, however, the water of dropfies has 
been very fully evacuated, and the indi- 
cation is to ft reng then the fyftem for pre- 
venting a relapfe, cold bathing may per- 
haps have a place. It is, at the fame time, 
to be admitted with caution; and can 
fcarcely be employed till the fyftem has 
otherwife recovered a good deal of vigour. 
When that indeed has happened, cold ba- 
thing may be very ufeful in confirming 
and completing it. 
MDCXCVI. OF PHYSIC. 
307 
MDCXCVI. 
In perlons recovering from dropfy, 
while the feveral means now mentioned 
for ftrengthening the fyftem are employ- 
ed, it will be proper at the fame time to 
keep conftantly in view the fupport of the 
watery excretions ; and confequently the 
keeping up the perfpiration by a great deal 
of exercife, and continuing the full flow of 
the urinary excretion by the frequent ufe 
of diuretics. 
SECT. 308 
PRACTICE 
SECT. II. 
Of the Hydrothorax, or Dropsy of the Breast* 
MDCXCVII, 
The preternatural colledion of ferous 
fluid in the thorax, to which we give the 
appellation of Hydrothorax, occurs more fre- 
quently than has been imagined. Its pre- 
fence, however, is not always to be very 
certainly known; and it often takes place 
to a confiderable degree before it be dif- 
covered. 
MDCXCVIIL OF PHYSIC. 
309 
MDCXCVIIL 
Thefe collections of watery fluids in the 
thorax, are found in different fituations. 
Very often the water is found at the fame 
time in both facs of the pleura, but fre- 
quently in one of them only. Sometimes 
it is found in the pericardium alone; but 
for the moft part it only appears there 
when at the fame time a collection is prefent 
in one or both cavities of the thorax. In 
fome inftances, the collection is found to 
be only in that cellular texture of the lungs 
which furrounds the bronchia, without 
there being at the fame time any effiifion 
into the cavity of the thorax. 
Pretty frequently the water collected 
conflfts chiefly of a great number of hy- 
datides in different fltuations; fometimes 
feemingly floating in the cavity, but fre- 
quently connected with and attached ta 
the 310 
PRACTICE 
particular parts of the internal furface of 
the pleura. 
MDCC. 
From the collection of water being thus 
in various fituations and circumftances, 
fymptoms arife which are different in dif- 
ferent cafes ; and from thence it becomes 
often difficult to afcertain the prefence and 
nature of the affeClion. I (hall, however, 
endeavour here to point out the moft com- 
mon fymptoms, and efpecially thofe of that 
principal and moft frequent form of the 
difeafe, when the ferous fluid is prefent in 
both facs of the pleura, or, as we ufually 
fpeak, in both cavities of the thorax. 
MDCCI. 
The difeafe frequently comes on with a 
fenfe of anxiety about the lower part of 
the fternum. This, before it has fubfift- OF PHYSIC. 
311 
ed long, comes to be joined with fome 
difficulty of breathing; which at firft ap- 
pears only upon the perfon's moving a little 
fafter than ufual, upon his walking up an 
acclivity, or upon his afcending a ftair- 
cafe: but after fome time, this difficulty 
of breathing becomes more conftant and 
coiffiderable, efpecially during the night, 
when the body is in a horizontal fituation. 
Commonly, at. the fame time, lying upon 
one fide is more eafy than upon the'other, 
or perhaps lying upon the back more eafy 
than upon either fide. Thefe circumftan- 
ces are ufually attended with a frequent 
cough, that is at firft dry; but which, 
after fome time, is accompanied with an 
expedoration of thin mucus. 
With all thefe fymptoms, the hy- 
drothorax is not certainly difcovered, as 
the fame fymptoms often attend other 
difeafes of the breaft. When, however, 
along with thefe fymptoms, there is at the 
fame 312 
PRACTICE 
fame time an oedematous fwelling of the 
feet and legs, a leucophlegmatic palenefs of 
the face, and a fcarcity of urine, the ex- 
iftence of a hydrothorax can be no longer 
doubtful. Some writers have told us, that 
fometimes in this difeafe, before the fwell- 
ing of the feet comes on, a watery fwell- 
ing of the fcrotum appears; but I have 
never met with any inftance of this. 
MDCCIL 
Whilft the prefence of the difeafe is 
•ibmewhat uncertain, there is a fymptom 
which fometimes takes place, and has been 
thought to be a certain charadieriftic of it; 
and that is, when, foon after the patient has 
fallen afleep, he is fuddenly awaked with 
a fenfe of anxiety and difficult breathing, 
and with a violent palpitation of the heart. 
Thefe feelings immediately require an eredl 
pofture; and very often the difficulty of 
breathing OF PHYSIC. 
313 
breathing continues to require and to pre- 
vent deep for a great part of the night. 
This fymptom I have frequently found 
attending the difeafe; but I have alfo met 
with feveral inftances in which this fymp- 
tom did not appear. I muft remark fur- 
ther, that 1 have not found this fymptom 
attending the empyema, or any other dif- 
eafe of the thorax ; and therefore, when it 
attends a difficulty of breathing, accompa- 
nied with any the fmalleft fymptom of 
dropfy, I have had no doubt in concluding 
the prefence of water in the cheft, and have 
always had my judgment Confirmed by the 
fymptoms which afterwards appeared. 
MDCCIL 
The hydrothorax often occurs with 
Very few, or almoft none, of the fymp- 
toms above mentioned; and is not, there- 
fore, very certainly difcovered till fome 
Vol, IV. 
X 
others 314 
PRACTICE 
others appear.; The moft decifive fymp- 
tom is a fluctuation of water in the cheft, 
perceived by the patient himfelf, or by the 
phyfician, upon certain motions of the 
body. How far the method propofed by 
Auenbrugger will apply to afcertain the 
prefence of water and the quantity of it 
in the cheft, I have not had occafion or 
opportunity to obferve. 
It has been faid, that in this difeafe fome 
tumour appears upon the fides or upon the 
back; but I have not met with any in- 
ftance of this. In one inftance of the dif- 
eafe, I found one fide of the thorax con- 
fiderably enlarged, the ribs (landing out 
farther on that fide than upon the other. 
A numbnefs and a degree of palfy in one 
or both arms, has been frequently obferved 
to attend a hydrothorax. 
Soon after this difeafe has made fome 
progrefs, the pulfe commonly becomes 
irregular, and frequently intermitting: but 
this OF PHYSIC. 
315 
this happens in fo many other difeafes of 
the bread, that unlefs when it is attended 
with fome other of the above-mentioned 
lymptoms it cannot be confidered as deno- 
ting the hydrothorax. 
MDCCIIL 
This difeafe, as ether dropfies, is com- 
monly attended with third and a fcarcity of 
urine, to be explained in the fame manner 
as in the cafe of anafarca (MDCLXXIII.) 
The hydrothorax, however, is fometimes 
without thirft, or any other febrile fymp- 
tom; although I believe this happens in 
the cafe of partial affections only, or when 
a more general affedlion is yet but in a 
flight degree. In both cafes, however, and 
more efpecially when the difeafe is confi- 
derably advanced, fome degree of fever is 
generally prefent: and I apprehend it to be 
in fuch cafe, that the perfons affedled are 
more than ufually fenflble to cold, and 
X 2 
com- 316 
PRACTICE 
complain of the coldnefs of the air when 
that is not perceived by other perfons. 
MDCCIV. 
The hydrothorax fom etimes appears 
alone, without any other fpecies of dropfy 
being prefent at the fame time: and in 
this cafe the difeafe, for the mo ft part, is a 
partial affection, as being either of one fide 
of the thorax only, or being a collection of 
hydatides in one part of the cheft. The 
hydrothorax, however, is very often a 
part of more univerfal dropfy, and when 
at the fame time there is water in all the 
three principal cavities and in the cellular 
texture of a great part of the body. I have 
met with feveral inftances, in which fuch 
univerfal dropfy began fir ft by an effufion 
into the thorax. The hydrothorax, however, 
more frequently comes on from an anafar- 
ca gradually increafing; and, as I have faid 
above, OF PHYSIC. 
317 
above, the general diathefis feems often to 
affect the thorax fooner than it does either 
the head or the abdomen. 
MDCCV. 
This difeafe feldom admits of a cure, 
or even of alleviation, from remedies. It 
commonly proceeds to give more and more 
difficulty of breathing, till the action of 
the lungs be entirely interrupted by the 
quantity of water effufed; and the fatal 
event frequently happens more fuddenly 
than was expected. In many of the in- 
Hances of a fatal hydrothorax, I have re- 
marked a fpitting of blood to come on fe- 
veral days before the patient died. 
MDCCVL 
The caufe of hydrothorax is often ma- 
nyeftly one or other of the general caufes 
X3 
of 318 
PRACTICE 
of dropfy pointed out above: but what 
it is that determines thefe* general caufes to 
act more efpecially in the thorax; and 
particularly what it is that produces the 
partial collections that occur there; I do 
not find to be eafily afeertained. 
MDCCVIL 
From what has been faid above, it will 
be evident, that the cure of hydrothorax 
mutt be very much the fame with that of 
anafarca; and when the former is joined 
with the latter as an effect of the fame 
general diathefis, there can be no doubt 
of the method of cure being the fame in, 
both. Even when the hydrothorax is 
alone, and the difeafe partial, from par- 
ticular caufes adding in the thorax only, 
there can hardly be any other meafures 
employed, than the general ones propofed 
above, There is only one particular mea- 
fure OF PHYSIC. 
319 
fure adapted to the hydrothorax; and that 
is, the drawing off the accumulated waters 
by a paracentefis of the thorax. 
MDCCVIII. 
To what cafes this operation may be 
moft properly adapted, I find it difficult 
to determine. That it may be executed 
with fafety, there is no doubt; and that it 
has been fometimes pracftifed with fuccefs, 
feems to be very well vouched. When 
the difeafe depends upon a general hydro- 
pic diathefis, it cannot alone prove a cure, 
but may give a temporary relief; and 
when other remedies feem to be employed 
with advantage, the drawing off the wa- 
ter may very much favour a complete 
cure. I have not. however, been fo fortu- 
nate as to fee it pradlifed with any fuccefs ; 
and even where it was moft promifmg, 
X4 
that 320 
PRACTICE 
that is, in cafes of partial affection, my 
expectations have been difappointed from 
it. 
SECT. OF PHYSIC. 
321 
SECT. in. 
Of Ascites, er Dropsy of the Lower Belly. 
MDCCIX. 
The name of Afcites is given to every 
collection of waters caufing a general (well- 
ing and diftention of the lower belly ; and 
fuch collections are more frequent than 
thofe which happen in the thorax. 
MDCCX. 
The collections in the lower belly, like 
thole of the thorax, are found in different 
litua- 322 
PRACTICE 
fituations. Moft commonly they are in 
the fac of the peritonaeum, or general 
cavity of the abdomen: but they often 
begin by facs formed upon, and connec- 
ted with, one or other of the vifcera; and 
perhaps the moft frequent inftances of this 
kind occur in the ovaria of females. 
Sometimes the water of afcites is found 
entirely without the peritonaeum, and be- 
tween this and the abdominal mufcles. 
MDCCXI. 
Thefe collections connected with parti- 
cular vifcera, and thofe formed without 
the peritonaeum, form that difeafe which 
authors have termed the cncyfted dropfy 
or hydropsfaccatus. Their precife feat, and 
even their exiftence, is very often difficult 
to be afcertained. They are generally 
formed by collections of hydatides. 
MDCCX1I. OF PHYSIC. 
323 
MDCCXII. 
In the moft ordinary cafe, that of ab- 
dominal dropfy, the fwelling at firft is in 
fome meafure over the whole belly, but 
generally appears moft confiderable in the 
epigaflrium. As the difeafe, however, 
advances, the fwelling becomes more uni- 
form over the whole. The diflention, 
and fenfe of weight, though confiderable, 
vary a little according as the pofture of the 
body is changed; the weight being felt 
the moft upon the fide on which the patient 
lies, while at the fame time on the oppofite 
fide the diflention becomes fomewhat lefs. 
In almofl all the inftances of afcites, the 
flucfluation of the water within, may be 
perceived by the pradlitioner's feeling, and 
fometimes by his hearing. This percep- 
tion of fluctuation does not certainly di- 
flinguifh the different ftates of dropfy; but 
ferves very well to diftinguifh dropfy, from 
tym- 324 
PRACTICE 
tympanites, from cafes of phyfconia, and 
from the Rate of pregnancy in women. 
MDCCXIIL 
An afcites frequently occurs when no 
other fpecies of dropfy does at the fame 
time appear; but fometimes the afcites 
is a part only of univerfal dropfy. In 
this cafe, it ufually comes on in confe- 
quence of an anafarca, gradually increa- 
sing ; but its being joined with anafarca, 
does not always denote any general dia- 
thelis, as for the moft part an afcites foon- 
er or later occafions oedematous fwellings 
of the lower extremities. When the col- 
lection of water in the abdomen, from 
whatever caufe, becomes confiderable, it 
is always attended with a difficulty of 
breathing : but this fymptom occurs often 
when, at the fame time, there is no water 
in the thorax. The afcites is fometimes 
un- OF PHYSIC. 
325 
unaccompanied with any fever ; but fre- 
quently there is more or lefs of fever pre- 
fent with it. The difeafe is never conft- 
derable, without being attended with third 
and a fcarcity of urine. 
MDCCXIV. 
In the diagnofis of afcites, the greateft 
difficulty that occurs, is in difcerning when 
the water is in the cavity of the abdomen, 
or when it is in the different ftates of en- 
cyfted dropfy above mentioned. There 
is, perhaps, no certain means of afcertain- 
ing this in all cafes; but in many we may 
attempt to form fome judgment with re- 
gard to it. 
When the antecedent circumftances 
give fufpicion of a general hydropic dia- 
thefis; when at the fame time fome de- 
gree of dropfy appears in other parts of 
the body ; and when, from its firft appear- 
ance, the fwelling has been equally over 
the 326 
PRACTICE 
the whole belly, we may generally pre- 
fume that the water is in the cavity of the 
abdomen. But when an afcites has not 
been preceded by any remarkably cachec- 
tic date of the fydcm, and when at its 
beginning the tumour and tendon had 
appeared in one part of the belly more 
than another, there is reafon to fufped an 
encyfted dropfy. Even when the tendon 
and tumour of the belly have become ge- 
neral and uniform over the whole; yet if 
the fyftem of the body in general appear to 
be little affected ; if the patient's Hrength 
be little impaired; if the appetite conti- 
nue pretty entire, and the natural deep 
be little interrupted ; if the menfes in fe- 
males continue to How as ufual; if there 
be yet no anafarca ; or, though it may have 
already taken place, if it be Hill condned 
to the lower extremities, and there be no 
leucophlegmatic palenefs or fallow colour 
in the countenance; if there be no fever, 
nor OF PHYSIC. 
327 
nor fo much third, or fcarcity of urine, as 
occur in a more general affeCtion; then, 
according as more of thefe different cir- 
cumftances take place, there will be the 
ftronger ground for fuppofing the afcites 
to be of the encyfted kind. 
The chief exception to be made from this 
as a general rule, will, in my opinion, be 
when the afcites may, with much probabi- 
lity, be prefumed to have come on in con- 
fequence of a fcirrhous liver; which, I ap- 
prehend, may occafion a collection of wa- 
ter in the cavity of the abdomen, while 
the general fyftem of the body may not 
be otherwife much affeCted. 
MDCCXV. 
With refpeCt to the cure of afcites 
when of the encyfted kind, it does not, fo 
far as I know, admit of any. When the 
collection of water is in the abdominal 
cavity alone, without any other fpecies of 
dropfy 328 
PRACTICE 
dropfy prefent at the fame time, I appre- 
hend the afcites will always be of difficult 
cure; for it may be prefumed to depend up- 
on a fcirrhofity of the liver, or other confi- 
derable affection of the abdominal vifcera, 
which I conceive to be of very difficult 
cure, and therefore the afcites depending 
upon them. At the fame time, fuch cafes 
may often admit of a temporary relief by 
the paracentelis. 
MDCCXVI. 
When the afcites is a part of univerfal 
dropfy, it may, as far as other cafes of that 
kind can, admit of a cure; and it will be 
obvious, that fuch a cure muft be obtain- 
ed by the fame means as above propofed 
for the cure of general anafarca. 
It frequently happens, that the afcites is 
attended with a diarrhoea; and, in that 
cafe, does not admit of the ufe of purga- 
tives fo freely as cafes of anafarca com- 
monly O F P H Y S I C. 
329 
monly do. It is therefore often to be 
treated by diuretics almoft alone. 
The diuretics that may be employed, are 
chiefly thofe above mentioned; but in af- 
cites, a peculiar one has been found out. 
It is a long-continued gentle friction of the 
Ikin over the whole of the abdomen, by 
the fingers dipped in oil. This has fome- 
times been ufeful in exciting an increafed 
flow of urine; but in moft of the trials of 
it which I have known made, it has failed 
in producing that effect. 
MDCCXVII. 
The afcites admits of a particular means 
for immediately drawing off the collec- 
ted waters; and that is the well known, 
operation of the paracentefis of the abdo- 
men. In what circumftances of afcites 
this operation can molt properly be pro- 
pofed, it is difficult to determine; but, 
Vol. IV. 
Y 
To' 330 
PRACTICE. 
To far as I can judge, it muft be regula- 
ted by very much the fame cormdera- 
tions as thofe above-mentioned with re- 
gard to the paracentefis of the thorax. 
The manner of performing the paracen- 
tefis of the abdomen, and the precautions 
to be taken with refped to it, are now fo 
commonly known, and delivered in fo 
many books, that it is altogether unnecef- 
fary for me to offer any directions upon 
that fubjeCt here; after the full 
and judicious information and directions 
given by Mr Bell, in the fecond volume 
of his Syflcm of Surgery. 
CHAP. OF PHYSIC. 
331 
G H A P. IV. 
Of General Swellings, arising from 
An increased Bulk of the whole 
Substance of particular Parts. 
MDCCXVIIL 
UPON the fubjedts of this chapter, 
feveral nofological difficulties occur, 
and particularly with refpedl to admitting 
the Phyfconia into the order of General 
Swellings. At prefent, however, it is not 
neceffiiry for me to difeufs this point, as 
I am here to omit entirely the confidera- 
tion 
Y 2 332 
PRACTICE 
tion of Phyfconia ; both becaufe it can fel- 
dom admit of any fuccefsful practice, and 
becaufe I cannot deliver any thing ufeful 
either with regard to the pathology or 
practice in fuch a difeafe. 
MDCCXIX. 
The only other genus of difeafe com- 
prehended under the title of the prefent 
chapter, is the Rachitis ; and this as being 
both a proper example of the clafs of Gz- 
chexy, and of the order of Intiimefcentia or 
General Swellings, I fliall offer fome ob- 
fervations with regard to it. 
Of Rachitis, or Rickets. 
MDCCXX. 
This difeafe has been fuppofed to have 
appeared only in modern times, and not 
above OF PHYSIC. 
333 
above two hundred years ago. This opi- 
nion, notwithftanding it has been main- 
tained by perfons of the moft refpedtable 
authority, appears to me, from many con- 
siderations, improbable ; but it is a point 
of too little confequence to detain my 
readers here. The only application of it 
which deferves any notice is, that it has 
led to a notion of the difeafe having arifen 
from the lues venerea, which had certainly 
made its firft appearance in Europe not 
very long before the date commonly af- 
fjgned for the appearance of rachitis: but 
I fhall hereafter fhow, that the fuppofed 
connection between the Siphylis and Ra- 
chitis is without foundation. 
MDCCXXI. 
In delivering the hiftory of the Rickets, I 
muft, in the firft place, obferve, that with 
refpecl to the antecedents of the difeafe, 
every thing to be found in authors upon this 
Y3 
fubjedl, 334 
PRACTICE 
fubjedl, appears to me to reft upon a very 
uncertain foundation. In particular, with 
refpect to the ftate of the parents whole 
offspring become affedted with this dif- 
eafe, I have met with many inftances of 
it, in children from feemingly healthy pa- 
rents ; and have met likewife with many 
inftances of children who never became 
affedted with it, although born of parents 
who, according to the common accounts, 
fhould have produced a rickety offspring : 
fo that, even making allowance for the 
uncertainty of fathers, 1 do not find the 
general opinion of authors upon this fub- 
jedt to be properly fupported. 
MDCCXXII, 
The difeafe, however, may be juftiy 
confidered as proceeding from parents; for 
it often appears in a great number of the 
fame family: and my obfcrvation leads 
me OF PHYSIC. 
335 
me to judge, that it originates more fre- 
quently from mothers than from fathers. 
So far as I can refer the difeafe of the 
children to the date of the parents, it has 
appeared to me moft commonly to arife 
from fome weaknefs, and pretty frequent- 
ly from a fcrophulous habit, in the mother. 
To conclude the fubject, I muft remark, 
that in many cafes I have not been able 
to difcern the condition of the parents, to 
which I could refer it. 
When nurfes, other than the mothers, 
have been employed to fuckle children, it 
has been fuppofed that fuch nurfes have 
frequently given occafion to the difeafe; 
and when nurfes have both produced and 
have fuckled children who became ric- 
kety, there may be ground to fufpect 
their having occafioned the difeafe in 
the children of other perfons : but I have 
had few opportunities of afcertaining this 
patter. It has in fome meafure appeared 
Y4 
to 336 
PRACTICE 
to me, that thole nurfes are moft likely to 
produce this difeafe, who give infants a 
large quantity of very watery milk, and 
who continue to fuckle them longer than 
the ufual time. Upon the whole, how- 
ever, I am of opinion, that hired nurfes 
feldom occafion this difeafe, unlefs when 
a predifpofition to it has proceeded from 
the parents. 
MDCCXXIII. 
With regard to the other antecedents, 
which have been ufually enumerated by- 
authors as the remote caufes of this difeafe, 
I judge the accounts given to be extremely 
fallacious; and I am very much perfua- 
ded, that the circumftances in the rearing 
of children, have lefs effect in producing 
rickets than has been imagined. It is 
indeed not unlikely, that fome of thefe 
circumftances mentioned as remote caufes 
may O F P H Y S I C. 
337 
may favour, while other circumftances 
may refift, the coming on of die difeafe ; 
but at the fame time, I doubt if any of 
the former would produce it where there 
was no predifpofition in the child's ori- 
ginal conftitution. This opinion of the 
remote caufes, I have formed from ob- 
ferving, that the difeafe comes on when 
none of thefe had been applied ; and more 
frequently that many of them had been 
applied without occafioning the difeafe. 
Thus the learned Zeviani alleges, that the 
difeafe is produced by an acid from the 
milk with which a child is fed for the firft 
nine months of its life : but almofl all 
children are fed with the fame food, and 
in which alfo an acid is always produced; 
while, at the fame time, not one in a thou- 
fand of the infants fo fed becomes affec- 
ted with the rickets. If, therefore, in the 
infants who become affected with this dif- 
eafe, a peculiarly noxious acid is produ- 
A-' • i* » * * * • 
ced3 338 
PRACTICE 
ced, we muft feek for fome peculiar caufe of 
its production, either in the quality of the 
milk, or in the conftitution of the child; 
neither of which, however, Mr Zeviani 
has explained. I cannot indeed believe 
that the ordinary acid of milk has any 
Ihare in producing this difeafe, becaufe I 
have known many inftances of the acid 
being produced and occasioning various 
diforders, without however its ever pro- 
ducing rickets. 
Another of the remote caufes commonly 
afligned, is the child's being fed with un- 
fermented farinaceous food. But over the 
whole world children are fed with fuch 
farinacea, while the difeafe of rickets is a 
tare occurrence : and 1 have known many 
inftances where children have been fed with 
a greater than ufual proportion of ferment- 
ed farinacea, and alfo a greater proportion of 
animal food, without thefe preventing the 
difeafe. In my apprehenfion, the like ob- 
fer-r O F P H Y S I C. 
339 
fervations might be made with refpect to 
moft of the circumftances that have been 
mentioned as the remote caufes of rickets. 
MDCCXXIV. 
Having thus offered my opinion con- 
cerning the fuppofed antecedents of this 
difeafe, I proceed now to mention the 
phenomena occurring after it has actually 
come on. 
The difeafe feldom appears before the 
ninth month, and feldom begins after the 
fecond year, of a child's age. In the interval 
between thefe periods, the appearance of 
the difeafe is fometimes fooner, fometimes 
later; and commonly at firft the difeafe 
comes on (lowly. The fir ft appearances 
are a flaccidity of the flefh, the body at 
the fame time becoming leaner, though 
food be taken in pretty largely. The head 
appears large with refpedt to the body; 
with 340 
PRACTICE 
with the fontanelle, and perhaps the fu- 
tures, more open than ufual in children 
of the fame age. The head continues to 
grow larger, in particular, the forehead be- 
coming unufually prominent; and at the 
fame time the neck continues (lender, or 
feems to be more fo, in proportion to 
the head. The dentition is flow, or much 
later than ufual; and thofe teeth which 
come out, readily become black, and fre- 
quently again fall out. The ribs lofe their 
convexity, and become flattened on the 
fides; while the fternum is pulhed out- 
ward, and forms a fort of ridge. At the 
fame time, or perhaps fooner, the epiphy- 
fes at the feveral joints of the limbs be- 
come fwelled; while the limbs between the 
joints appear, or perhaps actually become, 
more (lender. The bones feem to be every 
where flexible, becoming varioufly diflort- 
ed; and particularly the fpine of the back 
becoming incurvated in different parts of 
its 
< . * OF PHYSIC. 
341 
its length. If the child, at the time the dif- 
eafe comes on, had acquired the power of 
walking, it becomes daily more feeble in its 
motions, and more averfe to the exertion of 
them, loiing at length the power of walking 
altogether. Whilft thefe fymptoms go on 
increafing, the abdomen is always full, 
and preternaturally tumid. The appetite 
is often good, but the flools are generally 
frequent and loofe. Sometimes the fa- 
culties of the mind are impaired, and 
ftupidity or fatuity prevails; but com- 
monly a premature fenfibility appears, and 
they acquire the faculty of fpeech fooner 
than ufual. At the firft coming on of 
the difeafe, there is generally no fever at- 
tending it; but it feldom continues long, 
till a frequent pulfe, and other febrile 
fymptoms, come to be conftantly prefent. 
With thefe fymptoms the difeafe proceeds, 
and continues in fome inftances for fbme 
years ; but very often, in the courfe of 
thac 342 
PRACTICE 
that time, the difeafe ceafes to advance* 
and the health is entirely eftablifhed, ex- 
cept that the diftorted limbs produced 
during the difeafe continue for the reft of 
life, in other cafes, however, the difeafe 
proceeds increafing till it has aftecfted al- 
moft every function of the animal oeco- 
nomy, and at length terminates in death. 
The variety of fymptoms which in fuch 
cafes appear, it does not feem neceflary 
to enumerate, as they are not effential to 
the conftitution of the difeafe, but are 
merely confequences of the more violent 
conditions of it. In the bodies of thofe 
who have died, various morbid affedlions 
have been difcovered in the internal parts. 
Moft of the vifcera of the abdomen have 
been found to be preternaturally enlarged. 
The lungs have alfo been found in a mor- 
bid ftate, feemingly from fome inflam- 
mation that had come on towards the end 
of the difeafe. The brain has been com- 
monly OF PHYSIC. 
343 
monly found in a flaccid Rate, with effu- 
fions of a ferous fluid into its cavities. 
Very univerfally the bones have been 
found very fofc, and fo much foftened as 
to be readily cut by a knife. The fluids 
have been always found in a diflblved 
Rate, and the mufcular parts very fofc 
and tender ; and the whole of the dead 
body without any degree of that rigidity 
which is fo common in almoR all others. 
MDCCXXV. 
From thefe circumftances of the difeafe, 
it feems to confift in a deficiency of that 
matter which iliould form the folid parts 
of the body. This efpecially appears in 
the faulty ftate of ofiification, feemingly 
depending upon the deficiency of that 
matter which fhould be depofited in the 
membranes which are deftined to become 
bony, and fhould give them their due firm- 
nefs 344 
PRACTICE 
nefs and bony hardnefs. It appears that this 
matter is not fupplied in due quantity; 
but that, in place of it, a matter fitted to 
increafe their bulk, particularly in the 
epiphyfes, is applied too largely. What 
this deficiency of matter depends upon, is 
difficult to be afcertained. It may be a 
fault in the organs of digeftion and affi- 
milation, which prevents the fluids in ge- 
neral from being properly prepared; or it 
may be a fault in the organs of nutrition, 
which prevents the fecretion of a proper 
matter to be applied. With refpedt to the 
latter, in what it may confift, I am en- 
tirely ignorant, and cannot even difcern 
that fuch a condition exifts : but the for- 
mer caufe, both in its nature and exift- 
ence, is more readily perceived ; and it is 
probable that it has a confiderable influence 
in the matter; as in rachitic perfons a thin- 
ner ftate of the blood, both during life 
and after death, fo commonly appears. 
It OF PHYSIC. 
345 
It is this itate of the fluids, or a deficiency 
of bony matter in them, that I confider 
as the proximate caufe of the difeafe; and 
which again may in fome meafure depend 
upon a general laxity and debility of the 
moving fibres of the organs that perform 
the functions of digeftion and aflimilatiom 
MDCCXXVI. 
There is, however, fomething ftill want- 
ing to explain Why thefe circumftances 
difcover themfelves at a particular time of 
life, and hardly ever either before or after 
a certain period; and as to this I would 
offer the following conjectures. Nature 
having intended that human life fhould 
proceed in a certain manner, and that cer- 
tain functions fhould be exercifed at a cer- 
tain period of life only ; fo it has general- 
ly provided, that at that period, and not 
fooner, the body fhould be fitted for the ex- 
ercife 
Vol. IV. 
Z 346 
PRACTICE 
ercife of the functions fuited to it. To ap- 
ply this to our prefent fubjedt, Nature feems 
to have intended that children fliould walk 
only at twelve months old; and accordingly 
has provided, that againft that age, and no 
fooner, a matter fliould be prepared fit to 
give that firmnefs to the bones which is ne- 
ceflary to prevent their bending too eafily 
under the weight of the body. Nature, 
however, is not always Ready and exact 
in executing her own purpofes; and if 
therefore the preparation of bony matter 
fliall not have been made againfl the 
time there is particular occafion for it, 
the difeafe of rickets, that is, of foft and 
flexible bones, mutt come on; and will 
difccver itfelf about the particular pe- 
riod we have mentioned. Further, it will 
be equally probable, that if at the pe- 
riod mentioned the bones fliall have ac- 
quired their due firmnefs, and that nature 
goes on in preparing and fupplying the 
proper O F PHYSIC. 
347 
proper bony matter, it may be prefumed, 
that againft the time a child is two years 
old, fuch a quantity of bony matter will 
be applied, as to prevent the bones from 
becoming again foft and flexible, during 
the reft of life; unlefs it happen, as in- 
deed it fometimes does, that certain cau- 
fes occur to wafh out again the bony 
matter from the membranes in which it 
had been deposited. The account I have 
now given of the period at which the 
rickets occur, feems to confirm the opi- 
nion of its proximate caufe being a defi- 
ciency of bony matter in the fluids of the 
body. 
MDCCXXVIL 
lt has been frequently fuppofed, that a 
fiphylitic taint has a fhare in producing 
rickets; but fuch a fuppofition is altogether 
improbable. If our opinion of the rickets 
Z 2 
ha- 348 
PRACTICE 
having exifted in Europe before the fi- 
phylis was brought into it, be well found- 
ed, it will then be certain that the dif- 
eafe may be occafioned without any fi- 
phylitic acrimony having a fliare in its 
production. But further, when a fiphy- 
litic acrimony is tranfmitted from the pa- 
rent to the offspring, the fymptoms do not 
appear at a particular time of life only, 
and commonly more early than the period 
of rickets; the fymptoms alfo are very 
different from thofe of rickets, and unac- 
companied with any appearance of the 
latter; and, laftly, the fymptoms of fi- 
phylis are cured by means which, in the 
cafe of rickets, have either no effed, or a 
bad one. It may indeed poffibly happen, 
that iiphylis and rickets may appear in the 
fame perfon; but it is to be coniidered 
as an accidental complication: and the 
very few inftances of it that have occur- 
red, are by no means fufficient to eftablilh 
any OF PHYSIC. 
any neceffary connection between the two 
difeafes. 
349 
MDCCXXVIII. 
With refpecft to the deficiency of bony 
matter, which I confider as the proximate 
caufe of rickets, fome further conjectures 
might be offered concerning its remote 
caufes : but none of them appear to me 
very fatisfying ; and whatever they might 
be, it appears to me they muft again be 
refolved into the fuppofition of a general 
laxity and debility of the fyftem. 
MDCCXXIX. 
It is upon this fuppofition almoft alone 
that the cure of rickets has entirely pro- 
ceeded. The remedies have been fuch 
efpecially as were fuited to improve the 
tone of the fyftem in general, or of the 
Z3 
ftomach 350 
PRACTICE 
ftomach in particular: and we know that 
the latter are not only fuited to improve 
the tone of the ftomach itfelf, but by that 
means to improve alfo the tone of the 
whole fyftem. 
MDCCXXX. 
Of tonic remedies, one of the moft pro- 
mifing feems to have been cold bathing; 
and I have found it the mold powerful in 
preventing the difeafe. For a long time 
part, it has been the practice in this coun- 
ty, with people of all ranks, to walk 
their children from the time of their birth 
with cold water ; and from the time that 
children are a month old, it has been the 
practice with people of better rank to have 
them dipped entirely in cold water every 
morning : and wherever this practice has 
been purfued, I have not met with any 
inftance of rickets. Amongft our common 
people OF PHYSIC. 
351 
people, although they wafh their children 
with cold water only, yet they do not fo 
commonly praclife immeriion: and when 
amongft thefe I meet with infiances of 
rickets, I prefcribe cold bathing ; which 
accordingly has often checked the progrefs 
of the difeafe, and fometimes feems to 
have cured it entirely. 
J 
MDCCXXXI. 
The remedy of Ens Veneris, recommended 
by Mr Boyle, and iince his time very uni- 
verfally employed, is to be coniidered as en- 
tirely a tonic remedy. That or fome other 
preparation of iron I have almoft con- 
flantly employed, though not indeed al- 
ways with fuccefs. I have been persuad- 
ed, that the ens veneris of Mr Boyle, not- 
withftanding his giving it this appellation, 
was truly a preparation of iron, and no 
other than what we now name the Flores 
% 4 
Js'Iar- 352 
PRACTICE 
Niartiales: but it appears, that both Bene- 
voli and Buchner have employed a prepa- 
ration of copper ; and 1 am ready to be- 
lieve it to be a more powerful tonic than 
the preparations of iron. 
MDCCXXXII. 
Upon the fuppolition of tonic reme* 
dies being proper in this difeafe, I have en~ 
deavoured to employ the Peruvian bark: 
but from the difficulty of adminiftering it 
to infants in any ufeful quantity, I have 
not been able to difcover its efficacy ; but 
I am very ready to believe the teftimony 
of De Haen upon this fubjcct. 
MDCCXXIII. 
Exercife, which is one of the moft power- 
ful tonics, has been properly recommended 
for the cure of rickets; and as the exer- 
cife OF PHYSIC. 
353 
cife of geftation only can be employed* it 
Ihould always be, with the child laid in a 
horizontal fituation, as the carrying them, 
or moving them in any degree of an eredt 
pofture, is very apt to occafion fome 
diftortion. It is extremely probable, that, 
in this difeafe, friction with dry flannels 
may be found an ufeful remedy. 
MDCCXXXIV. 
It is alfo fufficiently probable, that the 
avoiding of moifture is not only advife- 
able, but may likewife be of fervice in the 
cure of this difeafe. 
There is no doubt that a certain diet 
may contribute to thefame end ; but what 
may be the moll eligible, I dare not deter- 
mine. I have no doubt that leavened 
bread may be more proper than unfer- 
mented farinacea; but I cannot find any 
reafon to believe that ftrong beer can ever 
be a proper remedy. 
Prac- 354 
PRACTICE 
Practitioners have been divided in opi- 
nion concerning the ufe of milk in this 
difeafe. Zeviani, perhaps from theory, 
condemns the ufe of it; but Benevoli em- 
ployed it without its impeding the cure of 
the difeafe. This laft I have often remark- 
ed in the courfe of my own practice. As it 
is difficult to feed children entirely without 
milk; fo I have commonly admitted it as a 
part of the diet of rickety children; and in 
many inftances 1 can affirm, that it did not 
prevent the cure of the difeafe. In cafes, 
however, of any appearance of rickets, and 
particularly of a flow dentition, I have dif- 
fuaded the continuance of a child upon the 
breaft; becaufethemilkof women is a more 
watery nouriffiment than that of cows: and 
I have efpecially difluaded the continuing 
a child upon the breaft, when I thought 
the nurfe gave rather too much of fuch a 
watery nourifhment; for, as has been above- 
mentioned, 1 have had frequent occafion to 
fufpecft, OF PHYSIC. 
355 
fufped, that the milk of fuch nurfes has a 
tendency to favour the coming on of rickets. 
MDCCXXXV. 
Befides the remedies and regimen now- 
mentioned, pra&itioners have commonly 
employed in this difeafe, both emetics and 
purgatives. When the appetite and dige- 
stion are considerably impaired, vomiting, 
if neither violent, nor frequently repeated, 
feems to be of fervice ; and by a moderate 
agitation of the abdominal vifcera, may 
in fome meafure obviate the Stagnation 
and confequent fwelling that ufually oc- 
cur in them. 
As the tumid State of the abdomen, 
fo constantly to be met with in this difeafe, 
feems to depend very much upon a tym- 
panitic affection of the inteStines; fo, both 
by obviating this, and by deriving from 
fhe abdominal vifcera, frequent gentle 
purga- 356 
PRACTICE 
purgatives may be of fervice. Zeviani, 
perhaps properly, recommends in parti- 
cular rhubarb; which, betides its purga- 
tive quality, has thofe alfo of bitter and 
aftringent. 
MDCCXXXVI. 
I have now mentioned moft of the re- 
medies commonly employed by the prac- 
titioners of former times ; but I muft not 
omit mentioning fome others that have 
been lately fuggefted. The late Mr De 
Haenrecommends theteftacea; andaffures 
us of their having been employed with 
fuccefs: but in the few trials which I have 
had occafion to make, their good effects 
did not appear. 
The late Baron Van Swieten gives us 
one inftance of rickets cured by the ufe 
of hemlock ; but I do not know that the 
practice has been repeated. 
BOOK BOOK III. 
OF THE 
IMPETIGINES; 
' , ' 11 1 Ji' . ' 
■ 
O R 
I 
DEPRAVED HABIT, with AFFECTIONS 
OF THE SKIN. 
MDCCXXXVII. 
I Find it difficult to give any Efficient- 
ly correct and proper charader of this 
order. The difeafes comprehended un- 
der 358 
PRACTICE 
der it, depend, for the moft part, upon a 
depraved Rate of the whole of the fluids, 
producing tumours, eruptions, or other 
preternatural affections of the fldn. Al- 
though it be extremely difficult to find a 
general character of the order that will ap- 
ply to each of the genera and fpecies, I 
fliall here treat of the principal genera 
which have been commonly comprehended 
under this order, and which I have enu- 
merated in my Nofology. 
CHAP. OF PHYSIC. 
359 
CHAP. I. 
Or ScROPHULA, OR THE KlNG*S EVIL. 
MDCCXXXVin. 
THE character of this difeafe I have 
attempted in my Nofology; but it 
will be more properly taken from the 
whole of its hiftory, now to be deliver- 
ed. 
MDCCXXXIX. 
It is commonly, and very generally, a 
hereditary difeafe; and although it fome- 
times 360 
PRACTICE 
times may, yet it rarely appears, but in 
children whofe parents had at fome pe- 
riod of their lives been affedted with it. 
Whether it may not fail to appear in the 
children of fcrophulous parents, and dif- 
cover itfelf afterwards in their offspring in 
the fucceeding generation, I cannot cer- 
tainly determine; but believe that this has 
frequently happened. It appears to me to 
be derived more commonly from fathers 
than from mothers; but whether this 
happens from there being more fcrophu- 
lous men than fcrophulous women mar- 
ried, I am not certain. 
With refpedt to the influence of parents 
in producing this difeafe, it deferves to be 
remarked, that in a family of many chil- 
dren, when one of the parents has been 
afFedled with fcrophula, and the other not; 
as it is ufual for fome of the children to 
be in conftitution pretty exadtly like the 
one parent, and others of them like the 
other ; OF PHYSIC. 
361 
other; it commonly happens that thofe 
children who moft refemble the fcrophu- 
lous parent become affeded with fcrophu- 
la, while thofe refembling the other parent 
entirely efcape. 
MDCCXL. 
The fcrophula generally appears at a 
particular period of life. It feldom ap- 
pears in the firft, or even in the fecond, 
year of a child's life; and moil commonly 
it occurs from the fecond, or, as fome allege, 
and perhaps more properly, from the third, 
to the feventh year. Frequently, however, 
it difcovers itfelf at a later period; and there 
are inftances of its firft appearance, at every 
period till the age of puberty ; after which, 
however, the firft appearance of it is very 
rare. 
Vol. IV. 
A a 
MDCCXLI. 362 
PRACTICE 
MDCCXLI. 
When it does not occur very early, we 
can generally diftinguifli the habit of 
body peculiarly difpofed to it. It moft 
commonly affedls children of foft and flac- 
cid habits, of fair hair and blue eyes; or 
at leaft affects thofe much more frequently 
than thofe of an oppofite complexion. It 
affects efpecially children of fmooth fkins 
and rofy cheeks; and fuch children have 
frequently a tumid upper lip, with a chop 
in the middle of it; and this tumour is 
often confiderablc, and extended to the 
columna nafi and lower part of the no- 
ftrils. The difeafe is fometimes joined 
with, or follows rickets; and although it 
frequently appears in children who have 
not had rickets in any great degree, yet 
it often attacks thofe who by a protube- 
rant forehead, by tumid joints, and a tu- 
mid abdomen, fhow that they had fome 
ra- OF PHYSIC. 
363 
rachitic difpofition. In parents who, with- 
out having had the difeafe themfelves, 
feem to produce fcrophulous children, we 
can commonly perceive much of the fame 
habit and conftitution that has been juft 
now defcribed. 
Some authors have fuppofed that the 
fmall-pox has a tendency to produce this 
difeafe; and Mr De Haen afferts its follow- 
ing the inoculated, more frequently than 
the natural, fmall-pox. This laft polition, 
however, we can confidently affirm to be a 
miftake; although it muft be allowed, that 
in fact the fcrophula does often come on 
immediately after the fmall-pox. It is, 
however, difficult to find any connexion 
between the two difeafes. According to 
my obfervation, the accident only happens 
in children who have pretty manifeftly th& 
fcrophulous difpofition ; and I have had 
feveral inftances of the natural fmall-pox 
coming upon children alleclcd at the fame 
A a 2 
time 364 
PRACTICE 
time with fcrophula, not only without this 
difeafe being any ways.aggravated by the 
fmall-pox, but even of its .being for fome 
time after much relieved. 
MDCCXLIL 
The fcrophula generally fhows itfelf firft 
at a particular feafon of the year ; and at 
fome time between the winter and fum- 
mer folftice; but commonly long before 
the latter period. It is to be obferved fur- 
ther, that the courfe of the difeafe i« 
ufually connected with the courfe of the 
feafons. Whilft the tumours and ulcera- 
tions peculiar to this difeafe, appear firft in 
the fpring, the ulcers are frequently heal- 
ed up in the courfe of the fucceeding fum- 
mer, and do not break out again till the 
enfuing fpring, to follow again with the 
feafon the fame courfe as before. 
MDCCXLIIL OF PHYSIC. 
365 
MDCCXLIII. 
Frequently the firft appearance of the 
difeafe is the tumid and chopped lip above 
mentioned. Upon other occafions the firft 
appearance is that of fmall fpherical or oval 
tumours, moveable under the ficin. They 
are foft, but with fome elafticity. They 
are without pain; and without any change 
in the colour of the fkin. In this ftate 
they often continue for a long time; even 
for a year or two, and fometimes longer. 
Moft commonly they firft appear upon 
the fidcs of the neck below the ears ; but 
fometimes alfo under the chin. In either 
cafe, they are fuppofed to affect in thefe 
places the conglobate or lymphatic glands 
only; and not at all the falivary glands, 
till the difeafe is very greatly advanced. 
The difeafe frequently affedls, and even at 
firft appears in other parts of the body. 
In particular, it affedls the joints of the el- 
bows 
A a 3 366 
PRACTICE 
bows and ankles, or thofe of the fingers 
and toes. The appearances about the 
joints are not commonly, as elfewhere, 
fmall moveable fwellings ; but a tumour 
almoft uniformly furrounding the joint, 
and interrupting its motion. 
MDCCXLIV. 
Thefe tumours, as I have faid, remain 
for fome time little changed ; and, from 
the time they firft appeared in the fpring, 
they often continue in this way till the re- 
turn of the fame feafon in the next, or per- 
haps the fecond year after. About that 
time, however, or perhaps in the courfe 
of the feafon in which they firft appear, 
the tumour becomes larger and more fix- 
ed ; the fkin upon it acquires a purple, 
feldorn a clear rednefs: but growing red- 
der by degrees, the tumour becomes foft- 
er, and allows the fluctuation of a liquid 
within OF PHYSIC. 
367 
within to be perceived. All this procefs, 
however, takes place with very little pain 
attending it. At length forae part of the 
fkin becomes paler; and by one or more 
fmall apertures a liquid is poured out. 
MDCCXLV. 
The matter poured out has at firfl the 
appearance of pus, but it is ufually of a 
thinner kind than that from phlegmonic 
abfcefles ; and the matter as it continues 
to be difcharged, becomes daily lefs puru- 
lent, and appears more and more a vifcid 
ferum, intermixed with fmall pieces of a 
white fubftance refembling the curd of 
milk. By degrees the tumour almoft entirely 
fubfides, while the ulcer opens more, and 
fpreads broader; unequally, however, in dif- 
ferent directions, and therefore is without 
any regular circumfcription. The edges of 
the ulcer are commonly fiat and fmooth, 
A a 4 
both 368 
PRACTICE 
both on their outfide and their inner edge, 
which feldom puts on a callous appear- 
ance. The ulcers, however, do not ge- 
nerally fpread much, or become deeper; 
but at the fame time their edges do not 
advance, or put on any appearance of 
forming a cicatrix. 
MDCCXLVI. 
In this condition the ulcers often con- 
tinue for a long time; while new tumours, 
with ulcers fucceeding them in the man- 
ner above defcribed, make their appearance 
in different parts of the body. Of the firft 
ulcers, however, fome heal up, while other 
tumours and ulcers appear in their vicinity, 
or in other parts of the body: and in this 
manner the difeafe proceeds, fome of the ul- 
cers healing up, at lead to a certain degree, 
in the courfe of rummer, and breaking out 
again in the fucceeding fpring: or it conti- 
nues ? or PHYSIC. 
369 
nues,by new tumoursand ulcers fuccceding 
them, in the fpring feafon, making their 
appearance fueceffively for feveral years. 
MDCCXLVII. 
In this way the difeafe goes on for 
feveral years ; but very commonly in 
four or five years it is fpontaneoufly 
cured, the former ulcers being healed up, 
and no new tumours appearing: and 
thus at length the difeafe ceafes entirely, 
leaving only fome indelible efchars, pale 
and fmooth, but in fome parts fhrivelled; 
or, where it had occupied the joints, lea- 
ving the motion of thefe impaired, or 
entirely deftroyed. 
MDCCXLVILL 
Such is the moft favourable courfe of 
this difeafe; and with us, it is more fre- 
quently 370 
PRACTICE 
quently fuch, than otherwife : but it is 
often a more violent, and fometimes a fa- 
tal malady. In thefe cafes, more parts of 
the body, are at the fame time affedled; 
the ulcers alfo feeming to be imbued with 
a peculiarly fharp acrimony, and therefore 
becoming more deep, eroding, fpreading, 
as well as feldomer healing up. In fuch ca- 
fes, the eyes are often particularly affected. 
The edges of the eye-lids are affected with 
tumour and fuperficial ulcerations; and 
thefe commonly excite obftinate inflam- 
mation in the adnata, which frequently 
produces an opacity of the cornea. 
When the fcrophula efpecially affects the 
joints, it fometimes produces there confl- 
derable tumours ; in the abfceffes follow- 
ing which, the ligaments and cartilages 
are eroded, and the adjoining bones are 
affected with a caries of a peculiar kind. 
In thefe cafes, alfo, of more violent fcro- 
phula, while every year produces a num- 
ber OF PHYSIC. 
371 
ber of new tumours and ulcers, their acri- 
mony feems at length to taint the whole 
fluids of the body, occafioning various dif- 
orders; and particularly a hectic fever, 
with all its fymptoms, which at length 
proves fatal, with fometimes the fymptoms 
of a phthifis pulraonalis. 
MDCCXLIX. 
The bodies of perSons who have died 
of this difeafe fhow many of the vifcera in 
a very morbid date; and particularly mod 
of the glands of the mefentery very much 
tumefied, and frequently in an ulcerated 
date. Commonly alfo a great number of 
tubercles or cyfts, containing matter of 
various kinds, appear in the lungs. 
MDCCL. 372 
PRACTICE 
MDCCL. 
Such is the hiftory of the difeafe: and 
from thence it may appear, that the na- 
ture of it is not eafily to be afcertained. It 
fcems to be a peculiar affetdion of the 
lymphatic fyftem ; and this in forae mea- 
fure accounts for its connexion with a 
particular period of life. Probably, how- 
ever, there is a peculiar acrimony of the 
fluids'that is the proximate caufe of the dif- 
eafe ; altho' of what nature this is, has not 
yet been difcovered. It may perhaps be ge- 
nerally diffufed in the fyftem, and exhaled 
into the feveral cavities and cellular texture 
of the body; and therefore, being taken 
up by the abforbents, may difcover itfelf 
cfpecially in the lymphatic fyftem. This, 
however, will hardly account for its being 
more confined to that fyftem, than happens 
in the cafe of many other acrimonies which 
may be fuppofed to be as generally diffufed. 
In OF PHYSIC. 
373 
In fhort, its appearance in particular con- 
ftitutions, and at a particular period of life, 
and even its being a hereditary difeafe, 
which fo frequently depends upon the 
tranfmiflion of a peculiar conftitution, are 
all of them circumftances which lead me 
to conclude, upon the whole, that this dil- 
eafe depends upon a peculiar conftitution of 
the lymphatic fyftem. 
MDCCLI. 
It fecms proper to obferve here, that 
the fcrophula does not appear to be a con- 
tagious difeafe; at lead: I have known many 
inftances of found children having had 
frequent and clofe intercourfe with fcro- 
phulous children without being infedled 
with the difeafe. This certainly fhows, 
that in this difeafe the peculiar acrimony 
of it is not exhaled from the furface of the 
body, but that it depends efpecially upon 
a peculiar conftjtution of the fyftem. 
MDCCLII. 374 
PRACTICE 
MDCCLII. 
Several authors have fuppofed the fcro- 
phula to have been derived from the ve- 
nereal difeafe ; but upon no juft grounds 
that 1 can perceive. In very many inftances, 
there can hardly be any fufpicion of the 
parents producing this difeafe having been 
imbued with fiphylis, or with any fiphyli- 
tic taint; and I have known feveral exam- 
ples of parents conveying fiphylis to their 
offspring, in whom, however, no fcrophu- 
lous fymptoms at any time afterwards 
appeared. Further, the fymptoms of the 
two difeafes are very different; and the 
difference of their natures appears particu- 
larly from hence, that while mercury 
commonly and readily cures the fiphylis, 
it does no fervice in fcrophula, and very 
often rather aggravates the difeafe. 
MDCCLIII. OF PHYSIC. 
375 
MDCLIII. 
For the cure of fcrophula, we have not 
yet learned any practice, that is certainly 
or even generally fuccefsful. 
The remedy which feems to be the moft 
fuccefsful, and which our practitioners 
efpecially trull to and employ, is the ufe of 
mineral waters; and indeed the walhing 
out, by means of thefe, the lymphatic fy- 
llem, would feem to be a meafure promi- 
fing fuccefs: but in very many inftances of 
the ufe of thefe waters, I have not been well 
fatisfied that they had fhortened the dura- 
tion of the difeafe more than had often 
happened when no fuch remedy had been 
employed. 
MDCCL1V. 
With regard to the choice of the mine- 
ral waters moll fit for the purpofe, I can- 
not with any confidence give an opinion. 
Almoft 376 
PRACTICE 
Almoft all kinds of mineral waters, whe- 
ther chalybeate, fulphureous, or faline, 
have been employed for the cure of fcro- 
phula, and feemingly with equal fuccefs 
and reputation: a circumftance which leads 
me to think, that, if they are ever fuccefs- 
ful, it is the elementary water, that is the 
chief part of the remedy. 
Of late, fea-water has been efpecially 
recommended and employed; but after 
numerous trials, I cannot yet difeover its 
fuperior efficacy. 
MDCCLV. 
The other remedies propofed by practi- 
cal writers are very numerous; but, upon 
that very account, I apprehend, they are 
little to be trufted; and as I cannot perceive 
any juft reafon for expeding fuccefs from 
them, I have very feldom employed them. 
Of late, the Peruvian bark has been 
much OF PHYSIC. 
377 
much recommended ; and as in fcrophu- 
lous perfons there are generally fome marks 
of laxity and flaccidity, this tonic may 
pofllbly be of fervice ; but in a great va- 
riety of trials, I have never feen it produce 
any immediate cure of the difeafe. 
In feveral inftances, the leaves of colts- 
foot have appeared to me to be fuccefs- 
ful. I have ufed it frequently in a ftrong 
decoction, and even then with advantage ; 
but have found more benefit from the 
exprefied juice, when the plant could be 
had in fomewhat of a fucculent ftate, 
foon after its firfl: appearance in the 
fpring. 
MDCCLVI. 
I have alfo frequently employed the hem- 
lock, and have fometimes found it ufeful 
in difcufling obftinate fwellings : but in 
this, it has alfo often difappointed me ; and 
Vol, IV. 
Bb 
I 378 
PRACTICE 
I have not at any time obferved that it 
difpofed fcrophulous ulcers to heal. 
I cannot conclude the fubjecl of inter- 
nal medicines without remarking, that I 
have never found, either mercury or anti- 
mony, in any lhape, of ufe in this difeafe; 
and when any degree of a feverifh date 
had come on, the ufe of mercury proved 
manifeftly hurtful. 
MDCCLVIL 
In the progrefs of fcrophula, fcveral 
external medicines are requisite. Several 
applications have been ufed for difcufling 
the tumours upon their firft coming on; 
but hitherto my own practice, in thefe 
refpedls, has been attended with very 
little fuccefs. The folution of faccharum 
faturni has feemed to be ufeful ; but 
it has more frequently failed: and I 
have had no better fuccefs with the fpi- 
ritus OF PHYSIC. 
379 
ritus Mindereri. Fomentations of every 
kind have been frequently found to do 
harm; and poultices feem only to hurry on 
a fuppuration. I am doubtful if this laft 
be ever pradiifed with advantage; for fcro- 
phulous tumours fometimes fpontaneoufly 
difappear, but never after any degree of 
inflammation has come upon them; and 
therefore poultices, which commonly in- 
duce inflammation, prevent that difcuf- 
fion of tumours, which might otherwife 
have happened. 
Even when fcrophulous tumours have 
advanced towards fuppuration, I am un- 
willing to haften the fpontaneous opening,, 
orto make it by the lancet, becaufe I appre- 
hend the fcrophulous matter is liable to be 
rendered more acrid by communication 
with the air, and to become more eroding 
and fpreading than when in its inclofed 
date. 
Bb 2 
MDCCLVIII. 380 
PRACTICE 
MDCCLVIIL 
The management of fcrophulous ulceri 
has, fo far as I know, been as little fuc- 
cefsful as that of the tumours. Efcha- 
rotic preparations, of either mercury or 
have been fometimes ufeful in 
bringing on a proper fuppuration, and 
thereby difpofing the ulcer to heal; but 
they have feldom fucceeded, and more 
commonly they have caufed the ulcer to 
fpread more. The efcharotic from which 
I have received moft benefit is burnt alum; 
and a portion of that mixed with* a mild 
ointment, has been as ufeful an application 
as any I have tried. The application, how- 
ever, that I have found moft ferviceable, 
and very univerfally admiflible, is that of 
linen cloths wetted with cold water, and 
frequently changed when they are becoming 
dry, it being inconvenient to let them be 
glued to the fore. They are therefore to 
be OF PHYSIC. 
381 
be changed frequently during the day; and 
a cloth fpread with a mild ointment or 
plafter may be applied for the night. In 
this practice I have fometimes employed 
fea-water; but generally it proved too ir- 
ritating ; and neither that nor any mine- 
ral water has appeared to be of more fer- 
vice than common water. 
MDCCLIX. 
To conclude what I have to offer upon 
the cure of fcrophula, I muft obferve, that 
cold bathing feems to have been of more 
benefit than any other remedy that I have 
had occafion to fee employed. 
B3 
CHAP. 382 
PRACTICE 
CHAP II. 
OF SlPHYLlS, OR THE VENEREAL DISEASE. 
MDCCLX 
AFTER practitioners have had fo 
much experience in treating this 
difeafe, and after fo many books have been 
publilhed upon the fubject, it does notfeem 
necefiary, or even proper, forme to attempt 
any full treatife concerning it; and I fhall 
therefore confine myfelf to fuch general 
remarks, as may ferve to illuftrate fome 
parts of the pathology or of the practice. 
MDCCLXL OF PHYSIC. 
383 
MDCCLXI. 
It is fufficiently probable, that, an- 
ciently, in certain parts of Afia, where 
the leprofy prevailed, and in Europe after 
that difeafe had been introduced into 
it, a difeafe of the genitals, refembling 
that which now commonly arifes from 
fiphylis, had frequently appeared: but it 
is equally probable, that a new difeafe, 
and what we at prefent term Sipbylis* 
was firfl brought into Europe about the 
end of the fifteenth century; and that the 
diflemper now fo frequently occurring, 
has been very entirely derived from that 
which was imported from America at the 
period mentioned. 
MDCLXII. 
This difeafe, at leaft in its principal 
circumftances, never arifes in any perfon 
B b 4 
but 384 
PRACTICE 
but from fome communication with a 
perfon already affeCted with it. It is moft 
commonly contracted in confequence of 
coition with an infedted perfon; but in 
what manner the infection is communi- 
cated, is, not clearly explained. I am per- 
fuaded, that in coition, it is communicated 
without there being any open ulcer either 
in the perfon communicating or in the per- 
fon receiving the infection; but in all other 
cafes, I believe it is never communicated 
in any other way than by a contact of ul- 
cer, either in the perfon communicating or 
in the perfon receiving the infection. 
MDCCLXIII. 
As it thus arifes from the contact of par- 
ticular parts, fo it always appears firft in 
the neighbourhood of the parts, to which 
the infeding matter had been immediately 
applied; and therefore, as moft common-* OF PHYSIC. 
385 
ly contracted by coition, it generally ap- 
pears firft in the genitals. 
MDCCLXIV. 
After its firfl: appearance in particular 
parts, more efpecially when thefe are the ge- 
nitals of either fex, its effects for fome time 
feem to be confined to thefe parts; and in- 
deed, in many cafes, never extends further. 
In other cafes, however, the infecting mat- 
ter paffes from the parts firfl: affected, and 
from the genitals therefore, into the blood- 
velfels; and being there difFufed, produces 
diforders in many other parts of the body. 
From this view of the circumftances, 
phyficians have very properly diftinguifhed 
the different ftates of the difeafe, according 
as they are local or are more univerfal. To 
the former, they have adapted appella- 
tions fuited to the manner in which the 
difeafe appears; and to the other the gene- 
ral 386 
PRACTICE 
ral affection, they have almoft totally con- 
fined the appellations of Sipbylis, Lucs Ve- 
nerea, or Pox. In the remarks I am now 
to offer, I fliall begin with confidering the 
local affection. 
MDCCLXV. 
This local affection appears chiefly in 
the form of gonorrhoea or chancre. 
The phenomena of gonorrhoea either up- 
on its firft coming on or in its after progrefs, 
or the fymptoms of ardor urinae, chordee, 
or others attending it, it is not ntceffary 
for me to defcribe. I fliall only here ob- 
ferve, that the chief circumftance to be 
taken notice of, is the inflamed Rate of the 
urethra, which I take to be infeparable 
from the difeafe. 
MDCCLXVL OF PHYSIC. 
387 
MDCCLXVL 
In thefe well-known circumftances, the 
gonorrhoea continues for a time longer or 
fhorter, according to the conftitution of the 
patient; it ufually remaining longeft in the 
molt vigorousand robuft, or according to 
the patient's regimen, and the care taken to 
relieve or cure the difeafe* In many cafes, 
if by a proper regimen the irritation of 
the inflamed date is carefully avoided, the 
gonorrhoea fpontaneoufly ceafes, the fymp- 
toms of inflammation gradually abating, 
the matter difcharged becoming of a thick- 
er and more vifcid conflftence, as well as of 
a whiter colour; till at length, the flow of 
it ceafes altogether; and whether it be thus 
cured fpontaneoufly, or by art, the dif- 
eafe often exifts without communicating 
any infection to the other parts of the 
body. 
MDCCLXVIL 388 
PRACTICE 
MDCCLXVII. 
In other cafes, however, the difeafe having 
been neglected, or by an improper regimen 
aggravated, it continues with all its fymp- 
toms for a long time; and produces va- 
rious other diforders in the genital parts, 
which, as commonly taken notice of by 
authors, need not be defcribed here. I 
fhall only obferve, that the inflammation 
of the urethra, which at firft feems to be 
feated chiefly, or only, in its anterior 
parts, is in fuch negledled and aggra- 
vated cafes fpread upwards along the ure- 
thra, even to the neck of the bladder. 
In thefe circumftances, a more confiderable 
inflammation is occafioned in certain parts 
of the urethra; and confequently, fup- 
puration and ulcer are produced, by which 
the venereal poifon is fometimes commu- 
nicated to the fyftem, and gives rife to a 
general fiphylis. 
MDCCLXVIII. OF PHYSIC. 
389 
MDCCLXVIII. 
It was fome time ago a pretty general 
fuppofition, that the gonorrhoea depended 
always upon ulcers of the urethra, pro- 
ducing a difcharge of purulent matter; and 
fuch ulcers do indeed fometimes occur in 
the manner that has been juft now men- 
tioned. We are now allured, however, from 
many diflecftions of perfons who had died 
when labouring under a gonorrhoea, that 
the difeafe may exift, and from many con- 
fiderations it is probable that it commonly 
does exift, without any ulceration of the 
urethra; fo that the difcharge which ap- 
pears, is entirely that of a vitiated mucus 
from the mucous follicles of the urethra. 
MDCCLXIX. 
Although moft of the fymptoms of go- 
norrhoea fhould be removed, yet it often 
happens 390 
PRACTICE 
happens that a mucous fluid continues td 
be difcharged from the urethra for a long 
time after; and fometimes for a great part 
of a perfon's life. This difcharge is what 
is commonly called a Gleet. 
With refpedt to this, it is proper to ob- 
ferve, that in fome cafes, when it is certain 
that the matter difcharged contains no ve- 
nereal poifon, the matter may, and often 
does put on that puriform appearance, and 
that yellow and greenifli colour, which ap- 
pears in the difcharge at the beginning and 
during the courfe of a virulent gonorrhoea. 
Thefe appearances in the matter of a gleet 
which before had been of a lefs coloured 
kind, have frequently given occafion to 
fuppofe that a frelh infection had been 
received ; but I am certain that fuch ap- 
pearances may be brought on by, per- 
haps, various other caufes : and particu- 
larly, by intemperance in venery and 
drinking concurring together. 1 believe, 
indeed, OF PHYSIC. 
391 
indeed, that this feldom happens to any 
but thofe who had before frequently la- 
boured under a virulent gonorrhoea, and 
have more or lefs of gleet remaining with 
them: but I muft alfo obferve, that in per- 
fons who at no period of their life had ever 
laboured under a virulent gonorrhoea, or 
any other fymptom of fiphylitic affection, 
I have met with instances of difcharges 
from the urethra refembling thofe of a vi- 
rulent gonorrhoea. 
The purpofe of thefe obfervations is, to 
fuggeft to practitioners what I have not 
found them always aware of, that in per- 
fons labouring under a gleet, fuch a re- 
turn of the appearances of a virulent go- 
norrhoea may happen without any new 
infection having been received, and confe- 
quently not requiring the treatment which 
a new infection might perhaps demand. 
When in the cure of gonorrhoea it was the 
practice to employ purgatives very fre- 
quently, 392 
PRACTICE 
quently, and fometimes thofe of the draftid 
kind, I have known the gleet, or fpurious 
gonorrhoea, by fuch a practice much in- 
creafed, and long continued, and the pa- 
tient's conftitution very much hurt. Nay, 
in order more certainly further to pre- 
vent miftakes, it is to be obferved, that 
the fpurious gonorrhoea is fometimes at- 
tended with heat of urine, and fome de- 
gree of inflammation; but thefe fymptoms 
are feldom confiderable, and, merely by 
the afliftance of a cool regimen, commonly 
difappear in a few days. 
MDCCLXX. 
With refpeft to the cure of a virulent 
gonorrhoea, I have only to remark, that 
if it be true, as I have mentioned above, 
that the difeafe will often, under a pro- 
per regimen, be fpontaneoufly cured; and 
that the whole of the virulent matter 
may be thus entirely difcharged without 
the OF PHYSIC. 
393 
the afliftance of art; it would feem 
that there is nothing required of prac- 
titioners, but to moderate and remove 
that inflammation which continues the 
difeafe, and occafions all the troublefome 
fymptoms that ever attend it. The foie 
bufinefs therefore of our art in the cure 
of gonorrhoea, is to take off the inflam- 
mation accompanying it: and this I think 
may commonly be done, by avoiding ex- 
ercife, by ufing a low and cool diet, by 
abftaining entirely from fermented and 
fpirituous liquors, and by taking plenti- 
fully of mild diluent drinks. 
MDCCLXXI. 
The heat of urine, which is lb trouble- 
fome in this difeafe, as it arifes from the 
increafed feniibility of the urethra in its in- 
flamed ftate; fo, on the other hand, the ir- 
ritation of the urine has the effect of in- 
creafing 
Vol. IV. 
Gc 394 
PRACTICE 
creating the inflammation, and is there- 
fore to be removed as foon as poflible. 
This can be done moft effectually by ta- 
king in a large quantity of mild watery 
liquors. Demulcents may be employed ; 
but unlefs they be accompanied with a 
large quantity of water, they will have 
little effect. Nitre has been commonly 
employed as a fuppofed refrigerant; but, 
from much obfervation, I am convinced, 
that in a fmall quantity it is ufelefs, and 
in a large quantity certainly hurtful; and, 
for this reafon, that every faline matter 
pafling with the urine generally gives 
fome irritation to the urethra. To pre- 
vent the irritation of the urethra arifing 
from its increafed fenfibility, the injec- 
tion of mucilage or of mild oil into it has 
been pradlifed; but I have feldom found 
this of much fervice. 
MDCCLXXIL OF PHYSIC. 
395 
MDCCLXXIL 
In gonorrhoea, as coftivenefs may be 
hurtful, both by an irritation of the fy-1- 
Item in general, and of the urethra in par- 
ticular, as this is occafioned always by the 
voiding of hardened faeces ; fo coftivenefs is 
to be carefully avoided or removed; and the 
frequent ufe of large glyfters of water and 
oil, I have found of remarkable benefit in 
this difeafe. If glyfters, however, do not 
entirely obviate coftivenefs, it will be ne- 
ceifary to give laxatives by the mouth; 
which, however, fhould be of the mildeft 
kind, and ihould do no more than keep 
the belly regular and a little loofe, without 
much purging* 
The pra&ice of frequent purging, 
which was formerly fo much in ufe, and 
is not yet entirely laid afide, has always 
appeared to me to be generally fuper- 
fluous, and often very hurtfuh Even 
C C 2 
what 396 
PRACTICE 
what are fuppofed to be cooling purga- 
tives, fuch as Glauber's fait, foluble tartar, 
and cryftals of tartar, in fo far as any part 
of them pafs by urine, they, in the fame 
manner as we have faid of nitre, may be 
hurtful; and fo far as they produce very 
liquid ftools, the matter of which is ge- 
nerally acrid, they irritate the redhim, and 
confequently the urethra. This laft ef- 
fect, however, the acrid, and in any de- 
gree draftic purgatives, more certainly pro- 
duce. 
MDCCLXXIII. 
In cafes of gonorrhoea attended with 
violent inflammation, blood-letting may- 
be of fervice; and in the cafe of perfons 
of a robuft and vigorous habit, in whom 
the difeafe is commonly the moft violent, 
blood-letting may be very properly em- 
ployed. As -general bleedings, however, 
when OF PHYSIC. 
397 
when there is no phlogiftic diathefls in 
the fyftem, have little effect in removing 
topical inflammation; fo in gonorrhoea, 
when the inflammation is confiderable, 
topical bleeding applied to the urethra by 
leeches, is generally more effectual in re- 
lieving the inflammation. 
MDCCLXXIV. 
When there is any phymofls attending a 
gonorrhoea, emollient fomentations applied 
to the whole penis are often of fervice. In 
fuch cafes it is neceflary, and in all others 
ufeful, to keep the penis laid up to the 
belly, when the patient either walks about 
or is fitting. > 
MDCCLXXV. 
Upon occafion of frequent priapifm and 
chordee, it has been found ufeful to ap- 
ply 
C c 3 398 
PRACTICE 
ply to the whole of the penis a poultice of 
crumb of bread moiftened with a ftrong 
folution of fugar of lead. I have, how- 
ever, been often difappointed in this prac- 
tice, perhaps by the poultice keeping the 
penis too warm, and thereby exciting the 
very fymptoms I wiflied to prevent. 
Whether lotions of the external urethra, 
with a folution of the fugar of lead, might 
be ufeful in this cafe, I have not properly 
tried. 
MDCCLXXVI. 
With refpect to the ufe of injections, fo 
frequently employed in gonorrhoea, I am 
perfuaded, that the early ufe of aftringent 
injections is pernicious ; not by occafion- 
ing a fiphylis, as has been commonly ima- 
gined ; but by increafing and giving occa- 
fion to all the confequences of the inflam- 
mation, particularly to the very trouble- 
fome OF PHYSIC. 
399 
Tome fymptom of fwelled tefticles. When, 
however, the difeafe has continued for 
fome time, and the inflammatory fymp- 
toms have very much abated, I am of opi- 
nion, that by injections of moderate aftrin- 
gency, or at leaft of this gradually increa- 
led, an end may be fooner put to the dif- 
eafe than wotild otherwife have happened; 
and that a gleet, fo readily occurring, may 
be generally prevented. 
MDCCLXXVII. 
Beiides the ufe of aftringent inje&ions, 
it has been common enough to employ 
thofe of a mercurial kind. With refpeft 
to thefe, although I am convinced that 
the infection producing gonorrhoea, and 
that producing chancres and fiphylis, are 
one and the fame; yet I apprehend, that 
in gonorrhoea mercury cannot be of ufe 
by correding the virulence of the infec- 
tion ; 
C c 4 400 
PRACTICE 
tion; and therefore that it is not uni- 
verfally ncceflary in this difeafe. I am 
perfuaded, however, that mercury ap- 
plied to the internal furface of the ure- 
thra, may be of ufe in promoting the 
more full and free difeharge of virulent 
matter from the mucous glands of it. 
Upon this fuppofition, 1 have frequently 
employed mercurial injections; and, as I 
judge, with advantage; thofe injections 
often bringing on fuch a date of the 
confidence and colour of the matter dif- 
charged, as we know ufually to pre- 
cede its fpontaneous ceafing. I avoid 
thefe injections, however, in recent cafes, 
or while much inflammation is dill pre- 
fent; but when that inflammation has 
fomewhat abated, and the difeharge not- 
withftanding ftill continues in a virulent 
form, I employ mercurial injections freely. 
I employ thofe only that contain mercury 
entirely in a liquid form, and avoid thofe 
which OF PHYSIC. 
401 
which may depofite an acrid powder in 
the urethra. That which I have found moft 
ufeful is a folution of the corrofive fubli- 
mate in water; fo much diluted as not to 
occafion any violent fmarting, but not fo 
much diluted as to give no fmarting at all. 
It is fcarce neceffary to add, that when there 
is reafon to fufpeCt there are ulcerations al- 
ready formed in the urethra, mercurial in- 
jections are not only proper, but the only 
effectual remedy that can be employed, 
MDCCLXXVIII, 
With regard to the cure of gonorrhoea, I 
have only one other remark to offer. As 
moft of the fymptoms arife from the irri- 
tation of a ftimulus applied, the effedls of 
this irritation may be often leffened by di- 
minifhing the irritability of the fyftem; 
and it is well known, that the moft certain 
means of accomplifiling this is by employ- 
ing 402 
PRACTICE 
ing opium. For that reafon I confider the 
practice both of applying opium directly 
to the urethra, and of exhibiting it by the 
mouth, to be extremely ufeful in moft cafes 
of gonorrhoea. 
MDCCLXXIX. 
After thus offering fome remarks with 
refpetft to gonorrhoea in general, I might 
proceed to confider particularly the vari- 
ous fymptoms which fo frequently attend 
it; but it does not feem neceffary for 
me to attempt this after the late publica- 
tions of Dr Foart Simmons, and of Dr 
Schwediauer, who have treated the fubjed: 
fo fully, and with fo much difcernment 
and {kill. 
MDCCLXXX. 
The other form of the local affection of 
fiphylis, O F P H Y S I C. 
403 
fiphylis, is that of chancre. The ordinary" 
appearance of this I need not defcribe, it 
having been already fo often done. Of 
the few remarks I have to offer, the firft 
is, that I believe chancres never appear 
in any degree -without immediately com- 
municating to the blood more or lefs of 
the venereal poifon; for I have conftantly, 
whenever chancres had appeared, found, 
that unlefs mercury was immediately 
given internally, fome fymptoms of a ge- 
neral fiphylis did certainly come on af- 
terwards ; and though the internal ufe of 
mercury fhould prevent any fuch appear- 
ance, it is ftill to be prefumed that the 
poifon had been communicated, becaufe 
mercury could act upon it in no other 
manner than as diffufed in the fluids. 
MDCCLXXXI. 
It has been a queftion among practi- 
tioners, 404 
PRACTICE 
tioners, upon the fubjedl of chancres, Whe- 
ther they may be immediately healed up 
by applications made to the chancres, or if 
they fhould be left open for fome time 
without any Rich application ? It has been 
fuppofed, that the fudden healing up of 
chancres might immediately force into the 
blood a poifon, which might have been 
excluded by being difcharged from the 
chancre. This, however, is a fuppolition 
that is very doubtful; and, upon the other 
hand,I am certain, thatthe longer a chancre 
is kept open, the more poifon it perhaps ge- 
nerates, and certainly fupplies it more co- 
pioufly to the blood. And although the 
above-mentioned fuppofition were true, it 
will be of little confequence, if the internal 
ufe of mercury, which I judge neceflary 
in every cafe of chancre, be immediately 
employed. I have often feen very trouble- 
fome confcquences follow from allowing 
chancres to remain unhealed; and the 
fymp- OF PHYSIC. 
405 
fymptoms of general fiphylis have always 
feemed to me to be more confiderable and 
violent in proportion as chancres had been 
buffered to remain longer unhealed. They 
ihould always, therefore, be healed as foon 
as poffible; and that, by the only very 
effectual means, the application of mer- 
curials to the chancre itfelf. Thofe that 
are recent, and have not yer formed any 
confiderable ulcer, may often be healed by 
the common mercurial ointment; but the 
moft powerful means of healing them has 
appeared to me, to be the application of 
red precipitate in a dry powder. 
MDCCLXXXII. 
When, in confequence of chancres, or 
of the other circumftances above men- 
tioned, by which it may happen, the ve- 
nereal poifon has been communicated to 
the blood, it produces many different 
fymp- 406 
PRACTICE 
fymptoms in different parts of the body, 
not neceffary to be enumerated and de- 
fcribed here, that having been already 
done by many authors with great accu- 
racy. 
MDCCLXXXIII, 
Whenever any of thofe fymptoms do 
in any degree appear, or as foon as it is 
known that the circumftances which give 
occafion to the communication of the ve- 
nereal poifon have taken place, 1 hold the 
internal ufe of mercury to be immediately 
neceflary ; and I am well perfuaded, that 
mercury employed without delay, and in 
fufficient quantity, will pretty certainly 
prevent the fymptoms which would other- 
wife have foon appeared, or will remove 
thofe that may have already difcovered 
themfelves. In both cafes, it will fecure 
the OF PHYSIC. 
407 
the perfon from any future confequences 
of fiphy lis from that infection. 
MDCCLXXXIV. 
This advice for the early and full ufe of 
mercury, I take to be the moft important 
that can be given with refpedt to the ve- 
nereal difeafe: And although I muft admit 
that the virulence of the poifon, may be 
greater in one cafe than in another; and 
even that one conftitution may be more 
favourable than another, to the violence of 
the difeafe; yet I am thoroughly convin- 
ced, that moft of the inftances which have 
occurred of the violence and obftinacy of 
fiphy lis have been owing very entirely to the 
negledt of the early application of mercury. 
MDCGLXXXV. 
Whatever other remedies of fiphylis may 
be 408 
PRACTICE 
be known, or may hereafter be found out, 
I cannot pretend to determine; but I am 
well perfuaded, that in moft cafes mer- 
cury properly employed will prove a very 
certain and effectual remedy. With re- 
fpecl to others that have been propofed, 
I lhall offer this remark only, that I 
have found the decodlion of the mezereon 
contribute to the healing of ulcers which 
feemed to have refifted the power of mer- 
cury. 
MDCCLXXXVI. 
With regard to the many and various 
preparations of mercury, I do not think 
it neceffary to give any enumeration of 
them here, as they arc commonly very 
well known, and have been lately well 
enumerated by Dr Schwediauer. The 
choice of them feems to be for the moll 
part a matter of indifference; as 1 believe 
cures O F P H Y S I C. 
409 
cures have been, and ftill may be, effected 
by many different preparations, if properly 
sdminiftered. The proper adminiftration. 
ieems to in the choofing thofe 
preparations which are the leaft ready to 
run off by ftool; and therefore the appli- 
cations externally by unction, are in many 
cafes the moft convenient, 'idly. In em- 
ploying the undtion, or in giving a pre- 
paration of mercury internally, in fuch 
quantity as may fhow its fenfible effects in 
the mouth. And, thirdly, without carry- 
ing thefe effects to a greater length, in the 
continuing the employment of mercury for 
feveral weeks, or till the fymptoms of the 
difeafe fhall have for fome time entirely 
difappeared. I fay nothing of the regi- 
men proper and neceffary for patients du- 
ring the employment of mercury, becaufe 
I prefume it to be very well known. 
Vol. IV. 
D d 
MDCCLXXXVIL 410 
PRACTICE 
MDCCLXXXVIL 
Amongft the other preparations of mer- 
cury, I believe the corrofive fublimate has 
often been employed with advantage; but 
I believe alfo, that it requires being con- 
tinued for a longer time than is neceffary 
in the employment of other preparations 
in the manner above propofed; and I fuf- 
pedt it has often failed in making a cure, 
becaufe employed while perfons were at the 
fame time expofed to the free air. 
MDCCLXXXVIIL 
Upon thefe points, and others relative 
to the adminiftration of mercury, and the 
cure of this difeafe, I might offer fome par- 
ticular remarks; but I believe they are ge- 
nerally underftood; and it is enough for 
me to fay here, that if practitioners will 
attend, and patients will fubmit, to the 
general OF PHYSIC. 
411 
general rules given above, they will feldom 
fail of obtaining a certain and fpeedy cure 
of the difeafe. 
D d 2 
CHAP. 412 
PRACTICE 
CHAP. III. 
Of SCURVY. 
MDCCLXXXIX. 
THIS difeafe appears fo frequently, 
and the effects of it are fo often fa' 
tai, in fleets and armies, that it has very 
properly engaged the particular attention 
of phyficians. It is indeed furprifing, that 
it had not fooner attracted the efpecial no- 
tice both of ftatefmen and phyficians, fo 
as to have produced thofe meafures and 
regulations that might prevent the havock 
which OF PHYSIC. 
413 
which it fb often occafions. Within thefe 
laft fifty years, however, it has been fo 
much attended to and fludied, that we 
might fuppofe every circumftance relating 
to it fo fully and exactly afcertained, as to 
render all further labour upon the fub- 
jedl fiiperfluous. This perhaps may be 
true ; but it appears to me, that there are 
ffill feveral circumftances regarding the 
difeafe not agreed upon among phyficians, 
as well as different opinions formed, fome 
of which may have a bad effect upon the 
practice: and this feems to me to be fo much 
the cafe, that I hope I fhall be excufed in 
endeavouring here to Rate the facts as they 
appear to me from the beft authorities, and 
to offer remarks upon opinions which may 
influence the practice in the prevention and 
cure of this difeafe. 
Dd3 
MDCCXC, PRACTICE 
414 
MDCCXC. 
With refpecl to the phenomena of the 
difeafe, they have now been fo fully ob- 
ferved, and fo accurately defcribed, that 
there is no longer any doubt in difcerning 
the difeafe when it is prefent, or in di- 
ftinguifhing it from almoft every other 
ailment. In particular it feems now to be 
fully determined, that there is one difeafe 
only, intitled to the appellation of Scurvy; 
that it is the fame upon the land as upon 
the fea; that it is the fame in all climates 
andfeafons, as depending every where upon 
nearly the fame caufes; and that it is not 
at all diverlified, either in its phenomena 
or its caufes, as had been imagined fome 
time ago. 
MDCCXCI. 
The phenomena of fcurvy, therefore, 
aro OF PHYSIC. 
415 
are not to be defcribed here, as it has been 
fo fully and accurately done elfewhere; 
and I fhall only endeavour to afcertain 
thofe fads with refpecft to the preven- 
tion and cure of the difeafe which feem 
not yet to be exactly agreed upon. And, 
firft, with refpect to the antecedents that 
may be coniidered as the remote caufes of 
the difeafe. 
MDCCXCII. 
The moft remarkable circumftance a- 
mongft the antecedents of this difeafe is, 
that it has moft commonly happened to 
men living very much on faked meats; 
and whether it ever arife in any other 
circumftances, is extremely doubtful. 
Thefe meats are often in a putrefcent 
ftate; and to the circumftance of the long 
continued ufe of animal food in a putref- 
cent and fomewhat indigeftible ftate, the 
Dd4 
difeafe 416 
PRACTICE 
difeafe has been efpecially attributed. Whe- 
ther the circumftance of the meat's being 
faked, has any effed in producing the dif- 
eafe, otherwife than by being rendered more 
fndigeftible, is a queftion that remains kill 
in difpute. 
MDCCXCIIL 
It Teems to me, that the fait concurs in 
producing the effect; for there is hardly 
any inftance of the difeafe appearing unlefs 
where faked meats had been employed, and 
fcarcely an example where the long conti- 
nued ufe of thefe did not produce it: befides 
all which, there are fome inftances where, 
by avoiding faked meats, or by diminilhing 
the proportion of them in diet, while other 
circum fiances remained much the fame, 
the difeafe was prevented from appearing. 
Further, if it may be admitted as an argu- 
ment upon this fubjed, I fhall hereafter en- 
deavour GF PHYSIC. 
417 
deavour to ffiow, that the large ufe of fait 
lias a tendency to aggravate and increafe 
the proximate caufe of fcurvy. 
MDCCXCIV. 
It muft, however, be allowed, that the 
principal circumftance in caufing fcurvy, 
is the living very much and very long 
upon animal food, efpecially when in a 
putrefcent ftate; and the clear proof of this 
is, that a quantity of frefli vegetable food 
will always certainly prevent the difeafe. 
MDCCXCV. 
While it has been held, that, in thofe 
circumftances in which fcurvy is produ- 
ced, the animal food employed was efpe- 
cially hurtful by its being of difficult di- 
geftion, this opinion has been attempted to 
be confirmed, by obferving, that the reft of 
the 418 
PRACTICE 
the food employed in the fame circumftan- 
ces was alfo of difficult digeftion. This is 
fuppofed to be efpecially the cafe of unfer- 
mented farinacea which fo commonly makes 
a part of the fca-diet: but I apprehend this 
opinion to be very ill founded; for the un- 
fermented farinacea, which are in a great 
proportion the food of infants, of women, 
and of the greater part of mankind, can 
hardly be fuppofed to be food of difficult 
digeftion : and with refpecl to the produc- 
tion of fcurvy, there are facts which ffiow, 
that unfermented farinacea, employed in 
large proportion, have had a coiffiderable 
effedl in preventing the difeafe. 
MDCCXCVI. 
It has been imagined, that a certain im- 
pregnation of the air upon the fea had an 
effect in producing fcurvy. But it is al- 
together improbable: for the only im- 
preg- OF PHYSIC. 
419 
pregnations which could be fufpected, are 
thofe of inflammable or mephitic air ; and 
it is now well known, that thefe impreg- 
nations are much lefs in the air upon the 
fea than in that upon the land ; befides, 
there are otherwife many proofs of the fa- 
lubrity of the fea-air. If, therefore, fea- 
air have any effect in producing fcurvy, 
it muft be by its fenfible qualities of cold 
or moiflure. 
MDCCXCVII. 
That cold has an effect in favouring 
the production of fcurvy, is manifest from 
hence, that the difeafe is more frequent 
and more confiderable in cold than in 
warm climates and feafons; and that even 
warm cloathing has a confiderable effect 
in preventing it, 
MDCCXCVIII, 420 
PRACTICE 
MDCCXCVIII. 
Moifture may in general have an effect 
in favouring the production of fcurvy, 
where that of the atmofphere in which 
men are placed is very confiderable: but 
the ordinary moifture of the fea-air is far 
from being fuch. Probably it is never 
confiderable, except in the cafe of unufual 
rains ; and even then, it is perhaps by 
the application of moifture to the bodies 
of men in damp cloathing only that it 
has any fliare in the production of fcurvy. 
At the fame time, I believe there is no 
inftance of either cold or moifture pro- 
ducing fcurvy, without the concurrence 
of the faulty fea diet. 
MDCCXCIX. 
Under thofe circumftances which pro- 
duce fcurvy, it commonly feems to occur 
pioft readily in the perfons who are the 
leaft or PHYSIC, 
421 
leaft exercifed; and it is therefore probable, 
that confinement and want of exercife may 
have a great fhare in producing the dif- 
eafe. 
MDCCC. 
It appears that weaknefs, in whatever 
manner occafioned, is favourable to the 
produ&ion of fcurvy. It is therefore pro- 
bable, that unufual labour and fatigue 
may often have fome fhare in bringing it 
on: and upon the fame account, it is pro- 
bable, that fadnefs and defpondency may 
induce a weaknefs of the circulation; and 
be thereby, as has been remarked, favour- 
able to the production of fcurvy. 
MDCCCI. 
It has alfo been obferved, that perfons 
negligent in keeping their fkin clean by 
wafliing and change of cloathing, are more 
liable 422 
PRACTICE 
liable than others to be affected with 
fcurvy. 
MDCCC1I. 
Several of thefe caufes, now mention- 
ed, concurring together, feem to produce 
fcurvy; but there is no proper evidence 
that any one of them alone will produce it, 
or that all the others uniting together will 
do it, without the particular concurrence 
of the fea diet. Alongft with this* how- 
ever, feveral of the other circumftances 
mentioned, have a great effect in produ- 
cing it fooner, and in a more confiderable 
degree, than would otherwife have hap- 
pened from the diet alone. 
MDCCCIIL 
From this view of the remote caufes, 
it will readily appear that the preven- 
tion OF PHYSIC. 
423 
tion of the difeafe may in fome mea- 
sure depend upon the avoiding of thofe 
circumftances which we have enumerated 
as contributing to bring on the difeafe 
fooner than it would otherwife come on. 
At the fame time, the only effectual means 
will be, by avoiding the diet of falted 
meats ; at leaft by lelfening the propor- 
tion of thefe, and ufing meat preferved 
otherwife than by fait; by ufing in diet 
any kind of efculent vegetable matter that 
can be obtained ; and efpecially by ufing 
vegetable matters the moft difpofed to a- 
cefcency, fuch as malt; and by drinking 
a large quantity of pure water. 
MDCCCIV. 
The cure of fcurvy feems now to be 
very well afcertained; and when the ne- 
ceffary means can be obtained, the difeafe 
is- commonly removed very quickly. The 
chief 424 
PRACTICE 
chief means is a food of frefli and fiictu-* 
lent vegetables, and thofe almoft of any 
kind that are at all efculent. Thofe moft 
immediately eHedlual are the acid fruits,- 
and, as being of the fame nature, all fort 
of fermented liquor. 
MDCCCV. 
The plants named alkalefcent, fuch as 
thofe of the garlic tribe and of the tetrady- 
namicB, are alfo particularly ufeful in the 
cure of this difeafe ; for, notwithftanding 
their appellation, they in the firft part of 
their fermentation undergo an 
and feem to contain a great deal of ace- 
fcent matter. At the fame time, they have 
generally in their compofition an acrid 
matter that readily pafl'es by urine, pro- 
bably by perforation; and, by promoting 
both excretions, are ufeful in the difeafe. 
It is probable, that fome plants of the co- 
niferous OF PHYSIC. 
425 
tiiferous tribe, fuch as the fpruce flr, and 
others pofTefied of a diuretic power, may 
likewife be of fome ufe. 
MDCCCVL 
It is fufficiently probable, that milk of 
every kind, and particularly its productions 
whey and butter-milk, may prove a cure 
of this difeafe. 
MDCCCVIL 
It has been common in this difeafe to 
employ the foflil acids ; but there is rea- 
Ibn to doubt if they be of any fervice, and 
it is certain they are not effectual remedies. 
They can hardly be thrown in, in fuch 
quantity as to be ufeful antifeptics; and as 
they do not feem to enter into the compo- 
fition of the animal fluids, and probably 
pafs off* unchanged by the excretions, fo 
Vol. IV. 
E e 
they 426 
PRACTICE 
they can do little in changing the ftate 
of the fluids. 
MDCCCVIIL 
The great debility which conftantly 
attends fcurvy, has naturally led phyfi- 
cians to employ tonic and ftrengthen- 
ing medicines, particularly the Peruvian 
bark; but the efficacy of it feems to me 
very doubtful. It is furprifing how loon 
the ufe of a vegetable diet reftores the 
ftrength of fcorbutic perfons ; which 
feems to fliow that the preceding debility 
had depended upon the hate of the fluids ; 
and confequently till the found ftate of thefe 
can be reftored, no tonic remedy can have 
much effect: but as the Peruvian bark 
has little power in changing the ftate of 
the fluids, fo it can have little effect in 
fcurvy. 
MDCCCIX. OF PHYSIC 
427 
MDCCCIX. 
I fliall conclude my obfervations upon 
the medicines employed in fcurvy, with 
Remarking, that the ufe of mercury is al- 
ways nianifeftly hurtful. 
MDCCCX. 
After having obferved that both the pre- 
vention and cure of this difeafe are now 
very well known, it may feem unneceflary 
to enter into much difcuflion concerning 
its proximate caufe : but as fuch difcuf- 
fions can hardly be avoided, and as falfe 
opinions may in fome meafure corrupt 
the practice, I fhall venture to fuggeft 
here what appears to me moft probable 
upon the fubjedd. 
E e 2 
MDCCOXL PRACTICE 
428 
MDCCCXI. 
Notwithflanding what has been aflert- 
ed by fome eminent perfons, I trud to the 
concurring tedimony of the moft part of 
the authors upon the fubjedt, that in feur- 
vy, the fluids fuffer a confiderable change. 
From thefe authors we learn, that in 
the blood drawn from the veins of per- 
fons labouring under the feurvy, the 
craflamentum is different both in colour 
and confidence from what it is in healthy 
perfons; and that at the fame time the 
ferum is commonly changed both in co- 
lour and tade. The excretions alfo, in 
fcorbutic perfons, fliow a change in the 
date of the fluids. The breath is fetid ; 
the urine is always high-coloured, and 
more acrid than ufual; and if that acrid 
exfudation from the feet, which Dr Hulme 
takes notice of, happens efpecially in fcor- 
butic perfons, it will be a remarkable 
proof OF PHYSIC. 
429 
proof to the fame purpofe.. But however 
this may be, there is evidence enough that 
in fcurvy the natural ftate of the fluids is 
confiderably changed. Further, I appre- 
hend it may be confidently prefumed from 
this, that the difeafe is brought on by a 
particular nourifliment introduced into 
the body, and is as certainly cured by the 
taking in of a different diet. In the latter 
cafe, the diet ufed has no other evident 
operation, than that of giving a particular 
ftate and condition to the fluids. 
MDCCCXII. 
Prefuming, therefore, that the difeafe 
depends upon a particular condition of 
the fluids of the body, the next fubjecl of 
inquiry is, What that condition may be ? 
With this view, I muft obferve, that the 
animal ceconomy has a fingular power of 
changing acefcent aliments, in fuch a 
E e 3 
man' 430 
PRACTICE 
manner, as to render them much more 
difpofed to putrefaction: and although, in 
a living Rate, they hardly ever proceed.' 
to an actually putrid Rate; yet in man, 
whofe aliment is of a mixed kind, it is 
pretty certain, that if he were to live en- 
tirely upon animal food, without a fre- 
quent fupply of vegetable aliment, his 
fluids would advance further towards pu- 
trefaction than is conliftent with health. 
This advance towards putrefaction feems 
to confift in the production and evolution 
of a faline matter which did not appear 
in the vegetable aliment, and could not be 
produced or evolved in it, but by carrying 
on its fermentation to a putrefactive ftate. 
That this faline ftate, is conftantly in fome 
meafure produced and evolved by the ani- 
mal procefs, appears from this, that certain 
excretions of faline matter are conftantly 
made from the human body, and are there- 
fore prefumed neceflary to its health. 
From OF PHYSIC. 
431 
From all this, it may be readily un- 
derftood, how the continual ufe of ani- 
mal food, efpecially when already in a pu- 
trefcent ftate, without a mixture of 
table, may have the effect of carrying the 
animal procefs too far, and particularly 
of producing and evolving a larger pro- 
portion of faline matter. That fuch a 
preternatural quantity of faline matter 
does exift in the blood of fcorbutic perr 
fons, appears from the ftate of the fluids 
above-mentioned. It will be a confirma- 
tion of all this to obferve, that every in- 
terruption of perfpiration, that is, the re- 
tention of faline matter, contributes to the 
production of fcurvy ; and this interrup- 
tion is efpecially owing to the application 
of cold, or to whatever elfe weakens the 
force of the circulation, fuch as the neglecft 
or want of exercife, fatigue, and defpon- 
dency of the mind. It deferves indeed to 
be remarked here, that one of the firft effects 
E e 4 
of 432 
-PRACTICE 
of the fcurvy once induced, is very foon 
to occafion a great debility of the fyftem, 
which occafions of courfc a more rapid 
progrefs of the difeafe. How the date of 
the fluids may induce fuch debility is not 
well underflood; but that it does depend 
upon fuch a ftate of the fluids, is rendered 
fufliciently prefumable from what has been 
faid above with regard to both the caufes 
and the cure of fcurvy. 
MDCCCXI1I. 
It is poflible, that this debility may 
have a great fliare in producing feveral of 
the phenomena of fcurvy; but a preter- 
naturally faline, and confequcntly diflblved 
Rate of the blood, will account for them 
with more probability; and 1 do not think 
it neceflary to perfons who are at all accu- 
flomed to reafon upon the animal occono- 
my, to explain this matter more fully. I 
have OF PHYSIC. 
433 
have only to add, that if my opinion in fup- 
pofing the proximate caufe of fcurvy to be 
a preternaturally faline Rate of the blood 
be at all founded, it will be fufficiently ob- 
vious, that the throwing into the body along 
with the aliment an unufual quantity of 
fait, may have a great (hare in producing 
the difeafe. Even fuppofing fuch fait to 
fuffer no change in the animal body, the 
efieCt of it may be confiderable; and this 
will be rendered ftill more probable, if it 
may be prefumed, that all neutral faits, 
confiding of a fixed alkali, are changed in 
the animal body into an ammoniacal fait; 
which I apprehend to be that efpecially 
prevailing in fcurvy. If I be at all right in 
concluding, that meats, from being faked, 
contribute to the production of fcurvy, it 
will readily appear, how dangerous it may 
be, to admit the conclufion from another 
theory, that they are perfectly innocent. 
MDCCCXIV. 434 
PRACTICE 
MDCCCXIV. 
Having thus endeavoured to explain 
what relates to the cure of fcurvy in ge- 
neral, I judge it proper to leave to other 
authors, what relates to the management 
of thofe fymptoms, which require a parti- 
cular treatment. 
CHAP. OF PHYSIC. 
435 
C H A P. IV, 
Of JAUNDICE. 
MDCCCXV. 
I Have here paffed over feveral of the 
titles in my nofology, becaufe they are 
difeafes not of this Illand. In thefe, there- 
fore, I have no experience; and without 
that, the compiling from other writers is 
always extremely fallacious. For thefe rea- 
fons I omit them; and fhall now only of- 
fer fome remarks upon the fubject of jaun- 
dice 436 
PRACTICE 
dice, the lad in order that I can poflibly 
introduce into my courfe of Ledlures. 
MDCCCXVL 
The jaundice confifts in a yellow co- 
lour of the ikin over the whole body, and 
particularly of the adnata of the eyes. 
This yellow colour may occur from diffe- 
rent caufes : but in the jaundice, hereafter 
to be ipore exadlly charadlerifed, I judge it 
to depend upon a quantity of bile prefent 
in the mafs of blood; and which, thrown 
out upon the furface, gives its own proper 
colour to the Ikin and eyes. 
MDCCCXVII. 
That the difeafe depends upon this, we 
know particularly and certainly from the 
caufes by which it is produced. In order 
to explain thefe, I muft obferve, that bile 
does OF PHYSIC. 
437 
does not exift in its proper form in the mafs 
of blood, and cannot appear in this form 
till it has palTed the fecretory organ of the 
liver. The bile therefore cannot appear in 
the mafs of blood, or upon the furface of 
the body, that is, produce jaundice from 
any interruption of its fecretion; and ac- 
cordingly, if jaundice does appear, it mull 
be in confequence of the bile, after it had 
been fecerned, being again taken into the 
blood-velfels. 
This may happen in two ways; ei- 
ther by an interruption of its excretion, 
that is, of its paifage into the duodenum, 
which by accumulating it in the biliary 
velfels, may give occaiion to its palling 
again into the blood-velfels; or it may 
pafs into thefe, by its being abforbed from 
the alimentary canal when it happens to 
be accumulated there in an unufual quan- 
tity. How far the latter caufe can take 
place, or in what circumftances it does 
occur, 438 
PRACTICE 
occur, I cannot clearly afcertain, and I 
apprehend that jaundice is feldom produ- 
ced in that manner. 
MDCCCXVIII. 
The former caufe of flopped excretion 
may be underftood more clearly ; and we 
have very certain proof of its being the or- 
dinary, and indeed almoft the uni verfal caufe 
of this difeafe. Upon this fubjecl it will be 
obvious, that the interrupted excretion of 
the bile muft depend upon an obftrudlion 
of the du cl us communis ch ole docbus; the moft 
common caufe of which is a biliary con- 
cretion formed in the gall-bladder, and 
from thence fallen down into the dudhis 
communis, it being at the fame time of fuch 
a lize as not to pafs readily through that 
duct into the duodenum. This dudt may 
likewife be obftrudled by a fpafmodic con- 
flri&ion affecting it: and fuch fpafm may 
happen, OF PHYSIC. 
439 
happen, either in the duCl itfelf, which we 
fuppofe to be contractile; or in the duo- 
denum preifmg the (ides of the dud clofe 
together; or, laftly, the dudt may be ob- 
ftrudled by a tumour comprefling it, and 
that ariling either in the coats of the dud. 
itfelf, or in any of the neighbouring parts 
that are, or may come to be, contiguous 
to it. 
MDCCCXIX. 
When fuch obftruftion happens, the 
fecreted bile muft be accumulated in the 
biliary dudts; and from thence it may 
either be abforbed and carried by the lym- 
phatics into the blood-veffels, or it may 
regurgitate in the dudls themfelves, and 
pafs from them direCtly into the afcending 
cava. In either way, it comes to be dif- 
fufed in the mafs of blood; and from 
thence may pafs by every exhalant veflel, 
and produce the difeafe in queftion. 
MDCCCXX, 440 
PRACTICE 
MDCCCXX. 
I have thus fhortly explained the ordi- 
nary produdion of jaundice : but it muft 
be obferved further, that it is at all times 
accompanied with certain other fymptoms, 
fuch as a whitenefs of the.faces alvina, which 
we readily account for from the abfence of 
bile in the inteftines ; and generally, alfo, 
with a certain confidence of the fasces, the 
caufe of which it is not fo eafy to explain. 
The difeafe is always accompanied alfo 
with urine of a yellow colour, or at leaft 
with urine that tinges a linen cloth with a 
yellow colour. Thefe are conftantly at- 
tending fymptoms ; and though not al- 
ways, yet there is commonly a pain felt 
in the epigaftrium, correfponding, as we 
fuppofe, to the feat of the dudtus com- 
munis. This pain is often accompa- 
nied with vomiting ; and even when 
the pain is not confiderable, a vomiting 
feme- OF PHYSIC 
441 
fometimes occurs. In fome cafes, when 
the pain is conliderable, the pulfe becomes 
frequent, full, and hard, and fome other 
fymptoms of pyrexia appear. 
MDCCCXXL 
When the jaundice is occafioned by tu- 
mours of the neighbouring parts compref- 
fing the biliary dtuft, I believe the difeafe 
can very feldom be cured. That fuch 
is the caufe of jaundice, may with fome 
probability be fuppofed, when it has 
come on in confequence of other dif- 
eafes which had fubfifted long before, 
and more efpecially fuch as had been at- 
tended with fymptoms of obftrudied vif- 
cera. Even when the jaundice has fub- 
fifted long without any intermiftion, and 
without any pain in the epigaftrium, an 
external compreftion is to be fufpecfted. 
Vol. IV. 
Ff 
MDCCCXXIL 442 
PRACTICE 
MDCCCXXII. 
In fuch circumftances, I confider the 
difeafe as incurable; and it is almofl only 
when the difeafe is occalioned by biliary 
concretions obftrudling the biliary du6t, 
that we may commonly expert relief, and 
that our art may contribute to the ob- 
taining it. Such cafes may be generally 
known, by the difeafe frequently difap- 
pearing and returning again ; by our find- 
ing, after the former accident, biliary con- 
cretions amongft the faeces; and by the 
difeafe being frequently accompanied with 
pain of the epigaftrium, and with vomi- 
tings ariling from fuch pain. 
MDCCCXXIIL 
In thefe cafes, we know of no certain 
and immediate means of expeding the 
paflage of the biliary concretions. This 
is OF PHYSIC. 
443 
is generally a work of time, depending 
upon the gradual dilatation of the biliary 
duel; and it is furprifing to obferve, from 
the fize of the flones which fometimes 
pafs through, what dilatation the duel 
will admit of. It proceeds, however, 
faller or flower upon different occafions; 
and therefore the jaundice, after a various 
duration, often ceafes fuddenly and fpon- 
taneoufly. It is this which has given rife 
to the belief, that the jaundice has been 
cured by fuch a number and fuch a variety 
of different remedies. Many of thefe, 
however, are perfectly inert, and many 
others of them fuch as cannot be fuppo- 
fed to have any effect in expeding the paf- 
fage of a biliary concretion. I fliall here, 
therefore, take no notice of the numerous 
remedies of jaundice mentioned by the 
writers on the Materia Medica, or even of 
thofe to be found in practical authors; 
but fhall confine myfelf to the mention of 
Ff 2 
thole 444 
PRACTICE 
thofe that may with probability be fuppo- 
fed to favour the pafTage of the concretion, 
or remove the obftacles to it which may 
occur. 
MDCCCXXIV. 
In the treatment of this difeafe, it is, 
in the firft place, to be attended to, that 
as the diftention of the biliary duct, by a 
hard mafs that does not eafily pals through 
it, may excite inflammation there; fo in 
perfons of tolerable vigour, blood-letting 
may be an ufeful precaution; and when 
much pain, together wTith any degree of 
pyrexia, occurs, it becomes an abfolutely 
neceflary remedy. In fome inftances of 
jaundice accompanied with thefe fymp- 
toms, I have found the blood drawn co- 
vered with an inflammatory cruft as thick 
as in cafes of pneumonia. 
DMCCCXXV. OF P H Y S I C. 
445 
MDCCCXXV. 
There is no means of pulhing forward 
a biliary concretion that is more probable 
than the adlion of vomiting; which, by 
comprefling the whole abdominal vifcera, 
and particularly the full and diflended 
gall-bladder and biliary veflels, may con- 
tribute, fometimes gently enough, to the 
dilatation of the biliary dudt. Accordingly 
vomiting has often been found ufeful for 
this purpofe : but at the fame time it is pof- 
lible, that the force exerted in the a6t of 
vomiting may be too violent, and there- 
fore gentle vomits ought only to be em- 
ployed. And either when, by the long 
continuance of the jaundice, it may be fuf- 
pecded that the lize of the concretion then 
palling is large ; or more efpecially when 
pain attending the difeafe gives apprehen- 
hon of inflammation, it may be prudent 
to avoid vomiting altogether. 
Ff3 
MDCCCXXVI. 446 
PRACTICE 
MDCCCXXVI. 
It has been ufual in the jaundice to em- 
ploy purgatives; and it is poflible that the 
action of the inteftines may excite the ac- 
tion of the biliary dudls, and thus favour 
the expul lion of the biliary concretion: 
but this, I think, cannot be of much effect; 
and the attempting it by the frequent ufe 
of purgatives, may otherwife hurt the pa- 
tient. For this reafon, 1 apprehend that 
purgatives can never be proper, excepting 
when there is a flow and bound belly. 
MDCCCXXVII. 
As the relaxation of the ikin contributes 
to relax the whole fyllem, and particularly 
to relieve the conftridion of fubjacent 
parts; fo, when the jaundice is attended 
with pain, fomentations of the epigaftrium 
may be of fervice, 
MDCCCV1IL OF PHYSIC. 
447 
MDCCCXXVI1I. 
As the folids of the living body are 
very flexible and yielding; fo it is pro- 
bable, that biliary concretions would in 
many cafes find the biliary duct readily 
admit of fuch dilatation as to render their 
paflage through it eafy, were it not that 
the diftention occafions a preternatural 
fpafmodic contraction of the parts below. 
Upon this account, opium is often of great 
benefit in jaundice; and the benefit re- 
fulting from its ufe, proves fufliciently the 
truth of the theory upon whiph the ufing 
of it has been founded. 
MDCCCXXIX. 
It were much to be wiilied, that a fol- 
vent of biliary concretions, which might 
be applied to them in the gall-bladder, or 
biliary duds, was difcovered: but none 
Ff 4 
fuch, 448 
P R A C T I C E, &c. 
fuch, To far as I know, has yet been found ; 
and the employment of foap in this dif- 
eafe, I confider as a frivolous attempt. 
Dr White of York has found a fol vent of 
biliary concretions when thefe are out of 
the body ; but there is not the leaft pro- 
bability, that it could reach them while 
lodged within. 
INDEX. INDEX 
To the FOUR VOLUMES. 
N. B. The Ciphers refer to the number of the Paragraphs* 
.Abscess, 25o 
Abscesses and Ulcers, the caufes oftheir dif- 
ferent ftates, 254 
Acids employed in fever, 134 
Acids refrigerant in fever, 134 
Action of the heart and arteries, how increafed 
for preventing the recurrence of the paroxyfms 
of intermitting fever, 230 
Adynamije, 1171 
Amenorrhoea, 995 
from retention, 996 
when occurring, 998 
fymptoms of, 999 
Ame- 450 
INDEX. 
Amenorrhoea, from retention, caufes of, 1000-2 
cure of, 1002-6 
from fuppreflion, 996 
when occurring, 1008 
fymptomsof, 1010 
caufes of, 1008-9 
cure of, 1011-12 
Amentia, 1598 
Anasarca, 1668 
the character of, 1668 
phenomena of, 1668-73 
cure of, 1674-96 
diftinguifhed from Leucophlegmatia, 1669 
St Anthony's fire. See Erythema. 
Antimonial emetics, employed in fevers, 181 
their different kinds, 181 
the adminiftration of 
them in fevers, 183-6 
Antiphlogistic regimen, 129 
how conduced, 130 
when employed in in- 
termittent fever, 234 
Antispasmodics, employed in fevers, 152,187 
Aphtha, 733 
Apoplexy, 1094 
diftinguifhed from palfy 1094 
diftinguifhed from fyncope, 1094 
Apo- INDEX. 
451 
Apoplexy, predifponent caufes of, IO95 
exciting caufes of, 1098-1115-16 
proximate caufe of, 1100-21 
serosa, proximate caufe of, 1114 
prognoftic, 1122-23 
frequently ending in hemi- 
plegia, 1122 
prevention of, 1124 
whether fanguine or ferous, ftimu- 
lants hurtful in it, 1136-37 
from powers that deftroy the mobi- 
lity of the nervous power, 1138 
cure of, 1131-9 
Afyrexia, 24 
Ascites, 1709 
character of, 1709 
its various feat, 1710-11 
the phenomena of, 1712-13 
its particular feat difficultly afcer- 
tained, 1714 
the cure of, 1715-17 
Asthma, 1373 
phenomena of, 1375 
exciting caufes of, 1381 
proximate caufe of, 1384 
diftinguiffied from other kinds of 
dyfpnoea, 1385 
Asthma, 452 
INDEX. 
Ast HMA,fometimesoccaGonsphthifispulmonalis, 1386 
frequently ends in hydrothorax 1386 
feldom entirely cured, 1387 
Astringents employed in intermittent fevers, 231 
joined with aromatics, employed in 
intermittent fevers, 231 
joined with bittters, employed in 
intermittent fevers, 231 
Atrabilis, 1029 
Atrophia ab alvi fluxu, 1607 
debilium, 1606 
inanitorum, 1607 
infantilis, 1605 
laftantium, 1605 
lateralis, 1606-11 
a leucorrhoea, 1607 
nervofa, 1606 
nutricum, 1607 
a ptyalifma, 1607 
rachitica, 1605 
fenilis, 1606-11 
Aura epileptpca, 1306 
B. 
Bitters employed in intermittent fevers, 231 
joined with aftringents, employed in 
termittents, '231 
Bli- INDEX. 
453 
Blistering, its effe&s, 189-197 
its mode of operation in the cure 
of fevers, 190-94 
when to be employed in fevers, 195; 
where to be applied in fevers, 196 
Blood-letting, the employment of it in 
fevers, 138-143 
the circumftances directing its ufe 
in fevers, 142 
the adminiftration of it in fevers, 143 
when employed in intermittent 
fevers, 234 
C. 
Cachexies, chara&er of the clafs, 1599 
Cachexy, the term, how applied by authors, 1600 
Calculus renalis, 429 
Calx nitrata antimonii, its ufe in fe- 
vers, 183-185 
Canine madness, 1525 
the cure of, 1525-1527 
Cardialgia, 1427 
Carditis, 383 
of the chronic kind, 383 
Carus, 1094 
Cataphora, 1094 
Catarrh, 1046 
Ca- 454 
INDEX 
Catarrh, predifpofition to, 104) 
fymptoms of, 1048 
remote caufes of, 1047 
proximate caufe of, *057 
cure of, 1065 
produces phthifis, Io5> 
pafl'es into pneumonia, 1054 
produces a peripneumonia notha, 1056 
contagious, 1062 
Catarrhus SUFFOCATIVUS, 376 
Chancre, method of treating, 1781 
CmcKEN-pox, 631 
how diftinguifhed from fmall-pox,632 
Chincough, 1402 
contagious, 1402 
frequently accompanied with fever, 1410 
phenomena, J4°4 
prognoftic in, 1413 
cure of, *4*4 
Chlorosis, 998 
Cholera, *453 
fymptoms of, x453- 
remote caufes of, 1458-60 
proximate caufe of, 1454 
cure of, 1462-64 
Chorea, *347 
phenomena of, 1347-53 
1 Cho- INDEX.. 
455 
Chorea, cure of 1354 
Chronic weaknefs, 1191 
Coeliaca, 1493 
Cold, its operations, 8$ 
abfolute, 88 
relative, 89 
its general effe&s on the human body, 90-91 
its morbid effects, 92 
moderates the violence of reaction in fever, 13 3 
its tonic power, how to be employed in 
fevers, 205 
Cold drink, an ufcful tonic in fevers, 206 
the limitation of its ufe in fevers, 207 
air applied in fevers, 208 
water applied to the furface of the body 
in fevers, 205-209 
Colic, 1435 
fymptoms of, 1435-38 
proximate caufe of, 1439 
cure of, 1441 
Devonfhire. See Colic of Poitou, 
of Poitou, 1451 
cure of, 1452 
Coma, 1094 
COMATA, IO93 
Contagions, 78 
their fuppofed variety, 79 
Con- 456 
INDEX 
Convulsions, 1253. 
Corpulency, 1621 
Ctnanche, 300 
MALIGNA, 3II 
PAROTIDEA, 332 
PHARYNGEA, 331 
TONSILLARIS, 30I 
TRACHEALIS, 318 
as affecting infants, 322-29 
the cure of it, 330 
Cystitis, 431 
D. 
Days, critical, in fevers, 107-124 
non-critical, 113 
Death, the caufes of, in general, 100 
the direct caufes of 100 
the indireft caufes of 100 
the caufes of in fever. 101 
Debility in fevers, the fymptoms of, 104 
how obviated, 202 
Delirium in general, explained, J529-S° 
in fever, of two kinds, 45 
or insanity without fever, 1550-57 
Diabetes, 1504 
fymptoms of, 1504--9 
Dia- INDEX. 
457 
Diabetes, remote caufes of, 1508 
proximate caufe of, 1510 -12 
cure of, 1513 
DlJETA AQJJEA, *57 
Diarrhoea, 1465 
diftinguiihed from dyfentery, 1466 
diftinguifhed from cholera, 1467 
proximate caufe of, 1468 
remote caufes of, 1471-93 
cure of, 1494-J5°3 
BiLiosA, 1480 
COLLIQJJATIVE, 1501 
MUCOSA, 1488 
Diathesis phlogistica, 62,247 
how removed, 266 
Diluents, their ufe in fevers, 154-58 
Diseases, the diftinguifhing of them, how attained, 2 
the prevention of them, on what founded, 3 
the cure of them, on what founded, 4 
Dropsies, 1643 
in general, the caufe of 1646 
of the breaft. See Hydrothorax. 
of the lower belly. See Afcltes. 
Dysentery, 1067 
contagious, 1075 
remote caufes of, 1072 
proximate caufe of, 1077 
Vol. IV. Gg Dy- 458 
INDEX. 
Dysentery, cure of, 1080 
ufe of mild cathartics to be fre- 
quently repeated in it, 1080 
rhubarb improper in it, 1080 
Dysenteria alba, 1070 
Dysmenorrhoea, 1014 
Dyspepsia, 1190 
remote caufes of, 1198 
proximate caufe of, 1193 
cure of, 1201 
flatulence in it, cure of, 1221 
heart-burn in it, cure of, 1221 
pains of ftomach in it, cure of, 1221 
vomiting in it, cure of, 1221 
Dyspnoea, 1365 
E. 
Effluvia, human, 85 
from marfhes, 85 
Emaciations, 1600 
caufes of, 1602-18 
cure of, 1619 
Emansio MENSIUM, 998 
Emetics, fuited to the cure of fevers, 174 
their effects, 176-180 
a mean of removing fpafm, 170 
the adminiftration of in fevers, 175 
, . Emf- INDEX. 
459 
Emetics, their ufe in intermittent fevers, 230-33 
Emprosthotonos, 1267 
Enteritis, 404 
phlegmonic or erythematic, 404 
caufes of, 407 
cure of, 409 
Epilepsy, 1282 
phenomena of, 1283 
proximate caufe ofj 1284 
remote caufes of, 1285 
predifponent caufes ofj 1310 
fympathic, 13 
cure of, 
idiopathic, I3 
cure of, 1319 
Epistaxis, 806 
the caufes of it, 808 
the various circumftances of, 807-18 
the management and cure of, 819-29 
Erysipelas, 274 
of the face* 708 
fymptoms of, 705-708 
prognofis of, 706 
proximate caufe of, 697 
cure of, 708-11 
phlegmonodes, in different parts 
of the body, 712 
G g 2 Ery- 460 
INDEX. 
Erysipelas, attending putrid fever, 713 
Erythema, 274 
Exanthemata, 585 
Exercise, ufeful in intermittent fevers, 231 
F. 
Fainting. See 1171 
Fatuity, 1529 
Fear, a remote caufe of fever, 97 
Fever, 8 
ftriftly fo called, the character of, 8 
phenomena of, 8-32 
remote caufes of are of a fedative na- 
ture, 36 
proximate caufe of, 33 
atony of the extreme veflels, a prin- 
cipal circumftance in the proximate 
caufe of it, 43-44 
fpafm, a principal part in the proxi- 
mate caufe of it, 40 
general doitrine of, 46 
the caufes of death in it, 101 
the prognofis of, 99 
indications of cure in, 126 
differences of, 53 
Fever INDEX. 
461 
Fever, continent, 28 
continued, 27 
inflammatory, 67 
miliary. See Miliary Fever. 
nervous, 67 
bilious, 71 
fcarlet. See Scarlet Fever. 
putrid, 72 
named fynocha, 67 
fynochus, 69 
typhus, 67 
he&ic, 74 
intermittent, the paroxyfms of, defcribed, 10 
the cold ftage of, 11 
the hot ftage of, if 
the fweating ftage of, 11 
of a tertian period, 25 
of a quartan period, 25 
of a quotidian period, 25 
caufed by marih effluvia, 84 
bile not the caufe of it, 51 
cure of, 228 
its paroxyfms, how prevent- 
ed, 22p 
attended with phlogiftic di- 
athefis, 254 
9 g 3 Fe- 462 
INDEX. 
Fever, intermittent, attended with congeftion in 
the abdominal vifcera, 234 
Remittent, 26 
Fluxes, without fever. See Profluvia, 
Fluoralbus. See Leucorrhaa, 
Fomentation of the lower extremities, its 
ufe in fevers, 199 
Fomites of contagion, 82 
Functions intelle&ual, diforders of, 1528-29 
G. 
Gangrene of inflamed parts, the caufe of 255-56 
marks of the tendency to, 257 
marks of its having come on, 257 
Gastritis, 384 
phlegmonic, or erythematic, 385 
phlegmonic, the feat of, 385 
the fymptoms of, 386 
the caufes of, 387 
the cure of, 393-397 
erythematic, how difcovered, 400 
the feat of, 385 
the cure of, 401 
Gastrodynia, 1427 
Gleet, 1769 
Gonorrhoea, 176$ 
phenomena of, 1767-°9 
Go- INDEX. 
463 
Gonorrhoea, cure of, 1770-78 
Gout, the character of, 492 
a hereditary difeafe, 500 
diftinguifhed from rheumatifm, 526 
predifponent caufes of, 493-500 
occafional caufes of, 502-505 
proximate caufe of, 527-533 
not a morbific matter, 529 
Regular, defcribed, 506-518 
pathology of, 533 
cure of, 537-573 
no effectual or fafe remedy yet 
found for the cure of it, 539 
medicines employed for it, 556 
whether it can be radically cured, 540 
treatment in the intervals of pa- 
roxyfms, 542 
treatment in the time of pa- 
roxyfms, 560 
regimen during the paroxyfms, 561 
external applications, how far 
fafe, 568-569 
blood-letting in the intervals of 
paroxyfms, 553 
in the time of pa- 
roxyfms, 563 
coftivenefs hurtful, 559 
Gg4 Gout, 464 
INDEX. 
Gout, Regular, laxatives to be employed, 559 
effects of alkalines, 558 
effects of Portland powder, 557 
Irregular, 518 
Atonic, 574-579 
pathology of, 534 
cure of, 580-82 
Retrocedent, 522 
pathology of, 535 
cure of, 580-582 
MiJplaced, 523 
pathology of, 536 
cure of, 583~584 
Tranflated, two particular cafes of, 525 
H. 
HjEMA TF. MESIS, IOI7 
arterial and venous, 1027 
from obftrufied menftruation, 1020 
from fuppreflion of the haemorr- 
hoidal flux, 1025 
from compreflion of the vafa 
brevia, by the fpleen, 1027 
from obftruQion of the liver, 1028 
Hematuria, 1033 
idiopathic, improbable, iO33>-34 INDEX? 
465 
Hematuria, calculofa, 1037 
cure of, 1038 
violenta, 1039 
from fuppreffion of accuftomed 
difcharges, 1041 
putrida, 1043 
fpuria et lateritia, 1044 
Hemiplegia, 1140 
caufes of, 1141 
frequently ;occafioned by apo- 
plexy, 1122 
frequently alternates with apo- 
plexy, 1144 
cure of, 1152 
ftimulants, of ambiguous ufe in 
ftimulants, external in, 1161 
Hemoptysis, 
the fymptoms ®f, 838-840 
the caufes of, 760-63-830-836 
how diftinguifhed from other 
fpittings of blood, 841-45 
cure of, 846-52 
Hemorrhagia uteri, 966 
Hemorrhagy, 
a&ive or paffive, 73$ 
character of, 736 
arterial, 744 
Hemor- 466 
INDEX. 
Hemorrhagy, venous, 768 
the caufes of the different fpe- 
cies appearing at different pe- 
riods of life, 750-73 
the general phenomena of, 738-43 
the remote caufes of, 774 
cure of, 776 
whether to be attempted 
by art, 776-81 
prevention of the firft attacks, 
or of the recurrence of, 782-89 
treatmentof when prefent, 789-805 
fymptomatic, 1015 
Hsmorrhoides vesicle, 1042 
Hjemorrhois, 
external and internal, 925 
phenomena of, 925-31 
nature of the tumours, 932 
caufes of, 933-43 
acquire a connexion with the 
fyftem, 943-44 
particularly with the ftomach, 946 
cure of, 947-65 
Hepatirrhoea, 1481 
Hepatitis, 412 
acute and chronic, 412 
Hepa- INDEX 
467 
HEPATiTiSjacute,the fymptoms of, 413-41J 
combined with pneumo- 
nic inflammation, 416 
remote caufes of it, 416 
feat of, 418 
various exit of pus produced 
in, 421 
cure of, 422 
chronic, the feat of, 418 
how difcovered, 423 
Hooping-cough. See Cbincough, 1402 
Horror, impreflion of, employed in intermittent 
fevers, 231 
Human effluvia, the caufe of fever, 81 
body, its temperature, 88 
body has a power of generating heat, 88 
Hydrophobia, 1525 
Hydrothorax, 1697 
where feated, 1698 
fymptoms of, 1701-03 
often combined with uni- 
verfal dropfy, 1704 
proximate caufe of, 1706 
cure of, 1707-08 
paracentefis in it, when 
proper, 1708 
X1YPERCATH ARSIS, 1477 
Hypo- 468 
INDEX. 
Hypochondriasis, 1222 
phenomena of, 1222 
diftinguifhed from dyfpepfia, 1226 
proximate caufe of, 1230 
cure of, 1232 
treatment of the mind in, 1244 
Hysteria, 1514 
fymptoms of, 1515-16 
paroxyfm or fit defcribed, 1515-16 
rarely appears in males, 1517 
how diftinguifhed from hypo- 
chondriafis, 1518-19 
proximate caufe of, 1522 
analogy between and epilepfy, 1523 
cure of, 1524 
libidinofa, *5l7 
Hysteric difeafe. See 
I. 
James's powder, its ufe in fever, 183 
Jaundice, 1815.16 
caufes of, 1816-21 
cure of, 1823-29 
Icterus. See Jaundice. 
Iliac pafhon. See Ileus. 
Ileus, INDEX. 
469 
Ileus, 1437 
Impetigines, 1737 
character of the order, 1737 
Indigestion. See Dyfpepjla. 
Inflammation, the phenomena of, 235 
internal, the marks of, 236 
the ftate of the blood in, 237 
the proximate caufe of, 239 
not depending upon a lentor 
of the blood, 241 
fpafm the proximate caufe 
of, 243-43 
terminated by refolution, 249 
by fuppuration, 250 
by gangrene, 255 
by fcirrhus, 258 
by effufion, 259 
by blitters, 260 
by exfudation, 261 
the remote caufes of, - 262 
the cure of in general, 264 
by refolution, 264 
when tending to 
fuppuration,268-70 
when tending to 
gangrene, 271 
3 In- 470 
INDEX. 
Inflammation, its general divifions, 273 
more ftricily cutaneous, 274 
of the bladder. See Cyflit is. 
of the brain. See Pbrenitis. 
of the heart. See Carditis. 
of the inteflines. See Enteritis. 
of the kidneys. See Nephritis. 
of the liver. See Hepatitis. 
of the lungs. See Pneumonia. 
of the pericardium. SetPericarditis. 
of the peritonaeum. See Peritonitis. 
of the fpleen. See Splenitis. 
of the ftomacb. See Gaftritis. 
of the uterus, . 432 
Insanity, 1535 
caufes of, I55°-57 
of different fpecies, 155 7 
partial and general, difference of, >575 
Intemperance in drinking, a remote caufe 
of fever, 97 
Intermission of fever, 24 
Interval of fever, 24 
Intumescenti je, 1620 
character of the order, 1620 
K. 
King's evil. See Screphulai 
K. INDEX. 
471 
Leucophlegmatia, 1669 
Leucorrhoea, 985 
character of, 986 
appearance of the matter difcharged 
in, 987-992 
the caufes of, 988 
the effects of, 990 
the cure of, 993 
Lethargus, 1094 
Lientery, 1469 
Looseness. See Diarrhoea. 
Madness. See Mania. 
canine. See Canine. 
Mania, 1558 
the fymptoms of, 1558 
the remote caufes of, 1559-61 
the treatment of, 1562-74 
occurring in fanguine temperaments, 1576 
in fanguine temperaments, cure of, 1577 
Marcores, 1600 
Marsh effluvia, a caufe of fever, 84 
Measles, 633 
the fymptoms of, 637-642 
the nature of, 644 
the cure of, 645-650 
of a putrid kind, 643 
Me- 472 
INDEX. 
Medicine, the inftitutions of, 4 
Melaena, to i 7 
Melancholia, 1575 
how diftinguilhed from hypo- 
chondriafis, 1587-88 
the character of, 1582-89 
the proximate caufe of* 1590 
the treatment of, 1592-97 
Melancholic temperamnet, 1230 
Melancholy. See Melancholia. 
Menorrhagia, 966 
adlive or paffive, 966 
when a difeafe, 968-75 
effects of, 972 
proximate caufe of, 977 
remote caufes of, 978 
cure of, 980 
Menses, immoderate flow of them. See Menorrhagia. 
Metallic tonics, employed in intermittent 
fevers, 231 
salts, refrigerant, 136 
Meteorismus, 1633 
Miasmata, 78 
Miliary fever, 
the general hiftory of, r 714-715 
of two kinds, red and white, 716" 
Mi- INDEX. 
473 
Miliary fever, white, the fymptomsof, 717-719 
the cure of, 720 
Morbus coeliacus, 1493 
MUCOSUS, IO7O 
NIGER, 1029 
Nephritis, 426 
the fymptoms of, 426 
the remote caufes of, 427 
the cure of, 430 
Nervous diseases. See Ncwrofes. 
Neuroses, 1090 
Neutral salts, diaphoretic in fevers, 159-161 
refrigerant in fevers, 133 
Nosology, Methodical, 2 
Obesity, when adifeafe, 1621 
Oneirodynia, 1598 
Ophthalmia, 278 
membranarum, 278 
its different degrees, 279-280 
it< remote caufes, 280 
the cure of, 288-290 
tarfi, 278 
the cure of, 288-290 
Opiates, employed in the hot ftage of in- 
termittent fevers, 233 
in the interval of intermittent fevers, 231 
Opisthotonos. See Tetanus. 
Vol. IV. H h Pal-. 474 
INDEX 
p. 
Palpitation of the heart, 1355 
the phenomena of, 1355 
the caufes of, 1356 
the cure of, 1363 
Palsy, 114° 
diftinguiflied from apoplexy, 1094 
caufes of, 1141 
Paracentesis inafcites, when to be attempted, 1717 
in hydrothorax, when proper, 1708 
Paraphrenitis, 343 
Paroxysm of intermittent fevers, the recur- 
rence, how to be prevented, 229 
Pemphigus, 732 
Pericarditis, 383 
Peripneumonia notha, 376 
fymptoms of, 379 
pathology of, 380 
the cure of, 3*31, 382 
fome of the fymptoms explained, 350 
Peripneumony, 342 
Peritonitis, 384 
Per uvian bark, not a fpecific, 213 
its tonic power, 214 
when proper in fever, 215 
bow mod employed, 216 
Peru- INDEX. 
475 
Peruvian bark, the adminiftration of, in in- 
termittent fevers, 232 
the tonic chiefly employed in inter- 
mittent fevers, 232 
Petechia, 734 
Phlegmasia, - 235 
Phlegmon, 274 
Phrenitis, 291 
the character of, 293 
the remote caufes of, 294 
the cure of, 295-299 
Phrensy. See Phrenitis. 
Physic, the practice of, how taught, I 
the theory of, how to be employed, 4 
Physconia, 1718 
Phthisis pulmonalis, the general charafter of, 853 
always withan ulcerationof the lungs, 85$ 
the pus coughed up, in how diftin- 
guilhed from mucus, 856 
accompanied with he€tic fever, 857 
the various caufes of it, 863 
from htemoptyfis, 864-86$ 
from pneumonia, 866-869 
from catarrh, 870-873 
from afthma, 875 
from tubercles, 876-882 
11 h 2 Phthi- 476 
INDEX. 
Phthisis fulmonalis, from calcareous matter 
in the lungs, 884 
if contagious, 886 
from tubercles, fymptoms of, 889 
its different duration, 896 
the prognofis in, 897 
the cure of, 899-924 
the treatment of, when arifing from 
tubercles, 906-921 
the palliation of fymptoms, 922-924 
Plague, 
the general character of, 665 
phenomena of, 665 
principal fymptoms of, 667 
proximate caufe of, 668 
prevention of, 670-685 
cure of, 686-605 
Pleurisy, " 341 
Pleurosthotonos. See Tetanus. 
Pneumonia, or pneumonic inflammation, 334 
general fymptoms of, 335-339 
feat of, 340-344 
prognofis of, 352-360 
cure of, 361 
the management of blood-letting in 
the cure of, 362-367 
the ufe of purgatives in, 370 
Pnfu- INDEX. 
477 
Pneumonia, the ufe of emetics in, 371 
the ufc of blifters in, 372 
the means of promoting expectora- 
tion in, 373 
the ufe of fweating in, 374 
the ufe of opiates in, 375 
Polysarcia, when a difeafe, 1621 
cure of, 1623-25 
Profluvia, 1045 
character of the clafs, 1045 
Pulse, the ftate of the during the paroxyfm of an 
intermittent fever, 12 
Purging, its ufe in continued fevers, 144 
intermittent fevers, 234 
Pus, how produced, 250 
Putrescency of the fluids in fever, the fymp- 
toms of, 105 
the tendency to in fever, how to be 
corrected, 222-226 
Pylorus scirrhous. See Dyfoepfia. 
Pyrexije, 6 
character of the clafs, 6 
orders of the clafs, 7 
Pyrosis, 1427 
fyrtiptoms of 1431 
proximate caufe of, 1433 
remote caufes of, 1432 
H h 3 Py- 478 
INDEX. 
Pyrosis, cure of, 
Stiecica of Sauvages, 1428 
Quinsy. See Cynanche. 
R. 
Rachitis, 
its origin, fy2o 
remote caufes of, 1721-23 
phenomena of, 1724 
proximate caufe of, 1725-28 
cure of, 1 729-36 
Reaction of the fyftem 
violent in fever, fymptoms of, 103 
violence of, how moderated, 127 
Refrigerants, the ufe of them in fever, 134 
Remedies, table of thofe employed in continued 
fevers, 227 
Remission of fever, 26 
Resolution of inflammation, how produced, 249 
Respiration, the changes of, during the pa- 
roxyfm of an intermittent, 13 
Revolution, diurnal, in the human body, 55 
Rheumatism, acute or chronic, 433 
ykute, the remote caufes of, 436 
the proximate caufe of, 455- 
Rhe v- INDEX. 
479 
Rheumatism, acute, the fymptoms of, 439-447 
cure of, 461-470 
Chronic, fymptoms of, 450 
how diftinguifhed from the acute, 451 
proximate caufe of, 472 
cure of, 473-476 
how diftinguifhed from gout, 526 
Rickets. See Rachitic. 
Rose. See Erythema. 
Rubefacients, the effe€ls of them. 
S. 
Scarlet fever, 651 
the fymptoms of, 656 
different from cynanche maligna,651 -65 5 
the cure of, 657-664 
Scrophula, 1738 
the phenomena of, 1738-1749 
proximate caufe of, 1750 
not contagious, 
not arifing from the lues venerea, 1752 
the cure of, 1753-59 
mejenterica, 1606 
Scurvy, *789 
remote caufes of, 1792-02 
cure of, 1804-1809 
proximate caufe of, 1811-14 
H h 4 Sina« 480 
INDEX. 
Sinapisms, the effects of them, 197 
Skin, affeCtions of. See Impetigines. 
Small-pox, general character of, 587 
fymptoms of the diftinCt kind, 589 
of the confluent kind,590-593 
general differences between diftinCt 
and confluent, 594 
caufes of thefe differences, 595-600 
prognofis in, 593 
cure of, 601-630 
inoculation of, 602 
the feveral practices of 
which it confifts, 603 
the importance of the fe- 
veral practices belong- 
ing to, 604-615 
management of fmall-pox received by 
infeCtion, 616-630 
Soda, *427 
Spasm,internal,meansof removingin fevers,152-187 
the proximate caufe of inflamma- 
tion, 243-248 
Spasmodic affections without fever, 1251 
of the animal functions, *254 
of the vital functions, 1355 
of the natural functions, 1427 
Sphacelus, 255 
Sple- INDEX. 
481 
Splenitis, 423 
Stimulants, when to be employed in fevers, 217 
their ufe in intermittent feveis, 230 
Stomach, its confent with the veflels on the fur- 
face of the body, 41 
Sudorifics, arguments for their ufe in fe- 
vers, 163-167 
againft their ufe in fevers, 164 
Suppuration of inflamed parts, the caufes of, 251 
the marks of a tendency to, 251 
formed, the marks of, 251 
Surface of the body, its confent with the fto- 
macb, 44 
Swellings, general. See Intumejcentia. 
adipofe, 1621 
flatulent, 1626 
watery. See Dropfies. 
Sweating, when hurtful in continued fevers, 165 
rules for the conduft of in continued 
fevers, 168 
the ufe of in intermittent fevers, 230 
Syncope, 1171 
phenomena of, 1171 
remote caufes of, 1174-1178 
predifpofition to, 1184 
Cure of, 1189 
Syn- 482 
INDEX. 
Syncope, diftinguifhed from apoplexy, 1094 
Synocha. See Fever. 
Synochus. See Fever. 
Syphilis, 1760 
originally from America, 1761 
how propagated, 1762 
and gonorrhoea, how diftinguiflied, 1764 
cure of, 1783-88 
Tabes a hydrope, 1609 
a fanguifluxu, 1608 
dorfalis, 1610 
glandularis, 1606 
mefenterica, 1606 
nutricum, 1608 
rachialgia, 1606* 
fcrophulofa, 1606 
Tartar emetic, its ufe in fevers, 185 
Tetanus, 1257 
remote caufes of, « 1268 
cure of, 1270 
pifhleumBarbadenfe, orBarbadoes tar in, 1280 
lateralis, 1268 
Tonic medicines employed in continued fevers, 211 
intermittent fevers, 231 
Toothach, how far different from rheuma- 
tifm, 477-480 
fymptoms of, 478 
Tooth- INDEX. 
483 
Tootiiach, predifpofition to, 481 
remote caufes of, 481-482 
proximate caufe of, 483 
cure of, 485-491 
Trismus. See Tetanus. 
NASCENTIUM, I28l 
Tussis. See Catarrh. 
Tympanites, the character of, 1627 
the different fpecies of, 1628-30 
inteftinalis, 1628 
enterophyfodes, 1628 
abdominalis, 1628 
afciticus, 1628 
phenomena of, 1632 
proximate caufe of, 1635-3$ 
cure of, • 1637-44 
Typhus. See Fever. 
the fpecies of, 70 
Vapours, or low fpirits. See Hypochondriasis. 
Venereal disease. See Syphilis. 
Venery, excefs in, a remote caufe of fever, 97 
VesaniJe, 
in general, 1528 
Vis medicatrix natural, 38 
St Vitus's dance. See Chorea. 
Vomiting of blood. See Hamatemefis. 
effects of, in continued fevers, 172,-173 
Vomit- 484 
INDEX. 
Vomiting, the ufe of in intermitting fevers, 230-3-4 
Vomiting of blood. See Hamatemefis. 
Urine, bloody. See Hamaturia. 
Urticaria, 
the hiftory and treatment of, 730 
W. 
Water-brash. See Pyrofis. 
Whites. See Leucorrhosa. 
Warm bathing, the effe&s of, in fever, 198 
the adminiftration of in fevers, 199 
the marks of the good effe&s, 200 
Wine the moft proper ftimulant in fevers, 218 
its convenient ufe in fevers, 219 
when hurtful or ufeful in fevers, 220 
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ios. 6d. in boards, or 12s.bound. 
16. Dr Smellie's fet of Anatomical Taeles, and an Abridgment of 
the Pradice of Midwifery, with a view to illuftrate his Treatife on 
that fubjed and Collodion of Cafes, Svo fize 6s. umo fize 5s. in 
boards. 
17. Thesaurus ledicus, five difputationuiruin academiaEdinenfi ad 
rem Medicam pertinentium, a collegio inftituto ad hoc urquetempus, 
deledns, 2 vols Svo. Vol. I. or II. or any of the fubfequent ones, 
may be had feparately. The whole is executed by the approbation of 
the prefent profefibrs of the different branches of the healing art. 
Vol. II. brings this colledion down to the year 1758, and is enriched 
with Dr A. Monro junior's celebrated thefis De t efib us et defemine 
in variis animalibus, who obligingly furniihed thepublifher with the 
accurate original engravings for illuftrating this fubjed, 12s. boards. 
A third andfourth volume are in the prefs, feleded and approved of 
by the Royal Medical Society of Edinburgh, which brings it down to 
1785, and completes the work. 
18. De morbis cceli mutatione medendis, audore Jacobo 
M. D. Med. Theoret. in Acad. Edin. Prof. &c. &c. &c. Edit, altera, 
aud. et emenda*. Svo, 2s. fewed. 
19. Albinus's Tables of the Skeleton and Mufcles of the Human 
Body, with Explanations, engraved by Andrew Bell. Neatly half- 
bound 11. 13 s. or in boards 11. 11 s. 6 d. in folio. 
20. Differtatio de Natura et Ufu Ladis in diverfis Animalibus, audore 
Thoma Young, M. D. in Adademia Edinenfi Artis Obftetricae Prof. 
8vo, is. fewed. 
21. Monro's Account of the Inoculation of the Small-pox in Scotland, 
8vo, is. fewed. 
22. Celsus de Medicin.a, cur. A.Morris,cum Indice, 8vo, 5s. bound. 
23. Dr Duncan's Medical Cases, feleded from the records of the 
Public Difpenfary at Edinburgh, Remarks and Obfer- 
various ; new edition corredcd, 5s. boards. 
24. -Elements of Therapeutics, or firft principles of 
the Pradice of Phylic, 2 vols, 6s. bound. The fame, one vol. Svo, 3". 
in boards. 
25. Heads of Lecture s on the Theory and Pradice of 
Medicine, new edition ccrreded and enlarged, with the Pathology, 
izmo, 3s. 6d. boards. 
27. A 
Books publijbedby C. Elliot, Edinburgh* Books pubT'jlj:d by C. Elliot, Edinburgh. 
a6. A Treatife upon the extraction of the Cryftalhne Lens. Ry Geo; 
Borthwick .Surgeon tothe uthRegiment of Dragoons, 8vo, 6 d. fewcd. 
27. The Univerfal Short Hand, being an Improvement on Mr By- 
rom's plan ; in which are fpeciniens from Dr Cullen and Monro's lec- 
tures, &c. &c. To which is alfo fubjoined, A new fcheme of Short- 
hand Writing, being an improvement of Mr Palmer's ; by which any 
perfon, without the afliftance of a maftcr, will be able in a Ihort time 
to follow any public fpeakei. A great many copperplates, &c. Price 
only 6s. in boards. This is the cheapeft book on the fubjedt ever pub- 
lifhcjd.-Byrom and Palmer fold together, formerly, at il. 1 is. 6d. 
28. Lind on the Putrid and Remitting Marsh-Kever which raged at 
Bengal in the year 1761, being a Tranflation of his Thefis, 8vo, is; 
29. Mead's whole Medical Wokks, complete in one volume8vo,nvith 
plates, 6s. bound. 
A LIST of THESES felccled by the Committee appointed 
by the Royal Medical Society, for forming a Third and 
Fourth Volume of the Thesaurus Medicus, and ap- 
proved of by the Society as the moft proper for republica- 
tion of all which have been publifhed in Edinburgh fince 
the year 1759. 
1764. De cinchona officinali. 
Pultney. 
1766. De vermibus inteftino- 
rum. Palmer. 
De rachitide. Nooth. 
i'jS'j. De aft. mufcul. Smith. 
1768. De febre remittente in 
Bengalia, 1762. Lind. 
y'J'JO- De febribus arcendis, 
&c. Monro Drummond. 
De elementariis mufic. 
fenfationibus. Odier. 
iTJi- De cynanche ftudula. 
Crawford. 
De perfpiratione infen* 
fibili. Hamilton. 
1772. De cyftirrhoea. Pam* 
ham. 
De vino. Wainman. 
1774. De morbis coeli mutat. 
medendis. Gregory. 
1775. Deplumbivirtut. Lille. 
1777. De irritabil. vaforum. 
Dennifon. 
De hom.variet. Hunter. 
1777. Dephyfiol.plant. Bell. 
De concodtione cibo- 
rum. Stephens. 
1778. De foetus human! nu- 
trimento. Evans. 
Deattraft.chem. Keir. 
De nutritione. Wade. 
1779. De igne. Cleghorn. 
De hydrocephalo in- 
terne. £>uin. 
1780. De confuet. H. Cullen 
Defrigore. H. Cullen. 
De cerebro. Nih'ell. 
1781. De vafis abforbentibus. 
Winterbottom. 
De fyncope. Hare. 
Deaeriseffedt. DeButts. 
1783. De tetano. Monro. 
De contagione. Owen. 
Signed by tie Committee : 
Edinburgh, 
Jan. 1784. 
Samuel Ferris, 
Stephen Dickson, 
Thomas Ryan, 
Richard Lubbock, 
Robert Coopbr.