FIRST LINES
OF THE 
PRACTICE OF PHYSIC.
BY
WILLIAM CULLEN, M.D.
LATE PROFESSOR OF THE PRACTICE OF PHYSIC IN THE
UNIVERSITY OF EDINBURGH, &c. &c.
IN TWO VOLUMES.
WITH PRACTICAL AND EXPLANATORY NOTES,
BY
JOHN ROTHERAM, M.D.
TO WHICH IS PREFIXED
THE LIFE OF THE AUTHOR.
VOL. II.
NEW-YORK:
PRINTED BY SAMUEL CAMPBELL, BOOK-SELLER AND STATIONER,
No. 37, HANOVER-SQUARE.
M,DCC,XCIII.



CONTENTS
OF THE
SECOND VOLUME.
PART I. BOOK IV.
CHAP. VI.
Page  
Of the Menorrhagia, or the immoderate flow of
the Menses 9
CHAP. VII.
Of the Leucorrhœa, Fluor Albus, or Whites 19
CHAP. VIII.
Of the Amenorrhœa or Interruption of the Menses 21
CHAP. IX.
Of Symptomatic Hemorrhages 30
Sect. I. Of the Hematemasis, or Vomiting of
Blood ibid
Sect II.  Of the Hematuria, or the voiding of
Blood from the Urinary Passage 39
BOOK V.
Of Profluvia, or Fluxes, with Pyrexia 46
CHAP. I.
Of the Catarrh 47
CHAP. II. 
Of the Dysentery 56
PART II.
Of Neuroses, or Nervous Diseases 65
BOOK I.
Of Comata, or, of the loss of Voluntary Motion 67
CHAP. I  
Of Apoplexy ibid
CHAP.

iv CONTENTS.
CHAP. II.
Page 88
Of Palsy 
BOOK II.
Of Adynamiæ, or Diseases consisting in a weakness,
or loss of Motion in either the vital or natural
Functions 101
CHAP. I.
Of Syncope, or Fainting ibid
CHAP. II.
Of Dyspepsia, or Indigestion 110
CHAP. III.
Of Hypochondrinsis, or the Hypochondriac Affec-
tion, commonly called Vapours or Low Spirits 126
BOOK III.
Of Spasmodic Affections without Fever 136
Sect. I. Of the Spasmodic Affections of the ani-
mal Functions 137
CHAP. I.
Of Tetanus 139
CHAP. II.
Of Epilepsy 153
CHAP. III.
Of the Chorea, or Dance of St. Vitus 178
Sect. II. Of the Spasmodic Affections of the Vi-
tal Functions 182
CHAP. IV.
Of the Palpitation of the Heart ibid
CHAP. V.
Of Dyspnœa, or difficult Breathing 185
CHAP. VI.
Of Asthma 187
CHAP. VII.
Of the Chincough, or Hooping Cough 198
Sect. III. Of the Spasmodic Affections in the
Natural Functions 209
CHAP.

CONTENTS. v
CHAP. VIII.
Of the Pyrosis, or what is named in Scotland
the Water-brash 
Page 20
CHAP. IX.
Of the Colic 212
CHAP. X. 
Of the Cholera 222
CHAP. XI.
Of Diarrhœa, or Looseness 227
CHAP. XII.	
Of the Diabetes	243
CHAP. XIII.	
Of the Hysteria, or the Hysteric Disease 247
CHAP. XIV.	
Of Canine Madness and Hydrophobia 254
BOOK IV.
Of Vesaniæ, or of the Disorders	of the Intellectual	
Functions 256
CHAP. I.	
Of Vesaniæ in general ibid
CHAP. II.	
Of Mania, or Madness 270
CHAP. III. 
Of Melancholy, and other forms Insanity 281
PART III. 
Of Cachexies 290
BOOK I.	
Of Emaciations 291
BOOK II.	
Of Intumescentiæ, or General Swellings 303
CHAP. I. 
Of Adipose Swellings 304
CHAP. II. 
Of Flatulent Swellings 308
CHAP. III. 
Of Watery Swellings, or Dropsies 318
Sect.

vi CONTENTS.
Sect. I.  Of Anasarca Page 330
Sect. II. Of the Hydrothorax, or Dropsy of
the Breast 344
Sect. III. Of the Ascites, or Dropsy of the
Lower Belly 350
CHAP. IV.
Of General Swellings, arising from an increased
bulk of the whole substance of particular parts 355
Of Rachitis, or Rickets ibid
BOOK III.
Of the Inpetignis, or depraved habit, with af-
fections of the Skin 367
CHAP. I.
Of Scrophula, or the King's Evil 368
CHAP. II.
Of Siphylis, or the Venereal Disease 378
CHAP. III.
Of Scurvy 394
CHAP. IV.
Of Jaundice 404
FIRST 

FIRST LINES
OF THE
PRACTICE OF PHYSIC.
PART I. BOOK IV.
CHAP. VI.
OF THE MENORRHAGIA,
OR THE
IMMODERATE FLOW OF THE MENSES.
DCCCCLXVI.
BLOOD discharged from the vagina may proceed
from different sources in the internal parts: but
I here mean, to treat of those discharges only, in which
the blood may be presumed to flow from the same
sources that the menses in their natural state proceed
from; and which discharges alone, are those proper-
ly comprehended under the present title. The title
of Metrorrhagia, or hæemorrhagia uteri, might compre-
hend a great deal more.
DCCCCLXVII.  
The menorrhagia may be considered as of two kinds;
either
Vol. II.             
B     

10 PRACTICE
either as it happens to pregnant and lying-in women,
or as it happens to women neither pregnant nor hav-
ing recently born children. The first kind, as con-
nected with the circumstances of pregnancy and child-
bearing, (which are not to be treated of in the present
course) I am not to consider here, but shall confine
myself to the second kind of menorrhagia only.
DCCCCLXVIII.
The flow of the menses is considered as immoderate,
when it recurs more frequently*, when it continues
longer, or when, during the ordinary continuance §,
it is more abundant † than is usual with the same per-
son at other times.                               
DCCCCLXIX.
As the most part of women are liable to some ine-
quality with respect to the period, the duration, and
the quantity of their menses; so it is not every ine-
quality in these respects that is to be considered as a
disease; but only those deviations, which are exces-
live in degree, which are permanent, and which in-
duce a manifest state of debility.
DCCCCLXX.
The circumstances (DCCCCLXVIII. DCCCCLXIX.)
are those which chiefly constitute the menorrhagia:
but it is proper to observe, that although I allow the
frequency, duration, and quantity of the menses to be
judged of by what is usual with the same individual at
other times; yet there is, in these particulars, so much
uniformity observable in the whole of the sex, that in
any
* The usual period is from twenty-seven to thirty days.
§ The time of it's continuance is very various in different people;
it seldom continues longer than eight days, or shorter than two.—
In general, women of a lax and delicate constitution have a more
copious and a longer continued discharge than robust people.
† It is extremely difficult to ascertain precisely what quantity is
usually discharged; but the women themselves can generally in-
form the physician with sufficient excatness for regulating the prac-
tice whether the discharge be immoderate. 

OF PHYSIC. 11
any individual in whom there occurs any considerable
deviation from the common measure, such a deviation
if constantly recurring, may be considered as at least
approaching to a morbid state, and as requiring most
of the precautions which I shall hereafter mention as
necessary to be attended to by those who are actually in
such a state.
DCCCCLXXI.
However we may determine with respect to the cir-
cumstances DCCCCLXVIII. DCCCCLXIX. it must still be
allowed, that the immoderate flow of the menses is
especially to be determined by those symptoms affect-
ing other functions of the body, which accompany and
follow the discharge.
When a larger flow than usual of the menses has
been preceded by headach, giddiness, or dispnœa, and
has been ushered in by a cold stage, and is attended
with much pain of the back and loins, with a frequent
pulse, heat, and thirst, it may then be considered as
preternaturally large.
DCCCCLXXII.
When, in consequence of the circumstances DCCCC-
LXVIII.—DCCCCLXXI. and the repetition of these, the
face becomes pale; the pulse grows weak: an unusu-
al debility is felt in exercise; the breathing is hurried
by moderate exercise; when, also, the back becomes
pained from any continuance in an erect posture;
when the extremities become frequently cold; and
when in the evening the feet appear to be affected with
œdematous swelling; we may from these symptoms
certainly conclude, that the flow of the menses has
been immoderate, and has already induced a danger-
ous state of debility.
DCCCCLXXIII.
The debility thus induced does often discover itself
also by affecions of the stomach, as anorexia and other
symp- 
B 2

12 PRACTICE
symptoms of dispepsia; by a palpitation of the heart,
and frequent faintings; by a weakness of mind liable
to strong emotions from slight causes, especially when
suddenly presented.
DCCCCLXXIV.
That flow of the menses, which is attended with
barrenness in married women, may be generally con-
sidered as immoderate and morbid.
DCCCCLXXV.
Generally, also, that flow of the menses may be con-
sidered as immoderate, which is preceded and follow-
ed by a leucorrhœa.
DCCCCLXXVI.
I treat of menorrhagia here as an active hemorrhagy,
because I consider menstruation, in its natural state, to
be always of that kind; and although there should be
cases of menorrhagia which might be considered as
purely passive, it appears to me that they cannot be so
properly treated of in any other place.
DCCCCLXXVII.
The menorrhagia (DCCCCLXXVII. et seq.) has for
its proximate cause, either the hemorrhagic effort of
the uterine vessels preternaturally increased, or a pre-
ternatural laxity of the extremities of the uterine ar-
teries, the hemorrhagic effort remaining as in the na-
rural state.
DCCCCLXXVIII.
The remote causes of the hemorrhagia may be, 1st,
Those which increase the plethoric state of the uterine
vessels; such as a full and nourishing diet, much strong
liquor, and frequent intoxication. 2dly, Those which
determine the blood more copiously and forcibly into
the uterine vessels; as violent strainings of the whole
body; violent shocks of the whole body from falls;
violent strokes or contusions on the lower belly; vio-
lent exercise, particularly in dancing; and violent pas-
sions of the mind, 3dly, Those which particularly ir-
ritate

OF PHYSIC. 13
ritate the vessels of the uterus; as excess in venery;
the exercise of venery in the time of menstruation; a
costive habit, giving occasion to violent straining at
stool; and cold applied to the feet*. 4thly, Those
which have forcibly overstrained the extremities of
the uterine vessels; as frequent abortions; frequent
child-bearing without nursing†; and difficult tedious
labours, Or, lastly, Those which induce a general lax-
ity; as living much in warm chambers, and drinking
much of warm enervating liquors, such as tea and
coffee.
DCCCCLXXIX.
The effects of the menorrhagia are pointed out in
DCCCCLXXII-DCCCCLXXIII. where I have mentioned
the several symptoms accompanying the disease; and
from these the consequences to be apprehended will
also readily appear.
DCCCCLXXX.
The treatment and cure of the menorrhagia must
be
* It is difficult to account for the cause of menorrhagia; it may
perhaps be owing to the circulation through the lower extremities
being obstructed or impeded, and consequently a greater flow of
blood to the uterus. The fact, however, is certain; for experience
sufficiently evinces that menorrhagia frequently follows an imprudent
exposure of the feet to cold, especially damp cold. Sitting in wet
shoes, or in a damp cold room with a stone floor, ought to be care-
fully avoided by ladies of a delicate constitution.
† By nursing, the fluids are determined to the breast, and in a
peculiar manner derived from the uterus. This part of the œcono-
my of nature physiologists have not yet sufficiently explained, but
the fact is well ascertained. Nursing is not only useful in preventing
menorrhagia, but as it derives the fluids from the uterus, it prevents
also frequent child-bearing; and consequently, which is the greatest
advantage of all others, time is allowed to the uterus for regaining it's
former tone and strength: The subsequent child-births are also ren-
dered more easy than they would other wise be, and the children
more healthy. It would be improper to enumerate all the advan-
tages of nursing in this place, as I shall reserve the consideration of
them for a future publication. 

14 PRACTICE
be different, according to the different causes of the
disease.
In all cases, the first attention ought to be given to
avoiding the remote causes, whenever that can be
done; and by that means the disease may be often en-
tirely avoided.
When the remote causes cannot be avoided, or when
the avoiding them has been neglected, and therefore
a copious menstruation has come on, it should be mo-
derated as much as possible, by abstaining from all ex-
ercise, either at the coming on, or during the conti-
nuance of the menstruation; by avoiding even an
erect posture as much as possible; by manning exter-
nal heat, and therefore warm chambers and soft beds;
by using a light and cool diet; by taking cold drink,
at lead as far as former habits will allow: by avoiding
venery; by obviating costiveness, or removing it by
laxatives that give little stimulus*.
The sex are commonly negligent, either in avoiding
the remote causes, or in moderating the first beginnings
of this disease. It is by such neglect that it so frequent-
ly becomes violent, and of difficult cure; and the fre-
quent repetition of a copious menstruation, may be
considered as a cause of great laxity in the extreme ves-
sels of the uterus.
DCCCCLXXXI.
* The laxatives that give little stimulus are manna, oil, tamarinds,
cassia, and such mild substances. Aloetic and other drastic purges,
must be carefully avoided. Rhubarb, in moderate doses, is only
admissible in cases where there is an evident atony of the stomach or
intestines: and in these cases it ought to be given in substance, or in
a watery infusion. The spirituous and vinous tinctures of it are
absolutely inadmissible in menorrhagia. A table-spoonful of the
following linctus, taken occasionally, will sufficiently obviate cos-
tiveness, without giving much stimulus:
ꝶ Man. opt. ℥ii.
Ol. ricini ℥i.
Syr. rosar. solut. ℥i.
Crem. tartar ℥fs.
M.f.Linct.

OF PHYSIC. 15
DCCCCLXXXI.
When the coming on of the menstruation has been
preceded by some disorder in other parts of the body
and is accompanied with pains of the back, resembling
parturient pains, together with febrile symptoms, and
when at the same time the flow seems to be copious,
then a bleeding at the arm may be proper, but it is
not often necessary; and it will in most cases be suffi-
cient to employ, with great attention and diligence,
those means for moderating the discharge which have
been mentioned in the last paragraph.
DCCCCXXXII.
When the immoderate flow of the menses shall seem
to be owing to a laxity of the vessels of the uterus, as
may be concluded from the general debility and laxity
of the person's habit; from the remote causes that have
occasioned the disease (DCCCCLXXVIII.) from the ab-
sence of the symptoms which denote increased action
in the vessels of the uterus (DCCCCLXXI.) from the fre-
quent recurrence of the disease; and particularly from
this, that in the intervals of menstruation the person
is liable to a leucorrhœa; then in such case the disease
is to be treated, not only by employing all the means
mentioned in DCCCCLXXX. for moderating the hemor-
rhagy, but also by avoiding all irritation, every irrita-
tion having the greater effect in proportion as the ves-
sels have been more lax and yielding. If, in such a
case of laxity, it shall appear that some degree of irri-
tation concurs, opiates may be employed to moderate
the discharge; but in using these, much caution is re-
quisite*.
If, notwithstanding these measures having been ta-
ken, the discharge shall prove very large, astringents†,
both
* Opiates used too liberally, generally increase the discharge, in
consequence of their very great power in relaxing the whole system.
† The astringents for internal use are, alum, catechu tincture of
roses, &c. Ten grains of alum, and as much catechu may be given
in powder, every two or three hours, with three or four spoonfuls 

16 PRACTICE
both external and internal, may be employed. In
such cases, may small doses of emetices be of service?
DCCCCLXXXIII.
When the menorrhagia depends on the laxity of the
uterine vessels, it will be proper, in the intervals of
menstruation, to employ tonic remedies; as cold bath-
ing and chalybeates*. The exercises of gestation, al-
so, maybe very useful, both for strengthening the whole
system, and for taking off the determination of the
blood to the internal parts.
DCCCCLXXXIV.
The remedies mentioned in these two last paragraphs,
may be employed in all cases of menorrhagia, from
whatever cause it may have proceeded, if the disease
shall have already induced a considerable degree of
debility in the body.
CHAP.
of tincture of roses to wash it down. The bark is sometimes of use
in these cases, especially when joined with alum. The external ap-
plications are, cold clothes soaked in vinegar and water applied to
the lower region of the abdomen, or to the pudenda; or a strong
decoction of oak-bark, with an ounce of alum dissolved in every pint
of it, may be applied cold to the same parts.
* The following form is very convenient.
ꝶ Rubigin. ferri. ℥ii.
Corr. Peruv. ℥i.
Syr. Simpl. q.f.
M.f.Elect.
The dose of this electuary is to be varied according to the constitu-
tion; the size of a nutmeg twice a day is usually given.
The bed forms of chalybeates, in these cases, are the mineral wa-
ters which contain iron dissolved by fixed air. Chalybeate waters
should not, in this disease, be drank in such large quantities as to
pass off by stool. A jill taken every three or four hours throughout
the day, with a spoonful of port wine, is more efficacious than a
pint, or even a quart, taken at once in the morning. The dose,
however, of these waters, varies according to the strength of the
particular water we use. Along with the chalybeate water, a scru-
ple, or half a drachm of Peruvian bark may be given twice a day.-
The following form is very agreeable, and is at the same time singu-
larly efficacious: 

OF PHYSIC. 17
CHAP. VII.
OF THE LEUCORRHŒA, FLUOR ALBUS, OR
WHITES.
DCCCCLXXXV.
EVERY serous or puriform discharge from the va-
gina, may be, and has been, comprehended un-
der one or other of the appellations I have prefixed
to this chapter. Such discharges, however, may be
various; and may proceed from various sources, not
yet well ascertained: but I confine myself here to treat
of that discharge alone which may be presumed to
proceed from the same vessels, which, in their natural
state, pour out the menses.
DCCCCLXXXVI.
I conclude a discharge from the vagina to be of this
kind*; 1. From its happening to women who are sub-
ject to an immoderate flow of the menses, and liable
to this from causes weakening the vessels of the uterus.
2. From its appearing chiefly, and often only, a lit-
tle before, as well as immediately after, the flow of the
menses. 3. From the flow of the menses being di-
minished, in proportion as the leucorrhœa is increased.
4. From the leucorrhœa continuing after the menses
have entirely ceased, and with some appearance of its
observing a periodical recurrence. 5. From the leu-
corrhœa
C
ꝶ Extract. cort. Peruv. ℥ii.
Extract. Campechens.
Extract. Glychyrrh. a a ℥fs.
Mucilag. Gum. Arab. q.f.
M.F. Elect.
The dose is half a drachm or two scruples twice a-day.
* The young practitioner ought to pay great attentions to the
diagnostics of the leucorrhœa delivered in this article.

18 PRACTICE
corrhœa being accompained with the effects of the
menorrhagia (DCCCCLXXII. DCCCCLXXIII.) 6. From
the discharge having been neither preceded by, nor
accompained with, symptoms of any topical affections
of the uterus. 7. From the leucorrhœa not having
appeared soon after communication with a person who
might be suspected of communicating infection, and
from the first appearance of the disease not being ac-
companied with any inflammatory affection of the pu-
denda*.
DCCCCLXXXVII.
The appearance of the matter discharged in the
leucorrhœa, is very various with respect to consistence
and colour; but from these appearances it is not al-
ways possible to determine concerning its nature, or
the particular source from whence it proceeds.
DCCCCLXXXVIII.
The leucorrhœa, of which I am to treat, as ascer-
tained by the several circumstances DCCCCLXXXVI. seems
to proceed from the same causes as that species of me-
norrhagia which I suppose to arise from the laxity of
the extreme vessels of the uterus. It accordingly of-
ten follows, or accompanies such a menorrhagia; but
though the leucorrhœa depends chiefly upon the laxi-
ty mentioned, it may have proceeded from irritations
inducing
*Nothing is more frequent with ignorant practitioners than to
mistake a gonorrhœa for a leucorrhœa. Women in general give the
name of whites to a gonorrhœa, and therefore the unwary practi-
tioner may the more easily be misled. The distiaguishing characte-
ristic of gonorrhœa is, as the author says, an inflammatory affection
of the pudenda; but, at few women will suffer an inspection of the
parts, we must pay some attention to the concomitant symptoms.
The running in a gonorrhœa is constant, and only in small quanti-
ties; in a leucorrhœa the discharge is inconstant, and in large
quantities. The other distinguishing marks of a gonorrhœa are,
smarting in making water, itching of the pudenda, increased incli-
nation for venery, a swelling of the labia and of the glands about
the groin. Some authors mention the colour of the discharged mat-
ter as a distinguishing mark; this, however, is inconstant. 

OF PHYSIC. 19
inducing that laxity, and seems to be always increased
by any irritations applied to the uterus.
DCCCCLXXXIX.
Some authors have alledged that a variety of cir-
cumstances in other parts of the body may have a
share in bringing on and in continuing this affection of
the uterus now under consideration: but I cannot dis-
cover the reality of those causes; and it seems to me,
that this leucorrhœa, excepting in so far as it depends
upon a general debility of the system, is always prima-
rily an affection of the uterus; and the affections of
other parts of the body which may happen to accom-
pany it, are for the raost part to be considered as ef-
fects, rather than as causes.
DCCCCXC.
The effects of the leucorrhœa are much the same
with those of menorrhagia; inducing a general debi-
lity, and, in particular, a debility in the functions of
the stomach. If, however, the leucorrhœa be mode-
rate, and be not accompanied with any considerable
degree of menorrhagia, it may often continue long
without inducing any great degree of debility, and it
is only when the discharge has been very copious as
well as constant, that its effects in that way are very
remarkable.
DCCCCXCI.
But, even when its effects upon the whole body
are not very considerable, it may still be supposed to
weaken the genital system; and it seems sufficiently
probable that this discharge may often have a share in
occasioning barrenness.
DCCCCXCII.
The matter discharged in the leucorrhœa, is at first
generally mild: but after some continuance of the
disease, it sometimes becomes acrid*; and by irritat-
ing
C 2
* The young practitioner must not conclude too hastily that an

20 PRACTICE
ing, or perhaps eroding, the surfaces over which it
passes, induces various painful disorders.
DCCCCXCIII.
As I have supposed that the leucorrhœa proceeds
from the same causes as that species of menorrhagia
which is chiefly owing to a laxity of the uterine vessels,
it must be treated, and the cure attempted, by the
same means as delivered in DCCCCLXXXII for the cure
of menorrhagia, and with lei's reserve in respect of the
use of astringents*.
DCCCCXCIV.
As the leucorrhœa generally depends upon a great
lost of tone in the vessels of the uterus, the disease has
been relieved, and sometimes cured by certain stimu-
lant medicines which are commonly determined to
the urinary passages, and from the vicinity of these are
often communicited to the uterus. Such, for exam-
ple, are canrharides, turpentine, and other balsams of
a similar nature†.
CHAP.
ulcer exists in the uterus when the matter discharged is acrid.-
Practice has offered many instances where the matter has excoriated
the pudenda, and yet no ulcer existed.
*The electuary mentioned at the end of the last note on Article
983, has been found very efficacious in some cases of leucorrhœa.—
It's dose may be increased to a drachm thrice a-day, either swallow-
ed as a bolus, or dissolved in an ounce of pure water, and half an
ounce of pure cinnamon-water. The chalybeate waters are used in
this, as well in the former disease; and they may be used in the
manner above mentioned. Practitioners recommend, in these
cases, a nutritive but not a heating diet, as mucilaginous broths
made with rice, especially veal-broth, jellies of all kinds, except those
that are high seasoned. Port-wine must be prescribed in a mode-
rate quantity, according to the habits of the patient.
†The practice here recommended is not without danger, and
must not be followed except with great caution and circumspection.
When the other means fail in producing relief, we may then have
recourse to these balsamics, or join them to the tonic astringents as,
ꝶ Gum. oliban.
Terebinth. venet
Alum.

OF PHYSIC. 21
CHAP. VIII.
OF THE AMENORRHŒA, OR INTERRUP-
TION OF THE MENSTRUAL FLUX.
DCCCCXCV.
WHATEVER, in a system of methodical nosolo-
gy, may be the fittest place for the amenor-
rhœa, it cannot be improper to treat of it here as an
object of practice, immediately after having consider-
ed the menorrhagia.
DCCCCXCVI.
The interruption of the menstrual flux is to be con-
sidered as of two different kinds; the one being when
the menses do not begin to flow at that period of life
at which they usually appear; and the other being
that when, after they have repeatedly taken place for
some time, they do, from other causes than concep-
tion, cease to return at their usual periods; The form-
er of these is named the retention, and the latter the
suppression, of the menses.
DCCCCXCVII.
As the flowing of the menses depends upon the
force
Terrn, japonic, a.a ʒi.
S.4, martis ʒss.
M.f. massa in pilulas equales.
No. 60. dividend.
Two or three of these pills may be given twice a-day or oftener.—
Some practitioneis have strongly recommended the following emul-
sion:
ꝶ Balsam. copaivi. ʒi.
Vitel. ovi No. 1.
Tere in nuit tar. ruumor. et adde gradatim.
Aq. font. ℥vii.
Syr. Simpl. ℥i.
M.f. Emulf.
The dose of this emulsion two or three spoonfuls three or four
times a-day. 

22 PRACTICE
force of the uterine arteries impelling the blood into
heir extremities, and opening these so as to pour out
red blood; so the interruption of the menstrual flux
must depend either upon the want of due force in the
action of the uterine arteries, or upon some preternatu-
ral resistance in their extremities. The former I sup-
pose to be the most usual cause of retention, the latter
the most common cause of suppression; and of each of
these shall now treat more particularly.
DCCCCXCVIII.
The retention of the menses, the emansio mensium
of Latin writers, is not to be considered as a disease
merely from the menses not flowing at that period
which is usual with most other women. This period
is so different in different women, that no time can be
precisely assigned as proper to the sex in general.—
In this climate, the menses usually appear about the
age of fourteen: but in many they appear more early,
and in many not till the sixteenth year: in which last
case it is often without any disorder being thereby oc-
casioned. It is not therefore from the age of the
person that the retention is to be considered as a dis-
ease; and it is only to be considered as such, when
about the time the menses usually appear, some disor-
ders arise in other parts of the body which may be im-
puted to their retention; being such as, when arising
at this period, are known from experience to be re-
moved by the flowing of the menses.
DCCCCXCIX.
These disorders are, a sluggishness, and frequent
sense of lassitude and debility, with various symptoms
of dyspepsia; and sometimes with a preternatural ap-
petite*. At the same time the face loses its vivid co-
lour,
* This is a very extraordinary symptom, which has not hitherto
been explained. It sometimes accompanies every cessation of the
uterine discharge, but frequently appears in the most violent degree
in pregnancy. In young women, the appetite for chalk, lime, rub-

OF PHYSIC. 23
lour, becomes pale, and sometimes of a yellowish hue;
the whole body becomes pale and flaccid; and the
feet, and perhaps also a great part of the body, become
affected with œdematous swelling. The breathing is
hurried by any quick or laborious motion of the body
and the heart is liable to palpitation and syncope.—
A headach sometimes occurs; but more certainly
pains of the back, loins, and haunches*.
M.
These symptoms, when occurring in a high degree,
constitute the chlorosis of authors, hardly ever appear-
ing separate from the retention of the menses; and,
attending to these symptoms, the cause of this reten-
tion may, I think, be perceived.
These symptoms manifestly show a considerable lax-
ity and flaccidity of the whole system; and therefore
give reason to conclude, that the retention of the men-
ses accompanying them, is owing to a weaker action
of the vessels of the uterus; which therefore do not
impel the blood into their extremities with a force
sufficient to open these, and pour out blood by them.
MI.
How it happens that at a certain period of life a
flaccidity of the system arises in young women not
originally affected with any such weakness or laxity,
and of which but a little time before, they had given
no indication, may be difficult to explain; but I
would attempt it in this way.
As a certain state of the ovaria in females, prepares
and disposes them to the exercise of venery, about the
very period at which the menses first appear, it is to be
pre-
bish, charcoal, and various absorbents, is the most prevalent. Stalh,
and his followers, made great use of this circumstance in supporting
their favourite, opinion of the vis mcdicatrix naturæ.
* These pains are not properly symptoms of the disease, but
but prognostics of the efforts nature makes to remove the disease:
They are symptoms of the vis medicatrix. 

24 PRACTICE
presumed, that the state of the ovaria and that of the
uterine vessels are in some measure connected toge-
ther; and as generally symptoms of a change in the
state of the former appear before those of the latter,
it maybe inferred that the state of the ovaria has a
great share in exciting the action of the uterine vessels
and producing the menstrual flux. But analogous to
what happens in the male sex, it may be presumed,
that in females a certain state of the genitals is neces-
sary to give tone and tendon to the whole system; and
therefore that, if the stimulus arising from the geni-
tals be wanting, the whole system may fall into a tor-
pid and flaccid state, and from thence the chlorosis and
retention of the nitres may arise.
MII.
It appears to me, therefore, that the retention of
the menses is to be referred to a certain state or affec-
tion of the ovaria: but what is precisely the nature of
this affection, or what are the causes of it, I will not
pretend to explain; nor can I explain in what man-
ner that primary cause of retention is to be removed.
In this, therefore, as in many other cases, where we
cannot assign the proximate cause of diseases, our in-
dications of cure must be formed for obviating and
removing the morbid effects or symptoms which ap-
pear.
MIII.
The effects, as has been said in M. consist in a ge-
neral flaccidity of the system, and consequently in a
weaker action of the vessels of the uterus; so that this
debility may be considered as the more immediate
cause of the retention. This, therefore, is to be cur-
ed by restoring the tone of the system in general, and
by exciting the action of the uterine vessels in parti-
ular.
MIV.
The tone of the system in general is to be restored
by

OF PHYSIC. 25
by exercise, and in the beginning of the disease, by
cold bathing. At the same time, tonic medicines*
may be employed; and of these the chalybeates have
been chiefly recommended.
MV.
The action of the vessels of the uterus may be ex-
cited:
1st, By determining the blood into them more co-
piously; which is to be done by determining the blood
into the descending aorta, by purging, by the exer-
cise of walking†, by friction, and by warm bathing of
the lower extremities. It is also probable that the
blood may be determined more copiously into the hy-
pogastric arteries which go to the uterus, by a com-
pression of the iliacs; but the trials of this kind hi-
therto made have seldom succeeded.
MVI
2dly, The action of the uterine vessels may be ex-
cited by stimulants applied to them. Thus those
purgatives which particularly stimutate the intestinum
rectum‡, may also prove stimulant to the uterine ves-
sels
Vol. II. D                    
* Forms of the tonic medicines have been given in some of the
preceding notes. The electuary in the note on article 983. is fre-
quently used with success. In this case, we must not use astringents,
but tonics, and consequently only such tonics as are not astringents,
at lead in a high degree. The simple bitter tonics frequently an-
fever where the symptoms are not severe. The infusum gentianæ
compositum of the new London Pharmacopœia is a good formula.
The dose of it is two ounces twice a day, or oftener, if the stomach
can bear it. Chalybeates are absolutely necessary if the disease with-
stands the use of bitters; they may be given in any of the forms
mentioned in the preceding notes.
† Dancing is also a proper exeicise in this disease-
‡ The stimulant purges are in general the drastic resins, as Scam-
tnony, Aloes, &c. Various formulæ of them have been recommend-
ed in these cases; the pilulæ Rusi is commonly used with good ef-
fect. It may be given in the quantity of half a drachm, or, in strong
constitutions, two scruples. It ought not to be repeated above
twice a week; and, in the intermediate days, we may employ the
tonic medicines above mentioned. The Pilulæ ecphracticæ of the 

26 PRACTICE
sels connected with those of the rectum. The exer-
cise of venery certainly proves a stimulus to the vessels
of the uterus; and therefore may be useful when, with
propriety, it can be employed. The various medi-
cines recommended as stimulants of the uterine ves-
sels, under the title of Emmenagogues, have never
appeared to me to be effectual; and I cannot perceive
that any of them are possessed of a specific power in
this respect. Mercury, as an universal stimulant, may
act upon the uterus, but cannot be very safely em-
ployed in chlorotic persons. One of the most power-
ful means of exciting the action of the vessels in every
part of the system is, the electrical shock; and it has
often been employed with success for exciting the ves-
sels of the uterus.
MVII.
The remedies (MIII-MVI.) now mentioned,
are those adapted to the retention of the menses; and I
am                                          
Edinburgh Pharmacopœia is another very effectual medicine in these
cases. It's dose is half a drachm twice a week, if we intend to
purge briskly, but, by giving a smaller quantity as ten, twelve, or
fifteen grains once a-day, a constant stimulus is preserved, which
some practitioners prefer. The following pills are also much re-
commended:
ꝶ. Pil. Gummos.
Alœs Socotorin, a a. ʒii.
Vin. Alœt. q. f.
M. f. Massa in pilulas 48 dividend.
The dose is 3 or 4 pills at bed time.
The Tinctura sacra is also frequently used as a brisk purge in these
cases; it's dose for this purpose must not be less than an ounce and
a half in most habits; but a strong constitution will require two
ounces or more. Other stimulants than purges have been employed
in amenorrhœa, as the tinctura sabina composita of the new London
Pharmacopœia; its dose is thirty or forty drops, in any suitable ve-
hicle, as the tinctura myrrhæ of the same Pharmacopœia, in doses
of twenty or thirty drops, is often recommended on the authority
of Boerhaave. 

OF PHYSIC. 27
am next to consider the case of suppression. In enter-
ing upon this, I must observe, that every interruption
of the flux, after it has once taken place, is not to be
considered as a case of suppression. For the flux, up-
on its first appearance, is not always immediately esta-
blished in its regular course; and therefore, if an in-
terruption happen soon after the first appearance, or
even in the course of the first, or perhaps second year
after, it may often be considered as a case of reten-
tion, especially when the disease appears with the
symptoms peculiar to that state.
MVIII.
Those which may be properly considered as cases
of suppression, are such as occur after the flux has been
for some time established in its regular course, and in
which the interruption cannot be referred to the caus-
es of retention (MII, MIII.) but must be imputed to
some resistance in the extremities of the vessels of the
uterus. Accordingly, we often find the suppression
induced by cold, fear, and other causes which may
produce a constriction of these extreme vessels. Some
physicians have supposed an obstructing lentor of the
fluids to occasion the resistance now mentioned: but
this is purely hypothetical, without any proper evi-
dence of the fact; and it is besides, from other consi-
derations, improbable.
MIX.
There are indeed some cases of suppression that seem
to depend upon a general debility of the system, and
consequently of the vessels of the uterus. But in such
cases, the suppression always appears as symptomatic of
other affections, and is therefore not to be considered
here.
MX.
The idiopathic cases of suppression (MVIII.) seldom
continue long without being attended with various
symptoms or disorders in different parts of the body;
very
D 2

28 PRACTICE
very commonly arising from the blood which should
have passed by the uterus, being determined more co-
piously into other parts, and very often with such
force as to produce hemorrhagies in these. Hence
hemorrhagies from the nose, lungs, stomach, and other
parts, have appeared in consequence of suppressed
menses. Besides these, there are commonly hysteric
and dyspeptic symptoms produced by the same cause;
and frequently colic pains, with abound belly.
MXI.
In the idiopathic cases of suppression, (MVII.) the
indication of cure is to remove the constriction affect-
ing the extreme vessels of the uterus; and for this pur-
pose, the chief remedy is warm bathing applied to the
region of the uterus. This, however, is not always
effectual, and I do not know of any other remedy a-
dapted to the indication. Besides this, we have per-
haps no other means of removing the constriction in
fault, but that of increasing the action and force of
the vessels of the uterus so as thereby to overcome the
refinance or constriction of their extremities. This
therefore is to be attempted by the same remedies in
the case of suppression, as those prescribed in the cases
of retention (MIV-MVI.). The tonics, however, and
cold bathing (MIV.) seem to be less properly adapted
to the cases of suppression, and have appeared to me
of ambiguous effect*.
MXII.
* The Emenagogues enumerated in the note on article 1006,
are more efficacious in these cases than the tonics and chalybeates
mentioned in the note on article 1004, for this reason, that the
suppression of the menses depends more on the constriction, than on
a laxity of the extreme vessels. Some cases indeed, occur, where a
lax habit is the cause of suppression, but they are rare. The phy-
sicians ought to be attentive in discriminating such cases, because a
liberal use of forcing emenagogues is always hurtful in them; they
can only be relieved by tonics, and especially by chalybeates.

OF PHYSIC. 29
MXII.
It commonly happens in the cases of suppression,
that though the menses do not flow at their usual pe-
riods, there are often at those periods some marks of
an effort having a tendency to produce the discharge.
It is therefore at those times especially when the ef-
forts of the system are concurring, that we ought to
employ the remedies for curing a suppression; and it
is commonly fruitless to employ them at other times,
unless they be such* as require some continuance in
their use to produce their effects.
MXIII.
Nearly similar to the cases of suppression, are those
cases in which the menses flow after longer intervals,
and in lesser quantity than usual; and when these cas-
es are attended with the disorders in the system (MX.)
they are to be cured by the same remedies as the cas-
es of entire suppression.
MXIV.
It may be proper in this place to take notice of the
desmenorrhea, or cases of menstruation in which the
menses seem to flow with difficulty, and are accompa-
nied with much pain in the back, loins, and lower
belly. We impute this disorder partly to some weak-
er action of the vessels of the uterus, and partly, per-
haps more especially, to a spasm of its extreme vessels.
We have commonly found the disease relieved by em-
ploying some of the remedies of suppression immedi-
ately before the approach of the period, and at the
same time employing opiates.
CHAP.
* Viz. tonics or alterants. 

30 PRACTICE
CHAP. IX.
OF SYMPTOMATIC HEMORRHAGIES.
MXV.
I HAVE thought it very improper in this work, to
treat of those morbid affections that are almost al-
ways symptomatic of other more primary diseases;
and this for several reasons, particularly because it
introduces a great deal of confusion in directing prac-
tice, and leads physicians to employ palliative mea-
sures only. I shall here, however, deviate a little from
my general plan, to make some reflections upon
symptomatic hemorrhagies.
MXVI.
The hemorrhagies of this kind that especially de-
serve our notice, are the Hematemesis, or Vomiting
of Blood; and the Hematuria, or the Voiding of
Blood from the urinary passage. Upon these I am
here to make some remarks; because, though they
are very generally symptomatic, it is possible that they
may be sometimes primary and idiopathic affections;
and because they have been treated of as primary dis-
eases in almost every system of the practice of phy-
sic.
SECT. I.
OF THE HEMATEMESIS, OR VOMITING
OF BLOOD.
MXVII.
I HAVE said above (in DCCCXLV.) in what man-
ner blood thrown out from the mouth may be
known

OF PHYSIC. 31
known to proceed from the stomach, and not from
the lungs: but it may be proper here to say more par-
ticularly, that this may be certainly known, when the
blood is brought up manifestly by vomiting without
any coughing; when this vomiting has been preceded
by some sense of weight, anxiety, and pain, in the re-
gion of the stomach; when the blood brought up is
of a black and grumous appearance, and when it is
manifestly mixed with other contents of the stomach;
we can seldom have any doubt of the source from
whence the blood proceeds, and therefore of the exist-
ence of the disease we treat of.
MXVIII.
We must allow it to be possible that a plethoric
state of the body from general causes may be accom-
panied with causes of a peculiar determination and
afflux of blood to the stomach, so as to occasion an
hemorrhagy there, and thence a vomiting of blood;
and in such a case this appearance might be consider-
ed as a primary disease. But the history of diseases
in the records of physic, afford little foundation for
such a supposition; and on the contrary, the whole
of the instances of a vomiting of blood which have
been recorded, are pretty manifestly symptomatic of a
more primary affection.
Of such symptomatic vomitings of blood, the chief
instances are the following.
MXIX.
One of the most frequent is that which appears in
consequence of a suppression of an evacuation of blood
which had been for some time before established in a-
nother part of the body, particularly that of the men-
strual flux in women.
MXX.
There are instances of a vomiting of blood happen-
ing from the retention of the menses: but such instances
are very uncommon; as a retention of the menses
rarely 

32 PRACTICE
rarely happens in consequence of, or even with, a ple-
thoric state of the body; and as rarely does it produce
that, or the hemorrhagy in question.
There are instances of a vomiting of blood happen-
ing to pregnant women; that might therefore also be
imputed to the suppression of the menses, which hap-
pens to women in that state. There have indeed been
more instances of this than of the former case; but
the latter are still very rare: for although the blood
which used to flow monthly before impregnation, is,
upon this taking place, retained, it is commonly so en-
tirely employed in dilating the uterine vessels, and in
the growth of the fœtus, that it is seldom found to
produce a plethoric state of the body, requiring a vi-
carious outlet.
The vomiting of blood, therefore, that is vicarious
of the menstrual flux, is that which commonly and al-
most only happens upon a suppression of that flux, af-
ter it had been for some time established.
MXXI.
When such a suppression happens, it may be sup-
posed to operate by inducing a plethoric state of the
whole body, and thereby occasioning hemorrhagy from
other parts of it; and hemorrhagies from many dif-
ferent parts of the body have been observed by phy-
sicians as occurring in consequence of the suppression
we speak of. It is however the great variety of such
hemorrhagies, that leads me to think, that with the
plethoric state of the whole body there must be always
some peculiar circumstances in the part from which
the blood flows, that determine its afflux to that par-
ticular, often singularly odd, part; and therefore, that
such hemorrhagies may from these circumstances occur
without any considerable plethora at the same time pre-
vailing in the whole system.
MXXII. 

OF PHYSIC. 33
MXXII.
It is to be observed, that if we are to expect an he-
morrhagy in consequence of a suppression of the menses
inducing a plethoric state of the system, we should ex-
pect especially an hemoptysis, or hemorrhagy from the
lungs, as a plethora might be expected to show its effects
especially there; and accordingly, upon occasion of
suppressed menses, that hemorrhagy occurs more fre-
quently than any other: but even this, when it does
happen, neither in its circumstances nor its consequen-
ces, leads us to suppose, that at the same time any con-
siderable or dangerous plethora prevails in the body.
MXXIII.
These considerations in MXXI. MXXII. will, I ap-
prehend, apply to our present subject; and I would
therefore alledge, that a hematemesis may perhaps
depend upon particular circumstances of the stomach
determining an afflux of blood to that organ, and may
therefore occur without any considerable or dangerous
plethora prevailing in the system. What are the cir-
cumstances of the stomach, which upon the occasion
mentioned, may determine an afflux of blood to it, I
cannot certainly or clearly explain; but presume that
it depends upon the connection and consent which we
know to subsist between the uterus and the whole of
the alimentary canal, and especially that principal part
of it the stomach.
MXXIV.
From these reflections, we may, I think, draw the
following conclusions:
I. That the hematemesis we speak of is hardly ever
a dangerous disease.
II. That it will hardly ever require the remedies suit-
ed to the cure of active hemorrhagy; and at least that
it will require these only in those unusual cases in
which there appear strong marks of a general plethora,
and
E
Vol. II.

34 PRACTICE
and in which the vomiting of blood appears to be con-
siderably active, very profuse, and frequently recurring.
III. That a vomiting of blood from suppressed mens-
es, ought seldom to prevent the use of these remedies
of amenorrhœa, which might be improper in the case
of an active idiopathic hemorrhagy.
MXXV.
Another case of symptomatic hematemesis quite
analogous to that already mentioned, is the hemate-
mesis following, and seemingly depending upon, the
suppression of an hemorrhoidal flux, which had been
established and frequent for some time before.
This may perhaps be explained by a general ple-
thoric state induced by such a suppression; and indeed
some degree of a plethoric state must in such a case be
supposed to take place; but that supposition alone
will not explain the whole of the case; for a general
plethora would lead us to expect an hemoptysis (MXX-
II.) rather than an hematemesis; and there is there-
fore something still wanting, as in the former case, to
explain the particular determination to the stomach.
Whether such an explanation can be got from the
connection between the different parts of the sangui-
ferous vessels of the alimentary canal, or from the
connection of the whole of these vessels with the ve-
na portarum, I shall not venture to determine. But
in the mean time I imagine that the explanation re-
quired is rather to be obtained from that connection
of the stomach with the hemorrhoidal affection that I
have taken notice of in DCCCCXLVI.
MXXVI.
However we may explain the hematemesis occasi-
oned by a suppression of the hemorrhois, the conside-
rations in MXX. MXXII. will apply here as in the ana-
logous case of hematemesis from suppressed menses;
and will therefore allow us also to conclude here, that 
the

OF PHYSIC. 35
the disease we now treat of will seldom be dangerous,
and will seldom require the same remedies that idio-
pathic and active hemorrhagia does.
MXXVII.
The cases of hematemesis already mentioned, may
be properly supposed to be hemorrhagies of the arterial
kind; but it is probable that the stomach is also liable
to hemorrhagies of the venous kind. (DCCLXVIII.)
In the records of physic there are many instances of
vomitings of blood, which were accompanied with
a tumefied spleen, which had compressed the vas
breve, and thereby prevented the free return of venous
blood from the stomach. How such an interruption
of the venous blood may occasion an hemorrhagy
from either the extremities of the veins themselves,
or from the extremities of their correspondent arte-
ries, we have explained above in DCCLXIX. and the
histories of tumefied spleens compressing the vasa bre-
via, afford an excellent illustration and confirmation
of our doctrine on that subject, and render it suffici-
ently probable that vomitings of blood often arise
from such a cause.
MXXVIII.
It is also possible, that an obstruction of the liver,
resisting the free motion of the blood in the vena por-
tarum, may sometimes interrupt the free return of
the venous blood from the vessels of the stomach, and
thereby occasion a vomiting of blood; but the in-
stances of this are neither so frequent nor so clearly
explained as those of the former case.
MXXIX.
Besides these cases depending on the state of the li-
ver or spleen, it is very probable that other hemor-
rhagies of the stomach are frequently of the venous
kind.
The disease named by Sauvages Melæna, and by
other
E 2 

36 PRACTICE
other writers commonly termed the Morbus Niger.
(DCCLXXII.) consisting in an evacuation either by vo-
miting or stool, and sometimes in both ways, of a
black and grumous blood, can hardly be otherwise
occasioned, than by a venous hemorrhagy from some
part of the internal surface of the alimentary canal.
It is, indeed, possible, that the bile may sometimes
put on a black and viscid appearance, and give a real
foundation for the appellation of an Atra Bilis: but
it is certain, that instances of this are very rare; and
it is highly probable that what gave occasion to the
notion of atra bilis among the ancients, was truly the
appearance of blood poured into the alimentary canal
in the manner I have mentioned; and which appear-
ance, we know, the blood always puts on when it has
stagnated there for any length of time. I suppose it
is now generally thought, that Boerhaave's notion of
such a matter existing in the mass of blood, is without
any foundation; whilst, by dissections in modern times,
it appears very clearly, that the morbus niger present-
ing such an appearance of blood, always depends up-
on the effusion and stagnation I have mentioned.
MXXX.
From this account of the melæna it will appear,
that vomitings of blood may arise in consequence of
blood being poured out in the manner I have menti-
oned, either into the cavity of the stomach itself, or
into the superior portions of the intestines, from whence
matters often pass into the stomach.
MXXXI.
Both in the case of the Melæena, and in the analo-
gous cases from affections of the spleen or liver, it will
appear, that the vomitings of blood occurring must be
considered as symptomatic affections, not at all to be
treated as a primary active hemorrhagy, but by reme-
dies. 

OF PHYSIC. 37
dies, if any such be known, that may resolve the pri-
mary obstructions*.
MXXXII.
I believe I have now mentioned almost the whole
of the causes producing a hematemesis; and certainly
the causes mentioned, are those which most common-
ly give occasion to that symptom. Possibly, however,
there may be some other causes of it, such as that sin-
gular one mentioned by Sauvages, of an aneurism of
the
* This is doubtless the most rational practice, namely, to resolve
the obstruction which has occasioned the blood to be thrown or
driven to the intestines. To discover this primary obstruction is,
however, extremely difficult; and, even when it is discovered, it is
frequently not easily resolved; in such cases, therefore, we must use
the general remedies for removing the plethora, except laxatives,
the operations of which, in general, derive the fluids to the intes-
tines. Sweating is perhaps the best general evacrmion for deter-
mining the fluids from the intestines; but it's use ought to be pre-
ceded by bleeding: and it ought not, in these cases, to be excited
by nauseating doses of emetics, as these produce the same effect as
laxatives; we must therefore have recourse to the light aromatic,
sage, mint, balm, wine-whey, &c. Camphor and opium are also
proper sudorifics in these cases. They may be given together, as
in the following bolus:
ꝶ. Camphor, gr. vi.
Spr. vini gutt. X.
Opii pur. gr. i.
Cons. card. ʒss. vel. q.s.
M.f. bolus.
Some practitioners have recommended large quantities of sperma-
ceti in cases of hematemesis, and not without reason. It may be
given in emulsions, with yolks of eggs, or in an eluctuary. I shall
therefore add a formula of each.
ꝶ. Spermat. cet. ℥ss.
Vitel. ovi q.s.
Tere in mortar. marmoreo, et adde
Aiq. font. ℥.
Styr. simpl. ℥i.
M. f. Emuls.
The dose of this emulsion is two or three table-spoonfulls every three
hours. 

38 PRACTICE
the aorta bursting into the stomach: and it is possible
that some diseases of other contiguous parts, which
have become closely adhering to the stomach, may
sometimes, by a rupture into the cavity of the sto-
mach, pour blood into it, which is afterwards re-
jected
ꝶ ℥ ʒ
Spermat. cet. ℥i.
Conserv. rosar. ℥ii.
Syr. simp. ℥i.
M. f. elect.
The dose of this electuary is a tea-spoonfull or two every two or
three hours.
If the hematemesis be violent, we must have recourse to some of
the styptics and astringents mentioned before in the cure of hemor-
rhage in general, as alum, catechu, kino, &c. of which I shall sub-
join some formulae.
ꝶ. Alum. ust. gr. iii.
Kino ℈ss.
M. f. Pulvis.
This powder may be repeated every two hours, and three table-
spoonfuls of the tincture of roses may be given to wash it down.
The electuarium japonicum of the Edinburgh Pharmacopœia is
well calculated for these cases; it's dose is a drachm and a half, or
two drachms. The extract of logwood is sometimes used in these
dose; with, considerable success. It may either be given alone in
doses of a scruple each every three hours, or joined with alum, as in
the following formula.
ꝶ Extract. lign. Campechens. ℈ss.
Alum. ust. gr. iii
M. f. pulvis.
This powder may be repeated every three hours; drinking after it
three table-spoonfulls of the tincture of roses: or a tea-cup full of
cold water, with twenty or thirty drops of the acidum vitriolicum
dilutum, or as much as is sufficient to give an agreeable acidity.
All these styptics and astringents are apt to produce costiveness
which must be removed by emollient clysters, as laxative medicines
are, for the reasons above mentioned, generally hurtful in these ca-
ses. The young pracitioner must not trull to these medicines for
completely curing an hemorrhage from the intestines; they are only
palliatives, and are of no other use than to check the violence of
the discharge until the true cause of the disease be discovered; and
the discovery of this cause must be left to the sagacity of the physi-
cian.

OF PHYSIC. 39
jected by vomiting. It is possible, also, that abscesses
and ulcerations of the stomach itself, may sometimes
pour blood into its cavity to be thrown up by vomiting.
I did not think it necessary among the symptoma-
tic vomitings of blood, to enumerate those from ex-
ternal violence, nor, what is analogous to it, that
which arises from violent straining to vomit; which
last, however, is much more rare than might be ex-
pected. In either of these cases the nature of the dis-
ease cannot be doubtful, and the management of it
will be readily understood from what has been deliver-
ed above with respect to moderating and restraining
hemorrhagy in general.
SECT II.
OF THE HEMATURIA, OR THE VOIDING
OF BLOOD FROM THE URINARY
PASSAGE.
MXXXIII.
IT is alledged, than an hematuria has occurred with-
out any other symptom of an affection of the kidneys or
urinary passages being present at the same time; and
as this happened to plethoric persons, and recurred at
fixed periods, such a case has been supposed to be an
instance of idiopathic hematuria, and of the nature of
those active hemorrhagies I have treated of before.
MXXXIV.
I cannot positively deny the existence of such a
case; but must observe, that there are very few in-
stances of such upon the records of physic; that none
have ever occurred to my observation, or to that of
my friends; and that the observations adduced may
be fallacious, as I have frequently observed an hema-
turia without symptoms of other affection of the kid-
ney 

40 PRACTICE
ney or urinary passages being, for the time, present;
whilst, however, fits of a nephralgia calculosa hav-
ing, before, or soon after, happened, rendered it to me
sufficiently probable, that the hematuria was owing to
a wound made by a stone present in some part of the uri-
nary passages. MXXXV.
The existence of an idiopathic hematuria is further
improbable, as a general plethora is more likely to
produce an hemoptysis (MXXII.) and as we do not
well know of any circumstances which might deter-
mine more particularly to the kidneys. An idiopathic
hematuria, therefore, must certainly be a rare occur-
rence; and instances of symptomatic affections of the
same kind are very frequent.
MXXXVI.
One of the most frequent is, that hematuria which
attends the nephralgia calculosa, and seems manifestly
to be owing to a stone wounding the internal surface
of the pelvis of the kidney or of the ureter. In such
cases, the blood discharged with the urine is
sometimes, of a pretty florid colour, but for the most
part is of a dark hue: the whole of it is some-
times diffused or dissolved, and therefore entirely sus-
pended in the urine; but if it is in any large quan-
tity, a portion of it is deposited to the bottom of the
vessel containing the voided blood and urine. On
different occasions, the blood voided puts on different
appearances. If the blood poured out in the kidney
has happened to stagnate for some time in the ureters
or bladder, it is sometimes coagulated, and the coa-
gulated part is afterwards broken down into a grumous
mass of a black or dark colour, and therefore gives
the same colour to the urine voided; or if the quan-
tity of broken down blood is small, it gives only a
brownish urine resembling coffee. It sometimes also
happens, that the blood stagnating and coagulating
in 

OF PHYSIC. 41
in the ureters, takes the form of these vessels, and is
therefore voided under the appearance of a worm;
and if the coagulated blood happens to have, as it
may sometimes have, the glutten separated from the
red globules, these worm-like appearances have their
external surface whitish, and the whole seemingly
forming a tube containing a red liquor. I have some-
times observed the blood which had seemingly been
coagulated in the ureter come away in an almost dry
state, resembling the half-burnt wick of a candle*.
MXXXVII.
These are the several appearances of the blood void-
ed in the hematuria calculosa, when it proceeds espe-
cially from the kidneys or ureter; and many of the same
appearances are observed when the blood proceeds
only from the bladder when a stone is lodged there;
but the attending symptoms will commonly point out
the different seat of the disease.
In one case, when a quantity of blood from the kid-
ney or ureter is coagulated in the bladder, and is there-
fore difficultly thrown out from this, the pain and un-
easiness on such an occasion may appear chiefly to be
in the bladder, though it contains no stone; but the
antecedent symptoms will commonly discover the na-
ture of the disease.
Vol. II. 
MXXXVIII.
F
* In general, the blood is coagulated and grumous; hence the
urine deposits a dark brown substance somewhat resembling coffee-
gounds. As the grumous blood is specifically heavier than the u-
rine, it falls to the bottom of the bladder, and is consequently voided
in greater quantity in the beginning than towards the end of mak-
ing water, the urine that comes off first being very deep coloured
and muddy, but becoming while it flows, gradually more transpa-
rent and pure, until at last it is perfectly of a natural appearance.
The patient generally mentions this circumstance in describing his
complaints, with this addition, that he has in the beginning some
difficulty of making water, but that this difficulty decreases in pro-
portion as the urine becomes more transparent. 

42 PRACTICE
MXXXVIII.
In any of the cases of the hematuria calculosa, it
will hardly be necessary to employ the remedies suited
to an active hemorrhagy. It will be proper only to
employ the regimen fit for moderating hemorrhagy in
general, and particularly here to avoid every thing
or circumstance that might irritate the kidneys or ure-
ters. Of such cases of irritation there is none more
frequent or more considerable than the presence of har-
dened fæces in the colon; and these therefore are to
be frequently removed, by the frequent use of gentle
laxatives*.
MXXXIX.
The hematuria calculosa† may be properly consi-
dered as a case of the hematuria violenta: and there-
fore I subjoin to that the other instances of hematuria
from external violence; such as that from external
contusion on the region of the kidney‡, and that from
the
* Clysters are preferable to purgatives in these cases, because
they are less stimulating; and the emollient clysters are preferable
to all others, for their only intention is to soften the hardened fæces.
The only purgatives to be used are those of the mildest kind, as
manna, oil, cassia, &c. The intention of purgatives, in these cases,
is only to remove the hardened fæces; and this intention can often
be sufficiently answered by a proper choice of food, as broths, es-
pecially those made of barley and young animal flesh; barley-gruel,
with prunes boiled in it; stewed endive, lettuce, and other olerace-
ous dishes.
† The hematuria calculosa being symptomatic, can only be cur-
ed by removing the cause; it may however, be greatly relieved by
demulcents, as lintseed-tea, decoctions of marshmallows, mucilage
of gum Arabic, thick barley-water, &c.
‡ The hematuria proceeding from a contusion of the region of
the kidneys, requires general and topical bleeding, with purges, and
an attention to the antiphlogistic regimen. Some praditioners re-
commend the warm balsams in these cases; but on account of their
heating quality, their use is somewhat doubtful. Nitre is not always
admissible, on account of its irritating the kidneys; but it is a pow-
erful antiphlogistic; and, if it is used in these cases, it must be well

OF PHYSIC. 43
the violent or long continued exercise of the muscles
incumbent on the kidneys. An instance of the latter
cause occurs especially in riding*.
MXL.
It may also be considered as a case of the hematuria
violenta, when the disease occurs in consequence of
the taking in of certain acrid substances, which pass
again especially by the urinary passages; and, by in-
flaming and swelling the neck of the bladder, bring on
a rupture of the over-distended blood-vessels, and give
occasion to a bloody urine. The most noted instance
of this is in the effect of cantharides in a certain quan-
tity, any way introduced into the body. And possi-
bly some other acrids may have the same effect†.
MXLI.
Beside these most frequent instances of hematuria,
which cannot be considered as idiopathic hemorrhagies,
there
F 2
diluted: the mucilaginous drinks are absolutely necessary, and ought
to be used plentifully.
* The only method of treating this kind of hematuria is by rest.
A person subject to it ought never to ride.
† This species of hematuria is cured by evacuating the acrid sub-
stance, and by the use of the mucilaginous drinks before mentioned.
The acrid substance may be evacuated by antiphlogistic purges, or
by the milder diuretics, as nitre, decoction of parsley roots, cream
of tartar whey, &c. The action of cantharides on die urinary pas-
sages is not well explained. We can scarcely believe that any part
of the cantharides is absorbed from the blistering plaister; yet its
effects are the same with those produced by taking the cantharides
internally. The strangury, and its concomitant symptoms, may be
relieved by large and plentiful dilution, and a free use of the mucilagi-
nous drinks. Camphor has been thought to have some specific qua-
lity in preventing and curing the strangury produced by blisters, and
experience warrants the conclusion; especially if the camphor is join-
ed with opium as in the following formula:
Rx. Camphor. gr. vi.
Spir. vini gutt. x.
Opii puri gr. i.
Conserv. rosar. ʒi.
M.f. bolus.

44 PRACTICE
there are some other instances of hematuria mentioned
by authors, that are still however manifestly symptoma-
tic; such as a discharge of blood from the urinary passag-
es, in consequence of a suppression of either the menstrual
or hemorrhoidal flux. These may be considered as
analogous to the hematemesis produced by the like
causes; and the several reflections made above on that
subject, will, I think, apply here, and particularly the
conclusions formed in MXXIV. Instances, however,
of either of these cases, and especially of the first, have
been extremely rare.
MXLII.
Of such symptomatic hematuria there is however,
one instance deserving notice; and that is, when a
suppression of the hemorrhoidal flux, either by a com-
munication of vessels, or merely by the vicinity of parts,
occasions a determination of the blood into the ves-
sels of the neck of the bladder, which in consequence
of a rixis or anastomosis, pour out blood to be voided
either with or without the urine. This case is what
has been named the Hemorrhoides Vesicaæ; and with
some propriety, when it is manifestly an evacuation
vicarious of what had before been usually made from
the rectum. With respect to the management of the
hemorrhoides vesicæ, I would apply the whole of the
doctrines that I have delivered above, with respect to
the cure of the proper hemorrhoidal affection*.
MXLIII.
There remains still to be mentioned one other in-
stance of symptomatic hematuria, which is that which
happens in the case of confluent and putrid small-pox,
as well as in several other instances of putrid diseas-
es. The blood, in such cases, may be presumed to
come from the kidneys; and I apprehend that it comes
from thence in consequence of that fluidity which is
always produced in the blood approaching to a putrid
state
* Articles 947, et sequent. 

OF PHYSIC. 45
state. Such hematuria, therefore, is not to be consi-
dered as a symptom of any affection of the kidneys,
tut merely as a mark of the putrescent state of the
blood.
MXLIV.
In certain diseases the urine is discharged of such a
deep red colour, as give a suspicion of its being ting-
ed by blood present in it; and this has given occasion
to Sauvages, amongst the other species of hematuria, to
mark the hematuria spuria, and the hematuria lateri-
tia; both of which, however, he supposes to be with-
out any blood present in the urine. In many cases it
is of importance, in ascertaining the nature of a dis-
ease, to determine whether the red colour of urine be
from blood present in it, or from a certain state of the
salts and oils which are always in greater or lesser pro-
portion constituent parts of the urine; and the ques-
tion may be commonly determined by the following
considerations.
It has been observed above, that when any consi-
derable quantity of blood is voided with the urine,
there is always a portion of it deposited at the bot-
tom of the vessel containing the voided blood and u-
rine; and in such a case there will be no doubt in at-
tributing the colour of the urine floating above, to
some part of the blood diffused in it. The question,
therefore, with respect to the presence of blood in the
urine, can only occur when no such deposition as I
have mentioned appears; and when the blood that
may be supposed to be present is dissolved or diffused,
and therefore entirely suspended in the urine. In this
case the presence of the blood may be commonly
known, 1st, By the colour which blood gives, differ-
ent from any urine without blood that I have ever
seen; and I think a little experience will enable most
persons to make this distinction. 2dly, By this, that
the presence of blood always diminishes the transpa- 
rency

46 PRACTICE
rency of the urine with which it is mixed: and it is
very seldom that urine, though very high-coloured,
loses its transparency; at least this hardly ever ap-
pears, if the urine is examined when recently voided.
3dly, When urine has blood mixed with it, it tinges
a piece of linen dipt into it with a red colour, which
the highest-coloured urine without blood never does.
4thly, High-coloured urine without blood, upon cool-
ing, and remaining at rest in a vessel, almost always
deposites a lateritious sediment; and if upon any oc-
casion bloody urine should deposite a sediment that
may be of a portion of the blood formerly diffused in
it, the difference, however, may be discerned by this,
that the sediment deposited by urine without blood,
upon the urine's being again heated, will be entirely
re-dissolved, which will not happen to any sediment
from blood. Lastly, we know no state of urine with-
out blood, which shews any portion of it coagulable
by a heat equal to that of boiling-water; but blood
diffused in urine is still coagulable by such a heat: and
by this test, therefore, the presence of blood in urine
may be commonly ascertained.
BOOK V.
OF PROFLUVIA, OR FLUXES, WITH
PYREXIA.
MXLV.
FORMER nosologists have established a class of
diseases under the title of Fluxes, or Profluvia;
but as in this class they have brought together a great
number of diseases, which have nothing in common,
excepting 

OF PHYSIC. 47
excepting the single circumstance of an increased dis-
charge of fluids, and which also are, in other respects,
very different from one another; I have avoided so
improper an arrangement, and have distributed most
of the diseases comprehended in such a class by the
nosologists, into places more natural and proper for
them*. I have, indeed, still employed here the gene-
ral title; but I confine it to such fluxes only as are
constantly attended with pyrexia, and which therefore
necessarily belong to the class of diseases of which I
am now treating.
Of the fluxes which may be considered as being ve-
ry constantly febrile diseases, there are only two, the
catarrh and dysentery; and of these therefore I now
proceed to treat.
CHAP. I.
OF THE CATARRH.
MXLVI.
THE catarrh is an increased excretion of mucus
from the mucous membrane of the nose, sauces,
and bronchiæ, attended with pyrexia.
Practical writers and nosologists have distinguished
the disease by different appellations, according as it
happens to affect those different parts of the mucous
membrane, the one part more or less than the other:
But I am of opinion, that the disease, although affect-
ing
* Sauvages enumerates no less than thirty-six genera of fluxes,
each of which is subdivided into numerous species. Vogel has for-
ty-five genera, under the title of profluvia, most of which are ex-
tremely different from each other in their essential qualities. 

48 PRACTICE
ing different parts, is always of the same nature, and
proceeds from the same cause. Very commonly, in-
deed, those different parts are affected at the same
time; and therefore there can be little room for the
distinction mentioned.
The disease has been frequently treated of under the
title of Tussis, or Cough; and a cough, indeed, always
attends the chief form of catarrh, that is, the increas-
ed excretion from the bronchiæ: but a cough is so
often a symptom of many other affections, which are
very different from one another, that it is improperly
employed as a generic title.
MXLVII.
The remote cause of catarrh is most commonly cold
applied to the body. This application of cold pro-
ducing catarrh, can in many cases be distinctly ob-
served; and I would believe it always to be so, were
men acquainted with, and attended to, the circum-
stances which determine cold to act upon the body.
See XCIV-XCVI.
From the same paragraphs we may learn what in
some persons gives a predisposition to catarrh.
MXLVIII.
The disease, of which I am now to treat, generally
begins with some difficulty of breathing through the
nose, and with a sense of some fullness stopping up
that passage. This is also often attended with some
dull pain and a sense of weight in the forehead, as well
as some stiffness in the motion of the eyes. These feel-
ings, sometimes at their very first beginning, and al-
ways soon after, are attended with the distillation from
the nose; and sometimes from the eyes, of a thin fluid,
which is often found to be some what acrid, both
by its taste, and by its fretting the parts over which
it passes.
MXLIX.
These symptoms constitute the coryza and gravedo
of 

OF PHYSIC. 49
of medical authors, and are commonly attended with
a sense of lassitude over the whole body. Sometimes
cold shiverings are felt, at least the body is more sensi-
ble than usual to the coldness of the air; and with all
this the pulse becomes, especially in the evenings,
more frequent: than ordinary.
ML.
These symptoms seldom continue long before they
are accompanied with some hoarseness, and a sense of
roughness and soreness in the trachea, and with some
difficulty of breathing, attributed to a sense of strait-
ness of the chest, and attended with a cough, which
seems to arise from some irritation felt at the glottis.
The cough is generally at first dry, occasioning pains
about the chest, and more especially in the breast.
Sometimes, together with these symptoms, pains re-
sembling those of the rheumatism are felt in several
parts of the body, particularly about the neck and
head. While these symptoms take place, the appe-
tite is impaired, some thirst arises, and a general lassi-
tude is felt over all the body.
MLI.
These symptoms (MXLVIII-ML.) mark the violence
and height of the disease; which, however, does not
commonly continue long. By degrees the cough be-
comes attended with a copious excretion of mucus;
which is at first thin, but gradually becoming thicker,
is brought up with less frequent and less laborious
coughing. The hoarseness and soreness of the tra-
chea, likewise going off, the febrile symptoms abating,
the cough becoming less frequent, and with less ex-
pectoration, the disease soon after ceases altogether.
MLII.
Such is generally the course of this disease, which is
commonly neither tedious nor dangerous; but, upon
some occasions, it is in both respects otherwise. A
person affected with catarrh seems to be more than u-
sually.
Vol. II.  
G

50 PRACTICE
sually liable to be affected by cold air; and in that
condition, if exposed to cold, the disease, which seem-
ed to be yielding, is often brought back with greater
violence than before: and is rendered not only more
tedious than otherwise it would have been, but also
more dangerous by the supervening of other diseases.
MLIII.
Some degree of the cynanche tonsillaris often ac-
companies the catarrh; and when the latter is aggra-
vated by a fresh application of cold, the cynanche al-
so becomes more violent and dangerous, in conse-
quence of the cough which is present at the same
time.
MLIV.
When a catarrh has been occasioned by a violent
cause; when it has been aggravated by improper ma-
nagement; and especially when it has been render-
ed more violent by fresh and repeated applications of
cold, it often passes into a pneumonic inflammation
attended with the utmost danger.
MLV.
Unless, however, such accidents as those of MLII-
MLIV. happen, a catarrh, in found persons not far
advanced in life, is, I think, always a slight disease,
and attended with little danger. But, in persons of a
phthifical disposition, a catarrh may readily produce
a hemoptysis, or perhaps form tubercles in the lungs;
and more certainly, in persons who have tubercles al-
ready in the lungs, an accidental catarrh may occa-
sion the inflammation of these tubercles, and in conse-
quence produce a phthisis pulmonalis.
MLVI.
In elderly persons, a catarrh sometimes proves a
dangerous disease. Many persons, as they advance
in life, and especially after they arrive at old age,
have the natural mucus of the lungs poured out in
greater quantity, and consequently requiring a fre-
quent

OF PHYSIC. 51
quent expectoration. If therefore a catarrh happen
to such persons, and increase the afflux of fluids to
the lungs, with some degree of inflammation, it may
produce the peripneumonia notha, which in such cas-
es is very often fatal, See CCCLXXVI-CCCLXXXII.
MLVII.
The proximate cause of catarrh seems to be an in-
creased afflux of fluids to the mucous membrane of
the nose, fauces, and bronchiæ, along with some de-
gree of inflammation affecting these parts. The lat-
ter circumstance is confirmed by this, that in the case
of catarrh, the blood drawn from a vein, commonly
exhibits the same inflammatory crust which appears in
the case of phlegmasiæ.
MLVIII.
The application of cold which occasions a catarrh,
probably operates by diminishing the perspiration usu-
ally made by the skin, and which is therefore deter-
mined to the mucous membrane of the parts above
mentioned. As a part of the weight which the body
daily loses by insensible evacuation, is owing to an ex-
halation from the lungs, there is probably a connec-
tion between this exhalation and the cutaneous per-
spiration, so that the one may be increased in propor-
tion as the other is diminished: and therefore we
may understand how the diminution of cutaneous per-
spiration, in consequence of the application of cold,
may increase the afflux of fluids to the lungs, and
thereby produce a catarrh.
MLIX.
There are some observations made by Dr. James
Keil which may seem to render this matter doubtful;
but there is a fallacy in his observations. The evident
effects of cold in producing coryza, leave the matter
in general without doubt; and there are several other
circumstances which show a connection between the
lungs and the surface of the body.
MLX. 
G2

52 PRACTICE
MLX.
Whether, from the suppression of perspiration, a
catarrh be produced merely by an increased afflux of
fluids, or whether the matter of perspiration be at the
same time determined to the mucous glands, and there
excite a particular irritation, maybe uncertain; but
the latter supposition is sufficiently probable.
MLXI.
Although, in the case of a common catarrh,
which is in many instances sporadic, it may be doubt-
ful whether any morbific matter be applied to the mu-
cous glands; it is, however, certain, that the symp-
toms of a catarrh do frequently depend upon such a
matter being applied to these glands; as appears from
the case of the measles, chin-cough, and especially
from the frequent occurrence of contagious and epide-
mical catarrh.
MLXII.
The mention of this last leads me to observe, that
there are two species of catarrh, as I have marked in
my Synopsis of Nosology. One of these, as I suppose,
is produced by cold alone, as has been explained above;
and the other seems manifestly to be produced by a
specific contagion.
Of such contagious catarrhs*, I have pointed out in
the Synopsis many instances occurring from the 14th
century down to the present day. In all these in-
stances the phenomena have been much the same;
and the disease has always been particularly remarka-
ble in this, that it has been the most widely and ge-
nerally spreading epidemic known. It has seldom ap-
peared in any one country of Europe, without appear-
ing successively in every other part of it; and in some
instances, it has been even transferred to America, and
has
* These epidemical catarrhs have been lately termed Influenzas.

OF PHYSIC. 53
has been spread over that continent, so far as we have
had opportunities of being informed.
MLXIII.
The catarrh from contagion appears with nearly
the same symptoms as those mentioned MXLVIII.-ML.
It seems often to come on in consequence of the ap-
plication of cold. It comes on with more cold shiver-
ing than the catarrh arising from cold alone, and soon-
er shows febrile symptoms, and these likewise in a
more considerable degree. Accordingly, it more spee-
dily runs its course, which is commonly finished in a
few days. It sometimes terminates by a spontaneous
sweat; and this, in some persons, produces a miliary
eruption. It is, however, the febrile state of this dis-
ease especially, that is finished in a few days: for the
cough, and other catarrhal symptoms, do frequently
continue longer; and often, when they appear to be
going off, they are renewed by any fresh application
of cold.
MLXIV.
Considering the number of persons who are affected
with catarrh, of either the one species or the other,
and escape from it quickly without any hurt, it may
be allowed to be a disease very free from danger; but
it is not always to be considered as such; for in some
persons it is accompanied with pneumonic inflamma-
tion. In the phthifically disposed, it often accele-
rates the coming on of phthisis; and in elderly per-
sons, it frequently proves fatal in the manner explain-
ed above, MLIV. and MLVI.
MLXV.
The cure of catarrh is nearly the same, whether it
proceed from cold or contagion; with this difference,
that in the latter case, remedies are commonly more
necessary than in the former.
In the cases of a moderate disease, it is commonly
sufficicnt to avoid cold, and to abstain from animal
food 

54 PRACTICE
food for some days*; or perhaps to lie a-bed, and by
taking frequently of some mild and diluent drink, a
little warmed, to promote a very gentle sweat; and
after these to take care to return very gradually only,
to the use of the free air.
MLXVI.
When the disease is more violent, not only the anti-
phlogistic regimen must be exactly observed, but va-
rious remedies also become necessary.
To take off the phlogistic diathesis which always at-
tends this disease, blood-letting, in a larger or smaller
quantity, and repeated according as the symptoms shall
require, is the proper remedy.
For restoring the determination of the fluids to the
surface of the body§, and at the same time for expe-
ding the secretion of mucus in the lungs, which may
take off the inflammation of its membrane, vomiting
is the most effectual means.
For the latter purpose, it has been supposed, that
squills,
* Perhaps an abstinence from all food would accelerate the cure:
The mucilaginous drinks ought to be taken in considerable quanti-
ties, and they are somewhat nutritive.
§ The means of producing a gentle and continued perspiration
have been mentioned in a former note. In catarrh, however, the
use of the warmer sudorifics seems more effectual. The elixir parc-
goricum, diluted with whey, especially whey made with the dulcified
spint of nitre, is of singular use; but it ought not to be given if there
is a considerable degree of phlogistiic diathesis. In this case a spoon-
ful of the following solution may be given every two or three hours,
till a sweat breaks out:
ꝶ. Tart. emet. gr. ii.
Aq. font. vi. ℥
Syr. Althææ ℥ii.
M.
It will be necessary for the patient to chew occasionally some muci-
laginous demulcent, as Extract of Liquorice, &c. or to take a tea-
spoonful of equal parts of oil and honey, in order to prevent the sharp
matter from irritating the fauces. The Elect, pectorale of the 

OF PHYSIC. 55
squills, gum ammoniac*, the volatile alkali, and some
other medicines, might be useful: but their efficacy
has never appeared to me to be considerable; and, if
squills have ever been very useful, it seems to have
been rather by their emetic, than by their expecto-
rant powers.
When the inflammatory affections of the lungs
seem to be considerable, it is proper, besides blood-
letting, to apply blisters on some part of the thorax.
As a cough is often the most troublesome circum-
stance of this disease, so demulcents may be employed
to alleviate it. See CCCLXXIII.
But after the inflammatory symptoms have much a-
bated, if the cough should still continue, opiates af-
ford the most effectual means of relieving it; and in
the circumstances just now mentioned, they may be
very safely employed. See CCCLXXV.
After the inflammatory and febrile states of this
disease are almost entirely gone, the most effectual
means of discussing all remains of the catarrhal af-
fection, is by some exercise of gestation diligently em-
ployed.
CHAP.
Edinburgh Pharmacopoeia not only relieves the tickling, but tends
to produce a salutary diaphoresis; its dose is the size of a nutmeg
three or four times a-day.
* The ammoniac and squills may be joined together in the fol-
lowing form:
ꝶ. Lac ammoniac. ℥iv.
Syr. Scillit. ℥iii.
M.
This mixture must be acknowledged to be somewhat nauseous,
but it has considerable efficacy. The dose of it is two; or (if the
stomach can bear it) three table spoonfuls twice a-day. 

56 PRACTICE
CHAP. II.
OF THE DYSENTERY.
MLXVII.
THE dysentery is a disease in which the patient has
frequent stools accompanied with much griping,
and followed by a tenesmus. The stools, though fre-
quent, are generally in small quantity; and the mat-
ter voided is chiefly mucus, sometimes mixed with
blood. At the same time the natural fæces seldom ap-
pear, and, when they do, it is generally in a compact
and hardened form.
MLXVIII.
This disease occurs especially in summer and autumn;
at the same time with autumnal intermittent and
remittent fevers; and with these it is sometimes com-
bined or complicated*.
MLXIX.
The disease comes on sometimes with cold shiver-
ings, and other symptoms of pyrexia; but more com-
monly the symptoms of the topical affection appear
first. The belly is costive, with an unusual flatulence
in the bowels. Sometimes, though more rarely, some
degree of diarrhœa is the first appearance. In most
cases the disease begins with griping, and a frequent
inclination to go to stool. In indulging this, little is
voided; but some tenesmus attends it. By degrees,
the stools becomes more frequent, the griping more
severe, and the tenesmus more considerable. Along
with these symptoms there is a loss of appetite; and
frequently sickness, nausea, and vomiting, also affect-
ing the patient. At the same time there is always
more or less of pyrexia present, which is sometimes of
the
* It appears more especially in armies encamped in low swampy
grounds, and, without proper management, is highly destructive.

OF PHYSIC. 57
the remittent kind, and observes a tertian period.—
Sometimes the fever is manifestly imflammatory, and
very often of a putrid kind. These febrile states con-
tinue to accompany the disease during its whole
course, especially when it terminates soon in a fatal
manner. In other cases, the febrile state almost en-
tirely disappears, while the proper dysenteric symp-
toms remain for a long time after.
MLXX.
In the course of the disease, whether of shorter or
longer duration, the matter voided by stool is very va-
rious. Sometimes it is merely a mucous matter,
without any blood exhibiting that disease which Dr.
Roderer has named the morbus mucosus, and others
the dysenteria alba. For the most part, however, the
mucus discharged is more or less mixed with blood.
This sometimes appears only in streaks amongst the
mucus; but at other times is more copious, tinging
the whole of the matter discharged; and upon some
occasions a pure and unmixed blood is voided in con-
siderable quantity. In other respects, the matter
voided is variously changed in colour and consistence,
and is commonly of a strong and unusually fetid odour;
It is probable, that sometimes a genuine pus is voided;
and frequently a putrid sanies, proceeding from gan-
grenous parts. There are very often mixed with the
liquid matter some films of a membranous appearance,
and frequently some small masses of a seemingly seba-
ceous matter.
MLXXI.
While the stools consisting of these various matters
are in many instances, exceedingly frequent, it is sel-
dom that natural fæces appear in them; and when
they do appear, it is, as I have mentioned, in the
form of scybala, that is, in somewhat hardened, sepa-
rate balls. When these are voided, whether by the
efforts of nature, or as solicited by art, they procure
a remis-
H

58 PRACTICE
a remission of all the sympto ms, and more especi-
ally of the frequent stools, griping, and tenesmus.
MLXXII.
Accompanied with these circumstances, the disease
proceeds for a longer or a shorter time. When the
pyrexia attending it is of a violent inflammatory kind,
and more especially when it is of a very putrid nature,
the disease often terminates fatally in a very few days,
with all the marks of a supervening gangrene. When
the febrile state is more moderate, or disappears alto-
gether, the disease is often protracted for weeks, and
even for months; but even then, after a various dura-
tion, it often terminates fatally, and generally in con-
sequence of a return and considerable aggravation of
the inflammatory and putrid states. In some cases,
the disease ceases spontaneously; the frequency of
stools, the griping, and tenesmus, gradually diminish-
es, while natural stools return. In other cases, the
disease, with moderate symptoms, continues long, and
ends in a diorrhœa, sometimes accompanied with li-
enteric symptoms.
MLXXIII.
The remote causes of this disease have been vari-
ously judged of. It generally arises in summer or au-
tumn, after considerable heats have prevailed for some
time, and especially after very warm, and at the same
time, very dry states of the weather; and the disease
is more frequent in warm, than in cooler climates.—
It happens, therefore, in the same circumstances and
seasons which considerably affect the state of the bile
in the human body; but as the cholera is often with-
out any dysenteric symptoms, and copious discharges
of bile have been found to relieve the symptoms of dy-
sentery, it is difficult to determine what connection
the disease has with the state of the bile.
MLXXIV.
It has been observed, that the effluvia from very pu-
trid 

OF PHYSIC. 59
trid animal substances, readily affect the alimentary
canal; and upon some occasions they certainly pro-
duce a diarrhœa; but, whether they ever produce a
genuine dysentery, I have not been able to learn with
certainty.
MLXXV.
The dysentery does often manifestly arise from the
application of cold, but the disease is always contagi-
ous; and by the propagation of such contagion, inde-
pendent of cold, or other exciting causes, it becomes
epidemic in camps and other places. It is, therefore,
to be doubted, if the application of cold does ever
produce the disease, unless where the specific contagi-
on has been previously received into the body: And
upon the whole, it is probable, that a specific contagi-
on is to be considered as always the remote cause of
this disease.
MLXXVI.
Whether this contagion, like many others, be of a
permanent nature, and only shows its effects in certain
circumstances which render it active, or if it be occa-
sionally produced, I cannot determine. Neither, if
the latter supposition be received, can I say by what
means it may be generated. As little do we know any
thing of its nature, considered in itself; or at most this
only, that in common with many other contagions, it
appears to be commonly of a putrid nature, and capa-
ble of inducing a putrescent tendency in the human
body. This, however, does not at all explain its pecu-
liar power in inducing those symptoms which proper-
ly and essentially constitute the disease of dysentery.
(MLXVII.)
MLXXVII.
Of these symptoms the proximate cause is still ob-
scure. The common opinion has been, that the dis-
ease depends upon an acrid matter received into, or
generated in, the intestines themselves exciting their
peris-
H2 

60 PRACTICE
peristaltic motion, and thereby producing the frequent
stools which occur in this disease. But this supposi-
tion cannot be admitted: for, in all the instances
known of acrid substances applied to the intestines
and producing frequent stools, they at the same time
produce copious stools, as might be expected from
acrid substances applied to any length of the intestines.
This, however, is not the case in dysentery; in which
the stools, however frequent, are generally in very
small quantity, and such as may be supposed to pro-
ceed from the lower parts of the rectum only. With
respect to the superior portions of the intestines, and
particularly those of the colon, it is probable they are
under a preternatural and considerable degree of con-
striction: For as I have observed above, the natural
fæces are seldom voided; and when they are, it is in
a form which gives reason to suppose, they have been
long retained in the cells of the colon, and consequent-
ly that the colon had been affected with a preternatu-
ral constriction. This is confirmed by almost all the
dissections which have been made of the bodies of dy-
senteric patients, in which, when gangrene had not
extirely destroyed the texture and form of the parts,
considerable portions of the great guts have been
found affected with a very considerable constriction.
MLXXVIII.
I apprehend, therefore, that the proximate cause of
dysentery, or at least the chief part of the proximate
cause, consists in a preternatural constriction of the co-
lon, occasioning at the same time those spasmodic ef-
forts which are felt in severe gripings; and which
efforts, propagated downwards to the rectum, occasion
there the frequent mucous stools and tenesmus.—
But, whether this explanation shall be admitted or
not, it will still remain certain, that hardened fæces re-
tained in the colon are the cause of the griping, fre-
quent stools and tenesmus: for the evacuation of these
fæces, 

OF PHYSIC. 61
fæces, whether by nature or by art, gives relief from
the symptoms mentioned ; and it will be more fully
and usefully confirmed by this, that the most immedi-
ate and successful cure of dysentery, is obtained by
an early and constant attention to the preventing the
constriction, and the frequent stagnation of fæces in
the colon.
MLXXIX.
In this manner I have endeavoured to ascertain the
proximate cause of dysentery, and therefore to point
out also the principal part of the cure, which from
want of the proper view of the nature of the disease,
seems to have been in several respects fluctuating and
undetermined among practitioners.
MLXXX.
The most eminent of our late practitioners, and of
greatest experience in this disease, seem to be of opi-
nion, that the disease is to be cured most effectually
by purging assiduously employed. The means may
be various; but the most gentle laxatives are usually
sufficient, and as they must be frequently repeated,
the most gentle are the most safe; the more especially
as an inflammatory state so frequently accompanies
the disease. Whatever laxatives produce an evacua-
tion of natural fæces, and a consequent remission of
the symptoms, will be sufficient to effectuate the cure.
But if gentle laxatives shall not produce the evacua-
tion now mentioned, some more powerful medicines
must be employed*: and I have found nothing more
proper
* I shall subjoin some formulas suitable for procuring a passage
in the dysentery.
ꝶ. Infus. Senn. ℥ii.
Mannæ opt. ℥i.
M. S. haust.
ꝶ Mannæ ℥i.
Sal. Glauber ℥ss.
Solve in aq. bullient, ℥iii. et adde
Tinct. Cardamomi ʒi 

62 PRACTICE
proper or convenient than tartar emetic, given in
small doses, and at such intervals as may determine
their operation to be chiefly by stool. Rhubarb, so
frequently employed, is in several respects amongst
the most improper purgatives.
MLXXXI.
Vomiting has been held a principal remedy in this
disease; and may be usefully employed in the begin-
ning of it, with a view to both the state of the stomach
and of the fever: but it is not necessary to repeat it
often; and unless the emetics employed operate also
by stool, they are of little service. Ipecacuanha seems
to possess no specific power: and it proves only useful
when so managed as to operate chiefly by stool.
MLXXXII.
For relieving the constriction of the colon, and e-
vacuating the retained fæces*, glysters may sometimes
be useful: but they are seldom so effectual as laxatives
given by the mouth; and acrid glysters, if they be not
effectual in evacuating the colon, may prove hurtful
by stimulating the rectum too much.
MLXXXIII.
The frequent and severe griping attending this dis-
ease, lead almost necessarily to the use of opiates, and
they are very effectual for the purpose of relieving from
the gripes; but by occasioning an interruption of the ac-
tion
Where stronger purgatives are requisite,
ꝶ. Resin. Jalap, gr. x. vel. xv.
Tere in mortario marmoreo, cum 
Armygdal. dulc. decort. No. iii.
Sach. alb. ʒi.
Deín adde
Aq. cinnamom. simpl. ℥iss.
M.
* Clysters in these cases ought to be made very large, and they
ought also to be very mild; as a pint and an half, or even two pints,
of thin lintseed-tea, or decoction of marsh-mallows, without any o-
ther addition. 

OF PHYSIC. 63
tion of the small guts, they favour the constriction of
the colon, and thereby sometimes aggravate the dis-
ease: and if at the same time the use of them supersede
in any measure the employing of purgatives, it com-
monly does much mischief; I believe it indeed to be
only the neglect of purging, that renders the use of
opiates very necessary*.
MLXXXIV.
When the gripes are both frequent and severe, they
may sometimes be relieved by the employment of a
semicupium, or by a fomentation of the abdomen,
continued for some time. In the same case, the pains
may be relieved, and, as I think, the constriction of
the colon may be taken off, by blisters applied to the
lower belly†.
MLXXXV.
At the beginning of this disease, when the fever is
any way considerable, blood-letting, in patients of to-
lerable vigour, may be proper and necessary; and,
when the pulse is full and hard, with other symptoms
of an inflammatory disposition, blood-letting ought
o be repeated. But, as the fever attending dysente-
ry is often of a putrid kind, or does, in the course of
the
* The griping is much relieved, and sometimes prevented, by
drinking plentifully of any mucilaginous warm liquors during the
operation of the purges; as barley-water, with bruised prunes boil-
ed in it*
†Blisters applied to the abdomen, besides being excessively trou-
blesome, must necessarily be extremely painful. Practitioners have
probably been deceived in thinking that blisters have relieved griping
in the dysentery, for they are seldom employed alone; and the effects
of purges and diluents have perhaps been mistaken for the effects of
a blister that might have happened to have been applied at the time
when these other remedies were used. Too strict an attention to the
false axiom, post hoc ergo propter hoc, has heen the source of nu-
merous errors in the practice of physic, and lus raised the reputa-
tion of the physician and his remedies, when the merit was only
due to nature. 

64 PRACTICE
the disease, become soon of that nature, blood-letting
must be employed with great caution.
MLXXXVI.
From the account now given of the nature of this
disease, it will be sufficiently obvious, that the use of
astringents in the beginning of it must be absolutely
pernicious.
MLXXXVII.
Whether an acrid matter be the original cause of
this disease, may be uncertain: but from the indiges-
tion and the stagnation of fluids in the stomach which
attend the disease, it maybe presumed, that some acrid
matters are constantly present in the stomach and intes-
tines, and therefore that demulcents may be always
usefully employed. At the same time, from this con-
sideration that mild oily matters thrown into the in-
testines into considerable quantity always prove laxa-
tive, I am of opinion that the oleaginous demulcents
are the most useful*.
MLXXXVIII.
* Some forms of these demulcents are given in the Pharmacopœia,
The following may be added for the sake of variety, as the patient
frequently loaths Linctuses.
ꝶ. Mann, opt.
Ol. Amygdal. recent, a a ℥i.
Syr. e Cort. aurant. ʒss.
M.
ꝶ. Syr. althææ.
Ol. Amygdal.
Elect. lenitiv. a a ℥i.
M.
ꝶ. Conserv. cynosbat. ℥i.
Syr. rosar.
Ol. Amygdal a a ℥ii.
M.
Two tea-spoonfuls of any of the above tinctures may be given
every hour, or every other hour, drinking, at the same time, bar-
ley-water with bruised prunes boiled in it.
The cure of a dysentery is briefly comprehended in keeping the
belly open, and using mucilaginous diluents and lubricants. 

OF PHYSIC. 65
MLXXXVIII.
As this disease is so often of an inflammatory or of
a putrid nature, it is evident that the diet employed in
it should be vegetable and acescent. Milk in its en-
tire state is of doubtful quality in many cases; but
some portion of the cream is often allowable, and
whey is always proper.
In the first stages of the disease, the sweet and suba-
cid fruits are allowable, and even proper. It is in
the more advanced stages only that any morbid acidi-
ty seems to prevail in the stomach, and to require
some reserve in the use of acescents. At the begin-
ning of the disease, absorbents seem to be superfluous;
and by their astringent and septic powers they may be
hurtful.
MLXXXIX.
When this disease is complicated with an intermit-
tent fever, and is protracted from that circumstance
chiefly, it is to be treated as an intermittent, by ad-
ministering the Peruvian bark, which, however, in
the earlier periods of the disease, is hardly to be ad-
mitted.
PART II.
OF
NEUROSES,
OR
NERVOUS DISEASES.
MXC.
IN a certain view, almost the whole of the diseases
of the human body might be called NERVOUS:
but
Vol. II. 
I  

66 PRACTICE
but there would be no use for such a general appella-
tion; and, on the other hand, it seems improper to
limit the term, in the loose inaccurate manner in
which it has been hitherto applied, to hysteric or hy-
pochondrical disorders, which are themselves hardly
to be defined with sufficient precision.
MXCI.
In this place I propose to comprehend, under the
title of NEUROSES, all those preternatural affections of
sense or motion which are without pyrexia, as a part
of the primary disease; and all those which do not
depend upon a topical affection of the organs, but up-
on a more general affection of the nervous system,
and of those powers of the system upon which sense
and motion more especially depend.
MXCII.
Of such diseases I have established a class, under the
title of NEUROSES or NERVOUS DISEASES. These I
again distinguish, as they consist, either in the inter-
ruption and debility of the powers of sense and moti-
on, or in the irregularity with which these powers are
exercised; and have accordingly arranged them under
the four orders of Comata, Adynamiæ, Spasmi, and Ve-
sanæ, to be defined as we proceed to treat of them
more particularly.
BOOK 

OF PHYSIC. 67
BOOK I.
OF COMATA;
OR, OF THE
LOSS OF VOLUNTARY MOTION.
MXCIII.
UNDER this title are comprehended those affec-
tions which have been commonly called the
Soporose diseases; but they are most properly distin-
guished by their consisting in some interruption or sup-
pression of the powers of sense and voluntary motion,
or of what are called the animal functions. These
are indeed usually suspended in the time of natural
sleep: but of all the diseases to be comprehended un-
der our title, sleep, or even the appearance of it, is
not constantly a symptom. Of such diseases I can
mark and properly explain two genera only, which
come under the titles of Apoplexy and Palsy.
CHAP. I.
OF APOPLEXY.
MXCIV.
APOPLEXY is that disease in which the whole of
the external and internal senses, and the whole
of the voluntary motions, are in some degree abolish-
ed; while respiration and the action of the heart con-
tinue
I 2 

68 PRACTICE
tinue to be performed*. By its being an affection of
the whole of the powers of sense and of voluntary
motion, we distinguish it from Palsy; and by its be-
ing with the continuance of respiration and the ac-
tion of the heart, it is distinguished from Syncope. I
have further added to the ordinary definition of apo-
plexy, that the abolition of the powers of sense and
motion is in some degree only; meaning by this to im-
ply, that, under the title of Apoplexy, are here com-
prehended those diseases which, as differing from it in
degree only, cannot, with a view either to pathology
or practice, be properly distinguished from it: Such
are the diseases sometimes treated of under the names
of Carus, Cataphora, Coma, and Lethargus.
MXCV.
Apoplexy, in all its different degrees, most common-
ly affects persons advanced in life, and especially those
above sixty years of age. It most usually affects persons
of large heads and short necks†, persons of a corpulent
habit, persons who have passed an indolent life and used
a full diet, and especially those who have indulged in
frequent intoxication. Men who have long laboured
under a frequent and copious discharge of blood from
the
* "The appearance of a profound and continual sleep," is by
Boerhaave judiciously added to the definition of Apoplexy.
To distinguish between a profound sleep and apoplexy, which very
much resemble each other, is, however, extremely easy. A man in
a profound sleep may in general be roused by the application of strong
stimulants to the organs of sense which produce no effect on an apo-
plectic patient.
To distinguish between apoplexy and a fit of drunkenness is not so
easy; for drunken people are sometimes incapable of being roused
by any stimulants, remaining totally insensible and motionless. The
fumes of the liquor with which they have been intoxicated may some-
times be discovered by smelling: a drunken fit may also be known by
the paleness of the drunken man's face, and by his manner of living.
† Different authors, one of whom is Boerhaave, have supposed
that a vertebra is wanting, the neck consisting only of six in instead
seven vertebrae. 

OF PHYSIC. 69
the hemorrhoidal vessels, upon either the suppression,
or spontaneous ceasing of that discharge, are particu-
larly liable to be affected with apoplexy.
MXCVI.
This disease frequently comes on very suddenly:
but in many cases it is preceded by various symptoms,
such as frequent fits of giddiness, frequent headachs, a
hemorrhagy from the nose, some transitory interrup-
tions of seeing and hearing, some false vision and hear-
ing, some transitory degree of numbness or loss of
motion in the extremities, some faltering of the
tongue in speaking, a loss of memory, a frequent drow-
siness, and frequent fits of incubus.
MXCVII.
An attention to these symptoms, and to the predis-
ponent circumstances, (MXCV.) will often enable us to
foresee the more violent attacks of this disease.
MXCVIII.
When the disease comes on suddenly to a considerable
degree, it has been frequently observed to have been
immediately induced by violent exercise; by a full
and long continued inspiration; by a fit of anger; by
much external heat, especially that arising from a
crowded assembly of people; by warm bathing; by
intoxication; by long stooping with the head down;
and a tight ligature about the neck. The disease has
been remarked to make its attacks most frequently in
the spring season, and especially when the vernal heat
suddenly succeeds to the winter cold.
MXCIX.
The symptoms denoting the presence of this dis-
ease will be sufficiently known from the definition giv-
en, MXCIV. Although the whole of the body is af-
fected with the loss of sense and motion, it sometimes
takes place more upon one side of the body than the
other; and, in that case, the side least affected whh
palsy is sometimes affected with convulsions. In this 
dis-

70 PRACTICE
disease there is often a stertorous breathing; and this
has been said to be a mark of the most violent state of
the disease; but it is not always present even in the
most complete form or most violent degree of the dis-
ease.
MC.
The proximate cause of this disease may be, in ge-
neral, whatever interrupts the motion of the nervous
power from the brain of the muscles from voluntary
motion; or, in so far as sense is affected, whatever
interrupts the motion of the nervous power from the
sentient extremities of the nerves to the brain,
MCI.
Such an interruption of the motions of the nervous
power may be occasioned, either by same compression of
the origin of the nerves, or by something destroying the
mobility of the nervous power. Both these causes we
must treat of more particularly; and, first, of that of
compression, seemingly the most frequent occasion of
apoplexy, and perhaps the occasion of all those apo-
plexies arising from internal causes.
MCII.
The less of sense and motion in particular parts of
the body, may be occasioned by a compression, either
of the origin of certain nerves only, or of the same
nerves in some part of their course from the brain to
the organs of sense and motion. Such cases of par-
tial compression will be more properly considered
hereafter; and the affection I am now to treat of be-
ing general, it must depend upon a very general com-
pression of the origin of the nerves, or medullary por-
tion of the brain; and therefore, this more general
compression only is to be considered here
MCIII.
This compression of the origin of the nerves or me.
dullary portion of the brain, may be produced in dif-
ferent ways; as,
1. By

OF PHYSIC. 71
1. By external violence fracturing and pressing in a
part of the cranium.
2. By tumours, sometimes soft, sometimes beny,
formed in different parts of the brain, or in its mem-
branes, and becoming of such a bulk as to compress
the medullary substance of the brain.
3. By the blood accumulated in the blood-vessels
of the brain, and distending them to such a degree as
to compress the medullary portion of the same.
4. By fluids effused in different parts of the brain,
or into the cavity of the cranium, and accumulated in
such quantity as to occasion the compression we treat
of.
And, as to this last, it is to be remarked here, that
the fluids effused may be of two kinds: that is, they
may be either a portion of the common mass of blood,
poured out from red vessels; or a portion of serum
or colourless fluid, poured out chiefly by the exha-
lants.
MCIV.
Of these several causes of compression, the first is
not to be considered here, because the removing it does
not belong to our province; and the confederation of
the second may be omitted, as in most instances it is
neither to be discerned nor cured by any means yet
known. The third and fourth causes of compression,
as they are the most frequent, and are also most pro-
perly the subjects of our art, so they are those which
deserve our particular attention; and we shall there-
fore endeavour to trace them further back in the se-
ries of causes which may produce them.
MCV.
Both the states of over-distention and of effusion,
may be produced by whatever increases the afflux and
impetus of the blood in the arteries of the head; such
as violent exercise, a violent fit of anger, external heat
applied,

72 PRACTICE
applied, or any strong pressure upon the descending
aorta.
MCVI.
But both these states of over-distention and of effu-
sion, may also and seem to be more frequently produc-
ed by causes that operate by preventing the free return
of the venous blood from the vessels of the head to
the right ventricle of the heart.
MCVII.
The venous vessels of the brain are of a conforma-
tion and distribution so peculiar, as lead us to believe,
that Nature intended to retard the motion of the
blood, and accumulate it in these vessels; and there-
fore, even very small additional resistances to the mo-
tion of the blood from these towards the right ventri-
cle of the heart, may still more readily accumulate
the blood in them. Such accumulation will most
readily happen in advanced life, when the venous sys-
tem in general is in a plethoric state, and when this
plethora takes place especially in the venous vessels of
the brain. It will, in like manner, be most apt to oc-
cur in persons whose heads are large with respect to
the rest of the body; and in persons of a short neck,
which is unfavourable to the return of the venous
blood from the head. The accumulation of blood in
the venous vessels of the brain, will also be most likely
to occur in persons of a corpulent habit, either be-
cause these may be considered to be in a plethoric
state, or because obesity, by occasioning a compression
of the blood-vessels in other parts of the body, more
readily fills those of the brain, which are entirely free
from any such compression.
MCVIII.
These are the circumstances in the constitution of
the body, which, producing a slower motion and re-
turn of the venous blood from the vessels of the head,
favour an accumulation and distention in them; and
we 

OF PHYSIC. 73
we now proceed to mention the several occasional
causes, which, in every person, may directly prevent
the free return of the blood from the vessels of the
head towards the heart. Such are,
1. Stooping down with the head, or other situa-
tions of the body in which the head is long kept in a
depending state, and in which the gravity of the blood
increases the afflux of it by the arteries, and opposes
the return of it by the veins.
2. A tight ligature about the neck, which compress-
es the veins more strongly than the arteries.
3. Any obstruction of a considerable number of the
veins carrying the blood from the head, and more
especially any considerable obstruction of the ascend-
ing vena cava.
4. Any considerable impediment of the free pas-
sage of the blood from the veins into the right ventri-
cle of the heart; and it is commonly by this, and the
immediately preceding circumstance, that polypous
concretions in the cava, or right ventricle, are found
to occasion apoplexy.
5. The return of blood from the veins of the head
towards the heart, is especially interrupted by every
circumstance that produces a more difficult transmis-
sion of the blood through the vessels of the lungs. It
is well known, that, at the end of every expiration,
some interruption is given to the free transmission of
the blood through the lungs; and that this at the same
time gives an interruption to the motion of the blood
from the veins into the right ventricle of the heart.
This clearly appears from that regurgitation of the
blood in the veins, which occasions the alternate heav-
ing and subsiding that is perceived in the brain of liv-
ing animals when the cranium is removed, and which
is observed to be synchronous with the alternate mo-
tions of respiration. From this we readily perceive,
that whatever occasions a difficulty in the transmission
of
Vol. II. 
K  

74 PRACTICE
of the blood through the lungs, must also interrupt
the free return of the venous blood from the vessels
of the head; and must therefore favour, and perhaps
produce, an accumulation of blood, and an over-dis-
tention in these vessels.
It is further to be observed, that as a very full in-
spiration, continued for any length of time, occasions
such an interruption of the free transmission of the
blood through the lungs, as produces a suffusion of
face, and a manifest turgescence of the blood-vessels
of the head and neck; so every full, and long-conti-
nued inspiration may occasion an accumulation of
blood in the vessels of the head, to a very considera-
ble degree. Thus, as every strong exertion of the
muscular force of the body requires, and is attended
with, a very full and long-continued inspiration, we
thence learn why the violent exertions of muscular
force have been so often the immediate or exciting
causes of apoplexy.
It may also be remarked, that corpulency and obe-
sity operate very much, by occasioning a more difficult
transmission of the blood through the vessels of the
lungs. It appears, that in fat persons, from the com-
pression of the blood-vessels in many parts of the bo-
dy, the vessels of the lungs are thereby kept very full;
so that, upon the least increase of bodily motion,
which sends the blood faster into the lungs, a more fre-
quent and laborious respiration becomes in such per-
sons immediately necessary. This shows, that, in such
persons, the blood is not freely transmitted through
the lungs; a circumstance which, as in other instances,
must give a constant resistance to the return of blood
from the vessels of the head, and therefore favour or
occasion an accumulation of blood in them.
Is the motion of the blood in the vessels of the head
rendered slower by study, care and anxiety?
MCIX. 

OF PHYSIC. 75
MCIX.
It is to be observed further, that these several caus-
es (MCV-MCVII.) of a preternatural fulness in the
blood-vessels of the brain, may produce apoplexy in
different ways, according as the fulness takes place in
the arteries or in the veins.
MCX.
Accordingly, first, the increased afflux of blood in-
to the arteries of the brain, and an increased action in
these, may either occasion a rupture of their extremi-
ties, and thereby an effusion of red blood producing
compression; or the same afflux and increased action
may occasion an increased exhalation from their ex-
tremities, of a serous fluid, which, if not as quickly
re-absorbed, may soon accumulate in such quantity as
to produce compression.
MCXI.
Secondly, The phletoric state of the venous vessels
of the brain, may operate in three different ways.
1. The fulness of the veins may give such resistance
to the blood flowing into them from the arteries, as
to determine the impetus of the blood to be so much
greater upon the extremities of the arteries as to occa-
sion a rupture of these, and consequently an effusion
of red blood, or the Hæmorrhagia cerebri, which
Hoffman considers as a frequent cause of apoplexy,
and which we have before explained in DCCLXXII.
2. Whilst the same resistance to the blood flowing
from the arteries into the veins, increases the impetus
of the blood in the former, this may, without occasi-
oning rupture, increase the exhalation from their ex-
halant extremities, and produce an effusion of a serous
fluid; in the same manner as such resistance in the
veins produces hydropic effusions in other parts of the
body.
 3. If we may suppose, as no lymphatics have been
yet discovered in the brain, that the ordinary absorb-
ents
K 2 

76 PRACTICE
ents are not present there, and that the exhaled fluids
are absorbed or taken up by the extremities of the
veins; this will show still more clearly that a resist-
ance to the motion of the blood in the veins of the
brain, may readily produce an accumulation of serous
fluid in its cavities, and consequently a compression
producing apoplexy.
MCXII.
Besides these causes of apoplexy from afflux in the
arteries, or resistance in the veins, an effusion of serum
may happen from two other causes. The one is a
relaxation of the exhalants, as in other cases of hy-
dropic diathesis prevailing in the body; and it is not
unusual for a general dropsy to end in apoplexy. The
second is an over-proportion of watery parts in the
mass of blood, which is therefore ready to run off by
the exhalants, as in the case of an ischuria renalis;
which, when it proves incurable, very commonly ter-
minates in apoplexy.
MCXIII.
We have now mentioned the several causes of apo-
plexy depending upon compression; and from the
whole it will appear, that the most frequent of all
these causes is a plethoric state, or an accumulation
and congestion of blood in the venous vessels of the
head, operating, according to its degree, in produc-
ing over-distention or effusion. The frequent opera-
tion of such a cause will especially appear from a con-
sideration of the predisponent circumstances (MXCV.)
and from the antecedent symptoms. (MXCVI.)
MCXIV.
From the view I have now given of the causes of
apoplexy arising from compression, it will readily ap-
pear that there is a foundation for the common dis-
tinction of this disease into the two kinds of Sanguine
and Serous. But this distinction cannot be very use-
fully applied in practice, as both kinds may often de-
pend

OF PHYSIC. 77
pend on the same cause, that is, a venous plethora, and
therefore requiring very nearly the same method of
cure. The only distinction that can be properly made
of apoplexies from compression, is perhaps the dis-
tinction of serous apoplexy, into that depending on
the plethora mentioned MCXIII. and that depending
upon hydropic diathesis, or an over-proportion of wa-
ter in the blood (MCXII.) the former causes giving a
proper idiopathic, the latter only a symptomatic, dis-
ease.
MCXV.
Beside the causes now mentioned, occasioning apo-
plexy by compression, I alledge there are other causes
producing the same disease, by directly destroying the
mobility of the nervous power. Such causes seem to
be the mephtic arising from fermenting liquors, and
from many other sources; the fumes arising from
burning charcoal, the fumes of mercury, of lead, and
of some other metallic substances; opium, alcohol,
and many other narcotic poisons: To all which I
would add the power of cold, of concussion, of electri-
city, and of certain passions of the mind.
MCXVI.
None of these poisons or noxious powers seem to
kill by acting first upon the organs of respiration, or
upon the sanguiferous system; and I believe their im-
mediate and direct action to be upon the nervous pow-
er, destroying its mobility, because the same poisons
show their power in destroying the irritability of mus-
cles and of the nerves connected with them, when
both these are entirely separated from the rest of the
body.
MCXVII.
It appears to me probable that the apoplectic state
in some degree accompanying, and almost always suc-
ceeding, an epileptic paroxysm, does not depend upon
compression, but upon a certain state of immobility of
the 

78 PRACTICE
the nervous power, produced by certain circumstan-
ces in the nervous system itself, which sometimes seem
to be communicated from one part of the body to ano-
ther, and at length to the brain.
MCXVIII.
The same observation may be made with respect to
many instances of hysteric paroxysm; and the circum-
stances, both of epileptic and hysteric paroxysms, end-
ing in coma, or a degree of apoplexy, lead me to
think, that also the apoplexy proceeding from retro-
cedent or atonic gout is of the same kind, or that it
depends upon an immobility of the nervous power,
rather than upon compression.
MCXIX.
It may indeed happen, that as the apoplectic and
gouty predispositions do often concur in the same
person; so it may frequently happen, that the apo-
plexy coming upon gouty persons, may sometimes de-
pend upon compression; and defections may, accord-
ingly, discover that the circumstances of such a cause
had preceded. But, in many cases of apoplexy fol-
lowing a retrocedent, or atonic gout, no such antece-
dent or concomitant circumstances, as commonly oc-
cur in cases of compression, do distinctly or clearly ap-
pear; while others present themselves, which point
out an affection of the nervous power alone.
MCXX.
With respect, however, to the circumstances which
may appear upon the dissection of persons dead of a-
poplexy, there may be some fallacy in judging, from
those circumstances, of the cause of the disease.
Whatever takes off or diminishes the mobility of the
nervous power, may very much retard the motion of
the blood in the vessels of the brain; and that perhaps
to the degree of increasing exhalation, or even of oc-
casioning rupture and effusion: so that, in such cases,
the marks of compression may appear, upon dissection,
though 

OF PHYSIC. 79
though the disease had truly depended on causes de-
stroying the mobility of the nervous power. This
seems to be illustrated and confirmed from what oc-
curs in many cases of epilepsy. In some of these, af-
ter a repetition of fits, recovered from in the usual
manner, a satuity is induced, which commonly de-
pends upon a watery inundation of the brain: And
in other cases of epilepsy, when fits have been often
repeated without any permanent consequence, there
happens at length a fatal paroxysm; and upon dissection
it appears, that an effusion of blood had happened. This,
I think, is to be considered as a cause of death, not as a cause
of the disease: for in such cases, I suppose that the
disease had diminished the action of the vessels of the
brain, and thereby had given occasion to a stagnation,
which produced the appearances mentioned. And I
apprehend the same reasoning will apply to the cases
of retrocedent gout, which, by destroying the energy
of the brain, may occasion such a stagnation as will
produce rupture, effusion, and death; and in such a
case, the appearances upon dissection might lead us to
think that the apoplexy had depended entirely upon
compression.
MCXXI.
The several causes mentioned in MCXV. are often
of such power as to occasion immediate death; and
therefore have not commonly been taken notice of as
affording instances of apoplexy; but, as the operation
of the whole of these causes is similar and analogous,
and as in most instances of the operation of these causes
an apoplectic state is manifestly produced, there can
be little doubt in considering most of the instances of
their effects as cases of apoplexy, and therefore such
as fall properly under our consideration here.
MCXXII.
This disease of apoplexy is sometimes entirely re-
covered from; but more frequently it ends in death,
or 

80 PRACTICE
or in a hemiplegia. Even when an attack of the dis-
ease is recovered from, we generally find it disposed
to return; and the repeated attacks of it almost al-
ways, sooner or later, bring on the events we have
mentioned.
MCXXIII.
The several events of this disease, in health, death,
or another disease, may be expected and foreseen from
a consideration of the predisponent circumstances
(MXCV.); of the antecedent symptoms (MXCVI.); of
the exciting causes (MXCVIII.); of the violence and
degree of the symptoms when the disease has come on
(MXCIV.); of the duration of the disease; and of the
effects of the remedies employed.
MCXXIV.
From the great danger attending this disease when
it has come on (MCXXII.), it will readily appear that
our care should be chiefly directed to the prevention
of it. This, I think, may be often done by avoiding
the remote and exciting causes; and how this may be
accomplished, will be obvious from the enumeration
of those causes given above (MXCVIII.) But it will also
appear from what is said above, that the prevention
of this disease will especially depend upon obviating
the predisponent cause; which, in most cases, seems
to be a plethoric state of the blood-vessels of the brain.
This, I think, may be obviated by different means;
and, in the first place, by a proper management of ex-
ercise and diet.
MCXXV.
The exercise ought to be such as may support the
perspiration, without heating the body or hurrying res-
piration; and, therefore commonly by some mode of
gestation. In persons not liable to frequent fits of
giddiness, and who are accustomed to riding on horse-
back, this exercise is, of all others, the best. Walk-
ing, and some other modes of bodily exercise, may be
em- 

OF PHYSIC. 81
employed with the restrictions just now mentioned;
but in old men, and in men of corpulent habits, bodi-
ly exercise ought always to be very moderate.
MCXXVI.
In persons who pretty early in life show the predis-
position to apoplexy, it is probable that a low diet,
with a good deal of exercise, might entirely prevent
the disease; but, in persons who are advanced in life
before they think of taking precautions, and are at the
same time of a corpulent habit, which generally sup-
poses their having been accustomed to full living, it
might not be safe to put them upon a low diet: and
it may be enough that their diet be rendered more
moderate than usual, especially with respect to animal-
food; and that, at supper, such food should be ab-
stained from altogether.
In drinking, all heating liquors are to be abstained
from, as much as former habits will allow; and the
smallest approach to intoxication is to be carefully
shunned. For ordinary draught, small beer is to be
preferred to plain water, as the latter is more ready to
occasion costiveness, which in apoplectic habits is to be
carefully avoided. The large use of tobacco in any
shape may be hurtful; and except in cases where it
has been accustomed to occasion a copious excretion
from the head, the interruption of which might not
be safe, the use of tobacco should be avoided; and
even in the circumstance mentioned, where it may be
in some measure necessary, the use of it should at least
be rendered as moderate as possible.
MCXXVII.
Evacuations by stool may certainly contribute to
relieve the plethoric state of the vessels of the head;
and, upon appearance of any unusual turgescence in
these, purging will be very properly employed: but,
when no such turgescence appears, the frequent repe-
tition of large purging might weaken the bedy too
much;
Vol. II. 
L 

82 PRACTICE
much; and, for preventing apoplexy, it may for the
most part be enough to keep the belly regular, and
rather open, by gentle laxatives*. In the summer
season, it may be useful to drink, every morning, of
a gentle laxative mineral water, but never in large
quantity.
MCXXVIII.
In the case of a plethoric state of the system, it
might be supposed that blood-letting would be the
most effectual means of diminishing the plethora, and
of preventing its consequences; and, when an attack
of apoplexy is immediately threatened, blood-letting
is certainly the remedy to be depended upon; and
blood should be taken largely, if it can be done, from
the jugular vein, or temporal artery. But, when
no threatening turgescence appears, the obviating
plethora is not judiciously attempted by blood-let-
ting, as we have endeavoured to demonstrate above,
DCCLXXXVIII. In doubtful circumstances, leeches ap-
plied to the temples or scarifications of the hind-head,
may be more safe than general bleedings.
MCXXIX.
When there are manifest symptoms of a plethoric
state in the vessels of the head, a seton, or pea-issue,
near the head, may be very useful in obviating any
turgescence of the blood.
MCXXX.
These are the means to be employed for preventing
the
* Gentle laxatives hare been often enumerated in the preceding
notes. In these cases, however, there is no danger to be apprehend-
ed from the use of the resinous drastics, provided that they are not
given in such doses as may weaken the patient too much. They
ought to be used tor the purpose of purging, but only for keeping
the body moderately open; and this effect may be safely produced
by five or eight grains of Rufus's pills taken occasionally at bed-time,
or by a tea-spoonful or two of the Tinct. jalap, or a table-spoonful
of the elixir sennae the morning. The same end may, in many
cases, be answered by a due attention to diet. 

OF PHYSIC. 83
the apoplexy which might arise from a plethoric state
of the vessels of the brain; and if, at the same time,
great care is taken to avoid the exciting causes (MXC-
VIII.), these means will be generally successful.
In the cases proceeding from other causes (MCXV.),
as their application is so immediately succeeded by
the disease, they hardly allow any opportunity for pre-
vention.
MCXXXI.
For the Cure of apoplexies from internal causes,
and which I suppose to be chiefly those from compres-
sion, the usual violence and fatality of it require that
the proper remedies be immediately and largely em-
ployed.
The patient is to be kept as much as possible in
somewhat of an erect posture, and in cool air, and
therefore neither in a warm chamber, nor covered
with bed-clothes, nor surrounded with a crowd of
people.
MCXXXII.
In all cases of a full habit, and where the disease
has been preceded by marks of a plethoric state, blood-
letting is to be immediately employed, and very large-
ly. In my opinion, it will be most effectual when the
blood is taken from the jugular vein; but if that can-
not be properly done, it may be taken from the arm.
The opening of the temporal artery, when a large
branch can be opened, so as suddenly to pour out a
considerable quantity of blood, may also be an effectu-
al remedy; but, in execution, it is more uncertain,
and may be inconvenient. It may be, in some mea-
sure supplied, by cupping and scarifying on the tem-
ples or hind-head. This, indeed, should seldom be
omitted: and these scarifications are always preferable
to the application of leeches.
With respect to every mode of blood-letting, this
is to be observed, that when in any case of apoplexy,
it
L 2  

84 PRACTICE
it can be perceived that one side of the body is more
affected with the loss of motion than the other, the
blood-letting, if possible, should be made on the side
opposite to that most affected*.
MCXXXIII.
Another remedy to be employed is purging, to be
immediately attempted by acrid glysters§; and at
the same time, if any power of swallowing remain,
by drastic purgatives given by the mouth. These,
however, left they may excite vomiting, should be
given in divided portions at proper intervals†.
MCXXXIV.
Vomiting has been commended by some practi-
tioners and writers: but, apprehending that this might
impel
* Dissections shew that the congestions producing apoplexy are al-
ways on the side not affected; and hence the propriety of the direction,
§ Acrid clysters are,
ꝶ. Elect. lenitiv. ℥i.
Sal. cathartic, amar. ℥iiss.
Aq. tepid, ℥xi.
M. f. Enema.
ꝶ. Sapon. alb. ℥iss.
Solve in aq. tepid. ℥x. cui adde
Syr. e spina cerv. ℥ii.
M. f. Enema.
ꝶ. Pulp. colocynth. ℥iii.
Coque per horæ quadrantem in aq. font.
q. s. ad colutaræ ℥xii. cui adde
Ol. Olivar. ℥i.
M. f. Enema.
† The drastic purges are, in these cases, to be given in draughts,
rather than in pills or boluses; the following form may be used:
ꝶ. Pulv. Jalap. ʒi.
Rad, zinzib. ℈i.
Infus. sem. lini ℥iii.
M. 
The dose of this mixture is two spoonfuls every two hours till it o-
perate: or we may use one of the formulae mentioned in the note
on article 1080, especially the last, repeating it every two hours till
it produces an effect. 

OF PHYSIC. 85
impel the blood with too much violence into the ves-
sels of the head, I have never employed it.
MCXXXV.
Another remedy to be immediately employed is
blistering; and I judge that this is more effectual when
applied to the head, or near to it, than when it is ap-
plied to the lower extremities. This remedy I do
not consider as a stimulant, or capable of making any
considerable revulsion; but, applied to the head, I
suppose it useful in taking off the hemorrhagic dispo-
sition so often prevailing there.
MCXXXVI.
It has been usual with practitioners, together with
the remedies already mentioned, to employ stimulants
of various kinds; but I am disposed to think them
generally hurtful; and they must be so, wherever the
sulness of the vessels, and the impetus of the blood in
these, is to be diminished. Upon this principle it is
therefore agreed, that stimulants are absolutely impro-
per in what is supposed to be a sanguine apoplexy;
but they are commonly supposed to be proper in the
serous. If, however, we be right in alledging that
this also commonly depends upon a plethoric state of
the blood-vessels of the brain, stimulants must be
equally improper in the one case as in the other.
MCXXXVII.
It may be argued from the almost universal employ-
ment of stimulants, and sometimes with seeming ad-
vantage, that they may not be so hurtful as my no-
tions of the causes of apoplexy lead me to suppose.
But this argument is, in several respects, fallacious;
and particularly in this, that in a disease which, un-
der every management, often proceeds so quickly to
a fatal termination, the effects of remedies are not to be
easily ascertained.
MCXXXVIII.
I have now mentioned the several remedies which
I think 

86 PRACTICE
I think adapted to the cure of apoplexy arising
from compression, and should next proceed to
treat of the cure of apoplexy arising from those
causes that directly destroy the mobility of the
nervous power But many of those causes are often
so powerful, and thereby so suddenly fatal in their ef-
fects, as hardly to allow of time for the use of reme-
dies; and such cases, therefore, have been so seldom
the subjects of practice, that the proper remedies are
not so well ascertained as to enable me to say much of
them here.
MCXXXIX.
When, however, the application of the causes,
(MCXV.) is not so powerful as immediately to kill, and
induces only an apoplectic state, some efforts are to be
made to obviate the consequences, and to recover the
patient; and even in some cases where the causes re-
ferred to, from the ceasing of the pulse and of respira-
tion, and from a coldness coming upon the body, have
induced an appearance of death; yet, if these appear-
ances have not continued long, there may be means of
recovering the persons to life and health, I cannot,
indeed, treat this subject completely; but for the cure
of apoplexy from several of the causes mentioned
MCXV. shall offer the following general directions.
1. When a poison capable of producing apoplexy
has been recently taken into the stomach, if a vomit-
ing spontaneously arises, it is to be encouraged; or, if
it does not spontaneously come on, a vomiting is to be
immediately excited by art, in order that the poison
nay be thrown out as quickly as possible. If, howe-
ver, the poison has been taken into the stomach long
before its effects have appeared, we judge that, upon
their appearance, the exciting of vomiting will be
useless, and may perhaps be hurtful.
2. When the poison taken into the stomach, or
otherwise applied to the body, has already induced an
apo- 

OF PHYSIC. 87
apoplectic state, as those causes do commonly at the
same time occasion a stagnation or slower motion of
the blood in the vessels of the brain and of the lungs,
so it will generally be proper to relieve this congestion
by taking some blood from the jugular vein, or from
the veins of the arm.
3. Upon the same supposition of a congestion in the
brain or lungs, it will generally be proper to relieve it
by means of acrid glysters producing some evacuation
from the intestines.
4. When these evacuations by blood-letting and
purging have been made, the various stimulants which
have been commonly proposed in other cases of apo-
plexy, may be employed here with more probability
and safety*. One of the most effectual means of rous-
ing apoplectics of this kind seems to be throwing cold
water on several parts of the body, or washing the bo-
dy all over with it.
5. Although the poison producing apoplexy hap-
pens to be so powerful as very soon to occasion the ap-
pearances of death above-mentioned; yet if this state
has not continued long, the patient may often be re-
coverable; and the recovery is to be attempted by the
same means that are directed to be employed for the
recovery of drowned persons, and which are now
commonly known.
CHAP.
* The stimulants are various according to the various parts of the
body to which they are generally applied, as volatile and vinous spi-
rits, or vinegar, to the nose and temples; acrid essential oils, mixed
with thrice their weight in hog's lard, to the breast and back; bli-
sters, hot sinapisms, and warm fomentations, with horse-radish, to the
extremities; frictions with warm brushes; the actual cautery to the
soles of the feet, and palms of the hands; with several other, which
are more particularly described in the notes on article 1161, et seq.

88 PRACTICE
CHAP. II.
OF PALSY.
MCXL.
PALSY is a disease consisting in a loss of the pow-
er of voluntary; motion, but affecting certain
parts of the body only, and by this it is distinguished
from apoplexy. (MXCIV.) One of the most frequent
forms of palsy is when it affects the whole of the mus-
cles on one side of the body; and then the disease is
named a Hemiplegia.
MCXLI.
The loss of the power of voluntary motion may
be owing either to a morbid affection of the muscles or
organs of motion, by which they are rendered unfit
for motion; or to an interruption of the influx of the
nervous power into them, which is always necessary
to the motions of those that are under the power of
the will. The disease, from the first of these causes,
as consisting in an organic and local affection, we refer
entirely to the class of local diseases. I am here to
consider that disease only which depends upon the in-
terrupted influx of the nervous power; and it is to
this disease alone I would give the appellation of
Palsy. A disease depending on an interrupted influx
of the nervous power, may indeed often appear as
merely a local affection; but as it depends upon an
affection of the most general powers of the system, it
cannot be properly separated from the systematic af-
fections.
MCXLII.
In palsy, the loss of motion is often accompanied
with the loss of sense; but as this is not constantly the
case, and as therefore the loss of sense is not an essen-
tial 

OF PHYSIC. 89
tial symptom of palsy, I have not taken it into my defi-
nition (MCXL.); and I shall not think it necessary to
take any further notice of it in this treatise; because,
in so far as it is in any case a part of the paralytic af-
fection, it must depend upon the same causes, and
will be cured also by the very same remedies, as the
loss of motion.
MCXLIII. 
The palsy then, or loss of motion, which is to be
treated of here, may be distinguished as of two kinds;
one of them depending upon an affection of the origin
of the nerves in the brain, and the other depending
upon an affection of the nerves in some part of their
course between the brain and the organs of motion.
Of the latter, as appearing in a very partial affection,
I am not to speak particularly here; I shall only
treat of the more general paralytic affections, and es-
pecially of the hemiplegia (MCXL.) At the same time
I expect, that what I shall say upon this subject will
readily apply to both the pathology and practice in
the cases of affections more limited.
MCXLIV.
The hemiplegia (MCXL.) usually begins with, or
follows, a paroxysm of apoplexy; and when the he-
miplegia, after subsisting for some time, becomes fatal,
it is commonly by passing again into the state of apo-
plexy. The relation therefore or affinity between the
two diseases, is sufficiently evident; and it is further
strongly confirmed by this, that the hemiplegia comes
upon persons of the same constitution (MXCV.), and is
preceded by the same symptoms (MXCVIII.), that have
been taken notice of with respect to apoplexy.
MCXLV.
When a fit of apoplexy has gone off, and there re-
mains a state of palsy appearing as a partial affection
only, it might perhaps be supposed that the origin
of the nerves is in a great measure relieved; but in so
far
M
Vol. II.

90 PRACTICE
far as commonly there still remain the symptoms of
the loss of memory, and of some degree of fatuity,
these, I think, show, that the organ of intellect, or
the common origin of the nerves, is still considerably
affected.
MCXLVI.
Thus, the hemiplegia, from its evident connection
with, and near relation to, apoplexy, may be properly
considered as depending upon like causes; and con-
sequently, either upon a compression preventing the
slow of the nervous power from the brain into the or-
gans of motion, or upon the application of narcotic or
other powers (MCXV.) rendering the nervous power
unfit to flow in the usual and proper manner.
MCXLVII.
We begin with considering the cases depending upon
compression.
The compression occasioning hemiplegia may be of
the same kind, and of all the different kinds that pro-
duce apoplexy; and therefore either from tumour,
over distension, or effusion. The existence of tumour
giving compression, may often be better discerned in
the case of palsy than in that of apoplexy, as its effects
often appear at first in a very partial affection.
MCXLVII.
The other modes of compression, that is, of over-
distension and effusion, may, and commonly do, take
place, in hemiplegia: and when they do, their opera-
tion here differs from that producing apoplexy, by its
effects being partial, and on one side of the body only.
It may seem difficult to conceive that an over-dis-
tension can take place in the vessels on one side of the
brain only; but it may be understood: and in the case
of a palsy which is both partial and transitory, it is per-
haps the only condition of the vessels of the brain that
can be supposed. In a hemiplegia, indeed, which sub-
sists for any length of time, there is probably always
an 

OF PHYSIC.91
an effusion, either sanguine or serous: but it is likely
that even the latter must be supported by a remaining
congestion in the blood-vessels.
MCXLIX. 
That a sanguine effusion can happen without be-
coming very soon general, and thereby occasioning
apoplexy and death, may also seem doubtful: but dis-
sections prove that in fact it does happen occasioning
palsy only; though it is true, that this more com-
monly depends upon an effusion of serous fluid, and of
this only.
MCL.
Can a palsy, occasioned by a compression, remain
though the compression be removed*?
MCLI.
From what has been said MCXLIV. it will be obvious,
that the hemiplegia may be prevented by all the seve-
ral means proposed MCXXV. et. seq. for the prevention
of apoplexy.
MCLII.
Upon the same grounds, the CURE of palsy must be
very much the same with that of apoplexy (MCXXX.
et. seq.); and when palsy has begun as an apoplexy,
it is presumed, that, before it is to be considered as
palsy, all those several remedies have been employed.
Indeed, even when it happens that on the first attack
of the disease the apoplectic state is not very complete,
and that the very first appearance of the disease is as a
hemiplegia, the affinity between the two diseases
(MCXLIV.) is such as to lead to the same remedies in
both cases. This is certainly proper in all those cases
in which we can with much probability impute the dis-
ease
M 2
* This question may be answered in the affirmative; because the
structure of the nerve may be destroyed by the compression, and the
nerve may therefore remain impervious to the nervous influeunce, after
the compression has been removed.

92 PRACTICE
ease to compression; and it is indeed seldom that a
hemiplegia from internal causes comes on but with a
considerable affection of the internal, and even of the
external senses, together with other marks of a com-
pression of the origin of the nerves.
MCLIII.
Not only, however, where the disease can be im-
puted to compression, but even where it can be im-
puted to the application of narcotic powers, if the dis-
ease come on with the appearances mentioned at the
end of last paragraph, it is to be treated in the same
manner as an apoplexy by MCXXXI-MCXXXIX.
MCLIV.
The cure of hemiplegia, therefore, on its first at-
tack, is the same, or nearly the same, with that of apo-
plexy: and it seems requisite that it should be different
only, 1. When the disease has subsisted for some
time; 2. When the apoplectic symptoms, or those*
marking a considerable compression of the origin of
the nerves, are removed; and particularly, 3. When
there are no evident marks of compression, and it is at
the same time known that narcotic powers have been
applied.
MCLV.
In all these cases, the question arises. Whether sti-
mulants may be employed, or how far the cure may
be entirely trusted to such remedies? Upon this ques-
tion, with respect to apoplexy, I have offered my opi-
nion in MCXXXVI. And, with respect to hemiplegia,
I am of opinion, that stimulants are almost always e-
qually dangerous as in the cases of complete apo-
plexy; and particularly, 1. In all the cases of hemip-
legia succeeding to a paroxysm of complete apoplexy;
2. In all the cases coming upon persons of the temper-
ament
* The most infallible of these marks is, the intellectual faculties
not returning. 

OF PHYSIC. 93
ament mentioned in MXCV. and after the same antece-
dents as those of apoplexy, (MCXVI.) and 3. In all
the cases coming on with symptoms of apoplexy from
compression.
MCLVI.
It is, therefore, in the cases MCLIV. only, that stimu-
lants are properly admissible: And even in the two
first of these cases, in which a plethoric state of the
blood-vessels of the brain may have brought on the
disease, in which a disposition to that state may still conti-
nue, and in which even some degree of congestion may
still remain, the use of stimulants must be an ambiguous
remedy; so that perhaps it is in the third of these cases
only that stimulants are clearly indicated and admissible.
MCLVII.
These doubts with respect to the use of stimulants,
may perhaps be overlooked or disregarded by those
whp alledge that stimulants have been employed with
advantage even in those cases (MCLV.) in which I
have said they ought to be avoided.
MCLVIII.
To compromise this contrariety of opinion, I must
observe, that even in the cases of hemiplegia depend-
ing upon compression, although the origin of the nerves
be so much compressed as to prevent so full a flow of
the nervous power as is necessary to muscular motion,
yet it appears from the power of sense still remaining,
that the nerves are, to a certain degree, still previous;
and therefore it is probable that stimulants applied,
may excite the energy of the brain so much, as in
some measure to force open the compressed nerves,
and to show some return of motion in paralytic mus-
cles. Nay, further, it may be allowed, that if these
stimulants be such as act more upon the nervous than
upon the sanguiferous system, they may possibly be
employed without any very hurtful consequence.
MCLIX.

94 PRACTICE
MCLIX.
But still it will be obvious, that although certain
stimulants act chiefly upon the nervous system, yet
they also act always in some measure upon the sangui-
ferous; so that, when they happen to have the latter
effect in any considerable degree, they may certainly
do much harm; and in a disease which they do not
entirely cure, the mischief arising from them may
not be discerned.
MCLX.
Whilst the employment of stimulants is so often an
ambiguous practice, we may perhaps go some length
towards ascertaining the matter, by considering the
nature of the several stimulants which may be employ-
ed, and some of the circumstances of their administra-
tion. With this view therefore, I shall now mention
the several stimulants that have been commonly em-
ployed, and offer some remarks upon their nature and
use.
MCLXI.
They are in the first place to be distinguished as ex-
ternal or internal. Of the first kind, we again distin-
guish them as they are applied to particular parts of
the body only, or as they are more generally applied
to the whole system. Of the first kind are,
1. The concentrated acids of vitriol or nitre; in-
volved, however, in oily or unctious substances, which
may obviate their corrosive, without destroying their
stimulant power*.
2. The
* Rubefacient ointments are compositions like the following;
ꝶ. Axung. porcin. ℥ii.
Acid vitriol. ℥i.
M.
Or,
ꝶ. Unguent, basilic. flav. ℥ii.
Acid vitriol. 3i.
M.
They soon redden and inflame the skin; and, when this effect is pro- 

OF PHYSIC. 95
2. The volatile alkaline spirits, especially in their
caustic state; but involved also in oils, for the purpose
just now mentioned*.
3. The same volatile spirits are frequently employ-
ed by being held to the nose, when they prove a pow-
erful stimulus to the nervous system; but it is at the
same time probable, that they may also prove a strong
stimulant to the blood-vessels of the brain.
4. A brine, or strong solution of sea-salt†.
5. The essential oils of aromatic plants‡, or of their
parts.
6. The essential oils of turpentine, or of other such
resinous substances.
7. The distilled oils of amber, or of other bitumin-
ous fossils§.
8. The rectified empyreumatic oils of animal or ve-
getable substances‖.
9. Va-
duced, they must be taken off, and the part anointed with common
ointment, or with oil.
* The Linimenta volatilia of the Pharmacopœias are not so strong
as the following:
ꝶ. Alkal. volatil. caustic ℥i.
Ol. olivar, ℥ii,
M.
In the new London Pharmacopoeia this composition is called Li-
nimentum Ammoniae Fortius.
† The brine that remains in the salt-pans, after the common salt
is crystalized, is the most effectual of these briny stimulants; it is
called in Edinburgh Oil of Salt.
‡ The Ol. Origani is generally used. It ought to be mixed with
some unctuous oil, as in the following formula:
ꝶ. Ol Origan, ʒii.
Axung. porcin. ℥iv.
M.
The aromatic oils dissolved in spirits make an elegant application;
but the distilled spirits of the plants themselves are more in use.
§ They are generally used with hog's-lard, in the proportion of
eight times their quantity of lard. Some practitioners, however,
take only twice the quantity of lard; but they are not so effectual
as some of the rubefacients above enumerated,
‖ The use of these empyreumatic oils is not so frequent now as

96 PRACTICE
9. Various vegetable acrids, particularly mustard*.
10. The acrid matter found in several insects, par-
ticularly cantharides†.
Some of these stimulants may be either applied in
substance; or may be dissolved in ardent spirits, by
which their stimulant power may be increased, or
more conveniently applied.
MCLXII.
The greater part of the substances now enumerated
show their stimulant power by inflaming: the skin of
the part to which they are applied; and when their
application is so long continued as to produce this ef-
fect; it interrupts the continuance of their use; and
the inflammation of the part does not seem to do so
much good as the frequent repetition of a more mode-
rate stimulus.
MCLXIII.
Analogous to these stimulants is the stinging of net-
tles, which has been frequently recommended.
Among the external stimulants, the mechanical one
of friction with the naked hand, the flesh-brush, or
flannel, is justly to be reckoned. Can the impregna-
tion of the flannels to be employed, with the fumes
of burning mastic, olibanum, &c. be of any service‡?
MCLXV.
formerly; they are extremely acrid, and if not used with caution,
often corrode the skin
* The form, in which the flour of mustard is used, is called a si-
napism. It is mixed with an equal quantity of bread-crumb or oat-
meal, and made into a paste with vinegar. Some practitioners add
bruised garlic, in the proportion of one fourth of the quantity of mu-
stard; bit it is extremely offensive, and the cataplasm without it an-
swers sufficiently well.
† These infects are the basis of blistering plasters and ointments.
‡ Many practitioners have thought that such impregnations have
been of singular service. The fumes of most of these resins are ei-
ther flowers, as they are called in the shops, or essential oils, both
of which are stimulating, and may therefore be supposed to be active.
The impregnating flannels or flesh-brushes with flour of mustard is
often used, and assists considerably in bringing on an inflammation.

OF PHYSIC. 97
MCLXIV.
With respect to the whole of these external stimu-
lants, it is to be observed, that they affect the part to
Which they are applied much more than they do the
whole system, and they are therefore indeed safer in
ambiguous cases; but, for the same reason, they are
of less efficacy in curing a general affection.
MCLXV.
The external applications which may be applied to
affect the whole system, are the powers of heat and
cold, and of electricity.
Heat, as one of the most powerful stimulants of the
animal œconomy, has been often employed in palsies,
especially by warm bathing. But as, both by stimu-
lating the solids and rarefying the fluids, this proves a
strong stimulus to the sanguiferous system, it is often
an ambiguous remedy; and has frequently been ma-
nifestly hurtful in palsies depending upon a congestion
of blood in the vessels of the brain. The most certain,
and therefore the most proper use of warm bathing
in palsies, seems to be in those that have been occasi-
oned by the application of narcotic powers. Are the
natural baths more useful by the matters with which
they may be naturally impregnated*.
MCLXVI.
Cold applied to the body for any length of time, is
always hurtful to paralytic persons: but if it be not
very intense, nor the application long continued, and
if at the same time the body be capable of a brisk reac-
tion,
Vol. II. 
N
* The natural baths contain so small a quantity of impregnating
substances as induces us to suspect that they cannot have any benefi-
dial powers superior to those of ordinary warm baths.
The use of warm baths ought not to be promiscuous. In cases of
palsies, arising from certain poisons, as the fumes of arsenic or metals.
and their ores; the warm baths seldom fail of procuring relief; and
some instances have been given by authors, of complete cures having
been performed by the use of baths alone. 

98 PRACTICE
tion, such an application of cold is a powerful stimu-
lant of the whole system, and has often been useful in
curing palsy. But, if the power of reaction in the bo-
dy be weak, any application of cold may prove very
hurtful†.
MCLXVII.
Electricity, in a certain manner applied, is certain-
ly one of the most powerful stimulants that can be em-
ployed to act upon the nervous system of animals;
and therefore much has been expected from it in the
cure of palsy. But, as it stimulates the sanguiferous
as well as the nervous system, it has been often hurt-
ful in palsies depending upon a compression of the
brain; and especially when it has been so applied as
to act upon the vessels of the head. It is safer when
its operation is confined to particular parts somewhat
remote from the head; and, further, as the operation
of electricity, when very strong, can destroy the mobi-
lity of the nervous power. I am of opinion, that it
is always to be employed with caution, and that it is
only safe when applied with moderate force, and when
confined to certain parts of the body remote from the
head. It is also my opinion, that its good effects are
to be expected from its repetition rather than from
its force, and that it is particularly suited to the cure
of those palsies which have been produced by the ap-
plication of narcotic powers.
MCLXVIII.
Amongst the remedies of palsy, the use of exercise
is not to be omitted. In a hemiplegia, bodily exer-
cise cannot be employed; and in a more limited af-
fection, if depending upon a compression of some part
of the brain, it would be an ambiguous remedy; but,
in
* The very great uncertainty of the power of reaction always
makes the application of cold a very doubtful remedy; and, as it is
evidently hurtful, wherever the reaction is weak, it ought to be used
with extreme caution.

OF PHYSIC. 99
in all cases where the exercises of gestation can be em-
ployed, they are proper; as, even in cases of compres-
sion, the stimulus of such exercise is moderate, and
therefore safe; and, as it always determines to the
surface of the body, it is a remedy in all cases of in-
ternal congestion.
MCLXIX.
The internal stimulants employed in palsy are vari-
ous, but chiefly the following.
1. The volatile alkaline salts, or spirits, as they are
called, are very powerful and diffusive stimulants, ope-
rating especially on the nervous system*; and even al-
though they operate on the sanguiferous, yet, if given
in frequently repeated small rather than in large doses,
their operation being transitory, is tolerably safe.
2. The vegetables of the class named Tetradyna-
mia, are many of them powerful diffusive stimulants;
and at the same time, as quickly passing out of the bo-
dy, and therefore of transitory operation, they are of-
ten employed with safety†. As they commonly prove
diuretic, they may in this way also be of service in
some cases of serous palsy.
3. The
N 2
* Of these there are several formulae in the shops, as, Spiritus vo-
latilis aromaticus, Spiritus volatilis oleosus, Spiritus salinus aromati-
cus. Their dose is from ten to sixty drops, The Eau de Luce
ought to be mentioned here, though it is seldom used internally, but
only for smelling to, as it is extremely penetrating. It is prepared
thus: mix together in a retort forty drops of rectified oil of amber,
an ounce of rectified spirit of wine, and twelve ounces of the strong-
est caustic volatile alkali. They must be distilled with a very mode-
rate fire. It is seldom limpid, but has a milky appearance, owing to
the imperfect solution of the oil in the spirit; and, if the alkali be
not very caustic, scarcely any of the oil is dissolved.
† White mustard-seeds may be given whole, in the quantity of two
tea-spoonfuls in half a tea-cupful of cold water. They ought to be
swallowed whole, that their acrid taste may not be perceived. The
dose may be repeated twice or thrice a-day. Horse-radish is another
plant of this class of vegetables, that has been much recommended;
it must be given in a cold watery infusion, or in an infusion of ale.

100 PRACTICE
3. The various aromatics, whether employed in
substance, in tincture, or in their essential oils, are of-
ten powerful stimulants; but being more adhesive and
inflammatory than those last mentioned, they are
therefore, in all ambiguous cases, less safe*.
4. Some other acrid vegetables have been employ-
ed; but we are not well acquainted with their peculiar
virtues, or proper use.
5. Some resinous substances, as guaiacum, and the
terebinthinate substances, or their essential oils, have
been, with some probability, employed; but they are
apt to become inflammatory. Decoctions of guaia-
cum, and some other sudorifics, have been directed to
excite sweating by the application of the fumes of
burning spirit of wine in the laconicum, and have in
that way been found useful.
6. Many of the fetid antispasmodic medicines have
been frequently employed in palsy; but I do not per-
ceive in what manner they are adapted to the cure
of this disease, and I have not observed their good ef-
fects in any cases of it.
7. Bitters, and the Peruvian bark, have also been
employed; but with no propriety or advantage that I
can perceive†.
MCLXX.
The scurvy-grass is another of the same class; it may be eaten raw,
or we may give forty or fifty drops of the Spiritus cochleariae, either
on a piece of sugar, or mixed with half an ounce of syrup, four or
five times a-day. This spirit ought to be kept well corked, as it
soon loses its activity, if it be exposed to the air.
* The aromatics best adapted for stimulating, in these cases, are
such as Linne calls spirantia; the chief of them are Marum, Rosema-
ry, Lavender, &c. Their spiritous waters are much more effica-
cious than the plants in substance, or in any other form; and their
efficacy is considerably increased by uniting them to volatile spirits,
as in some of the formulae mentioned in the note on par. 1169, 1. 6,
at the word system.
† In some cases, paralytic patients, for want of exercise, sink in-
to a state of debility, with loss of appetite, and consequent emacia-

OF PHYSIC. 101
MCLXX.
With respect to the whole of these internal stimu-
lants, it is to be observed, that they seldom prove very
powerful; and wherever there is any doubt concern-
ing the nature or state of the disease, they may readi-
ly do harm, and are often therefore of ambiguous use.
BOOK II.
OF ADYNAMIÆ;
OR
DISEASES CONSISTING IN A WEAKNESS OR
LOSS OF MOTION IN EITHER THE VITAL
OR NATURAL FUNCTIONS.
CHAP. I.
OF SYNCOPE OR FAINTING.
MCLXXI.
THIS is a disease in which the action of the heart
and respiration become considerably weaker
than usual, or in which for a certain time these func-
tions cease altogether.
MCLXXII.
Physicians having observed that this affection oc-
curs in different degrees, have endeavoured to distin-
guish these by different appellations: but as it is not
possible to ascertain these different degrees with any
precision,
tion, in which bitters, peruvian bark, and other tonics, are frequently
of some advantage. 

102 PRACTICE
precision, so there can be no strict propriety in em-
ploying those different names; and I shall here com-
prehend the whole of the affections of this kind un-
der the title of Syncope.
MCLXXIII.
This disease sometimes comes on suddenly to a con-
siderable degree, but sometimes also it comes on gra-
dually; and in the latter case, it usually comes on
with a sense of langour, and of anxiety about the
heart, accompanied at the same time, or immediately
after, with some giddiness, dimness of sight, and sound-
ing in the ears. Together with these symptoms, the
pulse and respiration become weak; and often so weak,
that the pulse is scarcely to be felt, or the respiration
to be perceived; and sometimes these motions, for a
certain time, cease altogether. While these symp-
toms take place, the face and whole surface of the bo-
dy become pale, and more or less cold according to
the degree and duration of the paroxysm. Very
commonly, at the beginning of this, and during its
continuance, a cold sweat appears, and perhaps conti-
nues, on the fore-head, as well as on some other parts
of the body. During the paroxysms, the animal
functions, both of sense and motion, are always in some
degree impaired, and very often entirely suspended.
A paroxysm of syncope is often, after some time, spon-
taneously recovered from; and this recovery is gene-
rally attended with a sense of much anxiety about the
heart.
Fits of syncope are frequently attended with, or end
in, vomiting; and sometimes with convulsions, or an
epileptic fit.
MCLXXIV.
These are the phenomena in this disease; and from
every view of the greatest part of them, there cannot
be a doubt that the proximate cause of this disease is
a very weak or a total ceasing of the action of the
heart. 

OF PHYSIC. 103
heart. But it will be a very difficult matter to explain
in what manner the several remote causes operate in
producing the proximate cause. This, however, I
shall attempt, though with that diffidence which be-
comes me in attempting a subject that has not hither-
to been treated with much success.
MCLXXIV†.
The remote cause of syncope may, in the first place,
be referred to two general heads. The one is, of
those causes existing and acting in the brain, or in
parts of the body remote from the heart, but acting
upon it by the intervention of the brain. The other
general head of the remote causes of syncope, is of
those existing in the heart itself, or in parts very im-
mediately connected with it, and thereby acting more
directly upon it in producing this disease.
MCLXXV. 
In entering upon the consideration of the first set of
those causes (MCLXXIV.), I must assume a proposition
which I suppose to be fully established in physiology.
It is this: That, though the muscular fibres of the
heart be endowed with a certain degree of inherent
power, they are still, for such action as is necessary to
the motion of the blood, very constantly dependent
upon a nervous power fent into them from the brain‡.
At least this is evident, that there are certain powers
acting primarily, and perhaps only in the brain, which
influence and variously modify the action of the heart.
I sup-
† The Paragraphs were thus numbered in the last edition.
‡ The author here differs somewhat in opinion from other physio-
logists. He allows, indeed, that the heart possesses a vis insita in s
certain degree,; but he will not allow this vis insita to be sufficient-
ly strong for carrying on the circulation; and he thinks that some
energy must; be imparted to the heart from the brain, in order to en-
able that important muscle to perform its office.
In support of this opinion, we have a plain fact, which the author
might have adduced, viz. that a ligature on the nerves going to the
heart immediately stops its motions.

104 PRACTICE
I suppose, therefore, a force very constantly during
life exerted in the brain, with respect to the moving
fibres of the heart, as well as of every part of the body:
which force I shall call the energy of the brain; and
which I suppose may be, on different occasions, strong-
er or weaker with respect to the heart.
MCLXXVI.
Admitting these propositions, it will be obvious,
that if I can explain in what manner the first set of
remote causes (MCLXXIV.) diminish the energy of the
brain, I shall at the same time explain in what manner
these causes occasion a syncope.
MCLXXVII.
To do this, I observe, that one of the most evident
of the remote causes of syncope is a hemorrhagy, or
an evacuation of blood, whether spontaneous or artisi-
cial. And as it is very manifest that the energy of
the brain depends upon a certain fulness and tension
of its blood-vessels, for which nature seems to have in-
dustriously provided by such a conformation of those
blood-vessels as retards the motion Of the blood both
in the arteries and veins of the brain; so we can rea-
dily perceive, that evacuations of blood, by taking off
the fullness and tension of the blood-vessels of the
brain, and thereby diminishing its energy with respect
to the heart, may occasion a syncope. In many per-
son, a small evacuation of blood will have this effect;
and in such cases there is often a clear proof of the
manner in which the cause operates, from this circum-
stance, that the effect can be prevented by laying the
body in a horizontal posture; which, by favouring the
afflux of the blood by the arteries, and retarding the
return of it by the veins, preserves the necessary ful-
ness of the vessels of the brain.
It is farther to be remarked here, that not only an
evacuation of blood occasions syncope, but that even a
change in the distribution of the blood, whereby a
larger 

OF PHYSIC. 105
larger portion of it flows into one part of the system
of blood-vessels, and consequently less into others,
may occasion a syncope. It is thus I explain the syn-
cope that readily occurs upon the evacuation of hy-
dropic waters, which had before filled the cavities of
the abdomen or thorax. It is thus also I explain the
syncope that sometimes happens on blood-letting, but
which does not happen till the ligature which had been
employed is united, and admits a larger afflux of blood
into the blood-vessels of the arm. Both these cases of
syncope show, that an evacuation of blood does not
always occasion the disease by any general effect on
the whole system, but often merely by taking off the
requisite fulness of the blood-vessels of the brain.
MCLXXVIII.
The operation of some others of the remote causes
of syncope, may be explained on the following princi-
ples. Whilst the energy of the brain is, upon differ-
ent occasions, manifestly stronger or weaker, it seems
to be with this condition, that a stronger exertion of it is
necessarily followed by a weaker state of the same. It seems
to depend upon this law in the constitution of the ner-
vous power, that the ordinary contraction of a muscle
is always alternated with a relaxation of the same;
that, unless a contraction proceeds to the degree of
spasm, the contracted state cannot be long continued;
and it seems to depend upon the same cause that the
voluntary motions, which always require an unusual
increase of exertion, and occasion fatigue, debility, and
at length irresistible sleep.
From this law, therefore, of the nervous power, we
may understand why a sudden and violent exertion
of the energy of the brain is sometimes followed by
such a diminution of it as to occasion a syncope; and
it is thus I suppose that a violent fit of joy produces
syncope, and even death. It is upon the same princi-
ple also, I suppose, that an exquisite pain may some-
times excite the energy of the brain more strongly
than
Vol. II. 
O  

106 PRACTICE
than can be supported, and is therefore followed by
such a diminution as must occasion fainting. But
the effect of this principle appears more clearly in
this, that a fainting readily happens upon the sudden
remission of a considerable pain; and thus I have seen
a fainting occur upon the reduction of a painful dislo-
cation.
MCLXXIX.
It seems to be quite analogous when a syncope im-
mediately happens on the finishing of any great and
long-continued effort, whether depending on the will,
or upon a propensity; and in this way a fainting
sometimes happens to a woman on the bearing of a
child. This may be well illustrated by observing, that
in persons already much weakened, even a very mode-
rate effort will sometimes occasion fainting.
MCLXXX.
To explain the operation of some other causes of
syncope, it may be observed, that as the exertions of
the energy of the brain are especially under the influ-
ence of the will, so it is well known that those modifi-
cations of the will which are named Passions and Emo-
tions, have a powerful influence on the energy of the
brain in its actions upon the heart, either in increasing
or diminishing the force of that energy. Thus, anger
has the former, and fear the latter effect; and thence
it may be understood how terror often occasions a syn-
cope sometimes of the most violent kind, named As-
phyxia,and sometimes death itself.
MCLXXXI.
As, from what I have just mentioned, it appears,
that the emotions of desire increase, and those of aver-
sion diminish, the energy of the brain; so it may be
understood, how a strong aversion, a horror, or the
feeling which arises upon the sight of a very disagreea-
ble object, may occasion fainting. As an example of
this, I have known more than one instance of a person's
fainting at the sight of a sore in another person.
MCLXXXII. 

OF PHYSIC. 107
MCLXXXII.
To this head of horror and disgust, I refer the ope-
ration of those odours which in certain persons occa-
sion syncope. It may be supposed, that those odours
are endowed with a directly sedative power, and may
thereby occasion syncope; but they are, many of them,
with respect to other persons, evidently of a contrary
quality; and it appears to me, that those odours occa-
sion syncope only in those persons to whom they are
extremely disagreeable.
MCLXXXIII.
It is, however, very probable, that among the caus-
es of syncope, there are some which, analogous to all
those we have already mentioned, ad by a directly se-
dative power: and such may either be diffused in the
mass of blood, and thereby communicated to the
brain; or may be only taken into the stomach, which
so readily and frequently communicates its affections
to the brain.
MCLXXXIV.
Having now enumerated, and, as I hope, explained,
the most part of the remote causes of syncope, that
either operate immediately upon the brain, or whose
operation upon other parts of the body is communi-
cated to the brain, it is proper to observe, that the
most part of these causes operate upon certain persons
more readily and more powerfully than upon others;
and this circumstance, which may be considered as the
predisponent cause of syncope, deserves to be inquired
into.
It is, in the first place, obvious, that the operation
of some of those causes depends entirely upon an idio-
syncrasy in the persons upon whom they operate;
which, however, I cannot pretend to explain. But,
in the next place, with respect to the greater part of
the other causes, their effects seem to depend upon a
temperament which is in one degree or other in com-
mon
O 2 

108 PRACTICE
mon to many persons. This temperament seems to
consist in a great degree of sensibility and mobility,
arising from a state of debility, sometimes depending
upon original conformation, and sometimes produced
by accidental occurrences in the course of life.
MCLXXXV.
The second set of the remote causes of syncope
(MCLXXIV.), or those acting directly upon the heart
itself, are certain organic affections of the heart itself,
or of the parts immediately connected with it, parti-
cularly the great vessels which pour blood into or
immediately receive it from the cavities, of the heart.
Thus a dilatation or aneurism of the heart, a polypus
in its cavities, abscesses or ulcerations in its substance,
a close adherence of the pericardium to the surface of
the heart, aneurisms of the great vessels near to the
heart, polypus in these, and ossifications in these or in
the valves of the heart, are one or other of them condi-
tions which, upon dissection, have been discovered in
those persons who had before laboured under frequent
syncope.
MCLXXXVI.
It is obvious, that these conditions are all of them,
either such as may, upon occasion, disturb the free and
regular influx into, or the free egress of the blood
from, the cavities of the heart; or such as may other-
wise disturb its regular action, by sometimes interrupt-
ing it, or sometimes exciting it to more violent and
convulsive action. The latter is what is named the
Palpitation of the Heart, and it commonly occurs in
the same persons who are liable to syncope.
MCLXXXVII.
It is this, as I judge, that leads us to perceive in
what manner these organic affections of the heart and
great vessels may occasion syncope: for it may be
supposed, that the violent exertions made in palpita-
tions may either give occasion to an alternate great
relax- 

OF PHYSIC. 109
relaxation, (MCLXXVIII.) or to a spasmodic contrac-
tion; and in either way suspend the action of the
heart, and occasion syncope it seems to me probable,
rhat it is a spasmodic contraction of the heart that oc-
casions the intermission of the pulse so frequently ac-
companying palpitation and syncope.
MCLXXXVIII.
Though it frequently happens that palpitation and
syncope arise, as we have said, from the organic affec-
tions above mentioned, it is proper to observe, that
diseases even when in a violent degree, do not always
depend oh such causes acting directly on the heart,
but are often dependent on some of those causes
which we have mentioned, above as acting primarily
on the brain.
MCLXXXIX.
I have thus endeavoured to give the pathology of
syncope; and of the cure I can treat very shortly.
The cases of syncope depending on the second set
of causes, (MCLXXIV.) and fully recited in MCLXXXV.
I suppose to be generally incurable; as our art, so far
as I know, has not yet taught us to cure any of those
several causes of syncope (MCLXXXV.)
The cases of syncope depending on the first set of
causes, (MCLXXIV.) and whole operation I have endea-
voured to explain in MCLXXVII. et seq. I hold to be
generally curable, either by avoiding the several occa-
sional causes there pointed out, or by correcting the
predisponent causes (MCLXXXIV.) The latter, I think,
may generally be done by correcting the debility or
mobility of the system, by the means which I have al-
ready had occasion to point out in another place*.
CHAP.
* See Article 217, &c. 

110
PRACTICE
CHAP. II.
OF DYSPEPSIA, OR INDIGESTION.
MCXC.
A WANT of appetite, a squeamishness, sometimes
a vomiting, sudden and transient distentions of the
stomach, eructations of various kinds, heartburns, pain
in the regions of the stomach, and a bound belly, are symp-
toms which frequently concur in the same person, and
therefore may be presumed to depend upon one and
the same proximate cause. In both views, therefore,
they may be considered as forming one and the fame
disease, to which we have given the appellation of
Dyspepsia, set at the head of this chapter.
MCXCI.
But as this disease is also frequently a secondary and
sympathic affection, so the symptoms above-mentioned
are often joined with many others; and this has given
occasion to a very confused and undetermined descrip-
tion of it, under the general title of Nervous Diseases,
or under that of Chronic Weakness. It is proper,
however, to distinguish; and I apprehend the symp-
toms enumerated above are those essential to the idio-
pathic affection I am now to treat of.
MCXCII.
It is indeed to be particularly observed, that these
symptoms are often truly accompanied with a certain
state of mind which may be considered as a part of
the idiopathic affection: but I shall take no further
notice of this symptom in the present chapter, as it
will be fully and more properly considered in the next,
under the title of Hypochondriasis.
MCXCIII.
That there is a distinct disease attended always with
a greater 

OF PHYSIC. 111
a greater part of the above symptoms, is rendered
very probable by this, that all these several symp-
toms may arise from one and the same cause; that is,
from an imbecility, loss of tone, and weaker action in
the muscular fibres of the stomach: and I conclude
therefore, that this imbecility may be considered as the
proximate cause of the disease I am to treat of under
the name of Dyspepsia.
MCXCIV.
The imbecility of the stomach, and the consequent
symptoms (MCXC.) may, however, frequently depend
upon some organic affection of the stomach itself, as
tumour, ulcer, or scirrhosity; or upon some affection
of other parts of the body communicated to the sto-
mach, as in gout, amenorrhœa, and some others. In
all these cases, however, the dyspeptic symptoms are
to be considered as secondary or sympathic affections,
to be cured only by curing the primary disease.—
Such secondary and sympathic cases cannot, indeed,
be treated of here; but as I presume that the imbeci-
lity of the stomach may often take place without ei-
ther any organic affection of this part, or any more
primary affection in any other part of the body; so I
suppose and expect it will appear, from the considera-
tion of the remote causes, that the dyspepsia may be
often an idiopathic affection, and that it is therefore
properly taken into the system of methodical Nosology,
and becomes the subject of our consideration here.
MCXCV.
There can be little doubt, that in most cases, the
weaker action of the muscular fibres of the stomach,
is the most frequent and chief cause of the symptoms
mentioned in MCXC.; but I dare not maintain it to be
the only cause of idiopathic dyspepsia. There is,
pretty certainly, a peculiar fluid in the stomach of ani-
mals, or at least a peculiar quality in the fluids, that
we know to be there, upon which the solution of the 
ali-

112 PRACTICE
aliments taken into the stomach chiefly depends: and
it is at the same time probable, that the peculiar quali-
ty of the dissolving or digesting fluids may be various-
ly changed, or that their quantity may be, upon occa-
fion, diminished. It is therefore sufficiently probable,
that a change in the quality or quantity of these fluids
may produce a considerable difference in the pheno-
mena of digestion, and particularly may give occasion
to many of the morbid appearances mentioned in
MCXC.
MCXCVI.
This seems to be very well founded, and points out
another proximate cause of dyspepsia beside that we
have already assigned: But, notwithstanding this, as
the peculiar nature of the digestive fluid, the changes
which it may undergo, or the causes by which it may
be changed, are all matters so little known, that I can-
not found any practical doctrine upon any supposition
with respect to them; and as, at the same time, the im-
becility of the stomach, either as causing the change in
the digestive fluid, or as being induced by that change,
seems always to be present, and to have a great share in
occasioning the symptoms of indigestion; so I shall still
consider the imbecility of the stomach as the proximate
and almost sole cause of dyspepsia. And I more rea-
dily admit of this manner of proceeding ; as, in my
opinion, the doctrine applies very fully and clearly to
the explaining the whole of the practice which expe-
rience has established as the most successful in this
disease.
MCXCVII.
Considering this, then, as the proximate cause of
dyspepsia, I proceed to mention the several remote
causes of this disease; as they are such, as, on differ-
ent occasions, seem to produce a loss of tone in the
muscular fibres of the stomach. They may, I think,
be considered under two heads. The first is, of those
which 

OF PHYSIC. 113
which act directly and immediately upon the stomach
itself: The second is, of those which act upon the
whole body, or particular parts of it, but in conse-
quence of which the stomach is chiefly or almost only
affected.
MCXCVIII.
Of the first kind are,
1. Certain sedative or narcotic substances taken
into the stomach; such as tea, coffee, tobacco, ar-
dent spirits, opium, bitters, aromatics, putrids, and
acescents.
2. The large and frequent drinking of warm water,
or of warm watery liquids.
3. Frequent surfeit, or immoderate repletion of the
stomach.
4. Frequent vomiting whether spontaneously aris-
ing, or excited by art.
5. Very frequent spitting, or rejection of saliva.
MCXCIX.
Those causes which act upon the whole body, or
upon particular parts and functions of it, are,
1. An indolent and sedentary life.
2. Vexation of mind, and disorderly passions of any
kind.
3. Intense study, or close application to business
too long continued.
4. Excess in venery.
5. Frequent intoxication; which partly belongs to
this head, partly to the former.
6. The being much exposed to moist and cold air
when without exercise.
MCC.
Though the disease, as proceeding from the last set
of causes, may be considered as a symptomatic affec-
tion only; yet as the affection of the stomach is gene-
rally the first, always the chief, and often the only ef-
fect which these causes produce or discover, I think
the affection of the stomach may be considered as the
disease
Vol. II. 
P  

114 PRACTICE
disease to be attended to in practice; and the more
properly so, as in many cases the general debility is
only to be cured by restoring the tone of the stomach,
and by remedies first applied to this organ.
MCCI.
For the cure of this disease, we form three several
indications; a preservative, a palliative, and a curative.
The first is, to avoid or remove the remote causes
just now enumerated.
The second is, to remove those symptoms which
especially contribute to aggravate and continue the
disease. And,
The third is, to restore the tone of the stomach;
that is, to correct or remove the proximate cause of
the disease.
MCCII.
The propriety and necessity of the first indication
is sufficiently evident, as the continued application,
or frequent repetition of those causes, must continue
the disease; may defeat the use of the remedies; or,
in spite of these, may occasion the recurrence of the
disease. It is commonly the neglected of this indication
which renders this disease so frequently obstinate.-
How the indication is to be executed, will be suffici-
ently obvious from the consideration of the several
causes: but it is proper for the practitioner to attend
to this, that the execution is often exceedingly diffi-
cult, because it is not easy to engage men to break in
upon established habits, or to renounce the pursuit of
pleasure; and particularly, to persuade men that these
practices are truly hurtful which they have often
practised with seeming impunity.
MCCIII.
The symptoms of this disease which especially con-
tribute to aggravate and continue it, and therefore
require to be more immediately corrected or removed,
are, first, the crudities of the stomach already produc-
ed 

OF PHYSIC. 115
ed by the disease, and discovered by a loss of appetite,
by a sense of weight and uneasiness in the stomach, and
particularly by the eructation of imperfectly digested
matters.
Another symptom to be immediately corrected, is
an unusual quantity, or a higher degree than usual, of
acidity present in the stomach, discovered by various
disorders in digestion, and by other effects to be menti-
oned afterwards.
The third symptom aggravating the disease, and
otherwise in itself urgent, is costiveness, and therefore
constantly requiring to be relieved.
MCCIV.
The first of these symptoms is to be relieved by ex-
citing vomiting; and the use of this remedy, therefore,
usually and properly begins the cure of this disease.
The vomiting may be excited by various means, more
gentle or more violent. The former may answer the
purpose of evacuating the contents of the stomach:
but emetics, and vomiting, may also excite the ordi-
nary action of the stomach; and both, by variously
agitating the system, and particularly by determining
to the surface of the body, may contribute to remove
the causes of the disease. But these latter effects can
only be obtained by the use of emetics of the more
powerful kind, such as the antimonial emetics especi-
ally are*.
MCCV.
The second symptom to be palliated, is an excess of
acidity, either in quantity or quality, in the contents
of the stomach. In man there is a quantity of acescent
aliments almost commonly taken in, and, as I think,
always undergoes an acetous fermentation in the sto-
mach; and it is therefore that, in the human stomach,
and
P 2
* The formulae and doses of antimonial emetics have been defer describ-
ed in a note on Article 185. 

116 PRACTICE
and in the stomachs of all animals using vegetable
food, there is always found an acid present. The a-
cid, however, is generally innocent, and occasions no
disorder, unless either the quantity of it is large, or the
acidity proceeds to a higher degree than usual. But,
in either of these cases, the acid occasions various dis-
orders, as flatulency, eructation, heartburn, gnawing
pains of the stomach, irregular appetites and cravings,
looseness, griping, emaciation, and debility. To ob-
viate or remove these effects aggravating and continu-
ing the disease, it is not only necessary to correct the
acid present in the stomach; but, especially as this a-
cid proves a ferment determining and increasing the
acescency of the aliments afterwards taken in, it is pro-
per also, as soon as possible, to correct the disposition
to excessive acidity.
MCCVI.
The acidity present in the stomach may be corred-
ed by the use of alkaline salts, or absorbent earths*;
or
* No part of the practice of physic requires more caution than
the administering alkaline salts, and absorbent earths. The alkaline
salts, by their caustic quality, corrode the stomach, and blunt its ac-
tion, when taken in too large quantities; and especially if, from a
mistaken diagnosis, no acid is in the stomach.
Lime-water is certainly preferable to the alkaline salts; its dose
may vary from two to four ounces twice a-day, according to the ur-
gency of the case.
The absorbent earths, as chalk, crabs eyes, &c. if they do not
meet with an acid, are apt to concrete into a hard indissoluble mass,
by the mucus of the stomach.
Magnesia is doubtless, in many cases, preferable to the calcareous
earth; when, on account of its purgative quality, we cannot conti-
nue its use. Chalk is preferable to the testaceous powders, because
it is free from that glutinous substance with which testaceous powders
abound, and which the more readily disposes them to concrete in the
stomach. The dose of magnesia is from ℈i. to ʒi. twice or thrice
a-day; and its purgative quality may, in many cases, be prevented,
by adding to each dose of it ten or fifteen grains of rhubarb, and five
or six drops of oil of anise-seed. 

OF PHYSIC. 117
or by such substances, containing these, as can be de-
composed by the acid of the stomach. Of the alka-
lines, the caustic is more effectual than the mild; and
this accounts for the effects of lime-water. By em-
ploying absorbents, we avoid the excess of alkali,
which might sometimes take place. The absorbents
are different, as they form a neutral more or less laxa-
tive; and hence the difference between magnesia alba
and other absorbents. It is to be observed, that alka-
lines and absorbents may be employed to excess; as
when employed in large quantity, they may deprive
the animal fluids of the acid necessary to their proper
composition.
MCCVII.
The disposition to acidity may be obviated by a-
voiding acescent aliments, and using animal-food little
capable of acescency. This, however, cannot be long
continued without corrupting the state of our blood;
and as vegetable food cannot be entirely avoided, the
excess of their acescency may in some measure be a-
voided, by choosing vegetable food the least disposed
to a vinous fermentation, such as leavened bread and
well fermented liquors, and, instead of fresh native
acids, employing vinegar.
MCCVIII.
The acid arising from acescent matters in a sound
state of the stomach, does not proceed to any high de-
gree, or is again soon involved and made to disappear:
but
The Decoctum cretaceum of the Edinburgh Pharmacopœia is a
good form for the exhibition of chalk. But chalk may be given
with ihubarb and oil of anise-feeds, like magnesia. The Trochisci
ecreta is a convenient form for giving the chalk, had the crabs eyes
been omitted. The following antacid troches are both effectual and
pleasant:
ꝶ. Magnes. alb. vi.
Sacch. alb. ʒiii.
Nuc. mosch. ℈ii.
M. f. trochisci cum mucilagin gum tragacanth. q.s. 

118 PRACTICE
but this does not always happen; and a more copious
acidity, or a higher degree of it, may be produced,
either from a change in the digestive fluids, become
less fit to moderate fermentation and to cover acidi-
ty, or from their not being supplied in due quantity.
How the former may be occasioned, we do not well
understand; but we can readily perceive that the lat-
ter, perhaps the former also, may proceed from a
weaker action of the muscular fibres of the stomach.
In certain cases, sedative passions, immediately after
they arise, occasion the appearance of acidity in the
stomach which did not appear before; and the life of
stimulants often corrects or obviates an acidity that
would otherwise have appeared. From these con-
siderations, we conclude, that the production and sub-
sistence of acidity in the stomach, is to be especial-
ly prevented by restoring and exciting the proper ac-
tion of it, by the several means to be mentioned here-
after.
MCCIX.
But it is also to be further observed, that though
there are certain powers in the stomach for preventing
a too copious acidity, or a high degree of it, they are
not however always sufficient for preventing acescen-
cy, or for covering the acidity produced; and there-
fore, as long as vegetable substances remain in the sto-
mach, their acescency may go on and increase. From
hence we perceive, that a special cause of the excess
of acidity may be, the too long retention of the aces-
cent matters in the stomach; whether this may be
from these matters being of more difficult solution, or
from the weakness of the stomach more slowly dis-
charging its contents into the duodenum, or from some
impediment to the free evacuation of the stomach by
the pylorus. The latter of these causes we are well
acquainted with, in the case of a scirrhous pylorus,
producing commonly the highest degree of acidity.
In

OF PHYSIC. 119
In all the instances of this scirrhosity I have met with,
I have found it incurable: but the first of these causes
is to be obviated by avoiding such aliments as are of
difficult solution; and the second is to be mended by the
several remedies for exciting the action of the stomach,
to be mentioned afterwards.
MCCX.
The third symptom commonly accompanying dys-
pepsia, which requires to be immediately removed, is
costiveness. There is so much connection between
the several portions of the alimentary canal with re-
spect to the peristaltic motion, that, if accelerated or
retarded in any one part, the other parts of it are
commonly affected in the same manner. Thus, as the
brisker action of the stomach must accelerate the acti-
on of the intestines, so the slower action of the intes-
tines must in some measure retard that of the sto-
mach. It is therefore of consequence to the proper
adion of the stomach, that the peristaltic motion of
the intestines determining their contents downwards,
be regularly continued; and that all costiveness, or
interruption of that determination, be avoided. This
may be done by the various means of exciting the
action of the intestines: but it is to be observed here,
that as every considerable evacuation of the intestines
weakens their action, and is ready therefore to induce
costiveness when the evacuation is over; so those pur-
gatives which produce a large evacuation, are unfit for
correcting the habit of costiveness. This, therefore,
should be attempted by medicines, which do no more
than solicit the intestines to a more ready discharge of
their present contents, without either hurrying their
adion, or increasing the excretions made into their
cavity; either of which effects might produce a purg-
ing. There are, I think, certain medicines peculiarly
proper on this occasion, as they seem to stimulate espe- 
cially

120 PRACTICE
cially the great guts, and to act little on the higher
parts of the intestinal canal*.
MCCXI.
We have thus mentioned the several means of exe-
cuting our second indication; and I proceed to the
third, which is, as we have said, the proper curative;
and it is to restore the tone of the stomach, the loss of
which we consider as the proximate cause of the dis-
ease, or at least as the chief part of it. The means of
satisfying this indication we refer to two heads. One
is, of those means which operate directly and chiefly
on the stomach itself; and the other is, of those means
which, operating upon the whole system, have their
tonic effects thereby communicated to the stomach.
MCCXII.
The medicines, which operate directly on the sto-
mach, are either stimulants or tonics.
The stimulants are saline or aromatic.
The saline are acids or neutrals.
Acids of all kinds seem to have the power of stimu-
lating the stomach, and therefore often increase appe-
tite: but the native acids, as liable to fermentation,
may otherwise do harm, and are therefore of ambigu-
ous use. The acids, therefore, chiefly and successful-
ly employed, are the vitriolic§, muriatic†, and the dis-
tilled acid of vegetables, as it is found in tar water,
which are all of them antizymics‡.
The
* Ten or fifteen grains of Pil. Rus. answer this purpose sufficiently
well. It is to be regretted that the Author did not mention those
certain medicines to which he alludes.
§ The dose of the vitriolic acid ought not to exceed ten drops,
and it should be well diluted with water.
† The Tinctura Martis of the Edinburgh College powerfully sti-
mulates the stomach, and acts at the same time as a tonic; its dose
is from ten to twenty drops thrice a-day, in a sufficient quantity of
any proper liquid, and it is a very agreeable medicine.
‡ I. e. resist fermentation. 

OF PHYSIC. 121
The neutral salts answering this intention, are espe-
cially those which have the muriatic acid in their
composition, though it is presumed that neutrals of
all kinds have more or less of the same virtue*.
MCCXIII.
The aromatics, and perhaps some other acrids, cer-
tainly stimulate the stomach, as they obviate the aces-
cency and flatulency of vegetable food: but their sti-
mulus is transitory; and if frequently repeated, and
taken in large quantities, they may hurt the tone of
the stomach†.
MCCXIV.
The tonics employed to strengthen the stomach are
bitters, bitters and astringents combined, and chaly- 
beates.
Bitters are undoubtedly tonic medicines, both with
respect to the stomach and the whole system: but
their long-continued use has been found to destroy
the tone of the stomach and of the whole system; and,
whether this is from the mere repetition of their to-
nic operation, or from some narcotic power joined
with the tonic in them, I am uncertain.
MCCXV.
Bitters and astringents combined, are, probably,
more effectual tonics than either of them taken sin-
gly; and we suppose such a combination to take place,
in the Peruvian bark; which therefore proves a pow-
erful
Vol. II.
Q 
* The, Sal digestivus, i.e. the muriatic acid saturated with vege-
table fixed alkali, was thought to be preferable to common salt in
promoting digestion. Hence its old name of Sal digestivus. Its
superiority over common salt is however doubtful.
†This caution against the too free use of aromatics ought to be
peculiarly attended to by the young practitioner. The speedy re-
lief which they procure tempts the patient to have frequent recourse
to them, which, as the Author justly observes, may materially hurt
the tone of the stomach, and consequently increase the disease which
they were intended to remove. 

122 PRACTICE
erful tonic, both with respect to the stomach and to
the whole system. But I have some ground to sus-
ped, that the long-continued use of this bark may,
like bitters, destroy both the tone of the stomach and
of the whole system*.
MCCXVI.
Chalybeates may be employed as tonics in various
forms†, and in considerable quantities, with safety.
They have been often employed in the form of mine-
ral waters, and seemingly with success: but whether
this is owing to the chalybeate in the composition
of these waters, or to some other circumstances at-
tending their use, I dare not positively determine;
but the latter opinion seems to me the more probable.
MCCXVII.
The remedies which strengthen the stomach, by be-
ing applied to the whole body, are, exercise and the
application of cold.
As exercise strengthens the whole body, it must al-
so strengthen the stomach; but it does this also in a
particular manner, by promoting perspiration, and
exciting the action of the vessels on the surface of the
body, which have a particular consent with the mus-
cular fibres of the stomach. This particularly ex-
plains why the exercises of gestation, though not the
most powerful in strengthening the whole system, are,
however, very powerful in strengthening the stomach;
of which we have a remarkable proof in the effects of
sailing.
* Forms of these tonics may be seen in the preceding notes on
Articles 982, 983, 993.
† See the notes on Articles 982, 983, 993.
In these cases the Tinctura Martis, mentioned in the note on Ar-
ticle 1212, is as proper a form of chalybeates as any we can use. Its
dose is from ten to twenty drops in any proper vehicle. A glass of
cold spring-water, acidulated with a few drops of this tincture, is
agreeable and refreshing, and may be used as the patient's common
drink; its agreeableness may be considerably increased by adding to
each half-pint glass, a table-spoonful of simple cinnamon-water.

OF PHYSIC. 123
failing. In strengthening the general system, as fa-
tigue must be avoided, so bodily exercise is of ambi-
guous use; and perhaps it is thereby, that riding on
horseback has been so often found to be one of the
most powerful means of strengthening the stomach,
and thereby of curing dyspepsia.
MCCXVIII.
The other general remedy of dyspepsia is the appli-
cation of cold: which may be in two ways; that is,
either by the application of cold air, or of cold water.
It is probable, that, in the atmosphere constantly sur-
rounding our bodies, a certain degree of cold, consider-
ably less than the temperature of our bodies them-
selves, is necessary to the health of the human body.
Such a degree of cold seems to strengthen the vessels
on the surface of the body, and therefore the muscular
fibres of the stomach. But, further, it is well known,
that if the body is in exercise sufficient to support
such a determination to the surface, as to prevent the
cold from producing an entire constriction of the
pores; a certain degree of cold in the atmosphere,
with such exercise, will render the perspiration more
considerable. From the sharp appetite that in such
circumstances is commonly produced, we can have
no doubt, that, by the application of such cold, the
tone of the stomach is considerably strengthened.
Cold air, therefore, applied with exercise, is a most
powerful tonic with respect to the stomach: and this
explains why, for that purpose, no exercises within
doors, or in dose carriages, are so useful as those in
the open air.
MCCXIX.
From the same reasoning, we can perceive, that the
application of cold water, or cold bathing, while it is
a tonic with respect to the system in general, and e-
specially as exciting the action of the extreme vessels,
must 
Q 2

124 PRACTICE
must in both respects be a powerful means of strength-
ening the tone of the stomach.
MCCXX.
These are the remedies to be employed towards a
radical cure of idiopathic dyspepsia; and it might be,
perhaps, expected here, that I should treat also of the
various cases of the sympathic disease. But it will be
obvious that this cannot be properly done without
treating of all the diseases of which the dyspepsia is a
symptom, which cannot be proper in this place. It
has been partly done already, and will be further
treated of in the course of this work. In the mean
time, it may be proper to observe, that there is not
so much occasion for distinguishing between the idi-
opathic and sympathic dyspepsia, as there is in many
other cases of idiopathic and sympathic diseases. For,
as the sympathic cases of dyspepsia are owing to a loss
of tone in some other part of the system, which is
from thence communicated to the stomach; so the
tone of the stomach restored, may be communicated
to the part primarily affected; and therefore the reme-
dies of the idiopathic may be often usefully employ-
ed, and are often the remedies chiefly employed, in
sympathic dyspepsia. 
MCCXXI.
Another part of our business here might be to say,
how some other of the urgent symptoms, besides
those above-mentioned, are to be palliated. On this
subject, I think it is enough to say, that the symptoms
chiefly requiring to be immediately relieved, are flatu-
lency, heartburn, other kinds of pain in the region of
the stomach, and vomiting.
The dyspeptic are ready to suppose that the whole
of their disease consists in a flatulency. In this it
will be obvious that they are mistaken; but, although
the flatulency is not to be entirely cured, but by
mending the imbecility of the stomach by the means
above- 

OF PHYSIC 125
above-mentioned; yet the flatulent distention of the
stomach may be relieved by carminitives, as they are
called, or medicines that produce a discharge of wind
from the stomach; such are the various antispasmo-
dics, of which the most effectual is the vitriolic æther
The heartburn may be relieved by absorbents*, an-
tispasmodics§ or demulcents†.
The other pains of the stomach may be sometimes
relieved by carminitives‖, but most certainly by opi-
ates
Vomiting is to be cured most effectually by opiates
thrown by injection into the anus.
CHAP.
* The absorbents have been described above, see note on Article
1206.
§ It may be doubtful whether antispasmodics are effectual in re-
moving heartburn. Opium undoubtedly often gives relief in doses
of twenty or thirty drops of laudanum.
†Extract of liquorice is as good a demulcent in these cases as any
in the list of the Materia Medica. Sucking a little piece of it, and
drinking a cup or two of weak lintseed-tea after it, seldom fail of
giving relief.
‖ Carminatives suitable in these cases are the essential oils of the
seeds of some aromatic umbiliferous plants, as Ol. Anisi. the dose
of which is fifteen or twenty drops on a piece of sugar, though com-
mon practice seldom goes half that length. The Oleum Carvi is
another excellent carminative, but it is very hot, and its dose must
never exceed five drops; two drops are a moderate dose. The O-
leum Menthæ is another good carminative; its dose is two or three
drops on a piece of sugar.
Two grains of the Extract of opium, or forty drops of the lauda-
num, are usually given in half a cupful of lintseed tea. The dose
may be increased to 100 drops of laudanum, in the same quantity of
vehicle, especially if the pain of the stomach be accompanied with
vomitings.

126 PRACTICE
CHAP. III.
OF HYPOCHONDRIASIS.
OR THE
HYPOCHONDRIAC AFFECTION,
COMMONLY CALLED
VAPOURS OR LOW SPIRITS.
MCCXXII.
IN certain persons there is a state of mind distin-
guished by a concurrence of the following cir-
cumstances: A langour, listlessness, or want of resolu-
tion and activity with respect to all undertakings; a
disposition to seriousness, sadness, and timidity; as to
all future events, an apprehension of the worst or most
unhappy state of them; and therefore, often upon
slight grounds, an apprehension of great evil. Such
persons are particularly attentive to the state of their
own health, to even the smallest change of feeling in
their bodies; and from any unusual feeling, perhaps
of the slightest kind, they apprehend great danger,
and even death itself. In respect to all these feelings
and apprehensions, there is commonly the most obsti-
nate belief and persuasion.
MCCXXIII.
This state of mind is the Hypochondriasis of medi-
cal writers. See Linnæi Genera Morborum, Gen.
76. et Sagari Systema Symptomaticum, Class XIII.
Gen. 5. The same state of mind is what has been
commonly called Vapours and Low Spirits. Though
the term Vapours may be founded on a false theory,
and therefore improper, I beg leave, for a purpose
that 

OF PHYSIC 127
that will immediately appear, to employ it for a little
here.
MCCXXIV.
Vapours, then, or the state of mind described above,
is, like every other state of mind, connected with a
a certain state of the body, which must be inquired in-
to in order to its being treated as a disease by the art
of physic.
MCCXXV.
This state of the body, however, is not very easily
ascertained: for we can perceive, that on different oc-
casions it is very different; vapours being combined
sometimes with dyspepsia, sometimes with hysteria, and
sometimes with melancholia, which are diseases seem-
ingly depending on very different states of the body.
MCCXXVI.
The combination of vapours with dyspepsia is very
frequent, and in seemingly very different circumstan-
ces. It is, especially, these different circumstances
that I would wish to ascertain; and I remark, that they
are manifestly of two different kinds. First, as the
disease occurs in young persons of both sexes, in per-
sons of a sanguine temperament, and of a lax and flac-
cid habit. Secondly, as it occurs in elderly persons of
both sexes, of a melancholic temperament, and of a
firm and rigid habit.
MCCXXVII.
These two different cases of the combination of the
vapours and dyspepsia, I consider as two distinct dis-
eases, to be distinguished chiefly by the temperament
prevailing in the persons affected.
As the dyspepsia of sanguine temperaments is often
without vapours; and as the vapours when joined
with dyspepsia in such temperaments, may be consi-
dered as, perhaps, always a symptom of the affection
of the stomach; so to this combination of dyspepsia
and vapours, I would still apply the appellation of
Dyspepsia, 

128 PRACTICE
Dyspepsia, and consider it as strictly the disease treated
of in the preceding chapter.
But the combination of dyspepsia and vapours in
melancholic temperaments, as the vapours or the
turn of mind peculiar to the temperament, nearly that
described above in MCCXXII. are essential circumstan-
ces of the disease; and as this turn of mind is often
with few, or only slight symptoms of dyspepsia; and,
even though the latter be amending, as they seem to
be rather the effects of the general temperament, than
of any primary or topical affection of the stomach; I
consider this combination as a very different disease
from the former, and would apply to it strictly the ap-
pellation of Hypochondriasis.
MCCXXVIII.
Having thus pointed out a distinction between Dys-
pepsia and Hypochondriasis, I shall now, using these
terms in the strict sense above mentioned, make some
observations which may, I think, illustrate the subject,
and more clearly and fully establish the distinction
proposed.
MCCXXIX.
The dyspepsia often appears early in life, and is
frequently much mended as life advances: but the
hypochondnasis seldom appears early in life, and more
usually in more advanced years only; and more cer-
tainly still, when it has once taken place, it goes on
increasing as life advances to old age.
This seems to be particularly well illustrated, by
our observing the changes in the state of the mind
which usually take place in the course of life. In
youth, the mind is chearful, active, rash, and movea-
ble: but as life advances, the mind by degrees be-
comes more serious, slow, cautious, and steady; till at
length, in old age, the gloomy, timid, distrustful, and
obstinate state of melancholic temperaments, is more
exquisitely formed. In producing these changes, it is
true,

OF PHYSIC. 129
true, that moral causes have a share; but it is at the
same time obvious, that the temperament of the body
determines the operation of these moral causes, sooner
or later, and in a greater or lesser degree, to have their
effects. The sanguine temperament retains longer the
character of youth, while the melancholic tempera-
ment brings on more early the manners of old age.
MCCXXX.
Upon the whole, it appears, that the state of the
mind which attends, and especially distinguishes hy-
pochondriasis, is the effect of that same rigidity of the
solids, torpor of the nervous power, and peculiar ba-
lance between the arterial and venous systems which
occur in advanced life, and which at all times take
place more or less in melancholic temperaments. If
therefore there be also somewhat of a like state of mind
attending the dyspepsia which occurs early in life in
sanguine temperaments and lax habits, it must depend
upon a different state of the body, and probably up-
on a weak and moveable state of the nervous power.
MCCXXXI.
Agreeable to all this, in dyspepsia, there is more of
spasmodic affection, and the affection of the mind (M-
CCXXII.) is often absent, and, when present, is perhaps
always of a slighter kind: while, in hypochondriasis,
the affection of the mind is more constant, and the
symptoms of dyspepsia, or the affections of the sto-
mach, are often absent, or, when present, are in a
slighter degree.
I believe the affection of the mind is commonly dif-
ferent in the two diseases. In dyspepsia, it is often
languor and timidity only, easily dispelled; while in
hypochondriasis, it is generally the gloomy and ri-
vetted apprehension of evil.
The two diseases are also distinguished by some o-
ther circumstances. Dyspepsia, as I have said, is oft-
en a symptomatic affection; while hypochondriasis
is, 
Vol. II. 
R

130 PRACTICE
is, perhaps, always a primary and idiopathic disease;
As debility may be induced by many different caus-
es, dyspepsia is a frequent disease; while hypochondri-
asis, depending upon a peculiar temperament, is more
rare.
MCCXXXII.
Having thus endeavoured to distinguish the two dis-
eases, I suppose the peculiar nature and proximate
cause of Hypochondriasis will be understood; and I
proceed therefore to treat of its cure.
So far as the affections of the body, and particular-
ly of the stomach, are the same here as in the case of
dyspepsia, the method of cure might be supposed to be
also the same; and accordingly the practice has been
carried on with little distinction: but I am persuaded
that a distinction is often necessary.
MCCXXXIII.
There may be a foundation here for the same pre-
servative indication as first laid down in the cure of
dyspepsia; (MCCII.) but I cannot treat this subject so
clearly or fully as I could with, because I have not
yet had so much opportunity of observation as I think
necessary to ascertain the remote causes; and I can
hardly make use of the observations of others, who
have seldom or never distinguished between the two
diseases. What, indeed, has been said with respect to
the remote causes of melancholia, will often apply to
the hypochondriasis, which I now treat of; but the
subject of the former has been so much involved in a
doubtful theory, that I find it difficult to select the
facts that might properly and strictly apply to the
latter. I delay this subject, therefore, till another oc-
casion; but in the mean time trust, that what I have
said regarding the nature of the disease, and some re-
marks I shall have occasion to offer in considering the
method of cure, may in some measure supply my defi-
ciency on this subject of the remote causes.
MCCXXXIV. 

OF PHYSIC. 131
MCCXXXIV.
The second indication laid down in the cure of dys-
pepsia (MCCI.) has properly a place here: but it is still
to be executed with some distinction.
MCCXXXV.
An anorexia, and accumulation of crudities in the
stomach, does not so commonly occur in hypochon-
driasis as in dyspepsia; and therefore vomiting (M-
CCIV.) is not so often necessary in the former as in
the latter.
MCCXXXVI.
The symptom of excess of acidity, from the slow
evacuation of the stomach in melancholic tempera-
ments, often arises to a very high degree in hypochon-
driasis; and therefore, for the same reason as in MCCV.
it is to be obviated and corrected with the utmost
care. It is upon this account that the several anta-
cids, and the other means of obviating acidity, are to
be employed in hypochondriasis, and with the same
attentions and confederations as in MCCVI. and follow-
ing; with this reflection, however, that the exciting
the action of the stomach there mentioned, is to be
a little differently understood, as shall be hereafter
explained.
MCCXXXVII.
As costiveness, and that commonly to a considerable
degree, is a very constant attendant of hypochondria-
sis, so it is equally hurtful as in dyspepsia. It may be
remedied by the same means in the former as in the
latter, and they are to be employed with the same re-
strictions as in MCCX.
MCCXXXVIII.
It is especially with respect to the third indication
laid down in the cure of dyspepsia (MCCI.) that there
is a difference of practice to be observed in the cure
of hypochondriasis; and that often one directly op-
posite,
R 2

132 PRACTICE
posite to that in the case of dyspepsia, is to be fol-
lowed.
MCXXXIX.
In dyspepsia, the chief remedies are the tonic medi-
cines, which to me seem neither necessary nor safe in
hypochondriasis; for in this there is not a loss of
tone, but a want of activity that is to be remedied.
Chalybeate mineral waters have commonly been
employed in hypochondriasis, and seemingly with suc-
cess. But this is probably to be imputed to the amuse-
ment and exercise usually accompanying the use of
these waters, rather than to the tonic power of the
small quantity of iron which they contain. Perhaps
the elementary water, by favouring the excretions,
may have a share in relieving the disease.
MCCXL.
Cold bathing is often highly useful to the dyspeptic,
and, as a general stimulant, may sometimes seem useful
to the hypochondriac; but it is not commonly so to
the latter; while, on the other hand, warm bathing,
hurtful to the dyspeptic, is often extremely useful to
the hypochondriac.
MCCXLI.
Another instance of a contrary practice necessary in
the two diseases, and illustrating their respective na-
tures, is, that the drinking tea and coffee is always
hurtful to the dyspeptic, but is commonly extremely
useful to the hypochondriac.
MCCXLII.
Exercise, as it strengthens the system, and thereby
the stomach, and more especially, as by increasing the
perspiration, it excites the action of the stomach, it
proves one of the most useful remedies in dyspepsia;
and further, as, by increasing the perspiration, it ex-
cites the activity of the stomach, it likewise proves an
useful remedy in the hypochondriasis. However, in
the latter case, as I shall explain presently, it is still a
more 

OF PHYSIC. l33
more useful remedy by its operation upon the mind
than by that upon the body.
MCCXLIII.
It is now proper that we proceed to consider the
most important article of our practice in this disease,
and which is, to consider the treatment of the mind;
an affection of which sometimes attends dyspepsia, but
is always the chief circumstance in hypochondriasis.
What I am to suggest here will apply to both diseases;
but it is the hypochondriasis that I am to keep most
constantly in view.
MCCXLIV.
The management of the mind in hypochondriacs,
is often nice and difficult. The firm persuasion that
generally prevails in such patients, does not allow their
feelings to be treated as imaginary, nor their appre-
hension of danger to be considered as groundless,
though the physician may be persuaded that it is the
case in both respects. Such patients, therefore, are
not to be treated either by raillery or by reasoning.
It is said to be the manner of hypochondriacs to
change often their physician; and indeed they often
do it consistently; for a physician who does not admit
the, reality of the disease, cannot be supposed to take
much pains to cure it, or to avert the danger of which
he entertains no apprehension.
If in any case the pious fraud of a placebo be al-
lowable, it seems to be in treating hypochondriacs:
who, anxious for relief, are fond of medicines, and,
though often disappointed, will still taste every new
drug that can be proposed to them.
MCCXLV.
As it is the nature of man to indulge every present
motion, so the hypochondriac cherishes his fears, and,
attentive to every feeling, finds in trifles light as air a
strong confirmation of his apprehensions. His cure
therefore depends especially upon the interruption of
his 

134 PRACTICE
his attention, or upon its being diverted to other ob-
jects than his own feelings.
MXXLVI.
Whatever aversion to application of any kind may
appear in hypochondriacs, there is nothing more per-
nicious to them than absolute idleness, or a vacancy
from all earnest pursuit. It is owing to wealth admit-
ting of indolence, and leading to the pursuit of transi-
tory and unsatisfying amusements, or to that of ex-
hausting pleasures only, that the present times exhibit
to us so many instances of hypochondriacism.
The occupations of business suitable to their cir-
cumstances and situation in life, if neither attended
with emotion, anxiety, nor fatigue, are always to be
admitted, and persisted in by hyponchondriacs. But
occupations upon which a man's fortune depends, and
which are always, therefore, objects of anxiety to me-
lancholic men; and more particularly where such oc-
cupations are exposed to accidental interruptions, dis-
appointments, and failures, it is from these that the
hypochondriac is certainly to be withdrawn.
MCCXLVII.
The hypochondriac, who is not necessarily, by cir-
cumstances or habits, engaged in business, is to be
drawn from his attention to his own feelings by some
amusement.
The various kinds of sport and hunting, as pursued
with some ardour, and attended with exercise, if not
too violent, are amongst the most useful.
All those amusements which are in the open air,
joined with moderate exercise, and requiring some
dexterity, are generally of use.
Within doors, company which engages attention,
which is willingly yielded to, and is at the same time
of a chearful kind, wiil be always found of great
service.
Play, in which some skill is required, and where
the 

OF PHYSIC. 135
the stake is not an object of much anxiety, if not too
long protracted, may often be admitted.
In dyspeptics, however, gaming, liable to sudden
and considerable emotions, is dangerous, and the long
continuance of it, with night-watching, is violently
debilitating. But in melancholies, who commonly
excel in skill, and are less susceptible of violent emo-
tions, it is more admissible, and is often the only a-
musement that can engage them.
Music, to a nice ear, is a hazardous amusement, as
long attention to it is very fatiguing.
MCCXLVIII.
It frequently happens, that amusements of every
kind are rejected by hypochondriacs; and in that case,
mechanical means of interrupting thought are the re-
medies to be sought for.
Such is to be found in brisk exercise, which requires
some attention in the conduct of it.
Walking is seldom of this kind; though, as grati-
fying to the restlessness of hypochondriacs, it has some-
times been found useful.
The required interruption of thought is best obtain-
ed by riding on horseback, or in driving a carriage of
any kind.
The exercise of sailing, except it be in an open
boat, engaging some attention, does very little ser-
vice.
Exercise in an easy carriage, in the direction of
which the traveller takes no part, unless it be upon
rough roads, or driven pretty quickly, and with long
continuance, is of little advantage.
MCCXLIX.
Whatever exercise may be employed, it will be
most effectual when employed in the pursuit of a jour-
ney; first, because it withdraws a person from many
objects of uneasiness and care which might present
themselves at home; secondly, as it engages in more
con- 

136 PRACTICE
constant exercise, and in a greater degree of it than is
commonly taken in airings about home; and, lastly,
as it is constantly presenting new objects which call
forth a person's attention.
MCCL.
In our system of Nosology we have, next to Hypo-
chondriasis, placed the Chlorosis, because I once
thought it might be considered as a genus comprehend-
ing, besides the Chlorosis of Amenorrhœa, some spe-
cies of Cachexy: but, as I cannot find this to be well
founded, and cannot distinctly point out any such dis-
ease, I now omit considering Chlorosis as a genus
here; and, as a symptom of Amenorrhœa, I have
endeavoured before to explain it under that title.
BOOK III.
OF
SPASMODIC AFFECTIONS,
WITHOUT FEVER.
MCCLI.
UNDER this title I am to comprehend all the
diseases which consist in motu abnormi; that is,
in a preternatural state of the contraction and motion
of the muscular or moving fibres in any part of the
body.
MCCLII.
It will hence appear, why, under this title, I have
comprehended many more diseases than Sauvages and
Sagar have comprehended under the title of spasmi,
or that Linnæus has done under the title of Motorii.
But 

OF PHYSIC. 137
But I expect it will be obvious, that, upon this occa-
sion, it would not be proper to confine our view to
the affections of the voluntary motion only; and if
those Nosologists have introduced into the class of
Spasmi, Palpitatio and Hysteria, it will be with equal
propriety that Asthma, Colica, and many other diseases,
are admitted.
MCCLIII.
It has been hitherto the method of our Nosologists
to divide the Spasmi into the two orders of Tonici and
Clonici, Spastici and Agitatorii; or, as many at pre-
sent use the terms, into Spasms strictly so called, and
convulsions. I find, however, that many, and indeed
most of the diseases to be considered under our title of
Spasmodic affections, in respect of tonic or Cloric con-
tractions, are of a mixed kind: and, therefore, I can-
not follow the usual general division; but have at-
tempted another, by arranging the several Spasmodic
diseases according as they affect the several functions,
Animal, Vital, or Natural.
SECT. I.
OF THE SPASMODIC AFFECTIONS OF THE
ANIMAL FUNCTIONS.
MCCLIV.
AGREEABLE to the language of the ancients, the
whole of the diseases to be treated of in this section
might be termed spasm; and many of the moderns
continue to apply the term in the same manner: but I
think it convenient to distinguish the terms of Spasm
and Convulsion, by applying the former, strictly to
what 
Vol. II. 
S

138 PRACTICE
what has been called the Tonic; and the latter, to
what has been called the Clonic Spasm. There is cer-
tainly a foundation for the are of those different terms,
as there is a remarkable difference in the state of the
contaction of moving fibres upon different occasions.
This I have indeed pointed out before in my treatise
of Physiology, but must also repeat it here.
MCCLV.
In the exercise of the several functions of the animal
œconomy, the contractions of the moving fibres are
excited by the will, or by certain other causes specially
appointed by nature for exciting those contractions;
and these other causes I name the natural causes. In
a state of health, the moving fibres are contracted by
the power of the will, and by the natural causes only.
At the same time the contractions used are in force
and velocity regulated by the will, or by the circum-
stances of the natural causes; and the contractions,
whether produced by the one or the other, are always
soon succeeded by a state of relaxation, and are not
repeated but when the power of the will or of the na-
tural causes is again applied.
MCCLVI.
Such are the conditions of the action of the moving
fibres in a state of health; but in a morbid state the
contractions of the muscles and moving fibres ordina-
rily depending upon the will are excited without the
concurrence of the will, or contrary to what the will
intends; and in the other functions they are excited
by the action of unusual and unnatural causes. In
both cases, the contractions produced may be in two
different states. The one is, when the contradictions
are to a more violent degree than is usual in health,
and are neither succeeded by a spontaneous relaxa-
tion, nor even readily yield to an extension either
from the action of antagonist muscles, or from other
extending powers applied. The state of contractions
is 

OF PHYSIC. 139
is what has been called a tonic spasm, and is what I
shall name simply and strictly a spasm. The other
morbid state of contraction is, when they are succeed-
ed by a relaxation, but are immediately again repeated
without the concurrence of the will or of the repeti-
tion of natural causes, and are at the same time com-
monly, with respect to velocity and force, more vio-
lent than in a healthy state. This state of morbid
contraction is what has been named a clonic spasm, and
what I must name simply and strictly a convulsion.
In this section I shall follow nearly the usual division
of the spasmodic diseases into those consisting in Spasm,
and those consisting in convulsion; but it may not
perhaps be in my power to follow such division ex-
actly.
CHAP. I.
OF TETANUS.
MCCLVII.
BOTH Nosologists and Practical writers have dis-
tinguished Tetanic complaints into the several
species of Tetanus, Opisthotonos, and Emprosthoto-
nos; and I have in my Nosology put the Trismus, or
Locked Jaw, as a genus distinct from the Tetanus.—
All this, however, I now judge to be improper; and
am of opinion, that all the several terms mentioned,
denote, and are applicable only to, different degrees
of one and the same disease; the history and cure of
which I shall endeavour to deliver in this chapter.
MCCLVIII.
Tetanic complaints may, from certain causes, occur
in
S 2  

140 PRACTICE
in every climate that we are acquainted with; but they
occur most frequently in the warmest climates, and
most commonly in the warmest seasons of such cli-
mates. These complaints affect all ages, sexes, tem-
peraments, and complexions. The causes from whence
they commonly proceed, are cold and moisture appli-
ed to the body while it is very warm, and especially
the sudden vicissitudes of heat and cold. Or, the dis-
ease is produced by puncture, lacerations, or other le-
sions of nerves in any part of the body. There are,
probably, some other causes of this disease; but they
are neither distinctly known, nor well ascertained.
Though the causes mentioned do, upon occasion, affect
all sorts of persons, they seem however to attack per-
sons of middle age more frequently than the older or
younger, the male sex more frequently than the female,
and the robust and vigorous more frequently than the
weaker.
MCCLIX.
If the disease proceed from cold, it commonly comes
on in a few days after the application of such cold;
but, if it arise soon a puncture or other lesion of a
nerve, the disease does not commonly come on for
many days after the lesion has happened, very often
when there is neither pain nor uneasiness remaining in
the wounded or hurt part, and very frequently when
the wound has been entirely healed up.
MCCLX.
The disease sometimes comes on suddenly to a vio-
lent degree, but more generally it approaches by flow
degrees to its violent state. In this case it comes on
with a sense of stiffness in the back part of the neck,
which, gradually increasing, renders the motion of the
head difficult and painful. As the rigidity of the
neck comes on and increases, there is commonly at
the same time a sense of uneasiness felt about the root
of the tongue; which by degrees, becomes a difficul-
ty 

OF PHYSIC. 141
ty of swallowing, and at length an entire interruption
of it. While the rigidity of the neck goes on increas-
ing, there arises a pain, often violent, at the lower
end of the sternum, and from thence shooting into the
back. When this pain arises, all the muscles of the
neck, and particularly those of the back part of it, are
immediately affected with spasm, pulling the head
strongly backwards. At the same time, the muscles
that pull up the lower jaw, which upon the first ap-
proaches of the disease were affected with some spastic
rigidity, are now generally affected with more violent
spasm, and set the teeth so closely together, that they
do not admit of the smallest opening.
This is what has been named the Locked Jaw, and
is often the principal part of the disease. When the
disease has advanced thus far, the pain at the bottom
of the sternum returns very frequently, and with it the
spasms of the hind-neck and lower-jaw are renewed
with violence and much pain. As the disease thus
proceeds, a greater number of muscles come to be af-
fected with spasms. After those of the neck, those
along the whole of the spine become affected, bending
the trunk of the body strongly backwards; and this is
what has been named the Opisthotonos.
In the lower extremities, both the flexor and ex-
tensor muscles are commonly at the same time affected,
and keep the limbs rigidly extended. Though the
extensors of the head and back are usually the most
strongly affected, yet the flexors, or those muscles of
the neck that pull the head forward, and the muscles
that should pull down the lower jaw, are often at the
same time strongly affected with spasm. During the
whole of the disease, the abdominal muscles are vio-
lently affected with spasm, so that the belly is strongly
retracted, and feels hard as a piece of board.
At length the flexors of the head and trunk become
so strongly affected as to balance the extensors, and to
keep

142 PRACTICE
keep the head and trunk, straight, and rigidly extend-
ed, incapable of being moved in any way; and it is
to this state the term Tetanus has been strictly applied.
At the same time, the arms, little affected before, are
now rigidly extended; the whole of the muscles be-
longing to them being affected with spasms, except
those that move the fingers, which often to the last
retain some mobility. The tongue also long retains
its mobility; but at length it also becomes affected
with spasms, which, attacking certain of its muscles
only, often thrust it violently out between the teeth.
At the height of the disease, every organ of volun-
tary motion seems to be affected; and amongst the
rest, the muscles of the face. The forehead is drawn up
into furrows, the eyes sometimes distorted, are com-
monly rigid, and immoveable in their sockets; the nose
is drawn up, and the cheeks are drawn backwards to-
wards the ears, so that the whole countenance express-
es the most violent grinning. Under these universal
spasms, a violent convulsion commonly comes on, and
puts an end to life.
MCCLXI.
These spasms are every where attended with most
violent pain. The utmost violence of spasm is, how-
ever, not constant; but, after subsisting for a minute
or two, the muscles admit of some remission of their
contraction, although of no such relaxation as can al-
low the action of their antagonists. This remission of
contraction gives also some remission of pain; but
neither is of long duration. From time to time, the
violent contractions and pains are renewed sometimes
evrry ten or fifteen minutes, and that often without
any evident exciting cause. But such exciting causes
frequently occur; for almost every attempt to motion,
as attempting a change of posture, endeavouring to
swallow, and even to speak, sometimes gives occasion
to a renewal of the spasms over the whole body.
MCCLXII. 

OF PHYSIC. 143
MCCLXII.
The attacks of this disease are seldom attended
with any fever. When the spasms are general and
violent, the pulse is contracted, hurried, and irregu-
lar; and the respiration is affected in like manner:
but, during the remission, both the pulse and respira-
tion usually return to their natural state. The heat of
the body is commonly not increased; frequently the
face is pale, with a cold sweat upon it; and very often
the extremities are cold, with a cold sweat over the
whole body. When, however, the spasms are fre-
quent and violent, the pulse is sometimes more full and
frequent than natural; the face is flushed,and a warm
sweat is forced out over the whole body.
MCCLXIII.
Although fever be not a constant attendant of this
disease, especially when arising from a lesion of nerves;
yet, in those cases proceeding from cold, a fever some-
times has supervened, and is said to have been at-
tended with inflammatory symptoms. Blood has been
ofren drawn in this disease, but it never exhibits any
inflammatory emit; and all accounts seem to agree,
that the blood drawn seems to be of a looser texture
han ordinary, and that it does not coagulate in the
usual manner.
MCCLXIV.
In this disease the head is seldom affected with deli-
rium or even contusion of thought, till the last stage
of it; when, by the repeated shocks of a violent
distemper, every function of the system is greatly dis-
ordered.
MCCLXV.
It is no less extraordinary, that, in this violent dis-
ease, the natural functions are not either immediately
or considerably affected. Vomitings sometimes ap-
pear early in the disease, but commonly they are not
continued; and it is usual enough for the appetite of
hunger 

144 PRACTICE
hunger to remain through the whole course of the dis-
ease; and what food happens to be taken down, seems
to be regularly enough digested. The excretions are
sometimes affected, but not always. The urine is
sometimes suppressed, or is voided with difficulty and
pain. The belly is costive: but, as we have hardly
any accounts excepting of those cases in which opiates
have been largely employed, it is uncertain whether
the costiveness has been the effect of the opiates or of
the disease. In several instances of this disease, a mi-
liary eruption has appeared upon the skin; but whe-
ther this be a symptom of the disease, or the effect of a
certain treatment of it, is undetermined. In the mean
while, it has not been observed to denote either safety
or danger, or to have any effect in changing the course
of the distemper.
MCCLXVI.
This disease has generally proved fatal; and this
indeed may be justly supposed to be the consequence
of its nature: but, as we know, that, till very lately,
physicians were not well acquainted with a proper me-
thod of cure; and that since a more proper method
has been known and practised, many have recovered
from this disease; it may be therefore concluded, that
the fatal tendency of it is not so unavoidable as has
been imagined.
In judging of the tendency of this disease, in parti-
cular cases, we may remark, that, when arising from
lesions of the nerves, it is commonly more violent, and
of more difficult cure, than when proceeding from
cold; that the disease which comes on suddenly, and
advances quickly to a violent degree, is always more
dangerous than that which is slower in its progress.
Accordingly, the disease often proves fatal before the
fourth day; and, when a patient has passed this peri-
od, he may be supposed to be in greater safety, and in
general the disease is the safer the longer it has con-
tinued.

OF PHYSIC. 145
tinued. It is however, to be particularly observed,
that, even for many days after the fourth, the disease
continues to be dangerous; and, even after some con-
siderable abatement of its force, it is ready to recur
again with its former violence and danger. It never
admits of any sudden, or what may be called a critical
solution; but always recedes by degrees only, and it is
often very long before the whole of the symptoms
disappear.
MCCLXVII.
From the history of the disease now described, it
will be evident, that there is no room for distinguish-
ing the tetanus, opisthotonos, and trismus or locked jaw,
as different species of this disease, since they all arise
from the same causes, and are almost constantly con-
joined in the same person, I have no doubt that the
emprosthotonos belongs also to the same genus; and as
the ancients have frequently mentioned it, we can have
no doubt of its having occurred; but, at the same
time, it is certainly in these days a rare occurrence;
and, as I have never seen it, nor find any histories in
which this particular state of the spasms is said to have
prevailed, I cannot mention the other circumstances
which particularly attend it, and may distinguish it
from the other varieties of tetanic complaints.
MCCLXVIII.
This disease has put on still a different form from
any of those above mentioned. The spasms have been
sometimes confined to one side of the body only, and
which bend it strongly to that side. This is what has
been named by Sauvages the Tetanus Lateralis, and
by some late writers the Pleurosthotonos, This form
of the disease has certainly appeared very seldom;
and, in any of the accounts given of it, I cannot find
any circumstances that would lead me to consider it as
any other than a variety of the species already menti-
oned, or to take further notice of it here.
MCCLXIX
Vol. II. 
T  

146 PRACTICE
MCCLXIX.
The pathology of this disease I cannot in any mea-
sure attempt; as the structure of moving fibres, the
state of them under different degrees of contraction,
and particularly the state of the sensorium, as variously
determining the motion of the nervous power, are all
matters very imperfectly, or not at all, known to me.
In such a situation, therefore, the endeavouring to give
any rules of practice, upon a scientific plan, appears
to me vain and fruitless; and towards directing the
cure of this disease, we must be satisfied with having
learned something useful from analogy, confirmed by
experience.
MCCLXX.
When the disease is known to arise from the lesion
of a nerve in any part of the body, the first, and, as I
judge, the most important step to be taken towards the
cure, is, by every possible means, to cut off that part
from all communication with the sensorium, either by
cutting through the nerves in their course, or perhaps
by destroying, to a certain length, their affected part
or extremity.
MCCLXXI.
When the cure of the disease is to be attempted by
medicine, experience has taught us that opium has
often proved an effectual remedy; but that, to render
it such, it must be given in much larger quantities
than have been employed in any other case; and in
these larger quantities, it may, in this disease, be given
more safely than the body has been known to bear in
any other condition. The practice has been, to give
the opium either in a solid or a liquid form, not in
any very large dose at once, but in moderate doses,
frequently repeated, at the interval of one, two, three
or more hours, as the violence of the symptoms seems
to require*. Even when large quantities have been
given
* Though the exhibition of opium in Tetanus has been the most 

OF PHYSIC. 147
given in this way, it appears that the opium does not
operate here in the same manner as in most other ca-
ses; for, though it procures some remission of the spasms
and pains, it hardly induces any sleep, or occasions that
stupor, intoxication, or delirium, which it often does
in other circumstances, when much smaller quantities
only have been given. It is therefore very properly
observed, that, in tetanic affections, as the opium
shows none of those affections by which it may endan-
ger life, there is little or no reason for being sparing in
the exhibition of it; and it may be given, probably
should be given, as largely and as fall as the symptoms
of the disease may seem to demand.
It is particularly to be observed, that though the
first exhibitions of the opium may have produced
some remission of the symptoms, yet the effects of
opium do not long continue in the system; and this
disease
T 2
universal practice, it must nevertheless be acknowledged, that, in ma-
ny, if not in most cases, it has been ineffectual. The disease, indeed
is in general fatal; but, in most of the cases that terminated happi-
ly, opium has been given, as the Author describes, either in large
doses, or frequently repeated small doses, we must necessarily conclude
that the practice ought to be followed.
I have seen only one case of Tetanus; it proceeded from a wound
which a carpenter received in the wrist of his left arm with a saw.
The inflammation was violent: the stiffness of the neck at first ap-
peared on the third day, when the inflammation began to abate after
bleeding, and the application of emollient poultices; the pulse was
weak and small; thirty drops of laudanum were given; the symp-
toms increased; and, on the day following, the jaw became fixed.
Thirty drops of laudanum were repeated; and the symptoms abat-
ing within two hours after its exhibition, indicated a repetition of
the dose, which, from its good effects, was a fourth time repeated
the same day. The wound suppurated; and the day following, with
two doses of forty drops of laudanum, the symptoms of Tetanus
wholly disappeared, but left the patient in a most debilitated state.
A costiveness supervened, that was removed with the use of manna
and Glauber's salts occasionally: The patient was nourished with
rich broths and wine; but he did not recover his former strength
till after six weeks although the wound was healed in half that time.

148 PRACTICE
disease being for some time ready to recur, it is com-
monly very necessary, by the time that the effects of
the opium given may be supposed to be wearing off,
and especially upon the least appearance of a return
of the spasms, to repeat the exhibition of the opium in
the same quantities as before. This practice is to be
continued while the disease continues to show any dis-
position to return; and it is only after the disease has
already subsisted for some time, and when considerable
and long-continued remissions have taken place, that
the doses of the opium may be diminished, and the
intervals of exhibiting them be more considerable.
MCCLXII.
The administering of opium in this manner, has in
many cases been successful; and probably would have
been equally so in many others, if the opium had not
been too sparingly employed, either from the timidity
of practitioners, or from its exhibition being prevent-
ed by that interruption of deglutition which so often
attends this disease. This latter circumstance directs,
that the medicine should be immediately and largely
employed upon the first approach of the disease, be-
fore the deglutition becomes difficult; or that, if this
opportunity be lost, the medicine, in sufficient quan-
tity, and with due frequency, should be thrown into
the body by glyster; which, however, does not seem
to have been hitherto often practised.
MCCLXXIII.
It is highly probable, that, in this disease, the intes-
tines are affected with the spasm that prevails so much
in other parts of the system; and therefore, that costive-
ness occurs here as a symptom of the disease*. It is
probably also increased by the opium, which is here
so largely employed; and, from whichever off these
causes
* This symptom occurred in the case mentioned in the preceding
note. 

OF PHYSIC. 149
causes it arises, it certainly must be held to aggravate
the disease, and that a relaxation of the intestinal ca-
nal will contribute to a relaxation of the spasms else-
where. This consideration directs the frequent exhi-
bition of laxatives while the power of deglutition re-
mains, or the frequent exhibition of glysters when it
does not; and the good effects of both have been fre-
quently observed.
MCCLXXIV.
It has been with some probability supposed, that
the operation of opium in this disease, may be much
assisted by joining with it some other of the most pow-
erful antispasmodics. The most promising are musk
and camphire; and some practitioners have been of
opinion, that the former has proved very useful in te-
tanic complaints. But, whether it be from its not
having been employed of a genuine kind, or in suffi-
cient quantity, the great advantage and propriety of
its use are not yet clearly ascertained. It appears to
me probable, that analogous to what happens with re-
spect to opium, both musk and camphire might be em-
ployed in this disease, in much larger quantities than
they commonly have been in other cases.
MCCLXXV.
Warm bathing has been commonly employed as a
remedy in this disease, and often with advantage; but,
so far as I know, it has not alone proved a cure; and,
in some cases, whether it be from the motion of the
body here required, exciting the spasms, or from the
fear of the bath, which some persons were seized with,
I cannot determine; but it is allowed, that the warm
bath hath in some cases done harm, and even occasi-
oned death. Partial fomentations have been much
commended, and, I believe, upon good grounds: And
I have no doubt but that fomentations of the feet and
legs, as we now usually apply them in fevers, might,
without

150 PRACTICE
without much stirring of the patient, be very assidu-
ously employed with advantage.
MCCLXXVI.
Unctuous applications were very frequently employ-
ed in this disease by the ancients: and some modern
practitioners have considered them as very useful.
Their effects, however, have not appeared to be con-
siderable; and, as a weak auxiliary only, attended
with some inconvenience, they have been very much
neglected by the British practitioners.
MCCLXXVII.
Bleeding has been formerly employed in this dis-
ease; but of late it has been found prejudicial, except-
ng in a few cases, where, in plethoric habits, a fever
has supervened. In general, the state of men's bodies
in warm climates is unfavourable to blood-letting:
and, if we may form indications from the state of the
blood drawn out of the veins, the state of this in teta-
nic diseases would forbid bleeding in them.
MCCLXXVIII.
Blistering also has been formerly employed in this
disease; but several practitioners assert, that blisters
are constantly hurtful, and they are now generally
omitted.
MCCLXXIX.
These are the practices that hitherto have been ge-
nerally employed; but of late we are informed by se-
veral West India practitioners, that in many instances
they have employed mercury with advantage. We
are told, that it must be employed early in the dis-
ease; that it is most conveniently administered by
unction, and should be applied in that way in large
quantities, so that the body may be soon filled with it,
and a salivation raised, which is to be continued till
the symptoms yield. Whether this method alone be
generally sufficient for the cure of this disease, or if it
may be assisted by the use of opium, and require this
in 

OF PHYSIC. 151
in a certain measure to be joined with it, I have not
yet certainly learned.
MCCLXXX.
I have been further informed, that the tetanus, in
all its different degrees, has been cured by giving in-
ternally the Pisselæum Barbadense, or, as it is vulgar-
ly called, the Barbadoes Tar. I think it proper to
take notice of this here, although I am not exactly in-
formed what quantities of this medicine are to be giv-
en, or in what circumstances of the disease it is most
properly to be employed.
MCCLXXX.*
In the former edition of this work, among the reme-
dies of tetanus I did not mention the use of cold ba-
thing; because, though I had heard of this, I was not
informed of such frequent employment of it as might
confirm my opinion of its general efficacy: nor was I
sufficiently informed of the ordinary and proper ad-
ministration of it. But now, from the information of
many judicious practitioners who have frequently em-
ployed it, I can say, that it is a remedy which in nu-
merous trials has been found to be of great service in
this disease; and that, while the use of the ambiguous
remedy of warm bathing is entirely laid aside, the use
of cold bathing is over the whole of the West Indies
commonly employed. The administration of it is
sometimes by bathing the person in the sea, or more
frequently by throwing cold water from a bason or
bucket upon the patient's body, and over the whole
of it: when this is done, the body is carefully wiped
dry, wrapped in blankets, and laid a-bed, and at the
same time a large dose of an opiate is given. By these
means a considerable remission of the symptoms is ob-
tained; but this remission, at first, does not common-
ly remain long, but returning again in a few hours,
the
* The Paragraphs were thus numbered in the last edition. 

152 PRACTICE
the repetition both of the bathing and the opiate be-
comes necessary. By these repetitions, however,
longer intervals of ease are obtained, and at length the
disease is entirely cured; and this even happens some-
times very quickly. I have only to add, that it does
not appear to me, from any accounts that I have yet
had, that the cold bathing has been so frequently em-
ployed, or has been found so commonly successful in
the cases of tetanus in consequence of wounds, as in
those from the application of cold.
MCCLXXXI.
Before concluding this chapter, it is proper for me
to take some notice of that peculiar case of the teta-
nus, or trismus, which attacks certain infants soon af-
ter their birth, and has been properly enough named
the Trismus Nascentium. From the subjects it af-
fects, it seems to be a peculiar disease: for these are
infants not above two weeks, and commonly before
they are nine days, old; insomuch that, in countries
where the disease is frequent, if children pass the peri-
od now mentioned, they are considered as secure a-
gainst its attacks. The symptom of it chiefly taken
notice of, is the trismus, or locked jaw, which is by
the vulgar improperly named the Falling of the Jaw.
But this is not the only symptom, as, for the most part,
it has all the same symptoms as the Opisthotonos and
Tetanus strictly so called, and which occur in the o-
ther varieties of the tetanic complaints above describ-
ed. Like the other varieties of tetanus, this is most
frequent in warm climates, but it is not, like those a-
rising from the application of cold, entirely confined
to such warm climates, as instances of it have occur-
red in most of the northern countries of Europe. In
these latter it seems to be more frequent in certain dis-
tricts than in others; but in what manner limited, I
cannot determine. It seems to be more frequent
in Switzerland than in France. I am informed of its
frequently

OF PHYSIC. 153
frequently occurring in the Highlands of Scotland;
but I have never met with any instance of it in the
low country. The particular causes of it are not well
known; and various conjectures have been offer-
ed; but none of them are satisfying. It is a disease
that has been almost constantly fatal; and this, also,
commonly in the course of a few days. The women
are so much persuaded of its inevitable fatality, that
they seldom or never call for the assistance of our art.
This has occasioned our being little acquainted with
the history of the disease, or with the effects of reme-
dies in it. Analogy, however, would lead us to em-
ploy the same remedies that have proved useful in the
other cases of tetanus: and the few experiments that
are yet recorded, seem to approve of such a practice.
CHAP. II.
OF EPILEPSY.
MCCLXXXII.
IN what sense I use the term Convulsion, I have ex-
plained above in MCCLVI.
The convulsions that affect the human body are
in several respects various; but I am to consider here
only the chief and most frequent form in which they
appear, and which is in the disease named Epilepsy.
This may be defined, as consisting in convulsions of
the greater part of the muscles of voluntary motion,
attended with a loss of sense, and ending in a state of
insensibility and seeming sleep.
MCCLXXXIII.
The general form or principal circumstances of this
disease,
VOL. II.
U

154 PRACTICE 
disease, are much the same in all the different persons
whom it affects. It comes by fits, which often attacks
persons seemingly in perfect health; and, after lasting
for some time, pass off, and leave the persons again in
their usual state. These fits are sometimes preceded
by certain symptoms, which to persons who have be-
fore experienced such a fit, may give notice of its ap-
proach, as we shall hereafter explain; but even these
preludes do not commonly occur long before the for-
mal attack, which in most cases comes on suddenly
without any such warning.
The person attacked loses suddenly all sense and
power of motion; so that, if standing, he falls imme-
diately, or perhaps, with convulsions, is thrown to
the ground. In that situation he is agitated with vi-
olent convulsions, variously moving his limbs and the
trunk of his body. Commonly the limbs on one
side of the body are more violently or more consider-
ably agitated than those upon the other. In all cases
the muscles of the face and eyes are much affected,
exhibiting various and violent distortions of the coun-
tenance. The tongue is often affected, and thrust
out of the mouth; while the muscles of the lower jaw
are also affected; and, shutting the mouth with vio-
lence while the tongue is thrust out between the teeth,
that is often grievously wounded.
While these convulsions continue, there is common-
ly at the same time a frothy moisture issuing from the
mouth. These convulsions have for some moments
some remissions, but are suddenly again renewed with
great violence. Generally, after no long time, the
convulsions cease altogether; and the person for some
time remains without motion, but in a state of abso-
lute insensibility, and under the appearance of a pro-
found sleep. After some continuance of this seeming
sleep, the person sometimes suddenly, but for the most
part by degrees only, recovers his senses and power
of 

OF PHYSIC. l55
of motion; but without any memory of what had pass-
ed from his being first seized with the fit. During
the convulsions, the pulse and respiration are hurried
and irregular; but, when the convulsions cease, they
return to their usual regularity and healthy state.
This is the general form of the disease; and it va-
ries only in different persons, or on different occasions
in the same person, by the phenomena mentioned be-
ing more or less violent, or by their being of longer or
shorter duration.
MCCLXXXIV.
With respect to the proximate cause of this disease,
I might say, that it is an affection of the energy of the
brain, which, ordinarily under the direction of the
will, is here, without any concurrence of it, impelled
by preternatural causes. But I could go no farther:
For, as to what is the mechanical condition of the
brain in the ordinary exertions of the will, I have no
distinct knowledge; and therefore must be also igno-
rant of the preternatural state of the same energy of
the brain under the irregular motions here produced.
To form, therefore, the indications of a cure, from a
knowledge of the proximate cause of this disease, I
must not attempt, but, from a diligent attention to
the remote causes which first induce and occasionally
excite the disease, I think we may often obtain some
useful directions for its cure. It shall therefore be my
business now, to point out and enumerate these re-
mote causes as well as I can.
MCCLXXXV.
The remote causes of epilepsy may be considered as
occasional or predisponent. There are, indeed, cer-
tain remote causes which act independently of any
predisposition; but, as we cannot always distinguish
these from the others, I shall consider the whole under
the usual titles of Occasional or Predisponent.
MCCLXXXVI.
U 2

156 PRACTICE
MCCLXXXVI.
The occasional causes, may, I think, be properly re-
ferred to two general heads; the first being of those
which seem to ad by directly stimulating and exciting
the energy of the brain; and the second, of those
which seem to act by weakening the same. With
respect to both, for the brevity of expressing a fact,
without meaning to explain the manner in which it
is brought about, I shall use the terms of Excitement
and Collapse. And though it be true, that with re-
spect to some of the causes I am to mention, it may be
a little uncertain whether they ad in the one way or
the other, that does not render it improper for us to
mark, with respect to others, the mode of their operat-
ing wherever we can do it clearly, as the doing so
may often be of use in directing our practice.
MCCLXXXVII.
First, then, of the occasional causes acting by excite-
ment: They are either such as act immediately and
directly upon the brain itself; or those which are first
applied to the other parts of the body, and are from
thence communicated to the brain.
MCCLXXXVIII.
The causes of excitement immediately and directly
applied to the brain, may be referred to the four heads
of, 1. Mechanical Stimulants; 2. Chemical Stimu-
lants; 3. Mental Stimulants; and 4. The peculiar
Stimulus of Over-distention.
MCCLXXXIX.
The mechanical stimulants may be, wounding in-
struments penetrating the cranium, and entering the
substance of the brain; or splinters of a fractured cra-
nium, operating in the same manner; or sharp-point-
ed ossifications, either arising from the internal surface
of the cranium, or formed in the membranes of the
brain.
MCCXC. 

OF PHYSIC. 157
MCCXC.
The chemical stimulants (MCCLXXXVIII.) may be
fluids from various causes lodged in certain parts of
the brain, and become acrid by stagnation or other-
wise.
MCCXCI.
The mental irritations acting by excitement, are,
all violent emotions of the active kind, such as joy
and anger. The first or thole is manifestly an excit-
ing power, acing strongly. and immediately, on the
energy of the brain. The second is manifestly, also,
a power acting in the same manner. But it must be
remarked, that it is not in this manner alone anger
produces its effects: for it acts, also, strongly on the
sanguiferous system, and may be a means of giving
the stimulus of over-distention; as, under a fit of an-
ger, the blood is impelled into the vessels of the head
with violence, and in a larger quantity.
MCCXCII.
Under the head of Mental Irritations, is to be
mentioned, the sight of persons in a fit of epilepsy,
which has often produced a fit of the like kind in the
spectator. It may, indeed, be a question. Whether
this effect be imputable to the Horror produced by a
sight of the seemingly painful agitations of the limbs,
and of the distortions in the countenance of the epi-
leptic person; or if it may be ascribed to the force of
imitation merely? It is possible, that horror may some-
times produce the effect: but certainly much may be
imputed to that propensity to imitation, at all times
so powerful and prevalent in human nature: and so
often operating in other cases of convulsive disorders,
which do not present any spectacle of horror.
MCCXCIII.
Under the same head of Mental Irritation. I think
proper to mention as an instance of it, the Epilepsia
Simulata, or the Feigned Epilepsy, so often taken no-
tice 

158 PRACTICE
tice of. Alrhough this, at the first, may be entirely
feigned, I have no doubt but that the repetition ren-
ders it at length real. The history of Quietism and
of Exorcisms leads me to this opinion: and which
receives a confirmation from what we know of the
power of imagination, in renewing epileptic and hys-
teric fits.
MCCXCIV.
I come now to the fourth head of the irritations
applied immediately to the brain, and which I appre-
hend to be that of the over-distension of the blood-
vessels in that organ. That such a cause operates in
producing epilepsy, is probable from this, that the
dissection of persons dead of epilepsy, has commonly
discovered the marks of a previous congestion in the
blood-vessels of the brain. This, perhaps, may be
supposed the effect of the fit which proved fatal: but
that the congestion was previous thereto, is probable
from the epilepsy being so often joined with headach,
mania, palsy, and apoplexy; all of them diseases de-
pending upon a congestion in the vessels of the brain.
The general opinion receives also confirmation from
this circumstance, that, in the brain of persons dead
of epilepsy, there have been often found tumours and
effusions, which, though seemingly not sufficient to
produce those diseases which depend on the compres-
sion of a considerable portion of the brain, may, how-
ever, have been sufficient to compress so many vessels
as to render the others upon any occasion of a more
than usual turgescence, or impulse of the blood into
the vessels of the brain more liable to an over-disten-
tion.
MCCXCV.
These considerations alone might afford foundation
for a probable conjecture with respect to the effects of
over-distention. But the opinion does not rest upon
conjecture alone. That it is also founded in fact, ap-
pears 

OF PHYSIC. 159
pears from hence, that a plethoric state is favourable
to epilepsy; and that every occasional turgescence,
or unusual impulse of the blood into the vessels of the
brain, such as a fit of anger, the heat of the sun, or of
a warm chamber, violent exercise, a surfeit, or a fit of
intoxication, are frequently the immediate exciting
causes of epileptic fits.
MCCXCVI.
I venture to remark further, that a piece of theory
may be admitted as a confirmation of this doctrine.
As I have formerly maintained, that a certain fulness
and tension of the vessels of the brain is necessary to
the support of its ordinary and constant energy, in
the distribution of the nervous power; so it must be
sufficiently probable, that an over-distension of these
blood-vessels may be a cause of violent excitement.
MCCXCVII.
We have now enumerated the several remote or oc-
casional causes of epilepsy, acting by excitement, and
acting immediately upon the brain itself. Of the
causes acting by excitement, but acting upon other
parts of the body, and from thence communicated to
the brain, they are all of them impressions producing
an exquisite or high degree either of pleasure or pain.
Impressions which produce neither the one nor the
other, have hardly any such effects, unless when such
impressions are in a violent degree; and then their
operation may be considered as a mode of pain. It is,
however, to be remarked, that all strong impressions
which are sudden and surprising, or, in other words,
unforeseen and unexpected, have frequently the effect
of bringing on epileptic fits.
MCCXCVIII.
There are certain impressions made upon different
parts of the body, which as they often operate with-
out producing any sensation, so it is uncertain to what
head they belong; but it is probable that the greater
part 

160 PRACTICE
part of them act by excitement, and therefore fall, to
be mentioned here. The chief instances are, The
teething of infants; worms; acidity or other acrimo-
ny in the alimentary canal; calculi in the kidneys;
acrid matter in abscesses or ulcers; or acrimony dif-
fused in the mass of blood, as in the case of some con-
tagions.
MCCXCIX.
Physicians have found no difficulty in comprehend-
ing how direct stimulants, of a certain force, may ex-
cite the action of the brain, and occasion epilepsy:
but they have hitherto taken little notice of certain
causes which manifestly weaken the energy of the
brain, and act, as I speak, by collapse. These, how-
ever, have the effect of exciting the action of the brain
in such a manner as to occasion epilepsy. I might
upon this subject, speak of the vis medicatrix naturæ;
and there is a foundation for the term; but, as I do
not admit the Stahlian doctrine of administering soul,
I make use of the term only as expressing a fact, and
would not employ it with the view of conveying an
explanation of the manner in which the powers of
collapse mechanically produce their effects. In the
mean time, however, I maintain, that there are certain
powers of collapse, which in effect prove stimulants,
and produce epilepsy.
MCCC.
That there are such powers, which may be termed
Indirect Stimulants, I conclude from hence, that seve-
ral of the causes of epilepsy are such as frequently
produce syncope, which we suppose always to depend
upon causes weakening the energy of the brain, (MC-
LXXVI.) It may give some difficulty to explain, why
the same cause sometimes occasion syncope, and some-
times occasion the reaction that appears in epilepsy;
and I shall not attempt to explain it: but this, I think,
does not prevent my supposing that the operation of
these 

OF PHYSIC. 161
these causes is by collapse. That there are such causes
producing epilepsy, will, I think, appear very clearly
from the particular examples of them I am now to
mention.
MCCCI.
The first to be mentioned, which I suppose to be
of this kind, is hemorrhagy, whether spontaneous or
artificial. That the same hemorrhagy which produc-
es syncope, often at the same time produces epilepsy,
is well known; and from many experiments and ob-
servations it appears, that hemorrhagies occurring to
such a degree as to prove mortal, seldom do so with-
out first producing epilepsy.
MCCCII.
Another cause acting, I suppose, by collapse, and
therefore sometimes producing syncope, and sometimes
epilepsy, is terror; that is, the fear of some great evil
suddenly presented. As this produces at the same
time a sudden and considerable emotion, (MCLXXX.)
so it more frequently produces epilepsy than syncope.
MCCCIII.
A third cause acting by collapse, and producing
epilepsy, is horror; or a strong aversion suddenly rais-
ed by a very disagreeable sensation, and frequently
arising from a sympathy with the pain or danger of
another person. As horror is often a cause of syncope,
there can be no doubt of its manner of operating in
producing epilepsy; and it may perhaps be explain-
ed upon this general principle, That as desire excites
action and gives activity, so aversion restrains from
action, that is, weakens the energy of the brain; and,
therefore, that the higher degrees of aversion may
have the effects of producing syncope or epilepsy.
MCCCIV.
A fourth set of the causes of epilepsy, which I sup-
pose also to act by collapse, are certain odours, which
occasion either syncope or epilepsy; and, with respect
to
Vol. II.
X 

162 PRACTICE
to the former, I have given my reasons (MCLXXXII.)
for supposing odours in that case to act rather as disa-
greeable than as sedative. These reasons will, I think,
also apply here; and perhaps the whole affair of odours
might be considered as instances of the effect of hor-
ror, and therefore belonging to the last head.
MCCCV.
A fifth head of the causes producing epilepsy by
collapse, is the operation of many substances consi-
dered. and for the most part properly considered, as
poisons. Many of these, before they prove mortal,
occasion epilepsy. This effect, indeed, may in some
cases be referred to the inflammatory operation which
they sometimes discover in the stomach, and other
parts of the alimentary canal; but, as the greater part
of the vegetable poisons show chiefly a narcotic, or
strongly sedative power, it is probably by this power
that they produce epilepsy, and therefore belong to
this head of the causes acting by collapse.
MCCCVI.
Under the head of the remote causes producing
epilepsy, we must now mention that peculiar one
whose operation is accompanied with what is called
the Aura Epileptica. This is a sensation of something
moving in some part of the limbs or trunk of the bo-
dy, and from thence creeping upwards to the head;
and when it arrives there, the person is immediately
deprived of sense, and falls into an epileptic fit. This
motion is described by the persons feeling it some-
times as a cold vapour, sometimes as a fluid gliding,
and sometimes as the sense of a small insect creeping
along their body; and very often they can give no
distinct idea of their sensation, otherwise than as in
general of something moving along. This sensation
might be supposed to arise from one affection of the
extremity or other part of a nerve acted upon by some
irritating matter; and that the sensation, therefore,
fol- 

OF PHYSIC. 163
followed the course of such a nerve: but I have never
found it following distinctly the course of any nerve;
and it generally seems to pass along the teguments.
It has been found in some instances to arise from
something pressing upon or irritating a particular
nerve, and that sometimes in consequence of contusi-
on or wound: but instances of these are more rare;
and the more common consequences of contusions and
wounds is a tetanus. This latter effect wounds pro-
duce, without giving any sensation of an aura or other
kind of motion proceeding from the wounded part to
the head; while, on the other hand, the aura produ-
cing epilepsy often arises from a part which never
had been affected with wound or contusion, and in 
which part the nature of the irritation can seldom be
discovered.
It is natural to imagine that this aura epileptica is
an evidence of some irritation or direct stimulus acting
in the part, and from thence communicated to the
brain, and should therefore have been mentioned a-
mong the causes acting by excitement; but the re-
markable difference that occurs in seemingly like
causes producing tetanus, gives some doubt on this
subject.
MCCCVII.
Having now enumerated the occasional causes of
epilepsy, I proceed to consider the predisponent. As
so many of the above-mentioned causes act upon cer-
tain persons, and not at all upon others, there must be
supposed in those persons a predisposition to this dis-
ease: But in what this predisposition consists, is not
to be easily ascertained.
MCCCVIII.
As many of the occasional causes are weak impres-
sions, and are applied to most persons with little or no 
effect, I conclude, that the persons affected by those
causes are more easily moved than others; and there-
fore
X 2

164 PRACTICE
fore that, in this case, a certain mobility gives the
predisposition. It will, perhaps, make this matter
clearer, to show, in the first place, that there is a
greater mobility of constitution in some persons than
in others.
MCCCIX.
This mobility appears most clearly in the state of
the mind. If a person is readily elated by hope, and
as readily depressed by fear, and passes easily and
quickly from one state to the other; if he is easily
pleased, and prone to gaiety, and as easily provoked
to anger, and rendered peevish; if liable, from slight
impressions, to strong emotions, but tenacious of none;
this is the boyish temperament qui colligit ac ponit
iram temere, et mutatur in horas; this is the varium et
mutabile fœmina; and, both in the boy and woman,
every one perceives and acknowledges a mobility of
mind. But this is necessarily conceded with an an-
alogous state of the brain; that is, with a mobility, in
respect of every impression, and therefore liable to a
ready alteration of excitement and collapse, and of
both to a considerable degree.
MCCCX.
There is, therefore, in certain persons, a mobility
of constitution, generally derived from the state of o-
riginal stamina, and more exquisite at a certain period
of life than at others; but sometimes arising from, and
particularly modified by, occurrences in the course
of life.
MCCCXI.
This mobility consists in a greater degree of either
sensibility or irrirtability. These conditions, indeed,
physicians consider as so necessarily connected, that
the constitution with respect to them, may be consider-
ed as one and the same: but I am of opinion that
they are different; and that mobility may sometimes
depend upon an increase of the one, and sometimes
on 

OF PHYSIC. 165
on that of the other. If an action excited, is, by re-
petition rendered more easily excited, and more vigo-
rously performed, I consider this as an increase of irri-
tability only. I go no farther on this subject here, as
it was only necessary to take notice of the case just
now mentioned, for the purpose of explaining why
epilepsy, and convulsions of all kinds, by being repeat-
ed, are more easily excited, readily become habitual,
and are therefore of more difficult cure.
MCCCXII.
However we may apply the distinction of sensibili-
ty and irritability, it appears that the mobility, which
is the predisponent cause of epilepsy, depends more
particularly upon debility, or upon a plethoric state
of the body.
MCCCXIII.
What share debility, perhaps by inducing sensibi-
lity, has in this matter, appears clearly from hence,
that children, women, and other persons of manifest
debility, are the most frequent subjects of this disease.
MCCCXIV.
The effects of a plethoric state in disposing to this
disease appears from hence, that plethoric persons are
frequently the subjects of it: that it is commonly ex-
cited, as I have said above, by the causes of any unu-
sual turgescence of the blood; and that it has been
frequently cured by diminishing the plethoric state of
the body.
That a plethoric state of the body should dispose
to this disease, we may understand from several con-
siderations. 1st, Because a plethoric state implies,
for the most part a laxity of the solids, and therefore
some debility in the moving fibres. 2dly, Because,
in a plethoric state, the tone of the moving fibres de-
pends more upon their tension, than upon their inhe-
rent power: and as their tension depends upon the
quantity and impetus of the fluid in the blood-vessels,
which 

166 PRACTICE
which are very changeable, and by many causes fre-
quently changed, so these frequent changes must give
a mobility to the system. 3dly, Because a plethoric
state is favourable to a congestion of blood in the
vessels of the brain, it must render these more readily
affected by every general turgescence of blood in the
system, and therefore more especially dispose to this
disease.
MCCCXV.
There is another circumstance of the body dispos-
ing to epilepsy, which I cannot so well account for:
and that is, the state of sleep: but whether I can ac-
count for it or not, it appears, in fact, that this state
gives the disposition I speak of; for, in many persons li-
able to this disease, the fits happen only in the time
of sleep, or immediately upon the person's coming out
of it. In a case related by De Haen, it appeared clear-
ly, that the disposition to epilepsy depended entirely
upon the state of the body in sleep*.
MCCCXVI.
Having thus considered the whole of the remote
causes of epilepsy, I proceed to treat of its cure, as I
have said it is from the consideration of those remote
causes only that we can obtain any directions for our
practice in the disease†.
I be-
* This was a very singular case. The chief circumstances in it
were, that the boy was more liable to the paroxysms when lying and
asleep, than when sitting up and awake. This peculiarity was not
observed till the disease had been of some standing, and, on a more
minute attention, the paroxysms were found to be more frequent
when the patient was in a peculiar state of sleeping, namely, when
he was drowsy, or when he snored in his sleep, than when he enjoy-
ed an easy and quiet sleep. A natural, quiet, and easy sleep, was
procured by the use of opium; and in a short time, the disease was
perfectly cured; but the boy died afterwards in consequence of a
tumor in his groin.
† Other causes of Epilepsy are enumerated by medical writers,
which the author, for the sake of brevity, left unnoticed.

OF PHYSIC. 167
I begin with observing, that as the disease may be
considered as sympathic or idiopathic, I must treat of
these separately, and judge it proper to begin with the
former.
MCCCXVII.
When this disease is truly sympathic, and depend-
ing upon a primary affection in some other part of the
body, such as acidity or worms in the alimentary ca-
nal, teething, or other similar causes, it is obvious that
such primary affections must be removed for the
cure of the epilepsy; but it is not our business here
to say how these primary diseases are to be treated.
MCCCXVIII.
There is, however, a peculiar case of sympathic
epilepsy; that is, the case accompanied with the au-
ra
Cases have occurred in which the epilepsy seems to have proceed-
ed from an hereditary taint.
Quicksilver, either accidentally or intentionally applied, has
been frequently found to produce epilepsy. Persons employed in
gilding of metals are often seized with tremblings of the hands, with
paisy, and with epilepsy, which can be attributed to nothing else than
the absorption of the vapours of mercury used in the operation, which
is as follows: the piece of metal to be gilt is first well cleaned and po-
lished; some mercury shaken with aqua fortis is spread upon it, till
the surface appears all over as white as silver: being then heated and
re-touched in those parts that have escaped the mixture, an amalga-
rna of mercury and gold is laid on it; the heat softening the amal-
gama, makes it fpread more uniformly; and the intervention of the
mercury and aqua fortis makes it adhere more firmly. The piece
thus covered with the amalgama is placed on a convenient support,
over a charcoal fire; and examined, from time to time, as the mer-
cury evaporates, that, if any deficiencies appear, they may be suppli-
ed with a little more of the amalgama before the operation is com-
pleted. This process necessarily exposes the artist to the fumes of
the mercury. 
Van Swieten says that he has seen skulls, in the dipploe of which
globules of mercury manifestly appeared; and he thinks it probable
that the mercury may possibly be thrown out into the cavities of the
brain itself, and produce much mischief.
Venery, when excessive, has been enumerated among the causes
of epilepsy by Boerhaave, but on what authority seems uncertain.

168 PRACTICE
ra epileptica, as described in MCCCVI, in which, though
we can perceive by the aura epileptica arising from a
particular part, that there is some affection in that
part; yet, as in many such cases we cannot perceive of
what nature the affection is, I can only offer the fol-
lowing general directions.
1st. When the part can with safety be entirely de-
stroyed, we should endeavour to do so by cutting it
out, or by destroying it by the application of an actual
or potential cautery.
2dly, When the part cannot properly be destroyed,
that we should endeavour to correct the morbid affec-
tion in it by blistering, or by establishing an issue up-
on the part.
3dly, When these measures cannot be executed, or
do not succeed, if the disease seems to proceed from
the extremity of a particular nerve which we can easi-
ly come at in its course, it will be proper to cut through
that nerve, as before proposed on the subject of teta-
nus.
4thly, When it cannot be perceived that the aura
arises from any precise place or point, so as to direct
to the above-mentioned operations; but, at the same
time, we can perceive its progress along the limb; it
frequently happens that the epilepsy can be prevented
by a ligature applied upon the limb, above the part
from which the aura arises: and this is always proper
to be done, both because the preventing a fit breaks
the habit of the disease, and because the frequent com-
pression renders the nerves less fit to propagate the
aura.
MCCCXIX.
The cure of idiopathic epilepsy, as I have said a-
bove, is to be direded by our knowledge of the remote
causes. There are therefore two general indications
to be formed: The first is, to avoid the occasional caus-
es; and the second is, to remove or correct the pre-
disponent. 
This

OF PHYSIC 169
This method, however, is not always purely palli-
ative; as in many cases the predisponent may be
considered as the only proximate cause, so our second
indication may be often considered as properly cura-
tive.
MCCCXX.
From the enumeration given above, it will be mani-
fest, that for the most part the occasional causes, so
far as they are in our power, need only to be known,
in order to be avoided; and the means of doing this
will be sufficiently obvious. I shall here, therefore,
offer only a few remarks.
MCCCXXI.
One of the most frequent of the occasional causes is
that of over-distension, (MCCCXIV.) which, so far as it
depends upon a plethoric state of the system, I shall
say hereafter how it is to be avoided. But as, not
only in the plethoric, but in every moveable constitu-
tion, occasional turgescence is a frequent means of ex-
citing epilepsy, the avoiding therefore of such turges-
cence is what ought to be most constantly the object
of attention to persons liable to epilepsy.
MCCCXXII.
Another of the most frequent exciting causes of this
disease are, all strong impressions suddenly made upon
the senses; for as such impressions, in moveable consti-
tutions, break in upon the usual force, velocity, and
order of the motions of the nervous system, they there-
by readily produce epilepsy. Such impressions, there-
fore, and especially those which are suited to excite
any emotion or passion of the mind, are to be most
carefully guarded against by persons liable to epilep-
MCCCXXIII.
In many cases of epilepsy, where the predisponent
cause cannot be correded or removed, the recurrence
of the disease can only be prevented by the strictest at-
tention 
Vol. II.
Y 

170 PRACTICE
tention to avoid the occasional; and as the disease is of-
ten confirmed by repetition and habit, so the avoiding
the frequent recurrence of it is of the utmost import-
ance towards its cure.
These are the few remarks I have to offer with re-
spect to the occasional causes; and must now observe
that, for the most part, the complete, or, as it is called,
the Radical Cure, is only to be obtained by removing
or correcting the predisponent cause.
MCCCXXIV.
I have said above, that the predisponent cause of
epilepsy is a certain mobility of the sensorium; and
that this depends upon a plethoric state of the system,
or upon a certain state of debility in it.
MCCCXXV.
How the plethoric state of the system is to be cor-
rected, I have treated of fully above in DCCLXXXIII.
et seq. and I need not repeat it here. It will be enough
to say, that it is chiefly to be done by a proper ma-
nagement of exercise and diet; and, with respect to
the latter, it is particularly to be observed here, that
an abstemious course has been frequently found to be
the most certain means of curing epilepsy.
MCCCXXVI.
Considering the nature of the matter poured out
by issues, these may be supposed to be a constant
means of obviating the plethoric state of the system;
and it is, perhaps, therefore, that they have been so oft-
en found useful in epilepsy. Possibly, also, as an open
issue maybe a means of determining occasional tur-
gesences to such places, and therefore of diverting
them in some measure from their action on the brain;
so also, in this manner, issues may be useful in epi-
lepsy.
MCCCXXVII.
It might be supposed that blood-letting would be
the most effectual means of correcting the plethoric
state 


OF PHYSIC. 171
state of the system; and such it certainly proves when
the plethoric state has become considerable, and imme-
diately threatens morbid effects. It is therefore, in such
circumstances, proper and necessary: but as we have
said above, that blood-letting is not the proper means
of obviating a recurrence of the plethoric state, and,
on the contrary, is often the means of savouring it;
so it is not a remedy advisable in every circumstance
of epilepsy. There is, however, a case of epilepsy in
which there is a periodical or occasional recurrence
of the fulness and turgescence of the sanguiferous
system, giving occasion to a recurrence of the disease.
In such cases, when the means of preventing plethora
have been neglected, or may have proved ineffectual,
it is absolutely necessary for the practitioner to watch
the returns of these turgescences, and to obviate their
effects by the only certain means of doing it, that is,
by a large blood-letting.
MCCCXXVIII.
The second cause of mobility which we have assign-
ed, is a state of debility. If this is owing, as it fre-
quently is, to original conformation, it is perhaps not
possible to cure it; but when it has been brought on
in the course of life, it possibly may admit of being
mended; and, in either case, much may be done to
obviate and prevent its effects.
MCCCXXIX.
The means of correcting debility, so far as it can be
done, are, The person's being much in cool air; the
frequent use of cold bathing; the use of exercise, a-
dapted to the strength and habits of the person; and,
perhaps, the use of astringent and tonic medicines.
These remedies are suited to strengthen the inherent
power of the solids or moving fibres: but as the
strength of these depends also upon their tention,
so when debility has proceeded from inanition, the
srength may be restored, by restoring the fulness and
tension
Y 2 

172 PRACTICE
tension of the vessels by a nourishing diet; and we
have had instances of the propriety and success of
such a practice.
MCCCXXX.
The means of obviating the effects of debility, and
of the mobility depending upon it, are the use of to-
nic and antispasmodic remedies.
The tonics are, Fear, or some danger of terror; as-
tringents; certain vegetable and metallic tonics; and
cold bathing.
MCCCXXXI.
That fear, or some degree of terror, may be of use
in preventing epilepsy, we have a remarkable proof
in Boerhaave's cure of the epilepsy, which happened
in the Orphan-house at Haerlem. See Kauu Boer-
haave's treatise, intitled Impetum Fociens, § 406.
And we have met with several other instances of the
same.
As the operation of horror is in many respects an-
alogous to that of terror, several seemingly superstiti-
ous remedies have been employed for the cure of e-
pilepsy; and, if they have ever been successful, I
think it must be imputed to the horror they had in-
spired*.
MCCCXXXII.
Of the astringent medicines used for the cure of e-
pilepsy, the most celebrated is the viscus quercinus,
which, when given in large quantities, may possibly
be useful; but I believe it was more especially so in
ancient times, when it was an object of superstition.
In
* Drinking a draught of the blood of a gladiator just killed;
drinking a draught of water with a toad at the bottom of the jug;
eating a piece of human liver, or the marrow of the bones of the leg
of a malefactor; powder of the human skull, or the moss that grows
on it; with a variety of such abominable remedies, were formerly
in great repute; and indeed some of them are still retained in severd
foreign Pharmacopœias.

OF PHYSIC. 173
In the few instances in which I have seen it employed,
it did not prove of any effect*.
MCCCXXXIII.
Among the vegetable tonics, the bitters are to be
reckoned; and it is by this quality that I suppose the
orange-tree leaves to have been useful: but they are
not always so.
MCCCXXXIV.
The vegetable tonic, which from its use in analogous
cases is the most promising, is the Peruvian bark;
this, upon occasion, has been useful, but has also often
failed. It is especially adapted to those epilepsies
which recur at certain periods, and which are at the
same time without the recurrence of any plethoric
state, or turgescence of the blood; and in such peri-
odical cases, if the bark is employed some time before
the expected recurrence, it may be useful; but it must
be given in large quantity, and as near to the time of
the expected return as possible.
MCCCXXXV.
The metallic tonics seem to be more powerful than
the vegetable, and a great variety of the former have
been employed.
Even arsenic has been employed in the cure of epi-
lepsy; and its use in intermittent fevers gives an analo-
gy in its favour.
Preparations of tin have been formerly recommend-
ed in the cure of epilepsy, and in the cure of the ana-
logous disease of hysteria; and several considerations
renders the virtues of tin, with respect to these diseas-
es, probable: but I have had no experience of its use
in such cases.
A much safer metallic tonic is to be found in the
preparations of iron; and we have seen some of them
employed
* The dose of it was from half a drachm to a drachm in powder,
an ounce in infusion. 

174 PRACTICE
employed in the cure of epilepsy, but have never
found them to be effectual. This, however, I think,
may be imputed to their not having been always em-
ployed in the circumstances of the disease, and in the
quantities of the medicine, that were proper and ne-
cessary*.
MCCCXXXVI.
Of the metallic tonics, the most celebrated and the
most frequently employed is copper, under various
preparation. What preparation of it may be the
most effectual, I dare not determine; but of late the
cuprum ammoniacum has been frequently found success-
ful†.
MCCCXXXVII.
Lately the flowers of zinc have been recommended
by a great authority as useful in all convulsive disor-
ders; but in cases of epilepsy, I have not hitherto
found that medicine useful‡.
MCCCXXXVIII.
There have been of late some instances of the cure
of epilepsy by the accidental use of mercury; and if
the late accounts of the cure of tetanus by this reme-
dy are confirmed, it will allow us to think that the
same may be adapted also to the cure of certain cases
of epilepsy.
MCCCXXXIX.
* The method of using iron, was described in a note on article
577.
† This was a favourite remedy of the Author's. He first intro-
duced it into practice in this country, and the preparation of it was
inserted in the Edinburgh Pharmacopœia.
It is employed by beginning with small doses of half a grain, and
increasing them gradually to as much as the stomach will bear. It
is, however, like all preparations of copper, a very dangerous medi-
cine, and ought to be used with caution.
‡ The great authority by which the flowers of zinc were recom-
mended was Gaubius. It is as dangerous a medicine as the cuprum
ammoniacum, and must be used with the same caution. 

OF PHYSIC. l75
MCCCXXXIX.
With respect to the employment of any of the a-
bove mentioned tonics in this disease, it must be ob-
served, that in all cases where the disease depends up-
on a constant or occasional plethoric state of the sys-
tem, these remedies are likely to be ineffectual; and
if sufficient evacuations are not made at the same time,
these medicines are likely to be very hurtful.
MCCCXL.
The other set of medicines which we have mention-
ed as suited to obviate the effects of the too great mo-
bility of the system, are the medicines named antis-
pasmodics. Of these there is a long list in the writers
on the Materia Medica, and by these authors re-
commended for the cure of epilepsy. The greater
part, however, of those taken from the vegetable king-
dom, are manifestly inert and insignificant*. Even
the root of the wild valerian hardly supports its cre-
dit.
MCCCXLI.
Certain substances taken from the animal kingdom
seem to be much more powerful: and of these the
chief, and seemingly the most powerful, is musk;
which, employed inks genuine state, and in due quan-
tity, has often been an effectual remedy†.
It
* This is certainly true; but it must be acknowledged that some
of them are manifestly active and useful, as the assafœtida, sagapenum,
and other fœtid gums. The pilulae gummosae of the Pharmacopœia's,
are good formulae for these nauscous medicines; and their being re-
puted inefficacious and insignificant seems to have arisen from their
not having been given in sufficiently large doses. They may be given
with safety to the quantity of two drachms in a day in repeated doses
of twenty or thirty grains each; and, if they should happen to purge,
this inconvenience may be prevented, by adding a quarter or half
a grain of opium to each dose of the pills, or taking ten drops of
laudanum after each dose, as occasion may require.
† Musk is more effectual when given in substance, than in any
preparation that has been attempted; it is given in doses of from ten

176 PRACTICE
It is probable also, that the oleum animale, as it has
been named, when in its purest state, and exhibited at
a proper time, may bean effectual remedy*.
MCCCXLII.
In many diseases, the most powerful antispasmodic
is certainly opium; but the propriety of its use in epi-
lepsy has been disputed among physicians* When
the disease depends upon a plethoric state in which
bleeding may be necessary, the employment of opium
is likely to be very hurtful: but, when there is no
plethoric or inflammatory state present, and the disease
seems to depend upon irritation or upon increased irri-
tability, opium is likely to prove the most certain re-
medy†. Whatever effects in this and other convul-
sive disorders have been attributed to the hyoscyamus,
must probably be attributed to its possessing a narcotic
power similar to that of opium.
MCCCXLIII.
With respect to the use of antispamodics, it is to be
observed, that they are always most useful, and per-
haps only useful, when employed at a time when epi-
leptic fits are frequently recurring, or near to the
times
to thirty grains, and frequently repeated. It may be made into a
bolus, as in the formula:
ꝶ. Mosch. gr. xv.
Tere in mortar, marmor. cum
Sacch. alb. ℈i. et adde
Confect. cardiac. ʒss. 
M. f. bolus.
This bolus may be repeated three or four times a day.
* The dose of this oil is from twenty to thirty drops; it is, how-
ever, seldom used.
† In those cases, in which some peculiar symptoms indicate the
approach of the fit, opium taken in a large dose has sometimes pre-
vented it altogether; but moft commonly, however, such a dose
greatly lessens its violence. Two grains of opium in substance, or
sixty or seventy drops of laudanum, are large doses. 

OF PHYSIC. 177
times of the accession of fits which recur after consi-
derable intervals.
MCCCXLIV.
On the subject of the cure of epilepsy, I have only
to add, that as the disease in many cases is continued
by the power of habit only, and that in all cases habit
has a great share in increasing mobility, and therefore
in continuing this disease; so the breaking in upon
such habit, and changing the whole habits of the sys-
tem, is likely to be a powerful remedy in epilepsy.
Accordingly, a considerable change of climate, diet,
and other circumstances in the manner of life, has
often proved a cure of this disease*.
MCCCXLV.
After treating of epilepsy, I might here treat of
particular convulsions, which are to be distinguished
from epilepsy by their being more partial: that is,
affecting certain parts of the body only, and by their
not being attended with a loss of sense, nor ending in
such a comatose state as epilepsy always does.
MCCCXLVI.
Of such convulsive affections many different instan-
ces have been observed and recorded by physicians.
But many of these have been manifestly sympathic af-
fections,
VOL. II. Z 
* After all that has been said on this disease, we must acknow-
ledge that we know but little of its true nature, and consequently no
certain method of cure can be given. It has baffled the skill of phy-
sicians from the earliest ages of physic, and still remains to be one of
those many diseases which we cannot certainly cure.
Some species of it, indeed, are certainly curable; but these are
few, and such only as are symptomatic, or arise from peculiar me-
chanical irritations.
Experience has moreover shewn us, that the disease often exists
without any apparent irritation, and without any cause observable on
dissection. Much room is therefore left for future investigations on
th it dark subject; and we must at present content ourselves with the
hopes that time will unfold what human ingenuity has not been capa-
ble of effecting.

178 PRACTICE
fections, to be cured only by curing the primary dis-
ease upon which they depend, and therefore not to be
treated of here: Or, though they are such as cannot
be referred to another disease, as many of them, how-
ever, have not any specific character with which they
occur in different persons, I must therefore leave them
to be treated upon the general principles I have laid
down with respect to epilepsy, or shall lay down with
respect to the following convulsive disorder; which as
having very constantly in different persons a peculiar
character, I think necessary to treat of more particu-
larly.
CHAP. III.
OF THE CHOREA OR DANCE OF ST. VITUS.
MCCCXLVII.
THIS disease affects both sexes, and almost only
young persons. It generally happens from the
age of ten to that of fourteen years*. It comes on al-
ways before the age of puberty, and rarely continues
beyond that period.
MCCCXLVIII.
It is chiefly marked by convulsive motions, some-
what varied in different persons, but nearly of one
kind in all; affecting the leg and arm on the same
side, and generally on one side only.
MCCCXLIX.
These convulsive motions commonly first affect the
leg
* I have seen it in a robust man of forty-two. This patient, after
various ineffectual remedies had been used, was cured by strong elec-
trical shocks directed through the whole body.

OF PHYSIC. 179
leg and foot. Though the limb be at rest, the foot
is often agitated by convulsive motions, turning it al-
ternately outwards and inwards. When walking is
attempted, the affected leg is seldom lifted as usual in
walking, but is dragged along as if the whole limb
were paralytic; and when it is attempted to be lifted,
this motion is unsteadily performed, the limb becom-
ing agitated by irregular convulsive motions.
MCCCL.
The arm of the same side is generally affected at
the same time; and, even when no voluntary motion
is attempted, the arm is frequently agitated with vari-
ous convulsive motions. But especially when volun-
tary motions are attempted, these are not properly ex-
ecuted, but are variously hurried or interrupted by
convulsive motions in a direction contrary to that in-
tended. The most common instance of this is in the
person's attempting to carry a cup of liquor to his
mouth, when it is only after repeated efforts, interrupt-
ed by frequent convulsive retractions and deviati-
ons, that the cup can be carried to the mouth.
MCCCL.
It appears to me, that the will often yields to these
convulsive motions, as to a propensity, and thereby
they are often increased, while the person affected
seems pleased with increasing the surprise and amuse-
ment which his motions occasion in the bystanders.
MCCCLII.
In this disease the mind is often affected with some
degree of fatuity; and often shows the same varied,
desultory, and causeless emotions which occur in hy-
steria.
MCCCLIII.
These are the most common circumstances of this
disease; but at times, and in different persons, it is
varied by some difference in the convulsive motions,
particularly by these affecting the head and trunk of
the
Z 2 

180 PRACTICE
the body. As in this disease there seem to be pro-
pensities to motion, so various fits of leaping and run-
ning occur in the persons affected; and there have
been instances of this disease, consisting of such con-
vulsive motions, appearing as an epidemic in a certain
corner of the country. In such instances, persons of
different ages are affected, and may seem to make an
exception to the general rule above laid down; but
still the persons are, for the most part, the young of
both sexes, and of the more manifestly moveable con-
stitutions.
MCCCLIV.
The method of curing this disease has been various-
ly proposed. Dr. Sydenham proposed to cure it by
alternate bleeding and purging. In some plethoric
habits I have found some bleeding useful; but in ma-
ny cases I have found repeated evacuations, especially
by bleeding, very hurtful.
In many cases, I have found the disease, in spite of
remedies of all kinds, continue for many months; but
I have also found it readily yield to tonic remedies, such
as the Peruvian bark, and chalybeates.
The late Dr. De Haen found several persons labour-
ing under this disease cured by the application of elec-
tricity.
SECT. 

OF PHYSIC. 182
SECT. II.
OF THE SPASMODIC AFFECTIONS OF THE
VITAL FUNCTIONS.
CHAP. IV†.
OF THE PALPITATION OF THE HEART.
MCCCLV.
THE motion thus named is a contraction or sys-
tole of the heart, that is performed with more
rapidity, and generally also with more force than usu-
al; and when at the same time the heart strikes with
more than usual violence against the inside of the ribs,
producing often a considerable sound.
MCCCLVI.
This motion or palpitation, is occasioned by a great
variety of causes, which have been recited with great
pains by Mr. Senac and others; whom however, I
cannot follow in all the particulars with sufficient dis-
cernment, and therefore shall here only attempt to re-
fer all the several cases of this disease to a few general
heads.
MCCCLVII.
The first is of those arising from the application of the
usual stimulus to the heart's contraction; that is, the
influx of the venous blood into its cavities, being made
with more velocity, and therefore, in the same time,
in greater quantity than usual. It seems to be in this
manner that violent exercise occasions palpitation.
MCCCLVIII.
A second bead of the cases of palpitation, is of those
arising from any resistance given to the free and entire
evacuation of the ventricles of the heart. Thus a li-
gature
† Though I have thought it proper to divide this book into sec-
tions, I think it necessary, for the convenience of references, to num-
ber the chapters from the beginning. 

183 PRACTICE
gature made upon the aorta occasions palpitations of
the most violent kind. Similar resistances, either in
the aorta or pulmonary artery, may be readily imagin-
ed; and such have been often found in dead bodies of
persons who, during life, had been much affected with
palpitations.
To this head are to be referred all those cases of
palpitation arising from causes producing an accumu-
lation of blood in the great vessels near to the heart.
MCCCLIX.
A third head of the cases of palpitation, is of those
arising from a more violent and rapid influx of the ner-
vous power into the muscular fibres of the heart. It
is in this manner that I suppose various causes acting
in the brain, and particularly certain emotions of the
mind, occasion palpitation.
MCCCLX.
A fourth head of the cases of palpitation, is of those
arising from causes producing a weakness in the acti-
on of the heart, by diminishing the energy of the
brain with respect to it. That such cases operate in
producing palpitation, I presume from hence, that all
the several causes mentioned above (MCLXXVII. et seq.)
as in this manner producing syncope, do often pro-
duce palpitation. It is on this ground that these two
diseases are affections frequently occurring in the same
person, as the same causes may occasion the one or the
other, according to the force of the cause and mobili-
ty of the person acted upon. It seems to be a law of
human œconomy, that a degree of debility occurring
in any function, often produces a more vigorous exer-
tion of the same, or at least an effort towards it, and
that commonly in a convulsive manner.
I apprehend it to be the convulsive action, frequent-
ly ending in some degree of a spasm, that gives occa-
sion to the intermittent pulse so frequently accompa-
nying palpitation.
MCCCLXI. 

OF PHYSIC 184
MCCCLXI.
A fifth head of the causes of palpitation may per-
haps be of those arising from a peculiar irritability or
mobility of the heart. This, indeed, may be consi-
dered as a predisponent cause only, giving occasion to
the action of the greater part of the causes recited a-
bove. But it is proper to observe, this predisposition
is often the chief part of the remote cause; insomuch
that many of the causes producing palpitation would
not have this effect but in persons peculiarly predis-
posed. This head, therefore, of the cases of palpita-
tion, often requires to be distinguished from all the
rest.
MCCCLXII.
After thus marking the several cases and causes of
palpitation, I think it necessary, with a view to the
cure of this disease, to observe, that the several causes
of it may be again reduced to two heads. The first
is, of those consisting in, or depending upon, certain
organic affections of the heart itself, or of the great
vessels immediately connected with it. The second
is, of those consisting in, or depending upon, certain
affections subsisting and acting in other parts of the
body, and acting either by the force of the cause, or
in consequence of the mobility of the heart.
MCCCLXIII.
With respect to the cases depending upon the first
set of causes, I must repeat here what I said with re-
spect to the like cases of syncope, that I do not know
any means of curing them. They, indeed, admit of
some palliation, first, by avoiding every circumstance
that may hurry the circulation of the blood; and, se-
condly, by every means of avoiding a plethoric state
of the system, or any occasional turgescence of the
blood. In many of these cases, blood-letting may give
a temporary relief: but in so far as debility and mobi-
lity

185 PRACTICE
lity are concerned, in such cases this remedy is likely
to do harm.
MCCCLXIV.
With respect to the cases depending upon the
other set of causes, they may be various, and require
very different measures: but I can here say in gene-
ral, that these cases may be considered as of two
kinds: one depending upon primary affections in o-
ther parts of the body, and acting by the force of the
particular causes; and another depending upon a
state of mobility in the heart itself. In the first of
these, it is obvious, that the cure of the palpitation must
be obtained by curing the primary affection: which
is not to be treated of here. In the second, the cure
must be obtained, partly by diligently avoiding the oc-
casional causes, partly and chiefly by correcting the
mobility of the system, and of the heart in particular;
for doing which we have treated of the proper means
elsewhere.
CHAP. V.
OF DYSPNOEA, OR DIFFICULT BREATH-
ING.
MCCCLXV.
THE exercise of respiration, and the organs of it,
have so constant and considerable a connection
with almost the whole of the other functions and parts
of the human body, that upon almost every occasion
of disease, respiration must be affected. Accordingly
some difficulty and disorder in this function, are in
fact symptoms very generally accompanying disease.
MCCCLXVI. 

OF PHYSIC. 185
MCCCLXVI.
Upon this account, the symptom of difficult breath-
ing deserves a chief place and an ample consideration
in the general system of Pathology; but what share
of consideration it ought to have in a treatise of Prac-
tice, I find it difficult to determine.
MCCCLXVII.
On this subject, it is, in the first place, necessary to
distinguish between the symptomatic and idiopathic
affections: that is, between those difficulties of breath-
ing which are symptoms only of a more general af-
fection, or of a disease subsisting primarily in other
parts than the organs of respiration, and that difficul-
ty of breathing which depends upon a primary affec-
tion of the lungs themselves. The various cases of
symptomatic dyspnœa I have taken pains to enume-
rate in my Methodical Nosology, and it will be obvi-
ous they are such as cannot be taken notice of here.
MCCCLXVIII.
In my Nosology I have also taken pains to point
out and enumerate the proper, or at least the greater
part of the proper, idiopathic cases of dyspnœa; but
from that enumeration it will, I think, readily ap-
pear, that few, and indeed hardly any, of these cases
will admit or require much of our notice in this place.
MCCCLXIX. 
The Dyspnœa Sicca*, species 2d, the Dyspnœa Ac-
rea§, sp. 3d, the Dyspnœa Terrea†, sp. 4th, and Dys-
pnœa
VOL. II A a 
* The definition, which the author gives of this species in his No-
sology is Dyspnœa cum tuffi plerumque sicca. It arises from vari-
ous causes, some of which are extremely difficult, if not impossible, to
be discovered.
§ The definition of this species is, Dyspnœa a minima quavis
tempestatum mutatione aucta.
† It is defined Dyspnœa cum tuffi materiam terream vel calculo-
sam ejiciente. This is sometimes the expulsion of a gouty matter. 

186 PRACTICE
pnœa Tboracica*, sp. 7th, are some of them with diffi-
culty known, and are all of them diseases which in
my opinion do not admit of cure. All, therefore,
that can be said concerning them here is, that they
may admit of some palliation; and this, I think, is to
be obtained chiefly by avoiding the plethoric state of
the lungs§, and every circumstance that may hurry
respiration.
MCCCLXX.
Of the Dyspnœa Extrinseca†, sp. 8th, I can say no
more, but that these external causes marked in the
Nosology, and perhaps some others that might have
like effects, are to be carefully avoided; or, when they
have been applied, and their effects have taken place, the
disease is to be palliated by the means mentioned in
the last paragraph.
MCCCLXXI.
The other species, though enumerated as idiopathic,
can hardly be considered as such, or as requiring to
be treated of here. 
The Dyspnœa Catarrhalis‡, sp. 1st may be consi-
dered as a species of catarrh, and is pretty certainly
to be cured by the same remedies as that species of ca-
tarrh which depends rather upon the increased afflux
of mucus to the bronchise, than upon any inflammato-
ry state of them‖.
The
* The definition of this species is, Dyspnœa a partibus thoracem
cingentibus laesis, vel male conformatis.
§ This intention is most speedily obtained by occasional bleeding.
† It is defined Dyspnœa a causis externis manifestis. These caus-
es are various, as exposure to dust of different kinds, to metallic fumes,
to vitiated air, to vaponrs of different kinds, &c.
‡ It is defined, Dyspnœa cum tuffi frequentc mucum viscidem
copiosum ejiciente.
‖ The remedies for this purpose are, emetics, sudorifics, and ex-
pectorants; formulae of which may be seen in the notes on article
1066, 

OF PHYSIC. 187
The Dyspnœa Aquosa*, sp. 5th, is certainly to be
considered as a species of dropsy, and is to be treated
by the same remedies as the other species of that dis-
ease.
The Dyspnœa Pinguedinosa†, sp. 6th, is in like
manner to be considered as a symptom or local effect
of the Polysarcia, and is only to be cured by correct-
ing the general fault of the system‡.
MCCCLXXII.
From this view of those idiopathic cases of dys-
pnœa, which are perhaps all I could properly arrange
under this title, it will readily appear that there is lit-
tle room for treating of them here: but there is still
one case of difficult breathing, which has been proper-
ly distinguished from every other under the title of
Asthma; and as it deserves our particular attention, I
shall here separately consider it.
CHAP. VI.
OF ASTHMA.
MCCCLXXIII.
THE term of Asthma has been commonly applied
by the vulgar, and even by many writers on the
Practice of Physic, to every case of difficult breathing,
that
A a 2
* It is desiued, Dyspnœa cum urina parca, et œdemate, pedum,
fine fluctuatione in pectore, vel aliis characteristicis hydrothoracis-
signis.
† It is defined, Dyspnœa in hominibus valde obesis.
‡ A low diet, sufficient exercise, sweating, and brisk purges, will
soon have the derived effect; and the disease may be prevented by
abstemious living. 

188 PRACTICE
that is, to every species of Dyspnœa. The Methodi-
cal Nosologists, also, have distinguished Asthma from
Dyspnœa chiefly, and almost solely, by the former be-
ing the same affection with the latter, but in a higher
degree. Neither of these applications of the term
seems to have been correct or proper. I am of opini-
on, that the term Asthma may be most properly ap-
plied, and should be confined, to a case of difficult
breathing that has peculiar symptoms, and depends
upon a peculiar proximate cause, which I hope to as-
sign with sufficient certainty. It is this disease I am now
to treat of, and it is nearly what Practical Writers have
generally distinguished from the other cases of diffi-
cult breathing, by the title of Spasmodic Asthma, or
of Asthma convulsivum; altho' by not distinguishing
it with sufficient accuracy from the other cases of Dys-
pnœa, they have introduced a great deal of confusion
into their treatises on this subject.
DCCCLXXIV.
The disease I am to treat of, or the Asthma to be
strictly so called, is often a hereditary disease. It*
seldom appears very early in life, and hardly till the
time of puberty, or after it. It affects both sexes, but
most frequently the male. I have not observed it td
be more frequent in one kind of temperament than
in another; and it does not seem to depend upon any
general temperament of the whole body, but upon a
particular constitution of the lungs alone. It frequent-
ly attacks persons of a full habit; but it hardly ever
continues to be repeated for some length of time with-
out occasioning an emaciation of the whole body.
MCCCLXXV.
The attacks of this disease are generally in the
night-time, or towards the approach of night; but
there are also some instances of their coming on in
the
* This description of the disease under consideration is excellent. 

OF PHYSIC. 189
the course of the day. At whatever time they come
on, it is for the most part suddenly, with a sense of
tightness and stricture across the breast, and a sense of
straitness in the lungs impeding inspiration. The per-
son thus attacked, if in a horizontal situation, is imme-
diately obliged to get into somewhat of an erect pos-
ture, and requires a free and cool air. The difficulty
of breathing goes on for some time increasing; and
both inspiration and exspiration are performed slowly,
and with a wheezing noise. In violent fits, speaking
is difficult and uneasy. There is often some propen-
fity to coughing, but it can hardly be executed
MCCCLXXVI.
These symptoms often continue for many hours to-
gether, and particularly from midnight till the morn-
ing is far advanced. Then commonly a remission
takes place by degrees; the breathing becomes less la-
borious and more full, so that the person can speak and
cough with more ease; and, if the cough brings up
some mucus, the remission becomes immediately more
considerable, and the person falls into a much wished-
for sleep.
MCCCLXXVII.
During these fits the pulse often continues in its na-
tural state; but in some persons the fits are attended
with a frequency of pulse, and with some heat and
thirst, as marks of some degree of fever. If urine be
voided at the beginning of a fit, it is commonly in
considerable quantity, and with little colour or odour -
but, after the fit is over, the urine voided is in the or-
dinary quantity of a high colour, and sometimes depo-
sites a sediment. In some persons, during the fit, the
face is a little flushed and turgid; but more common-
ly it is somewhat pale and shrunk.
MCCCLXXVIII.
After some sleep in the morning, the patient, for
the rest of the day, continues to have more free and
easy 

190 PRACTICE
easy breathing, but it is seldom entirely such. He
still feels some tightness across his breast, cannot
breathe easily in a horizontal posture, and can hardly
bear any motion of his body, without having his
breathing rendered more difficult and uneasy. In the
afternoon he has an unusual flatulency of his stomach,
and an unusual drowsiness; and, very frequently, these
symptoms precede the first attacks of the disease.
But, whether these symptoms appear or not, the diffi-
culty of breathing returns towards the evening; and
then sometimes gradually increases, till it becomes as
violent as in the night before: or if, during the day,
the difficulty of breathing has been moderate, and
the person got some sleep in the first part of the night,
he is, however, waked about midnight, or at some
time between midnight and two o'clock in the morn-
ing; and is then suddenly seized with a fit of difficult
breathing, which runs the same course as the night
before.
MCCCLXXIX.
In this manner fits return for several nights succes-
sively: but generally, after some nights passed in this
way, the fits suffer more considerable remissions. This
especially happens when the remissions are attended
with a more copious expectoration in the mornings,
and that this continues from time to time throughout
the day. In these circumstances, asthmatics, for a
long time after, have not only more easy days, but en-
joy also nights of entire sleep, without the recurrence
of the disease.
MCCCLXXX.
When this disease, however, has once taken place in
the manner above described, it is ready to return at
times for the whole of life after. These returns,
however, happen with different circumstances in dif-
ferent persons.
MCCCLXXXI. 

OF PHYSIC. 191
MCCCLXXXI.
In some persons the fits are readily excited by exter-
nal heat, whether of the weather or of a warm cham-
ber, and particularly by warm bathing. In such per-
sons fits are more frequent in summer, and particular-
ly during the dog-days, than at other colder seasons.
The same persons are also readily affected by changes
of the weather; especially by sudden changes made
from a colder to a warmer, or, what is commonly the
same thing, from a heavier to a lighter atmosphere.
The same persons are also affected by every circum-
stance threatening the capacity of the thorax, as by
any ligature made, or even by a plaster laid, upon it;
and a like effect happens from any increased bulk of
the stomach, either by a full meat, or by air collected
in it. They are likewise much affected by exercise, or
whatever else can hurry the circulation of the blood.
MCCCLXXXII.
As asthmatic fits seem thus to depend upon some
fulness of the vessels of the lungs, it is probable that
an obstruction of perspiration, and the blood being
less determined to the surface of the body, may fa-
vour an accumulation in the lungs, and thereby be a
means of exciting asthma. This seems to be the case
of those asthmatics who have fits most frequently in
the winter-season, and who have commonly more of a
catarrhal affection accompanying the asthma; which
therefore occurs more frequently in winter, and more
manifestly from the application of cold.
MCCCLXXXIII.
Beside these cases of asthma excited by heat or cold,
there are others, in which the fits are especially excit-
ed by powers applied to the nervous system; as by
passions of the mind, by particular odours, and by ir-
ritations of smoke and dust.
That this disease is an affection of the nervous sys-
tem, and depending upon a mobility of the moving fi-
bres

192 PRACTICE
bres of the lungs, appears pretty clearly from its be-
ing frequently attended with other spasmodic affecti-
ons depending upon mobility; such as hysteria, hy-
pochondriasis, dyspepsia, and atonic gout.
MCCCLXXXIV.
From the whole of the history of asthma now deliver-
ed, I think it will readily appear, that the proximate
cause of this disease is a preternatural, and in some
measure a spasmodic, constriction of the muscular fibres
of the bronchiæ; which not only prevents the dilata-
tion of the bronchiæ necessary to a free and full in-
spiration, but gives also a rigidity which prevents a
full and free expiration. This preternatural constric-
tion, like many other convulsive and spasmodic af-
fections, is readily excited by a turgescence of the blood,
or other cause of any unusual fulness and distention
of the vessels of the lungs.
MCCCLXXXV.
This disease, as coming by fits, may be generally
distinguished from most other species of dyspnœa, whose
causes being more constantly applied, produce there-
fore a more constant difficulty of breathing. There
may, however, be some fallacy in this matter, as some
of these causes may be liable to have abatements and
intensities, whereby the dyspnœa produced by them
may seem to come by fits; but I believe it is seldom
that such fits put on the appearance of the genuine
asthmatic fits described above. Perhaps, however,
there is still another case that may give more difficulty;
and that is, when several of the causes, which we have
assigned as causes of several of the species of difficult
breathing referred to the genius of Dyspnœa, may have
the effect of exciting a genuine asthmatic fit. Whe-
ther this can happen to any but the peculiarly predis-
posed to asthma, I am uncertain; and therefore, whe-
ther, in any such cases, the asthma may be consider-
ed as symptomatic; or if, in all such cases, the asthma
may 

OF PHYSIC. 193
may not still be considered and treated as an idiopa-
thic disease.
MCCCLXXXVI.
The asthma, though often threatening immediate
death, seldom occasions it; and many persons have
lived long under this disease. In many cases, however,
it does prove fatal; sometimes very quickly, and per-
haps always at length. In some young persons it has
ended soon, by occasioning a phthisis pulmonalis. Af-
ter a long continuance, it often ends in a hydrothorax;
and commonly, by occasioning some aneurism of the
heart or great vessels, it thereby proves fatal.
MCCCLXXXVII.
As it is seldom that an asthma has been entirely cur-
ed; I therefore cannot propose any method of cure
which experience has approved as generally successful,
But the disease admits of alleviation in several respects
from the use of remedies; and my business now shall
be chiefly to offer some remarks upon the choice and
use of the remedies which have been commonly em-
ployed in cases of asthma.
MCCCLXXXVIII.
As the danger of an asthmatic fit arises chiefly from
the difficult transmission of the blood through the ves-
sels of the lungs, threatening suffocation; so the most
probable means of obviating this seems to be blood-
letting: and therefore, in all violent fits, practitioners
have had recourse to this remedy. In first attacks,
and especially in young and plethoric persons, blood-
letting maybe very necessary, and is commonly allow-
able. But it is also evident, that, under the frequent
recurrence of fits, blood-letting cannot be frequently
repeated without exhausting and weakening the pati-
ent too much. It is further to be observed, that blood-
letting is not so necessary as might be imagined, as
the passage of the blood through the lungs is not so
much
VOL. II. 
B b 

194 PRACTICE
interrupted as has been commonly supposed. This I
particularly conclude from hence, that, instead of the
suffusion of face, which is the usual effect of such inter-
ruption, the face, in asthmatics fits, is often shrunk
and pale. I conclude the same also from this, that,
in asthmatic fits, blood-letting does not commonly
give so much relief as, upon the contrary supposition,
might be expected.
MCCCLXXXIX.
As I have alledged above, that a turgescence of the
blood is frequently the exciting cause of asthmatic fits,
so it might be supposed, that a plethoric state of the
system might have a great share in producing a tur-
gescence of the blood in the lungs; and especially,
therefore, that blood-letting might be a proper reme-
dy in asthma: I allow it to be so in the first attacks
of the disease: but as the disease, by continuing, gene-
rally takes off the plethoric state of the system; so, af-
ter the disease has continued for some time, I alledge
that blood-letting becomes less and less necessary.
MCCCXC.
Upon the supposition of asthmatics being in a ple-
thoric state, purging might be supposed to prove a re-
medy in this disease: but, both because the supposi-
tion is not commonly well founded, and because purg-
ing is seldom found to relieve the vessels of the thorax,
this remedy has not appeared to be well suited to asth-
matics; and large purging has always been found to
do much harm. But as asthmatics are always hurt by
the stagnation and accumulation of matters in the ali-
mentary canal, so costiveness must be avoided, and an
open belly proves useful. In the time of fits, the em-
ployment of emollient and moderately laxative glys-
ters* has been found to give considerable relief.
MCCCXCI.
* A clyster of milk, with a little salt, is generally sufficient.
The costiveness may be removed by mucilaginous laxatives of the

OF PHYSIC. 195
MCCCXCI.
As a flatulency of the stomach, and other symp-
toms of indigestion, are frequently attendants of asth-
ma, and very troublesome to asthmatics; so, both for
removing these symptoms, and for taking off all deter-
mination to the lungs, the frequent use of gentle vo-
mits* is proper in this disease. In certain cases, where
a fit was expected to come on in the course of the
night, a vomit given in the evening has frequently
seemed to prevent it.
MCCCXCII.
Blistering between the shoulders, or upon the
breast, has been frequently employed to relieve asth-
matics; but in the pure spasmodic asthma we treat of
here, I have rarely found blisters useful, either in pre-
venting or relieving fits.
MCCCXCIII.
Issues are certainly useful in obviating plethora;
but as such indications seldom arise in cases of asthma,
so issues have been seldom found useful in this disease.
MCCCXCIV.
As asthmatic fits are so frequently excited by a tur-
gescence of the blood, so the obviating and allaying
of this by acids and neutral salts, seems to have been
at all times the object of practitioners. See FLOYER
on the Asthma.
MCCCXCV.
Although a plethoric state of the system may seem
to dispose to asthma, and the occasional turgescence
of the blood may seem to be frequently the exciting
cause of the fits; yet it is evident, that the disease
must have arisen chiefly from a peculiar constitution
in
B b 2
milder kind, as manna, cassia, &c. or by a proper attention to diet,
especially by using the pulps of particular fruits, as prunes or raisins
boiled in barley-water; roasted apples eaten with brown sugar, &c.
* Vomits ought, in these cases, to be mild. Some formulae of
them are given in one of the notes on article 185. 

196 PRACTICE
in the moving fibres of the bronchiæ, disposing them
upon various occasions to fall into a spasmodic con-
striction; and therefore, that the entire cure of the
disease can only be expected from the correcting of
that predisposition, or from correcting the preterna-
tural mobility or irritability of the lungs in that re-
spect.
MCCCXCVI.
In cases wherein this predisposition depends upon
original conformation, the cure must be difficult, and
perhaps impossible; but it may perhaps be moderated
by the use of antispasmodics. Upon this footing, va-
rious remedies of that kind have been commonly em-
ployed, and particularly the fetid gums; but we have
not found them of any considerable efficacy, and have
observed them to be sometimes hurtful by their heat-
ing too much. Some other antispasmodics which
might be supposed powerful, such as musk, have not
been properly tried. The vitriolic ether has been
found to give relief, but its effects are not lasting.
MCCCXCVII.
As in other spasmodic affections, so in this, the most
certain and powerful antispasmodic is opium*. I
have often found it effectual, and generally safe; and
if there have arisen doubts with respect to its safety,
I believe they have arisen from not distinguishing be-
tween certain plethoric and inflammatory cases of dys-
pnœa, improperly named Asthma, and the genuine
spasmodic asthma we treat of here.
MCCCXCVIII.
* The great efficacy of opium, in cases of spasmodic asthma, is
fully confirmed by experience. It ought to be given in large doses,
but not often repeated in the day. It seems to be most useful when
given occasionally to allay the violence of the fit, or to prevent its.
accession. Thus, forty drops of laudanum have been frequently
found to relieve the symptoms when the fit is violent; or when tak-
en at the approach of the fit, to have wholly suppressed it, or at least 
to have considerably blunted its violence. 

OF PHYSIC. 197
MCCCXCVIII.
As in many cases this disease depends upon a pre-
disposition which cannot be corrected by our art, so in
such cases the patient can only escape the disease by a-
voiding the occasional or exciting causes, which I have
endeavoured to point out above. It is, however, dif-
ficult to give any general rules here, as different asth-
matics have their different idiosyncrasies with respected
to externals. Thus, one asthmatic finds himself easiest
living in the midst of a great city, while another can-
not breathe but in the free air of the country. In the
latter case, however, most asthmatics bear the air of a
low ground, if tolerable free and dry, better than that
of the mountain.
MCCCXCIX.
In diet, also, there is some difference to be made
with respect to different asthmatics. None of them
bear a large or full meal, or any food that is of slow
and difficult solution in the stomach; but many of
them bear animal food of the lighter kinds, and in
moderate quantity. The use of vegetables which rea-
dily prove flatulent, are always very hurtful. In re-
cent asthma, and especially in the young and pletho-
ric, a spare, light, and cool diet is proper, and com-
monly necessary; but, after the disease has continued
for years, asthmatics commonly bear, and even require,
a tolerably full diet, though in all cases a very full diet
is very hurtful.
MCCCC.
In drinking, water, or cool watery liquors, is the
only safe and fit drinks for asthmatics; and all liquors
ready to ferment and become flatulent, are hurtful to
them. Few asthmatics can bear any kind of strong
drink; and any excess in such is always very hurtful
to them. As asthmatics are commonly hurt by taking
warm or tepid drink; so, both upon that account, and
Upon account of the liquors weakening the nerves of
the 

198 PRACTICE
the stomach, neither tea nor coffee is proper in this
disease.
MCCCCI.
Asthmatics commonly bear no bodily motion easi-
ly but that of the most gentle kind. Riding, howe-
ver, on horseback, or going in a carriage, and especi-
ally sailing, are very often useful to asthmatics.
CHAP. VII.
OF THE CHINCOUGH, OR HOOPING-
COUGH.
MCCCCII.
THIS disease is commonly epidemic, and manifest-
ly contagious. It seems to proceed from a con-
tagion of a specific nature, and of a singular quality.
It does not like most other contagions, necessarily pro-
duce a fever; nor does it, like most others, occasion
any eruption, or produce otherwise any evident change
in the state of the human fluids. It has, in common
with the catarrhal contagion, and with that of the
measles, a peculiar determination to the lungs; but
with particular effects there, very different from those
of the other two; as will appear from the history of
this disease now to be delivered.
MCCCCIII.
This contagion, like several others, affects persons
but once in the course of their lives; and therefore,
necessarily, children are most commonly the subjects of
this disease: but there are many instances of it occur-
ring in persons considerably advanced in life; though
it is probable, that the further that persons are advanc-
ed 

OF PHYSIC. 199
ed in life, they are the less liable to be affected with
this contagion.
MCCCCIV.
The disease commonly comes on with the ordinary
symptoms of a catarrh arising from cold; and often,
for many days, keeps entirely to that appearance; and
I have had instances of a disease which though evi-
dently arising from the chincough contagion, never
put on any other form than that of a common ca-
tarrh. 
This, however, seldom happens; for, generally, in
the second, and at farthest in the third, week after
the attack, the disease puts on its peculiar and charac-
teristic symptom, a convulsive cough. This is a
cough in which the exspiratory motions peculiar to
coughing are made with more frequency, rapidity,
and violence, than usual. As these circumstances,
however, in different instances of coughing, are in
very different degrees; so no exact limits can be put
to determine when the cough can be strictly said to
be convulsive; and it is therefore especially by ano-
ther circumstance that the chincough is distinguished
from every other form of cough. This circumstance
is, when many exspiratory motions have been convul-
sively made, and thereby the air is in great quantity
thrown out from the lungs, a full inspiration is neces-
sarily and suddenly made; which, by the air rushing
in through the glottis with unusual velocity, gives a
peculiar sound. This sound is somewhat different in
different cases, but is in general called a Hoop; and
from it the whole of the disease is called the Hooping
Cough. When this sonorous inspiration has happen-
ed, the convulsive coughing is again renewed, and con-
tinues in the same manner as before, till a quantity of
mucus is thrown up from the lungs, or the contents of
the stomach are thrown up by vomiting. Either of
these evacuations commonly puts an end to the
coughing,

200 PRACTICE
coughing, and the patient remains free from it for
some time after. Sometimes it is only after several
alternate fits of coughing and hooping that expectora-
tion or vomiting takes place; but it is commonly af-
ter the second coughing that these happen, and put
an end to the fit.
MCCCCV.
When the disease, in this manner, has taken its
proper form, it generally continues for a long time af-
ter, and generally from one month to three; but
sometimes much longer, and that with very various
circumstances.
MCCCCVI.
The fits of coughing return at various intervals,
rarely observing any exact period. They happen fre-
quently in the course of the day, and more frequently
still in the course of the night. The patient has com-
monly some warning of their coming on; and, to a-
void that violent and painful concussion which the
coughing gives to the whole body, he clings fast to
any thing that is near to him, or demands to be held
fast by any person that he can come at.
When the fit is over, the patient sometimes breathes
fast, and seems fatigued for a little after: but in many
this appears very little; and children are commonly so
entirely relieved, that they immediately return to
their play, or what else they were occupied in before.
MCCCCVII.
If it happens that the fit of coughing ends in vo-
miting up the contents of the stomach, the patient is
commonly immediately after seized with a strong
craving and demand for food, and takes it in very
greedily.
MCCCCVIII.
At the first coming on of this disease, the expecto-
ration is sometimes none at all, or of a thin mucus
only; and while this continues to be the case, the fits
of  

OF PHYSIC. 201
of coughing are more violent, and continue longer;
but commonly the expectoration soon becomes con-
siderable, and a very thick mucus, often in great
quantity, is thrown up; and as this is more readily
brought up, the fits of coughing are of shorter dura-
tion.
MCCCCIX.
The violent fits of coughing frequently interrupt
the free transmission of the blood through the lungs,
and thereby the free return of blood from the vessels
of the head. This occasions that turgescence and suf-
fusion of face which commonly attends the fits of
coughing, and seems to occasion also those eruptions
of blood from the nose, and even from the eyes and
ears, which sometimes happen in this disease. 
MCCCCX.
This disease often takes place in the manner we
have now described, without any pyrexia attending
it; but, though Sydenham had seldom observed it,
we have found the disease very frequently accompani-
ed with pyrexia, sometimes from the very beginning,
but more frequently only after the disease had conti-
nued for some time. When it does accompany the
disease, we have not found it appearing under any re-
gular intermittent form. It is constantly in some de-
gree present; but with evident exacerbations towards
evening, continuing till next morning.
MCCCCXI.
Another symptom v ery frequently attending the chin-
cough, is a difficulty of breathing; and that not only
immediately before and after fits of coughing, but as
constantly present, though in different degrees in dif-
ferent persons. I have hardly ever seen an instance of
a fatal chincough, in which a considerable degree of
pyrexia and dyspnœa had not been for some time con-
stantly present.
MCCCCXII. 
VOL. II. 
C c 

202 PRACTICE
MCCCCXII.
When by the power of the contagion this disease
has once taken place, the fits of coughing are often re-
peated, without any evident exciting cause: but, in
many cases, the contagion may be considered as giv-
ing a predisposition only ; and the frequency of fits
depends in some measure upon various exciting cau-
ses; such as, violent exercise; a full meal; the having
taken in food of difficult solution; irritations of the
lungs by dull, smoke, or disagreeable odours of a strong
kind; and, especially any considerable emotion of the
mind.
MCCCCXIII.
Such are the chief circumstances of this disease,
and it is of various event; which, however, may be
commonly foreseen by attending to the following
considerations.
The younger that children are, they are in the
greater danger from this disease; and of those to whom
it proves fatal, there are many more under two years
old than above it.
The older that children are, they are the more se-
cure against an unhappy event; and this I hold to be
a very general rule, though I own there are many ex-
ceptions to it.
Children born of phthisical and asthmatic parents
are in the greatest danger from this disease.
When the disease, beginning in the form of a ca-
tarrh, is attended with fever and difficult breathing,
and with little expectoration, it often proves fatal,
without taking on the form of the hooping cough;
but, in most of such cases, the coming on of the con-
vulsive cough and hooping, bringing on at the same
time a more frequent expectoration, generally removes
the danger.
When the disease is fully formed, if the fits are nei-
ther frequent nor violent, with moderate expectora-
tion, 

OF PHYSIC. 203
tion, and the patient, during the intervals of the fits,
is easy, keeps his appetite, gets sleep, and is without
fever or difficult breathing, the disease is attended with
no danger; and these circumstances becoming daily
more favourable, the disease very soon spontaneously
terminates.
An expectoration, either very scanty or very copi-
ous, is attended with danger; especially if the latter
circumstance is attended with great difficulty of breath-
ing.
Those cases in which the fits terminate by a vomit-
ing, are immediately followed by a craving of food,
are generally without danger.
A moderate hemorrhagy from the nose often proves
salutary; but very large hemorrhagies are generally
very hurtful.
This disease coming upon persons under a state of
much debility, has very generally an unhappy event.
The danger of this disease sometimes arises from
the violence of the fits of coughing, occasioning apo-
plexy, epilepsy, or immediate suffocation: but these
accidents are very rare; and the danger of the disease
seems generally to be in proportion to the fever and
dyspnœa attending it.
MCCCCXIV.
The cure of this disease has been always considered
as difficult, whether the purpose be to obviate its fatal
tendency when it is violent, or merely to shorten the
course of it when it is mild. When the contagion it
recent, and continues to act, we neither know how
to correct, nor how to expel it; and therefore the dis-
ease necessarily continues for some time: but it is pro-
bable, that the contagion in this as in other instances
ceases at length to act; and that then the disease con-
tinues, as in other convulsive affections, by the power
of habit alone. 
MCCCCXV.
C c 2 

204 PRACTICE
MCCCCXV.
From this view of the matter I maintain, that the
practise must be different, and adapted to two differ-
ent indications, according to the period of the disease.
At the beginning of the disease, and for some time af-
ter, the remedies to be employed must be such as may
obviate the violent effects of the disease, and the fatal
tendency of it; but, after the disease has continued
for some time, and is without any violent symptoms,
the only remedies which can be required are those
which may interrupt its course, and put an entire stop
to it sooner than it would have spontaneously ceased.
MCCCCXVI.
For answering the first indication. In plethoric sub-
jects, or in others, when from the circumstances of
the cough and fits it appears that the blood is diffi-
cultly transmitted through the lungs, blood-letting*
is a necessary remedy; and it may be even necessary
to repeat it, especially in the beginning of the disease:
but, as spasmodic affections do not commonly admit
of much bleeding, so it is seldom proper in the chin-
cough to repeat this remedy often.
MCCCCXVII.
As costiveness frequently attends this disease, so it
is necessary to obviate or remove it by laxatives em-
ployed; and keeping an open belly is generally use-
ful: but large evacuations in this way are commonly
hurtful†.
MCCCCXVIII.
To obviate or remove the inflammatory determin-
ation
* Bleeding, in these cases, is best performed by leeches; and they
seem to give greater relief when applied about the neck than on any
other part.
† In general, the belly may be kept open by a proper attention
to diet: roasted apples, eaten with brown sugar, stewed prunes, and
other similar food, which children generally devour with avidity, suf-
ficiently answer the purpose of removing or preventing costiveness. 

OF PHYSIC. 205
ation to the lungs that sometimes occurs in this dis-
ease, blistering is often useful, and even repeated blis-
tering has been of service; but issues have not so
much effect, and should by no means supersede the re-
peated blistering that may be indicated. When blis-
ters are proper, they are more effectual when applied
to the thorax, than when applied to any distant parts.
MCCCCXIX
Of all other remedies, emetics are the most useul in
this disease; both in general by interrupting the re-
turn of spasmodic affections, and in particular by de-
termining very powerfully to the surface of the body,
and thereby taking off determinations to the lungs.
For these purposes, I think, full vomiting is frequently
to be employed; and, in the intervals necessary to be
left between the times of full vomiting, nauseating do-
ses of the antimonial emetics may be useful*. I have
never found the sulphur auratum, so much praised by
Clossius, to be a convenient medicine, on account of
the uncertainty of its dose; and the tartar emetic, em-
ployed in the manner directed by the late Dr. Fother-
gill, has appeared to be more useful.
MCCCCXX.
* The method of giving tartar emetic in nauseating doses has
been frequently mentioned in preceding notes; but in cases of chin-
cough, where children are generally our patients, we are under the
necessity of varying the doses to the age and constitution. When
the child is under a year old, we ought to note the weak solution of
tartar emetic, specified in the end of the last note on article 185, in
repeated doses of a table-spoonful every ten or fifteen minutes, till
it operates. Large doses, especially to young children, are frequent-
ly attended with dangerous consequences, of which the following
case is a sufficient proof.
To a child not ten months old, that laboured under the chincough,
half a grain of tartar emetic was given in a little cinnamon-water.
A violent vomiting was produced, and the child died suddenly, dur
ing the action of the medicine: on inspecting the body after death,
we found the stomach burst, there being in it a laceration that ad-
mitted two fingers. The inspection of this body has always made
me extremely cautious in administering emetics to young children.

206 PRACTICE
MCCCCXX.
These are the remedies to be employed in the first
stage of the disease for obviating its fatal tendency,
and putting it into a safe train. But in the second
stage, when I suppose the contagion has ceased to act,
and that the disease continues merely by the power of
habit, a different indication arises, and different re-
medies are to be employed.
MCCCCXXI.
This disease, which often continues for a long time,
does not, in my opinion, continue during the whole
of that time in consequence of the contagion's re-
maining in the body, and continuing to act in it.
That the disease does often continue long after the
contagion has ceased to act, and that too by the pow-
er of habit alone, appears to me probable from hence,
that terror has frequently cured the disease; that any
considerable change in the state of the system, such as
the coming on of the small-pox, has also cured it; and
lastly, that it has been cured by antispasmodic and to-
nic medicines; whilst none of all these means of cure
can be supposed either to correct or to expel a mor-
bific matter, though they are evidently suited to
change the state and habits of the nervous system.
MCCCCXXII.
From this view we are directed to the indication
that may be formed, and in a great measure to the re-
medics which may be employed in what we suppose to
be the second stage of the disease. It may perhaps be
alledged, that this indication of shortening the course
of the disease is not very important or necessary, as it
supposes that the danger or violence is over, and, in
consequence, that the disease will soon spontaneously
cease. The last supposition, however, is not well
founded; as the disease, like many other convulsive
and spasmodic affections, may continue for a long
time by the power of habit alone, and by the repeti-
tion

OF PHYSIC. 207
tion of paroxysms may have hurtful effects; more espe-
cially as the violence of paroxysms, and therefore
their hurtful effects, may be much aggravated by va-
rious external causes that may be accidentally applied.
Our indication, therefore, is proper; and we proceed
to consider the several remedies which may be employ-
ed to answer it:
MCCCCXXIII.
Terror may possibly be a powerful remedy, but it is
difficult to measure the degree of it that shall be pro-
duced; and, as a slight degree of it may be ineffectual,
and a high degree of it dangerous, I cannot propose
to employ it.
MCCCCXXIV.
The other remedies which we suppose suited to our
second indication, and which indeed have been fre-
quently employed in this disease, are antispasmodics
or tonics.
Of the antispasmodics, castor has been particularly
recommended by Dr. Morris; but in many trials we
have not found it effectual.
With more probability musk has been employed:
but whether it be from our not having it of a genuine
kind, or not employing it in sufficiently large doses, I
cannot determine; but we have not found it common-
ly successful. Of antispasmodics, the most certainly
powerful is opium: and when there is no considera-
ble fever or difficulty of breathing present, opium has
often proved useful in moderating the violence of the
chincough; but I have not known it employed so as
entirely to cure the disease.
If hemlock has proved a remedy in this disease, as
we must believe from Dr. Butter's accounts, I agree
with that author, that it is to be considered as an an-
tispasmodic. Upon this supposition, it is a probable
remedy; and from the accounts of Dr. Butter and
some others, it seems to have been often useful: but, 
in

208 PRACTICE
in our trials, it has often disappointed us, perhaps
from the preparation of it not having been always
proper*.
MCCCCXXV.
Of the tonics, I consider the cupmoss, formerly ce-
lebrated, as of this kind; as also the bark of the mis-
letoe; but I have had no experience of either, as I
have always trusted to the Peruvian bark. I consider
the use of this medicine as the most certain means of
curing the disease in its second stage; and when there
has been little fever present, and a sufficient quantity
of the bark has been given, it has seldom failed of
soon putting an end to the disease.
MCCCCXXVI.
When convulsive disorders may be supposed to con-
tinue by the force of habit alone, it has been found
that a considerable change in the whole of the cir-
cumstances and manner of life has proved a cure of
such diseases; and analogy has applied this in the
case of the chincough so far, that a change of air has
been employed, and supposed to be useful. In seve-
ral instances I have observed it to be so; but I have
never found the effects of it durable, or sufficient to
put an entire stop to the disease.
BOOK
* Experience has not found that any of the antispasmodics have
ever been employed with much advantage in this disease. All of
them are extremely nauseous, and consequently difficultly given to
children who cannot well swallow pills. 

OF PHYSIC. 209
BOOK III. SECT. III.
OF THE SPASMODIC AFFECTIONS IN THE
NATURAL FUNCTIONS.
CHAP. VIII.
OF THE PYROSIS, OR WHAT IS NAMED IN
SCOTLAND THE WATER-BRASH.
MCCCCXXVII.
THE painful sensations referred to the stomach, and
which are probably occasioned by real affections
of this organ, are of different kinds. Probably they
proceed from affections of different natures, and should
therefore be distinguished by different appellations;
but I must own that the utmost precision in this mat-
ter will be difficult. In my essay towards a methodi-
cal Nosology, I have, however, attempted it. For
those pains that are either acute and pungent, or ac-
companied with a sense of distension, or with a sense of
constriction, if they are at the same time not attended
with any sense of acrimony or heat, I employ the ap-
pellation of Gastrodynia. To express those painful or
uneasy sensations which seem to arise from a sense of
acrimony irritating the part, or from such a sense of
heat as the application of acrids, whether externally
or internally applied, often gives, I employ the term
of Cardialgia; and by this I particularly mean to de-
note those feelmgs which are expressed by the term
Heartburn in the English language. I think the term
Soda has been commonly employed by practical wri-
ters, to express an affection attended with feelings of
the latter kind.
MCCCCXXVIII. 
VOL. II. 
D d

210 PRACTICE
MCCCCmFVIII.
Beside the pains denoted by the terms Gastrodinia,
Periadynia, Cardialgia, and Soda, there is, I think,
another painful sensation different from all of these,
which is named by Mr. Sauvages Pyrosis Suecica;
and his account of it is taken from Linnæus, who
names it Cardialgia Sputatoria. Under the title of
Pyrosis Mr. Sauvages has formed a genus, of which
the whole of the species, except the eighth, which he
gives under the title of Pyrosis Suecica, are all of
them species of the Gastrodynia or of the Cardialgia;
and if there is a genus to be formed under the title of
Pyrosis, it can in my opinion comprehend only the spe-
cies I have mentioned. In this case, indeed, I own
that the term is not very proper; but my aversion to
introduce new names has made me continue to employ
the term of Mr. Sauvages.
MCCCCXXIX.
The Gastrodynia and Cardialgia I judge to be for
the most part symptomatic afffections; and therefore
have given them no place in this work: but the Py-
rosis, as an idiopathic disease, and never before treat-
ed of in any system, I propose to treat of here.
MCCCCXXX.
It is a disease frequent among people in lower life,
but occurs also, though more rarely, in people of
better condition. Though frequent in Scotland, it is
by no means so frequent as Linnæus reports it to be
in Lapland. It appears most commonly in persons
under middle age, but seldom in any persons before
the age of puberty. When it has once taken place,
it is ready to recur occasionally for a long time after;
but it seldom appears in persons considerably advanc-
ed in life. It affects both sexes, but more fre-
quently the female. It sometimes attacks pregnant
women, and some women only when they are in that
condition. Of other women, it more frequently af-
fects 

OF PHYSIC. 211
fects the unmarried; and of the married, most fre-
quently the barren. I have had many instances of
its occurring in women labouring under a fluor albus.
MCCCCXXXI.
The fits of this disease usually come on in the morn-
ing and forenoon, when the stomach is empty. The
first symptom of it is a pain at the pit of the stomach,
with a sense of constriction, as if the stomach was
drawn towards the back; the pain is increased by
raising the body into an erect posture, and therefore
the body is bended forward. This pain is often very
severe; and, after continuing for some time, it brings
on an eructation of a thin watery fluid in considerable
quantity. This fluid has sometimes an acrid taste,
but is very often absolutely insipid. The eructation
is for some time frequently repeated; and does not
immediately give relief to the pain which preceded
it, but does so at length, and puts an end to the fit.
MCCCCXXXII.
The fits of this disease commonly come on without
any evident exciting cause; and I have not found it
steadily connected with any particular diet. It at-
tacks persons using animal food, but I think more fre-
quently those living on milk and farinacea. It seems
often to be excited by cold applied to the lower ex-
tremeties: and is readily excited by any considerable
emotion of mind. It is often without any symptoms.
of dyspepsia.
MCCCCXXXIII.
The nature of this affection is not very obvious;
but I think it may be explained in this manner: It
seems to begin by a spasm of the muscular fibres of
the stomach; which is afterwards, in a certain man-
ner, communicated to the blood-vessels and exhalants,
so as to increase the impetus of the fluids in these ves-
sels, while a constriction takes place on their extremi-
ties. While therefore the increased impetus deter-
mines
D d 2 

212 PRACTICE
mines a greater quantity than usual of fluids into those
vessels, the constriction upon their extremeties allows
only the pure watery parts to be poured out, analogous,
as I judge, in every respect, to what happens in the
diabetes hystericus.
MCCCCXXXIV.
The practice in this disease is as difficult as the the-
ory. The paroxysm is only to be certainly relieved
by opium. Other antispasmodics, as vitriolic ether
and volatile alkali, are sometimes of service, but not
constantly so. Although opium and other antispas-
modics relieve the fits, they have no effect in prevent-
ing their recurrence. For this purpose, the whole of
the remedies of dyspepsia have been employed without
success. Of the use of the nux vomica, mentioned as
a remedy by Linnæus, I have had no experience.
CHAP. IX.
OF THE COLIC.
MCCCCXXXV.
THE principal symptom in this disease is a pain
felt in the lower belly. It is seldom fixed and
pungent in one part, but is a painful distension in
some measure spreading over the whole of the belly;
and particularly with a sense of twisting or wringing
round the navel. At the same time, with this pain,
the navel and teguments of the belly are frequently
drawn inwards, and often the muscles of the belly are
spasmodically contracted, and this in separate portions,
giving the appearance of a bag full of round balls.
MCCCCXXXVI. 

OF PHYSIC. 213
MCCCCXXXVI.
Such pains, in a certain degree, sometimes occur in
cases of diarrhœa and cholera; but these are less vio-
lent and more transitory, and are named Gripings.
It is only when more violent and permanent, and at-
tended with costiveness, that they constitute colic.
This is also commonly attended with vomiting, which
in many cases is frequently repeated, especially when
any thing is taken down into the stomach; and in
such vomitings, not only the contents of the stomach
are thrown up, but also the contents of the duodenum,
and therefore frequently a quantity of bile.
MCCCCXXXVII.
In some cases of colic, the peristaltic motion is in-
verted through the whole length of the alimentary
canal, in such a manner that the contents of the great
guts, and therefore stercoracecus matter, is thrown up
by vomiting; and the same inversion appears still
more clearly from this, that what is thrown into the
rectum by glyster is again thrown out by the mouth-
In these circumstances of inversion the disease has been
named Ileus, or the Iliac Passion; and this has been
supposed to be a peculiar disease distinct from colic;
but to me it appears that the two diseases are owing to
the same proximate cause, and have the same symp-
toms, only in a different degree.
MCCCCXXXVIII.
The colic is often without any pyrexia attending it.
Sometimes, however, an inflammation comes upon
the part of the intestine especially affected; and this
inflammation aggravates all the symptoms of the dis-
ease, being probably what brings on the most consi-
derable inversion of the peristaltic motion; and, as
the stercoraceous vomiting is what especially distin-
guishes the ileus, this has been considered as always
depending on an inflammation of the intestines. How-
ever, I can affirm, that as there are inflammations of
the

214 PRACTICE
the intestines without stercoraceous vomiting, so I have
seen instances of stercoraceous vomiting without in-
flammation; and there is therefore no ground for dis-
tinguishing ileus from colic, but as a higher degree of
the same affection.
MCCCCXXXIX.
The symptoms of the colic, and the dissections of
bodies dead of this disease, show very clearly, that it
depends upon a spasmodic constriction of a part of the
intestines; and that this therefore is to be considered
as the proximate cause of the disease. In some of the
dissections of persons dead of this disease, an intus-sus-
ception has been remarked to have happened; but
whether this be constantly the case in all the appear-
ances of ileus, is not certainly determined.
MCCCCXL.
The colic has commonly been considered as being
of different species, but I cannot follow the writers on
this subject in the distinctions they have established.
So far, however, as a difference of the remote cause
constitutes a difference of species, a distinction may per-
haps be admitted; and accordingly in my Nosology I
have marked seven different species: but I am well
persuaded, that in all these different species the prox-
imate cause is the same, that is, a spasmodic constriction
of a part of the intestines; and consequently, that in
all these cases the indication of cure is the same, that
is, to remove the constriction mentioned. Even in,
the several species named Stercorea, Callosa, and Cal-
culosa, in which the disease depends upon an obstruc-
tion of intestine, I am persuaded that these obstructi-
ons do not produce the symptoms of colic, excepting
in so far as they produce spasmodic constrictions of the
intestines; and therefore, that the means of cure in
these cases, so far as they admit of cure, must be ob-
tained by the same means which the general indica-
tion above mentioned suggests.
MCCCCXLI. 

OF PHYSIC. 215
MCCCCXLI.
The cure, then, of the colic universally, is to be ob-
tained by removing the spasmodic constrictions of the
intestines; and the remedies suited to this purpose
may be referred to three general heads:
1. The taking off the spasm by various antispasmo-
dic powers.
2. The exciting the action of the intestines by pur-
gatives.
3. The employing mechanical dilatation.
MCCCCXLII.
Before entering upon a more particular account of
these remedies, it will be proper to observe, that in all
cases of violent colic, it is advisable to practise blood-
letting; but as it may be useful in obviating the in-
flammation which is commonly to be apprehended,
and even as it may be a means of relaxing the spasm
of the intestine. This remedy may perhaps be im-
proper in persons of a weak and lax habit, but in all
persons of tolerable vigour it will be a safe remedy;
and in all cases where there is the least suspicion of
an inflammation actually coming on, it will be abso-
lutely necessary. Nay, it will be even proper to re-
peat it perhaps several times, if, with a full and hard
pulse, the appearance of the blood drawn, and the re-
lief obtained by the first bleeding, shall authorise such
repetition.
MCCCCXLIII.
The antispasmodic powers that may be employed,
are, the application of heat in a dry or humid form,
the application of blisters, the use of opium, and the
use of mild oils.
The application of heat, in a dry form, has been
employed by applying to the belly of the patient a
living animal, or bladders filled with warm water, or
bags of substances which long retain their heat; and
all these have sometimes been applied with success; 
but

216 PRACTICE
but none of them seem to me so powerful as the appli-
cation of heat in a humid form.
This may be employed either by the immersion of
a great part of the body in warm water, or by fo-
menting the belly with cloths wrung out of hot water.
The immersion has advantages from the application of
it to a greater part of the body, and particularly to
the lower extremities: but immersion cannot always
be conveniently practised, and fomentation may have
the advantage of being longer continued; and it may
have nearly all the benefit of immersion, if it be at
the same time applied both to the belly and to the
lower extremities.
MCCCCXLIV.
From considering that the teguments of the lower
belly have such a connection with the intestines, as at
the same time to be affected with spasmodic contrac-
tions, we perceive that blisters applied to the belly
may have the effect of taking off the spasms both from
the muscles of the belly and from the intestines; and
accordingly, blistering has often been employed in the
colic with advantage. Analogous to this, rubefaci-
ents applied to the belly have been frequently found
useful.
MCCCCXLV.
The use of opium in colic may seem to be an ambi-
guous remedy. Very certainly it may for some time
relieve the pain, which is often so violent and urgent,
that it is difficult to abstain from the use of such a re-
medy. At the same time, the use of opium retards
or suspends the peristaltic motion so much, as to allow
the intestines to fall into constrictions; and may there-
fore, while it relieves the pain, render the cause of
the disease more obstinate. On this account, and
further as opium prevents the operation of purga-
tives so often necessary in this disease, many practiti-
oners are averse to the use of it, and some entirely re-
ject  

OF PHYSIC. 217
ject the use of it as hurtful. There are, however, o-
thers who think they can employ opium in this disease
with much advantage.
In all cases where the colic comes on without any
previous costiveness, and arises from cold, from passi-
ons of the mind, or other causes which operate especi-
ally on the nervous system, opium proves a safe and
certain remedy; but in cases which have been preced-
ed by long costiveness, or where the colic, though not
preceded by costiveness, has however continued for
some days without a stool, so that a stagnation of fæces
in the colon is to be suspected, the use of opium is of
doubtful effect. In such cases, unless a stool has been
first procured by medicine, opium cannot be employ-
ed but with some hazard of aggravating the disease.
However, even in those circumstances of costiveness,
when, without inflammation, the violence of the spasm
is to be suspected, when vomiting prevents the exhibi-
tion of purgatives, and when with all this the pain is
extremely urgent, opium is to be employed, not only
as an anodyne, but also as an antispasmodic, necessary
to favour the operation of purgatives; and may be so
employed, when, either at the same time with the opi-
ate, or not long after it, a purgative can be exhibited.
Is the hyosciamus, as often showing, along with its
narcotic, a purgative quality, better suited to this dis-
ease than opium?
MCCCCXLVI.
It is seemingly on good grounds that several prac-
titioners have recommended the large use of mild oils
in this disease, both as antispasmodics and as laxatives;
and, where the palate and stomach could admit them,
I have found them very useful. But as there are few
Scottish stomachs that can admit a large use of oils, I
have had few opportunities of employing them.
MCCCCXLVII.
The second set of remedies adapted to the cure of
colic, 
VOL. II.
E e 

218 PRACTICE
colic, are purgatives; which, by exciting the action
of the intestines, either above or below the obstructed
place, may remove the constriction; and therefore
these purgatives may be given either by the mouth,
or thrown by glyster into the anus. As the disease is
often seated in the great guts; as glysters, by having a
more sudden operation, may give more immediate re-
lief; and as purgatives given by the mouth are ready
to be rejected by vomiting; so it is common, and in-
deed proper, to attempt curing the colic in the first
place by glysters. These may at first be of the mildest
kind, consisting of a large bulk of water, with some
quantity of a mild oil; and such are sometimes suffi-
ciently efficacious: however, they are not always so;
and it is commonly necessary to render them more
powerfully stimulant by the addition of neutral salts,
of which the most powerful is the common or marine
salt. If these saline glysters, as sometimes happens, are
rendered again too quickly, and on this account or other-
wise are found ineffectual, it may be proper, instead
of these salts, to add to the glysters an infusion of sen-
na, or of some other purgative that can be extracted
by water. The antimonial wine* may be sometimes
employed in glysters with advantage. Hardly any
glysters are more effectual than those made of turpen-
tine properly§ prepared. When all other injections
are
* Tartar Emetic is surer than the antimonial wine ; but it is a
very violent remedy, and ought to be used with caution even in cly-
sters. Five or six grains is the usual quantity given in clysters.
§ The proper manner of preparing turpentine clysters is as follows:
ꝶ. Tereb. Venet. ʒvi.
Vitel. Ov. No. ii.
Tere in mortario marmorea donec penitus solvetur
Terebiathina; dein adde gradatim,
Aq. font. frigida, ʒiii.
Huic assude 

OF PHYSIC. 219
are found ineffectual, recourse is to be had to the in-
jection of tobacco-smoke; and, when even this fails,
recourse is to be had to the mechanical dilatation to
be mentioned hereafter.
MCCCCXLVIII.
As glysters often fail altogether in relieving this
disease, and as even when they give some relief they
are often imperfect in producing a complete cure; so it is
generally proper, and often necessary, to attempt a more
entire and certain cure by purgatives given by the mouth.
The more powerful of these, or, as they are called, the
Drastic Purgatives, may be sometimes necessary; but
their use is to be avoided, both because they are apt to
be rejected by vomiting, and because when they do
not succeed in removing the obstruction they are rea-
dy to induce an inflammation. Upon this account it
is usual, and indeed, proper, at least in the first place,
to employ the milder and less inflammatory purgatives.
None have succeeded with me better than the crys-
tals of tartar*, because this medicine may be conve-
niently given, in small but repeated doses, to a consi-
derable quantity; and under this management it is
the purgative least ready to be rejected by vomiting,
and much less so than the other neutral salts. If a
stronger purgative be required, jalap§, properly pre-
pared,
E e 2
Aq. font, tepid, ℔i.
M. f. Enema, Itatim injiciend.
If the turpentine does not dissolve sufficiently with the yolks of
two eggs, a third may be added.
* Crystals of tartar may be given in doses of two drams each, re-
peated every two hours oftener. The chief objection against the
use of this salt is its difficult solution in water, and therefore many
practitioners prefer the soluble tartar, or the Rochel salt.
§ The Pulvis Jalap, comp. of the Edinburgh Pharmacopœia an-
swers in general very well; but, the following formula is less liable
to be rejected by the vomiting which so frequently accompanies this
disease.
ꝶ. Resin. Jalap gr. xii,
Amygdal. dulc. decorticat. No. vi. 

220 PRACTICE
pared, is less offensive to the palate, and fits better
upon the stomach, than most other powerful purga-
tives. On many occasions of colic, nothing is more
effectually purgative than a large dose of calomel*.
Some practitioners have attempted to remove the ob-
structions of the intestines by antimonial emetics§ ex-
hibited in small doses repeated at proper intervals;
and when these doses are not entirely rejected by vo-
miting, they often prove effectual purgatives.
When every purgative has failed, the action of the
intestines has been effectually excited by throwing
cold water on the lower extremities.
MCCCCXLIX.
The third means of overcoming the spasm of the in-
testines in this disease, is by employing a mechanical
dilatation; and it has been frequently supposed that
quicksilver, given in large quantity, might operate in
this manner. I have not, however, found it success-
ful; and the theory of it is with me very doubtful.
Some authors have mentioned the use of gold and sil-
ver pills, or balls, swallowed down; but I have no ex-
perience of such practices, and I cannot suppose them
a probable means of relief.
MCCCCL.
Another means of mechanical dilatation, and a
more
Sacch. alb. ʒi.
Tere in mortario marmoreo, et adde graditim,
Aq. Cinnamom. simpl. ℥i.
M. f. haust.
Half of this portion may be given at once, and the other half an hour
afterward.
* This is French practice, but it is dangerous. It has however
been serviceable in many cases, when given in doses of 12 or 15
grains, or even a scruple when other purgatives have failed. 
§ As the stomach (as was before observed) is very irritable in this
disease, the practitioner will find considerable difficulty in managing
animonials. It is better to avoid them altogether, for they may
do much mischief. 

OF PHYSIC. 221
more probable measure, is by injecting a large quan-
tity of warm water by a proper syringe, which may
throw it with some force, and in a continued stream,
into the rectum. Both from the experiments report-
ed by the late Mr. De Haen, and from those I myself
have had occasion to make, I judge this remedy to be
one of the most powerful and effectual*.
MCCCCLI.
I have now mentioned all the several means that
may be employed for the cure of the colic, considered
as a genus; but before I quit this subject, it may be
expected that I should take notice of some of the spe-
cies which may seem to require a particular considera-
tion. In this view it may be expected that I should
especially take notice of the species named the Colic
of Poitou, and particularly known in England by the
name of the Devonshire Colic.
MCCCCLII.
This species of the disease is certainly a peculiar
one, both in respect of its cause and its effects; but,
as to the first, it has been lately so much the subject
of investigation, and is so well ascertained by the
learned physicians, Sir George Baker and Dr. Hardy,
that it is unnecessary for me to say any thing of it
here.
With respect to the cure of it*, so far as it appears
in
* It is to be thrown up, by means of a large syringe, in such
quantities, till the patient begins to feel a sense of uneasiness from
the great distention which it occasion. Some patients have borne
two gallons to be injected, and the cares were attended with the
desired success.
The cases in which these large injections are most useful, are those
in which hardened fæces are accumulated in the colon. The warm
water answers two intentions, viz. dilating the passage, and soften-
ing the fæces.
§ In the early stages of this disease, the belly is to be kept open
by the mildest laxatives, and a milk diet strictly used. The follow-
ing formula answers extremely well; 

222 PRACTICE
in the form of a colic, my want of experience concern-
ing it does not allow me to speak with any confidence
on the subject; but, so far as I can learn from others,
it appears to me, that it is to be treated by all the se-
veral means that I have proposed above for the cure of
colic in general.
How far the peculiar effects of this disease are to be
certainly foreseen and obviated, I have not properly
learned; and I must leave the matter to be determin-
ed by those who have had sufficient experience in it.
CHAP. X.
OF THE CHOLERA.
MCCCCLIII.
IN this disease, a vomiting and purging concurring
together, or frequently alternating with one another,
are the chief symptoms. The matter rejected both
upwards and downwards appears manifestly to consist
chiefly of bile.
MCCCCLIV.
From this last circumstance I conclude, that the
disease depends upon an increased secretion of the
bile, and its copious effusion into the alimentary ca-
nal; and, as in this it irritates and excites the mo-
tions
ꝶ. Mannæ.
Ol. olivar. a a ℥i.
M. f. Linctus.
This quantity is a proper dose, and it may be repeated every day
with thirty or forty drops of laudanum at bed-time. If the symp-
toms, however, do not abate, we may (at the same time,) give
large emollient clysters. 

OF PHYSIC. 223
tions above mentioned, I infer, that the bile thus ef-
fused in larger quantity is at the same time also of a
more acrid quality. This appears likewise from the
violent and very painful gripings that attend the dis-
ease, and which we can impute only to the violent
spasmodic contractions of the intestines that take place
here. These spasms are commonly communicated to
the abdominal muscles, and very frequently to those
of the extremities.
MCCCCLV.
In the manner now described, the disease frequent-
ly proceeds with great violence, till the strength of
the patient is greatly, and often suddenly weakened;
while a coldness of the extremities, cold sweats, and
faintings, coming on, an end is put to the patient's
life, sometimes in the course of one day. In other
cases the disease is less violent, continues for a day or
two, and then ceases by degrees; though such reco-
veries seldom happen without the assistance of reme-
dies.
MCCCCLVI.
The attacks of this disease are seldom accompanied
with any symptoms of pyrexia: and though, during
the course of it, both the pulse and respiration are
hurried and irregular, yet these symptoms are gene-
rally so entirely removed by the remedies that quiet
the spasmodic affection peculiar to the disease, as to
leave no ground for supposing that it had been accom-
panied by any proper pyrexia.
MCCCCLVII.
This is a disease attending a very warm state of the
air; and in very warm climates, it may perhaps ap-
pear at any time of the year: but even in such cli-
mates it is most frequent during their warmest seasons;
and in temperate climates, it appears only in the
warm seasons. Dr. Sydenham considered the appear-
ances of this disease in England to be confined to the
month

224 PRACTICE
month of August; but he himself observed it to ap-
pear sometimes towards the end of summer, when the
season was unusually warm; and that, in proportion to
the heat, the violence of the disease was greater.—
Others have observed that it appeared more early in
summer, and always sooner or later, according as the
great heats sooner or later set in.
MCCCCLVIII.
From all these circumstances, it is, I think, very
evident that this disease is the effect of a warm atmos-
phere, producing some change in the state of the bile
in the human body; and the change may consist, ei-
ther in the matter of the bile being tendered more
acrid, and thereby fitted to excite a more copious se-
cretion; or, in the same matter, its being prepared to
pass off in larger quantity than usual.
MCCCCLIX.
It has been remarked, that in warm climates and
seasons, after extremely hot and dry weather, a fall of
rain cooling the atmosphere seems especially to bring
on this disease; and it is very probable that an ob-
structed perspiration may have also a share in this,
though it is also certain that the disease does appear
when no change in the temperature of the air, nor any
application of cold, has been observed.
MCCCCLX.
It is possible, that, in some cases, the heat of the
season may give only a predisposition, and that the
disease may be excited by certain ingest a or other caus-
es; but it is equally certain, that the disease has occur-
red without any previous change or error, either in
diet, or in the manner of life, that could be observed.
MCCCCLXI.
The Nosologists have constituted a Genus under
the title of Cholera, and under this have arranged as
species, every affection in which a vomiting and purg-
ing of any kind happened to concur. In many of
these 

OF PHYSIC. 225
these species, however, the matter evacuated is not bi-
lious; nor does the evacuation proceed from any
cause in the state of the atmosphere. Further, in ma-
ny of these species also, the vomiting which occurs is
not an essential, but merely an accidental, symptom
from the particular violence of the disease. The ap-
pellation of Cholera therefore should, in my opinion,
be confined to the disease I have described above;
which by its peculiar cause, and perhaps also by its
symptoms, is very different from all the other species
that have been associated with it. I believe that all
the other species arranged under the title of Cho-
lera by Sauvages or Sagar, may be properly enough
referred to the genus of Diarrhœa; which we are to
treat of in the next chapter.
The distinction I have endeavoured to establish be-
tween the proper Cholera, and the other diseases that
have sometimes got the same appellation, will, as I
judge, supersede the question, Whether the Cholera,
in temperate climates, happens at any other season
than that above assigned?
MCCCCLXII.
In the case of a genuine cholera, the cure of it has
been long established by experience.
In the beginning of the disease, the evacuation of
the redundant bile is to be favoured by the plentiful
exhibition of mild diluents*, both given by the mouth,
and injected by the anus; and all evacuant medicines,
employed in either way, are not only superfluous, but
commonly hurtful.
MCCCCLXIII.
When the redundant bile appears to be sufficiently
washed out, and even before that, if the spasmodic af-
fections
VOL. II. 
* Thin rice-gruel is as proper a mild diluent as any we can use;
as is also water in which a crust of bread is boiled. A very small
quantity of port wine may be added to these diluents if the pulse be
small or weak.

226 PRACTICE
fections of the alimentary canal become very violent,
and are communicated in a considerable decree to other
parts of the body, or when a dangerous debility seems
to be induced, the irritation is to be immediately
obviated by opiates in sufficiently large doses, but
in small bulk, and given either by the mouth, or by
glyster*.
MCCCCLXIV.
Though the patient be in this manner relieved, it
frequently happens, that when the operation of the opi-
um is over, the disease shows a tendency to return;
and, for at least some days after the first attack, the ir-
ritability of the intestines, and their disposition to fall
into painful spasmodic contractions, seem to continue.
In this situation,the repetition of the opiates, for perhaps
several days, may come to be necessary; and as the
debility commonly induced by the disease favours the
disposition to spasmodic affections, it is often useful and
necessary, together with the opiates, to employ the to-
nic powers of the Peruvian bark§.
CHAP. 
* A pill consisting of a grain of opium may be given every two
hours, and if it does not relieve the symptoms after the third or
fourth repetition, we may inject the following glyster:
ꝶ. Decoct. Hord. ℥x.
Tinct. Thebaic. ʒii.
M. f. Enema.
This clyster may be repeated twice, or thrice if there be occasion.
§ The bark in these cases, is often successfully given along with 
rhuhurb, as in the following formula:
ꝶ. Pulv. Cort. Peruv. ℥fs.
Rad. Rhei. ʒi.
M. f. Pulv. in part, æqual. xii. dividend.
One of these powders may be given three times a day with a
glass of port wine. 

OF PHYSIC. 227
CHAP. XI.
OF DIARRHŒA OR LOOSENESS.
MCCCCLXV. 
THIS disease consists in evacuation by stool, more
frequent and of more liquid matter than usual.
This leading and characteristic symptom is so diversi-
fied in its degree, in its causes, and in the variety of
matter evacuated, that it is almost impossible to give
any general history of the disease.
MCCCCLXVI.
It is to be distinguished from dysentery, by not be-
ing contagious; by being generally without fever;
and by being with the evacuation of the natural ex-
crements, which are, at least for some time, retained
in dysentery. The two diseases have been commonly
distinguished by the gripings being more violent in
the dysentery; and they are commonly less violent
and less frequent in diarrhœa: but as they frequently
do occur in this also, and sometimes to a considerable
degree, so they do not afford any proper distinction*.
MCCCCLXVII.
A diarrhœa is to be distinguished from cholera
chiefly by the difference of their causes; which, in
cholera, is of one peculiar kind; but in diarrhœa is
prodigiously diversified, as we shall see presently. It
has been common to distinguish cholera by the eva-
cuation downwards being of bilious matter, and by
this being always accompanied with a vomiting of the
same kind; but it does not universally apply, as a diar-
rhœa
F f 2
* Tenesmus is a distinguishing symptom of dysentery, but it is
sometimes present in diarrhœa also; especially those diarrhœas
which proceed from acrid or putrid substances in the intestines. 

228 PRACTICE
rhœa is sometimes attended with vomiting, and even
of bilious matter.
MCCCCLXVIII.
The disease of diarrhœa, thus distinguished, is very
greatly diversified; but in all cases, the frequency of
stools is to be imputed to a preternatural increase of the
peristaltic motion in the whole, or at least in a consi-
derable portion, of the intestinal canal. This increas-
ed action is in different degrees, is often convulsive and
spasmodic, and at any rate is a motus abnormis: for
which reason, in the Methodical Nosology, I have re-
ferred it to the order of Spasmi, and accordingly treat
of it in this place.
MCCCCLXIX.
Upon the same ground, as I consider the disease
named Lientery to be an increased peristaltic motion
over the whole of the intestinal canal, arising from a
peculiar irritability, I have considered it as merely a
species of diarrhœa. The idea of a laxity of the in-
testinal canal being the cause either of lientery, or
other species of diarrhœa, appears to me without foun-
dation, except in the single case of frequent liquid
stools from a palsy of the sphincter ani.
MCCCCLXX.
The increased action of the peristaltic motion, I con-
sider as always the chief part of the proximate cause
of diarrhœa: but the disease is further, and indeed
chiefly, diversified by the different causes of this in-
creased action; which we are now to inquire into
MCCCCLXXI.
The several causes of the increased action of the in-
tesines may be referred, I think, in the first place, to
two general heads.
The first is, of the diseases of certain parts of the
body which, either from a content of the intestines
with these parts, or from the relation which the intes-
tines have to the whole system, occasion an increased
action 

OF PHYSIC. 229
action in the intestines, without the transference of
any stimulant matter from the primary diseased part
to them.
The second head of the causes of the increased ac-
tion of the inteitines is the stimuli of various kinds,
which are applied directly to the intestines themselves.
MCCCCLXXII.
That affections of other parts of the system may
affect the intestines without the transference or ap-
plication of any stimulant matter, we learn from hence
that the passions of the mind do in some persons excite
diarrhœa.
MCCCCLXXIII.
That diseases in other parts may in like manner af-
fect the intestines, appears from the dentition of in-
fants frequently exciting diarrhœa. I believe that the
gout often affords another instance of the same kind;
and probably there are others also, though not well
ascertained.
MCCCCLXXIV.
The stimuli (MCCCCLXXI.) which may be applied
to the intestines are of very various kinds; and are ei-
ther,
1. Matters introduced by the mouth.
2. Matters poured into the intestines by the several
excretories opening into them.
3. Matters poured from certain preter-natural open-
ings made into them in certain diseases.
MCCCCLXXV.
Of those (MCCCCLXXIV, I.) introduced by the
mouth, the first to be mentioned are the aliments
commonly taken in. Too great a quantity of these
taken in, often prevents their due digestion in the sto
mach; and by being thus sent in their crude, and pro-
bably acrid, state to the intestines, they frequently ex-
cite diarrhœa.
The same aliments, though in proper quantity, yet
having 

230 PRACTICE
having too great a proportion, as frequently happens,
of saline or saccharine matter along with them, prove
stimulant to the intestines, and excite diarrhœa.
But our aliments prove especially the causes of di-
arrhœa, according as they, from their own nature, or
from the weakness of the stomach, are disposed to un-
dergo an undue degree of fermentation there, and
thereby become stimulant to the intestines. Thus
acescent aliments are ready to produce diarrhœa; but
whether from their having any directly purgative qua-
lity, or only as mixed in an over proportion with the
bile, is not well determined.
MCCCCLXXVI.
Not only the acescent, but also the putrescent dis-
position of the aliments, seems to occasion a diarrhœa;
and it appears that even the effluvia of putrid bodies,
taken in any way in large quantity, have the same ef-
fect.
Are oils or fats, taken in as a part of our aliments,
ever the cause of diarrhœa? and if so, in what manner
do they operate*?
MCCCCLXXVII.
The other matters introduced by the mouth, which
may be causes of diarrhœa, are those thrown in either
as medicines, or poisons that have the faculty of stimu-
lating the alimentary canal. Thus, in the list of the
Materia Medica, we have a long catalogue of those
named purgatives; and in the list of poisons, we have
many possessed of the same quality. The former,
riven in a certain quantity, occasion a temporary di-
arrhœa; and given in very large doses, may occasion
it in excess, and continue it longer than usual, produ-
cing that species of diarrhœa named a Hypercatharsis.
MCCCCLXXVIII.
* Rancid oils and fats certainly irritate the intestines; and may
therefore produce Diarrhœa. 

OF PHYSIC. 251
MCCCCLXXVIII.
The matters (MCCCLXXIV, 2.) poured into the cavi-
ty of the intestines from the excretories opening into
them, and which may occasion diarrhœa, are either
those from the pancreatic or biliary dud, or those
from the excretories in the coats of the intestines
themselves.
MCCCCLXXIX.
What changes may happen in the pancreatic juice,
I do not exactly know; but I suppose that an acrid
fluid may issue from the pancreas, even while still en-
tire in its structure; but more especially when it is in a
supporated, scirrhous, or cancerous state, that a very
acrid matter may be poured out by the pancreatic
dud, and occasion diarrhœa.
MCCCCLXXX.
We know well, that from the biliary duct the bile
may be poured out in greater quantity than usual; and
there is little doubt of its being also sometimes pour-
ed out of a more than ordinary quality. It is very
probable, that in both ways the bile is frequently a
cause of diarrhœa.
Though I have said above that diarrhoea may be
commonly distinguished from cholera I must admit
here, that as the causes producing that state of the
bile which occasions cholera, may occur in all the dif-
ferent possible degrees of force, so as, on one occasion,
to produce the most violent and distinctly marked
cholera; but, upon another, to produce only the gen-
tlest diarrhœa: which, however, will be the same dis-
ease, only varying in degree: So I think it probable,
that in warm climates, and in warm seasons, a diar-
rhœa biliosa of this kind may frequently occur, not to
be always certainly distinguished from cholera.
However this may be, it is sufficiently probable,
that, in some cases, the bile, without having been ad-
ed upon by the heat of the climate or season, may be
redundant 

232 PRACTICE
redundant and acrid, and prove therefore a particular
cause of diarrhœa.
MCCCCLXXXI.
Beside bile from the several causes and in the con-
ditions mentioned, the biliary duct may pour out pus;
or other matter from abscesses in the liver, which may
be the cause of diarrhœa.
Practical writers take notice of a diarrhœa wherein
a thin and bloody liquid is discharged; which they
suppose to have proceeded from the liver, and have
therefore given the disease the name of Hepatirrhœa:
but we have not met with any instance of this kind;
and therefore cannot properly say any thing concern-
ing it.
MCCCCLXXXII.
A second set of excretories, from which matter is
poured into the cavity of the intestines, are those
from the coats of the intestines themselves; and are ei-
ther the exhalants proceeding directly from the extre-
mities of arteries, or the excretories from the mucous
follicles: and both these sources occur in prodigious
number over the internal surface of the whole intesti-
nal canal. It is probable that it is chiefly the effusion
from these sources which, in most instances, gives the 
matter of the liquid stools occurring in diarrhœa.
MCCCCLXXXIII.
The matter from both sources may be poured out
in larger quantity than usual, merely by the increased
action of the intestines, whether that be excited by
the passions of the mind (MCCCCXXII.) by diseases in
other parts of the system (MCCCCLXXV, I.) or by the
various stimulants mentioned MCCCCLXXV. and follow-
ing; or the quantity of matter poured out may be in-
creased, not so much by the increased action of the in-
testines, as by an increased afflux of fluids from other
parts of the system.
Thus, cold applied to the surface of the body, and
suppressing 

OF PHYSIC. 223
suppressing perspiration, may determine a greater
quantity of fluids to the intestines.
Thus, in the ischuria renatis, the urine taken into
the blood-vessels is sometimes determined to pass off
again by the intestines.
In like manner, pus or serum may be absorbed from
the cavities in which they have been stagnant, and
be again poured out into the intestines, as frequently
happens, in particular with respect to the water of
dropsies.
MCCCCLXXXIV. 
It is to be observed here, that a diarrhœa may be
excited not only by a copious afflux of fluids from
other parts of the system, but likewise by the mere
determination of various acrid matters from the mass of
blood into the cavity of the intestines. Thus it is sup-
posed that the morbific matter of fevers is sometimes
thrown out into the cavity of the intestines, and
gives a critical diarrhœa: and whether I do or do not
admit the doctrine of ciitical evacuations, I think it
is probable that the morbific matter of the exanthe-
mata is frequently thrown upon the intestines, and
occasions diarrhœa.
MCCCCLXXXV.
It is to me further probable, that the putrescent
matter diffused in the mass of blood in putrid diseases,
is frequently poured out by the exhalants into the in-
testines, and proves there the cause, at least in part, of
the diarrhœa so commonly attended with these dis-
eases.
MCCCCLXXXVI.
Upon this subject of the matters poured into the ca-
vity of the intestines, I have chiefly considered them
as poured out in unusual quantity, but it is probable
that, for the most part, they are also changed in their
quality, and become of a more acrid and stimulant na-
ture;
VOL. II. 
G g  

234 PRACTICE
ture; upon which account especially it is that they
excite, or at least increase, a diarrhœa.
MCCCCLXXXVII.
How far, and in what manner, the exhahnt fluid
may be changed in its nature and quality, we do not
certainly know: but with respect to the fluid from
the mucous excretories, we know, that, when poured
out in unusual quantity, it is commonly, at the same
time, in a more 1iquid and acrid form; and may prove,
therefore, considerably irritating.
MCCCCLXXXVIII.
Though the copious effusion of a more liquid and
acrid matter from the mucous excretories, be proba-
bly owing to the matter being poured out immediate-
ly as it is secreted from the blood into the mucous fol-
licles, without being allowed to stagnate in the latter,
so as to acquire that milder quality and thicker con-
sistence we commonly find in the mucus in its natural
state; and although we might suppose that the excre-
tions of a thin and acrid fluid should always be the ef-
fect of every determination to the mucous follicles,
and of every stimulant applied to them: yet it is cer-
tain, that the reverse is sometimes the case; and that,
from the mucous follicles, there is frequently an in-
creased excretion of a mucus, which appears in its
proper form of a mild viscid, and thickish matter.
This commonly occurs in the case of dysentery; and
it has been observed to give a species of diarrhœa,
which has been properly named the Diarrhœa Mucosa.
MCCCCLXXXIX.
A third source of matter poured into the cavity of
the intestines, and occasioning diarrhœa (MCCCC-
LXXIV, 3.) is from those preternatural openings re-
duced by diseases in the intestines or neighbouring
parts. Thus the blood-vessels on the internal surface
of the intestines may be opened by erosion, rupture,
or anastomosis, and pour into the cavity their blood,
which, 

OF PHYSIC. 235
which, either by its quantity or by its acrimony, whe-
ther inherent, or acquired by stagnation, may some-
times give a diarrhœa evacuating bloody matter. This
is what I think happens in that disease which has
called the Melæna or Morbus Niger.
MCCCCXC.
Another preternatural source of matter poured in-
to the cavity of the intestines, is the rupture of absces-
ses seated either in the coats of the intestines them-
selves, or in any of the contiguous viscera, which, du-
ring an inflamed state, had formed an adhesion with
some part of the intestines. The matter thus poured
into their cavity may be various; purulent, or sanious,
or both together, mixed at the same time with more
or less of blood; and in each of these states may be a
cause of diarrhœa.
MCCCCXCI.
Amongst the stimuli that may be directly applied to
the intestines, and which, by increasing their peristal-
tic motion, may occasion diarrhœa, I must not omit
to mention worms, as having frequently that effect.
MCCCCXCII.
I must also mention here a state of the intestines,
wherein their peristaltic motion is preternaturally in-
creased, and a diarrhœa produced; and that is, when
they are affected with an erythematic inflammation.
With respect to the existence of such a state, and its
occasioning diarrhœa, see what is said above in CCC-
XCVIII. and following. Whether it is to be consider-
ed as a particular and distinct case of diarrhœa, or is
always the same with some of those produced by one
or other of the causes above mentioned, I have not
been able to determine.
MCCCCXCIII.
Lastly, by an accumulation of alimentary or of o-
ther matter poured in the cavity of the intestines from
several of the sources above mentioned, a diarrhœa
may
G g 2 

236 PRACTICE
may be especially occasioned when the absorption of
the lacteals, or of other absorbents, is prevented, ei-
ther by an obstruction of their orifices, or by an ob-
struction of the mesenteric glands, through which
alone the absorbed fluids can be transmitted.
In one instance of this kind, when the chyle pre-
pared in the stomach and duodenum is not absorbed in
the course of the intestines, but passes off in considera-
ble quantity by the anus, the disease has been named
morbus Cœliaca, or simply and more properly Cœliaca;
which accordingly I have considered as a species of
diarrhœa.
MCCCCXCIV.
I have thus endeavoured to point out the various
species of disease that may come under the general
appellation of Diarrhœa; and from that enumeration
it will appear, that many, and indeed the greater part
of the case of diarrhœa, are to be considered as sympa-
thetic affections, and to be cured only by curing the
primary disease upon which they depend; of which,
however, I cannot properly treat here. From our
enumeration it will also appear, that many of the ca-
ses of diarrhœa which may be considered as idiopa-
thic, will not require my saying much of them here.
In many instances, the disease is ascertained, and also
the cause assigned, by the condition of the matter e-
vacuated; so that what is necessary to correct or re-
move it will be sufficiently obvious to practitioners of
any knowledge. In short, I do not find that I can of-
fer any general plan for the cure of diarrhœa; and
all that I can propose to do on this subject, is to give
some general remarks on the practice that has been
commonly followed in the cure of this disease.
MCCCCXCV.
The practice in this disease has chiefly proceeded
upon the supposition of an acrimony in the fluids or
of a laxity in the simple and moving fibres of the in-
testines; 

OF PHYSIC. 237
testines; and the remedies employed have according-
ly been Correctors of particular acrimony, general
demulcents, evacuants by vomiting or purging, as-
tringents, or opiates. Upon each of these kinds of
remedy I shall now offer some remarks.
MCCCCXCVI.
An acid acrimony is, upon several occasions, the
cause of diarrhœa, particularly in children; and in
such cases the absorbent earths have been very proper-
ly employed. The common, however, and promis-
cuous use of these has been very injudicious; and
where there is any putrescency, they must be hurtful.
MCCCCXCVII.
The cases in which there is a putrid or putrescent
acrimony prevailing, have been, I think, too seldom
taken notice of; and, therefore, the use of acids too
seldom admitted. The acrimony to be suspected in
bilious cases, is probably of the putrescent kind.
MCCCCXCVIII.
The general correctors of acrimony are the mild
diluents and demulcents. The former have not been
so much employed in diarrhœa as they ought; for,
joined with demulcents, they very much increase the
effects of the latter: and although the demulcents,
both mucilaginous and oily, may by themselves be
useful, yet without the assistance of diluents they can
hardly be introduced in such quantity as to answer the
purpose*.
MCCCCXCIX.
* Lintseed-tea is both diluent and demulcent; but as the patient
sometimes loaths it, we may in its place use a decoction of marsh-
mallows root, or of quince seed. These infusions and decoctions
ought to be extremely thin. An ounce of bruised quince-seed will
make three pints of water as thick and ropy as the white of an egg;
hence a drachm is sufficient for a pint of the decoction.
We have another instance of a diluent and demulcent in the al-
mond emulsion, which is an exceedingly elegant medicine. The
formulæ in both the London and Edinburgh Pharmacopœias are not
well adapted to cases of diarrhœa: for the former contains sugar,

228 PRACTICE
MCCCCXCIX.
As indigestion and crudities present in the stomach
are so often the cause of diarrhœa, vomiting must
therefore be frequently very useful in this disease.
In like manner, when the disease proceeds, as it oft-
en does, from obstructed perspiration, and increased
afflux of fluids to the intestines, vomiting is perhaps
the most effectual means of restoring the determina-
tion of the fluids to the surface of the body.
It is possible also, that vomiting may give some in-
version of the peristaltic motion which is determined
too much downwards in diarrhœa; so that upon the
whole it is a remedy which may be very generally use-
ful in this disease*.
MD.
Purging has been supposed to be more universally
necessary, and has been more generally practised.
This however, in my opinion, proceeds upon very mis-
taken notions with respect to the disease; and such a
practice seems to me for the most part superfluous, and
in many cases very hurtful. It goes upon the suppo-
sition of an acrimony present in the intestines, that
ought to be carried out by purging: but, if that acri-
mony has either been introduced by the mouth, or
brought into the intestines from other parts of the
body, purging can neither be a means of correcting
nor of exhausting it; and must rather have the effect
of increasing its afflux, and of aggravating its effects.
From
and the latter bitter almonds; both of which increase the irritation.
In these cases, therefore, an emulsion made with sweet almonds and
gum arabic, is preferable to either of the others: as,
ꝶ. Amygdal. dulc. decorticat. ℥i.
Gum Arabic. ℥i.
Tere in mortario marmoreo, et adde gradatim.
Aq. font. lb. i.
M.f. Emuls.
* The methods of giving the tartar emetic, for producing either
vomiting or sweating, may be seen in the notes on article 185. 

OF PHYSIC. 259
From whatever source the acrimony which can excite
a diarrhœa proceeds, it may be supposed sufficient to
evacuate itself, so far as that can be done by purging;
and as in cholera, so in the same kind of diarrhœa, it
will be more proper to assist the evacuation by diluents
and demulcents, than to increase the irritation by pur-
gatives.
MDI.
If, then, the use of purgatives in diarrhœa may be
considered, even when an acrimony is present, as su-
perfluous, there are many other cases in which it may
be extremely hurtful. If the irritability of the intes-
tines shall, from affection, in other parts of the system,
or other causes, have been already very much, increas-
ed, purgatives must necessarily aggravate the disease.
In the case of lientery, nobody thinks of giving a pur-
gative; and in many cases of diarrhœa approaching
to that, they must be equally improper. I have al-
ready observed, that when diarrhœa proceeds from an
afflux of fluids to the intestines, whether in too great
quantity, or of an acrid quality, purgatives may be
hurtful; and whoever, therefore, considers the nu-
merous and various sources from which acrid matter
may be poured into the cavity of the intestines, will
readily perceive, that, in many cases of diarrhœa, pur-
gatives may be extremely pernicious.
There is one case in particular to be taken notice
of. When, from a general and acrid dissolution of
the blood, the serous fluids run off too copiously into
the cavity of the intestines, and excite that diarrhœa
which attends the advanced state of hectic fever, and
is properly called a Colliquative Diarrhœa; I have, in
such cases, often seen purgatives given with the most
baneful effects.
There is still another case of diarrhœa in which
purgatives are pernicious; and that is, when the dis-
ease depends, as we have alledged it sometimes may
upon an erythematic inflammation of the intestines.
I need 

240 PRACTICE
I need hardly add, that if there be a case of diarrhœa
depending upon a laxity of the solids, purgatives can-
not there be of any service, and may do much harm.
Upon the whole, it will, I think, appear, that the use
of purgatives in diarrhœa is very much limited; and
the promiscuous use of them, which has been so com-
mon, is injudicious, and often pernicious. I believe
the practice has been chiefly owing to the use of
purgatives in dysenteric cases, in which they are truly
useful; because, contrary to the case of diarrhœa, there
is in dysentery a considerable constriction of the intes-
tines*.
MDII.
Another set of remedies employed in diarrhœa are
astringents. There has been some hesitation about
the employment of these in recent cases, upon the
supposition that they might occasion the retention of
an acrid matter that should be thrown out. I cannot,
however, well understand or assign the cases in which
such caution is necessary; and I think that the power
of astringents is seldom so great as to render their use
very
* Notwithstanding all the author advances concerning the danger
of purgatives in a diarrhœa, there are some cases in which they are
of singular utility. His arguments in this article are doubtless
just; and, in the species of diarrhœa which he here enumerates, pur-
gatives are certainly hurtful: but many instances of diarrhœa occur,
which proceed from an acrimony that is extremely tenacious, and
that adheres closely to the internal surface of the intestines, or is re-
tained in their folds. In such cases, purgatives are the only re-
medies for removing the disease, and ought therefore to be used. In
all other cases, (as the author justly observes,) they are certainly
pernicious.
Having ascertained when purgatives are proper, the next consi-
deration is, what purgatives ought to be used? The answer is obvi-
ous:—Neutral salts, particularly Soda phosphorata, Rochel Salt,
Glaubers salts, and Epsom lalt, which are enumerated in the order
of their being agreeable, but in a contrary order to their degree
of efficacy; the Epsom salt being the least agreeable, but the
most efficacious. 

OF PHYSIC. 241
very dangerous. The only difficulty which has occur-
red to me, with respect to their use, has been to judge of
the circumstances to which they are especially adapt-
ed. It appears to me to be only in those where the
irritability of the intestines depends upon a loss of
tone: and this, I think, may occur either from the
debility of the whole system, or from causes acting on
the intestines alone. All violent or long continued
spasmodic and convulsive affections of the intestinal
canal necessarily induce a debility there; and such
causes often take place, from violent irritation, in co-
lic, dysentery, cholera, and diarrhœa*.
MDIII.
The last of the remedies of diarrhœa that remain to
be
VOL. II. 
H h 
* The astringents to be used when they are proper, are various:
as Alum, Logwood, Catechu, Rhubarb, &c. The author justly
remarks, that astringents are only useful in cases of debility, and
therefore the tonic astringents are undoubtedly preferable to any
other. Rhubarb and Peruvian bark, each possessing both these qua-
lities, may therefore be advantageously used conjointly, as in the
following formula: 
ꝶ. Pulv. Cort. Peruv. ℥i.
Rad. Rhei, ℥ss.
M. f. Pulv.
The dose of this powder may be varied according to circumstances,
from a scruple to a dram, twice a-day, with a glass of port wine
after it.
It may not be improper to observe, that in diarrhoeas in general
peculiar attention must be paid to diet. The oleraceous and aces-
cent vegetables must be carefully avoided; as must also all fermented
liquors except port wine; of the farinaceous vegetables, rice is the
best; and rice-water; with a little cinnamon and port wine, is the
most proper drink for patients in these cases. Roasted meats are
preferable to boiled; and veal, lamb, or chickens, preferable to beef
or mutton. Pork is very improper, as are also all kinds of fish.
Puddings of all kinds without fruit are very proper food for, such
patients, especially rice-puddings made without eggs, but with milk
and cinnamon; and also rice-milk, sago with port wine, blanc
mange, &c. 

242 PRACTICE
be mentioned are opiates. The same objections have
been made to the use of these, in recent cases of diar-
rhœa, as to that of astringents; but on no good
grounds: for the effect of opiates, as astringent, is ne-
ver very permanent; and an evacuation depending
upom irritation, though it may be for some time sus-
pended by opiates, yet always returns very soon. It
is only by taking off irritability that opiates are useful
in diarrhœa; and therefore, when the disease depends
upon an increase of irritability alone, or when, though
proceeding from irritation, that irritation is corrected
or exhausted, opiates are the most useful and certain
remedy. And though opiates are not suited to correct
or remove an irritation applied, they are often of great
benefit in suspending the effects of that irritation
whenever these are violent: and, upon the whole,
it will appear, that opiates may be very frequently,
and with great propriety, employed in the cure of
diarrhœa.
CHAP. XII.
OF THE DIABETES.
MDIV.
THIS disease consists in the voiding of an unusually
large quantity of urine.
As hardly any secretion can be increased without
an increased action of the vessels concerned in it, and
as some instances of this disease are attended with affec-
tions manifestly spasmodic, I have had ho doubt of
arranging the diabetes under the order of Spasmi.
MDV.
This disease is always accompanied with a great de-
gree  

OF PHYSIC. 243
gree of thirst, and therefore with the taking in of a
great quantity of drink. This in some measure ac-
counts for the very extraordinary quantities of urine
voided: but still, independent of this, peculiar dis-
ease certainly takes place; as the quantity of urine
voided does almost always exceed the whole of the
liquids, and sometimes the whole of both solids and li-
quids, taken in.
MDVI.
The urine voided in this disease is always very clear,
and at first sight appears entirely without any colour:
but, viewed in a certain light, it generally appears
to be slightly tinged with a yellowish green, and
in this respect has been very properly compared to a
solution of honey in a large proportion of water.
Examined by the taste, it is very generally found
to be more or less sweet; and many experiments that
have now been made in different instances of the dis-
ease, show clearly that such urine contains, in consider-
able quantity, a saccharine matter which appears to be
very exactly of the nature of common sugar.
MDVII.
Doctor Willis seems to me to have been the first
who took notice of the sweetness of the urine in dia-
betes, and almost every physician of England has since
taken notice of the same. It is to be doubted, indeed,
if there is any case of idiopathic diabetes in which the
urine is of a different kind. Though neither the an-
cients, nor, in the other countries of Europe, the mo-
derns, till the latter were directed to it by the English,
have taken notice of the sweetness of the urine, it does
not persuade me, that either in ancient or in modern
times the urine in diabetes was of another kind. I
myself, indeed, think I have met with one instance
of diabetes in which the urine was perfectly insipid;
and it would seem that a like observation had occur-
red to Dr. Martin Lister. I am persuaded, however,
that
H h 2  

244 PRACTICE
that such instances are very rare; and that the other 
is by much the more common, and perhaps the al-
most universal occurrence. I judge, therefore, that
the presence of such a saccharine matter may be con-
sidered as the principal circumstance in idiopathic di-
abetes; and it gives at least the only case of that dis-
ease that I can properly treat of here, for I am only
certain that what I am further to mention relates to
such a case.
MDVIII.
The antecedents of this disease, and consequently
the remote causes of it, have not been well ascertain-
ed. It may be true that it frequently happens to men
who, for a long time before, had been intemperate in
drinking; that it happens to persons of a broken con-
stitution, or who, as we often express it, are in a
cachectic state ; that it sometimes follows intermit-
tent fevers; and that it has often occurred from excess
in the drinking of mineral waters. But none of these
causes apply very generally to the cases that occur:
such cases are not always, nor even frequently, fol-
lowed by a diabetes; and there are many instances of
diabetes which could not be referred to any of them.
In most of the cases of this disease which I have met
with, I could not refer it to any particular cause
MDIX.
This disease commonly comes on slowly, and almost
imperceptibly, without any previous disorder. It of-
ten rises to a considerable degree, and subsists long
without being accompanied with evident disorder in
any particular part of the system. The great thirst
which always, and the voracious appetite which fre-
quently occurs in it, are often the only remarkable
symptoms. Under the continuance of the disease, the
body is often greatly emaciated; and a great weak-
ness also prevails. The pulse is commonly frequent;
and an obscure fever is for the most part present.-
When the disease proves fatal, it generally ends with
a fever 

OF PHYSIC. 245
a fever, in many circumstances, particularly those of
emaciation and debility, resembling a hectic.
MDX.
The proximate cause of this disease is not certainly
or clearly known. It seems to have been sometimes
connected with calculous affections of the kidneys; and
it is possible, that an irritation applied there may in-
crease the secretion of urine. It perhaps often does
so; but how it should produce the singular change
that takes place in the state of the urine, is not to be
easily explained. It certainly often happens, that cal-
culous matters are long present in the urinary passages,
without having any such effect as that of producing
diabetes in any shape.
Some have supposed that the disease occurs from a
relaxed state of the secretory vessels of the kidneys;
and indeed the dissections of persons who had died of
this disease have shown the kidneys in a very flaccid
state. This, however, is probably to be considered as
rather the effect than the cause of the disease.
That no topical affection of the kidneys has a share
in producing this disease, and that a fault in the assi-
mulation of the fluids is rather to be blamed, I con-
clude from hence, that even the solid food taken in,
increases the quantity of the urine voided, at the same
time with an increase of the saccharine matter above-
mentioned.
MDXI.
The diabetes has been supposed to be owing to a
certain state of the bile; and it is true, that this disease
has sometimes occurred in persons who were at the
same time affected with diseases of the liver: but this
occurrence does not often take place; and the diabe-
tes frequently occurs separately from any affection of
the liver. In twenty instances of diabetes which I
have seen, there was not in any on: of them any evi-
dent affection of the liver.
The

246 PRACTICE
The explanation that has been offered of the nature
and operation of the bile, in producing diabetes, is ve-
ry hypothetical, and nowise satisfying.
MDXII.
As I have already said, I think it probable, that in
most cases the proximate cause of this disease is some
fault in the assimilatory powers or in those employed
in converting alimentary matters into the proper ani-
mal fluids. This I formerly hinted to Dr. Dobson,
and it has been prosecuted and published by him;
but I must own that it is a theory embarrassed with
some difficulties which I cannot at present very well
remove.
MDXIII.
The proximate cause of diabetes being so little
known or ascertained, I cannot propose any rational
method of cure in the disease*. From the testimony
of several authors, I believe that the disease has been
cured: but I believe also, that this has seldom happen-
ed; and when the disease has been cured, I doubt
much if it was effected by the several remedies to
which these cures have been ascribed. In all the in-
stances of this disease which I myself have seen, and in
several
* The disease is happily not very common; but, when a physici-
an is called, he is under the necessity of doing something, and not
remaining inactive some general directions may therefore be ac-
ceptable to the young practitioner.
The cure will principally consist in avoiding whatever may relax
the renal vessels, especially by avoiding strong drink. As the quan-
tity of urine is always less in proportion as the perspiration is in-
creased, it seems advisable to keep the surface of the skin lax and
perspirable; and, if the patient's strength allows him, he ought fre-
quently to use bodily exercise to promote sweat. For a similar rea-
son, external cold must be avoided, because by diminishing perspira-
tion, a larger quantity of fluids is derived to the kidneys.
In some cases, the disease may be probably owing to a lax or
weak state of the kidneys: hence the indication of tonic, as Peru-
vian bark, and other tonic bitters.

OF PHYSIC. 247
several others of which I have been informed, no cure
of it has ever been made in Scotland, though many
instances of it have occurred, and in most of them the
remedies recommended by authors have been diligent-
ly employed. I cannot, therefore, with any advan-
tage, enter into a detail of these remedies; and as the
disease, together with its several circumstances, when
they shall hereafter occur, is likely to become the sub-
ject of diligent investigation, I avoid going farther at
present, and judge it prudent to suspend my opinion
till I shall have more observations and experiments up-
on which I can form it more clearly.
CHAP. XIII.
OF THE HYSTERIA, OR THE HYSTERIC
DISEASE.
MDXIV.
THE many and various symptoms which have been
supposed to belong to a disease under this appella-
tion, render it extremely difficult to give a general
character or definition of it. It is, however, proper
in all cases to attempt some general idea; and there-
fore, by taking the most common form, and that con-
currence of symptoms by which it is principally dis-
tinguished, I have formed a character in my system of
Methodical Nosology, and shall here endeavour to il-
lustrate it by giving a more full history of the pheno-
mena.
MDXV.
The disease attacks in paroxysms or fits. These
commonly begin by some pain and fulness felt in the
left 

248 PRACTICE
left side of the belly. From this a ball* seems to move
with a grumbling noise into the other parts of the bel-
ly; and, making as it were various convolutions
there, seems to move into the stomach; and more
distinctly still rises up to the top of the gullet, where
it remains for some time and by its pressure upon the
larynx gives a sense of suffocation. By the time that
the disease has proceeded thus far, the patient is af-
fected with a stupor and insensibility, while at the same
time the body is agitated with various convulsions.
The trunk of the body is wreathed to and fro, and
the limbs are variously agitated; commonly the con-
vulsive motion of one arm and hand, is that of beating
with the closed fist, upon the breast very violently
and repeatedly. This state continues for some time,
and has during that time some remissions and renew-
als of the convulsive motions; but they at length
cease, leaving the patient in a stupid and seemingly
sleeping state. More or less suddenly, and frequently
with repeated sighing and sobbing, together with a
murmuring noise in the belly, the patient returns to
the exercise of sense and motion, but generally with-
out any recollection of the several circumstances that
had taken place during the fit.
MDXVI.
This is the form of what is called an hysteric parox-
ysm, and is the most common form; but its parox-
ysms are considerably varied in different persons, and
even in the same person at different times. It differs,
by having more or fewer of the circumstances above-
mentioned: by these circumstances being more or
less violent; and by the different duration of the
whole fit.
Before the fit there is sometimes a sudden and unu-
sually large slow of limpid urine. At the coming on
of
* Commonly called Globus hystericus by authors.

OF PHYSIC. 249
of the fit, the stomach is sometimes affected with vo-
miting, the lungs with considerable difficulty of breath-
ing, and the heart with palpitations. During the fit,
the whole of the belly, and particularly the navel, is
drawn strongly inwards; the sphincter and ani is some-
times so firmly constricted as not to admit a small
glyster-pipe, and there is at the same time an entire
suppression of urine. Such fits are, from time to time,
ready to recur; and during the intervals, the patients
are liable to involuntary motions, to fits of laughing
and crying, with sudden transition from the one to the
other; while sometimes false imaginations, and some
degree of delirium, also occur.
MDXVII.
These affections have been supposed peculiar to the
female sex; and indeed they most commonly appear
in females: but they sometimes, though rarely, at-
tack the male sex; never, however, that I have ob-
served, in the same exquisite degree.
In the female sex, the disease occurs especially
from the age of puberty to that of thirty-five years;
and though it does sometimes, yet very seldom ap-
pears before the former or after the latter of these pe-
riods.
At all ages, the time at which it most readily occurs
is that of the menstrual period.
The disease more especially affects the females of
the most exquisitely sanguine and plethoric habits,
and frequently affects those of the most robust and mas-
culine constitutions.
It affects the barren more than breeding women,
and therefore frequently young widows.
It occurs especially in those females who are liable
to the Nymphomania; and the Nosologists have pro-
perly enough marked one of the varieties of this dis-
ease by the title of Hysteria Libidinosa.
In the persons liable to the fits of this disease, it is
readily
VOL. II. 
I i 

250 PRACTICE
readily excited by the passions of the mind, and by
every considerable emotion, especially those brought
on by surprise.
The persons liable to this disease acquire often such
a degree of sensibility, as to be strongly affected by
every impression that comes upon them by surprise.
MDXVIII.
In this history, there appears to be a concurrence
of symptoms and circumstances properly marking a
very particular disease, which I think may be distin-
guished from all others. It seems to me to have been
improperly considered by physicians as the same with
some other diseases, and particularly with hypochon-
driasis. I he two diseases may have some symptoms
in common, but for the most part are considerably dif-
ferent.
Spasmodic affections occur in both diseases; but
neither so frequently nor to so great a degree, in hy-
pochondriasis as in hysteria.
Persons liable to hysteria are sometimes affected at
the same time with dyspepsia. They are often, how-
ever, entirely free from it; but I believe this never
happens to persons affected with hypochondriasis.
These different circumstances mark some difference
in the two diseases; but they are still more certainly
distinguished by the temperament* they attack, and by
the time§ of life at which they appear to be most ex-
quisitely formed.
It has been generally supposed, that the two diseas-
es differ only in respect of their appearing in different
sexes. But this is not well founded: for although the
hysteria appears most commonly in females, the male
sex
* Hysteria attacks the sanguine and plethoric, but Hypochondri-
asis the melancholic.
§ Hypochondriasis scarcely ever appears early in life, nor Hyste-
ria late; and Hypochondriasis becomes aggravated, but Hysteria re-
lieved by advancing age. 

OF PHYSIC. 251
sex is not absolutely free from it, as I have observed
above; and although the hypochondriasis may be
most frequent in men, the instances of it in the female
sex are very common*.
MDXIX.
From all these considerations, it must I think, ap-
pear, that the hysteria may be very well, and properly,
distinguished from hypochondriasis.
Further, it seems to me to have been with great im-
propriety, that almost every degree of the irregular
motions of the nervous system has been referred to the
one or the other of these two diseases. Both are
marked by a peculiarity of temperament, as well as
by certain symptoms commonly accompanying that;
but some of these, and many others usually marked by
the name of nervous symptoms, may, from various
causes, arise in temperaments different from that which
is peculiar to either hysteria or hypochondriasis, and
without being joined with the peculiar symptoms of
either the one or the other disease: so that the appel-
lations of Hysteric and Hypochondriac are very inac-
curately applied to them. Under what view these
symptoms are otherwise to be considered, I am not
ready to determine; but must remark, that the appel-
lation of Nervous Diseases is too vague and undefined
to be of any useful application.
MDXX.
Having thus endeavoured to distinguish hysteria
from every other disease, I shall now attempt its pecu-
liar pathology. With respect to this, I think it will,
in the first place, be obvious, that its paroxysms be-
gin by a convulsive and spasmodic affection of the ali-
mentary canal, which is afterwards communicated to
the brain, and to a great part of the nervous system.
Although
I i 2
* The Hypochondriasis in women has frequently been mistaken
for Hysteria.

252 PRACTICE
Although the disease appears to begin in the alimen-
tary canal, yet the connection which the paroxysms so
often have with the menstrual flux, and with the dis-
eases that depend on the state of the genitals, shows,
that the physicians have at all times judged rightly in
considering this disease as an affection of the uterus
and other parts of the genital system.
MDXXI.
With regard to this, however, I can go no farther.
In what manner the uterus, and particularly the ova-
ria, are affected in this disease; how the affection of
these is communicated, with particular circumstances,
to the alimentary canal; or how the affection of this,
rising upwards, affects the brain, so as to occasion
the particular convulsions which occur in this disease,
I cannot pretend to explain.
But although I cannot trace this disease to its first
causes, or explain the whole of the phenomena, I
hope, that with respect to the general nature of the dis-
ease, I may form some general conclusions, which may
serve to direct our conduct in the cure of it
MDXXII
Thus, from a consideration of the predisponent and
occasional causes, it will, I think, appear, that the
chief part of the proximate cause is a mobility of the
system, depending generally upon its plethoric state.
MDXXIII.
Whether this disease ever arises from a mobility of
the system, independent of any plethoric state of it, I
cannot positively determine; but in many cases that
have subsisted for some time, it is evident that a sen-
sibility, and consequently a mobility, are acquired,
which often appear when neither a general plethora
can be supposed to subsist, nor an occasional turges-
cence to have happened. However, as we have
shown above, that a distension of the vessels of the
brain seems to occasion epilepsy, and that a turges-
cence

OF PHYSIC. 253
cence of the blood in the vessels of the lungs seems to
produce asthma; so analogy leads me to suppose, that
a turgescence of blood in the uterus, or in other parts
of the genital system, may occasion the spasmodic and
convulsive motions which appear in hysteria. It will,
at the same time, be evident, that this affection of the
genitals must especially occur in plethoric habits; and
every circumstance mentioned in the history of the
disease serves to confirm this opinion with respect to
its proximate cause.
MDXXIV.
From this view of the subject, the analogy of hys-
teria and epilepsy will readily appear; and why,
therefore, I am to say that the indications of cure are
the same in both.
As the indications, so the several means of answer-
ing them are so much the same in both diseases, that
the same observations and directions, with regard to
the choice and employment of these remedies, that
have been delivered above on the subject of epi-
lepsy, will apply pretty exactly to hysteria; and there-
fore need not to be repeated here*. 
CHAP.
* Although the indications of cure maybe the same in both dis-
eases, yet in hysteria we are more frequently under the necessity of
relieving the violence of the symptoms than in epilepsy; and for
this purpose we must hive recourse to a variety of antispasmodics.
Asafoetida, in various forms, is usually employed; as are also
volatile spirits: but both these joined, prove more efficacious than
either of them finely. There are excellent formulae of thin kind in
the London and Edinburgh pharmacopoeias, under the title of Spi-
ritus Amoniae foetidus. It's dose is twenty or thirty drops, re-
peated according to the urgency of the case, several times a-day.
The Tinctura Castorei composita of the Edinburgh Pharmaco-
poeia is another excellent formula of the same kind; it is a remedy
of real efficacy. The dose of it is thirty or forty drops repeated
occasionally.
The Tinctura Valerianae volatilis of both the pharmacopoeias is
also frequently used. It's dose is a tea-spoonful or two.
Few of the compositions of the shops are found to be more effi-
cacious antispasmodics than the Spiritus Ætheris Vitriolicua com-
positus of the London Pharmacopeia. It's dose is from thirty to

254 PRACTICE
CHAP. XIV.
OF CANINE MADNESS AND HYDROPHOBIA.
MDXXV.
THIS disease has been so exactly and fully describ-
ed in books that are in every body's hands, that
it is on no account necessary to give any history of it
here; and with respect to the pathology of it, I find
that I can say nothing satisfying to myself, or that I
can expect to prove so to others. I find also, with re-
spect to the cure of this disease, that there is no sub-
ject in which the fallacy of experience appears more
strongly than in this. From the most ancient to the
present times, many remedies for preventing and cur-
ing
fifty drops in two or three spoonfulls of cold water; and it must be
swallowed immediately on pouring out of the vial.
These and other antispasmodics may be used promiscuously; for,
in different cases and constitutions, they prove differently efficacious.
Sometimes they may be variously combined with one another, and
with opium. Opium, however, ought not to be used, except where
other antispasmodics fail, as it always leaves the patient remarkably
low, and liable to returns of the paroxysms.
Besides the use of these remedies internally, some of them may be
usefully employed externally; as strong volatile spirits to the nose,
the vitriolic aether to the temples, &c.
These remedies are chiefly designed for occasionally removing the
violence of the symptoms; but the fetid gums, in substance, must
be used, when we wish to procure permanent effects. The formu-
lae of them are in both our Pharmacopoeias, under the title of gum-
pills; but they will be found much more efficacious by adding to
them a little castor, as in the following formula:
ꝶ. Pilul. Gummos. Edinb. ℥ss.
Castor Russic. ʒi.
Syr. simpl. q. s.
M. f. mass. in pilulas lxxv. equales dividend.
Five of these pills may be taken twice a-day washing them down
with a tea-cupful of cold water with a tea-spoonful of volatile tinc-
ture of valerian in it.
The Pilulæ fœtidæ of the Sweedish Pharmacopœia, in which cas-
tor is one of the ingredients, is preferable to either of our gum-pills.

OF PHYSIC. 255
ing this disease have been recommended under the
sanction of pretended experience, and have perhaps
also kept their credit for some time: but succeeding
times have generally, upon the same ground of expe-
rience, destroyed that credit entirely; and most of the
remedies formerly employed are now fallen into abso-
lute neglect. In the present age, some new remedies
have been proposed, and have experience alledged to
vouch for their efficacy; but many doubts still remain
with respect to this: and though I cannot determine
in this matter from my own experience, I think it in-
cumbent on me to give the best judgment I can form
with respect to the choice of the remedies at present
recommended.
MDXXVI.
I am, in the first place, firmly persuaded, that the
most certain means of preventing the consequences
of the bite, is to cut out, or otherwise destroy, the part
in which the bile has been made. In this every body
agrees; but with this difference, that some are of opi-
nion that it can only be effectual when it is done very
soon after the wound has been made, and they there-
fore neglect it when this opportunity is missed. There
have been, however, no experiments made proper to
determine this matter: and there are many considera-
tions which lead me to think, that the poison is not
immediately communicated to the system; and there-
fore, that this measure of destroying the part may be
practised with advantage, even many days after the
bite has been given.
MDXXVII.
Whilst the state of our experience, with respect to
several remedies now in use, is uncertain, I cannot
venture to assert that any of these is absolutely inef-
fectual; but I can give it as my opinion, that the effi-
cacy of mercury, given very largely, and persisted in
for a long time, both as a means of preventing the 
disease,

256 PRACTICE
disease, and of curing it when it has actually come on,
is better supported by experience than that of any
other remedy now proposed or commonly employed.
BOOK IV.
OF
VESANIÆ,
OR OF THE
DISORDERS OF THE INTELLECTUAL
FUNCTIONS.
CHAP. I.
OF VESANIÆ IN GENERAL.
MDXXVIII.
THE Nosologists, Sauvages and Sagar, in a class of
diseases under the title of VESANIÆ, have com-
prehended the two orders, of Hallucinationes or False
Perceptions, and of Morositates or Erroneous Appe-
tites and Passions; and, in like manner, Linnæus in
his class of MENTALES, corresponding to the Vesaniæ
of Sauvages, has comprehended the two orders of Ima-
ginarii and Pathetici, nearly the same with the Hallu-
cinationes and Morositates of that author. This, how-
ever, from several considerations, appears to me im-
proper; and I have therefore formed a class of Vesa-
nia; nearly the same with the Paranoiæ of Vogel, ex-
cluding

OF PHYSIC. 257
cluding from it the Hallucinationes and Morositates,
which I have referred to the Morbi Locales. Mr.
Vogel has done the like, in separating from the Para-
noiæ the false perceptions and erroneous appetites;
and has thrown these into another class, to which he
has given the title of Hvperæsteses.
MDXXIX.
It is indeed true, that certain hallucinationes and 
morositates are frequently combined with what I
propose to consider as strictly a vesania or an errone-
ous judgment; and sometimes the hallucinationes
seem to lay the foundation of, and to form almost en-
tirely, the vesania. But as most part of the halluci-
nationes enumerated by the Nosologists are affections
purely topical, and induce no other error of judgment
beside that which relates to the single object of the
sense or particular organ affected; so these are certain-
ly to be separated from the diseases which consist in a
more general affection of the judgment. Even when
the hallucinationes constantly accompany or seem to
induce the vesania, yet being such as arise from inter-
nal causes, and may be presumed to arise from the
same cause as the more general affection of the judg-
ment, they are therefore to be considered as symptoms
of this only.
In like manner I judge with respect to the morosi-
tates, or erroneous passions, that accompany vesania;
which, as consequences of a false judgment, must be
considered as arising from the same causes, and as
symptoms only, of the more general affection.
There is, indeed, one case of a morositas which
seems to induce a vesania, or more general affection of
the judgment; and this may lead us to consider the
vesania, in this case, as a symptom of an erroneous
appetite, but will not afford any good reason for com-
prehending the morositates in general under the vesa-
niæ, considered as primary diseases.
VOL. II.  
The 
K k

258 PRACTICE
The limitation, therefore, of the class of Vesaniæ
to the lesions of our judging faculty, seems from every
consideration to be proper.
The particular diseases to be comprehended under
this class, may be distinguished according as they af-
fect persons in the time of waking or sleeping. Those
which affect men awake, may again be considered, as
they consist in an erroneous judgment, to which I shall
give the appellation of Delirium; or as they consist in
a weakness or imperfection of judgment, which I shall
name Fatuity. I begin with the consideration of De-
lirium.
MDXXX.
As men differ greatly in the soundness and force of
their judgment, so it may be proper here to ascertain
more precisely what error or imperfection of our judg-
ing faculty is to be considered as morbid, and to ad-
mit of the appellations of Delirium and Fatuity. In
doing this, I shall first consider the morbid errors of
judgment under the general appellation of Delirium,
which has been commonly employed to denote every
mode of such error.
MDXXXI.
As our judgment is chiefly exercised in discerning
and judging of the several relations of things, I ap-
prehend that delirium may be defined to be,—In a
person awake, a false or mistaken judgment of those
relations of things, which as occurring most frequent-
ly in life, are those about which the generality of
men form the same judgment; and particularly when
the judgment is very different from, what the person
himself had before usually formed.
MDXXXII.
With this mistaken judgment of relations there is
frequently joined some false perception of external ob-
jects, without any evident fault in the organs of sense,
and which seems therefore to depend upon the imagi-
nation

OF PHYSIC. 259
nation arising from a condition in the brain present-
ing objects which are not actually present. Such
false perceptions must necessarily occasion a delirium,
or an erroneous judgment, which is to be considered
as the disease.
MDXXXIII.
Another circumstance, commonly attending deliri-
um, is a very unusual association of ideas. As, with
respect to most of the affairs of common life, the ideas
laid up in the memory are, in most men, associated in
the same manner; so a very unusual association, in any
individual, must prevent his forming the ordinary
judgment of those relations which are the most com-
mon foundation of association in the memory: and
therefore this unusual and commonly hurried associa-
tion of ideas, usually is, and may be considered as, a
part of delirium. In particular it may be considered
as a certain mark of a general morbid affection of the
intellectual organs, it being an interruption or perver-
sion of the ordinary operations of memory, the com-
mon and necessary foundation of the exercise of judg-
ment.
MDXXXIV.
A third circumstance attending delirium, as in emo-
tion or passion, sometimes of the angry, sometimes of
the timid kind; from whatever cause in the percep-
tion or judgment, it is proportioned to such cause, ei-
ther in the manner formerly customary to the person
himself, or in the manner usual with the generality of
other men.
MDXXXV.
Delirium, then, may be more shortly defined,—In a
person awake, a false judgment arising from percepti-
ons of imagination, or from false recollection, and
commonly producing disproportionate emotions.
Such delirium is of two kinds; as it is combined
with pyrexia and comatose affections; or, as it is en-
tirely
K k 2

260 PRACTICE
tirely without any such combination. It is the latter
case that we name Insanity; and it is this kind of de-
lirium only that I am to treat of here.
MDXXXVI.
Insanity may perhaps be properly considered as a
genus comprehending many different species, each of
which may deserve our attention; but before proceed-
ing to the consideration of particular species, I think
it proper to attempt an investigation of the cause of
insanity in general.
MDXXXVII.
In doing this, I shall take it for granted, as demon-
strated elsewhere, that although this disease seems to
be chiefly, and sometimes solely, an affection of the
mind; yet the connection between the mind and bo-
dy in this case is such, that these affections of the mind
must be considered as depending upon a certain state
of our corporeal part. See Halleri Prim. Lin. Phy-
sio. log. § DLXX. See Boerhaavii Inst. Med,
§ DLXXXI. DCXCVI.
MDXXXVI1I.
Admitting this proposition, I must in the next place
assume another, which I likewise suppose to be demon- 
strated elsewhere. This is, that the part of our body
more immediately connected with the mind, and
therefore more especially concerned in every affection
of the intellectual functions, is the common organ of
the nerves; which I shall, in what follows, speak of
under the appellation of the Brain.
MDXXXIX.
Here, however, in assuming this last proposition, a
very great difficulty immediately presents itself. Al-
though we cannot doubt that the operations of our in-
tellect always depend upon certain motions taking
place in the brain, (see Gaub. Path. Med. § 523;)
yet these motions have never been the objects of our
senses, nor have we been able to perceive that any par-
ticular 

OF PHYSIC. 261
ticular part of the brain has more concern in the ope-
rations of our intellect than any other. Neither have
we attained any knowledge of what share the several
parts of the brain have in that operation; and there-
fore, in this situation of our science, it must be a very
difficult matter to discover those states of the brain
that may give occasion to the various state of our intel-
lectual functions.
MDXL.
It may be observed, that the different state of the
motion of the blood in the vessels of the brain has
some share in affecting the operations of the intellect:
and physicians, in seeking for the causes of the differ-
ent states of our intellectual functions, have hardly
looked further than into the state of the blood, or into
the condition of the blood itself: but it. is evident that
the operations of the intellectual functions ordinarily
go on, and are often considerably 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
state of the intellectual functions depends chiefly upon
the state and condition of what is termed the Nervous
Power, or, as we suppose, of a subtile very moveable
fluid, included or inherent, in a manner we do not
clearly understand, in every part of the medullary sub-
stance of the brain and nerves, and which in a living
and healthy man is capable of being moved from eve-
ry one part to every other of the nervous system.
MDXLII.
With respect to this power, we have pretty clear
proof that it frequently has a motion from the sentient
extremities of the nerves towards the brain, and there-
by produces sensation; and we have the same proof,
that in consequence or volition the nervous power has
a motion from the brain into the muscle or organs
of 

262 PRACTICE
of motion. Accordingly, as sensation excites our in-
tellectual operations, and volition is the effect of
these, and as the connection between sensation and
volition is always by the intervention of the brain and
of intellectual operations; so we can hardly doubt,
that these latter depend upon certain motions, and
the various modification of these motions, in the
brain.
MDXLIII.
To ascertain the different states of these motions
may be very difficult; and physicians have commonly
considered it to be so very mysterious, that they have
generally despaired of attaining any knowledge with
regard to it; but I consider such absolute despair, and
the negligence it inspires, to be always very blamea-
ble; and I shall now venture to go some length in the
inquiry, hoping that some steps made with tolerable
firmness may enable us to go still further.
MDXLIV.
To this purpose, I think it evident, that the nervous
power, in the whole as well as in the nervous system,
and particularly in the brain, is at different times in
different degrees of mobility and force. To these dif-
ferent states, I beg leave to apply the terms of Excite-
ment and Collapse. To that state in which the mobili-
ty and force are sufficient for the exercise of the func-
tions, or when these states are any way preternatural-
ly increased, I give the name of Excitement; and to
that state in which the mobility and force are not suf-
ficient for the ordinary exercise of the functions, or
when they are diminished from the state in which they
had been before, I give the name of Collapse. I beg,
however, it may be observed, that by these terms I
mean to express matters of fact only; and without in-
tending, by these terms, to explain the circumstance
or condition, mechanical, of the nervous power or flu-
id in these different states.
MDXLV.

OF PHYSIC. 263
MDXLV.
That these different states of excitement and collapse
take place on different occasions, must, I think, be
manifest from numberless phenomena of the animal
œconomy: but it is especially to our present purpose
to observe, that the different states of excitement and
collapse, are in no instance more remarkable, than in
the different states of waking and sleeping. In the
latter, when quite complete, the motion and mobili-
ty of the nervous power, with respect to the whole of
what are called the Animal Functions, entirely cease,
or, as I would express it, are in a state of collapse; and
are very different from the state of waking, which in
healthy persons I would call a state of general and
entire excitement.
MDXLVI.
This difference in the states of the nervous power in
sleeping and waking being admitted, I must in the
next place observe, that when these states are changed
from the one into the other, as commonly happens
every day, the change is hardly ever made instantane-
ously, but almost always by degrees, and in some
length of time only: and this may be observed with
respect to both sense and motion. Thus when a per-
son is falling asleep, the sensibility is gradually dimi-
nished: so that, although some degree of sleep has
come on, slight impressions will excite sensation, and
bring back excitement; which the same, or even
stronger impressions, will be insufficient to produce
when the state of sleep has continued longer, and is,
as we may say, more complete. In like manner, the
power of voluntary motion is gradually diminished.
In some members it fails sooner than in others; and it is
some time before it becomes general and considerable
over the whole.
The same gradual progress may be remarked in a
person's coming out of sleep: The ears in this case are
often

264 PRACTICE
often awake before the eyes are opened or see clearly,
and the senses are often awake before the power of
voluntary motion is recovered; and it is curious to
observe, that, in some cases, sensations may be excited
without producing the ordinary association of ideas.
See Mem. de Berlin. 1752.
MDXLVII.
From all this, I think it will clearly appear, that not
only the different states of excitement and collapse can
take place in different degrees, but that they can
take place in different parts of the brain, or at least,
with respect to the different functions, in different de-
grees.
As I presume that almost every person has perceived
the gradual approach of sleeping and waking, I like-
wise suppose every person has observed, that, in such
intermediate state of unequal excitement, there almost
always occurs more or less of delirium, or dreaming,
if any body chooses to call it so. There are in this
state false perceptions, false associations, false judg-
ments, and disproportionate emotions; in short, all
the circumstances by which I have above defined deli-
rium.
This clearly shows that delirium may depend, and
I shall hereafter endeavour to prove that it commonly
does depend upon some inequality in the excitement
of the brain; and that both these assertions are found-
ed on this, that, in order to the proper exercise
of our intellectual functions, the excitement must be
complete, and equal in every part of the brain. For
though we cannot say that the vestiges of ideas are
laid up in different parts of the brain, or that they are
in some measure diffused ever the whole, it will follow
upon either supposition, that as our reasoning our in-
tellectual operations always require the orderly and ex-
act recollection or memory of associated ideas; so, if
any part of the brain is not excited, or not excitable,
that 

OF PHYSIC. 265
that recollection cannot properly take place, while at
the same time other parts of the brain, more excited
and excitable, may give false perceptions, associations,
and judgments.
MDXLVIII.
It will serve to illustrate this, that the collapse in
sleep is more or less complete; or that the sleep, as
we commonly speak, is more or less profound; and
therefore, that in many cases, though sleep takes place
to a considerable decree, yet certain impressions do
still take effect, and excite motions, or, if you will,
sensations in the brain; but which sensations, upon
account of the collapsed state of so great a part of the
brain, are generally of the delirious kind, or dreams,
consisting of false perceptions, associations, and judg-
ments, that would have been corrected if the brain had
been entirely excited.
Every one, I believe, has observed, that the most
imperfect sleeps, are those chiefly attended with dream-
ing; that dreams, therefore, most commonly occur
towards morning, when the complete state of sleep is
passing away; and further, that dreams are most com-
monly excited by strong and uneasy impressions made
upon the body.
I apprehend it may also be an illustration of the
same thing, that, even in waking hours, we have an
instance of an unequal state of excitement in the brain
producing delirium. Such, I think, occurs in the
case of fever. In this it is manifest, that the energy
of the brain, or its excitement, is considerably dimi-
nished with respect to the animal functions: and it is
accordingly upon this ground that I have explained
above, in XLV. the delirium which so commonly at-
tends fever. To what I have there said I shall here
only add, that it may serve to confirm my doctrine,
that the delirium in fever comes on at a certain period
of the disease only, and that we can commonly discern
its
VOL. II. 
L l 

266 PRACTICE
its approach by a more than usual degree of it appear-
ing in the time of the patient's falling into or coming
out of sleep. It appears, therefore, that delirium,
when it first comes on in fever, depends upon an ine-
quality of excitement; and it can hardly be doubted,
that the delirium which comes at length to prevail in
the entirely weakened state of fevers, depends upon
the same cause prevailing in a more considerable de-
gree.
MDXLIX.
From what has been now delivered, I hope it will
be sufficiently evident, that delirium may be, and fre-
quently is, occasioned by an inequality in the excite-
ment of the brain.
How the different portions of the brain may at the
same time be excited or callapsed in different degrees
or how the energy of the brain may be in different de-
grees of force, with respect to the several animal, vital,
and natural functions, I cannot pretend to explain;
but it is sufficiently evident in fact, that the brain
may be at one and the same time in different conditi-
ons with respect to these functions. Thus in inflam-
matory diseases, when by a stimulus applied to the
brain the force of the vital functions is preternaturally
increased, that of the animal is either little changed,
or considerable diminished. On the contrary, in ma-
ny cases of mania, the force of the animal functions
depending always on the brain, is prodigiously increas-
ed, while the state of the vital function in the heart is
very little or not at all changed. I must therefore say
again, that how difficult soever it may be to explain
the mechanical or physical condition of the brain
in such cases, the facts are sufficient to show that there
is such an inequality as may disturb our intellectual
operations.
MDL.
I have thus endeavoured to explain the general
cause

OF PHYSIC. 267
cause of Delirium; which is of two kinds: according
as it is with, or without, pyrexia. Of the first I take
no further notice here, having explained it as well as
I could above in XLV.
I proceed now to consider that delirium which pro-
perly belongs to the class of Vesaniæ, and which I
shall treat of under the general title of Insanity.
MDLI.
In entering upon this subject, it immediately occurs,
that in many instances of insanity, we find, upon dis-
section after death, that peculiar circumstances had
taken place in the general condition of the brain. In
many cases, it has been found of a drier, harder, and
firmer consistence, than what it is usually of in per-
sons who had not been affected with that disease. In
other cases, it has been found in a more humid, soft,
and flaccid state; and in the observations of the
late Mr. Meckel*, it has been found considerably
changed in its density or specific gravity. Whether
these different states have been observed to be uni-
formly the same over the whole of the brain, I cannot
certainly learn; and I suspect the dissectors have not
always accurately inquired into this circumstance:
but in several instances, it appears that these states had
been different in different parts of the brain; and in-
stances of this inequality will afford a confirmation of
our general doctrine.
The accurate Morgagni has observed, that in mani-
acal persons the medullary portion of the brain is un-
usually dry, hard, and firm: And this he had so fre-
quently observed, that he was disposed to consider it
as generally the case. But in most of the particular
instances which he has given, it appears, that, for the
most part, while the cerebrum was of an unusually
hard and firm consistence, the cerebellum was of its
usual
L l 2
* Memoir, de Berlin pour l'annee 1764. It appeared in many
instances of insane person, that the medullary substance of the cere-
brum was drier, and of a less specific gravity, than in persons uho
had been always of a sound judgment. 

268 PRACTICE
usual softness: and in many of the cases it was unsu-
ally soft and flaccid. In some other cases, Morgagni
observes, that while a part of the cerebrum was hard-
er and firmer than ordinary, other parts of it were
preternaturally soft.
MDLII.
These observations tend to confirm our general doc-
trine: and there are others which I think will apply
to the same purpose.
Upon the dissection of the bodies of persons who
had laboured under insanity, various organic affections
had been discovered in particular parts of the brain;
ad it is sufficiently probable, that such organic af-
fections might have produced a different degree of
excitement in the free and affected parts, and must
have interrupted in some measure the free communi-
cation between the several parts of the brain, and in
either way have occasioned insanity.
There have occurred so many instances of this kind,
that I believe physicians are generally disposed to sus-
spect organic lesions of the brain to exist in almost
every case of insanity.
MDLIII.
This, however, is probably a mistake: for we know
that there have been instances of insanity from which
the persons have entirely recovered; and it is difficult
to suppose that any organic lesions of the brain had in
such case taken place. Such transitory cases, indeed,
render it probable, that a state of excitement, change-
able by various causes, had been the cause of such in-
stances of insanity.
MDLIV.
It is indeed further asserted, that in many instances
of insane persons, their brain had been examined after
death, without showing that any organic lesions had
before subsisted in the brain, or finding that any mor-
bid state of the brain then appeared. This, no doubt,
may 

OF PHYSIC. 269
may serve to show, that organic lesions had not been
the cause of the disease; but it does not assure us that
no morbid change had taken place in the brain: for it
is probable, that the dissectors were not always aware
of its being the general condition of hardness and den-
sity, as different in different parts of the brain, that
was to be attended to, in order to discover the cause of
the preceding disease; and therefore many of them
had not with this view examined the state of the brain,
as Morgagni seems carefully to have done.
MDLV.
Having thus endeavoured to investigate the cause
of insanity in general, it were to be wished that I could
apply the doctrine to the distinguishing the several
species of it, according as they depend upon the differ-
ent state and circumstances of the brain, and thereby
to the establishing of a scientific and accurately adapted
method of cure. These purposes, however, appear to
me to be extremely difficult to be attained; and I can-
not hope to execute them here. All I can do is to
make some attempts, and offer some reflections which
further observation and greater sagacity, may hereaf-
ter render more useful.
MDLVI.
The ingenious Dr. Arnold has been commendably
employed in distinguishing the different species of in-
sanity as they appear with respect to the mind; and
his labours may hereafter prove useful, when we shall
come to know something more of the different states of
the brain corresponding to these different states of the
mind; but at present I can make little application of
his numerous distinctions. It appears to me that he
has chiefly pointed out and enumerated distinctions,
that are merely varieties, which can lead to little or
no variety of practice: and I am especially led to form
the latter conclusion, because these varieties appear to
me to be often combined together, and to be often
changed 

270 PRACTICE
changed into one another, in the same person; in
whom we must therefore suppose a general cause of
the disease, which, so far as it can be known, must
establish the pathology, and especially direct the prac-
tice.
MDLVII.
In my limited views of the different states of insani-
ty, I must go on to consider them under the two heads
of Mania and Melancholia: and though I am sensible
that these two genera do not comprehend the whole
of the species of insanity, I am not clear in assigning
the other species which may not be comprehended
under those titles. I shall, however, endeavour, on
proper occasions, as I go along, to point them out as
well as I can.
CHAP. II.
OF MANIA, OR MADNESS.
MDLVIII.
THE circumstances which I have mentioned above
in MDXXXV. as constituting delirium in general,
do more especially belong to that kind of it which I
shall treat of here under the title of MANIA.
There is sometimes a false perception or imagination
of things present that are not; but this is not a con-
stant, nor even a frequent, attendant of the disease.
The false judgment, is of relations long before laid up
in the memory. It very often turns upon one single
subject; but more commonly the mind rambles from
one subject to another with an equally false judgment
con- 

OF PHYSIC. 271
concerning the most part of them; and as at the same
time there is commonly a false association, this increas-
es the confusion of ideas, and therefore the false judg-
ments. What for the most part more especially dis-
tinguishes the disease is a hurry of mind, in pursuing
any thing like a train of thought, and in running from
one train of thought to another. Maniacal persons
are in general very irascible; but what more particu-
larly produces their angry emotions is, that their
false judgments lead to some action which is always
pushed with impetuosity and violence; when this is
interrupted or restrained, they break out into violent
anger and furious violence against every person near
them, and upon every thing that stands in the way of
their impetuous will. The false judgment often turns
upon a mistaken opinion of some injury supposed to
have been formerly received, or now supposed to be
intended: and it is remarkable, that such an opinion
is often with respect to their former dearest friends and
relations; and therefore their resentment and anger
are particularly directed towards these. And although
this should not be the case, they commonly soon lose
that respect and regard which they formerly had for
their friends and relations. With all these circum-
stances, if will be readily perceived, that the disease
must be attended very constantly with that incoherent
and absurd speech we call raving. Further, with the
circumstances mentioned, there is commonly joined an
unusual force in all the voluntary motions; and an
insensibility or resistance of the force of all impressi-
ons, and particularly a resistance of the powers of sleep,
of cold, and even of hunger; though indeed in ma-
ny instances a voracious appetite takes place.
MDLIX.
It appears to me that the whole of these circum-
stances and symptoms point out a considerable and un-
usual excess in the excitement of the brain, especially
with 

272 PRACTICE
with respect to the animal functions; and it appears
at the same time to be manifestly in some measure un-
equal, as it very often takes place with respect to these
functions alone, while at the same time the vital and
natural are commonly very little changed from their
ordinary healthy state.
MDLX.
How this excess of excitement is produced, it may
be difficult to explain. In the various instances of
what Sauvages has named the Mania Metastatica, and
in all the instances I have mentioned in my Nosology
under the title of the Mania Corporea, it may be suppos-
ed that a morbid organic affection is produced in some
part of the brain; and how that may produce an in-
creased or unequal excitement in certain parts of it, I
have endeavoured to explain above in MDLII. But I
must at the same time acknowledge, that such remote
causes of mania have very rarely occurred; and that
therefore some ether causes of the disease must be
sought for.
The effects of violent emotions or passions of the
mind have more frequently occured as the remote
causes of mania; and it is sufficiently probable, that
such violent emotions, as they do often immediately
produce a temporary increase of excitement, so they
may, upon same occasions of their permanent inhe-
rence or frequent repetition, produce a more consi-
derable and more permanent excitement, that is, a
mania.
With respect to those causes of mania which arise in
consequence of a melancholia which had previously
long subsisted; whether we consider that melancholia
as a partial insanity, or as a long persisting attachment to
one train of thinking, it will be readily perceived, that
in either case such an increase of excitement may take
place in so considerable a degree, and in so large a
portion

OF PHYSIC. 273
portion of the brain, as may give occasion to a complete
mania.
MDLXI.
These considerations with regard to the remote
causes appear to me to confirm sufficiently our general
doctrine of increased and unequal excitement in the
mania which I have described above; but I must own
that I have not exhausted the subject, and that there
are cases of mania of which I cannot assign the remote
causes: but although I cannot in all cases explain in
what manner the mania is produced, I presume, from
the explanation given, and especially from the symp-
toms enumerated above, to conclude, that the dis-
ease described above depends upon an increased ex-
citement of the brain; an opinion in which I am the
more confirmed, as I think it will point out the proper
method of cure. At least I think it will most clearly
explain the operation of those remedies, which, so far
as I can learn from my own experience and that of
others, have proved the most successful in this disease;
and, to illustrate this, I now enter upon the considera-
tion of these remedies, and to make some remarks upon
the proper manner of employing them.
MDLXII.
Restraining the anger and violence of madmen is
always necessary for preventing their hurting them-
selves or others: but this restraint is also to be consi-
dered as a remedy. Angry passions are always ren-
dered more violent by the indulgence of the impetu-
ous motions they produce; and even in madmen the
feeling of restraint will sometimes prevent the efforts
which their passion would otherwise occasion. Re-
straint, therefore, is useful, and ought to be complete;
but it should be executed in the easiest manner possi-
ble for the patient, and the strait waistcoat answers eve-
ry purpose better than any other that has yet been
thought of. The restraining madmen by the force of
other
VOL. II. 
M m 

274 PRACTICE
other men, as occasioning a constant struggle and vio-
lent agitation, is often hurtful. Although, on many
occasions, it may not be safe to allow maniacs to be
upon their legs or to walk about, it is never desirable
to confine them to a horizontal situation; and whene-
ver it can be admitted, they should be more or less in
an erect posture. Although there may be no symp-
toms of any preternatural fulness or increased impetus
of blood in the vessels of the brain, a horizontal pos-
ture always increases the fulness and tension of these
vessels, and may thereby increase the excitement of
the brain.
MDLXIII.
The restraint mentioned requires confinement with-
in doors, and it should be in a place which presents as
few objects of sight and hearing as possible; and par-
ticularly, it should be removed from the objects that
the patient was formerly acquainted with, as these
would more readily call up ideas and their various asso-
ciations. It is for this reason that the confinement of
madmen should hardly ever be in their usual habita-
tion; or if they are, that their apartment should be
stripped of all its former furniture. It is also for the
most part proper, that maniacs should be without the
company of any of their former acquaintance; the ap-
pearance of whom commonly excites emotions that
increase the disease. Strangers may at first be offen-
sive; but in a little time they come to be objects either
of indifference or of fear, and they should not be fre-
quently changed.
MDLXIV.
Fear being a passion that diminishes excitement,
may therefore be opposed to the excess of it; and
particularly to the angry and irascible excitement of
maniacs. These being more susceptible of fear than
might be expected, it appears to me to have been
commonly useful. In most cases it has appeared to
be

OF PHYSIC. 275
be necessary to employ a very constant impression of
fear; and therefore to inspire them with the awe and
dread of some particular persons, especially of those
who are to be constantly near them. This awe and
dread is therefore, by one means or other, to be ac-
quired; in the first place, by their being the authors
of all the restraints that may be occasionally proper;
but sometimes it may be necessary to acquire it even
by stripes and blows. The former, although having
the appearance of more severity, are much safer than
strokes or blows about the head. Neither of them,
however, should be employed further than seems ve-
ry necessary, and should be trusted only to those whose
discretion can be depended upon. There is one case
in which they are superfluous; that is, when the ma-
niacal rage is either not susceptible of fear, or incapa-
ble of remembering the objects of it; for in such in-
stances, stripes and blows would be wanton barbarity.
In many cases of a moderate disease, it is of advantage
that the persons who are the authors of restraint and
punishment should be upon other occasions the be-
stowers of indulgence and gratification that is admis-
sible; never, however, needing to employ their
awe when their indulgence shall have led to any
abuse.
MDLXV.
Although in mania, no particular irritation nor ful-
ness of the system seem to be present, it is plain, that
the avoiding all irritation and means of fulness is pro-
ner; and therefore, that a diet neither stimulating
nor nourishing is commonly to be employed. As it
may even be useful to diminish the fulness of the sys-
tem so both a low and a spare diet is likely in most ca-
ses to be of service.
MDLXVI.
Upon the same principle, although no unusual ful-
ness of the body be present, it may be of advantage
to
M m 2  

276 PRACTICE
to diminish even its ordinary fulness by different eva-
cuations.
Blood-letting, in particular, might be supposed use-
ful; and in all recent cases of mania it has been com-
monly practised, and I think with advantage; but
when the disease has subsisted for some time, I have
seldom found blood-letting of service. In those in-
stances in which there is any frequency or fulness of
pulse, or any marks of an increased impetus of the
blood in the vessels of the head, blood-letting is a pro-
per and even a necessary remedy. Some practitioners,
in such cases, have preferred to a particular manner of
blood-letting, recommending arteriotomy, scarifying
the hind-head, or opening the jugular vein; and
where any fulness or inflammatory disposition in the
vessels of the brain is to be suspected, the opening of
the veiled nearest to them is likely to be of the great-
est service. The opening, however, of either the
temporal artery or the jugular vein in maniacal per-
sons is very often inconvenient; and it may generally
be sufficient to open a vein in the arm, while the body
is kept in somewhat of an erect posture, and such a
quantity of blood drawn as nearly brings on a deliqui-
um ammi, which is always a pretty certain mark of
some diminution of the fulness and tension of the ves-
sels of the brain.
MDLXVII.
For the same purpose of taking off the fulness and
tension of these vessels of the brain, purging may be
employed; and I can in no other view understand
the celebrated use of hellebore among the ancients. I
cannot, however, suppose any specific power in helle-
bore; and can by no means find that, at least the
black hellebore, is so efficacious with us as it is said to
have been at Anticyra, As costiveness, however, is
commonly a very constant and hurtful attendant of
mania, purgatives come to be sometimes very neces-
sary; 

OF PHYSIC. 277
sary; and I have known some benefit obtained from
the frequent use of pretty drastic purgatives. In this,
however, I have been frequently disappointed; and I
have found more advantage from the frequent use of
cooling purgatives, particularly soluble tartar, than
from more drastic medicines.
MDLXVIII.
Vomiting has also been frequently employed in ma-
nia; and by determining powerfully to the surface of
the body, it may possibly diminish the fulness and
tension of the vessels, and thereby the excitement of
the brain; but I have never carried the use of this re-
medy so far as might enable me to judge properly of
its effects. Whether it may do harm by impelling
the blood too forcibly into the vessels of the brain,
or whether by its general agitation of the whole sys-
tem it may remove that inequality of excitement
which prevails in mania, I have not had experience
enough to determine.
MDLXIX.
Frequent shaving of the head has been found of ser-
vice in mania, and by promoting perspiration it pro-
bably takes off from the excitement of internal parts.
This, however, it is likely, may be more effectually
done by blistering, which more certainly takes off the
excitement of subjacent parts. In recent cases it I as
been found useful by inducing sleep; and when it has
that effect, the repetition of it may be proper: but in
maniacal cases that have lasted for some time, blister-
ing has not appeared to me to be of any service; and
in such cases also I have not found perpetual blisters,
or any other form of issue, prove useful.
MDLXX.
As heat is the principal means of first exciting the
nervous system, and establishing the nervous power
and vital principle in animals; so, in case of preterna-
tural excitement, the application of cold might be
supposed

278 PRACTICE
supposed a proper remedy: but there are many instan-
ces of maniacs who have been exposed for a great
length of time to a considerable degree of cold with-
out having their symptoms any wise relieved. This
may render in general the application of cold a doubt-
ful remedy; but it is at the same time certain, that
maniacs have often been relieved, and sometimes en-
tirely cured, by the use of cold bathing, especially
when administered in a certain manner. This seems
to consist, in throwing the madman in the cold wa-
ter by surprise; by detaining him in it for some length
of time; and pouring water frequently upon the head,
while the whole of the body except the head is im-
mersed in the water; and thus managing the whole
process, so as that, with the assistance of some fear, a
refrigerant effect may be produced. This, I can af-
firm, has been often useful; and that the external ap-
plication of cold may be of service, we know further
from the benefit which has been received in some ma-
niacal cases from the application of ice and snow to
the naked head, and from the application of the not-
ed Clay Clap.
Warm bathing also has been recommended by
some practical writers; and in some rigid melancholic
habits it may possibly be useful, or as employed in
the manner prescribed by some, of immersing the low-
er parts of the body in warm water, while cold water
is poured upon the head and upper part. Of this
practice, however, I have had no experience, and in
the common manner of employing warm bathing I
have found it rather hurtful to maniacs.
MDLXXI.
According to my supposition that the disease de-
pends upon an increased excitement of the brain, e-
specially with respect to the animal functions, opium,
so commonly possible in inducing sleep, or a consi-
derable collapse as to the functions, should be a
powerful

OF PHYSIC. 279
powerful remedy of mania. That it has truly proved
such, I believe from the testimony of Bernard Huet,
whose practice is narrated at the end of Wepferi His-
toria Apoplecticorum. I leave to my readers to study
this in the work I have referred to, where every part
of the practice is fully, and it appears to me, very ju-
diciously delivered. I have never indeed carried the
trial so far as seems to be requisite to an entire cure:
but I have frequently employed in some maniacal cas-
es large doses of opium; and when they had the effect
of inducing sleep, it was manifestly with advantage.
At the same time, in some cases, from doubts, whe-
ther the disease might not depend upon some organic
lesions of the brain, when the opium would be super-
fluous; and in other cases, from doubts, whether there
might not be some inflammatory affection joined with
the mania, when the opium would be hurtful, I have
never pushed this remedy to the extent that might be
necessary to make an entire cure.
MDLXXII.
Camphire has been recommended as a remedy of
mania, and there are instances alledged of its having
performed an entire cure. As it appears from the ex-
periments of Beccaria that this substance is possessed
of a sedative and narcotic virtue, these cures are not
altogether improbable: but in several trials, and even
in large doses, I have found no benefit from it; and
excepting those in the Philosophical Transactions, No.
400. I have hardly met with any other testimonies in
its favour.
MDLXXIII.
I have been informed that some maniacs have been
cured by being compelled to constant and even hard
labour; and as a forced attention to the conduct of
any bodily exercise is a very certain means of divert-
ing the mind from pursuing any train of thought, it is
highly 

280 PRACTICE
highly probable that such exercise may be useful in
many cases of mania.
I must conclude this subject with observing, that e-
ven in several cases of complete mania I have known
a cure take place in the course of a journey carried on
for some length of time.
MDLXXIV.
These are the remedies which have been chiefly
employed in the mania that has been above describ-
ed, and I believe they have been employed promiscu-
ously without supposing that the mania was to be dis-
tinguished into different species. Indeed I am not
ready to say how far it is to be so distinguished, but I
shall offer one observation which may possibly merit
attention.
It appears to me that there are two different cases of
mania that are especially different according to the ori-
ginal temperament of the persons whom the disease
affects. It perhaps occurs most frequently in persons
of a melancholic or atrabilarian temperament; but it
certainly does also often occur in persons of that very
opposite temperament which physicians have named
the Sanguine. According as the disease happens to
occur in persons of the one or other of these tempera-
ments I apprehend it may be considered as of a differ-
ent nature; and I believe, that accurate observation,
employed upon a sufficient number of cases, would dis-
cern some pretty constant difference, either of the
symptoms, or at least of the state of symptoms, in the
two cases. I imagine that false imaginations, particu-
lar aversions and resentments, are more fixed and stea-
dy in the melancholic than in the sanguine; and that
somewhat inflammatory is more commonly joined
with mania in the sanguine than in the melancholic.
If such difference, however, does truly take place, it
will be obvious, that it may be proper to make some
difference also in the practice. I am opinion, that in
the 

OF PHYSIC. 281
the mania of sanguine persons, blood-letting and other
antiphlogistic measures are more proper, and have been
more useful, than in the melancholic. I likewise ap-
prehend that cold bathing is more useful in the san-
guine than in the melancholic: but I have not had ex-
perience enough to ascertain these points with suffici-
ent confidence.
I have only to add this other observation, that ma-
niacs of the sanguine temperament recover more fre-
quently and more entirely than those of the melancho-
lic.
CHAP. III.
OF MELANCHOLY AND OTHER FORMS
OF INSANITY.
MDLXXV.
MELANCHOLY has been commonly considered
as a partial insanity; and as such it is defined
in my Nosology: but I now entertain doubts if this be
altogether proper. By a partial insanity, I understand
a false and mistaken judgment upon one particular sub-
jed, and what relates to it; whilst, on every other
subject, the person affected judges as the generality of
other men do. Such cases have certainly occurred;
but, I believe, few in which the partial insanity is strict-
ly limited. In many cases of general insanity, there
is one subject of anger or fear, upon which the false
judgment more particularly turns, or which is at least
more frequently than any other the prevailing object
of delirium: and though, from the inconsistency which
this principal object of delirium must produce, there
is
VOL. II. 
N n   

282
PRACTICE
is therefore also a great deal of insanity with regard
to most other objects; yet this last is in very different
degrees, both in different persons, and in the same per-
son at different times. Thus persons considered as ge-
nerally insane, will, however, at times, and in some
cases, pretty constantly judge properly enough of pre-
sent circumstances and incidental occurrences; though,
when these objects engaging attention are not pre-
sented, the operations of imagination may readily
bring back a general confusion, or recal the particular
object of the delirium. From these considerations, I
am inclined to conclude, that the limits between ge-
neral and partial insanity cannot always be so exactly
assigned, as to determine when the partial affection is
to be considered as giving a peculiar species of disease,
different from a more general insanity.
MDLXXVI.
When insanity, neither strictly partial, nor entirely
nor constantly general, occurs in persons of a sanguine
temperament, and is attended with agreeable, rather
than with angry or gloomy emotions, I think such a
disease must be considered as different from the Ma-
nia described above: and also, though partial, must
be held as different from the proper Melancholia to
be mentioned hereafter.
MDLXXVII.
Such a disease, as different from those described M-
DLIV. requires, in my opinion, a different administra-
tion of remedies; and it will be proper for me to take
particular notice of this here.
Although it may be necessary to restrain such insane
persons as we have mentioned MDLXXVI. from pursu-
ing the objects of their false imagination or judgment,
it will hardly be requisite to employ the same force
of restraint that is necessary in the impetuous and an-
gry mania. It will be generally sufficient to acquire
some awe over them, that may be employed, and
sometimes

OF PHYSIC. 283
sometimes even be necessary, to check the rambling
of their imagination, and incoherency of judgment.
MDLXXV1II.
The restraint just now mentioned as necessary will
generally require the patient's being confined to one
place, for the sake of excluding the objects, and more
particularly the persons, that might excite ideas con-
neded with the chief objects of their delirium. At
the same time, however, if it can be perceived there
are objects or persons that can call off their attention
from the pursuit of their own disordered imagination,
and fix it a little upon some others, these last may be
frequently presented to them: and for this reason, a
journey, both by its having the effect of interrupting
all train of thought, and by presenting objects engag-
ing attention, may often be useful. In such cases al-
so, when the insanity, though more especially fixed
upon one mistaken subject, is not confined to this
alone, but is further apt to ramble over other subjects,
with incoherent ideas, I apprehend the confining or
forcing such persons to some constant uniform labour,
may prove an useful remedy.
MDLXXIX.
When such cases as in MDLVI. occur in sanguine
temperaments, and may therefore approach more
nearly to Phrenitic Delirium; so, in proportion as the
symptoms of this tendency are more evident and con-
siderable, blood-letting and purging will be the more
proper and necessary.
MDLXXX.
To this species of insanity, when occurring in san-
guine temperaments, whether it be more or less parti-
al, I apprehend that cold bathing is particularly a-
dapted; while, in the partial insanity of melancholic
persons, as I shall show hereafter, it is hardly admissi-
ble.
MDLXXXI.  
N n 2 

284 PRACTICE
MDLXXXI.
Having thus treated of a species of insanity, differ-
ent, in my apprehension, from both the Mania and
Melancholia, I proceed to consider what seems more
properly to belong to this last.
MDLXXXII.
The disease which I name Melancholia is very oft-
en a partial insanity only. But as in many instances,
though the false imagination of judgment seems to be
with respect to one subject only; yet it seldom happens
that this does not produce much inconsistency in the
other intellectual operations: And as, between a ve-
ry general and a very partial insanity, there are all the
possible intermediate degrees; so it will be often diffi-
cult, or perhaps improper, to distinguish melancholia
by the character of Partial Insanity alone. If I mis-
take not, it must be chiefly distinguished by its occur-
ring in persons of a melancholic temperament, and by
its being always attended with some seemingly ground-
less, but very anxious, fear.
MDLXXXIII.
To explain the cause of this, I must observe, that
persons of a melancholic temperament are for the most
part of a serious thoughtful disposition, and disposed
to fear and caution, rather than to hope and temerity.
Persons of this cast are less moveable than others by
any impressions; and are therefore capable of a closer
or more continued attention to one particular object,
or train of thinking. They are even ready to be en-
gaged in a constant application to one subject; and
are remarkably tenacious of whatever emotions they
happen to be affected with.
MDLXXXIV.
These circumstances of the melancholic character,
seem clearly to shew, that persons strongly affected
with it may be readily seized with an anxious fear;
and that this, when much indulged, as is natural to
such

OF PHYSIC. 285
such persons, may easily grow into a partial infinity.
MDLXXXV.
Fear and dejection of mind, or a timid and despond-
ing disposition, may arise in certain states, or upon cer-
tain occasions of mere debility: and it is upon this
footing, that I suppose it sometimes to attend dyspep-
sia. But in these cases, I believe the despondent dis-
position hardly ever arises to a considerable degree, or
proves so obstinately fixed as when it occurs in per-
sons of a melancholic temperament. In these last, al-
though the fear proceeds from the same dyspeptic
feelings as in the other case, yet it will be obvious,
that the emotion may arise to a more considerable de-
gree; that it may be more anxious, more fixed, and
more attentive; and therefore may exhibit all the va-
rious circumstances which I have mentioned in MCC-
XXII. to take place in the disease named HYPOCHON-
DRIASIS.
MDLXXXVI.
In considering this subject formerly in distinguishing
Dyspepsia from Hypochondriasis, although the symp-
toms affecting the body be very much the same in
both, and even those affecting the mind be somewhat
similar, I found no difficulty in distinguishing the lat-
ter disease, merely from its occurring in persons of a
melancholic temperament, But I must now acknow-
ledge, that I am at a loss how to determine in all cas-
es hypochondriasis and melancholia may be distin-
guished from one another, whilst the same tempera-
ment is common to both.
MDLXXXVII.
I apprehend, however, that the distinction may be
generally ascertained in the following manner.
The hypochondriasis I would consider being al-
ways attended with dyspeptic symptoms: and though
there may be, at the same time, an anxious melancho-
lic fear arising from the feeling of these symptoms; 
yet

286 PRACTICE
yet while this fear is only a mistaken judgment with
respect to the state of the person's own health, and to
the danger to be from thence apprehended, I would
still consider the disease as hypochondriasis, and as dis-
tinct from the proper melancholia. But when an anx-
ious fear and despondency arises from mistaken judg-
ment with respect to other circumstances than those of
health, and more especially when the person is at the
same time without any dyspeptic symptoms, every
one will readily allow this to be a disease widely dif-
ferent from both dyspepsia and hypochondriasis; and
it is, what I would strictly name Melancholia.
MDLXXXVIII.
In this there seems little difficulty; but as an exqui-
sitely melancholic temperament may induce a torpor
and slowness in the action of the stomach, so it gene-
rally produces some dyspeptic symptoms; and from
thence there may be some difficulty in distinguishing
such a case from hypochondriasis. But I would main-
tain, however, that when the characters of the tem-
perament are strongly marked; and more particularly
when the false imagination turns upon other subjects
than that of health, or when, though relative to the
person's own body, it is of a groundless and absurd
kind; then, notwithstanding the appearance of some
dyspeptic symptoms, the case is still to be considered
as that of a melancholia, rather than a hypochondri-
asis.
MDLXXXIX.
The disease of melancholia, therefore manifestly
depends upon the general temperament of the body:
and although, in many persons, this temperament is
not attended with any morbid affection either of mind
or body; yet when it becomes exquisitely formed,
and is in a high degree, it may become a disease affect-
ing both, and particularly the mind. It will therefore
be proper to consider in what this melancholic tempe-
rament 

OF PHYSIC. 287
rament especially consists; and to this purpose, it may
be observed, that in it there is a degree of torpor in
the motion of the nervous power, both with respect to
sensation and volition; that there is a general rigidity
of the simple solids; and that the balance of the san-
guiferous system, is upon the side of the veins. But
all these circumstances are the directly opposite of those
of the sanguine temperament; and must therefore also
produce an opposite state of mind.
MDXC.
It is this state of the mind, and the state of the brain
corresponding to it, that is the chief object of our pre-
sent consideration. But what that state of the brain
is, will be supposed to be difficult to explain; and it
may perhaps seem rash in me to attempt it.
I will, however, venture to say, that it is probable
the melancholic temperament of mind depends upon
a drier and firmer texture in the medullary substance
of the brain; and that this perhaps proceeds from a
certain want of fluid in that substance, which appears
from its being of a lesser specific gravity than usual.
That this state of the brain in melancholia does actu-
ally exist, I conclude, first, from the general rigidity
of the whole habit; and, secondly, from dissections,
showing such a state 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 anywise
difficult to suppose, that the same state of the brain
may in a moderate degree give melancholia; and in
a higher, that mania which melancholia so often passes
into; especially if I shall be allowed further to suppose,
that either a greater degree of firmness in the substance
of the brain may render it susceptible of a higher de-
gree of excitement, or that one portion of the brain
may be liable to acquire a greater firmness than others,
and consequently give occasion to that inequality if
excitement upon which mania so much depends. 
MDXCI.

288 PRACTICE
MDXCI.
I have thus endeavoured to deliver what appears to
me most probable with respect to the proximate cause
of melancholia; and although the matter should in
some respects remain doubtful, I am well persuaded
that these observations may often be employed to di-
rect our practice in this disease, as I shall now endea-
vour to show.
MDXCII.
In most of the instances of melancholia, the mind
is to be managed very much in the same manner as I
have advised above with regard to hypochondriasis;
but as in the case of proper melancholia, there is com-
monly a false imagination or judgment appearing as a
partial insanity, it may be further necessary in such
cases to employ some artifices for correcting such ima-
gination or judgment.
MDXCIII.
The various remedies for relieving the dyspeptic
symptoms which always attend hypochondriasis, will
seldom be either requisite or proper in melancholia.
There is only one of the dyspeptic symptoms, which,
though there should be no other, is very constantly
present in melancholia, and that is costiveness. This
it is always proper and even necessary to remove; and
I believe it is upon this account that the use of purga-
tives has been found so often useful in melancholia.
Whether there be any purgatives peculiarly proper in
this case, I dare not positively determine; but with
respect to the choice of purgatives in melancholia, I
am of the same opinion that I delivered above on this
same subject with respect to mania.
MDXCIV.
With respect to other remedies, I judge that blood-
letting will more seldom be proper in melancholia than
in mania; but how far it may be any in case proper,
must 

OF PHYSIC. 289
must be determined by the same consideration as in
the case of mania.
MDXCV.
The cold bathing that I judged to be so very use-
ful in several cases of insanity, is, I believe, in melan-
cholia, hardly ever fit to be admitted; at least 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 melan-
cholia, it is probable that warm bathing may be often
useful.
MDXCVI.
With respect to opiates which I have supposed
might often be useful in cases of mania, I believe
they can seldom be properly employed in the partial
insanities of the melancholic, except in certain instanc-
es of violent excitement, when the melancholia ap-
proaches nearly to the state of mania.
MDXCVII.
In such cases of melancholia approaching to a state
of mania, a low diet may sometimes be necessary; but
as the employing a low diet almost unavoidably leads
to the use of vegetable food, and as this in every tor-
pid state of the stomach is ready to produce some dys-
peptic symptoms, such vegetable food ought, in mo-
derate cases of melancholia, to be used with some
caution.
Though exercise, as a tonic power, is not proper
either in hypochondriasis or melancholia; yet, with
respect to its effects upon the mind, it may be extreme-
ly useful in both, and in melancholia is to be employ-
ed in the same manner that I have advised above in the
case of hypochondriasis.
MDXCVIII.
Having now delivered my doctrine with respect to
the forms of insanity, I should in the next place pro-
ceed to consider the other genera of Amentia and
Oneir
VOL. II. 
O o  

290 PRACTICE
Oneirodynia, which in the Nosology I have arranged
under the order of Vesaniæ: but as I cannot pretend
to throw much light upon these subjects, and as they
are seldom the objects of practice, I think it allowable
for me to pass them over at present; and the particu-
lar circumstances of this work in some measure require
that I should do so.
PART III.
OF CACHEXIES.
MDXCIX.
UNDER this title I propose to establish a class of
diseases, which consist in a depraved state of the
whole, or of a considerable part, of the habit of the
body, without any primary pyrexia or neurosis com-
bined with that state.
MDC.
The term Cachexy has been employed by Linnæus
and Vogel, as it had been formerly by other authors,
for the name of a particular disease; but the disease
to which these authors have affixed it, comes more
properly under another appellation and the term of
Cachexy is more properly employed by Sauvages and
Sagar for the name of a class. In this I have follow-
ed the last-mentioned nosologists, though I find it dif-
ficult to give such a character of the class as will clear-
ly apply to all the species I have comprehended under
it. This difficulty would be still greater, if, in the
class I have established under the title of Cachexies, I
were to comprehend all the diseases that those other
nosologists have done; but I am willing to be thought
deficient

OF PHYSIC. 291
deficient rather than very incorrect. Those difficul-
ties, however, which still remain in methodical noso-
logy, must not affect us much in a treatise of practice.
If can here properly distinguish and describe the se-
veral species that truly and most commonly exist, I
shall be the less concerned about the accuracy of my
general classification; though at the same time this,
I think, is always to be attempted; and I shall pursue
it as well as I can.
BOOK I.
OF EMACIATIONS.
MDCI.
EMACIATION, or a considerable diminution of
the bulk or plumpness of the whole body, is for
the most part only a symptom of disease, and very sel-
dom to be considered as a primary and idiopathic af-
fection. Upon this account, according to my gene-
ral plan, such a symptom might perhaps have been
omitted in the Methodical Nosology: but both the
uncertainty of concluding it to be always symptoma-
tic, and the consistency of system, made me introduce
into the Nosology, as others had done, an order under
the title of Marcores; and this renders it requisite
now to take some notice of such diseases.
MDCII.
Upon this occasion, therefore, I hope it may be
useful to investigate the several causes of emaciation
in all the different cases of disease in which it appears.
And this I attempt, as the surest means of determining
how for it is primary, or a symptomatic affection on-
ly;
O o 2 

292 PRACTICE
ly; and even the latter view, the investigation may
be attended with some advantage.
MDCIII.
The causes of emaciation may, I apprehend, be refer-
red to two general heads; that is, either to a general
deficiency of fluid in the vessels of the body, or to the
particular deficiency of the oil in the cellular tex-
ture of it*. These causes are frequently combined
together; but it will be proper, in the first place, to
consider them separately.
MDCIV.
As a great part of the body of animals is made up
of vessels filled with fluids, the bulk of the whole must
depend very much on the size of these vessels, and
the quantity of fluids present in them: and it will
therefore be sufficiently obvious, that a deficiency of
the fluids in these vessels must, according to its degree,
occasion a proportionate diminution of the bulk of
the whole body. This, however, will appear still
more clearly, from considering that in the living and
sound body the vessels every where seem to be preter-
naturally distended by the quantity of fluids present in
them; but being at the same time elastic, and con-
stantly endeavouring to contract themselves, they must
on the withdrawing of the distending force, or, in
other words, upon a diminution of the quantity of
fluids, be in proportion contracted and diminished in
their size: And it may be further observed, that as
each part of the vascular system communicates with
every other part of it; so every degree of diminution
of the quantity of fluid, in any one part, must in pro-
portion diminish the bulk of the vascular system, and
consequently of the whole body§.
MDCV.
* Might not a third cause be added, viz. a deficiency of the so-
lid parts*
§ There may, however, be a partial without general emaciation, 

OF PHYSIC 293 
The diminution and deficiency of the fluids may be
occasioned by different causes; such as, first, by a due
quantity of ailments not being taken in; or by the ali-
ment taken in not being of a sufficiently nutritious
quality. Of the want of due quantity of aliment not
being taken into the body, there is an instance in the
atrophia lactantium Sauvagesii, species 3. and many
other examples have occurred of the emaciation from
want of food, occasioned by poverty, and other acci-
dental causes.
With respect to the quality of food, I apprehend
it arises from the want of nutritious matter in the food
employed, that persons living entirely on vegeta-
bles are seldom of a plump and succulent habit*.
MDCVI.
A second cause of the deficiency of fluids may be,
the aliments taken in not being conveyed to the 
blood-vessels. This may occur from a person's being
affected with a frequent vomiting; which, rejecting
the food soon after it had been taken in, must prevent
the necessary supply of fluids to the blood-vessels§.
Another
as is the case in a palsied limb; but the partial diminution of bulk
in the diseased limb, is not owing to a lessened quantity of the ge-
neral mass of the circulating fluids, but to the languid circulation
in that part, the arteries not propelling the blood through it with
sufficient vigour.
* As the author says at the conclusion of his chapter "After
"having considered the various causes of emaciations, I should per-
"haps treat of their cure: but it will readily appear, that the
"greater part of the cases above mentioned are purely symptomatic,
"and consequently that the cure of them must be that of the pri-
"mary disease upon which they depend. Of those cases that can
"any wise be considered as idiopathic, it will appear that they
"are to be cured, entirely by removing the remote causes;" It
may not be improper to treat of the cure as we proceed.
The species of emaciation may be obviously cured by a rich and
nutritious diet.
§ This species may be cured by preventing the vomiting by an-

294 PRACTICE
Another cause, frequently interrupting the conveyance
of the alimentary matter into the blood-vessels, is an
obstruction of the conglobate lymphatic glands of the
mesentery, through which the chyle must necessarily
pass to the thoracic duct. Many instances of emacia-
tion, seemingly depending upon this cause, have been
observed by physicians, in persons of all ages, but espe-
cially in the young. It has been remarked, that such
cases have most frequently occurred in scrophulous
persons, in whom the mesenteric glands are commonly
affected with tumour or obstruction, and in whom,
generally at the same time, scrophula appears exter-
nally. Hence the Tabes scrophulosa Synop, Nosolog. vol.
ii. p. 266.: And under these I have put as synonimes
Tabes glandularis, sp. 10.; Tabes mesenterica. sp. 9.;
Scrophuta mesenterica, sp. 4.; Atrophia infantilis, sp.
13.; Atrophia rachitica, sp. 8; Tabes rachialgica, sp.
16. At the same time, I have frequently found the
case occurring in persons who did not show any exter-
nal appearance of scrophula, but in whom the mesen-
teric obstruction was afterwards discovered by dissec-
tion. Such also I suppose to have been the case in
the disease frequently mentioned by authors under the
title of the Atrophia infantum. This has received its
name from the time of life at which it generally ap-
pears; but I have met with instances of it at fourteen
years of age ascertained by dissection. In several such
cases which I have seen, the patients were without
scrophulous appearances at the time, or at any period
of their lives before*.
In
tispasmodics, especially opium, and by the use of gentle laxatives
occasionally. A nutritious diet will also be necessary in these ca-
ses.
*These cases are generally incurable; if, however, there be no
suspicion of scrophula we may attemt a cure, by endeavouring to
remove the obstruction, either by invigorating the habit, or by act-
ive experients. Open and pure air, with exercise suited to the

OF PHYSIC. 295
In the case of phthisical persons, I shall hereafter
mention another cause of their emaciation; but it is
probable that an obstruction of the mesenteric glands,
which so frequently happens in such persons, concurs
very powerfully in producing the emaciation that
takes place.
Although a scrophulous taint may be the most fre-
quent cause of mesenteric obstructions, it is sufficiently
probable that other kinds of acrimony may produce
the same, and the emaciation that follows.
It may perhaps be supposed, that the interruption of
the chyle's passing into the blood-vessels may be some-
times owing to a fault of the absorbents on the inter-
nal surface of the intestines. This, however, cannot
be readily ascertained : but the interruption of the
chyle's passing into the blood-vessels may certainly be
owing to a rupture of the thoracic duct; which, when
it does not prove soon fatal, by occasioning a hydro-
thorax, must in a short time produce a general ema-
ciation*.
MDCVII.
A third cause of the deficiency of the fluids may be
a fault in the organs of digestion, as not duly convert-
ing the aliment into a chyle fit to form in the blood-
vessels a proper nutritious matter. It is not, however,
easy to ascertain the cases of emaciation which are to
be attributed to this cause; but I apprehend that the
emaciation which attends long subsisting cases of dys-
pepsia, or of hypochondriasis, is to be explained chief-
ly in this way. It is this which I have placed in the
Nosology under the title of the Atrophia debilium;
and of which the Atrophia Nervosa, Sauv. sp. I. is a
proper
strength of the patient, the use of chalybeate waters, have admirable
effects in these cases.
Peruvian bark so often used as a tonic, is improper in all cases
of obstructed glands, as are also astringent
* This is an absolutely incurable case.

296 PRACTICE
proper instance, and therefore put there as a synonime.
But the other titles of Atrophia Lateralis, Sauv. sp.
15. and Atrophia senilis, Sauv. sp II. are not so pro-
perly put there, as they must be explained in a differ-
ent manner*.
MDCVIII.
A fourth cause of a deficiency of the fluids in the
body, may be excessive evacuations made from it by
different outlets; and Sauvages has properly enume-
rated the following species, which we have put as sy-
nonimes under the title of Atrophia inanitorum; as,
Tables Nutricum, sp. 4. Atrophia nutricum, sp. 5. Atro-
phia à leucorrhœa, sp. 4. Atrophia ab alvi fluxu, sp.
6. Atrophia a ptyalismo, sp. 7. and lastly, the Tabes à
sanguifluxu; which, it is to be observed, may arise not
only from spontaneous hemorrhagies or accidental
wounds, but also from blood-letting in too large a
quantity, and too frequently repeated.
Upon this subject it seems proper to observe, that
a meagre habit of body frequently depends upon a
full perspiration being constantly kept up, though at
the same time a large quantity of nutritious aliment
is regularly taken in§.
MDCIX.
Besides 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 con-
siderable part of the body, by the fluids being drawn
into one part, or collected into one cavity; and of
this
* This species of emaciation may be successfully cured by the
means of those remedies mentioned in the notes on the articles 1204,
1206, 1210, 1212, 1213, 1215, 1216, 1221.
§ In these cases astringents are the principal remedies on which
we must depend; and those astringents must be chosen which are a-
dapted to suppress the peculiar evacuation that occasions the disease.

OF PHYSIC. 297
this we have an instance in the Tabes à hydrope*,
Sauv. sp. 5.
MDCX.
In the Methodical Nosology, among the other sy-
nonimes of the Atrophia inamtorum, I have set down
the Tabes dorsalis; but whether properly or not, I at
present very much doubt. In the evacuation consi-
dered as the cause of this tabes, as the quantity eva-
cuated is never so great as to account for a general de-
ficiency of fluids in the body, we must seek for ano-
ther explanation of it. And whether the effects of
the evacuation may be accounted for, either from the 
quality of the fluid evacuated, or from the singularly
enervating pleasure attending the evacuation, or from
the evacuation's taking off the tension of parts, the ten-
sion of which has a singular power in supporting the
tension and vigour of the whole body, I cannot posi-
tively determine; but I apprehend that upon one or
other of these suppositions the emaciation attending
the tabes dorsalis must be accounted for; and there-
fore, that it is to be considered as an instance of the
Atrophia debilium, rather than of the Atrophia inani-
torum§.
MDCXI.
A fifth cause of a deficiency of fluids and of emaci-
ations in the whole or in a particular part of the body,
may be the concretion of the small vessels, either not
admitting of fluids, or of the same proportion as be-
fore; and this seems to me to be the case in the Atro-
phia senilis, Sauv. sp. 2. Or it may be a palsy of the
larger trunks of the arteries rendering them unfit to
propel blood into the smaller vessels; as is frequently
the
VOL. II. 
P p
* The emaciation from this cause is merely symptomatic, and
can only be cured by curing the primary disease.
§ If a particular abominable practice be the cause, it must be a-
bandoned before the cure can be attempted. 

298 PRACTICE
the case of paralytic limbs, in which the arteries are
affected as well as the muscles. The Atrophia latera-
lis, Sauv. sp. 15. seems to be of this nature*.
MDCXII.
A second general head of the causes of emaciation I
have mentioned in MDCXII. to be a deficiency of oil.
The extent and quantity of the cellular texture in
every part of the body, and therefore how considera-
ble part it makes in the bulk of the whole, is now well
known. But this substance, in different circumstan-
ces, is more or less filled with an oily matter; and
therefore the bulk of it, and in a great measure that of
the whole body, must be greater or less according as
this substance is more or less filled in that manner.
The deficiency of the fluids, for a reason to be imme-
diately explained, is generally accompanied with a
deficiency of oil: but physicians have commonly at-
tended more to the latter cause of emaciation than to
the other, that being usually the most evident; and I
shall now endeavour to assign the several causes of
the deficiency of oil as it occurs upon different occa-
sions.
MDCXIII.
The business of secretion in the human body is in
general little understood, and in no instance less so
than that of the secretion of oil from blood which
does not appear previously to have contained it. It
is possible, therefore, that cur theory of the deficiency
of oil may be in several respects imperfect; but there
are certain facts that may in the mean time apply to
the present purpose.
MDCXIV.
First, it is probable, that a deficiency of oil may be
owing to a state of the blood in animal bodies less fit-
ted
* This is one of the incurable species of emaciation, and it can
only be relieved by a very nutritious and invigorating diet.

OF PHYSIC. 299
ted to afford a secretion of oil, and consequently to
supply the waste of it that is constantly made. This
state of the blood must especially depend upon the
state of the aliments taken in, as containing less of oil
or oily matter. From many observations made, both
with respect to the human body and to that of other
animals, it appears pretty clearly, that the aliments
taken in by men and domestic animals, according as
they contain more of oil, are in general more nutriti-
ous, and in particular are better fitted to fill the cellu-
lar texture of their bodies with oil. I might illustrate
this, by a minute and particular consideration of the
difference of alimentary matters employed; but it will
be enough to give two instances. The one is, that
the herbaceous part of vegetables, does not fatten a-
nimals, so much as the feeds of vegetables, which ma-
nifestly contain in any given weight a greater propor-
tion of oil; and a second instance is, that in general
vegetable aliments do not fatten men so much as ani-
mal food, which generally contains a larger propor-
tion of oil.
It will be obvious, that upon the same principles a
want of food, or a less nutritious food, may not
only occasion a general deficiency of fluids (MDCIV.)
but must also afford less oil, to be poured into the cel-
lular texture. In such cases, therefore, the emacia-
tion produced, is to be attributed to both these general
causes*.
MDCXV.
A second case of the deficiency of oil may be ex-
plained in this manner. It is pretty manifest, that
the oil of the blood is secreted and deposited in the
cellular texture in greater or lesser quantity, according
as the circulation of the blood is faster or slower; and
therefore
P p 2
* The cure of this species of emaciation will be best effected by
a rich diet of animal food.

300 PRACTICE
therefore that exercise, which hastens the circula-
tion of the blood, is a frequent cause of emaciation.
Exercise produces this effect in two ways. 1st, By in-
creasing the perspiration, and thereby carrying off a
greater quantity of the nutritious matter, it leaves less
of it to be deposited in the cellular texture; thereby
not only preventing an accumulation of fluids, but, as
I have said above, causing a general deficiency of these,
which must also cause a deficiency of oil in the cellu-
lar texture. 2dly, It is well known, that the oil de-
posited in the cellular texture is upon many occasions,
and for various purposes of the œconomy, again ab-
sorbed, and mixed or diffused in the mass of blood, to
be from thence perhaps carried entirely out of the bo-
dy by the several excretions. Now, among other pur-
poses of the accumulation and re-absorption of oil,
this seems to be one, that the oil is requisite to the pro-
per action of the moving fibres in every part of the
body; and therefore that nature has provided for an
absorption of oil to be made according as the action
of the moving fibres may demand it. It will thus be
obvious, that the exercise of the muscular and moving
fibres every where, must occasion an absorption of
oil; and consequently that such exercise not only pre-
vents the secretion of oil, as has been already said,
but may also cause a deficiency of it by occasioning
an absorption of what had been deposited; and in
this way, perhaps especially, does it produce emacia-
tion*.
MDCXVI.
A third case of the deficiency of oil may occur
from the following cause. It is probable, that one
purpose of the accumulation of oil in the cellular tex-
ture of animals is, that it may, upon occasion, be again
absorbed
* Abstinence from too severe exercise is the only cure for this
species of the disease. 

OF PHYSIC. 301
absorbed from thence, and carried into the mass of
blood, for the purpose of enveloping and correcting
any unusual acrimony arising and existing in the state
of the fluids. Thus, in most instances in which we
can discern an acrid state of the fluids, as in scurvy,
cancer, syphilis, poisons, and several other diseases,
we find at the same time a deficiency of oil and an
emaciation take place; which, in my apprehension,
must be attributed to the absorption of oil, which the
presence of acrimony in the body excites.
It is not unlikely that certain poisons introduced in-
to the body, may subsist there; and, giving occasion
to an absorption of oil, may lay a foundation for the
Tabes à veneno*, Sauv. sp. 17.
MDCXVII.
A fourth cause of emaciation, and which I would
attribute to sudden and considerable absorption of oil
from the cellular texture, is that of fever, which so
generally produces emaciation. This may perhaps
be in part attributed to the increased perspiration,
and therefore to the general deficiency of fluids that
may be supposed to take place: but whatever share
that may have in producing the effect, we can, from
the evident shrinking and diminution of the cellular
substance, wherever it falls under our observation,
certainly conclude, that there has been a very consi-
derable absorption of the oil which had been before
deposited in that substance. This explanation is ren-
dered the more probable from this, that I suppose the
absorption
* As this kind of emaciation proceeds from various causes, the
practitioner, must, (after having ascertained the true cause) endea-
vour to remove it: and this must be left entirely to his own sagacity.
It may however be proper to observe, that several of these emacia-
tions proceed from incurable diseases; as from Cancer, Scrophula,
&c. and consequently admit of no cure: And those emaciations
which proceed from scurvy, syphilis, or those diseases which we can
cure, are only to be cured by curing the primary disease. 

302 PRACTICE
absorption mentioned is necessarily made for the pur-
pose of enveloping or correcting an acrimony, which
manifestly does in many, and may be suspected to
arise in all cases of fever. The most remarkable in-
stance of emaciation occurring in fevers, is that which
appears in the case of hectic fevers. Here the emaci-
ation may be attributed to profuse sweatings that com-
monly attend the disease: but there is much reason
to believe, that an acrimony is present in the blood;
which, even in the beginning of the disease, prevents
the secretion and accumulation of oil; and in the
more advanced states of it, must occasion a more con-
siderable absorption of it; which, from the shrinking
of the cellular substance, seems to go farther than in
almost any other instance*.
Upon the subject of emaciations from a deficiency
of fluids, it may be observed, that every increased
evacuation excites an absorption from other parts,
and particularly from the cellular texture; and it is
therefore probable, that a deficiency of fluids, from
increased evacuations, produces an emaciation, not
only by the waste of the fluids in the vascular system,
but also by occasioning a considerable absorption from
the cellular texture.
MDCXVIII.
I have thus endeavoured to explain the several cases
and causes of emaciation; but I could not prosecute
the consideration of these here in the order they are
set down in the Methodical Nosology. In that work
I was engaged chiefly in arranging the species of Sau-
vages; but it is my opinion now, that the arrange-
ment there given is erroneous, in both combining and
separating species improperly: and it seems to me
more
* This emaciation is purely symptomatic, and consequently can-
not be cured but by removing the primary disease, and a subsequent
very nutritious diet, consisting chiefly of animal food.

OF PHYSIC. 303
more proper here to take notice of diseases, and put
them together, according to the affinity of their na-
ture, rather than by that of their external appearances.
I doubt, if even the distinction of the Tabes and Atro-
phia, attempted in the Nosology, will properly apply;
as I think there are certain diseases of the same nature,
which sometimes appear with, and sometimes with-
out, fever.
MDCXIX.
After having considered the various cases of ema-
ciations, I should perhaps treat of their cure: but it
will readily appear, that the greater part of the cases
above-mentioned are purely symptomatic, and conse-
quently that the cure of them must be that of the pri-
mary diseases upon which they depend. Of those ca-
ses that can anywise be considered as idiopathic, it
will appear that they are to be cured, entirely by re-
moving the remote causes; the means of accomplish-
ing which must be sufficiently obvious.
BOOK II.
OF
INTUMESCENTIÆ,
OR
GENERAL SWELLINGS.
MDLXX.
THE swellings to be treated of in this place are
those which extend over the whole or a great
part of the body; or such at least, as, though of small
extent;

304 PRACTICE
extent, are however of the same nature with those that
are more generally extended.
The swellings comprehended under this artificial
order, are hardly to be distinguished from one another
otherwise than by the matter they contain or consist
of: and in this view I have divided the order into four
sections, as the swelling happens to contain, 1st, Oil;
2d, Air; 3d, A watery fluid; or 4th, As the increased
bulk depends upon the enlargement of the whole sub-
stance of certain parts, and particularly of one or more
of the abdominal viscera.
CHAP. I.
OF ADIPOSE SWELLINGS.
MDCXXI.
THE only disease to be mentioned in this chapter,
I have, with other Nosologists, named Polysar-
cia; and in English it may be named Corpulency, or,
more strictly Obesity; as it is placed here upon the
common supposition of its depending chiefly upon the
increase of oil in the cellular texture of the body.
This corpulency, or obesity, is in very different de-
grees in very different persons, and is often consider-
able without being considered as a disease. There is,
however, a certain degree of it, which will be gene-
rally allowed to be a disease; as, for example, when
it renders persons, from a difficult respiration, uneasy
in themselves, and, from the inability of exercise, un-
fit for discharging the duties of life to others: and
for that reason I have given such a disease a place here.
Many physicians have considered it as an object of
practice,

OF PHYSIC. 305
practice, and as giving, even in no very high degree,
a disposition to many diseases; I am of opinion that it
should be an object of practice more frequently than it
has been, and therefore that it merits our considera-
tion here.
MDCXXII.
It may perhaps be alledged, that I have not been
sufficiently correct, in putting the disease of corpulen-
cy as an intumescentia pinguedinosa, and therefore
implying its being an increase of the bulk of the bo-
dy from an accumulation of oil in the cellular texture
only. I am aware of this objection: and as I have al-
ready said, that emaciation (MDCII.) depends either
upon a general deficiency of fluids in the vascular sys-
tem, or upon a deficiency of oil in the cellular tex-
ture; so I should perhaps have observed farther, that
the corpulency, or general fulness of the body, may
depend upon the fulness of the vascular system as well
as upon that of the cellular texture. This is true;
and for the same reasons I ought, perhaps, after Lin-
næus and Sagar, to have set down plethora as a parti-
cular disease, and as an instance of morbid intume-
scence. I have, however, avoided this, as Sauvages
and Vogel have done; because I apprehend that ple-
thora is to be considered as a state of temperament
only, which may indeed dispose to disease; but not as
a disease in itself, unless, in the language of the Stah-
lians, it be a plethora commota, when it produces a
disease accompanied with particular symptoms, which
give occasion to its being distinguished by a different
appellation. Further, it appears to me, that the
symptoms which Linnæus, and more particularly
those which Sagar employs in the character of pletho-
ra, never do occur but when the intumescentia pin-
guedinosa has a great share in producing them. It is,
however, very necessary to observe here, that plethora
and obesity are generally combined together; and that
in
VOL. II. 
Q q  

306 PRACTICE
in some cases of corpulency it may be difficult to de-
termine which of the causes has greatest share in pro-
ducing it. It is indeed very possible that a plethora
may occur without great obesity; but I apprehend
that obesity never happens to a considerable degree
without producing a plethora ad spatium in a great
part of the system of the aorta, and therefore a pletho-
ra ad molem in the lungs, and in the vessels of the
brain.
MDCXXIII.
In attempting the cure of polysarcia, I am of opi-
nion that the conjunction of plethora and obesity, in-
the manner just now mentioned, should be constantly
attended to; and when the morbid effects of the ple-
thoric habit are threatened, either in the head or lungs,
that blood-letting is to be practised: but at the same
time it is to be observed, that persons of much obesi-
ty do not bear blood-letting well; and when the cir-
cumstances I have mentioned do not immediately re-
quire it, the practice upon account of obesity alone,
is hardly ever to be employed. The same remark is
to be made with respect to any other evacuations that
may be proposed for the cure of corpulency: for with-
out the other means I am to mention, they can give
but a very imperfect relief; and, in so far as they ei-
ther empty or weaken the system, they may favour
the return of plethora, and the increase of obesity.
MDCXXIV.
Polysarcia, or corpulency, whether it depend upon
plethora or obesity, whenever it either can be consi-
dered as a disease, or threatens to induce one, is to be
cured, or the effects of it are to be obviated, by diet
and exercise. The diet must be sparing; or rather,
what is more admissible, it must be such as affords lit-
tle nutritious matter. It must therefore be chiefly, or
almost only, of vegetable matter, and at the very ut-
most of milk. Such a diet should be employed, and
generally 

OF PHYSIC. 307
generally ought to precede exercise: for obesity does
not easily admit of bodily exercise; which is, howe-
ver, the only mode that can be very effectual. Such,
indeed, in many cases, may seem difficult to be admit-
ted; but I am of opinion, that even the most corpu-
lent may be brought to bear it, by at first attempting
it very moderately, and increasing it by degrees very
slowly, but at the same time persisting in such at-
tempts with great constancy*.
MDCXXV.
As these, though the only effectual measures, are
often difficult to be admitted or carried into execu-
tion, some other means have been thought of and em-
ployed for reducing corpulency. These, if I mistake
not, have all been certain methods of inducing a saline
state in the mass of blood; for such I suppose to be
the effects of vinegar and of soap, which have been
proposed. The latter, I believe, hardly passes into
the blood-vessels, without being resoLved and formed
into a neutral salt, with the acid which it meets with
in the stomach. How well acrid and saline substanc-
es are fitted to diminish obesity, may appear from
what has been said above in MDCXV. What effects
vinegar, soap, or other substances employed, have
had in reducing corpulency, there have not proper
opportunities of observing occurred to me: but I am
well persuaded, that the inducing a saline and acrid
state of the blood, may have worse consequences than
the corpulency it was intended to correct; and that
no person should hazard these, while we may have re-
course to the more safe and certain means of absti-
nence and exercise.
CHAP.
Q q 2
* Besides the means mentioned by the author, evacuations of
different kinds ought to be occasionally made, especially by purging
and sweating.

308 PRACTICE
CHAP. II.
OF FLATULENT SWELLINGS.
MDCXXVI.
THE cellular texture of the human body very rea-
dily admits of air, and allows the same to pass
from any one to every other part of it. Hence Em-
physemata have often appeared from air collected in
the cellular texture under the skin, and in several
other parts of the body. The flatulent swellings un-
der the skin, have indeed most commonly appeared in
consequence of air immediately introduced from with-
out: but in some instances of flatulent swellings, espe-
cially those of the internal parts not communicating
with the alimentary canal, such an introduction can-
not be perceived or supposed; and therefore, in these
cases, some other cause of the production and collec-
tion of air must be looked for, though it is often not
to be clearly ascertained.
In every solid as well as every fluid substance which
makes a part of the human body, there is a considera-
ble quantity of air in a fixed state, which may be again
restored to its elastic state, and separated from those
substances, by the power of heat, putrefaction, and
perhaps other causes: but which of these may have
produced the several instances of pneumatosis and fla-
tulent swellings that have been recorded by authors, I
cannot pretend to ascertain. Indeed upon account
of these difficulties, I cannot proceed with any clear-
ness on the general subject or pneumatosis; and there-
fore, with regard to flatulent swellings, I find it ne-
cessary to confine myself to the consideration of those
of the abdominal region alone; which I shall now treat
of under the general name of Tympanites.
MDCXXVII. 

OF PHYSIC. 309
MDCXXVII.
The tympanites is a swelling of the abdomen; in
which the teguments appear to be much stretched by
some distending power within, and equally stretched
in every posture. of the body. The swelling does not
readily yield to any pressure; and in so far as it does,
very quickly recovers its former state upon the pressure
being removed. Being struck, it gives a found like a
drum, or other stretched animal membranes. No
fluctuation within is to be perceived; and the whole 
feels less weighty than might be expected from its bulk.
The uneasiness of the distention is commonly relieved
by the discharge of air from the alimentary canal,
either upwards or downwards.
MDCXXVIII.
These are the characters by which the tympanites
may be distinguished from ascites or physconia; and
many experiments show, that the tympanites always
depends upon a preternatural collection of air, some-
where within the teguments of the abdomen; but
the seat of the air is in different cases somewhat dif-
ferent; and this produces the different species of the
disease.
One species is, when the air collected is entirely
confined within the cavity of the alimentary canal, and
chiefly in that of the intestines. This species, there-
fore, is named the Tympanites intestinalis, Sauv. sp. I.
It is, of all others, the most common; and to it espe-
cially belong the characters given above.
A second species is, when the air collected is not
entirely confined to the cavity of the intestines, but is
also present between their coats; and such is that
which is named by Sauvages Tympanites enterophysodes,
Sauv. sp. 3. This has certainly been a rare occur-
rence; and has probably occurred only in conse-
quence of the tympanites intestinalis, by the air escap-
ing from the cavity of the intestines into the inter-
stices 

310 PRACTICE
stices of the coats. It is, however, possible that an
erosion of the internal coat of the intestines may give
occasion to the air, so constantly present in their cavi-
ty, to escape into the interstices of their coats though
in the whole their cavity there has been no previous
accumulation.
A third species is, when the air is collected in the
sac of the peritonæum, or what is commonly called
the cavity of the abdomen, that is, the space between
the peritenreum and viscera; and then the disease is
named tympanites abdominalis, Sauv. sp. 2. The ex-
istence of such a tympanites, without any tympanites
intestinalis, has been disputed; and it certainly has
been a rare occurrence; but from several dissections,
it is unquestionable that such a disease has sometimes
truly occurred.
A fourth species of tympanites is, when the tympa-
nites intestinalis and abdominalis are joined together,
or take place at the same time. With respect to this,
it is probable that the tympanites intestinalis is the pri-
mary disease; and the other, only a consequence of
the air escaping, by an erosion or rupture of the coats
of the intestines, from the cavity of these into that of
the abdomen. It is indeed possible, that in conse-
quence of erosion or rupture, the air which is so con-
stantly present in the intestinal canal, may escape
from thence in such quantity into the cavity of the ab-
domen, as to give a tympanites abdominalis, whilst there
was no previous considerable accumulation of air in
the intestinal cavity itself; but I have not facts to as-
certain this matter properly.
A fifth species has also been enumerated. It is
when a tympanites abdominalis happens to be joined
with the hydrops ascites; and such a disease therefore
is named by Sauvages tympanites asciticus, Sauv. sp. 4.
In most cases of tympanites, indeed, some quantity of
serum has, upon dissection, been found in the sac of
the 

OF PHYSIC. 311
the peritonæum; but that is not enough to constitute
the species now mentioned, and when the collection
of serum is more considerable, it is commonly where,
both from the causes which have preceded, and likewise
from the symptoms which attend, the ascites may be
considered as the primary disease; and therefore that
this combination does not exhibit a proper species of
the tympanites.
MDCXXIX.
As this last is not a proper species, and as some of
the others are not only extremely rare, but even when
occurring, are neither primary, nor to be easily distin-
guished, nor, as considered in themselves, admitting
of any cure, I shall here take no further notice of
them; confining myself in what follows, to the con-
sideration of the most frequent case, and almost the
only object of practice, the tympanites intestinalis.
MDCXXX.
With respect to this, I cannot perceive that it arises
in any peculiar temperament, or depends upon any
predisposition, which can be discerned. It occurs in
either sex, at every age, and frequently in young per-
sons.
MDCXXXI. 
Various remote causes of it have been assigned; but
many of these have not commonly the effect of pro-
ducing this disease; and although some of them have
been truly antecedents of it, I can in few instances
discover the manner in which they produce the disease,
and therefore cannot certainly ascertain them to have
been causes of it.
MDCXXXII.
The phenomena of this disease in its several stages
are the following.
The tumor of the belly sometimes grows very
quickly to a considerable degree, and seldom in the
slow manner the ascites commonly comes on. In some
cases, 

312 PRACTICE
cases, however, the tympanites comes on gradually,
and is introduced by an unusual flatulency of the sto-
mach and intestines, with frequent borborygmi, and
an uncommonly frequent expulsion of air upwards and
downwards. This state is also frequently attended
with colic pains, especially felt about the navel, and
upon the sides towards the back; but generally as
the disease advances, these pains becomes less consi-
derable. As the disease advances, there is a pretty
constant desire to discharge air, but it is accomplished
with difficulty; and when obtained, and although it
gives some relief from the sense of distension, this re-
lief is commonly transient and of short duration.—
While the disease is coming on, some inequality of tu-
mour and tension may be perceived in different parts
of the belly; but the distension soon becomes equal
over the whole, and exhibits the phenomena mention-
ed in the character. Upon the first coming on of the
disease, as well as during its progress, the belly is
bound, and the fæces discharged are commonly hard
and dry. The urine, at the beginning, is usually ve-
ry little changed in quantity or quality from its natu-
ral state: but as the disease continues, it is commonly
changed in both respects; and at length sometimes
a stranguary, and even an ischuria, comes on. The
disease has seldom advanced far, before the appetite is
much impaired, and digestion ill performed; and the
whole body, except the belly, becomes considerably
emaciated. Together with these symptoms, a thirst
and uneasy sense of heat at length comes on, and a
considerably frequency of pulse occurs, which conti-
nues throughout the course of the disease. When the
tumor of the belly arises to a considerable bulk, the
breathing becomes very difficult, with a frequent dry
cough. With all these symptoms the strength of the
patient declines; and the febrile symptoms daily
increasing, death at length, ensues, sometimes proba-
bly 

OF PHYSIC. 313
bly in consequence of a gangrene coming upon the
intestines.
MDCXXXIII.
The tympanites is commonly of some duration, and
to be reckoned a chronic disease. It is very seldom
quickly fatal, except where such an affection sudden-
ly arises in fevers. To this Sauvages has properly
given a different appellation, that of Meteorismus; and
I judge it may always be considered as a symptomatic
affection, entirely distinct from the tympanites we are
now considering.
MDCXXXIV.
The tympanites is generally a fatal disease, seldom
admitting of cure; but what may be attempted in this
way, I shall try to point out, after I shall have endea-
voured to explain the proximate cause, which alone
can lay the foundation of what may be rationally at-
tempted towards its cure.
MDCXXXV.
To ascertain the proximate cause of tympanites, is
somewhat difficult. It has been supposed in many
cases, to be merely an uncommon quantity of air pre-
sent in the alimentary canal, owing to the extrication
and detachment of a greater quantity of air than usu-
al from the alimentary matters taken in. Our vegeta-
ble aliments, I believe, always undergo some degree of
fermentation; and in consequence, a quantity of air from
extricated and detached from them in the stomach
and intestines; but it appears that the mixture of the
animal fluids which our aliments meet with in the ali-
mentary canal, prevents the same quantity of air from
being detached from them that would have been in
their fermentation without such mixture; and it is
probable that the same mixture contributes also to the
reabsorption of the air that had been before in some
measure detached. The extrication, therefore, of an
unusual quantity of air from the aliments, may, in cer-
tain
VOL. II. 
R r 

316 PRACTICE
tain circumstances, be such, perhaps, as to produce a
tympanites: so that this disease may depend upon a
fault of the digestive fluids, whereby they are unfit to
prevent the too copious extrication of air, and unfit al-
so to occasion that reabsorption of air which in sound
persons commonly happens. An unusual quantity of
air in the alimentary canal, whether owing to the na-
ture of the aliments taken in, or to the fault of the
digestive fluid, does certainly sometimes take place;
and may possibly have, and in some measure certainly
has, a share in producing certain flatulent disorders of
the alimentary canal; but cannot be supposed to pro-
duce the tympanites, which often occurs when no
previous disorder had appeared in the system. Even
in those cases of tympanites which are attended at
their beginning with flatulent disorders in the whole of
the alimentary canal, as we know that a firm tone of
the intestines both moderates the extrication of air
and contributes to its reabsorption or ready expulsion,
so the flatulent symptoms which happen to appear at
the coming on of a tympanites are, in my opinion, to
be referred to a loss of tone in the muscular fibres of
the intestines, rather than to any fault in the digestive
fluids.
MDCXXXVI.
These, and other considerations, lead me to con-
clude, that the chief part of the proximate cause of
tympanites, is a loss of tone in the muscular fibres of
the intestines. But further, as air of any kind accu-
mulated in the cavity of the intestines should, even by
its own elasticity, find its way either upwards or down-
wards, and should also, by the assistance of inspira-
tion, be entirely thrown out of the body; so, when
neither the reabsorption nor the expulsion takes place,
and the air is accumulated so as to produce tympan-
ites, it is probable that the passage of the air along
the course of the intestines is in some places of these
inter- 

OF PHYSIC. 315
interrupted. This interruption, however, can hardly
be supposed to proceed from any other cause than
spasmodic constrictions in certain parts of the canal;
and I conclude, therefore, that such constrictions con-
cur as part in the proximate cause of tympanites.—
Whether these spasmodic constrictions are to be attri-
buted to the remote cause of the disease, or may be
considered as the consequence of some degree of atony
first arising, I cannot with certainty, and do not find it
necessary to determine.
MDCXXXVII.
Having thus endeavoured to ascertain the proxi-
mate cause of tympanites, I proceed to treat of its
cure; which indeed has seldom succeeded, and al-
most never but in a recent disease. I must, however,
endeavour to say what may be reasonably attempted;
what has commonly been attempted; and what at-
tempts have sometimes succeeded in the cure of this
disease.
MDCXXXVIII.
It must be a first indication to evacuate the air ac-
cumulated in the intestines: and for this purpose it is
necessary that those constrictions, which had especially
occasioned its accumulation, and continue to inter-
rupt its passage along the course of the intestines
should be removed. As these, however, can hardly
be removed but by exciting the peristaltic motion in
the adjoining portions of the intestines, purgatives
have been commonly employed; but it is at the same
time agreed, that the more gentle laxatives only ought
to be employed, as the more drastic, in the overstretch-
ed and tense state of the intestines, are in danger of
bringing on inflammation.
It is for this reason, also, that glysters have been
frequently employed; and they are the more necessa-
ry, as the fæces collected are generally found to be in
a hard and dry state. Not only upon account of this
state
R r 2 

316 PRACTICE
state of the fæces, but, farther, when glysters produce
a considerable evacuation of air, and thus show that
they have some effect in relaxing the spasms of the
intestines, they ought to be repeated very frequently.
MDCXXXIX.
In order to take off the constrictions of the intes-
tines, and with some view also to the carminative ef-
fects of the medicines, various antispasmodics have
been proposed, and commonly employed; but their
effects are seldom considerable, and it is alledged that
their heating and inflammatory powers have some-
times been hurtful. It it, however, always proper to
join some of the milder kinds with both the purgatives
and glysters that are employed*; and it has been ve-
ry properly advised to give always the chief of antis-
pasmodics, that is, an opiate, after the operation of
purgatives is finished.
MDCXL.
In consideration of the overstretched tense, and dry
state of the intestines, and especially of the spasmodic
constrictions that prevail, fomentations and warm
bathing have been proposed as a remedy; and are
said to have been employed with advantage: but
it has been remarked, that very warm baths have not
been found so useful as tepid baths long continued.
MDCXLI.
Upon the supposition that this disease depends espe-
cially upon an atony of the alimentary canal, tonic re-
medies
* The antispasmodics that are to be joined with purgatives ought
to be essential oils, especially the essential oils of umbelliferous
plants, as oil of aniseed, oil of carui, &c. and their dose ought to be
moderate. In many cases they may be used in repeated small doses
by themselves on a piece of sugar. The dose of the ol anisi ought
not to exceed ten or twelve drops, nor of the ol. carui five drops;
larger doses are too heating. It may be proper also to observe, that
the essential oils of the verticellated plants, as mint, marjoram,
thyme, &c. are much too heating, and much more so those of the
aromatics, as cloves, cinnamon, &c.

OF PHYSIC. 317
medies seem to be properly indicated. Accordingly
chalybeates, and various bitters, have been employed;
and, if any atonic*, the Peruvian bark might probably
be useful.
MDCXLII.
But as no tonic remedy is more powerful than cold
applied to the surface of the body, and cold drink
thrown into the stomach; so such a remedy has been
thought of in this disease. Cold drink has been con-
stantly prescribed, and cold bathing has been employed
with advantage; and there have been several in-
stances of the disease being suddenly and entirely cur-
ed by the repeated application of snow to the lower
belly.
MDCXLIII.
It is hardly necessary to remark, that, in the diet of
tympanitic persons, all sorts of food ready to become
flatulent in the stomach are to be avoided; and it is
probable, that the fossil acids and neutral salts, as an-
tizymics, may be useful§.
MDCXLIV.
In obstinate and desperate cases of tympanites, the
operation of the paracentesis has been proposed: but
it is a very doubtful remedy, and there is hardly any
testimony of its having been practised with success.
It must be obvious, that this operation is a remedy
suited especially, and almost only, to the tympanites
abdominalis; the existence of which, separately from
the intestinalis, is very doubtful, at least not easily as-
certained. Even if its existence could be ascertained,
yet it is not very likely to be cured by this remedy;
and
* The author here surely meant to say tonic; and atonic seems
to be a typographical error; but it was so printed in the last edition
published before his death.
§ The fossil acids are undoubtedly very powerful in resisting fer-
mentation; and if the air in the intestines is produced by fermenta-
tion, they are consequently highly useful.

318 PRACTICE
and how far the operation might be safe in tympan-
ites intestinalis, is not yet determined by any proper
experience.
CHAP. III.
OF WATERY SWELLINGS, OR DROPSIES.
MDCXLV.
A PRETERNATURAL collection of serous or
watery fluids, is often formed in different parts
of the human body; and although the disease thence
arising be distinguished according to the different
parts which it occupies, yet the whole of such collec-
tions come under the general appellation of Dropsies.
At the same time, although the particular instances
of such collection are to be distinguished from each
other according to the parts they occupy, as well as by
other circumstances attending them; yet all of them
seem to depend upon some general causes, very much
in common to the whole. Before proceeding,
therefore, to consider the several species, it may be
proper to endeavour to assign the general causes of
dropsy.
MDCXLVI.
In persons in health, a serous or watery fluid seems
to be constantly poured out, or exhaled in vapour, in-
to every cavity and interstice of the human body ca-
pable of receiving it; and the same fluid, without re-
maining long or being accumulated in these spaces,
seems constantly to be soon again absorbed from
thence by vessels adapted to the purpose. From this
view

OF PHYSIC. 319
view of the animal œconomy, it will be obvious, that
if the quantity poured out into any space, happens
to be greater than the absorbents can at the same
time take up, an unusual accumulation of serous fluid
will be made in such parts; or though the quantity
poured out be not more than usual, yet if the absorp-
tion be any wise interrupted or diminished, from this
cause also an unusual collection of fluids may be occa-
sioned.
Thus, in general, dropsy may be imputed to an
increased effusion, or to a diminished absorption; and
I therefore proceed to inquire into the several causes
of these.
MDCXLVII.
An increased effusion may happen, either from a
preternatural increase of the ordinary exhalation, or
from the rupture of vessels carrying, or of sacs con-
taining, serous or watery fluids.
MDCXLVIII.
The ordinary exhalation may be increased by vari-
ous causes, and particularly by an interruption given
to the free return of the venous blood from the ex-
treme vessels of the body to the right ventricle of the
heart. This interruption seems to operate by resisting
the free passage of the blood from the arteries into the
veins, thereby increasing the force of the arterial flu-
ids in the exhalants, and consequently the quantity of
fluid which they pour out.
MDCXLIX.
The interruption of the free return of the venous
blood from the extreme vessels, may be owing to cer-
tain circumstances affecting the course of the venous
blood; very frequently, to certain conditions in the
right ventricle of the heart itself, preventing it from
receiving the usual quantity of blood from the vena
cava; or to obstructions in the vessels of the lungs pre-
venting the entire evacuation of the right ventricle, 
and

320 PRACTICE
and thereby hindering its receiving the usual quan-
tity of blood from the cava. Thus, a polypus in the
right ventricle of the heart, and the ossification of its
valves, as well as all considerable and permanent ob-
structions of the lungs, have been found so be causes
of dropsy.
MDCL.
It may serve as an illustration of the operation of
these general causes, to remark, that the return of the
venous blood is in some measure resisted when the
posture of the body is such as gives occasion to the
gravity of the blood to oppose the motion of it in the
veins, which takes effect when the force of the circu-
lation is weak; and from whence it is that an upright
posture of the body produces or increases serous swell-
ings in the lower extremities.
MDCLI.
Not only those causes interrupting the motion of
the venous blood more generally, but, farther, the in-
terruption of it in particular veins, may likewise have
the effect of increasing exhalation, and producing
dropsy. The most remarkable instance of this is,
when considerable obstructions of the liver prevent
the blood from flowing freely into it from the vena
portarum and its numerous branches; and hence these
obstructions are a frequent cause of dropsy.
MDCLII.
Scirrhosities of the spleen and other viscera, as well
as the scirrhosity of the liver, have been considered
as causes of dropsy; but the manner in which they
can produce the disease, I do not perceive, except it
may be where they happen to be near some consider-
able vein, by the compression of which they may oc-
casion some degree of ascites; or, by compressing the
vena cava, may produce an anasarca of the lower ex-
tremities. It is indeed true, that scirrhosities of the
spleen and other viscera, have been frequently disco-
vered

OF PHYSIC. 321
vered in the bodies of hydropic persons: but I be-
lieve they have been seldom found unless when scir-
rhosities of the liver were also present; and I am in-
clined to think, that the former have been the effects
of the latter, rather than the cause of the dropsy; or,
that, if scirrhosities of the other viscera have appeared
in hydropic bodies when that of the liver was not pre-
sent, they must have been the effects of some of those
causes of dropsy to be hereafter mentioned; and con-
sequently to be the accidental attendants, rather than
the causes, of such dropsies.
MDCLIII.
Even in smaller portions of the venous system, the
interruption of the motion of the blood in particular
veins has had the same effect. Thus a polypus form-
ed in the cavity of a vein, or tumours formed in its
coats, preventing the free passage of the blood through
it, have had the effect of producing dropsy in parts to-
wards the extremity of such veins.
MDCLIV. 
But the cause most frequently interrupting the mo-
tion of the blood through the veins is, the compressi-
on of tumours existing near to them; such as aneu-
risms in the arteries, abscesses, and scirrhous or steato-
matous tumours in the adjoining parts.
To this head may be referred the compression of
the descending cava by the bulk of the uterus in preg-
nant women, and the compression of the same by the
bulk of water in the ascites; both of which compressi-
ons frequently produce serous swellings in the lower
extremities.
MDCLV.
It may be supposed, that a general preternatural
plethora of the venous system may have the effect of
increasing exhalation; and that this plethora may
happen from the suppression of fluxes, or evacuations
of blood, which had for some time taken place in the
body,
VOL. II. 
S s

322 PRACTICE
body, such as the menstrual and hemorrhoidal fluxes.
A dropsy, however, from such a cause, has been at
least a rare occurrence; and when it seems to have
happened, I should suppose it owing to the same caus-
es as the suppression itself, rather than to the pletho-
ra produced by it.
MDCLVI.
One of the most frequent causes of an increased ex-
halation, I apprehend to be the laxity of the exhalant
vessels. That such a cause may operate, appears pro-
bable from this, that paralytic limbs, in which such a
laxity is to be suspected, are frequently affected with
serous, or, as they are called, œdematous swellings.
But a much more remarkable and frequent exam-
ple of its operation occurs in the case of a general de-
bility of the system, which is so often attended with
dropsy. That a general debility does induce dropsy,
appears sufficiently from its being so commonly the
consequence of powerfully debilitating causes; such
as fevers, either of the continued or intermittent kind,
which have lasted long; long-continued and some-
what excessive evacuations of any kinds; and in short,
almost all diseases that have been of long continu-
ance, and have at the same time induced the other
symptoms of a general debility.
Among other causes inducing a general debility of
the system, and thereby dropsy, there is one to be
mentioned as frequently occurring, and that is, in-
temperance in the use of intoxicating liquors; from
whence it is that drunkards of all kinds, and especi-
ally dram-drinkers, are so affected with this disease.
MDCLVII.
That a general debility may produce a laxity of the
exhalants, will be readily allowed: and that by this
especially it occasions dropsy, I judge from thence,
that while most of the causes already mentioned are
suited to produce dropsies of particular parts only, the
state 

OF PHYSIC. 323
state of general debility gives rise to increased exhala-
tion into every cavity and interstice of the body, and
therefore brings on a general disease. Thus, we have
seen effusions of a serous fluid made, at the same time,
into the cavity of the cranium, into that of the thorax
and of the abdomen, and likewise into the cellular tex-
ture almost over the whole of the body. In such cas-
es, the operation of a general cause discovered itself,
by these several dropsies increasing in one part as they
diminished in another, and this alternately in the dif-
ferent parts. This combination, therefore, of the dif-
ferent species of dropsy, or rather, as it may be term-
ed, this universal dropsy, must, I think, be referred to
a general cause; and in most instances, hardly any o-
ther can be thought of, but a general laxity of the ex-
halants. It is this, therefore, that I call the hydropic
diathesis; which frequently operates by itself; and
frequently, in some measure, concurring with other
causes, is especially that which gives them their full
effect.
This state of the system, in its first appearance,
seems to be what has been considered as a particular
disease under the name of Cachexy; but in every in-
stance of it that has occurred to me, I have always
considered, and have always found, it to be the be-
ginning of general dropsy.
MDCLVIII.
The several causes of dropsy already mentioned may
produce the disease, although there be no preternatu-
ral abundance of serous or watery fluid in the blood-
vessels; but it is now to be remarked, that a preterna-
tural abundance of that kind may often give occasion
to the disease, and more especially when such abu-
dance concurs with the causes above enumerated.
One cause of such preternatural abundance may be
an unusual quantity of water taken into the body
Thus an unusual quantity of water taken in by drink-
ing,
S s 2 

324 PRACTICE
ing, has sometimes occasioned a dropsy. Large quan-
tities of water, it is true, are upon many occasions
taken in; and being as readily thrown out again by
stool, urine, or perspiration, have not produced any
disease. But it is also certain, that upon some occa-
sions, an unusual quantity of watery liquors taken in
has run off by the several internal exhalants, and pro-
duced a dropsy. This seems to have happened, ei-
ther from the excretories not being fitted to throw out
the fluid so fast as it had been taken in, or from the
excretories having been obstructed by accidentally
concurring causes. Accordingly it is said, that the
sudden taking in of a large quantity of very cold wa-
ter, has produced dropsy, probably from the cold pro-
ducing a constriction of the excretories.
The proportion of watery fluid in the blood may be
increased, notqq only by the taking in a large quantity
of water by drinking, as now mentioned, but it is
possible that it may be increased also by water taken
in from the atmosphere by the skin in an absorbing or
imbibing state. It is well known that the skin may
be, at least, occasionally in such a state; and it is pro-
bable, that it many cases of beginning dropsy, when
the circulation of the blood on the surface of the bo-
dy is very languid, that the skin may be changed
from a perspiring to an imbibing state; and thus, at
least, the disease may be very much increased.
MDCLIX.
A second cause of a preternatural abundance of wa-
tery fluids in the blood-vessels, may be, an interrup-
tion of the ordinary watery excretions; and according-
ly it is alledged, that persons much exposed to a cold
and moiil air are liable to dropsy. It is also said, that
an interruption, or considerable diminution, of the
urinary secretion, has produced the disease: and it is
certain, that in the case of an ischuria renalis, the se-
rosity retained in the blood-vessels has been poured 
out

OF PHYSIC. 325
out into some internal cavities, and has occasioned
dropsy.
MDCLX.
A third cause, of an over-proportion of serous fluid
in the blood ready to run off by the exhalants, has
been very large evacuations of blood, either spontane-
ous or artificial. These evacuations, by abstracting a
large proportion of red globules and gluten, which are
the principal means of retaining serum in the red ves-
sels, allow the serum to run off more readily by the
exhalants: and hence dropsies have been frequently
the consequence of such evacuations.
It is possible also, that large and long-continued is-
sues, by abstracting a large proportion of gluten, may
have the same effect.
An over-proportion of the serous parts of the blood,
may not only be owing to the spoliation just now men-
tioned, but may, I apprehend, be likewise owing to
a fault in the digesting and assimilating powers in the
stomach and other organs; whereby they do not pre-
pare and convert the aliments taken in, in such a
manner as to produce from them the due proportion
of red globules and gluten; but, still continuing to
supply the watery parts, occasion these to be in an o-
ver-proportion, and consequently ready to run off in
too large quantity by the exhalants. It is in this
manner that we explain the dropsy, so often attending
chlorosis: which appears always at first by a pale co-
lour of the whole body, showing a manifest deficien-
cy of red blood; which in that disease can only be
attributed to an imperfect digestion and assimilation.
Whether a like imperfection takes place in what
has been called a Cachexy, I dare not determine. This
disease indeed has been commonly and very evidently
owing to the general causes of debility above mention-
ed: and it being probable that the general debility
may affect the organs of digestion and assimilation; so
the 

326 PRACTICE
the imperfect state of these functions, occasioning a
deficiency of red globules and gluten, may often con-
cur with the laxity of the exhalants in producing
dropsy.
MDCLXI.
These are the several causes of increased exhalation,
which I have mentioned as the chief cause of the ef-
fusion producing dropsy; but I have likewise observ-
ed in MDCXLVII: that with the same effect, an effu-
sion may also be made by the rupture of vessels carry-
ing watery fluids.
In this way, a rupture of the thoracic dud, has giv-
en occasion to an effusion of chyle and lymph into
the cavity of the thorax: and a rupture of the lacte-
als has occasioned a like effusion into the cavity of the
abdomen; and in either case, a dropsy has been pro-
duced.
It is sufficiently probable, that a rupture of lympha-
tics, in consequence of strains, or the violent com-
pression of neighbouring muscles, has occasioned an
effusion; which, being diffused in the cellular texture,
alias produced dropsy.
It belongs to this head of causes, to remark, that
there are many instances of a rupture or erosion of the
kidneys, ureters, and bladder of urine; whereby the
urine has been poured into the cavity of the abdomen,
and produced an ascites.
MDCLXII.
Upon this subject, of the rupture of vessels carrying,
or of vesicles containing, watery fluids, I must observe,
that the dissection of dead bodies has often shown ve-
sicles formed upon the surface of many of the inter-
nal parts; and it has been supposed that the rupture
of such vesicles, commonly named Hydatides, together
with their continuing to pour out a watery fluid, has
been frequently the cause of dropsy. I cannot deny
the 

OF PHYSIC. 327
the possibility of such a cause, but suspect the matter
must be explained in a different manner.
There have been frequently found, in almost every
different part of animal bodies, collections of spherical
vesicles, containing a watery fluid; and in many cases
of supposed dropsy, particularly in those called the
preternatural encysted dropsies, the swelling has been
entirely owing to a collection of such hydatides. Ma-
ny conjectures have been formed with regard to the
nature and production of these vesicles; but the mat-
ter at last seems to be ascertained. It seems to be cer-
tain, that each of these vesicles has within it, or an-
nexed to it, a living animal of the worm kind; which
seems to have the power of forming a vesicle for the
purpose of its own œconomy, and of filling it with a
watery fluid drawn from the neighbouring parts: and
this animal has therefore been properly named by late
naturalists, the Tænia hydatigena. The origin and
œconomy of this animal, or an account of the several
parts of the human body which it occupies, I cannot
prosecute further here; but it was proper for me, in
delivering the causes of dropsy, to say thus much of
hydatides: and I must conclude with observing, I am
well persuaded, that most of the instances of preterna-
tural encysted dropsies which have appeared in many
different parts of the human body, have been truly
collections of such hydatides; but how the swellings
occasioned by these are to be distinguished from other
species of dropsy, or how they are to be treated in
practice, I cannot at present determine.
MDCLXIII.
After having mentioned these, I return to consider
the other general cause of dropsy, which I have said
in MDCXLVI. may be, An interruption or diminution
of the absorption that should take up the exhaled flu-
ids from the several cavities and interstices of the bo-
dy;

328 PRACTICE
dy; the causes of which interruption, however, are
not easily ascertained.
MDCLXIV.
It seems probable, that absorption may be diminish-
ed, and even cease altogether, from a loss of tone in
the absorbent extremities of the lymphatics. I can-
not indeed doubt that a certain degree of tone or act-
ive power is necessary in these absorbent extremities;
and it appears probable, that the same general debili-
ty which produces that laxity of the exhalant vessels,
wherein I have supposed the hydropic diathesis to con-
sist, will at the same time occasion a loss of tone in the
absorbents; and therefore that a laxity of the exha-
lants will generally be accompanied with a loss of
tone in the absorbents; and that this will have a share
in the production of dropsy. Indeed it is probable
that the diminution of absorption has a considerable
share in the matter: as dropsies are often cured by
medicines which seem to operate by exciting the acti-
on of the absorbents.
MDCLXV.
It has been supposed, that the absorption performed
by the extremities of lymphatics may be interrupted
by an obstruction of these vessels, or at least of the
conglobate glands through which these vessels pass.
This, however, is very doubtful. As the lymphatics
have branches frequently communicating with one
another, it is not probable that the obstruction of any
one, or even several of these, can have any considera-
ble effect in interrupting the absorption of their extre-
mities.
And for the same reason it is as little probable that
the obstruction of conglobate glands can have such an
effect: at least it is only an obstruction of the glands 
of the mesentery, through which so considerable a por-
tion of the lymph passes, that can possibly have the ef-
fect of interrupting absorption. But even this we
should

OF PHYSIC. 329
should not readily suppose, there being reason to be-
lieve that these glands, even in a considerably tume-
fied state, are not entirely obstructed: And according-
ly I have known several instances of the most part of
the mesenteric glands being considerably tumefied,
without either interrupting the transmission of fluids
to the blood-vessels, or occasioning any dropsy.
An hydropic swelling, indeed, seems often to affect
the arm from a tumour of the axillary gland: but it
seems to me doubtful, whether the tumour of the arm
may not be owing to some compression of the axilla-
ry vein, rather than to an obstruction of the lympha-
tics. 
MDCLXVI.
A particular interruption of absorption may be sup-
posed to take place in the brain. As no lymphatic
vessels have yet very certainly been discovered in that
organ, it may be thought, that the absorption, which
certainly takes place there, is performed by the extre-
mities of veins, of by vessels that carry the fluid di-
rectly into the veins; so that any impediment to the
free motion of the blood in the veins or the brain,
may interrupt the absorption there, and occasion that
accumulation of serous fluid which so frequently oc-
curs from a congestion of blood in these veins. But
I give all this as a matter of conjecture only.
MDCLXVII.
Having thus explained the general causes of drop-
sy, I should proceed, in the next place, to mention the
several parts of the body in which serous collections
take place, and so to mark the different species of
dropsy: but I do not think it necessary for me to en-
ter into any minute detail upon this subject. In ma-
ny cases these collections arc not to be ascertained by
any external symptoms, and therefore cannot be the
objects of practice; and many of them, though in
some measure discernible, do not seem to be curable
by
VOL. II
T t 

330 PRACTICE
by our art. I the more especially avoid mentioning
very particularly the species, because that has already
been sufficiently done by Dr. D. Monro, and other
writers, in every body's hands. I must confine my-
self here to the consideration of those species which are
the most frequently occurring and the most common
objects of our practice; which are, the Anasarca,
Hydrothorax, and Ascites; and each of these I shall
treat in so many separate sections.
SECT. I.
OF ANASARCA.
MDCLXVIII.
The Anasarca is a swelling upon the surface of the
body, at first commonly appearing in particular parts
only, but at length frequently appearing over the
whole. So far as it extends, it is an uniform swelling
over the whole member, at first always soft, and rea-
dily receiving the pressure of the finger, which forms
a hollow that remains for some little time after the
pressure is removed, but at length rises again to its
former fulness. This swelling generally appears, first,
upon the lower extremities; and there too only in the
evening, disappearing again in the morning. It is
usually more considerable as the person has been
more in an erect posture during the day; but there
are many instances of the exercise of walking prevent-
ing altogether its otherwise usual coming on. Al-
though this swelling appears at first only upon the feet
and about the ankles; yet if the causes producing it
continue to act, it gradually extends upwards, occu-
pying

OF PHYSIC. 331
pying the legs, thighs, and trunk of the body, and
sometimes even the head. Commonly the swelling of
the lower extremities diminishes during the night;
and in the morning, the swelling of the face is most
considerable, which again generally disappears almost
entirely in the course of the day.
MDCLXIX.
The terms of Anasarca and Leucophlegmatia have
been commonly considered as synonimous; but some
authors have proposed to consider them as denoting
distinct diseases. The authors who are of this last
opinion employ the name of Anasarca for that disease
which begins in the lower extremities, and is from
thence gradually extended upwards in the manner I
have just now described; while they term Leucophleg-
matia, that in which the same kind of swelling appears
even at first very generally over the whole body.
They seem to think also, that the two diseases proceed
from different causes; and that, while the anasarca
may arise from the several causes in MDCXLVIII.-M-
DCLX. the leucophlegmatia proceeds especially from
a deficiency of red blood, as we have mentioned in m-
dclx. et seq. I cannot, however, find any proper
foundation for this distinction. For although in drop-
sies proceeding from the causes mentioned in MDCLX,
et seq. the disease appears in some cases more immedi-
ately affecting the whole body; yet that does not esta-
blish a difference from the common case of anasarca:
for the disease, in all its circumstances, comes at length
to be entirely the same; and in cases occasioned by a
deficiency of red blood, I have frequently observed it
to come on exactly in the manner of an anasarca, as
above described.
MDCLXX.
An anasarca is evidently a preternatural collection
of serous fluid in the cellular texture immediately un-
der the skin. Sometimes pervading the skin itself, it
oozes
T t 2 

332 PRACTICE
oozes out through the pores of the cuticle; and some-
times, too gross to pass by these, it raises the cuticle in
blisters. Sometimes the skin, not allowing the water
to pervade it, is compressed and hardened, and at the
same time so much distended, or to give anasarcous tu-
mours an unusual firmness. It is in these last circum-
stances also that an erythematic inflammation is ready
to come upon anasarcous swellings.
MDCLXXI.
An anasarca may immediately arise from any of the
several causes of dropsy which act more generally up-
on the system: and even when other species of dropsy
from particular circumstances, appear first; yet when-
ever these proceed from any causes more generally af-
fecting the system, an anarsaca sooner or later comes
always to be joined with them.
MDCLXXII.
The manner in which this disease commonly first
appears, will be readily explained by what I have said
in MDCL. respecting the effects of the posture of the
body. Its gradual progress, and its affecting, after
some time, not only the cellular texture under the skin,
but probably also much of the same texture in the in-
ternal parts, will be understood partly from the com-
munication that is readily made between the several
parts of the cellular texture; but especially from the
same general causes of the disease producing their ef-
fects in every part of the body. It appears to me,
that the water of anasarcous swellings is more readily
communicated to the cavity of the thorax, and to the
lungs, than to the cavity of the abdomen, or to the
viscera contained in it.
MDCLXXIII.
An anasarca is almost always attended with a scarci-
ty of urine; and the urine voided, is, from its scarci-
ty always of a high colour; and from the same cause,
after cooling, readily lets fall a copious reddish sedi-
ment.

OF PHYSIC. 333
ment. This scarcity of urine may sometimes be ow-
ing to an obstruction of the kidneys; but probably is
generally occasioned by the watery parts of the blood
running off into the cellular texture, and being
thereby prevented from passing in the usual quantity to
the kidneys.
The disease is also generally attended with an unu-
sual degree of thirst; a circumstance I would attribute
to a like abstraction of fluid from the tongue and fauces,
which are extremely sensible to every diminution of
the fluids in these parts.
MDCLXXIV.
The cure of anasarca is to be attempted upon three
general indications.
1. The removing the remote causes of the disease.
2. The evacuation of the serous fluid already col-
lected in the cellular texture.
3. The restoring the tone of the system, the loss of
which may be considered in many cases as the proxi-
mate cause of the disease.
MDCLXXV.
The remote causes are very often such as had not
only been applied, but had been removed* long be-
fore the disease came on. Although, therefore, their
effects remain, the causes themselves cannot be the
objects of practice; but if the causes still continue to
be applied, such as intemperance, indolence, and some
others, they must be removed. For the most part,
the remote causes are certain diseases previous to the
dropsy, which are to be cured by the remedies parti-
cularly adapted to them, and cannot be treated of
here. The curing of these, indeed, may be often dif-
ficult; but it was proper to lay down the present in-
dication, in order to show, that when these remote
causes
* These are large evacuations of different kinds, but especially
hemorrhagies, which have ceased before the dropsy came on. 

334 PRACTICE
causes cannot be removed, the cure of the dropsy
must be difficult, or perhaps impossible. In many
cases, therefore, the following indications will be to
little purpose; and particularly, that often the execu-
tion of the second will not only give the patient a
great deal of fruitless trouble, but commonly also hur-
ry on his fate.
MDCLXXVI.
The second indication for evacuating the collected
serum, may be sometimes executed with advantage,
and often, at least, with temporary relief. It may be
performed in two ways. First, by drawing off the
water directly from the dropsical part, by openings
made into it for that purpose: Or, secondly, by ex-
citing certain serous excretions; in consequence of
which, an absorption maybe excited in the dropsical
parts, and thereby the serum absorbed and carried into
the blood-vessels may afterwards be directed to run
out, or may spontaneously pass out, by one or other of
the common excretions.
MDCLXXVII.
In an anasarca, the openings into the dropsical part
are commonly to be made in some part of the lower
extremeties; and will be most properly made by ma-
ny small punctures reaching the cellular texture. For-
merly, considerable incisions were employed for this
purpose: but as any wound made in dropsical parts,
which, in order to their healing, must necessarily in-
flame and suppurate, are liable* to become gangre-
nous; so it is found to be much safer to make the open-
ings by small punctures only, which may heal up by
the first intention. At the same time, even with re-
spect to these punctures, it is proper to observe, that
they should be made at some distance from one another,
and
* Peculiarly liable in this disease on account of the diminished
tone and consequently the diminished strength of the parts. 

OF PHYSIC. 335.
and that care should be taken to avoid making them
in the most depending parts.
MDCLXXVIII.
The water of anasarcous limbs may be sometimes
drawn off by pea-issues, made by caustic a little below
the knees: for as the great swelling of the lower ex-
tremities is chiefly occasioned by the serous fluid ex-
haled into the upper parts constantly falling down to
the lower; so the issues now mentioned, by evacuating
the water from these upper parts, may very much relieve
the whole of the disease. Unless, however, the issues be
put in before the disease is far advanced, and before
the parts have very much lost their tone, the places
of the issues are ready to become affected with gan-
grene.
Some practical writers have advised the employ-
ment of setons, for the same purpose that I have
proposed issues; but I apprehend, that setons will
be more liable than issues to the accident just now
mentioned.
MDCLXXIX.
For the purpose of drawing out serum from anasar-
cous limbs, blisters have been applied to them, and
sometimes with great success; but the blistered parts are
ready to have a gangrene come upon them. Blistering
is therefore to be employed with great caution; and
perhaps only in the circumstances that I have mention-
ed above to be fit for the employment of issues.
MDCLXXX.
Colewort-leaves applied to the skin, readily occasion
a watery exsudation from its surface; and applied to
the feet and legs affected with anasarca, have some-
times drawn off the water very copiously, and with
great advantage.
Analogous, as I judge, to this, oiled silk-hose put
upon the feet and legs, so as to shut out all communi-
cation with the external air, have been found some-
times to draw a quantity of water from the pores of
the 

336 PRACTICE
the skin, and are said in this way to have relieved ana-
sarcous swellings; but in several trials made, I have
never found either the application of these hose, or
that of the colewort-leaves, of much service.
MDCLXXXI.
The second means proposed in MDCLXXVI. for draw-
ing off the water from dropsical places, may be the
employment of emetics, purgatives, diuretics, or su-
dorifics*.
MDCLXXXII.
As spontaneous vomiting has sometimes excited an
absorption in hydropic parts, and thereby drawn off
the waters lodged in them, it is reasonable to suppose
that vomiting excited by art may have the same effect;
and accordingly it has been often practised with ad-
vantage. The practice, however, requires that the
strong antimonial emetics be employed, and that they
be repeated frequently after short intervals.
MDCLXXXIII.
Patients submit more readily to the use of purga-
tives, than to that of emetics; and indeed they com-
monly bear the former more easily than the latter.
At the same time, there are no means we can employ
to procure a copious evacuation of serous fluids with
greater certainty than the operation of purgatives, and
it is upon these accounts that purging is the evacuation
which has been most frequently, and perhaps with
most success, employed in dropsy. It has been gene-
rally found necessary to employ purgatives of the more
drastic kind; which are commonly known, and need
not be enumerated here*. I believe, indeed, that
the
* How does this last agree with the first sentence of this ariticle?
§ The Drastic purgatives are Jalap, Colocynth, Gamboge,
Scammony, &c. Their Drastic quality however depends very much
on the dose in which they are given, small doses being gently laxa-
tive, while large ones are very violent in their operation. They
ought seldom to be given alone, but in conjunction with some aro-
matic, which greatly increases their action, and at the same time 

OF PHYSIC. 337
the more drastic purgatives are the most effectual for ex-
citing absorption, as their stimulus is most readily com-
municated to the other parts of the system; but of late
an opinion has prevailed, that some milder purgatives
may be employed with advantage. This opinion has
prevailed particularly with regard to the crystals vul-
garly called the Cream of Tartar, which in large dos-
es, frequently repeated, have sometimes answered the
purpose of exciting large evacuations both by stool and
urine, and has thereby cured dropsies. This medi-
cine, however, has frequently failed, both in its opera-
tion
VOL. II. 
U u
prevents the uneasiness of griping, with which their operation is fre-
quently attended: most of these drastics being resinous substances,
they are difficultly soluble in the alimentary canal, or if reduced to
a powder they are liable to concrete; in either case their action is
impeded. To remedy these inconveniencies, it is usual to add to
them some salt, which both divides the resin and prevents it's con-
cretion; and consequently increases it's action. For these reasons,
we find in the shops many formulæ, in which the drastic resins are
mixed with either salts or aromatics, or both: As, the Pulvis Alœ-
ticus, Pulvis e Scammonio compositus, Pulvis e Scammonio cum A-
lœ, Pulvis e senna compositus, and Electuarium e Scammonio of the
London Pharmacopœia; and, the Pulvis e Jalappa compositus, Pulvis
e Scammonio compositus Pilulæ Alœticæ, Pilulæ ex colocynthide
cum Alœ, Pilulæ, e Jalappa, and Pilulae Rusi of the Edinburgh.
Pharmacopœia.
Any of the foregoing compositions, if given in sufficient doses,
are very active and brisk purges. Many more might be contrived,
and on some occasions may be necessary. For procuring a brisk
discharge of fluids, an addition of Calomel is remarkably efficacious
as in the following formula:
ꝶ. Scammon.
Calomel.
Crem. Tart.
Zinzib ä. ä. p, æ.
M.s. Pulv.
The dose of this powder is two scruples or a drachm, it is extremely
active and ought to be used with care, the patients being kept mo-
derately warm, and drinking some thin mucilaginous liquor during
it's operation.

338 PRACTICE
tion and effects, when the drastic purgatives have been
more successful.
Practitioners have long ago observed, that, in the
employment of purgatives, it is requisite they be re-
peated after as short intervals as the patient can bear;
probably for this reason, that when the purging is not
carried to the degree of soon exciting an absorption,
the evacuation weakens the system, and thereby in-
creases the afflux of fluids to the hydropic parts.
MDCLXXXIV.
The kidneys afford a natural outlet for a great part
of the watery fluids contained in the blood-vessels; and
the increasing the excretion by the kidneys to a consi-
derable degree, is a means as likely as any other of
exciting an absorption in dropsical parts. It is upon
this account that diuretic medicines have been al-
ways properly employed in the cure of dropsy. The
various diuretics that may be employed, are enumerat-
ed in every treatise of the Materia Medica and of the
Practice of Physic, and therefore need not be repeated
here. It happens, however, unluckily, that none of
them are of very certain operation; neither is it well
known why they sometimes succeed, and why they so
often fail; nor why one medicine should prove of ser-
vice when another does not. It has been generally
the fault of writers upon the Practice of Physic, that
they give us instances of cases in which certain medi-
cines have proved very efficacious, but neglect to
tell us in how many other instances the same have
failed.
MDCLXXXV.
It deserves to be particularly observed here, that
there is hardly any diuretic more certainly powerful
than a large quantity of common water taken in by
drinking. I have indeed observed above, in MDCLVIII.
that a large quantity of water, or of watery liquors,
taken in by drinking, has sometimes proved a cause of
dropsy; 

OF PHYSIC. 339
dropsy; and practitioners have been formerly so much
afraid that watery liquors taken in by drinking might
run off into the dropsical places and increase the dis-
ease, that they have generally enjoined the abstaining,
as much as possible, from such liquors. Nay, it has
been further asserted, that by avoiding this supply of
exhalation, and by a total abstinence from drink, dropsies
have been entirely cured. What conclusion is to be
drawn from these facts, is however, very doubtful.
A dropsy arising from a large quantity of liquids taken
into the body, has been a very rare occurrence; and
there are, on the other hand, innumerable instances of
very large quantities of water having been taken in and
running off again very quickly by stool and urine,
without producing any degree of dropsy. With respect
to the total abstinence from drink, it is a practice of
the most difficult execution; and therefore has been
so seldom practised, that we cannot possibly know how
far it might prove effectual. The practice of giv-
ing drink very sparingly, has indeed been often em-
ployed: but in a hundred instances I have seen it car-
ried to a great length without any manifest advantage;
while, on the contrary, the practice of giving drink
very largely has been found not only safe, but very of-
ten effectual in curing the disease. The ingenious and
learned Dr. Millman has, in my opinion, been com-
mendably employed in restoring the practice of giv-
ing large quantities of watery liquors for the cure of
dropsy. Not only from the instances he mentions from
his own practice, and from that of several eminent
physicians in other parts of Europe, but also from
many instances in the records of physic, of the good
effects of drinking large quantities of mineral waters
in the cure of dropsy, I can have no doubt of the
practice recommended by Dr. Millman being very of-
ten extremely proper. I apprehend it to be especial-
ly adapted to those cases in which the cure is chiefly
at
U u 2 

340 PRACTICE
attempted by diuretics. It is very probable that these
medicines can hardly be carried in any quantity to
the kidneys without being accompanied with a large
portion of water; and the late frequent employment
of the crystals of tartar has often shown, that the diu-
retic effects of that medicine are almost only remarka-
ble when accompanied with a large quantity of water;
and that without this, the diuretic effects of the medi-
cine seldom appear. I shall conclude this subject with
observing, that as there are so many cases of dropsy
absolutely incurable, the practice now under conside-
ration may often fail, yet in most cases it may be safe-
ly tried; and if it appear that the water taken in passes
readily by the urinary secretion, and especially that it
increases the urine beyond the quantity of drink taken
in, the practice may probably be continued with
great advantage: but, on the contrary, if the urine be
not increased, 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 augment
the disease.  
MDCLXXXVI.
Another set of remedies which may be employed
for exciting a serous excretion, and thereby curing
dropsy, is that of sudorifics. Such remedies, indeed,
have been sometimes employed; but however useful
they may have been thought, there are few accounts
of their having effected a cure; and although I have
had some examples of their success, in most instances
of their trial they have been ineffectual.
Upon this subject it is proper to take notice of the
several means that have been proposed and employed
for dissipating the humidity of the body; and parti-
cularly that of beat externally applied to the surface
of it. Of such applications I have had no experience;
and then propriety and utility must rest upon the cre-
dit of the authors who relate them. I shall offer only
this 

OF PHYSIC. 341
this conjecture upon the subject: That if such mea-
sures have been truly useful, as it has seldom been by
the drawing out of any sensible humidity, it has pro-
bably been by their restoring the perspiration, which
is so often greatly diminished in this disease; or, per-
haps, by changing the state of the skin, from the im-
bibing condition which is alledged to take place, into
that of perspiring.
MDCLXXXVII.
When, by the several means now mentioned, we
shall have succeeded in evacuating the water of drop-
sies, there will then especially be occasion for our third
indication; which is, to restore the tone of the system,
the loss of which is so often the cause of the disease.
This indication, indeed, may properly have place
from the very first appearance of the disease; and cer-
tain measures adapted to this purpose may, upon such
first appearance, be employed with advantage. In
many cases of a moderate disease, I am persuaded that
they may obviate any future increase of it.
MDCLXXXVIII.
Thus, upon what is commonly the first symptoms
of anasarca, that is, upon the appearance of what are
called Oedematous Swellings of the feet and legs, the
three remedies of bandaging, friction, and exercise,
have often been used with advantage.
MDCLXXXIX.
That some degree of external compression is suited
to support the tone of the vessels, and particularly to
prevent the effects of the weight of the blood in dilat-
ing those of the lower extremities, must be sufficiently
evident; and the giving that compression by a bandage
properly applied, has been often useful. In apply-
ing such a bandage, care is to be taken that the com-
pression may never be greater on the upper than on
the lower part of the limb; and this, I think, can hard- 
ly

342 PRACTICE
ly ever be so certainly avoided, as by employing a
properly constructed laced stocking.
MDCXC.
Friction is another means by which the action of
the blood-vessels may be promoted, and thereby
the stagnation of fluids in their extremities prevented.
Accordingly, the use of the flesh-brush has often con-
tributed to discuss œdematous swellings. It appears
to me, that friction, for the purposes now mentioned,
is more properly employed in the morning, when the
swelling is very much gone off, than in the evening,
when any considerable degree of it has already come
on. I apprehend also, that friction being made from
below upwards only, is more useful than when made
alternately upwards and downwards. It has been 
common, instead of employing the flesh-brush, to
make the friction by warm and dry flannels; and this
may in some cases be the most convenient: but I can-
not perceive that the impregnation of these flannels
with certain dry fumes is of any benefit.
MDCXCI.
With respect to exercise, I must observe, that al-
though persons being much in an erect posture during
the day, may seem to increase the swelling which
comes on at night; yet as the action of the muscles
has a great share in promoting the motion of the ve-
nous blood, so I am certain, that as much exercise in
walking as the patient can easily bear, will often pre-
vent that œdematous swelling, which much standing,
and even sitting, would have brought on.
MDCXCII.
These measures, however, although they may be
useful at the coming on of a dropsy, whose causes are
not very powerful, will be often insufficient in a more
violent disease; and such therefore will require more
powerful remedies. These are, exercise and tonic
medicines; which may be employed both during the
course

OF PHYSIC. 343
course of the disease and especially after the water has
been evacuated.
MDCXCIII.
Exercise is suited to assist in every function of the ani-
mal œconomy, particularly to promote perspiration,
and thereby prevent the accumulation of watery flu-
ids in the body. I apprehend also, that it may be the
most effectual means for preventing the skin from be-
ing in an imbibing state; and, as has been hinted a-
bove on the subject of Emaciation (MDCVII.) I am per-
suaded, that a full and large perspiration will always
be a means of exciting absorption in every part of the
system. Exercise, therefore, promises to be highly
useful in dropsy; and any mode of it may be employ-
ed that the patient can most conveniently admit of. It
should, however, always be as much as he can easily
bear: and in anasarca, the share which the exercise of
muscles has in promoting the motion of the venous
blood, induces me to think that bodily exercise, to
whatever degree the patient can bear it, will always
be the most useful. From some experience also, I am
persuaded, that by exercise alone, employed early in
the disease, many dropsies may be cured.
MDCXCIV.
Besides exercise, various tonic remedies are properly
employed to restore the tone of the system. The
chief of these are, chalybeates, the Peruvian bark, and
various bitters. These are not only suited to restore
the tone of the system in general, but are particularly
useful in strengthening the organs of digestion, which
in dropsies are frequently very much weakened; and
for the same purpose also aromatics may be frequently
joined with the tonics.
MDCXCV.
Cold bathing is upon many occasions the most pow-
erful tonic we can employ; but at the beginning of
dropsy, when the debility of the system is considerable,
it 

344 PRACTICE
it can hardly be attempted with safety. After, how-
ever, the water of dropsies has been very fully evacuat-
ed, and the indication is to strengthen the system for
preventing a relapse, cold bathing may perhaps have a
place. It is, at the same time, to be admitted with
caution; and can scarcely be employed till the system
has otherwise recovered a good deal of vigour. When
that indeed has happened, cold bathing may be very
useful in confirming and completing it.
MDCXCVI.
In persons recovering from dropsy, while the seve-
ral means now mentioned for strengthening the system
are employed, it will be proper at the same time to
keep constantly in view the support of the watery ex-
cretions; and consequently the keeping up the per-
spiration by a great deal of exercise, and continuing
the full flow of the urinary excretion by the frequent
use of diuretics.
SECT. II.
OF THE HYDROTHORAX OR DROPSY OF
THE BREAST.
MDCXCVII.
THE preternatural collection of serous fluid in the
thorax, to which we give the appellation of Hydrotho-
rax, occurs more frequently than has been imagined.
Its presence, however, is not always to be very cer-
tainly known; and it often takes place to a considera-
ble degree before it be discovered.
MDCXCVIII.
These collections of watery fluids in the thorax, are
found 

OF PHYSIC. 345
found in different situations. Very often the water
is found at the same time in both sacs of the pleura,
but frequently in one of them only. Sometimes it is
found in the pericardium alone; but for the most part
it only appears there when at the same time a collec-
tion is present in one or both cavities of the thorax.
In some instances, the collection is found to be only
in that cellular texture of the lungs which surrounds
the bronchiæ, without there being at the same time
any effusion into the cavity of the thorax.
Pretty frequently the water collected consists chief-
ly of a great number of hydatides in different situati-
ons; sometimes seemingly floating into the cavity, but
frequently connected with and attached to particular
parts of the internal surface of the pleura.
MDCXCIX.
From the collection of water being thus in various
situations and circumstances, symptoms arise which
are different in different cases; and from thence it be-
comes often difficult to ascertain the presence and na-
ture of the affection. I shall, however, endeavour
here to point out the most common symptoms, and
especially those of that principal and most frequent
form of the disease, when the serous fluid is present in
both sacs of the pleura, or, as we usually speak, in
both cavities of the thorax.
MDCC.
The disease frequently comes on with a sense of anx-
iety about the lower part of the sternum. This, be-
fore it has subsisted long, comes to be joined with
some difficulty of breathing; which at first appears on-
ly upon the person's moving a little faster than usual,
upon his walking up an activity, or upon his ascend-
ing a stair-case: but after some time, this difficulty of
breathing becomes more constant and considerable,
especially during the night, when the body is in a
horizontal situation. Commonly, at the same time,
lying
VOL. II. 
X x  

346 PRACTICE
lying upon one side is more easy than upon the other,
or perhaps lying upon the back more easy than upon
either side. These circumstances are usually attended
with a frequent cough, that is at first dry; but which,
after some time, is accompanied with an expectoration
of thin mucus.
With all these symptoms, the hydrothorax is not
certainly discovered, as the same symptoms often at-
tend other diseases of the breast. When, however,
along with these symptoms, there is at the same time
an œdematous swelling of the feet and legs, a leuco-
phlegmatic paleness of the face, and a scarcity of urine,
the existence of a hydrothorax can be no longer
doubtful. Some writers have told us, that sometimes
in this disease, before the swelling of the feet comes
on, a watery swelling of the scrotum appears: but I
have never met any instance of this.
MDCCI.
Whilst the presence of the disease is somewhat un-
certain, there is a symptom which sometimes takes
place, and has been thought to be a certain character-
istic of it; and that is, when, soon after the patient has
fallen asleep, he is suddenly awaked with a sense of
anxiety and difficult breathing, and with a violent
palpitation of the heart. These feelings immediately
require an erect posture; and very often the difficulty
of breathing continues to require and to prevent sleep
for a great part of the night. This symptom I have
frequently found attending the disease; but I have
also met with several instances in which this symptom
did not appear. I must remark further, that I have
not found this symptom attending the empyema, or
any other disease of the thorax; and therefore, when
it attends a difficulty of breathing, accompanied with
any the smallest system of dropsy, I have had no doubt
in concluding the presence of water in the chest, and
have 

OF PHYSIC. 347
have always had my judgment confirmed by the symp-
toms which afterwards appeared.
MDCCII.
The hydrothorax often occurs with very few, or
almost none, of the symptoms above mentioned; and
is not, therefore, very certainly discovered till some
others appear. The most decisive symptom is a fluc-
tuation of water in the chest, perceived by the pati-
ent himself, or by the physician, upon certain motions
of the body. How far the method proposed by Auen-
brugger will apply to ascertain the presence of water
and the quantity of it in the chest, I have not had oc-
casion or opportunity to observe.
It has been said, that in this disease some tumour ap-
pears upon the sides or upon the back; but I have not
met with any instance of this. In one instance of the
disease, I found ope side of the thorax considerably en-
larged, the ribs standing out farther on that side than
upon the other.
A numbness and a degree of palsy in one or both
arms, has been frequently observed to attend a hydro-
thorax.
Soon after this disease has made some progress, the
pulse commonly becomes irregular, and frequently
intermitting: but this happens in so many other dis-
eases of the breast, that, unless when it is attended with
some other of the above mentioned symptoms, it can-
not be considered as denoting the hydrothorax.
MDCCIII.
This disease, as other dropsies, is commonly attend-
ed with thirst and a scarcity of urine to be explained
in the same manner as in the case of anasarca (MDC-
LXXIII.) The hydrothorax, however, is sometimes
without thirst, or any other febrile symptom; although
I believe this happens in the case of partial affections
only, or when a more general affection is yet but in a
slight degree. In both cases, however, and more espe- 
cially
X x 2

348 PRACTICE
cially when the disease is considerably advanced, some
degree of fever is generally present: and I apprehend
it to be in such case, that the persons affected are
more than usually sensible to cold, and complain of
the coldness of the air when that is not perceived by
other persons.
MDCCIV.
The hydrothorax sometimes appears alone, with-
out any other species of dropsy being present at the
same time: and in this case the disease, for the most
part, is a partial affection, as being either of one side
of the thorax only, or being a collection of hydatides
in one part of the chest. The hydrothorax, however,
is very often a part of more universal dropsy, and when
at the same time there is water in all the three princi-
pal cavities and in the cellular texture of a great part
of the body. I have met with several instances, in
which such universal dropsy began first by an effusion
into the thorax. The hydrothorax, however, more
frequently comes on from an anasarca gradually in-
creasing; and, as I have said above, the general dia-
thesis seems often to affect the thorax sooner than it
does either the head or the abdomen.
MDCCV.
This disease seldom admits of a cure, or even of alle-
viation, 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 effused; and the fatal event fre-
quently happens more suddenly than was expected.—
In many of the instances of a fatal hydrothorax, I have
remarked a spitting of blood to come on several days
before the patient died.
MDCCVI.
The cause of hydrothorax is often manifestly one or
other of the general causes of dropsy pointed out a-
bove: but what it is that determines these general
causes 

OF PHYSIC. 349
causes to act more especially in the thorax, and parti-
cularly what it is that produces the partial collections
that occur there, I do not find to be easily ascertained.
MDCCVII.
From what has been said above, it will be evident,
that the cure of hydrothorax must be very much the
same with that of anasarca; and when the former is
joined with the latter as an effect of the same general
diathesis, there can be no doubt of the method of cure
being the same in both. Even when the hydrotho-
rax is alone, and the disease partial, from particular
causes acting in the thorax only, there can hardly be
any other measures employed, than the general ones
proposed above. There is only one particular mea-
sure adapted to the hydrothorax; and that is, the
drawing off the accumulated waters by a paracentesis of
the thorax.
MDCCVIII.
To what cases this operation may be most properly
adapted, I find it difficult to determine. That it may
be executed with safety, there is no doubt; and that
it has been sometimes practised with success, seems to
be very well vouched*. When the disease depends
upon
* In the memoirs of the Academy of Sciences at Paris, for 1703.
M. Du Verney relates the case of a woman who had both an As-
cites and Hydrothorax. He first emptied the abdomen by tap-
ping, and a few days afterwards, he pierced the thorax with a tro-
char, near to the spine, between the second and third false ribs; by
which opening he drew off a considerable quantity of water; the o-
peration gave immediate relief to the patient, and she was able to
return to her ordinary employments in about a month's time.
Bianchi also relates a successful operation of tapping the thorax;
but he seems to be timid in his practice, and confesses that he has
seldom ventured on the operation.
The practice of evacuating water contained in the thorax by an
incision is very old. We find it recommended by Hippocrates,
with particular directions for performing the operation, in his second
book on diseases, See the Geneva edition of Foesius'. Hippocrates,
pag. 483. 

350 PRACTICE
upon a general hydropic diathesis, it cannot alone
prove a cure, but may give a temporary relief; and
when other remedies seem to be employed with advan-
tage, the drawing off the water may very much fa-
vour a complete cure. I have not, however, been so
fortunate as to see it practised with any success ; and
even where it was most promising, that is, in cases of
partial affection, my expectations have been disappoint-
ed from it.
SECT. III.
OF ASCITES, OR DROPSY OF THE LOWER
BELLY.
MDCCIX.
The name of Ascites is given to every collection of
waters causing a general swelling and distension of the
lower belly : and such collections are more frequent
than those which happen in the thorax.
MDCCX.
The collections in the lower belly, like those of the
thorax, are found in different situations. Most com-
monly they are in the sac of the peritonæum, or gene-
ral cavity of the abdomen : but they often begin by
sacs formed upon, and connected with, one or other
of
That the practice was frequently attended with success, in those
early ages, is sufficiently evident by the context; for Hippocrates.
after describing the operation, and the subsequent management of
the patient says, " If pus appear on the plaster covering the wound,
" on the fifth day after the operation, the patient generally reco-
" vers; if not, he is seized with a cough and thirst, and dies." 

351 OF PHYSIC.
of the viscera; and perhaps the most frequent in-
stances of this kind occur in the ovaria of females.
Sometimes the water of ascites is found entirely with-
out the peritonæum, and between this and the abdomi-
nal muscles.
MDCCXI.
These collections connected with particular viscera,
and those formed without the peritonæum, form that
disease which authors have termed the encysted dropsy,
or hydrops saccatus. Their precise seat, and even
their existence, is very often difficult to be ascertain-
ed. They are generally formed by collections of hy-
datides.
MDCCXII.
In the most ordinary case, that of abdominal drop-
sy, the swelling at first is in some measure over the
whole belly, but generally appears most considerable
in the epigastrium. As the disease, however, advanc-
es, the swelling becomes more uniform over the whole.
The distension and sense of weight, though consider-
able, vary a little according as the posture of the body
is changed ; the weight being felt the most upon the
side on which the patient lies, while at the same time
on the opposite side the distension becomes somewhat
less. In almost all the instances of ascites, the fluctu-
ation of the water within, may be perceived by the
practitioner's feeling, and sometimes by his hearing.
This perception of fluctuation does not certainly dis-
tinguish the different states of dropsy ; but serves very
well to distinguish dropsy from tympanites, from cases
of physconia, and from the state of pregnancy in
women.
MDCCXIII.
As ascites frequently occurs when no other species
of dropsy does at the same time appear; but some
times the ascites is a part only of universal dropsy.
In this case, it usually comes on in consequence of an
ana- 

352 PRACTICE
anasarca, gradually increasing; but its being joined
with anasarca, does not always denote any general dia-
thesis, as for the most part an ascites sooner or later oc-
casions œdematous swellings of the lower extremities.
When the collection of water in the abdomen, from
whatever cause, becomes considerable, it is always at-
ended with a difficulty of breathing ; but this symp-
tom occurs often when, at the same time, there is no
water in the thorax. The ascites is sometimes unac-
companied with any fever ; but frequently there is
more or less of fever present with it. The disease is
never considerable, without being attended with thirst
and scarcity, of urine.
MDCCXIV.
In the diagnosis of ascites, the greatest difficulty that
occurs, is in discerning when the water is in the cavity
of the abdomen, or when it is in the different states of
encysted dropsy above mentioned. There is, perhaps,
no certain means of ascertaining this in all cases; but
in many we may attempt to form some judgment with
regard to it.
When the antecedent circumstances give suspicion
of a general hydropic diathesis; when at the same
time some degree of dropsy appears in other parts of
the body ; and when, from its first appearance, the
swelling has been equally over the whole belly, we may
generally presume that the water is in the cavity of
the abdomen. But when an ascites has not been pre-
ceded by any remarkable cachectic state of the system,
and when at its beginning the tumour and tension had
appeared in one part of the belly more than ano-
ther, there is reason to suspect an encysted dropsy;
Even when the tension and tumour of the belly have
become general and uniform over the whole ; yet if
the system of the body in general appear to be little
affected; if the patient's strength be little impaired ;
if the appetite continue pretty entire. and the natural
sleep

OF PHYSIC. 353
sleep be little interrupted ; if the menses in females
continue to flow as usual; if there be yet no anasarca;
or, though it may have already taken place, if it be
still confined to the lower extremities, and there be no
leucophlegmatic paleness or sallow colour in the coun-
tenance ; if there be no fever, nor so much thirst, or
scarcity of urine, as occur in a more general affection;
then, according as more of these different circumstanc-
es take place, there will be the stronger ground for
supposing the ascites to be of the encysted kind.
The chief exception to be made from this as a gene-
ral rule, will, in my opinion, be when the ascites may
with much probability, be presumed to have come on
in consequence of a scirrhous liver; which, I appre-
hend, may occasion a collection of water in the cavity
of the abdomen, while the general system of the body
may not be otherwise much affected.
MDCCXV.
With respect to the cure of ascites when of the en-
cysted kind, it does not, so far as I know, admit of
any. When the collection of water is in the abdomi-
nal cavity alone, without any other species of dropsy
present at the same time, I apprehend the ascites will
always be of difficult cure ; for it may be presumed to
depend upon a scirrhosity of the liver, or other consi-
derable affection of the abdominal viscera, which I
conceive to be of very difficult, cure, and therefore
the ascites depending upon them. At the same time,
such cases may often admit of a temporary relief by
the paracentesis.
MDCCXVI
When the ascites is a part of universal dropsy, it
may, as far as other cases of that kind can, admit of a
cure; and it will be obvious, that such a cure must be
obtained by the same means as above proposed for the
cure of general anasarca*.
It frequently happens that the ascites is attended
Vol. II. Y y with
* See the notes on Article 1683. 

354 PRACTICE
with a diarrhœa; and, in that case, does not admit of
the use of purgatives so freely as cases of anasarca
commonly do. It is therefore often to be treated by
diuretics almost alone.
The diuretics that may be employed, are chiefly
those above-mentioned ; but in ascites, a peculiar one
has been found out. It is a long-continued gentle
friction of the skin over the whole of the abdomen,
by the fingers dipped in oil. This has sometimes been
useful in exciting an increased flow of urine ; but in
most of the trials of it which I have known made, it
has failed in producing that effect.
MDCCXVII.
The ascites admits of a particular means for imme-
diately drawing off the collected waters : and that is
the well-known operation of the paracentesis of the
abdomen. In what circumstances of ascites this ope-
ration can most properly be proposed, it is difficult to
determine ; but, so far as I can judge, it must be re-
gulated by very much the same considerations as those
above-mentioned with regard to the paracentesis of
the thorax.
The manner of performing the paracentesis of the
abdomen, and the precautions to be taken with respect
to it, are now so commonly known, and delivered in
so many books, that it is altogether unnecessary for
me to offer any directions upon that subject here;
especially after the full and judicious information and
directions given by Mr. Bell, in the second volume
of his System of Surgery. 

355 OF PHYSIC.
CHAP. IV.
OF GENERAL SWELLINGS, ARISING FROM
AN INCREASED BULK OF THE WHOLE
SUBSTANCE OF PARTICULAR PARTS.
MDCCXVIII.
UPON the subjects of this chapter, several nosolo-
gical difficulties occur, and particularly with re-
spect to admitting the Physconia into the order of Ge-
neral Swellings. At present, however, it is not neces-
sary for me to discuss this point, as I am here to omit
entirely the consideration of Physconia ; both because
it can seldom admit of any successful practice, and
because I cannot deliver any thing useful either
with regard to the pathology or practice in such a dis-
ease.
MDCCXIX.
The only other genus of disease comprehended un-
der the title of the present chapter, is the Rachitis;
and this being both a proper example of the class of
Cachexy, and of the order of Intumescentiæ or General
Swellings, I shall offer some observations with regard
to it.
OF RACHITIS, OR RICKETS.
MDCCXX.
This disease has been supposed to have appeared
only in modern times, and not above two hundred
years. This opinion, notwithstanding it has been
maintained by persons of the most respectable authori-
ty*, appears to me, from many considerations, impro-
bable; but it is a point of too little consequence to
Y y 2 detain
* Boerhaave was of this opinion, see Van Swieten's commentary
on Aphorism 1482.

356 PRACTICE
detain my readers here. The only application of it
which deserves any notice is, that it has led to a no-
tion of the disease having arisen from the lues venera,
which had certainly made its first appearance in Eu-
rope not very long before the date commonly assigned
for the appearance of rachitis : but I shall hereafter
show, that the supposed connection between the Si-
phylis and Rachitis is without foundation*.
MDCCXXI.
In delivering the history of the Rickets, I must, in
the first place, observe, that with respect to the ante-
cedents of the disease, every thing to be found in au-
thors upon this subject, appears to me to rest upon a
very uncertain foundation. In particular with respect
to the state of the parents whose offspring become af-
fected with this disease, I have met with many instan-
ces of it in children from seemingly healthy pa-
rents ; and have met likewise with many instances
of children who never became affected with it, al-
though born of parents who according to the common
accounts, should have produced a rickety offspring 
so that, even making allowance for the uncertainty of
fathers, I do not find the general opinion of authors
upon this subject to be properly supported.
MDCCXXII.
The disease, however, may be justly considered as
proceeding from parents; for it often appears in a
great number of the same family ; and my observation
leads me to judge, that it originates more frequently
from mothers than from fathers. So far as I can refer
the disease of the children to the state of the parents,
it has appeared to me most commonly to arise from
some weakness, and pretty frequently from a scrophu-
lous habit, in the mother. To conclude the subject,
I must remark, that in many cases I have not been
able to discern the condition of the parents, to which
I could refer it.
When
* See Article 1727. 

357 OF PHYSIC.
When nurses, other than the mothers, have been
employed to suckle children, it has been supposed that
such nurses have frequently given occasion to the dis-
ease* ; and when nurses have both produced and have
suckled children who became rickety, there may be
ground to suspect their having occasioned the disease
in the children of other persons : but I have had few
opportunities of ascertaining this matter. It has in
some measure appeared to me that those nurses are most
likely to produce this disease, who give infants a large
quantity of very watery milk, and who continue to
suckle them longer than the usual time. Upon the
whole, however, I am of opinion, that hired nurses sel-
dom occasion this disease, unless when a predisposition
to it has proceeded from the parents.
MDCCXXIII.
With regard to the other antecedents, which have
been usually enumerated by authors as the remote
causes of this disease, I judge the accounts given to be
extremely fallacious ; and I am very much persuaded,
that the circumstances in the rearing of children, have
less effect in producing rickets than has been imagin-
ed. It is indeed not unlikely, that some of these cir-
cumstances mentioned as remote causes may favour,
while other circumstances may resist, the coming on
of the disease ; but at the same time, I doubt if any of
the former would produce it where there was no pre-
disposition in the child's original constitution. This
opinion of the remote causes, I have formed from ob-
serving, that the disease comes on when none of these
had been applied ; and more frequently that many of
them had been applied without occasioning the dis-
ease. Thus the learned ZEVIANI alledges, that the
disease
* This opinion was held by Boerhaave, and notwithstanding what
the Author says at the end of this paragraph, the opinion is certain-
ly founded on experience. 

358 PRACTICE
disease is produced by an acid from the milk with
which a child is fed for the first nine months of its
life ; but almost all children are fed with the same
food, and in which also an acid is always produced ;
while, at the same time, not one in a thousand of the
infants so fed becomes affected with the rickets. If,
therefore, in the infants who become affected with this
disease, a peculiarly noxious acid is produced, we must
seek for some peculiar cause of its production, either
in the quality of the milk, or in the constitution of
the child ; neither of which, however, Mr. Zeviani
has explained. I cannot indeed believe that the or-
dinary acid of milk has any share in producing this
disease, because I have known many instances of the
acid being produced and occasioning various disorders,
without, however, its ever producing rickets.
Another of the remote causes commonly assigned, is
the child being fed with unfermented farinaceous
food. But over the whole world children are fed
with such farinacea, while the disease of rickets is a
rare occurrence : and I have known many instances
where children have been fed with a greater than
usual proportion of fermented farinacea, and also a
greater proportion of animal food, without these pre-
venting the disease. In my apprehension, the like
observations might be made with respect to most of
the circumstances that have been mentioned as the re-
mote causes of rickets.
MDCCXXIV.
Having thus offered my opinion concerning the sup-
posed antecedents of this disease, I proceed now to
mention the phenomena occurring after it has actual-
ly come on*.
The disease seldom appears before the ninth month,
and
* This admirable description of the disease merits the peculiar
attention of the young practitioner. 

OF PHYSIC 359
and seldom begins after the second year, of a child's 
age. In the interval between these periods, the ap-
pearance of the disease is sometimes sooner, sometimes
later ; and commonly at first the disease comes on
slowly. The first appearances are, a flaccidity of
the flesh, the body at the same-time becoming leaner,
though food be taken in pretty largely. The head
appears large with respect to the body; with the fon-
tanelle, and perhaps the sutures, more open than usual
in children of the same age. The head continues to
grow larger; in particular, the forehead becoming un-
usually prominent; and at the same time the neck con-
tinues slender, or seems to be more so, in proportion to
the head. The dentition is slow, or much later than
usual; and those teeth which come out, readily become
black, and frequently again fall out. The ribs lose
their convexity, and become flattened on the sides ;
while the sternum is pushed outward, and forms a sort
of ridge. At the same time, or perhaps sooner, the
epiphyses at the several joints of the limbs become
swelled ; while the limbs between the joints appear,
or perhaps actually become, more slender. The bones
seem to be every where flexible, becoming variously
distorted; and particularly the spine of the back be-
coming incurvated in different parts of its length. If
the child, at the same time the disease comes on, had
acquired the power of walking, it becomes daily more
feeble in its motions, and more averse to the exertion
of them, losing at length the power of walking alto-
gether. Whilst these symptoms go on increasing,
the abdomen is always full, and preternaturally tumid.
The appetite is often good, but the stools are general-
ly frequent and loose. Sometimes the faculties of the
mind are impaired, and stupidity or satuity prevails ;
but commonly a premature sensibility appears, and
they acquire the faculty of speech sooner than usual.
At the first coming on of the disease, there is general-
ly

360 PRACTICE
ly no fever attending it: but it seldom continues long,
till a frequent pulse, and other febrile symptoms,
come to be constantly present. With these symptoms
the disease proceeds, and continues in some instances
for some years; but very often, in the course of that
time, the disease ceases to advance, and the health is
entirely established, except that the distorted limbs,
produced during the disease, continue for the rest of
life. In other cases, however, the disease proceeds in-
creasing, till it has affected almost every function of
the animal œconomy, and at length terminates in
death. The variety of symptoms which in such cases
appear, it does not seem necessary to enumerate, as
they are not essential to the constitution of the disease,
but are merely consequences of the more violent con-
ditions of it. In the bodies of those who have died,
various morbid affections have been discovered in the
internal parts. Most of the viscera of the abdomen
have been found to be preternaturally enlarged. The
lungs have also been found in a morbid state, seeming-
ly from some inflammation that had come on towards
the end of the disease. The brain has been common-
ly found in a flaccid state, with effusions of a serous
fluid into its cavities. Very universally the bones
have been found very soft. and so much softened as to
readily cut by a knife. The fluids have been always
found in a dissolved state, and the muscular parts very
soft and tender ; and the whole of the dead body with-
out any degree of that rigidity which is so common
in almost all others.
MDCCXXV.
From these circumstances of the disease, it seems to
consist in a deficiency of that matter which should
form the solid parts of the body. This especially ap-
pears in the faulty state of ossification, seemingly de-
pending upon the deficiency of that matter which
should be deposited in the membranes which are des-
tined 

361 OF PHYSIC. 
stined to become bony, and should give them their
due firmness and bony hardness. It appears that this
matter is not supplied in due quantity ; but that, in
place of it, a matter fitted to increase their bulk, par-
ticularly in the epiphyses, is applied too largely.
What this deficiency of matter depends upon, is diffi-
cult to be ascertained. It may be a fault in the organs
of digestion and assimilation, which prevents the flu-
ids in general from being properly prepared: or it
may be a fault in the organs of nutrition, which pre-
vents the secretion of a proper matter to be applied.
With respect to the latter, in what it may consist, I
am entirely ignorant, and cannot even discern that
such a condition exists : but the former cause, both
in its nature and existence, is more readily perceived;
and it is probable that it has a considerable influence in
the matter; as in rachitic persons a thinner state of the
blood, both during life and after death, so commonly
appears. It is this state of the fluids, or a deficiency
of bony matter in them,, that I consider as the proxi-
mate cause of the disease; and which again may in
some measure depend upon a general laxity and debi-
lity of the moving fibres of the organs that perform
the functions of digestion and assimilation.
MDCCXXVI
There is, however, some thing still wanting to explain,
why these circumstances discover themselves at a par-
ticular 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 should proceed in a certain manner, and
that certain functions should be exercised at a certain
period of life only ; so it has generally provided, that
at that period, and not sooner, the body should be fit-
ted for the exercise of the functions suited to it. To
apply this to our present subject, Nature seems to have
intended that children should walk only at twelve
Vol. II. Z z months

362 PRACTICE  
months old; and accordingly has provided, that against
that age, and no sooner, a matter should be prepared
fit to give that firmness to the bones which is necessary
to prevent their bending too easily under the weight
of the body. Nature, however, is not always steady
and exact in executing her own purposes; and if
therefore the preparation of bony matter shall not have
been made against the time there is particular occasi-
on for it, the disease of rickets, that is, of soft and flex-
ible bones, must come on ; and will discover itself about 
the particular period we have mentioned. Further, it
will be equally probable, that if at the period menti-
oned the bones shall have acquired their due firmness,
and that nature goes on in preparing and supplying the
proper bony matter, it may be presumed, that against
the time a child is two years old, such a quantity of
bony matter will be applied as to prevent the bones
from becoming again soft and flexible during the rest
of life ; unless it happens, as indeed it sometimes does,
that certain causes occur to wash out again the bony
matter from the membranes in which it had been de-
posited. The account I have now given of the period
at which the rickets occur, seems to confirm the opi-
nion of its proximate cause being a deficiency of bo-
ny matter in the fluids of the body,
MDCCXXVII.
It has been frequently supposed, that a siphylitic
taint has a share in producing rickets ; but such a
supposition is altogether improbable. If our opinion
of the rickets having existed in Europe before the si- 
phylis was brought into it, be well founded, it will
then be certain that the disease may be occasioned
without any siphylitic acrimony having a share in its
production. But further, when a siphylitic acrimony
is transmitted from the parent to the offspring, the
symptoms do not appear at a particular time of life on-
ly, and commonly more early than the period of rick-
ets; 

363 OF PHYSIC.
ets; the symptoms also are very different from those
of rickets, and unaccompanied with any appearance of
the latter : and, lastly, the symptoms of siphylis are
cured by means which, in the case of rickets, have ei-
ther no effect, or a bad one. It may indeed possibly
happen, that siphylis and rickets may appear in the
same person ; but it is to be considered as an accident-
al complication : and the very few instances of it that
have occurred, are by no means sufficient to esta-
blish any necessary connection between the two dis-
eases.
MDCCXXVIII.
With respect to the deficiency of bony matter,
which I consider as the proximate cause of rickets,
some further conjectures might be offered concerning
its remote causes ; but none of them appear to me ve-
ry satisfying; and whatever they might be, it appears
to me they must again be resolved into the supposition
of a general laxity and debility of the system.
MDCCXXIX.
It is upon this supposition almost alone that the
cure of rickets has entirely proceeded. The remedies
have been such especially as were suited to improve
the tone of the system in general, or of the stomach in
particular: and we know that the latter are not only
suited to improve the tone of the stomach itself, but
by that means to improve also the tone of the whole
system.
MDCCXXX.
Of tonic remedies, one of the most promising seems
to have been cold bathing; and I have found it the
most powerful in preventing the disease. For a long
time past, it has been the practice in this country,
with people of all ranks, to wash 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
Z z 2 dipped 

PRACTICE 364
dipped entirely in cold water every morning: and
wherever this practice has been pursued, I have not
met with any instance of rickets. Amongst our com-
mon people, although they wash their children with
cold water only, yet they do not so commonly practise
immersion: and when amongst these I meet with in-
stances of rickets, I prescribe cold bathing; which ac-
cordingly has often checked the progress of the dis-
ease, and sometimes seems to have cured it entirely.
MDCCXXXI.
The remedy of Ens Veneris, recommended by Mr.
Boyle, and since his time very universally employed,
is to be considered as entirely a tonic remedy. That
or some other preparation of iron I have almost con-
stantly employed, though not indeed always with
success. I have been persuaded, that the ens veneris
of Mr. Boyle, notwithstanding his giving it this appel-
lation, was truly a preparation of iron, and no other
than what we now name the Flores Martiales* : but
it appears, that both Benevoli and Buchner have em-
ployed a preparation of copper; and I am ready to
believe it to be a more powerful tonic than the prepa-
rations of iron §.
MDCCXXXII.
Upon the supposition of tonic remedies being pro-
per
* The dose of this medicine is from four to twenty grains, it
must be given in the form of a bolus. The young practitioner
ought to beware of preferring flores martiales in pills, which will
swell and crumble to pieces if they are not composed of a consider-
able quantity of some gummi resin.
The Flores martiales, may be very conveniently given in a tincture
of proof spirit. There is a formula of it in the last London Phar-
macopœia, under the name of Tinctura ferri Ammoniacalis. The
dose of it is a tea-spoonful in a wine glass of cold water, and it is a
very elegant form of administering chalybeates.
§ Copper is a very dangerous remedy, as was mentioned above in
the notes on article 1336. The Author had a very high opinion of
copper as a tonic. 

365 OF PHYSIC. 
per in this disease, I have endeavoured to employ the
Peruvian bark : but from the difficulty of administer-
ing it to infants in any useful quantity, I have not
been able to discover its efficacy ; but I am very ready
to believe the testimony of De Haen upon this sub-
ject*.
MDCCXXXIII.
Exercise, which is one of the most powerful tonics,
has been properly recommended for the cure of rick-
ets ; and as the exercise of gestation only can be em-
ployed, it should always be, with the child laid in a
horizontal situation ; as the carrying them or moving
them in any degree of an erect posture, is very apt to
occasion some distortion. It is extremely probable,
that, in this disease, friction with dry flannels may be
found an useful remedy.
MDCCXXXIV.
It is also sufficiently probable, that the avoiding of
moisture is not only advisable, but may likewise be of
service in the cure of this disease.
There is no doubt that a certain diet may contribute
to the same end ; but what may be the most eligible,
I dare not determine. I have no doubt that leaven-
ed bread may be more proper than unfermented fari-
nacea ; but I cannot find any reason to believe that
strong beer can even be a proper remedy.
Practi-
* It is doubtless difficult to make children swallow a sufficient quan-
tity of bark to produce any good effects, yet it is not impossible.
The formula best adapted for children, is the powder of the extract ;
but as it sometimes occasions constipation, this effect must be guarded
against by some proper laxatives, especially by Rhubarb given either
with the bark or separately. The following formula is a proper dose
for a child of two years old, to be repeated twice a-day ;
ꝶ. Extr. Cort. Peruv. dur. gr. viii.
Pulv. Rad. Rhei. gr. x.
Sacch. alb. gr. xv.
M. f. pulv. 

366 PRACTICE
Practitioners have been divided in opinion concern-.
ing the use of milk in this disease. Zeviani, perhaps
from theory, condemns the use of it; but Benevoli
employed it without its impeding the cure of the dis-
ease. This last I have often remarked in the course of
my own practice. As it is difficult to feed children
entirely without milk ; so I have commonly admitted
it as a part of the diet of rickety children ; and in ma-
ny instances I can affirm, that it did not prevent the
cure of the disease. In cases, however, of any appear-
ance of rickets, and particularly of a slow dentition, I
have dissuaded the continuance of a child upon the
breast; because the milk of women is a more watery
nourishment than that of cows: and I have especially
dissuaded the continuing a child upon the breast,
when I thought the nurse gave rather too much of
such a watery nourishment; for, as has been above
mentioned, I have had frequent occasion to suspect,
that the milk of such nurses has a tendency to favour
the coming on of rickets*.
MDCCXXXV.
Besides the remedies and regimen now mentioned,
practitioners have commonly employed in this disease,
both emetics and purgatives. When the appetite and
digestion are considerably impaired, vomiting, if nei-
ther violent nor frequently repeated, seems to be of
service ; and, by a moderate agitation of the abdomi-
nal viscera, may in some measure obviate the stagna-
tion and consequent swelling that usually occur in
them.
As the tumid state of the abdomen, so constantly to
be met with in this disease, seems to depend very much
upon a tympanitic affection of the intestines : so, both
by obviating this, and by deriving from the abdomi-
nal viscera, frequent gentle purgatives may be of ser-
vice.
* How does this accord with the last sentence of article 1722. 

367 OF PHYSIC. 
vice. Zeviani, perhaps properly, recommends in par-
ticular rhubarb ; which, besides its purgative quality,
has those also of bitter and astringent.
MDCCXXXVI.
I have now mentioned most of the remedies com-
monly employed by the practitioners of former times ;
but I must not omit mentioning some others that have
been lately suggested. The late Mr. De Haen re-
commends the testacea; and assures of their having
been employed with success; but in the few trials
which I have had occasion to make, their good effects
did not appear.
The late Baron Van Swieten gives us one instance
of rickets cured by the use of hemlock ; but I do not
know that the practice has been repeated.
BOOK III.
OF THE
IMPETIGINIS;
OR
DEPRAVED HABIT, WITH AFFECTIONS OF
THE SKIN.
MDCCXXXVII.
I FIND it difficult to give any sufficiently correct
and proper character of this order. The diseases
comprehended under it, depend, for the most part, up-
on a depraved state of the whole of the fluids, produc- 
ing

68 PRACTICE 
ing tumours, eruptions, or other preternatural affec-
tions of the skin. Although it be extremely difficult
to find a general character of the order that will ap-
ply to each of the genera and species, I shall here treat
of the principal genera which have been commonly
comprehended under this order, and which I have
enumerated in my Nosology.
CHAP. I.
OF SCROPHULA, OR THE KING's EVIL.
MDCCXXXVIII.
THE character of this disease I have attempted in
my Nosology : but it will be more properly
taken from the whole of its history, now to be deliver-
ed.
MDCCXXXIX.
It is commonly, and very generally, a hereditary
disease; and although it sometimes may, yet it rarely
appears, but in children whose parents had at some
period of their lives been affected with it. Whether
it may not fail to appear in the children of scrophu-
lous parents, and discover itself afterwards in their
offspring in the succeeding generation, I cannot cer-
tainly determine; but believe that this has frequently
happened. It appears to me to be derived more com-
monly from fathers than from mothers; but whether
this happens from there being more scrophulous men
than scrophulous women married, I am not certain.
With respect to the influence of parents in produc-
ing this disease, it deserves to be remarked, that in a
family of many children, when one of the parents has
been 

369 OF PHYSIC. 
been affected with scrophula, and the other not;
as it is usual for some of the children to be in con-
ftitution pretty exactly like the one parent, and others
of them like the other; it commonly happens, that
those children who most resemble the scrophulous pa-
rent become affected with scrophula, while those re-
sembling the other parent entirely escape.
MDCCXL.
The scrophula generally appears at a particular pe-
riod of life. It seldom appears in the first, or even in
the second year of a child's life ; and most commonly
it occurs from the second, or, as some alledge, and per-
haps more properly, from the third, to the seventh
year. Frequently, however, it discovers itself at a
later period ; and there are instances of its first appear-
ance, at every period till the age of puberty; after
which, however, the first appearance of it is very
rare.
MDCCXLI.
When it does not occur very early, we can general-
ly distinguish the habit of body peculiarly disposed to
it. It most commonly affects children of soft and
flaccid habits, of fair hair and blue eyes ; or at least
affects those much more frequently than those of an
opposite complexion. It affects especially children of
smooth skins and rosy cheeks; and such children have
frequently a tumid upper lip, with a chop in the mid-
dle of it; and this tumour is often considerable, and
extended to the columna nasi and lower part of the
nostrils. The disease is sometimes 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 those who, by a protuberant fore-
head, by tumid joints, and a tumid abdomen, show
that they had some rachitic disposition. In parents
who, without having had the disease themselves, seem
to produce scrophulous children, we can commonly
Vol. II. 3 A per- 

370 PRACTICE
perceive much of the same habit and constitution that
has been just now described.
Some authors have supposed that the small-pox has
a tendency to produce this disease ; and Mr. De Haen
asserts its following the inoculated, more frequently
than the natural small-pox. This last position, how-
ever, we can confidently affirm to be a mistake; al-
though it must be allowed, that in fact the scrophula
does often come on immediately after the small-pox.
It is, however, difficult to find any connection between
the two diseases. According to my observation, the
accident only happens in children who have pretty
manifestly the scrophulous disposition ; and I have had
several instances of the natural small-pox coming up-
on children affected at the same time with scrophula,
not only without this disease being any ways aggravat-
ed by the small-pox, but even of its being for some
time after much relieved.
MDCCXLII.
The scrophula generally shows itself first at a par-
ticular season of the year; and at some time between
the winter and summer solstice ; but commonly long
before the latter period. It is to be observed further,
that the course of the disease is usually connected with
the course of the seasons. Whilst the tumours and
ulcerations peculiar to this disease, appear first in the
spring, the ulcers are frequently healed up in the
course of the succeeding summer, and do not break out
again till the ensuing spring, to follow again with the
season the same course as before.
MDCCXLIII.
Frequently the first appearance of the disease is the
tumid and chopped lip above mentioned. Upon other
occasions, the first appearance is that of small spheri-
cal or oval tumours, moveable under the skin. They
are soft, but with some elasticity. They are without
pain; and without any change in the colour of the
skin. 

371 OF PHYSIC. 
skin; In this state they often continue for a long
time; even for a year or two, and sometimes longer. 
Most commonly they first appear upon the sides of
the neck below the ears; but sometimes also under
the chin. In either case, they are supposed to affect
in these places the conglobate or lymphatic glands
only : and not at all the salivary glands, till the dis-
ease is very greatly advanced. The disease frequently
affects, and even at first appears in, other parts of the
body. In particular, it affects the joints of the elbows
and ankles, or those of the fingers and toes. The ap-
pearances about the joints are not commonly, as else-
where, small moveable swellings; but a tumour almost
uniformly surrounding the joint, and interrupting its
motion.
MDCCXLIV.
These tumours, as I have said, remain for some time
little changed ; and, from the time they first appear
in the spring, they often continue in this way till the
return of the same season in the next, or perhaps the
second year after. About that time, however, or per-
haps in the course of the season in which they first ap-
pear, the tumour becomes larger and more fixed ; the
skin upon it requires a purple, Seldom a clear redness :
but growing redder by degrees, the tumour becomes
softer, and allows the fluctuation of a liquid within to
be perceived. All this process, however, takes place
with very little pain attending it. At length some
part of the skin becomes paler ; and by one or more
small apertures a liquid is poured out.
MDCCXLV.
The matter poured out has at first the appearance of
pus, but it is usually of a thinner kind than that from
phlegmonic abscesses ; and the matter as it continues
to be discharged, becomes daily less purulent, and ap-
pears more and more a viscid serum, intermixed with
small pieces of a white substance resembling the curd
of milk. By degrees the tumour almost entirely sub-
3 A 2 sides 

372 PRACTICE
sides while the ulcer opens more, and spreads broad- 
er : unequally, however, in different directions, and
therefore is without any regular circumscription.— 
The edges of the ulcer are commonly flat and smooth,
both on their outside and their inner edge, which sel-
dom puts on a callous appearance. The ulcers, how-
ever, do not generally spread much, or become deep-
er ; but at the time their edges do not advance, or put
on any appearance of forming a cicatrix.
MDCCXLVI.
In this condition the ulcers often continue for a
long time; while new tumours, with ulcers succeed-
ing them in the manner above described, make their
appearance in different parts of the body. Of the
first ulcers, however, some heal up, while other tu-
mours and ulcers appear in their vicinity, or in other
parts of the body ; and in this manner the disease
proceeds, some of the ulcers healing up, at least to a
certain degree, in the course of summer, and breaking
out again in the succeeding spring ; or it continues,
by new tumours and ulcers succeeding them, in the
spring season, making their appearance successively for 
several years.
MDCCXLVII.
In this way the disease goes on for several years;
but very commonly in four or five years it is spontane-
ously cured, the former ulcers being healed up, and
no new tumours appearing ; and thus at length the
disease ceases entirely, leaving only some indelible
eschars, pale and smooth, but in some parts shrivelled;
or, where it had occupied the joints, leaving the mo-
tion of these impaired, or entirely destroyed.
MDCCXLVIII.
Such is the most favourable course of this disease ;
and with us, it is more frequently such, than other-
wise : but it is often a more violent, and sometimes a
fatal malady. In these cases, more parts of the body
are 

373 OF PHYSIC. 
are at the same time affected ; the ulcers also seeming
to be imbued with a peculiar sharp acrimony, and
therefore becoming more deep, eroding, spreading, as
well as seldomer healing up. In such cases, the eyes
are often particularly affected. The edges of the eye-
lids are affected with tumour and superficial ulcera-
tions ; and these commonly excite obstinate inflamma-
tion in the adnata, which frequently produces an opa-
city of the cornea.
When the scrophula especially affects the joints, it
sometimes produces there considerable tumours ; in
the abscesses following which, the ligaments and car-
tilages are eroded, and the adjoining bones are affect-
ed with a caries of a peculiar kind. In these cases,
also, of more violent scrophula, while every year pro-
duces a number of new tumours and ulcers, their acri-
mony seems at length to taint the whole fluids of the
body, occasioning various disorders; and particularly
a hectic fever, with all its symptoms, which at length
proves fatal, with sometimes the symptoms of phthisis
pulmonalis.
MDCCXLIX.
The bodies of persons who have died of this disease
show many of the viscera in a very morbid state ; and
particularly most of the glands of the mensentery
very much tumefied, and frequently in an ulcerated
state. Commonly also a great number of tubercles
or cysts, containing matter of various kinds, appear in
the lungs.
MDCCL.
Such is the history of the disease ; and from thence
it may appear, that the nature of it is not easily to be
ascertained. It seems to be a peculiar affection of the
lymphatic system ; and this in some measure accounts
for its connection with a particular period of life.
Probably, however, there is a peculiar acrimony of the
fluids that is in the proximate cause of the disease; al-
though 

374 PRACTICE 
though of what nature this is, has not yet been disco-
vered. It may perhaps be generally diffused in the
system, and exhaled into the several cavities and cellu-
lar texture of the body : and therefore, being taken
up by the absorbents, may discover itself especially in
the lymphatic system. This, however, will hardly
account for its being more confined to that system,
than happens in the case of many other acrimonies
which maybe supposed to be as generally diffused.—
In short, its appearance in particular constitutions, and
at a particular period of life, and even its being a
hereditary disease, which so frequently depends upon
the transmission of a peculiar constitution, are air of
them circumstances which lead me to conclude, upon
the whole, that this disease depends upon a peculiar
constitution of the lymphatic system.
MDCCLI
It seems proper to observe here, that the scrophula,
does not appear to be a contagious disease; at least I
have known many instances of sound children having
had frequent and close intercourse with scrophulous,
children without being infected with the disease. This,
certainly shows, that in this disease the peculiar acri-
mony of it is not exhaled from the surface of the body,
but that it depends especially upon a peculiar consti-
tution of the system.
MDCCLII.
Several authors have supposed the scrophula to have
been derived from the venereal disease ; but upon no
just grounds that I can perceive. In very many in-
stances, there can hardly be any suspicion of the pa-
rents producing this disease having been imbued with
siphylis to their offspring, in whom, however, no scro-
phulous symptoms at any time afterwards appeared.
Further, the symptoms of the two diseases are very dif-
ferent ; and the difference of their natures appear par-
ticularly from hence, that while mercury commonly
and 

375 OF PHYSIC. 
and readily cures the siphylis, it does no service in
scrophula, and very often rather aggravates the dis-
ease.
MDCCLIII.
For the cure of scrophula, we have not yet learned
any practice that is certainly or even generally success-
ful.
The remedy which seems to be the most successful,
and which our practitioners especially trust to and
employ, is the use of mineral waters; and indeed the
washing out, by means of these, the lymphatic system,
Would seem to be a measure promising success : but in
very many instances of the use of these waters, I have
not been well satisfied that they had shortened the du-
ration of the disease more than had often happened
when no such remedy had been employed.
MDCCLIV.
With regard to the choice of the mineral waters
most fit for the purpose, I cannot with any confidence
give an opinion
Almost all kinds of mineral waters, whether chaly-
beate, sulphureous, or saline, have been employed for
the cure of scrophula, and seemingly with equal suc-
cess and reputation : a circumstance which leads me to
think, that, if they are ever successful, it is the ele-
mentary water that is the chief part of the remedy.
Of late, sea-water has been especially recommend-
ed and employed; but after numerous trials, I cannot
yet discover its superior efficacy.
MDCCLV
The other remedies proposed by practical writers
are very numerous; but, upon that very account, I
apprehend they are little to be trusted: and as I can-
not perceive any just reason for expecting success from
them, I have very seldom employed them.
Of late, the Peruvian bark has been much recom-
mended : and as in scrophulous persons there are ge-
nerally 

376 PRACTICE 
nerally some marks of laxity and flaccidity, this tonic
may possibly be of service; but in a great variety of
trials, I have never seen it produce any immediate cure
of the disease.
In several instances, the leaves of colts-foot have
appeared to me to be successful. I have used it fre-
quently in a strong decoction, and even then with ad-
vantage : but have found more benefit from the ex-
pressed juice, when the plant could be had in somewhat
of a succulent state, soon after its first appearance in the
spring. MDCCLVI.
I have also frequently employed the hemlock, and
have sometimes found it useful in discussing obstinate
swellings: but in this, it has also often disappointed
me : and I have not at any time observed that it dis-
posed scrophulous ulcers to heal.
I cannot conclude the subject of internal medicines
without remarking, that I have never found either
mercury or antimony, in any shape, of use in this dis-
ease; and when any degree of a feverish state had
come on, the use of mercury proved manifestly hurtful
MDCCLVII.
In the progress of scrophula, several external medi-
cines are requisite. Several applications have been
used for discussing the tumours upon their first com-
ing on; but hitherto my own practice, in these re-
spects, has been attended with very little success.—
The solution of the saccharum saturni has seemed to
be useful; but it has more frequently failed : And I
have had no better success with the spiritus Mindereri.
Fomentations of every kind have been frequently
found to do harm; and poultices seem only to hurry
on a suppuration. I am doubtful if this last be ever
practised with advantage; for scrophulous tumours
sometimes spontaneously disappear, but never after a-
ny degree of inflammation has come upon them ; and
therefore poultices, which commonly induce in-
flammation

377 OF PHYSIC 
flammation, prevent that discussion of tumours, which
might otherwise have happened.
Even when scrophulous tumours have advanced to-
wards suppuration, I am unwilling to hasten the spon-
taneous opening, or to make it by the lancet; because
I apprehend the scrophulous matter is liable to be ren-
dered more acrid by communication with the air, and
to become more eroding and spreading than when in
its inclosed state.
MDCCLVIII
The management of scrophulous ulcers has, so far
as I know, been as little successful as that of the tu-
mours. Escharotic preparations, of either mercury or
copper have been sometimes useful in bringing on a
proper suppuration, and thereby disposing the ulcer to
heal; but they have seldom succeeded, and more com-
monly they have caused the ulcer to spread more. The
escharotic from which I have received most benefit:
is burnt alum, and a portion of that mixed with a
mild ointment, has been as useful an application as a-
ny I have tried. The application, however, that I
have found most serviceable and very universally ad-
missible, 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 sore.
They are therefore to be changed frequently during
the day ; and a cloth spread with a mild ointment or
plaister may be applied for the night. In this prac-
tice I have sometimes employed sea-water; but gene-
rally it proved too irritating; and neither that nor any
mineral water has appeared to be of more service than
common water.
MDCCLIX.
To conclude what I have to offer upon the cure of
scrophula, I must observe, that cold bathing seems to
have been of more benefit than any other remedy
that I have had occasion to see employed.
Vol. II. 3 B CHAP. 

373 PRACTICE 
CHAP. II.
OF SIPHILIS, OR THE VENEREAL DISEASE.
MDCCLX.
AFTER practitioners have had so much experi-
ence in treating this disease, and after so many
books have been published upon the subject, it does
not seem necessary, or even proper, for me to attempt
any full treatise concerning it; and I shall therefore
confine myself to such general remarks, as may serve
to illustrate some parts of the pathology or of the
practice.
MDCCLXI.
It is sufficiently probable, that, anciently, in certain
parts of Asia, where the leprosy prevailed, and in Eu-
rope after that disease had been introduced into it, a
disease of the genitals, resembling that which now
commonly arises from siphylis, had frequently appear-
ed : but it is equally probable, that a new disease, and
what we at present term Siphylis, was first brought in-
to Europe about the end of the fifteenth century; and
that the distemper now so frequently occurring, has
been very entirely derived from that which was im-
ported from America at the period mentioned*.
MDCCLXII.
* Various opinions have been held by different physicians about
the origin of this disease ; some supposing it to have existed in the
old world, while others think it was imported from the new world,
discovered by Columbus. The dispute produced many controversial
traces, from the perusal of which, the young practitioner can gain
little advantageous knowledge. All that we certainly know about
the origin of the disease is, that it was first observed among the French,
when they were at Naples in the year 1493, and that it was brought
into France by the French who returned thither with Charles. Co-
lumbus landed at Palos on the 15th of March in the same year, on
his return from his first voyage. The disease therefore, if imported
by Columbus's crew must have spread rapidly through Europe. 

OF PHYSIC. 379
MDCCLXII.
This disease, at least in its principal circumstances,
never arises in any person but from some communi-
cation with a person already affected with it. It is
most commonly contracted in consequence of coition
with an infected person ; but in what manner the in-
fection is communicated, is not clearly explained. I
am persuaded, that in coition, it is communicated
without there being any open ulcer either in the per-
son receiving the infection; but in all other cases, I
believe it is never communicated in any other way
than by a contact of ulcer, either in the person com-
municating, or in the person receiving the infection.
MDCCLXIII.
As it thus arises from the contact of particular parts,
so it always appears first in the neighbourhood of the
parts to which the infecting matter had been immedi-
diately applied; and therefore, as most commonly
contracted by coition, it generally appears first in the
genitals.
MDCCLXIV.
After its first appearance in particular parts, more
especially when these are the genitals of either sex, its
effects for some time seem to be confined to these
parts; and indeed, in many cases, never extends fur-
ther. In other cases, however, the infecting matter
passes from the parts first affected, and from the geni-
tal, therefore, into the blood-vessels ; and being there
diffused, produces disorders in many other parts of
the body.
From this view of the circumstances, physicians
have very properly distinguished the different states of
the disease, according as they are local or are more
universal. To the former, they have adapted appella-
tions suited to the manner in which the disease ap-
pears; and to the other the general affection, they 
have almost totally confined the appellations of Siphy-
3 B 2 lis,

380 PRACTICE 
lis, Lues Venerea, or Pox. In the remarks I am now
to offer, I shall begin with considering the local affec-
tion.
MDCCLXV.
This local affection appears chiefly in the form of
gonorrhœa or chancre.
The phenomena or gonorrhœa, either upon its first
coming on or in its after progress, or the symptoms of
ardor urinæ, chordee, or others attending it, it is not
necessary for me to describe. I shall only here observe,
that the chief circumstance to be taken notice of, is
the inflamed state of the urethra, which I take to be
inseparable from the disease.
MDCCLXVI
In these well-known circumstances, the gonorrhœa
continues for a time longer or shorter, according to
the constitution of the patient; it usually remaining
longest in the most vigorous and robust, or according
to the patient's regimen, and the care taken to relieve
or cure the disease. In many cases, if by a proper re-
gimen the irritation of the inflamed state is carefully
avoided, the gonorrhœa spontaneously ceases, the
symptoms of inflammation gradually abating, the mat-
ter discharged becoming of a thicker and more viscid
consistence, as well as of a whiter colour ; till at
length, the flow of it ceases altogether ; and whether
it be thus cured spontaneously, or by art, the disease
often exists without communicating any infection to
the other parts of the body.
MDCCLXVII.
In other cases, however, the disease having been
neglected, or by an improper regimen aggravated, it
continues with all its symptoms for a long time; and
produces various other disorders in the genital parts,
which, as commonly taken notice of by authors, need
not be described here. I shall only observe, that the
inflammation of the urethra, which at first seems to
be 

OF PHYSIC. 381
be seated chiefly, or only, in its anterior parts, is in
such neglected and aggravated cases spread upwards
along the urethra, even to the neck of the bladder.
In these circumstances, a more considerable inflam-
mation is occasioned in certain parts of the urethra;
and consequently, suppuration and ulcer are produc-
ed, by which the venereal poison is sometimes com-
municated to the system, and gives rise to a general
siphylis.
MDCCLXVIII.
It was some time ago a pretty general supposition,
that the gonorrhœa depended always upon ulcers of
the urethra, producing a discharge of purulent mat-
ter; and such ulcers do indeed some times occur in
the manner that has been just now mentioned. We
are now assured, however, from many dissections of
persons who had died when labouring under a gonor-
rhœa, that the disease may exist, and from many con-
siderations it is probable that it commonly does exist,
without any ulceration of the urethra ; so that the dis-
charge which appears, is entirely that of a vitiated mu-
cus from the mucous follicles of the urethra.
MDCCLXIX,
Although most of the symptoms of gonorrhœa
should be removed, yet it often happens that a mu-
cous fluid continues to be discharged from the urethra
for a long time after, and sometimes for a great part
of a person's life. This discharge is what is common-
ly called a Gleet.
With respect to this, it is proper to observe, that in
some cases, when it is certain that the matter discharg-
ed contains no venereal poison, the matter may, and
often does, put on that puriform appearance, and that
yellow and greenish colour, which appears in the dis-
charge at the beginning and during the course of vi-
rulent gonorrhœa. These appearances in the matter
of a gleet, which before had been of a less coloured 
kind,

382 PRACTICE  
kind, have frequently given occasion to suppose that a
fresh infection had been received : but I am certain
that such appearances may be brought on by, per-
haps, various other causes; and particularly, by in-
temperance in venery and drinking concurring toge-
ther. I believe, indeed, that this seldom happens to
any but those who had before frequently laboured
under a virulent gonorrhœa, and have more or less of
gleet remaining with them: but I must also observe,
that in persons who at no period of their life had ever
laboured under a virulent gonorrhœa, or any other
symptom of siphylitic affection, I have met with in-
stances of discharges from the urethra resembling
those of a virulent gonorrhœa.
The purpose of these observations is, to suggest to
practitioners what I have not found them always aware
of, that in persons labouring under a gleet, such a re-
turn of the appearances of a virulent gonorrhœa may
happen without any new infection having been receiv-
ed, and consequently not requiring the treatment
which a new infection might perhaps demand. When,
in the cure of gonorrhœa, it was the practice to em-
ploy purgatives very frequently, and sometimes those
of the drastic kind, I have known the gleet, or spuri-
ous gonorrhœa, by such a practice much increased
and long continued, and the patient's constitution ve-
ry much hurt. Nay in order more certainly further
to prevent mistakes, it is to be observed, that the spu-
rious gonorrhœa is sometimes attended with heat of
urine, and some degree of inflammation ; but these
symptoms are seldom considerable, and, merely by
the assistance of a cool regimen, commonly disappear
in a few days.
MDCCLXX.
With respect to the cure of a virulent gonorrhœa,
I have only to remark, that if it be true, as I have men-
tioned above, that the disease will often, under a pro-
per 

383 OF PHYSIC. 
per regimen, be spontaneously cured; and that the
whole of the virulent matter may be thus entirely
discharged without the assistance of art; it would
seem that there is nothing required of practitioners,
but to moderate and remove that inflammation which
continues the disease, and occasions all the trouble-
some symptoms that ever attend it. The sole bu-
siness therefore of our art in the cure of gonorrhœa, is
to take off the inflammation accompanying it: and
this I think may commonly be done, by avoiding ex-
ercise, by using a low and cool diet, by abstaining en-
tirely from fermented and spirituous liquors, and by
taking plentifully of mild diluent drinks.*
MDCCLXXI
* This simple method of curing a gonorrhœa is, in many cases,
sufficient, but it can only be depended on when the disease is light
and the patient of a healthy constitution. As every virulent gonor-
rhœa is evidently produced by the action of the venereal poison, the
judicious practitioner will seldom trust to this method without the
use of mercurials after the inflammatory symptoms have been some
what subdued. They ought to be given in such cases in very small
quantities, so as to produce only a slight effect on the mouth ; and
their use ought to be continued till every symptom disappears.
Mercury may be used internally or externally as occasion may re-
quire; if it does not affect the bowels nor purge, the common mer-
curial pill of the Edenburgh pharmacopœa is as good a formula as
any we have in the shops. It's dose must be regulated by the effects
it produces. In general, we begin with a four grain pill every night, 
and continue that quantity till the gums be slightly affected, or a
coppery taste be perceived in the mouth. When either of these
symptoms appear, we are certain that the mercury is received, in a
sufficient quantity, into the general mass of the blood, for destroying
the venereal virus, and then a pill may be given once in two or three
days, so as to keep up the same slight affection of the mouth, but
without increasing it. If the pill purges, we then are to have re-
course to the strong mercurial ointment, half a dram of which must
be rubbed into the hams night and morning, till the mouth be af-
fected in the manner above described.
The patient ought to wear flannel drawers during the whole time
of the continuing the rubbing, which ought to be regulated by the
degree of affection perceived in the mouth. The use either of the
pill or of friction must be continued eight or ten days after every
symptom of the disease has disappeared. 

384 PRACTICE 
MDCCLXXI.
The heat of urine, which is so troublesome in this 
disease, as it arises from the increased sensibility of the
urethra in its inflamed state ; so, on the other hand, the
irritation of the urine has the effect of increasing the
inflammation, and is therefore to be removed as soon
as possible. This can be done most effectually by tak-
ing in a large quantity of mild watery liquors. De-
mulcents may be employed; but unless they be ac-
companied with a large quantity of water, they will-
have little effect.* Nitre has been commonly employ-
ed as a supposed refrigerant: but, from much obser-
vation, I am convinced, that in a small quantity it is
useless, and in a large quantity certainly hurtful*; and
for this reason, that every saline matter passing with
the urine generally gives some irritation to the urethra.
To prevent the irritation of the urethra arising from
its increased sensibility, the injection of mucilage or of
mild oil into it has been practised ; but I have seldom
found this of much service.
MDCCLXXII.
In gonorrhœa, as constiveness may be hurtful, both
by an irritation of the system in general, and of the
urethra in particular, as this is occasioned always by the
avoiding of hardened fæces ; so constiveness is to be
carefully avoided or removed ; and the frequent use of
large glysters of water and oil, I have found of remar-
kable benefit in this disease. If glysters, however, do
not
* Lintseed-tea, a very thin decoction of marsh-mallow root, or
thin barley-water, will, in most cases, answer the intention sufficient-
ly well. The common almond emulsion has been recommended in
these cases, and when taken in large quantities is certainly very effica-
cious. It may be used as the patient's common drink.
† The use of nitre has been strongly recommended by many practi-
cal writers, in cases of simple gonorrhœa accompained with this symp-
tom ; but it must be acknowledged, (as the author justly observes,)
to be hurtful by it's irritating quality. It is certainly a refrigerant, 

385 OF PHYSIC. 
not entirely obviate costiveness, it will be necessary to
give laxatives by the mouth : which, however, should
be of the mildest kind, and should do no more than
keep the belly regular and a little loose, without much
purging*.
The practice of frequent purging, which was for-
merly so much in use, and is not yet entirely laid aside,
has always appeared to me to be generally superfluous,
and often very hurtful. Even what are supposed to
be cooling purgatives, such as Glauber's salt, soluble
tartar, and crystals of tartar, in so far as any part of them
pass by urine, they, in the same manner as we have said of
nitre, may be hurtful; and so far as they produce very li-
quid stools, the matter of which is generally acrid, they ir-
ritate the rectum, and consequently the urethra. This
last effect, however, the acrid, and in any degree dras-
tic, purgatives, more certainly produce.
MDCCLXXIII.
In cases of a gonorrhœa attended with violent inflam-
mation, blood-letting may be of service; and in the
case of persons of a robust and vigorous habit, in whom
the disease is commonly the most violent, blood-letting
may be very properly employed. As general bleed-
ings, however, when there is no phlogistic diathesis in
the system, have little effect in removing topical in-
flammation ; so in gonorrhœa, when the inflammation
is considerable, topical bleeding applied to the urethra
Vol. II. 3 C by
and as such is allaying the inflammatory symptoms; but it is inad-
missible in cases where the ardor urinæ is violent.
* A tea-spoonful of the following electuary taken occasionally
will keep the belly sufficiently open.
ꝶ. Pulv. Jalap. ʒi.
Nitri. ℥ii.
Elect. Lenitiv. ℥i.
Syr. Simpl. q, s.
M. f. Elect. 

386 PRACTICE
by leeches, is generally more effectual in relieving the
inflammation*.
MDCCLXXIV.
When there is any phymosis attending a gonorrhœa,
emolient fomentations applied to the whole penis are
often of service. In such cases it is necessary, and in
all others useful, to keep the penis laid up to the bel-
ly, when the patient either walks about or is sitting§.
MDCCLXXV.
Upon occasion of frequent priapism and chordee, it
has been found useful to apply to the whole of the pe-
nis a poultice of crumb of bread moistened with a
strong solution of sugar of lead. I have, however,
been often disappointed in this practice, perhaps by the
poultice keeping the penis too warm, and thereby
exciting the very symptoms I wished to prevent.
Whether lotions of the external urethra with a solution
of the sugar of lead, might be useful in this case, I have
not properly tried†.
MCCCLXXVI.
With respect to the use of injections, so frequently
employed in gonorrhœa, I am persuaded that the early
use of astringent injections is pernicious ; not by oc-
casioning
* The good effects of leeches in these cases are confirmed by ex-
perience. They may be applied on the under side of the penis, and
three or four thus applied have frequently produced amazing effects.
The operation, however, is extremely painful, and is seldom sub-
mitted to a second time by a patient who has once experienced it.
§ In all cases of inflammation of the urethra these emollient ap-
plications give great relief. The common white bread poultice may
be used during the night time or while the patient is in bed; and,
warm flannels impregnated with lintseed-tea while he is sitting up.
† The sugar of lead solution may perhaps be objected against on
account of it's stopping the discharge, and inducing a swelled testicle,
which has sometimes followed it's application. Wrapping the penis
up in linen rags wet with cold water, frequently answers the purpose
of preventing the violence of the symptoms, as well as any more
complicated application. The cold wet rags ought to be renewed
whenever they grow warm. 

387 OF PHYSIC. 
casioning a siphylis, as has been commonly imagined;
but by increasing and giving occasion to all the conse-
quences of the inflammation, particularly to the very
troublesome symptoms of swelled testicles. When,
however, the disease has continued for some time, and
the inflammatory symptoms have very much abated, I
am of opinion, that by injections of moderate astrin-
gency, or at least of this gradually increased, an end
may be sooner put to the disease than would other-
wise have happened ; and that a gleet, so readily oc-
curring, may be generally prevented*.
MDCCLXXVII.
Besides the use of astringent injections, it has been
common enough to employ those of a mercurial kind.
With respect to these, although I am convinced that
3 C 2 the
* The practice of using astringent injections is extremely com-
mon ; but, (as the author justly observes,) their use is frequently at-
tended with disagreeable consequences. In general they do harm
when used during the continuance of the inflammatory symptoms,
or even too soon after these symptoms have disappeared. If, how-
ever, (after the inflammatory symptoms are overcome, and mercury
has been used for six weeks or two months in the manner described
in the note on article 1770,) the running still continues, we may
then have recourse to these astringent injections. They may be made
of sugar of lead and white vitriol well diluted with water as in the
following:
ꝶ. Sacch. Saturn,
Vitriol, alb. ă ă ʒƒs.
Aq. font, ℥viii.
M. et cola per chartam.
Half an ounce of this injection slightly warmed may be thrown
up in the urethra twice a-day ; but if it produce any smarting, it
ought to be diluted with more water,
Solutions of copper have also been used with advantage in these
cases, but they are of so corrosive a nature, as frequently to do harm,
if not very much diluted.
An imprudent or too frequent use of any these injections, especially
if they are too strong or not sufficiently diluted, sometimes inflames
or even excoriates the urethra, and hence much mischief arises. The
cautious practitioner must therefore never use them so strong as to
produce much smarting. 

388 PRACTICE
the infection producing gonorrhœa, and that produc-
ing chancres and siphylis, are one and the same ; yet
I apprehend, that in gonorrhœa mercury cannot be of
use by correcting the virulence of the infection ; and
therefore that it is not universally necessary in this
disease. I am persuaded, however, that mercury ap-
plied to the internal surface of the urethra, may be of
use in promoting the more full and free discharge of
virulent matter from the mucous glands of it. Upon
this supposition, I have frequently employed mercu-
rial injections ; and, as I judge, with advantage ;
those injections often bringing on such a state of the
consistence and colour of the matter discharged, as we
know usually to precede its spontaneous ceasing. I
avoid these injections, however, in recent cases, or
while much inflammation is still present ; but when
that inflammation has somewhat abated, and the dis-
charge notwithstanding still continues in a virulent
form, I employ mercurial injections freely. I employ
those only that contain mercury entirely in a liquid
form, and avoid those which may deposite an acrid
poweder in the urethra. That which I have found 
most useful is a solution of the corrosive sublimate in
water; so much diluted as not to occasion any violent
smarting, but not so much diluted as to give no smart-
ing at all. It is scarce necessary to add, that when
there is reason to suspect there are ulcerations already
formed in the urethra, mercurial injections are not
only proper, but the only effectual remedy that can
be employed.
MDCCLXXVIII.
With regard to the cure of gonorrhœa, I have only
one other remark to offer. As most of the symptoms
arise from the irritation of a stimulus applied, the ef-
fects of this irritation may be often lessened by dimi-
nishing the irritability of the system ; and it is well
known, that the most certain means of accomplishing 
this

389 OF PHYSIC. 
this is by employing opium. For that reason, I con-
sider the practice both of applying opium directly to
the urethra*, and of exhibiting it by the mouth, to
be extremely useful in most cases of gonorrhœa.
MDCCLXXIX.
After thus offering some remarks with respect to go-
norrhœa in general, I might proceed to consider par-
ticularly the various symptoms which so frequently at-
tend it; but it does not seem necessary for me to at-
tempt this after the late publications of Dr. Foart
Simmons, and of Dr. Schwediaur, who have treated
the subject so fully, and with so much discernment
and skill§.
MDCCLXXXI.
* Opium may be very conveniently applied to the urethra by in-
jection ; and for this purpose a diluted solution of opium in water
is preferable to a spirituous or vinous solution. A grain of opium
dissolved in an ounce of water, and the solution drained, may be in-
jected twice or thrice a-day ; and thirty or forty drops of laudanum
may be given every night at bed-time.
§ As a swelled testicle frequently attends a suppressed gonorrhœa,
it may be proper to give the young practitioner some directions con-
cerning the management of it.
Sometimes without any other preceding symptom, but generally
on a premature stopping of a gonorrhœa, a pain is felt in the sper-
matic vessels and epididymis. The pair, continuing, the vessels and
epididymis begin to swell. and the pain and swelling are soon com-
municated to the testicle.
In these cases, we must confine the patient to his bed, bleeding
him if the inflammatory diathesis appears to be universal ; but, if
not, three or four leeches may be applied to the inflamed part. A
brisk purge must be given, for which purpose an ounce of Glauber's
Salt, with a large quantity of water, answers sufficiently well Gold
pledgets soaked in a solution of Sugar of Lead, described in the
note on article 267. must be applied to the Scrotum, and their place
supplied with fresh cold ones, as often as they grow warm by lying
on the parts. A warm poultice of bread and milk, must be also ap-
plied to the glans penis or to the whole penis. The patient must be
kept on a very spare diet, using for his drink cold water with a scru-
ple of nitre in each pint of it. This regimen generally allays the
violence of the symptoms, within twenty four hours ; but, it will
be necessary to continue the use of the cold pledgets and warm poul- 

PRACTICE 380 
MDCCLXXX.
The other form of the local affection of siphylis, is
that of chancre. The ordinary appearance of this I
need not describe, it having been already so often done.
Of the few remarks I have to offer, the first is, that I
believe chancres never appear in any degree without
immediately communicating to the blood more or less
of the venereal poison ; for I have constantly, when-
ever chancres has appeared, found, that unless mer-
cury was immediately given internally, some symp-
toms of a general siphylis did certainly come on after-
wards ; and though the internal use of mercury should
prevent any such appearance, it is still to be presumed
that the poison had been communicated, because mer-
cury could ad upon it in no other manner than as dis-
sused in the fluids.
MDCCLXXXI.
It has been a question among practitioners, upon
the subject of chancres, Whether they may be imme-
diately healed up by applications made to the chancres,
or if they should be lest open for some time without
any such application ? It has been supposed, that the
sudden
tice for three or four days or longer, and to repeat the purge. After
the pain and swelling have been completely removed, the patient may
sit up, but it will be prudent for him to use a suspensory bandage for
the scrotum, as the weight of the testicles, by stretching spermatics
cords will be apt to occasion the return of all the symptoms.
Sometimes the gonorrhœa, if it has preceded the swellings of the
epididymis and testicles, will be again brought on ; but, it likewise
sometimes happens that, on discussing the tumor in the scrotum the
glands of the groin begin to be painful and to swell. In these cases
we must apply cold pledgets to these glands as well as to the scro-
tum ; and rub, at the same time, some strong mercurial ointment on
the inside of the thighs, in the course of the lymphatics going to
these glands ; and, if the penis be not inflamed, half a dram or a
scruple of mercurial ointment ought to be rubbed on the base of the
glans penis in the inside of the prepuce.
Such is the general method of treating cases of this kind, and a pru-
dent continuance of it seldom fail of success. 

391 OF PHYSIC. 
sudden healing up of chancres might immediately
force into the blood a poison, which might have been
excluded by being discharged from the chancre.
This, however, is a supposition that is very doubtful;
and, upon the other hand, I am certain, that the long-
er a chancre is kept open, the more poison it perhaps
generates, and certainly supplies it more copiously to
the blood. And although the above-mentioned sup-
position were true, it will be of little consequence, if
the internal use of mercury, which I judge necessary
in every case of chancre, be immediately employed.
I have often seen very troublesome consequences fol-
low from allowing chancres to remain unhealed ; and
the symptoms of general siphylis have always seemed
to me to be more considerable and violent in propor-
tion as chancres, had been suffered to remain longer
unhealed : They should always, therefore, be healed
as soon as possible ; and that by the only very effect-
al means, the application of mercurials to the chancre
itself. Those that are recent, and have not yet form-
ed any considerable ulcer, may often be healed by the
common mercurial ointment; but the most powerful
means of healing them has appeared to me, to be the
application of red precipitate in a dry powder*.
MDCCLXXXII.
* Although chancres may be very speedily healed by red preci-
pitate alone, yet it will be necessary sometimes to use an ointment
made of the red precipitate and twice or thrice it's weight of fresh
hogs lard. The precipitate will by this means be more constantly
kept on the part. The practitioner, however, must be cautious lest
he use too great a quantity of precipitate, which, by it's corrosive
quality, sometimes increases the ulcer it was meant to heal.
During the use of this application, it will be necessity also to use
mercury either internally or externally, in the manner described in
the note on article 1770. 
The application of the laps infernalis to chancres, comes recom-
mended to us on the authority of some eminent practitioners. It
is however a dangerous application, and frequently produces ulcers
that are extremely difficult to heal. 

392 PRACTICE 
MDCCLXXXII.
"When, in consequence of chancres, or of the other
circumstances above mentioned, by which it may hap-
pen the venereal poison has been communicated to the
blood, it produces many different symptoms in differ-
ent parts of the body, not necessary to be enumerated
and described here, that having been already done by
many authors with great accuracy.
MDCCLXXXIII.
Whenever any of those symptoms do in any degree
appear, or as soon as it is known that the circumstan-
ces which give occasion to the communication of the
venereal poison has taken place, I hold the internal use
of mercury to be immediately necessary; and I am well
persuaded, that mercury employed without delay, and
in sufficient quantity, will pretty certainly prevent the
symptoms which would otherwise have soon appeared,
or will remove those that may have already discovered
themselves. In both cases, it will secure the person
from any future consequences of siphylis from that in-
fection.
MDCCLXXXIV.
This advice for the early and full use of mercury, I
take to be the most important that can be given with
respect to the venereal disease; And although I must
admit that the virulence of the poison may be greater
in one case than in another, and even that one consti-
tution may be more favourable than another to the
violence of the disease ; yet I am thoroughly con-
vinced, that most of the instances which have occurred
of the violence and obstinacy of siphylis have been
owing very entirely to the neglect of the early appli-
cation of mercury*.
MDCCLXXXV.
* In a word, mercury is a certain specific for siphylis, and a sure
antidote against the venereal poison. If it be properly used, it sel-
dom fails of producing a cure ; and this cure will always be more 

393 OF PHYSIC. 
MDCCLXXXV.
Whatever other remedies * of siphylis may be
known, or may hereafter be found out, I cannot pre-
tend to determine; but I am well persuaded, that in
most cases mercury properly employed will prove a
very certain and effectual remedy. With respect to
others that have been proposed, I shall offer this remark
only, that I have found the decoction of the meze-
reon contribute to the healing of ulcers which seem-
ed to have resisted the power of mercury.
MDCCLXXXVI.
With regard to the many and various preparations
of mercury, I do not think it necessary to give any
enumeration of them here, as they are commonly ve-
ry well known, and have been lately well enumerated
by Dr. Schwediaur. The choice of them seems to be
for the most part a matter of indifference; as I believe
cures have been, and still may be, effected by many
different preparations, if properly administered. The
proper administration§ seems to consist, 1st, In the
choosing those preparations which are the least ready
to run off by stool; and therefore the applications ex-
ternally by unction are in many cases the most conve-
nient. 2dly, In employing the unction, or in giving
a preparation of mercury internally, in such quantity
as may show its sensible effects in the mouth. And
3dly, without carrying these effects to a greater length,
In the continuing the employment of mercury for se-
veral weeks, or till the symptoms of the disease shall
have for some time entirely disappeared. I say no-
Vol. II. 3 D thing
speedy, in proportion, as mercury has been used in the earlier stage
of the disease.
* We have no occasion to seek for other remedies than mercury :
and the practitioner who risks his patient's health, and his own re-
putation, on the uncertain effects of other remedies, surely deserves
reprehension.
§ See the notes on Article 1770 

394 PRACTICE
thing of the regimen proper and necessary for patients
during the employment of mercury, because I presume
it to be very well known.
MDCCLXXXV1I.
Amongst the other preparations of mercury, I be-
lieve the corrosive sublimate has often been employed
with advantage: but I believe also, that it requires be-
ing continued for a longer time than is necessary in
the employment of other preparations in the manner
above proposed ; and I suspect it has often failed in
making a cure, because employed while persons were
at the same time exposed to the free air.
MDCCLXXXVIII.
Upon these points, and others relative to the admi-
nistration of mercury, and the cure of this disease, I
might offer some particular remarks: but I believe
they are generally understood ; and it is enough for
me to say here, that if practitioners will attend, and
patients will submit, to the general rules giVen above,
they will seldom fail of obtaining a certain and speedy
cure of the disease.
CHAP. III.
OF SCURVY.
MDCCLXXXIX.
THIS disease appears so frequently, and the effects
of it are so often fatal in fleets and armies, that
it has very properly engaged the particular attention
of physicians. It is indeed surprising that it had not
sooner attracted the especial notice both of statesmen
and physicians, so as to have produced those measures
and 

395 OF PHYSIC. 
and regulations that might prevent the havock which
it so often occasions. Within these last fifty years,
however, it has been so much attended to and studied,
that we might suppose every circumstance relating to
it so fully and exactly ascertained, as to render all fur-
ther labour upon the subject superfluous. This per-
haps may be true ; but it appears to me, that there are
still several circumstances regarding the disease not
agreed upon among physicians, as well as different opi-
nions formed, some of which may have a bad effect
upon the practice ; and this seems to me to be so
much the case, that I hope I shall be excused in endea-
vouring here to state the facts as they appear to me
from the best authorities, and to offer remarks upon
opinions which may influence the practice in the pre-
vention and cure of this disease.
MDCCXC.
With respect to the phenomena of the disease, they
have now been so fully observed, and so accurately
described, that there is no longer any doubt in discern-
ing the disease when it is present, or in distinguishing
it from almost every other aliment. In particular, it
seems now to be fully determined, that there is one
disease only, intitled to the appellation of Scurvy ;
that it is the same upon the land as upon the sea ; that
it is the same in all climates and seasons, as de-
pending every where upon nearly the same causes;
and that it is not at all diversified, either in its pheno-
mena or its causes, as had been imagined some time
ago.
MDCCXCL
The phenomena of scurvy, therefore, are not to be
described here, as it has been so fully and accurately
done elsewhere ; and I shall only endeavour to ascer-
tain those facts with respect to the prevention and cure
of the disease which seem not yet to be exactly a-
greed upon. And, first, with respect to the antece-
3 D 2 dents 

390 PRACTICE
dents that may be considered as the remote causes of
the disease.
MDCCXCII.
The most remarkable circumstances amongst the
antecedents of this disease is, that it has most common-
ly happened to men living very much on salted meats;
and whether it ever arise in any other circumstances,
is extremely doubtful. These meats are often in a
putrescent state ; and to the circumstance of the long
continued use of animal food in a putrescent and
somewhat indigestive state, the disease has been espe-
cially attributed. Whether the circumstances of the
meat's being salted, has any effect in producing
the disease, otherwise than by being rendered more
indigestible, is a question that remains still in dispute.
MDCCXCIII.
It seems to me, that the salt concurs in producing
the effect ; for there is hardly any instance of the dis-
ease appearing unless where salt meats had been em-
ployed, and scarcely an example where the long conti-
nued use of these did not produce it; besides all which,
there are some instances where, by avoiding salted
meats, or by diminishing the proportion of them in di-
et, while other circumstances remained much the
same, the disease was prevented from appearing. Fur-
ther, if it may be admitted as an argument upon this
subject, I shall hereafter endeavour to show, that the
large use of salt has a tendency to aggravate and in-
crease the proximate cause of scurvy.
MDCCXCIV.
It must, however, be allowed, that the principal
circumstance in causing scurvy, is the living very much
and very long upon animal food, especially when in a
putrescent state ; and the clear proof of this is, that a
quantity of fresh vegetable food will always certainly
prevent the disease.
MDCCXCV.

OF PHYSIC. 397
MDCCXCV.
While it has been held, that, in those circumstances
in which scurvy is produced, the animal food employ-
ed was especially hurtful by its being of difficult diges-
tion, this opinion has been attempted to be confirm-
ed, by observing, that the rest of the food employed
in the same circumstances was also of difficult digesti-
on. This is supposed to be especially the case of
unfermented farinacea which so commonly makes a
part of the sea-diet. But I apprehend this opinion to
be very ill-founded ; for the unfermented farinacea,
which are in a great proportion the food of infants, of
women, and of the greater part of mankind, can hard-
ly be supposed to be food of difficult digestion : and
with respect to the production of scurvy, there are
facts which show, that unfermented farinacea, em-
ployed in large proportion, have had a considerable
effect in preventing the disease.
MDCCXCVI.
It has been imagined, that a certain impregnation of
the air upon the sea had an effect in producing scurvy.
But it is altogether improbable : for the only impreg-
nations which could be suspected, are those of inflam-
mable or mephitic air; and it is now well known,
that these impregnations are much less in the air upon
the sea than in that upon the land ; besides, there are
otherwise many proofs of the salubrity of the sea-air.
If, therefore, sea-air have any effect in producing
scurvy, it must be by its sensible qualities of cold or
moisture.
MDCCXCVII.
That cold has an effect in favouring the production
of scurvy, is manifest from hence, that the disease is
more frequent and more considerable in cold than in
warm climates and seasons ; and that even warm
cloathing has a considerable effect in preventing it.
MDCCXCVIII.
Moisture may in general have an effect in favouring
the

PRACTICE 398
the production of scurvy, where that of the atmosphere
in which men are placed is very considerable: but the
ordinary moisture of the sea-air is far from being such.
Probably it is never considerable, except in the case
of unusual rains; and even then it is perhaps by the
application of moisture to the bodies of men in damp
cloathing only that it has any share in the produc-
tion of scurvy. At the same time, I believe, there
is no instance of either cold or moisture producing
scurvy, without the concurrence of the faulty sea-
diet.
MDCCXCIX.
Under those circumstances which produce scurvy, it
commonly seems to occur most readily in the persons
who are the least exercised ; and it is therefore proba-
ble, that confinement and want of exercise may have a
great share in producing the disease.
MDCCC.
It appears that weakness, in whatever manner occa-
sioned, is favourable to the production of scurvy. It
is therefore probable, that unusual labour and fatigue
may often have some share in bringing it on : and
upon the same account, it is probable, that sadness and
despondency may induce a weakness of the circula-
tion ; and thereby, as has been remarked, favourable
to the production of scurvy.
MDCCCI.
It has also been observed, that persons negligent
in keeping their skin clean by washing and change of
cloathing, are more liable than others to be affected
with scurvy.
MDCCCII.
Several of these causes, now mentioned, concurring
together, seem to produce scurvy ; but there is no pro-
per 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 sea-diet.
Along with this, however, several of the, other circum-
stances 

399 OF PHYSIC. 
stances mentioned have a great effect in producing it
sooner, and in a more considerable degree, than
would otherwise have happened from the diet alone.
MDCCCIII.
From this view of the remote causes, it will readily
appear, that the prevention of the disease may in
some measure depend upon the avoiding of those cir-
cumstances which we have enumerated as contributing
to bring on the disease sooner than it would otherwise
come on. At the same time, the only effectual means
will be, by avoiding the diet of salted meats; at least
by lessening the proportion of these, and using meat
preserved otherwise than by salt; by using in diet
any kind of esculent vegetable matter that can be ob-
tained ; and especially by using vegetable matters the
most disposed to acescency, such as malt; and by
drinking a large quantity of pure water.
MDCCCIV.
The cure of scurvy seems now to be very well as-
certained ; and when the necessary means can be ob-
tained, the disease is commonly removed very quick-
ly. The chief means is a food of fresh and succulent
vegetables, and those almost of any kind that are at
all esculent. Those most immediately effectual are
the acid fruits, and, as being of the same nature, all
sort of fermented liquor.
MDCCCV.
The plants named alkalescent, such as those of the
garlic tribe and of the tetradynamiæ*, are also parti-
cularly
* The plants of this class ought to be used in large quantities, and
raw. The more active species are, Horse-radish, Mustard, Water-
cress, garden-cress, Scurvy grass : The milder species are, Radishes,
Turnips, Cabbages, Cauliflowers, Brocoli, &c.
To the above list, may be added some other antiscorbutics of dif-
ferent classes ; as Malt, Spinach, Beet, Carrots, Celery, Endive,
Lettuce, Asparagus, the young shoots of Hops, Purslain, with se-
veral others. All these fresh vegetables must be eaten in large quan-
tities ; they ought indeed to constitute the patient's chief food, and
his drink may be a fresh infusion of malt. 

400 PRACTICE 
cularly useful in the cure of this disease; for, notwith-
standing their appellation, they in the first part of
their fermentation undergo an ascency, and seem to
contain a great deal of acescent matter. At the same
time, they have generally in their composition an
acrid matter that readily passes by urine, probably by
perspiration ; and by promoting both excretions, are
useful in the disease. It is probable, that some plants
of the coniferous tribe, such as the spruce fir, and
other possessed of a diuretic power, may likewise be of
some use.
MDCCCVI.
It is sufficiently probable, that milk of every kind,
and particularly its productions whey and butter-milk,
may prove a cure of this disease.
MDCCCVII.
It has been common in this disease to employ the
fossil acids; but there is reason to doubt if they be of
any service, and it is certain they are not effectual re-
medies. They can hardly be thrown in such quan-
tity as to be useful in antiseptics ; and as they do not
seem to enter into the composition of the animal flu-
ids, and probably pass off unchanged by the excreti-
ons, so they can do little in changing the state of the
fluids.
MDCCCVIII.
The great debility which constantly attends scurvy,
has naturally led physicians to employ tonic and
strengthening medicines, particularly the Peruvian
bark ; but the efficacy of it seems to me very doubt-
ful. It is surprising how soon the use of a vegetable
diet restores the strength of scorbutic persons; which
seems to show that the preceding debility had depend-
ed upon the state of the fluids; and consequently, till
the sound state of these can be restored, no tonic re-
medy can have much effect: but as the Peruvian bark 
has

401 OF PHYSIC. 
has little power in changing the state of the fluids, so
it can have little effect in scurvy.
MDCCCIX.
I shall conclude my observations upon the medi-
cines employed in scurvy, with remarking, that the
use of mercury is always manifestly hurtful.
MDCCCX.
After having observed that both the prevention and
cure of this disease are now very well known, it may
seem unnecessary to enter into much discussion con-
cerning its proximate cause : but as such discussions
can hardly be avoided, and as false opinions may in
some measure corrupt the practice, I shall venture to
suggest here what appears to me most probable upon
the subject.
MDCCCXI.
Notwithstanding what has been asserted by some
eminent persons, I trust to the concurring testimony
of the most part of the authors upon the subject, that
in scurvy the fluids suffer a considerable change.
From these authors we learn, that in the blood
drawn from the veins of persons labouring under the
scurvy, the crassamentum is different both in colour
and consistence from what it is in healthy persons;
and that at the same time the serum is commonly
changed both in colour and taste. The excretions al-
so, in scorbutic persons, show a change in the state of
the fluids. The breath is fetid ; the urine is always
high-coloured, and more acrid than usual; and if that
acrid exsudation from the feet, which Dr. Hulme takes
notice of, happens especially in scorbutic persons, it
will be a remarkable proof to the same purpose. But
however this may be, there is evidence enough that
in scurvy the natural state of the fluids is considerably
changed. Further, I apprehend it may be confidently
presumed from this, that the disease is brought on by
a particular nourishment introduced into the body, and
VOL. II. 3E is 

402 PRACTICE
is as certainly cured by the taking in of a different di-
et. In the latter case, the diet used has no other evi-
dent operation, than that of giving a particular state
and condition to the fluids.
MDCCCXII.
Presuming therefore, that the disease depends upon
a particular condition of the fluids of the body, the
next subject of inquiry is, What that condition may
be?
With this view I must observe, that the animal
œconomy has a singular power of changing acescent
aliments, in such a manner, as to render them much
more disposed to putrefaction; and although, in a
living state, they hardly ever proceed to an actually
putrid state ; yet in man, whole aliment is of a mixed
kind, it is pretty certain, that if he were to live entire-
ly upon animal food, without a frequent supply of ve-
getable aliment, his fluids would advance further to-
wards putrefaction than is consistent with health.-
This advance towards putrefaction seems to consist in
the production and evolution of a saline 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 state. That this saline
state is constantly in some measure produced and evolv-
ed by the animal process, appears from this, that cer-
tain excretions of saline matter are constantly made
from the human body, and are therefore presumed ne-
cessary to its health.
From all this, it may be readily understood, how
the continual use of animal food, especially when al-
ready in a putrescent state, without a mixture of vege-
table, may have the effect of carrying the animal
process too far, and particularly of producing and
evolving a larger proportion of saline matter. That
such a preternatural quantity of saline matter does ex-
ist in the blood of scorbutic persons, appears from
the 

403 OF PHYSIC. 
the state of the fluids above-mentioned. It will be a
confirmation of all this to observe, that every interrup-
tion of perspiration, that is, the retention of saline.
matter, contributes to the production of scurvy ; and
this interruption is especially owing to the application
of cold, or to whatever else weakens the force of the
circulation, such as the neglect or want of exercise,
fatigue, and despondency of the mind. It deserves in-
deed to be remarked here, that one of the first effects
of the scurvy once induced, is very soon to occasion a
great debility of the system, which occasions of course
a more rapid progress of the disease. How the state of
the fluids may induce such a debility is not well un-
derstood ; but that it does depend upon such a state
of the fluids, is rendered sufficiently presumable from
what has been said above with regard to both the
causes and the cure of scurvy.
MDCCCXIII.
It is possible that this debility may have a great share
in producing several of the phenomena of scurvy ; but
a preternaturally saline, and consequently dissolved,
state of the blood, will account for them with more
probability; and I do not think it necessary to persons
who are at all accustomed to reason upon the animal
œconomy, to explain this matter more fully. I have 
only to add, that if my opinion in supposing the prox-
imate cause of scurvy to be a preternaturally saline
state of the blood, be at all founded, it will be suffi- 
ciently obvious, that the throwing into the body along
with the aliment an unusual quantity of salt, may have
a great share in producing the disease. Even suppos-
ing such salt to suffer no change in the animal body,
the effect of it may be considerable ; and this will be
rendered still more probable, if it may be presumed,
that all neutral salts, consisting of a fixed alkali, are
changed in the animal body into an ammoniacal salt;
which I apprehend to be that especially prevailing in 
3 E 2 scurvy.

404 PRACTICE 
scurvy. If I be at all right in concluding, that meats,
from being salted, contribute to the production of scur-
vy, it will readily appear, how dangerous it may be to
admit the conclusion from another theory, that they
are perfectly innocent.
MDCCCXIV.
Having thus endeavoured to explain what relates
to the cure of scurvy in general, I judge it proper to
leave to other authors, what relates to the manage-
ment of those symptoms which require a particular
treatment.
CHAP. IV.
OF JAUNDICE.
MDCCCXV.
I HAVE here passed over several of the titles in my
nosology, because they are diseases not of this island.
In these, therefore, I have no experience ; and with-
out that, the compiling from other writers is always
extremely fallacious. For these reasons I omit them ;
and shall now only offer some remarks upon the subject
of jaundice, the last in order that I can possibly intro-
duce in my course of Lectures.
MDCCCXVI.
The jaundice consists in a yellow colour of the skin
over the whole body, and particularly of the adnata of
the eyes. This yellow colour may occur from differ-
ent causes : but in the jaundice, hereafter to be more
exactly characterised, I judge it to depend upon a
quantity of bile present in the mass of blood ; and
which,

405 OF PHYSIC. 
which, thrown out upon the surface, gives its own pro-
per colour to the skin and eyes.
MDCCCXVII.
That the disease depends upon this we know parti-
cularly and certainly from the causes by which it is
produced. In order to explain these, I must observe,
that bile does not exist in its proper form in the mass
of blood, and cannot appear in this form till it has pass-
ed the secretory organ of the liver. The bile, there-
fore, cannot appear in the mass of blood, or upon the
surface of the body, that is, produce jaundice from any
interruption of its secretion; and accordingly, if jaun-
dice does appear, it must be in consequence of the
bile, after it had been secerned, being again taken into
the blood-vessels.
This may happen in two ways; either by an inter-
ruption of its excretion, that is, of its passage into the
duodenum, which by accumulating it in the biliary
vessels, may give occasion to its passing again into the
blood-vessels; or it may pass into these, by its being
absorbed from the alimentary canal, when it happens
to be accumulated there in an unusual quantity. How
far the latter cause can take place, or in what circum-
stances it does occur, I cannot clearly ascertain, and I
apprehend that jaundice is seldom produced in that
manner.
MDCCCXVIII.
The former cause of stopped excretion may be un-
derstood more clearly ; and we have very certain proof
of its being the ordinary, and indeed the almost univer-
sal, cause of this disease. Upon this subject it will be
obvious, that the interrupted excretion of the bile
must depend upon an obstruction of the ductus com-
munis choledochus; the most common cause of which
is a biliary concretion formed in the gall-bladder, and
from thence fallen down into the ductus communis,
it being at the same time of such a size as not to pass
readily 

406 PRACTICE  
readily through that duct into the duodenum. This
duct may likewise be obstructed by a spasmodic con-
striction affecting it : and such spasm may happen, ei-
ther in the duct itself, which we suppose to be contrac-
tile ; or in the duodenum pressing the sides of the duct
close together; or, lastly, the duct may be obstructed
by a tumour compressing it, and that arising either in
the coats of the duct itself, or in any of the neighbour-
ing parts that are, or may come to be, contiguous to
it.
MDCCCXIX.
When such obstruction happens, the secreted bile
must be accumulated in the biliary ducts; and from
thence it may either be absorbed and carried by the
lymphatics into the blood-vessels, or it may regurgitate
in the ducts themselves, and pass from them directly
into the ascending cava. In either way, it comes to be
diffused in the mass of blood ; and from thence may.
pass by every exhalant vessel, and produce the disease
in question.
MDCCCXX.
I have thus shortly explained the ordinary produc-
tion of jaundice : but it must be observed further,
that it is at all times accompanied with certain other
symptoms, such as a whiteness of the fæces alvinæ.
which we readily account for from the absence of bile.
in the intestines; and generally, also, with a certain
consistence of the fæces, the cause of which is not so
easy to explain. The disease is always accompanied
also with urine of a yellow colour, or at least with urine
that tinges a linen cloth with a yellow colour. These
are constantly attending symptoms; and though not
always, yet there is commonly, a pain felt in the epiga-
strium, corresponding, as we suppose, to the seat of the
ductus communis. This pain is often accompanied
with vomiting; and even when the pain is not consi-
derable, a vomiting sometimes occurs. In some cases,
when 

407 OF PHYSIC. 
When the pain is considerable, the pulse becomes fre-
quent, full, and hard, and some other symptoms of py-
rexia appear.
MDCCCXXI.
When the jaundice is occasioned by tumours of the
neighbouring parts compressing the biliary duct, I be-
lieve the disease can very seldom be cured. That such
is the cause of jaundice, may with some probability be
supposed, when it has come on in consequence of other
diseases which had subsisted long before, and more espe-
cially such as had been attended with symptoms of ob-
structed viscera. Even when the jaundice has subsist-
ed long without any intermission, and without any
pain in the epigastrium, an external compression is to
be suspected.
MDCCCXXII.
In such circumstances, I consider the disease as in-
curable ; and it is almost only when the disease is oc-
casioned by biliary concretions obstructing the biliary
duct, that we may commonly expect relief, and that
our art may contribute to the obtaining it. Such
cases may be generally known by the disease frequent-
ly disappearing and returning again ; by our finding,
after the former accident, biliary concretions amongst
the fæces; and by the disease being frequently accom-
panied with pain of the epigastrium, and with vomit-
ings arising from such pain.
MDCCCXXIII.
In these cases, we know of no certain and immedi-
ate means of expediting the passage of the biliary con-
cretions. This is generally a work of lime depending
upon the gradual dilatation of the biliary duct; and it
is surprising to observe, from the size of the stones
which sometimes pass through, what dilatation the
duct will admit of. It proceeds, however, faster or
slower upon different occasions; and therefore the
jaundice, after a various duration, often ceases sudden- 
ly

408 PRACTICE 
ly and spontaneously. It is this which has given rise
to the belief, that the jaundice has been cured by
such a number and such a variety of different reme-
dies. Many of these, however, are perfectly inert, and
many others of them such as cannot be supposed to
have any effect in expediting the passage of a biliary
concretion. I shall here, therefore, take no notice of
the numerous remedies of jaundice mentioned by the
writers on the Materia Medica, or even of those to be
found in practical authors; but shall confine myself to
the mention of those that may with probability be sup-
posed to favour the passage of the concretion, or re-
move the obstacles to it which may occur.
MDCCCXXIV.
In the treatment of this disease, it is in the first place,
to be attended to, that as the distension of the biliary
duct, by a hard mass that does not easily pass through
it, may excite inflammation there ; so, in persons of
tolerable vigour, blood-letting may be an useful pre-
caution ; and when much pain, together with any
degree of pyrexia, occurs, it becomes an absolutely
necessary remedy. In some instances of jaundice ac-
companied with these symptoms, I have found the
blood drawn covered with an inflammatory crust as
thick as in cases of pneumonia.
MDCCCXXV.
There is no means of pushing forward a biliary con-
cretion that is more probable than the action of vo-
miting ; which, by compressing the whole abdominal
viscera, and particularly the full and distended gall-
bladder and biliary vessels, may contribute, sometimes
gently enough, to the dilatation of the biliary duct.
Accordingly vomiting has often been found useful for
this purpose ; but at the same time it is possible, that
the force exerted in the act of vomiting may be too
violent, and therefore gentle vomits ought only to be
employed. And either when, by the long continu-
ance 

409 OF PHYSIC. 
ance of the jaundice, it may be suspected that the size
of the concretion then passing is large; or more espe-
cially when pain attending the disease gives apprehen-
sion of inflammation, it may be prudent to avoid vo-
miting altogether.
MDCCCXXVI. 
It has been usual in the jaundice to employ purga-
tives ; and it is possible that the action of the intes-
tines may excite the action of the biliary ducts, and
thus favour the expulsion of the biliary concretion :
but this, I think, cannot be of much effect; and the
attempting it by the frequent use of purgatives, may
otherwise hurt the patient. For this reason I appre-
hend, that purgatives can never be proper, excepting
when there is a slow and bound belly*.
MDCCCXXVII.
As the relaxation of the skin contributes to relax
the whole system, and particularly to relieve the con-
striction of subjacent parts ; so, when the jaundice is
attended with pain, fomentations of the epigastrium
may be of service.
MDCCCXXVIII.
As the solids of the living body are very flexible and
yielding; so it is probable, that biliary concretions
would in many cases find the biliary duct readily ad-
mit of such dilatation as to render their passage
through it easy, were it not that the distension occa-
sions a preternatural spasmodic contraction of the parts
below. Upon this account, opium is often of great
benefit in jaundice; and the benefit resulting from its
Vol. II. 3 F use,
* The good effects of purgatives, in removing biliary concre-
tions in the duct, are sufficiently apparent by daily experience. It
is true, indeed, that all purgatives have not this effect, especially
such as are, of a gentle and slow operation. The drastic purges, how-
ever, whose action is both brisk, and of long continuance, have fre-
quently been attended with good effects. Some formulæ of these
brisk drastics have been described in the notes on article 1683. 

410 PRACTICE
use, proves sufficiently the truth of the theory upon
which the using of it has been founded.
MDCCCXXIX. 
It were much to be wished, that a solvent of biliary
concretions, which might be applied to them in the
gall-bladder or biliary ducts, was discovered; but none
such, so far as I know, has yet been found ; and the
employment of soap in this disease, I consider as a
frivolous attempt. Dr. White of York has found a
solvent of biliary concretions when these are out of
the body; but there is not the least probability that
it could reach them while lodged within.
INDEX.

INDEX
TO THE TWO VOLUMES.
N. B. The Figures refer to the number of Paragraphs.
A
ABSCESS, 250
ABSCESSES and ULCERS, the causes of their dif-
ferent states 254
ACIDS, employed in fever 134
refrigerant in fever ib.
ACTION of the heart and arteries, how increased for pre-
venting the recurrences of the paroxysms of in-
termitting fever 330
ADYNAMÆ 1171
AMENORRHOEA, 995
from retention, 996
when occurring 998
symptoms of 999
causes of 1000—2
cure of 1002—6
a AME- 

ii INDEX.
AMENORRHOEA from suppression, 996
when occurring 1008
symptoms of 1010
causes of 1008—9
cure of 1011—12
AMENTIA 1598
ANASCARA, 1668
the character of ib.
phenomena of 1668—73
cure of 1674—96
distinguished from Leucophlegmatia 1669
ST. ANTHONY'S FIRE. See Erythema.
ANTIMONIAL EMETICS, employed in fevers 181
their different kinds ib.
the administration of them in
fevers 183-6
ANTIPHLOGISTIC REGIMEN, 129
how conducted 130
when employed in inter-
mittent fevers 234
ANTISPASMOTICS employed in fevers 152—187
APHTHA 733
APOPLEXY, 1094
distinguished from palsy ib.
distinguished from syncope ib.
predisponent causes of 1095
exciting causes of 1098—1115—16.
proximate cause of 1100—21
SEROSA, proximate cause of 1114
prognostic 1122—23
frequently ending in hemiplegia 1122
prevention of 1124
whether sanguine or serous, stimulants
hurtful in it 1136—37
from powers that destroy the mobility
of the nervous power 1138
cure of 1131—39
APYREXIA 24
ASCITES, 1709
character of ib.
its various seat 1710—11
the phenomena of 1712—13
ASCITES, 

iii INDEX. 
ASCITES, its particular seat difficultly ascertained 1714
the cure of 1715—17
ASTHMA, 1373
phenomena of 1373
exciting causes of 1381
proximate cause of 1384
distinguished from other kinds of dyspnœa 1385
ASTHMA, sometimes occasions the phthisis pulmonalis 1386
frequently ends in hydrothorax ib.
seldom entirely cured ib.
ASTRINGENTS, employed in intermittent fevers 231
joined with aromatics, employed in in-
termittent fevers ib.
joined with bitters, employed in inter-
mittent fevers. ib.
ATRABILIS 1029
ATROPHIA, ab alvi fluxu 1607
debilium 1606
inanitorium 1607
infantilis l605
lactantium ib.
lateralis 1606—11
a leucorrhœa, 607
nervosa, 606
nutricum, 607
a ptyalisma, ib.
rachitica, 605
senilis, 1606—11
AURA EPILEPTICA, 1306
B.
BITTERS employed in intermittent fevers, 231
joined with astringents, employed in intermittents, ib.
BLISTERING, its effects, 189—197
its mode of operation in the cure of
fevers, 190—194
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 circumstances directing its use in fevers, 142
the administration of it in fevers, 143
when employed in intermittent fevers, 234
C.
CACHEXIES character of the class, 1599
CACHEXY, 

iv INDEX.
CACHEXY, the term, how applied by authors, 600
CALCULUS RENALIS, 429
CALX NITRATA ANTIMONII, its use in fevers, 183—185
CANINE MADNESS, 1525
the cure of, 1525—1527
CARDIALGIA, 1427
CARDITIS, 383
of the chronic kind, ib.
CARUS, 1094
CATAPHORA, ib.
CATARRH, 1046
predisposition to, 1047
symptoms of, 1048
remote causes of, 1047
proximate cause of, 1047
cure of, 1065
produces phthisis, 1055
passes into pneumonia, 1054
produces a peripneumonia notha, 1056
CONTAGIOUS, 1062
CATARRHUS SUFFOCATIVUS, 376
CHANCRE, method of treating, 1781
CHICKEN-POX, 631
how distinguished from small-pox, 632
CHINCOUGH, 1402
contagious, ib
frequently accompained with fever, 1410
phenomena, 1404
prognostic in, 1413
cure of, 1414
CHLOROSIS, 998
CHOLERA, 1453
symptoms of, 1453-56
remote causes of, 1458—60
proximate causes of, 1454
cure of, 1462—64
CHOREA, 1347
phenomena, 1347—53
cure of, 1354
CHRONIC weakness, 1191
COELIACA, 1493
COLD,

INDEX. v
COLD, its operations, 88
absolute, ib.
relative, 89
its general effects on the human body, 90—91
its morbid effects, 92
moderates the violence of reaction in fever, 133
its tonic power, how to be employed in fevers, 205
COLD drink, an useful tonic in fevers, 206
the limitation of its use in fevers, 207
air applied in fevers, 208
water applied to the surface of the body in fevers, 205—209
COLIC, 1435
the symptoms of, 1435—38
proximate cause of, 1439
cure of, 1441
Devonshire. See Colic of Poitou.
COLIC, of Poitou, 1451
cure of, 1452
COMA, 1094
COMATA, 1093
CONTAGIONS, 78
their supposed variety, 79
CONVULSIONS, 1253
CORPULENCY, 1621
CYNANCHE, 300
MALIGNA, 311
PAROTIDEA, 232
PHARYNGEA, 331
TONSILLARIS, 301
TRACHEALIS, 318
as affecting infants, 322—329
the cure of it, 330
CYSTITIS, 431
D.
DAYS critical, in fevers, 107—124
non-critical, 113
DEATH, the causes of, in general, 100
the direct causes of, ib.
the indirect causes of, ib.
the causes of it in fever, 101
DEBILITY, in fevers, the symptoms of, 104
DEBILITY, 

vi INDEX.  
DEBILITY, how obviated, 202
DELIRIUM, in general, explained, 1529—50
in fever, of two kinds, 45
or INSANITY without fever, 1550—57
DIABETES, 1504
symptoms of, 1504—9
remote cause of, 1508
proximate cause of, 1510—12
cure of, 1,513
DIÆTA AQUEA, 157
DIARRHOEA, 1465
DIARRHOEA, distinguished from dysentery, 1466
distinguished from cholera,1467
proximate cause of, 1468
remote causes of, 1471-93
cure of, 2494—1503
BILIOSA, 1480
COLLIQUATIVE, 1501
MUCOSA, 1488
DIATHESIS PHLOGISTICA, 62—247
how removed, 260
DILUENTS, their use in fevers, 154—158
DISEASES, the distinguishing of them, how attained, 2
the prevention of them, on what founded, 3
the cure of them, on what founded, 4
DROPSIES, 1645
in general, the cause of them, 1646
of the breast. See Hydrothorax.
of the lower belly. See Ascites.
DYSENTERY, 1067
contagious, 1075
remote causes of, 1072
proximate cause of, 1077
cure of, 1080
use of mild cathartics to be frequently repeat-
ed in it, ib.
rhubarb improper in it, ib.
DYSENTERIA ALBA, 1070
DYSMENORHOEA, 1014
DYSPEPSIA, 1190
remote causes of, 1198
DYSPEPSIA, 

vii INDEX. 
DISPEPSIA, proximate cause of 1193
cure of 1201
flatulence in it, cure of 1221
heart-burn in it, cure of ib.
pains of stomach in it, cure of ib.
vomiting in it, cure of ib.
DYSPNOEA, 1365
E. 
EFFLUVIA, human 85
from marshes ib.
EMACIATIONS, 1600
causes of 1602—18
cure of 1619
EMANSIO MENSIUM 998
EMETICS, suited to the cure of fevers 174
their effects 176—180
a means of removing spasm 170
the administration of, in fevers 175
their use in intermittent fevers 230—233
EMPROSTHOTONOS, 1267
ENTERITIS, 404
phlegmonic or erythematic ib.
causes of 407
cure of 409
EPILEPSY, 281
phenomena of 1283
proximate causes of 1284
remote causes of 1285
predisponent causes of 1310
sympathic, 1316
cure of 1317
idiopathic, 1316
cure of 1319
EPISTAXES, 806
the causes of it 808
the various circumstances of 807—818
the management and cure of 819—829
ERYSIPELAS, 274
of the face 708
symptoms of 705—708
prognosis of 706
b ERYSIPELAS,

viii INDEX. 
ERYSIPELAS, proximate cause of 697
cure of 708—711
phlegmonodes in different parts of the body 712
attending putrid fever 713
ERYTHEMA, 274
EXANTHEMATA, 585
EXERCISE, useful in intermittent fevers 231
F.
FAINTING See Syncope. 1171
FATUITY, 1529
FEAR, a remote cause of fever 97
FEVER, 8
strictly so called, the character of 8—32
phenomena of 8
remote causes of, are of a sedative nature 36
proximate cause of 33
atony of the extreme vessels, a principal circum-
stance in the proximate cause of it 43—44
spasm, a principal part in the proximate cause of it 40
general doctrine of 46
the causes of death in it 101
the prognosis of 99
indications of cure in 126
differences of 53
continent 28
continued 27
inflammatory 67
miliary. See Miliary Fever.
nervous 67
bilious 71
scarlet. See Scarlet Fever.
putrid 72
named synocha 67
synochus 69
typhus 67
hectic, 74
intermittent, the paroxysms of, described 10
the cold stage of 11
FEVER, 

INDEX. ix
FEVER, intermittent, the hotstage of 11
the sweating stage of ib.
of a tertian period 25
of a quartan period ib.
of a quotidian period ib.
caused by marsh effluvia 84
bile not the cause of it 51
cure of 228
its paroxysms, how prevented 229
attended with phlogistic diathesis 234
intermittent, attended with congestion
in the abdominial viscera 234
remittent, 26
FLUXES, without fever. See Profluvia.
FLUOR ALBUS. See Leucorrhœa.
FOMENTATION of the lower extremities, its use in fevers 199
FOMITES of contagion 82
FUNCTIONS intellectual, disorders of 1528—29
G.
GANGRENE of inflamed parts, the cause of 255—256
marks of the tendency to 257
marks of its having come on ib.
GASTRITIS, ib.
phlegmonic or erythematic 385
phlegmonic, the seat of ib.
the symptoms of 386
the causes of 387
the cure of 393—397
erythematic, how discovered 400
the seat of 385
the cure of 401
GASTRODYNIA, 427
GLEET, 1769
GONORRHOEA, 1765
phenomena of 65—69
cure of 1770—78
GOUT, the character of 492
a hereditary disease 500
distinguished from rheumatism 526
b 2 GOUT, 

x INDEX. 
GOUT, predisponent causes of 493—500
occasional causes of 502—505
proximate cause of 527—533
not a morbific matter 529
Regular, described 506—518
pathology of 533
cure of 537—573
no effectual or safe 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 paroxysms 542
treatment in the time of paroxysms 560
regimen during the paroxysms 561
external applications, how far safe 562—569
blood-letting in the intervals of paroxysms 553
-in the time of paroxysms 563
costiveness hurtful 559
laxatives to be employed ib.
effects of alkalines 553
effects of Portland powder 557
Irregular 518
Atonic, 574—599
pathology of 534
cure of 580—582
Retrocedent, 522
pathology of 535
cure of 580—582
GOUT, Misplaced, 523
pathology of 536
cure of 583—584
Translated, two particular cases of 525
H.
HÆMATEMESIS, 1017
arterial and venous 1027
from obstructed menstruation 1020
from suppression of the hemorrhoidal flux 1025
from compression of the vasa brevia by the
spleen 1027
from obstruction of the liver 1028
HÆMATURIA, 

xi INDEX. 
HÆMATURIA, 1033
idiopathic, improbable 1033—34
calculosa 1037
cure of 1038
violenta 1039
from suppression of accustomed discharges 1041
putrida 1043
spuria et lateritia 1044
HÆMIPLEGIA, 1140
causes of 1141
frequently occasioned by apoplexy 1142
frequently alternates with apoplexy 1144
cure of 1152
stimulants, of ambiguous use in 1160
stimulants, external in 1161
HÆMOPTYSIS,
the symptoms of 838—840
the causes of 760—763—830—836 
how distinguished from other spittings of
blood 841—45
cure of 846—52
HÆMORRHAGIA UTERI, 966
HEMORRHAGY,
active or passive 735
character of 736
arterial 744
venous 768
the causes of the different species appearing at
different periods of life 750-773
the general phenomena of 738—743
the remote causes of 774
cure of 776
-whether to be attempted by art 776—81
prevention of the first attacks, or of the
recurrence of 782—789
treatment of when present 789—805
symptomatic 1015
HÆMORRHOIDES VESICÆ 1042
HÆMORRHOIS,
external and internal 925
phenomena of 925—931
nature of the tumours 932
HÆMORRHOIS, 

xii INDEX.
HÆMORRHOIS, causes of 933—943
acquire a connection with the system 943—944
particularly with the stomach 946
cure of 947—965
HEPATIRRHOEA, 1481
HEPATITIS, 412
acute and chronic ib.
acute, the symptoms of 413—415
combined with pneumonic inflammation 416
remote causes of it ib.
seat of 418
various exit of pus produced in 421
cure of 422
chronic, the seat of 418
how discovered 423
HOOPING-COUGH. See Chincough. 1402
HORROR, impression of, employed in intermittent fevers 231
HUMAN effluvia the cause of fever 81
body, its temperature 88
body has a generating heat ib.
HYDROPHOBIA, 1525
HYDROTHORAX, 1697
where seated 1698
symptoms of 1701—03
often combined with universal dropsy 1704
proximate cause of 1706
cure of 1707—08
paracentesis in it, when proper 1708
HYPERCATHARSIS, 1477
HYPOCHONDRASIS, 1222
phenomena of ib.
distinguished from dyspepsia 1226
proximate cause of 1230
cure of 1232
treatment of the mind in 1244
HYSTERIA, 1514
symptoms of 1515-16
paroxysm or fit described ib.
rarely appears in males 1517
how distinguished from hypochondriasis 1518—19
proximate cause of 1522
analogy between and epilepsy 1523
HYSTERIA,

xiii INDEX. 
HYSTERIA, cure of 2524
libidinosa 1517
HYSTERIC DISEASE. See Hysteria.
I.
JAMES'S powder, its use in fever 183
JAUNDICE, 1815—16
causes of 1816—21
cure of 1823—29
ICTERUS. See Jaundice.
ILIAC passion. See Ileus.
ILEUS, 1437
IMPETIGINES, I737
character of the order ib.
INDIGESTION. See Dyspepsia.
INFLAMMATION, the phenomena of 235
internal the marks of 236
the state of the blood in 237
the proximate cause of 239
not depending upon a lentor of the blood 241
spasm the proximate cause of 243—248
terminated by resolution 249
by suppuration 250
by gangrene 255
by scirrhus 258
by effusion 259
by blisters 260
by exsudations 261
the remote causes of 262
the cure of in general 264
by resolution ib.
when tending to suppuration 268—70
when tending to gangrene 271
its general divisions 273
more strictly cutaneous 274
of the bladder. See Cystitis.
of the brain. See Phrenitis.
of the heart. See Carditis.
of the intestines. See Enteritis.
of the kidneys. See Nephritis. 
of the liver. See Hepatitis.
INFLAMMATION, 

xiv INDEX.
INFLAMMATION, of the lungs. See Pneumonia
of the pericardium. See Pericarditis,
of the peritonæum. See Peritonitis.
of the spleen. See Splenitis.
of the stomach. See Gastritis.
of the uterus 432
INSANITY, 1535
causes of 1550—57
of different species l557
partial and general difference of 1575
INTEMPERANCE IN DRINKING, a remote cause of fever 97
INTERMISSION OF FEVER, 24
INTERVAL OF FEVER, 124
INTEMESCENTIÆ, 1620
character of the order ib.
K.
KING'S EVIL. See Scrophula
L.
LEUCOPHLEGMATIA. 1669
LEUCORRHOEA, 985
character of 986
appearance of the matter discharged in 987—992
the causes of 988
the effects of 990
the cure of 993
LETHARGUS, 1094
LIENTARY, 1469
LOOSENESS. See Diarrhœa.
M.
MADNESS. See Mania.
CANINE. See Canine.
MANIA, 1558
the symptoms of ib.
the remote causes of 1559—61
the treatment of 1562—74
MANIA, 

xv INDEX. 
MANIA, occurring in sanguine temperments 1576
in sanguine temperaments, cure of 1577
MARCORES, 1600
MARSH EFFLUVIA, a cause of fever 84
MEASLES, 633
the symptoms of 637—642
the nature of 644
cure of 645—650
of a putrid kind 634
MEDICINE, the institution of 4
MELÆNA, 1017
MELANCHOLIA, 1575
how distinguished from hypochon-
driasis, 1587—88
the character of 1582—89
the proximate cause of 1590
the treatment of 1592—97
MELANCHOLIC TEMPERAMENT, 1230
MELANCHOLY. See Melancholia. 
MENORRHAGIA, 966
active or passive ib.
when a disease 968—75
effects of 972
proximate cause of 977
remote causes of 978
cure of 980
MENSES, immoderate flow of them. See Menorrhagia. 
METALLIC TONICS, employed in intermittent fevers 231
SALTS, refrigerant 136
METEORISMUS, 1638
MIASMATA, 78
MILIARY FEVER, 
the general history of 714—715
MILIARY FEVER, of two kinds, red and white 710
white, the symptoms of 717—719
the cure of 720
MORBUS COELIACUS, 1493
MUCOSUS, 1070
NIGER, 1029
N. 
NEPHRITIS, 426
the symptoms of ib.
c NEPHRITIS,

xvi INDEX.
NEPHRITIS,
the remote causes of 427
the cure of 430
NERVOUS DISEASES. See Neuroses.
NEUROSES, 1090
NEUTRAL SALTS, diaphoretic in fevers 159—161
refrigerant in fevers 135
NOSOLOGY, Methodical 2
O.
OBESITY, when a disease 1621
ONEIRODYNIA, 1598
OPHTHALMIA, 278
membranarum ib.
its different degrees 279—280
its remote causes ib.
the cure of 288—290
tarsi 278
the cure of 288—290
OPIATES, employed in the hot stage of intermittent fevers 233
in the interval of intermittent fevers 231
OPISTHOTONOS. See Tetanus.
P.
PALPITATION of the heart 1355
the phenomena of ib.
the causes of 1356
the cure of 1363
PALSY, 1140
distinguished from apoplexy l094
causes of 1141
PARACENTESIS in ascites, when to be attempted 1717
in hydrothorax, when proper 1708
PARAPHRENITIS, 343
PAROXYSM of intermittent fever, the recurrence, how to
be prevented 732
PEMPHIGUS, 229
PERICARDITIS, 383
PERIPNEUMONIA NOTHA, 376
symptoms of 379
pathology of 380
the cure of 381—382
some of the symptoms explained 350
PERIPNEUMONY, 242
PERITONITIS, 

xv INDEX. 
PERITONITIS, 384
PERUVIAN BARK, not a specific 213
its tonic power 214
when proper in fever 215
how most effectually employed 216
the administration of, in intermittent fevers 232
the tonic chiefly employed in intermittent fevers ib.
PETECHIA, 734
PHLEGMASIÆ 235
PHLEGMON, 274
PHRENITIS, 291
the character of 293
the remote causes of 294
the cure of 295-299
PHRENSY. See Phrenitis. 
PHYSIC, the practice of, how taught 1
the theory of, how to be employed 4
PHYSCONIA, 1718
PHTHISIS PULMONALIS, the general character of 853
always with an ulceration of the lungs 855
the pus coughed up, how distinguished 
from mucus 856
accompanied with, hectic fever 857
the various causes of it 862
from hæmoptysis 864-865
from pneumonia 866-869
from catarrh, 870-873
from asthma 875
from tubercles 876-882
from calcareous matter in the lungs 884
if contagious 886
from tubercles, symptoms of 889
its different duration 896
the prognosis in 897
the cure of 899-924
the treatment of when arising from tu- 
bercles 906-921
the palliation of symptoms 922-924
PLAGUE, 
the general character of 665
phenomena of ib.
principal symptoms of 667
C 2 PLAGUE,

xvii INDEX.  
PLAGUE, proximate cause of 668
prevention of 670—685
cure of 686—695
PLEURISY, 341
PLEUROSTHOTONOS. See Tetanus.
PNEUMONIA, or PNEUMONIC INFLAMMATION, 334
general symptoms of 335—339
seat of 340—344
prognosis of 352—360
cure of 361
the management of blood-letting in the
cure of 362—367
the use of purgatives in 370
the use of emetics in 371
the use of blisters in 372
the means of promoting expectoration in 373
the use of sweating in 374
the use of opiates in 375
POLYSARCA, when a disease 1621
cure of 1623—25
PROFLUVIA, 1045
character of the class ib.
PULSE, the state of the, during the paroxysm of an in-
termittent fever 12
PURGING, its use in continued fevers 144
intermitent fevers 234
PUS, how produced 250
PUTRESCENCY of the fluids in fever, the symptoms of 105
the tendency to in fever, how to be
corrected 222—226
PYLORUS, SCIRRHOUS. See Dyspepsia.
PYREXIÆ, 6
character of the class 7
orders of the class ib.
PYROSIS, 1427
symptoms of 1431
proximate cause of 1433
remote causes of 1432
cure of 1434
Suecica of Sauvages 
Q.
QUINCY. See Cynanche.
RACHITIS, 

xviii INDEX. 
R.
RACHITIS, 1719
its origin 1720
remote causes of 1721-23
phenomena of 1724
proximate cause of 1725—28
cure of 1729—36
REACTION of the system 59
violent in fever, symptoms of 103
violence of, how moderated 127
REFRIGERANTS, the use of them in fever 134
REMEDIES, table of those employed in continued fevers 227
REMISSION of fever 26
RESOLUTION of inflammation, how produced 249
RESPIRATION, the changes of, during the paroxysm
of an intermittent 13
REVOLUTION, diurnal, in the human body 55
RHEUMATISM, acute or chronic 433
Acute, the remote causes of 436
the proximate cause of 445-460
the symptoms of 439—447
cure of 461—470
Chronic, symptoms of 450
how distinguished from the acute 451
proximate cause of 472
cure of 473—476
how distinguished from gout 526
RICKETS. See Rachitis.
ROSE. See Erythema.
RUBEFACIENTS, the effects of them.
S.
SCARLET FEVER, 651
the symptoms of 636
different from cynanche maligna 651-655
the cure of 657-664
SCROPHULA, 1738
the phenomena of 1738-1749
the proximate cause of 1750
not contagious 1751
not arising from the lues venerea 1752
the cure of 1753-1759
Mesenterica 1606
SCURVY,

xix INDEX. 
SCURVY, 1789
remote cause of 1792—1802
cure of 1804—09
proximate cause of 1811-14
SINAPISMS, the effects of them 197
SKIN, affections of. See Impetigines.
SMALL-POX, general character of 587
symptoms of the distinct kind 589
of the confluent kind 590—593
general differences between distinct and
confluent 594
causes of these differences 595—600
prognosis in 593
cure of 601—630
inoculation of 602
the several practices of which it
consists 603
the importance of the several
practices belonging to 604—615
management of small-pox received by in-
fection 616—630
SODA, 1427
SPASM, internal, means of recovering in fevers 152—187
the proximate cause of inflammation 243—248
SPASMODIC affection without fever 1251
of the animal functions 1425
of the vital functions 1355
of the natural functions 1427
SPACELUS, 255
SPLENITIS, 425
STIMULANTS, when to be employed in fevers 217
their use in intermittent fevers 230
STOMACH, its consent with the vessels on the surface of
the body 44
SUDORIFICS, arguments for their use in fevers 163—167
against their use in fevers 164
SUPPURATION of inflamed parts, the causes of 251
the marks of a tendency to ib.
formed, the the marks of ib.
SURFACE of the body, its consent with the stomach 44
SWELLINGS, general. See Intumescentiæ.
adipose 1621
SWELLINGS, 

xx INDEX. 
SWELLINGS, flatulent 1626
watery. See Dropsies.
SWEATING, wheu hurtful in continued fevers 165
rules for the conduct of in continued fevers 168
use of in intermittent fevers 230
SYNCOPE, 1171
phenomena of ib.
remote causes of 1174—1178
predisposition to 1184
cure of 1189
distinguished from apoplexy 1094
SYNOCHA. See Fever.
SYNOCHUS. See Fever.
SIPHYLIS, 1760
originally from America 1761
how propagated 1762
and gonorrhœa, how distinguished 1764
the cure of 1783—88
T.
TABES á hydrope 1609
à sanguifluxu 1608
dorsalis 1610
glandularis 1606
mesenterica ib.
nutricum 1608
rachialgia 1606
scrophulosa ib.
TARTAR EMETIC, its use in fevers 183
TETANUS, 1257
remote causes of 1268
cure of 1270
pissileum Barbadense, or Barbadoes tar, in 1280
LATERALIS, 1268
TONIC medicines employed in continued fevers 211
intermittent fevers 231
TOOTHACH, how far different from rheumatism 477—480
symptoms of 478
predisposition to 481
remote causes of 481—482
proximate cause of 483
cure of 485—491
TRISMUS, 

xxi INDEX.  
TRISMUS. See Tetanus.
NASCENTIUM, 1281
TUSSIS. See Catarrh.
TYMPANITES, the character of 1627
the different species of, 1628—30
intestinalis 1628
enterophysodes ib.
abdominalis ib.
asciticus ib.
phenomena of 1632
proximate cause of 1635—36
cure of 1637—44
TYPHUS. See Fever.
the species of 70
V.
VAPOURS, or low spirits. See Hypochrondriasis.
VENEREAL DISEASE. See Siphylis.
VENERY, excess in, a remote cause of fever 97
VESANIÆ,
in general 1528
VIS MEDICATRIX NATURÆ, 38
ST. VITUS'S DANCE. See Chorea.
VOMITING OF BLOOD. See Hæmatemesis.
effects of in continued fever 172—173
the use of intermitting fevers 230—34
U.
URINE, bloody. See Hæmaturia.
URTICARIA, the history and treatment of 730
W.
WATER-BRASH. See Pyrosis.
WHITES. See Leucorrhœa.
WARM-BATHING, the effects of in fever 198
the administration of in fever 199
the marks of the good effects 200
WINE, the most proper stimulant in fevers 218
its convenient use in fevers 219
when hurtful or useful in fevers 220
THE END.