1&~& ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Ann;.. Section. f sx . f Number ..^J...^.Q..7T:S.J... Form 113c, W. D.. S. G. O. po 3—10543 (Revised Jun« 13, 1938) 'tJO* £ftt *+^ SYNOPSIS ; Of THE UNIVERSAL PRACTICE OF MEDICINE. EXHIBITING A CONCISE VIEW OF ALL DISEASES, BOTH INTERNAL AND EXTERNAL : ILLUSTRATED WITH COMPLETE COMMENTARIES. BY JOSEPH LIEUTAUD, FIRST PHYSICIAN TO LEWIS XV. TRANSLATED FROM THE LATIN, BY EDWIN A. ATLEE, M. D. FELLOW OF THE COLLEGE OF PHYSICIANS, PHILADELPHIA, \ PHILADELPHIA. PUBLISHED BY EDWARD AND RICHARD PARKER, NO. 178 HIGH STREET. Abraham Bowman, Printer. 1816. 1 DISTRICT OF PENNSYLVANIA, TO WIT: Be it remembered, That on the twenty-fourth clay of July, in the forty-first year of the Independence of the United States of America, A. D 1816. / Edwin A. Atlee, M. D. of the said District, hath deposited in this office the title of a book, the right whereof he claims as Proprietor, in the words following, to wit: "Synopsis of the Universal Practice of Medicine, exhibiting a concise View of all Diseases, both Internal and External: illustrated with complete Commentaries. By Joseph Lieutaud, first Physician to Lewis XV. Translated from the Latin, by Edwin A. Atlee, M. D. Fellow of the College of Physicians, Philadelphia." In Conformity to the Act of the Congress of the United States, intitled, " An Act for the Encouragement of Learning, by securing the Copies of Maps, Clwrts, and Books, to the Authors and Proprietors of such Copies, during the Times therein men- tioned."—And also to the Act, entitled, " An Act supplementary to An Act, entitled, " An act for the Encouragement, of Learning, by securing the Copies of Maps, Charts, and Books, to the Authors and Pi oprietars of such Copies during the Times therein mentioned," and extending the Benefits thereof to the Arts of designing, engraving, and etching historical and other Prints." D. CALDWELL, Clerk of the District of Pennsylvania. TO THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, THIS WORK IS AFFECTIONATELY AND RESPECTFULLY INSCRIBED, BY THEIR FRIEND, THE TRANSLATOR. TO NATHANIEL CHAPMAN M. D. PROFESSOR OF INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE IN THE UNIVERSITY OF PENNSYLVANIA. THIS WORK IS ALSO DEDICATED BY THE TRANSLATOR, AS A TESTIMONY OF ESTEEM AND RESPECT. INDEX. BOOK THE FIRST. OF INTERNAL DISEASES. SECTION THE FIRST. Pf Diseases that may be called General, or of Uncertain Seat. Page. Fevers -- - - - - n Simple continued Fever .-- - .23 Putrid continued Fever 25 Ardent or burning Fever - - - 30 Malignant Fever - 34 The Plague - - - - - 44 Sudor Anglicus. Sweating Sickness - - 50 Intermittent Fever - - - - 52 Quotidian Fever - - - - - 60 Tertian Fever - - - - - 62 Quartan ------ 64 Remitting - 66 Plethora, Fulness of the Vessels - - - 68 JEstus Morbosus. Morbid Heat ... 70 Loss of Strength - - - - 71 Scarcity of Blood - - - - - 74 Retrocession of Evacuations and Eruptions - 76 Pains ------ 78 Catarrhal Affections - - - - 81 Cachexy - - - - 84 Scurvy ----- 87 Lues Venerea .... 93 Scrophula - - - - - 102 Arthritis - -- - - -107 Rheumatism - - - - - 113 Hypochondriasis - - - * - 118 Dropsy - .... 123 Stagnation of Blood and Pus - - - 129 Obstruction and Schirrus - - - 131 Tumours .-. - - - 137 Phlogosis or Inflammation - - - 140 Purulence or Suppuration - - - 145 Gangrene --- - - -151 Insects and Extraneous Bodies - - - 153 Poisons ... - 157 INDEX. SECTION THE SECOND. OF INTERNAL DISEASES OF THE HEAD. Page. Vertigo - - - - - -163 Apoplexy - - - - - 166 Sleepy Affections - - - - 173 Tremor - - 176 Palsy ------ 178 Dulness of Mind and Memory - - - 181 Pervigilium, or Want of Sleep - - - 183 Incubus, or Night Mare - - - - 185 Melancholy - - - 186 Mania.....- - 189 Phrensy ... - - - 191 Convulsions - - - - - 194 Epilepsy - - - - - 199 SECTION THE THIRD. OF INTERNAL DISEASES OF THE BREAST. Hoarseness - 205 Cough ------ 206 Suffocating Catarrah - - - - 211 Inflammation of the Breast -• - - - 213 Peripneumonia Notha - - - 221 Asthma - - - - . - - 223 Suffocation - - 227 Haemoptysis or spitting of Blood - - 230 Phthisis, or Consumption - - 233 Vomica, or Abscess of the Lungs - 236 Empyema - - - - 238 Dropsy of the Breast - - - 240 Palpitation of the Heart ... . 244 Syncope. Fainting - - - - 246 Singultus. Hiccough - - - 249 SECTION THE FOURTH. OF INTERNAL DISEASES OF THE ABDOMEN. Bad Digestion ------- 253 Vomiting -...... 259 Vomiting of Blood --.___ £62 Canine Hunger, or a Dog's Appetite - - 265 INDEX. iii Page. Pain of the Stomach - - 266 Ileus. Colic, Iliac Passion ■- 269 Cholera. Purging and Vomiting of Bile - - 272 Diarrhasa - 274 Bloody Flux - - - - - 277 Tenesmus ----- 283 Alvus Adstricta. Costiveness - - - 284 Colic Pain - - - - 28? Flatulency and Tymphanites - - - 299 Worms ----- 304 Hepatic or Liver Colic - 309 Hepatitis - « - - - 312 Icterus. Jaundice - - - 315 Nephritis - - - - - 319 Lithiasis - 322 Bloody Urine - 329 .Ulcers of the Kidneys and Bladder - - 331 Diabetes - - - - 339 Involuntary Dicharge of Urine - - - 341 Catarrh of the Bladder - 342 Dropsy of the Abdomen ... 343 BOOK THE SECOND. RESPECTING EXTERNAL DISEASES. SECTION THE FIRST. Of those which are General, or of Uncertain Seat. Obesitas. Corpulence or Fatness - 353 Atrophia. Falling away of the Flesh - 355 Haemorrhage. Profuse discharge of Blood - 359 Phlegmon, Inflammation; and Abscess - - 361 Ulcer and Fistula - 354 Bubo - - - - - 369 Carbuncle or Anthrax - - - 372 Furuncle and Epinyctis - - - - 374 ffidema and Emphysema - - - 375 Schirrus and Cancer - - - - 375 Aneurism and Varix 38^ Cystic Tumours - - - 3gy Sarcoma. Verrucae et Cornua; Wens, &c. - 390 The Bite and Puncture of Animals - - 39^ iv INDEX. Page. Tarantismus - - - 397 Hydrophobia. Canine Madness - - 398 Contusion and Wound - - - 402 Burns - - - - 407 Gangrene - - 409 SECTION THE SECOND. OF EXTERNAL DISEASES OF THE HEAD. Cephalalgia. Headach - - - - 413 Insolation - - - - 416 Concussion of the Brain - - - - 418 Parotis - - - - 421 Bronchoccle - - - 423 Gutta Rosacea - 424 Diseases of the Eyes * 426 Diseases of the Nose - - 439 Diseases of the Ears - 444 Diseases of the Mouth - 449 Troublesome Swallowing - 457 Angina - - 46Q SECTION THE THIRD. OF DISEASES OF THE TRUNK AND LIMBS. Spurious Pleurisy - - - - 467 Diseases of the Loins - 468 Ilerniae, and similar Affections - - 469 Diseases of the Genitals - 474 Diseases of the Anus - 489 Diseases of the Limbs - - - 498 Diseases of the Bones - - - 511 SECTION THE FOURTH. OF DISEASES OF THE SKIN. Vitiated Sweat - - - - 519 Phthiriasis. The Lousy Evil - - « 521 Spots and Efflorescences - 522 Herpes and Itch - - - 525 INDEX. v Page. Scabies. Itch - - - 528 Impetigo - - - 530 Lepra. Leprosy - - - 531 Erysipelas - - 535 Scarlet Fever - - 537 Morbilli. Measles ... - 539 Variola. Small-Pox - - - 542 BOOK THE THIRD. DISEASES OF WOMEN AND CHILDREN. SECTION THE FIRST. Of the Diseases of Virgins and Married Women, Hysterics - 549 Pica. Malacia ----- gg^ Chlorosis - - 557 Diseases from Catamenia - - - 558 Sterility. Barrenness - 565 Diseases of Pregnant Women ... 553 Diseases of Puerperal Women - - 572 Diseases of the Breasts - - 581 Diseases of the Genitals - - 584 False Conception - 593 SECTION THE SECOND. OF THE DISEASES OF INFANTS. Colostration - 605 Fever - -Small-Pox and Measles 606 607 Atrophy -Dropsy and Jaundice -Venereal Disease - 608 609 610 Scurvy -Scrophula - -Cough -Vomiting - -Tormina - 611 613 614 616 617 Looseness of the Belly 618 Costiveness - 619 vi INDEX. Page. Worms - - 620 Swelling of the Belly - 622 Hernial Prominence of the Navel - - ibid Stone and Ischury - - 623 Prolapse of the Anus and Piles - 624 Epilepsy and Convulsion - 625 Aptha? ... 627 Dentition ----- 629 Dropsy of the Brain - 630 Rickets --- - - - 632 The Hip Disease - - - - - 633 Diseases of the Skin ... - 636 THE TRANSLATOR'S PREFACE. IN giving to the world this "Work, my principal object has been, to render publicly useful, by rescuing; from unmerited neglect, an Author of the first eminence; whose eulogy were I to attempt, it would argue pre- sumption, as, to use a vulgar phrase, I am not jit to hold the candle to him. Indeed, while engaged in the arduous undertaking, my admiration was often excited, that some one of the eminent practitioners who have quoted his writings, had not, e'er this, dressed him in an English garb. The reader will discover a laconic and satyrical style, which I have found to be characteristic of the Author, and therefore considered myself bound to follow as accurately as possible. There is also now and then apparent, a vein of piety, which renders it the more precious to those who value gold more highly than tinsel; and although time was, when perhaps this would have nearly shut up its way in the medical world, it is, nevertheless, truly pleasing to see in this enlightened day, numbers of the practitioners of the healing art, in various religious so- cieties, who are not ashamed to wear the badge of Chris- tianity. Infidelity scarce dares to lift its head amongst them, because the darkness in which it delights, is so dis- pelled, that its hideous deformities are too apparent. The remedies directed for the diseases respectively treated of, are classed according to the Author's nomen- clature in his Materia Medica, or Second Pa?*£,which I had some thoughts of translating, but declined it in consideration of the many modern improvements in this branch of our science. As this Work has been patronised by many who are not physicians, to whom I feel grateful, inasmuch as their motive for encouraging it was purely di.sinferesJad viii THE TRANSLATOR'S PREFACE. and benevolent; I regret that the nature and limits of it, did not admit of it being rendered more intelligible; notwithstanding hope that it will prove to them a useful Family Physician. It is probable also that I shall never have an opportunity, more suitable than the present, to acknowledge the kind attention and friendly regard of some of the practitioners of this city, who since my re- sidence here, have expended the hand of encouragement when much needed. These remarks being premised, nothing further ap- pears necessary. Good wine needs no bush: and if, in drawing it from the European to an American cask, I have been favoured to preserve it genuine, not even at- tempting to correct its austerity, I shall have attained one desideratum, that of being a faithful TRANSLATOR. Philadelphia, fth Month 1816, EXTRACT FROM THE AUTHOR'S PREFACE. THE mind is astonished when viewing the miserable condi- tion of mankind, ignorant of their future destiny, catching with cries, the first breath of life, and yielding it in a short time to inevitable Fate. Nor do the poor sufferers spend even this short span of existence in peace, but are wearied with number- less afflictions, among which the formidable Phalanx of Dis- eases lifts its dire head. Some through stress of gloomy care, and influenced as it were, by an unlucky planet, have laid guilty hands upon themselves. Hence it is little to be wondered at that some licentious ones, tainted with an impertinent Itch for Scribbling, should through impatience and fickleness of mind rashly bring upon themselves the misfortunes with which they are borne down, and which they impiously charge upon the Su- preme Author of Good. Those, however, who excel in virtue, and are better acquainted with Nature, have on all hands refut- ed these cavillers, and more rationally concluded that adversi- ties are owing to the wickedness of mankind, who would never have suffered them, had they not deviated from the simple man- ner of life of their progenitors. When man was yet rude and uncultured, in the new Earth and under the recently formed Heaven, and the uncorrupted fruits of the Ground were his food: when lowly Tents were the habitations of Flocks and their Lords in common; when the chaste wife not more polished than her husband feasting on nuts, made up her ill-contrived covering of skins, and strewed her rustic couch with leaves; when as cultivators of paternal Fields and keepers of Flocks, they indulged in moderate labour and grew old in unimpaired vigor: Then were they governed by the Law of Nature, and were not anxious, so long as Truth flour- ished, to solve the perplexities of human Laws. Little solicit- ous about the origin and causes of things, so sedulously traced by their descendants, they followed the Philosophy of Nature, by which they discovered Effects, and used to discern Right PREFACE. from Wrong, and salutary from noxious things. It was not ne-* cessary that men who kept off disease by this simple mode of living, should unravel the Problems of Medicine; for although ignorant of this science, they enjoyed a life untainted and un- contracted by Maladies. And when grey hairs approached, they despised not an old age so conspicuous for Virtue; but welcomed it with the highest honours and religious veneration, until having filled up the measure of their lives in placid indus- try, they, without fear departed to their Heavenly Rest. But when the world became foolish and degenerate, Idleness crept in, and the accursed love of Gold led mankind captive. All morals were perverted, Sons refused to follow the footsteps of their Fathers, they vied one with another in splendour, wealth and family distinction, and began to devise base things, not blushing to change black into white. Ever panting after hap- piness, they betook themselves to sumptuous Edifices, decor- ated their bodies with softest raiment, Gold and Purple, exhi- bited to the wondering crowd, Feasts of exquisite dainties, tortur- ed with every variety of cookery; in short, exhausted by every species of luxury and gluttony, every vice followed close at their heels, the practice of which in a short time obliterated shame, and all things gradually went to decay and ruin. It is no marvel, if as this destruction advanced, all the laws of the Animal ^Economy should have been perverted, and a griev- ous host of diseases should afflict these madmen, who notwith- standing yielded very reluctant submission to these calamities. Even then however they might have provided for their restora- tion, had they profited by this chastisement, and settled theix fluctuating minds by the precepts of wisdom: but, borne away by their own lusts, they thought little about investigating the cause of their misery, although conscious of their licentious man- ner of life, and made no exertion to avert these fell distempers, but only to mollify or remove them by chance remedies, or such as were at hand, the good or bad effects of which they noted. So that from their observations, collected and arranged, might have sprung that primitive and rude art of healing, which in its infancy dwelt in Egypt, from whence it migrated into Greece, and of which no learned man is ignorant. Among the Greeks, the first who collected the scattered Theo- ries of Diseases (assisted perhaps by the writings of Asclepi- ades) and reduced them into a System when culled from the Vo- tive Tables in the Temple of jEsculapius, was HIPPOCRA- TES, whose writings are truly precious, although they have much dross and impurity mixed with them, unless as some con- jecture, his legitimate works have been contaminated by spuri- PREFACE. 3 ous additions. Even the Hippocratic Art might haVe been lost by the injuries of time and rudeness of the age, if Galen had not undertaken, with his great abilities, to restore it, torn as it was by innumerable sects, after the lapstfof six hundred years. This Galen was a Physician, second to none, but he has be- fouled his writings with vanity and verbosity enough to sicken one. The Medical Art advanced but little afterwards, nor did the other sciences experience a better fate until the 7th century, when the Arabs and Saracens laid waste almost all the world, and even Athens and Rome. Yet there were not wanting, among these barbarians, some who cultivated the Greek Lan- guage and gave earnest attention to promote the study of Me- dicine ; and through the care of these the art was revived, and slowly advanced, until a century had nearly elapsed: since which time innumerable medical writings have appeared, many of which are condemned to oblivion, and given to the moths and worms, while others contain many things which are tolerable, but are chiefly made up of mere hypotheses, rendered prolix by a great round of words that weary the reader. There are not- withstanding a few more durable than brass, and fraught with exquisite observations. But various domestic concerns forbid me comparing this mass of all kinds of books, nor is it in the power of men, incumbered as I am with practice and frequent watching of the sick, to look them over. Hence many, of no mean rank, urged by these difficulties, have bestowed great labour to encounter this almost insupera- ble disadvantage, or by some means to smooth the rugged path of Medical Science. These, by comprising in few words what were here and there written in mbre diffuse style, endeavoured to limit this exceedingly ample science. Various Compendia have appeared: exhibiting rather a speci- men of learning than a just rule of practice, which therefore, with leave of the illustrious authors, afford little satisfaction to a mind desirous of knowing what is true and expedient. And al- though nothing would be more out of date than for me to culti- vate this Broom, yet the unfortunate event of the above-mention- ed works, has in no wise withheld me from my undertaking. Whether I shall be more successful, let those determine, who have traced the recesses of Clinical Medicine. Yet far be it from me, after a view of so many publications of the samenature, to write an Iliad after Homer, or serve up Colewort twice boiled. My design is vastly distant from these Compendia, and the principal part of this work is drawn from my own store-house, I mean from my clinical and anatomicaj notes, some of which 4 PREFACE. are already superannuated, and contending with mouldiness, I have thus saved them from destruction, but do not publish them entire, (as I had hastily thrown them together in sheets) rather as abridgments or deductions that I might spare the labour of my readers. This Epitome is" not only contained herein, but also that of the copious works of the most fabulous writers, which I have searched with unwearied labour, not without re- pentance for the undertaking, that I might pick out from the immense confusion of Books, such only as were of use in prac- tice, and reduce them to my plan. Wherefore, from all these, accurately digested, and disposed in clearer order according to their importance, leaving out the learned and curious comments with which others abound, and lopping off every thing foreign from my purpose, this Synopsis has been produced, not an , elementary or didactic work, but made up of mere observations, • while engaged among the sick and the dead. I have enumerated under distinct heads, all Affections of what kind soever, among which some have occurred hitherto unheard of. The signs by which they are known, and the symptoms whereby they are attended, are carefully noticed. An accurate history of Diseases does not always require to relate separately, whatsoever Authors have advanced on any subject, for their works more often savour of subtilty of genius, than careful observations in practice. Moreover, every one knows, that to consider these morbid appearances of nature, sometimes as signs, sometimes as symptoms, according to the whim or pleasure of Physicians, ren- ders it difficult to distinguish them one from the other. It may be well also to remark that all that are reckoned under the title of any disease, in no wise manifest themselves in every subject, but some or other of* them, are sooner or later, to be discovered, so that we only cite those which are general and uncertain. By this we may understand why an accurate delin- eation of each morbid affection would be arduous and difficult, since there is none which, on account of the inexhaustible vari- eties, is not continually exhibiting a new appearance: For it is known to all that diseases of the same name or of the same spe- cies, never occur clearly alike in practice, both on account of numberless circumstances derived from temperament, age, sex, season, state of the atmosphere &c. and by reason of different modes of living, and of treating diseases. They miss the mark and labour in vain, who delight to follow this trifling exactness in describing this or that disease. The more experienced practitioners have for a long time com- plained, that the science of Medicine has been corrupted by the luxuriant wit of Physicians, and that nothing scarcely comes to PREFACE. 5 light, except Hypotheses, celebrated by the most empty Babble of the Schools, which, when brought to the Touchstone of Truth, are found to be mere notions. Shamefully indeed do they blunder who think to derive a Medical Theory from such trifles, since it rather consists in Knowledge previously obtained, from mathe- matical science, experimental natural philosophy, anatomical demonstration, chemistry, natural history, &c, and in accurately observing the Phcenomena of Nature, and the powers of the animal Economy, as well in the sound as in the morbid state: from all which, selected and arranged by assiduous care, a genuine Theory of Medicine is deduced, such as was sketched out, by the ancients, and improved by some great men of the Profession, which a series of years has spared, whilst other Theories changeable at the nod of the learned, have year after year put on new faces. Therefore utterly rejecting all Hypo- thesis, I have not said a word on the proximate cause of disease, which is involved in obscurity, and I doubt not that whatsoever those have written on that subject, who have not blushed to deal in such trifles, will be rejected by the scrutiny of the more judi- cious. But the remote and manifest causes are carefully noted, from which when rightly examined, the genuine lineage of a Disease is mostly traced. It must be obvious to all, of what use toward the develope- ment of the most intricate diseases, and for the advancement of Medicine, observations taken from dissections of dead bodies are, wherefore there is cause to admire that medical writers, so little studious of a matter of such importance, should have writ- ten scarcely a word on the subject, or have treated it superfi- cially. On which account I have exhibited histories almost numberless, from the heaps of subjects which I have dissected for 20 years and upwards, extracted and abridged to suit this work. To these I have thought fit to subjoin whatsoever Bo* netus, Mangetus, and other moderns have recorded from the writings of Soothsayers. Nevertheless there was necessity to make a choice, since many authors, consulting only their own reputation, or ignorant of Anatomy, have gained no credit on the subject. Therefore whatsoever scattered observations I have drawn from this abundant source, I have collected and related in an abridged stile, which I thought could not be unacceptable to Physicians. Yet it must not be passed over in silence, that all diseases, even the more violent, do not always occasion any evident injury to the viscera, as very frequently when examined after death, they plainly appear unhurt, which ought to be well noticed, lest articles omitted in the history of these should rashly be considered as defects. 6 PREFACE. The Prognosis of Diseases I have touched upon in a few words, because I judged it vain and needless to repeat in each article, that delirium, convulsions, comatose affections, difficulty of breathing, stertor, faintings^ cold sweats, and other oppressive symptoms usually attending fatal diseases, portend an unhappy issue, which certainly can be unknown to none, however rude and inexperienced. But some symptoms occur, which by rea- son of various circumstances, ought sometimes to be considered favourable, sometimes disastrous; such as fevers, eruptions, hemorrhages, vomiting, diarrhoea, &c. which I have thought it worth the while carefully to note down. Nevertheless learned and experienced Physicians know that the science of future events is obscure, and the judgment concerning life and death uncer- tain. On this account Hippocrates rightly advises to predict with caution, affirming that nothing certain as to the event can be concluded in acute diseases. And perhaps this most ancient Founder of Medicine, has given us more instruction by this Saying, than by his diffuse works on Prognosis, out of which notwithstanding among many things doubtful and very intricate, some excellent observations, to be mentioned in their place, may be gathered. I have dwelt very little, or only incidentally, on the Rules of Diet, although on the observance of these the cure principally depends: But advice on this subject appears superfluous, as I think no practitioner will be unmindful of them. As to Reme dies, I have selected from the senseless hotch-potch of them, such only as were often tested among the sick, as each practitioner is able to discover those most suitable for the cure of each dis- ease. The more experienced confess with one accord, that few remedies are required in acute diseases, in which it is customary, after premising the obvious medicines, to delay or forbear, until the nature of the disease become manifest. It is otherwise in chronic complaints, for the cure of which it is mostly expedient to prepare the way by repeated trials, from which we learn of what moment it is, in this state of things, that many remedies should be known, by the careful examination of which the desir- ed end is frequently attained, but every one may see the ne- cessity of a cautious choice, as medicines rarely do good, unless they be given with judgment, especially as it is confessed by all, that a Physician should be the Contemplator and Servant of Nature, and his duty, to direct her spontaneous movements with caution, or to complete and perfect her deficient and weak en- deavours with timely assistance, otherwise he is wanting in the duty entrusted to him, if either in preserving health or removing PREFACE. 7 diseases, he attempt anything against the law's of nature, or fall Upon distempers with hostile force, against her will. Nothing forbids..the. conjecture that no morbid affection is in- fcuperable, if attacked in proper time and with suitable weapons* But " hoc opus, hie labor est" It is expedient to deal cautiously with remedies, though they may appear innocent^ since it re- mains a fixed maxim that many maladies may safely be left to the, mere powers of nature, which through untimely or prepos- terous applications, may be rendered more violent or even fatal. The vulgar part of Physicians are with truth accused of rash- ness, who, without investigating the nature of a disorder, or but slightly attending to the pulse, hasten to apply their remedies : while the learned and experienced, being more slow of judgment, think that nothing ought to be done without properly consider- ing all circumstances, and candidly own that the effects of medi- cines are doubtful and deceptive, whatever those may babble to the contrary who arrogate to themselves the name of Physician. For it is established among practitioners of the first rank, that nature is the best healer of diseases, and that the most common affections if left to her, are spontaneously removed; but that in others there is no small advantage in calling in the aid of Art, provided our remedies be given in proper time and in suitable doses, nevertheless even such as are adapted to the relief of mankind, do sometimes become hurtful through bad and pre- sumptuous administration. From this it is evident how far they err from the mark, who, despising simples, and adhering to the disgusting notions of the Arabians, overturn the healthful endeavours of nature, by their ill-timed apparatus of remedies; and reduce their borrowed pre- scriptions to the rule of their boastful craft. Alas! wretched pa- tients, unless nature vanquish the disorder and overcome their preposterous helps. Nor do they less deviate from the right way of cure, who venture indiscriminately to take what reme- dies come to hand, among the variety collected haphazard un- der certain names of classes, since it frequently happens, that they occur in such abundance that the more experienced anx- iously hesitate in selecting this or that. They also shamefully blunder, who persuade themselves that every morbid affection is to be attacked with the same weapons, and after the manner pf Mountebanks, boast of a few Nostrums, which soon cheapen when they become known. Nor do they more unhappily miss their aim, who setting aside familiar remedies, preach up only those that are more rare and unheard of. Because no one de- nies, that all remedies, cautiously administered, of what kind soever, whether indigenous or exotic, simple or compound, d»>- 8 PREFACE. mestic or officinal, Chemical or pharmaceutical, deserve their respective praise. It is evident from the ancient monuments of our Science, that the first practitioners gave simple and domestic Medicines, which they either prepared, or committed to the care of some of their pupils, until, perhaps, by the unlucky vanity of both, this most excellent Art was entrusted to certain unskilful persons, who were gaping after gain, more than the welfare of the sick, and took advantage of the credulity of the unwary, by their im- postures and wonder-working pageantry: so that shrewd men discovering the fraud under their atrocious buffoonery, and ri- diculous jestings, have lampooned both the genuine and spu- rious Arts together. Pharmacy as derived from the Greeks and Latins, Was confined within narrow limits. The Arabians restored and enlarged it perhaps beyond the proper bounds, for truly there was none, even among the meanest, who withheld his part toward its amplification. Chemistry was rejected, and although very ancient, was rarely claimed, for medical use; so that it scarcely raised its head, till the beginning of the last Century. But the ancient Medico-chemists were of little use, because they purposely obscured their writings, or used strange and barbarous words, that they might gain the admiration of the ignorant. Their successors, however, or rather a part of them, have without deceit, illustrated this noble Art; which would have been of greater benefit, had they not, with too eager desire, been ever in pursuit of novelties, and striving to add to the shops already overstocked, various trifling and superfluous articles: mere baubles for the multitude. Hence, in process of time this prodigious furniture of the Shops so encreased, that scarce any one, even the most experi- enced, could without great difficulty select from the superabun- dant store, the most suitable or beneficial. Such is this Synopsis of the Universal Practice of Medicine, which I thought would not be unsuitable to make a matter of public benefit, that practitioners might be at no loss in discov- ering the nature of any disorder, and properly administering aid. Nor ought the genuine science of Medicine, to aim at any thing else, according to the judgment of Hippocrates, but to direct the spontaneous efforts of nature, and to study lest any thing be at- tempted against her will, lest it might in any degree render her efforts abortive. On the other hand, from the preposterous use of even the best of Medicines, in despite of the powers of nature proceeds a spurious art, adulterated by the deceptions of a num- ber of Scoundrels, and condemned by the judicious as hurtful and destructive. Whence it happens, that what the Supremf PREFACE. 9 Crjeator, in his abundant goodness prepared for the comfort of the sick, is converted into their bane, by these presumptuous fel- lows, who never understood even the Rudiments of true medi- cal Science : And thus this most useful art, perhaps without an equal among all the other blessings of the Deity, becomes, through the fault of Physicians, the cause qf destruction. C vm BOOK THE FIRST. RESPECTING INTERNAL DISEASES. SECTION THE FIRST. Of Diseases that may be called General, or of Uncertain Seats FEVERS. THE Genuine nature of Fever, lies in great obscurity, and perhaps its differences are not more clearly manifest, notwith- standing what some authors of the first note have advanced on the subject, amongst the innumerable novices, who have scribbled on the same theme, of whom the greater part too much attach- ed to their own physiological opinions, or treading in the foot- steps of others, have disgraced their writings with mere hy- potheses, and comments ,or premature learning, insomuch, that amid this abundance of words, it is difficult to disentangle cer- tainties from uncertainties, useful, from trivial. Hence many of no mean rank have doubted, whether it would not be better to give up the undertaking, and confine themselves to new obser- vations, out of which, when well investigated and arranged, there might be produced a sounder Theory. I leave this to the more learned, and will only candidly and briefly publish what I have collected from a practice_of thirty years. To begin therefore, with things more familiar. While I have unremittingly watched the sick, day and night, there appeared to me, to be only four .species of Fevers, of the continued kind, / viz. The simple continued, by some called continent, because it continues as it were in the same state, without exacerbation, which is to be admitted with some limitation. We can fix noth- ing certain as to its duration, yet it rarely exceeds fourteen days, unless its course be interrupted by injudicious treatment. Tfye putrid continued, which is marked by evident exacerbations, and symptoms of encreased violence, and by a certain Dys- crasia, or ill habit of the blood and humours, tending to pu- tridity. Whence it happens that it rarely ceases without some previous evacuation, by which the blood and juices are freed 12 FEVERS. from their impurities; and indeed this spontaneous or critical evacuation shews the character of a Putrid Fever. Ardent or burning Fever, which from the intense thirst, and heat of the intestines, is justly distinguished from all others. And lastly, the Malignant, the direful symptoms of which seetn to arise from an injury of the Brain and Nerves; and in this respect differs greatly from the others. It is well known, that this last is of longer continuance, and mostly epidemic, contagious, or pestilential. But the above mentioned Fevers, rarely discover themselves, by certain and constant signs; for one while they run their course with gentleness, at other times, they exercise greater Tyranny, so that these different species might be considered as nearly allied; whence it happens that frequently they appear scarcely to differ one from the other. From all which it is not to be wondered at, if many Writers of approved credit, even Boerhaave himself, were of the mind that all fevers exhibited various grades, as it were, of one and the same disease. Nor does the observation of epidemic fevers oppose this opinion, which in the same constitution of climate, and season, shew themselves under different appearances, or counterfeit the Type of various diseases, by which the inattentive, deceived by their affinity, often precipitate themselves into a fatal error. Nor are we ignorant, that continued and intermittent Fevers, are allied, as well in the manner of their exacerbations and paroxysms, which really come on at stated times, as with respect to their ac- cession, period, and crisis; as continued Fevers often take the nature of intermittents, while intermittents run into continued. Notwithstanding, whatsoever may be indicated concerning their affinity, we will follow order in the description of them, that a just and clear method of cure may be discovered. Nor is the view of the Symptoms of Fevers attended with less difficulty, which, requiring a different treatment, ought rightly to be distinguished from essentials, which flow from a depraved state .of the blood, 'Tis true that Symptomatic Fevers grow out of other diseases, and hence are called erysipelatic, inflam- matory, dysenteric, catarrhal, rheumatic, arthritic, milk (fever) lochial, cachectic, scorbutic, 8?c. the fevers indeed, are clearly manifest, which attend the small-pox, measles, scarlet erup- tion, erysipelas, inflammation, dysentery, catarrh, rheumatism, gout, formation of milk, suppression of the lochia; and lastly pains, contusions, wounds, burns, &c. But those are very ob- scure, which arise from plethora, cachexy, depraved bile, scur- vy, lues venerea, scrophula, hysteric and hypocondriac affections, %eat of the blood, gluttony, depraved humours, and worms FEVERS. 13 lodged in the intestinal canal, obstructions, internal abscess, gangrene, stagnations, suppressed evacuations, recession of erup- tions, translation of the milk, exhausted strength, affections of the mind, insolation, &c. concerning which in their proper places. But all these obscurely handed down, await our suc- cessors, who will not grudge to sweat in this arduous field of labour. Litde better have those authors succeeded, who from the view of this or the other symptom, have given trifling or incongruous names of Fevers: For it is hard to tell what they mean by fevers which they called algid, or numb, epial, or hot and cold, lipyri- al, the same; comatose, phrenit'tc, from thirst, from hunger, panting, anxious; asodes, or attended with inquietudes, nausea, &c. syncopal or attended with fainting, vomitory, terminal, ca- catorial, or attended with copious stools, sudatory, uretic, colli- quative, &c. But leaving these idle doatings, I proceed to things of a more abstruse nature, to wit, to the examination of Fevers, having as yet no Type, which can be referred neither to essential nor symptomatic. For every practitioner knows that the commencement^^ invasion, not only of continued but of in j- termittent fevers, is doubtful, so that their nature at the begin- ning is wrapped in great "obscurity. Fevers especially of a bad kind, as we shall say hereafter, are very intricate at their com- mencement, nor are they ever clearly manifest until after the seven or twelve first days, on which account they who have more experience than the vulgar, remain in anxiety, and suspend their judgment, unless a general epidemic constitution of the air, come to their aid. The troubles of Physicians are not confined even to these limits, for they are subject to still greater in the ascertaining of fevers, from the incongruous regimen, or pre- posterous mode of cure of those fevers which depart from their specific nature, and put on a different appearance, which are therefore called corrupt fevers. Lastly, complicated fevers are not more happily explained, in which for example, continual and intermittent, essential and symptomatic, acute and chronic, &c. are joined together, by which even the more judicious are puzzled, ; so that very often there would be need of an Mdi~ pus to help them out. From what has been said, it appears how difficult it is to trace the genuine character of diseases, nor is the event more clearly marked, notwithstanding what Hippocrates and Prosper Al- pinus (who has given his doctrine in a more accurate method) have written on the subject; as well as innumerable ancient, and some modern writers, who have done their best to promote this art of foretelling. But we may collect this one thing out of their It FEVERS. endless labours, to wit. that predictions are uncertain, and there- fore that we must presage with caution. This is a maxim ot Hippocrates, who after more mature consideration, condemn- ed, as it were, his own works, like a writer of unblemished Truth. We may however attain some certainty concerning Prognosis in Fevers, as well from the monuments of the an- cients and moderns, as from our own particular observations, which I have thought would not be foreign from my purpose briefly and distinctly to publish. The Face, that we may begin from the upper parts, is first presented to the observation of Physicians, for from this, well examined, may be gathered many signs of death or health, which are as follow: The Hippocratic Face, as they call it, affords a class of dangerous signs, especially at the beginning of a disease, this consists of the pointed nose, hollow eyes, sunk temples, dry and leaden skin, &c. moreover the countenance flushed with unusual redness, a strong pulsation of the carotids, the eyes fiery and stern, and having a fixed or uncertain set or cast, denote haemorrhage or delirium. The light hurtful (ex- cept in small-pox and meazles) dulness or loss of sight, the eyes immoveable, dim, or half shut and convulsed in sleep, forebode an unlucky event. From spontaneous tears also, while the other signs are bad, may be prognosticated Death. Redness of the cheeks, in acute fevers, is the forerunner of an exacerbation, or denotes a consumption of the lungs, particularly, if the alx nari~ urn are moved with every inspiration. A tumid countenance, in acute fevers, portends nothing bad, except their long contin- unance. Eruptions of an itching or other kind, about the lips and nostrils, indicate a speedy and safe termination. • Nor are signs less worthy of observation, discovered in the * /mouth which have the following appearances. Thirst, intense and clammy, or deficient, is cause of no little fear; but its sud- den cessation in ardent fevers, strikes the greatest terror, con- firmed by various distressing concomitants. Tremor of the lips, livid and dark spots, and difficulty of swallowing, are enumerated among the bad symptoms. The same judgment may be given concerning a dry furred tongue, as if burnt, or covered over with a foul crust. A Ptyalism is innocent, and even considered salutary in small-pox, and some epi- demic fevers. We can fix no certain criterion concerning the gritting or gnashing of the teeth, even without febrile hor- ror and rigor, unless we first enquire whether, in usual health, it is customary for the patients so to do in sleep. No one is ignorant (to continue the subjeet on the Head) that very severe head-aches, stubborn wakefulness, convulsive par- SEVERS. 15 oxysms, and stupour of parts, are to be accounted as unfavoura- ble and 'deadly signs. When delirium comes on with drowsi- ness, it threatens danger. If convulsions quickly follow great discharges of Blood, we may look for Death. Haemorrhage from the Nose sometimes relieves the head, and may mostly be considered harmless, while within certain limits, beyond which it is certainly of dangerous tendency. Practitioners care little about Tinnitus Aurium, nor are they more afraid of Deafness, among the common symptoms of fevers of a bad kind, especi- ally if it happens in the decline of the disease. Lastly, we must have regard to the habit of mind, for no one denies that it is easier for the dull and fearless to recover, than for those who are more delicate and timorous; for it is certain that a host of diseases is derived from Terror and Fear. Grey hairs exhibit an amazing effect of perturbation of mind, which is brought on in a few hours from fear of death; accounts have testified this to have often happened under these circumstances. Henqe it is evident, of how great moment it is, that the sick should be kept from every thing that may distress them, nor is this the least duty of Physicians. Havmg duly attended to what concerns the head, we come now to the Breast. Wherefore, deficient or tremulous voicey difficulty of breathing, stertor and hiccough threaten Death; danger is to be expected also from anxiety about the Prsecordia, which torments the sick in every posture. But we must not prog- nosticate evil concerning that difficulty in the chest, which pre- cedes a crisis, or certain cutaneous eruptions. Connected with the Breast, is the Pulse, that Cynosura, as it is called, or direct-.. ing Star of Practice, from proper attention to which is discover- ed the genuine state of the Heart, and the degree of Fever or of Strength, which every one knows is of the greatest conse- quence in our prognostications. Therefore a Pulse preserving a medium between full and empty, vehement and languid, hard and soft, affords no small hope of the recovery of health. We may form the same judgment, of the equality, proportion and order of its strokes: A pulse, on the contrary, small and con- tracted, unequal and irregular, hard and quick, indicates a dis- ease of a more violent and dangerous nature: If it be weak and intermitting, and yields easily to pressure, with frequent re- currence of -fainting, the patient is hastening to a close. The arteries seized with a kind of spasm,, or vibrating beyond the usual measure, presage no good. Lastly, a pulse resembling a healthy one, or appearing to approach the natural, during the prevalence of violent symptoms, threatens a fatal event. To this head belong those exacerbations, which occurring irregular- 16 FEVERS. ]y, or on alternate days, portend nothing dangerous, yet when daily or often repeated, are much to be dreaded. But when they arise, for instance, on the fourth day, they denote a tedious disorder, which indeed produces the affinity above noticed, be- tween continued and intermittent fevers. Moreover, other cir- cumstances are observable, in examining the pulse, namely an unusual subsultus tendinum, which is esteemed a sign of a griev- ous disease. At the same time appear dryness, heat or cold- ness of the skin from which according to circumstances, or the combination of other signs, various presages are derived. Finally Rn unusual tremor of the hands, and irregular motion of them, are considered as symptoms bordering on death. To return to our proposed order; there are yet many prog- nostic signs to be gathered from rightly observing the Abdomen ; the usual inflation of which, or swelling under the border of the ribs more conspicuous than common portends nothing bad. But if this prominence of the abdomen should arise to a very great degree, and be attended with very acute pain, it frequently leads. to Death. A vomiting at the commencement of a disease is ac- counted favourable, nor need we fear it at other stages of the disorder, if viscid or bilious matter be expelled, otherwise it is thought to be dangerous, especially if emetics and cathartics have been given without effect, particularly if black and fetid sa- hurra be thrown off, we may send for the Bier. Nothing is to be feared from the alvine discharge, which sometimes relieves the head—Yet if it exceed the natural limits, it is not without dan- ger. Moreover involuntary discharges, or more than usually serous, frothy, adipose, full of worms, bloody and excessively putrid, cause difficult work for physicians. As it respects the appearance of the Urine, when that is very plentiful, high co- loured, bloody, especially in small-pox, viscid and black, it oc- casions no small apprehension. If it suddenly stop, or be emit- ted without the knowledge of the patient, it indicates a grievous and dangerous disorder. High coloured urine in the beginning of acute fever, indicates a short disease, but of doubtful event. Urine discoloured, bloody, or of a vinous colour, in affections of the brain, is unfavourable. But if it be turbid, and impregnat- ed with various matters at the time of coction, all things turn out to our wish. We add nothing concerning other signs discover- ed by Slacks from examining of Urinals, seeing they are consid- ered by experienced practitioners as treacherous. The habit of Body, also affords its share in forming a prognostic. From sweats, for example, gendy or profusely breaking out, for the most part fevers are judged of. If it is de- ficient in intermittents, they become more obstinate. Sometinjes FEVERS. 17 however, sweats are taken in the aggregate of symptoms, for if they preceed the accession of fever, they augur ill; if more co- pious through the course of the disease, or if continued, clammy and foetid, they are never void of danger. The more they re- cede from the natural state in odor, consistence and color, the more are they to be feared. Lasdy, it is generally known, that cold sweats, especially of the Face, are the forerunners of death. Exanthemata, pustules, and other cutaneous eruptions are dread- ed without reason, seeing they often render a disease lighter. Pustules of the mouth, are preludes of health in all fevers ; and even from petechia in malignant fevers, no greater danger need be apprehended. Skivering and Chills, at the commence- ment of paroxysms, or febrile exacerbations, portend no evil; but if they are lengthened out more than common, they indicate a tedious disease : AVhen they occur inordinately, they excite sus- picion of lurking suppuration, or threaten delirium, or other ag- gravated symptoms. Concerning cold chills, or horripilation from hysterico-hypocondriac affections, from atrophia, or any other continued disease, (of which in another place) I add nothing. The next thing now is briefly to treat of Pains, which respect the whole habit of body. Therefore, febrile pain fixed in any part, while it proceeds not from disease of the viscera, is not of a dangerous nature—but if a puffing up or flushing, purulence or gangrene be detected, the thing is of dangerous aspect. When pain suddenly vanishes, while other symptoms are not mended, the sick will soon depart to rest. But there occur pains which are to be righdy distinguished from febrile ones, as they arise from another cause, but are exasperated by febrile heat: of this kind, are the syphilitic, scorbutic, rheumatic, &c. which com- monly occasion more fear than danger. These are the pheno- mena of fever, from which are collected the signs of health or death. But it must ever be deeply remembered, that judgments concerning acute diseases are almost always uncertain, where- fore it behoves us to predict with caution. Lastly, it is to be re- marked, concerning the phomomena of fevers above related, that many occur which do not interfere with the usual method of cure, and that some dangerous ones demand peculiar treatment; while others that are merely critical, baffle all remedy. But righdy to distinguish these salutary and spontaneous movements of nature, from which appears the hope of cure, from the genu- ine symptoms, which bring apprehensions of death, is an ardu- ous and difficult task, unless an accurate Doctrine of Crises be preserved; which on this account I have judged it suitable to subjoin in these general terms. D 18 FEVERS. Beyond all appearance of doubt, it remains fixed, that vari- ous febrile appearances among those enumerated, which consti- tute the crisis, or shew it to be near at hand, often excite the greatest terror in those who are inexperienced. So that I do not hesitate to assert, that scarcely any acute fever occurs, which may not be distinguished by some crisis, more or less obvious, whatever some among the moderns may babble to the contrary, who, knowing nothing of delay or waiting, are used to subvert all things by their incongruous and untimely medicines. Never- theless, according to the highest medical authority, or rather ac- cording to the law of nature herself, a Crisis is nothing else than the spontaneous exit of morbific matter, which is mostly preced- ed by the most aggravated violence of the humors; or it is a certain disturbance in the animal oeconomy, to prevent which the incautious, or those blinded by novel opinions, direct all their endeavours, to the greatest injury to the sick : Wherefore, it is litde wonder if many patients, as well by this struggle of nature, as by injudicious remedies, are brought to the hazard of life, or to death itself. For it is proved by multiplied and accurate ob- servation, that fevers are resolved through certain emunctories of the body, or by some eruption. To this end contribute spit- ting, hoemorrhages, vomiting, purging, urine more plentiful, or full of various substances, abscesses, buboes, anthraces, efflores- cences, or cutaneous pustulae, &c. by which the seeds of fevers, now subdued, are carried off, so that these being driven out, all things are restored to their Halcyon state. But when these ef- forts of nature become neither absolute or legitimate, nor vary from the stated time, the disease is protracted or exasperated, which, that they may more clearly be noticed, we have thought it necessary to publish the doctrine of critical Days, in which, for the most part the crises are wont to happen. The Critical Days, according to the illustrious arbiter Hip- pocrates, are, the fourth from the invasion, the seventh, ele- venth, fourteenth, seventeenth and twenty-first. From hence it is obvious that these periods are strictly contained within three and a half days, which to be sure has little agreement, as some have affirmed, with the superstitious numbers of Pytha- goras. Every one knows that various patients in fever, even against a preposterous method of cure, either are restor- ed to health, or fall victims to death, on the fourth, seventh, eleventh, fourteenth days, &c. Hence it appears that the com- putation of Hippocrates is accurate, which allows it to be protracted to the forty-second day, or the term of twelve * periods, consisting of three and a half days. It is known more- over that the legitimate Tertians are rarely continued beyond the FEVERS. 19 seventh Paroxysm or circuit: that inflammatory fevers are found mostly to extend to the fourth or seventh day: that Peripneu- monia is completed by resolution on the fourth, or runs into suppuration, whereby the disease is prolonged till the seventh, fourteenth, and even twenty-first: that the scarletina, measles, and erysipelas, for the most part yield to the septenary number: that Small-Pox become conspicuous on the third and fourth days from the attack, and that Pus is formed about the seventh. Lastly, there are innumerable histories of epidemic fevers, in which a sweat broke out, with remission of disease, on the seventh day. But the Work would swell to an immense size, if I should add all the examples of these periods. I may add one, for instance, in the Epilepsy of Children, the continuance of which, according to some in whom we may place confidence, is for seven months or as many years; to say nothing of the Ca- tamenia, the course of which is completed in five periods of seven years. These are the laws established by nature, accord- ing to which, fevers are used to run their courses, which how*- ever we cannot always follow, or observe, by reason of the doubt- ful or obscure invasion of some fevers, by which indeed all calculation is frustrated. From this we learn that, at a certain fixed time, the morbific matter, by the action of the vital organs, is thrown off, and in this action consists the caction of the morbific virus, lurking in the recess of the viscera, as has perhaps been too much talked about by the ancients, and unadvisedly neglected by the mod- erns. To these efforts of nature do they attend, who consult \ the good of the sick, and have no pretensions to the art of Rob- bery : Whatever incongruity the word Coction may present, we think it ought to be adopted, because it is sanctioned by time, and publicly received. Yet it is expedient to remark, that the above mentioned times of Crises, are not always governed by immutable laws; for the climate, seasons, age, temperament, peculiar method of treatment, mode of living, and innumerable other things, lessen or encrease the powers of nature, suited to this work, and therefore hinder or hasten the crisis. It even sometimes happens, that it is brought about in an imperceptible manner, or is altogether wanting, which nevertheless does not prevent the more experienced from attending to critical days; lest by an untimely remedy, they should turn every thing upside down. Nor are even those Practitioners free from this fear, respecting the seventh day, who oppose the doctrine of Crises. A very accurate history of this subject, is to be seen in a French Lexicon, which they call an Encyclopedia, by Bordeau, an eminent, and illustrious Physician of Paris. 20 FEVERS. From the foregoing, we may learn that the simple method of cure is the more salutary, which, every one knows, consists in the cautious use of venesections, emetics, cathartics, diluents, refrigerants, moderators, antiseptics, diaphoretics, and sedatives", concerning which we shall presently speak particularly. But there is a necessity for a choice of them, seeing that a cure is not always safely performed by the power of the above men- tioned remedies, but they rather occasion harm, if they produce effects contrary to the indication of nature. For whither nature inclines, there we ought to lead her, because if we set her aside, the administration of remedies will rest upon no foundation, or upon one that is but fabulous. Perhaps nothing more assists the healthy endeavours of nature, than the most spare diet, yea, even the copious use of water alone, so long as it does not op- press the stomach by its quantity; or from six to twelve pints drank within twenty-four hours, laying aside all other drinks, during the three or four first days from the attack, powerfully prevents the "febrile orgasms, and has snatched many that were diligent in« the use of this regimen, from the jaws of death. It is well known that a certain quack of Malta, administered the coldest water for" aliment and drink, for thirty days and longer, in a certain very' acute disease, with inconsiderate boldness to be sure, but with happy success. Nor does this copious ingurgitation of water, or any other plentiful draughts, hinder the cure, although the' bloodvessels beat forcibly, if the blood be not carried with too' great impetus, or the vessels do not swell immoderately; and' the prima: vice be emptied by emetico-cathartics, if they should be filled with depraved sordes. Taught by multiplied experi* ence, we do not hesitate to assert, that by this very sparing re- gimen alone, otherwise consonant with reason, the fever has fled, or that the subsequent symptoms, by which it was usual to be exasperated, were assuaged: Finally, that every acute dis- ease becomes more easy of cure thereby. To this method are alone to be opposed the exhausted powers of nature, the weak habits of infants, and of those in extreme age, under which cir- cumstances this method of cure might not be proper. \ Although Bhod-letting is justly considered among the first re- _j medies in fevers, yet it does not agree with alh For it frer quently affords no relief, and indeed very frequently when re- peated without judgment, it is capable of bringing on the greatest injury. We cannot doubt that inflammatory fevers demand a certain number of bleedings, yet there occur some epidemic constitutions of fevers of this kind, in which Huxham, and other celebrated practitioners, who paid great attention to them, have considered them as very hurtful. Nor ought we in fevers of any FEVERS. 21 kind, to strike a vein indifferently through the course of the disease; for blood-letting after the third or fourth day from the first on- set, ought rarely to be judged of advantage unless in a very urgent case, which practitioners should bear in mind, who are very prone to venesection, if they value the health of their pa- tients, and are seeking an honourable character. It is allowed by all that emetico-cathartics, given without de- lay, in the first invasion of a disorder^ while it is expedient to have an eye to the primae viae, afford present help. For if this evacuation is omitted, in acute diseases, every fever is encreased by venisections, because the emptied vessels allow a more free ingress to the depraved remains of concoction. But the case is otherwise, through the course of the disorder, within the com- pass of which, these evacuations ought to be prescribed with the utmost caution, lest the coction should be prevented, that is, un- til the organs become more yielding, or recover their pristine flexibility, for as Hippocrates says : " concocta medicari oportet non cntda." And it is a maxim in medical law, that a physi- cian should do nothingliefore this previous spontaneous opera- tion of the humors, for they not only labour in vain, who attempt an evacuation by prematurely giving cathartics, but frequently excite latent motions, or occasion disturbances scarcely to be quieted by paregorics. This is the doctrine of the ancient fa- thers of medicine, confirmed by daily practice, which we cannot slight, without great risk. This doctrine is followed by the most experienced and free from prejudice, while those who are blinded by new theories, and talk of nothing in fevers but pu- tridity, rush into the contrary practice, to the greatest injury of their patients. Nor do we think this controversy can be decided, unless the principal powers of these remedies be first honestly considered, for that a cathartic is given with a two-fold view, ap- pears agreeable to reason and experience: namely, in the first place, that the depraved juices, putrid matter, or depraved bile itself, lodged in the stomach and intestinal canal, may be carried off, lest being drawn to the blood through the lacteal vessels, they should cause damage or excite a more dangerous or stubborn fever. With this view, an extemporaneous evacuation of this saburra, is considered salutary and necessary, and therefore, at the commencement of a fever, we have above hinted that it ought to be administered without delay: In the second place, that the sickly humor mixed with the blood and juices, may be directed to the intestinal sink, or sewer. But this matter is first to be subjected to the action of these organs, that it may be freed from its own obstructions, and become more obedient to purg- ing, or may more easily be carried off, otherwise the vessels 22 FEVERS. scarcely suffer this morbid matter to be thrown off, and the or- gans confine it, being seized with a spasmodic stricture, and become insusceptible of the stimulus of cathartics. Hence it is litde to be wondered at if practitioners attempt this excretion to no purpose, before the signs of concoction appear. And by this untimely method the symptoms become aggravated, and baffle the utmost endeavours of these incautious ones. No one is ignorant, (to prosecute our design) that the use of Diluents and correctors is very general. It is well known that these articles are profitable in all stages of disease, to assuage the wild movements of the blood, to make the impacted humors flow more easily, to promote a flaccidity of the fibre, and assist the secretions. Water in the most simple state performs this of- fice most happily, and perhaps excels all ptisans, apozems, and gruels that are made for this purpose, since the aforesaid medi- cines borrow their principal virtue from Water itself, as we have above insisted. There are some, however, who reject the crude water, as they call it, wherefore, in this case, let it be impreg- nated with some of these corrective herbs, or let sugar, honey, lemon-juice, syrup, &c. be added to it. Refrigerants and anti- putrid medicines also, which check the force of the humors, and break the impetus of the blood, and preserve this fluid from pu- trescency, are in great esteem in the practice of medicine; and particularly, Diaphoretics mitigate the inward fires with which the viscera are often inflamed, and with medicines of the same nature, afford wonderful help if the fever disposes to sweat, otherwise we must deal cautiously with them, and beware lest this hypothesis beguile us. Nor are Narcotics given more safe- ly, for by inducing a stupor on the vital organs, they sometimes impede the subduing of the morbid matter, and it is stirred up to the destruction of the patient. Frequently also, by the action of these medicines, diseases change from their proper character and present a distracted species, by which the inexperienced are deceived. It is known, moreover, that by these remedies, phrenetic patients are hurried to madness, or seized with deathly sleep. These are the general remedies, by which Fevers are usually removed, they succeed to our wish, if exhibited with a sparing and cautious hand; and they may annul the mandates of fate. But they become destructive, when administered in great abun- dance, and indiscriminately by the unskilful. The more simple have the preeminence over the rest, nor are those formulae con- sisting of such a multitude of ingredients, undeservedly banish- ed in our day, which for the most part oppose each other, being absurdly heaped together, and prepared for mere ostentation SIMPLE CONTINUED FEVER. 23 which to be sure, savour more of ignorance than of learning. What wonder, if such confused and untimely remedies should hinder the more salubrious efforts of nature, operating against her consent; and more to be dreaded than the disease itself, should draw after them so many miseries and deaths. Alas! indeed, for the wretched patients, who commit themselves to such silly nostrummongers, and suffer the torments of their foolish doatings. Hoffman, and innumerable writers of the first rank, have in very plain terms condemned this dangerous practice, and have lacerated the authors of this unlucky method, with very cutting reproofs. Hippocrates followed nothing scarce- ly in acute diseases, but low diet. Etmuller insisted on aque- ous drink alone in the first stages of disease. Baglivi was strenuously opposed to the multiplied use and farrago of medi- cine, and did not hesitate to assert, that the greater vehemence of symptoms was more owing to bad treatment, than to the dis- order. It is well known that the famous Reed, Coch, and other Physicians of the first note, were of the same judgment. The observations of Sanctorius during the prevalence of Plague, are consonant with the above animadversions. Finally, the illustrious Lobb, (to omit the advice and testimonies of others) is perhaps more severe than what is right, against this unwarrantable method of cure, since he spares neither bleedings, emetics nor cathartics. From all which it may be gathered, that the Phoenomena of disordered nature are immersed in dark and impervious obscurity, and therefore that the path of Medi- cine is arduous and rugged. These are the difficulties of the art, which so many of the unskilful little suspect, who have never indeed commenced with the rudiments of genuine medi- cine, and, like cattle, only tread in the footsteps of others. But they escape not the notice of the fathers of the Art, who have spent a life among the sick, and perhaps have had no other re- ward of their labour and erudition. SIMPLE CONTINUED FEVER. Called also, Synocha not Putrid, Ephemeral, Continent, &?c. IT has been rashly considered by some, as a putrid fever of J. milder kind, or of a lower grade, since it shews no putridity, nor mark of concoction, although it frequently seems to be dis- tinguished by a certain peculiar crisis., or spontaneous evacua- tion. Ephemeral, or diary, because of its duration being most- 24 SIMPLE CONTINUED FEVER. ly confined within twenty-four hours, and rarely extending to more days. It assumed to itself the title of Continent among the ancients, because they supposed it| to be without remission and exacerbation, which if brought to more accurate examination, will be found not always consistent with the truth. Lastly, it is named among the vulgar Courbature, and by the Provincial Galls it is called mour foundamen, which vernacular name seems hap- pily to express the nature and cause of the disease. At the first attack, the simple continued scarcely differs from other fevers ; and indeed Hippocrates plainly denies that it can then be des- tinguished from them. Galen contends for the contrary, as- serting that this fever shews itself by indubitable marks. If it were lawful to settle this dispute, between such great men, I could easily believe that both had wandered from the right track. It is not to be concealed that at some times this species of fever scarcely discovers itself, at others is very common. But it frequently shews itself by certain signs, as will appear by the following sketch. It begins for the most part with shivering and chills, as is common in almost all acute fevers. Heat succeeds the cold, and is in the young and growing very intense. The pulse is found to be full and equal. The patients complain mostly of pain of the head, loins, or other part. Efflorescent pustules often break out, and at length the simple continued fever terminates in sweat or hcemorrhage. Moreover it runs its course, as it were, in one uniform tenor; it is encreased by no exacerbations, or ob- stinate symptoms, nor is it protracted beyond a few days, rarely reaching to the seventh. To these we may add, that the fore- runners of other fevers, namely loathing of food, spontaneous lassitudes, &c. are here evidently wanting. This is an observa- tion of Lommius fully approved in my own practice. The course of this fever declares nothing certain, since there oc- cur similar paroxysms of intermittent fevers ; but the solution of each is different, as the termination of this Ephemeral fever is, according to Galen, short and speedy—and leaves no conse- quences ; while the paroxysms of intermittents are gradually mitigated, even after the sweating is perfected. Yet it is not to be concealed that these marks are sometimes more obscure, be- cause besides intermittents, there occur some symptomatic fevers, which have the appearance of ephemeral: So that, the patho- gnomonic signs being absent, even experienced practitioners re- main in anxiety, lest diseases of a different kind from the forego- ing, or from the genuine constitution of the patient, should be discovered. Affections of the mind> watching protracted beyond measure, excessive labour, insolation, inclemency of weather, PUTRID CONTINUED FEVER. 25 gluttony, &c. may justly be enumerated among the common causes of this fever. The young, the vigorous, the luxurious, and free from care are supposed to be prone to Ephemeral Fe- ver. Forestus observed, that men addicted to holy things, from the Abbots to the Monks, were more liable to simple conti- nued Fevers; which is void of danger, unless it be diverted from its proper character, by medicine. The inexperienced ought to bear this carefully in mind, that remedies rarely do good in this. case, but rather occasion no small damage; which the experienc- ed very well know, who are used to commit the business of cure to a suitable regimen of diet, by which indeed the sick are in a short time placed out of danger. From the above it is easily gathered, that the principal cure of this fever is performed by the mere powers of nature, unless a vehement heat of the blood, or depraved humors, lodging in the primae viae, or other accident demand some aid; among which, venesection and emetics claim the preference, which are even \ used, not injudiciously, by some who are in doubt as to the na- ture of the disorder. But for the most part, the whole business is effected by diet alone, or by diluents and correctives, not omit- ting the milder diaphoretics, if obstructed perspiration be com- plained of. Refrigerants also, and nitrous medicines are thought useful, when there is no propensity to sweat. The bowels in the mean time must be kept free, yet this ought not to be excit- ed by cathartics, unless after the cessation of the fever, nor is there always need of this purgation. Within these limits they are not restrained, whose dull minds have but a smack of the elements of Medical Science ; while they terrify the credulous bystanders, by muttering about the danger of the disorder; and therefore draw blood with a liberal hand, and administer medi- cines of all kinds, even the more powerful; by which indeed some of their patients are tired out, while others, by the powers of the natural oeconomy alone, overcome the disorder and the untimely remedy. Nor do these Quacks suffer themselves to be disturbed by the unexpected termination of a disease, but rather with a bold face, hesitate not to ascribe the happy event to their own wonderful method of cure. ----««»o—---- PUTRID CONTINUED FEVER. WE are scarcely able to define, from the very intricate writ- ings of the ancients, what is to be understood by Putrid Syno- E 26 PUTRID CONTINUED FEVER. cha. Nor does its origin more clearly manifest itself, which i* supposed to consist in a certain fault of the humors, tending to alkalescence. Whatever be its most remote cause, it seems to be placed beyond all doubt, that from hence arises a certain morbific humor, subjected to the powers of nature, that it may be eliminated through the various emunctories of the body. And this defecation of whatsoever kind it may be, or purgation, ex- hibits the genuine character of this fever; which Sydenham therefore denominated the depuratory Fever. This physician has truly merited much in the practice of Medicine, who has committed to writing, an accurate history (perhaps too contract- ed) of various epidemic constitutions. Some think that they have hit the nail on the head, who be- ing deceived by the word, putridity, imagined a real corruption of humors in this fever; and the fcetor of the sweat, stools, and urine itself, as the disorder increases, does not a little favour this opinion. But such excretions yielding very similar odour may be discovered in other fevers of a different species, where there arises not the least suspicion of putrescent humors in the vessels. Some, whom this Hypothesis will not suit, have imagined a kind of purulence in the very receptacle of the blood, being induced to think thus, because the urine and expectoration often smell like pus ; which we think foreign from the Truth. Nor do they conjecture more happily who suspect a putrid dissolution of the Blood, for these trifling reasons, that the blood in this disease of- ten passes its bounds, and causes frequent haemorrhages ; and be- sides, that this fluid drawn by the lancet seems to become pu- trid in a short time. Nor do they mistake less, who contend that all the putridity is confined to the intestinal tube ; which in their view, is abundantly proved by the very offensive smell of the alvine faces. But these are mere comments ; since we can never conceive how persons seized with this disorder, with these evident marks of a previous corruption of the blood, should not only not hasten to death, but even should be restored to perfect health in a little time : Whereas, a true putridity of the blood and humors ought to exclude every hope of recovery, differing none at all from a mixed death, which can not be restored either by the powers of nature or the art of medicine. Moreover, it is well known that many enjoying vigorous health, emit from the mouth and body a fetor remarkably odious to all. Add to this, that if we attend to the family of vegetables, many occur which exhale the worst odor, wMle of a sound, natural and entire contexture. What hinders therefore, that the juices of animals, free from disso- lution or corruption, should put on this appearance.. Nor are PUTRID CONTINUED FEVER. 27 writers wanting, in short, who consider the gangrene which is used to accompany this species of fever, as a most certain mark of latent putridity; which plainly contradicts experience. For it is known, that nothing more effectually prevents the putrefac- tion of bodies, than cold, from which, when extreme, animals are seized with gangrene, or mortification itself, as in an instant. Which phenomenon, clearly obvious to all, if I mistake not, overturns this opinion. Nevertheless we may observe, according to the illustrious Van Sweiten, that the blood and humors, weakened by this fever, when deprived of vital heat, are like mortified parts, more apt to become putrid. r For no one is ignorant'that blood and urine, in bowls and urinals, when left to themselves, putrify in a short time. Nor is it to be wondered at, that Ballonius should assert, that he had observed myriads of worms in blood drawn. We may add to these, that the bodies of those who die of this fever more speedily putrefy, so that those who dissect them can scarcely bear the sight of them. But nothing can be inferred from hence, since all these occur in various subjects, which had not the least previous marks of putridity. From hence it is evi- dent, of how great moment it is to give appropriate names to dis- orders, because from this source proceed innumerable errors, which are lamented by the sick themselves. For it is well known that this name, putrid, has long been the refuge of Empi- rics, who when they meet with a fever of a hidden character, without hesitation pronounce it to be putrid. Persons of a sanguineous temperament, are thought to be liable to this species of fever. It often also attacks those who are in the habit of untimely labour after eating; nor does it spare those who indulge in wine and venery. Like other fevers, the continued putrid fever begins with chills and shivering, nausea and vomiting, with pain of the bowels for the most part accom- panying the first invasion, also headach, drowsiness or delirium. Intense heat succeeds these, which afterwards abates a little, and again grows stronger. The pulse at first is equal and soft, afterwards hard and unequal, with subsultus tendinum and dry skin. There is an exacerbation every day, which is greater on alternate days. But it is for the most part comprehended in periods consisting of seven or three and an half days, so that it is usually distinguished by the fourteenth, or twenty-first. Besides the pain of the head, sometimes excessive, raging throughout the course of the disorder, other alarming symptoms Occur, namely, drowsiness, obstinate wakefulness, delirium, con- vulsions, and fatal haemorrhages. Pains are not only felt in the loins and joints, as is usual in other fevers, but they also affect the 28 PUTRID CONTINUED FEVER. breast and right hypocondrium. We say nothing of those which arise from the stuffing and heat of the viscera, and becoming a kind of chronic disease, creep from one part to another, and therefore exasperate the febrile symptoms. The difficulty of breathing and fever encreasing daily, and varying in the same manner, the patient's circumstances become worse and worse ; in the meantime the strength fails, and rest- lessness exerts its greatest fierceness. The mouth is defiled with offensive sordes, the tongue, at first covered with mucus, at length becomes rough and blackish. Some complain of a spurious angina, or are seized with a kind of Ptyalism. The urine appears sometimes high coloured, sometimes clear or dis- turbed, but without sediment before the fourteenth day. The Hypocondria heave, and the whole abdomen swells; lastly, the evacuations by stool become very foetid, or are filled with lum- brici. From this complication of signs or symptoms, it is abun- dandy manifest, that the fever at present treated of, becomes dangerous, or soon approximates to malignancy. For which reason it is no wonder if many have thought both to be one and the same disease. But the putrid fever if it vary not from its character, sooner runs its course. Moreover, there is a certain injury of the brain and nerves through the whole course of a ma- lignant fever, while it is observed to be temporary, and fleeting in putrid fever. Finally, in this last, a depuration is common, but is missing in the malignant. Here the Doctrine of Crises is of great benefit, lest the powers of the animal ceconomy be worn out by ill-timed reme- dies, and all things turned upside down. The more salubrious and common excretions are made through the kidneys and pores pf the skin, but sometimes an haemorrhage serves the purpose of these. The Urine, about the fourteenth day is turbid, and when at rest, suffers a certain feculence to separate itself, and at that time all the symptoms become milder. Critical sweats break out mostly about the same time, or a little later; if they appear sooner they are of no use, unless fcetid ones procure some relief. Discharges of Blood are much to be desired, provided they are kept within proper bounds. Sometimes also this depuration is effected by viscid, thick, and whitish expectorations. But they mistake, who think them purulent, whom we have above noticed to have entertained a false notion, that the whitish sedi- ment of urine was of the same nature. As relates to vomiting daily experience testifies that it is seldom useful, even in the time of crises: a diarrhaea about the critical period is more bene- ficial ; nor is it thought hurtful about the decline of the disorder • otherwise a profuse evacuation of this kind is considered danger- PUTRID CONTINUED FEVER. 29 ous, especially if it be serous. Lastly, nothing certain can be said concerning erysipelatous or pustulous eruptions, &c. From the bodies of such as die of this disease, when dis- sected, there is little to be discovered. Yet we may see some hurt sustained by the viscera when examined: such as the ves- sels swelled with black and feculent blood, polypous concretions, as they call them, in the ventricles of the heart, which are form- ed during the struggles of death. Stuffings and inflammationa of different degrees, and finally, putrid appearances, as well as purulent and gangrenous; the lungs, liver, omentum, mesentery, intestines, &c. ulcerated, to which we may add, stagnations of a serous nature, or of a different kind, as well in the head as in the breast and abdomen. We may also mention Worms, some- times solitary, sometimes collectively, in the convolutions of the intestines. But all these seem inadequate to explain the nature of a putrid fever, seeing they are mere morbid products, or exhibit what may be called morbid injuries, being common in all affections, so that the genuine cause of the disorder, concerning which we are treating, is hid from the eyes of scru- tiny. The cure of this fever, usually begins with one or two venesec- tions, if nothing forbid, in order that the inflammatory obstruc- tions as it were may be lessened, which often occasion difficulty to the physicians. But a greater number of bleedings occasion extreme damage, notwithstanding what they adduce to the con- trary, who never understood the real character of the disorder. After the vessels are emptied, an emetic affords the greatest re* lief, by which the depraved remains of digestion, or of any sordes lodging in the primae vise are cleared off, from whence an unmanageable diarrhoea originates, by which the sick are worri- ed during the whole course of the disease, and the critical sweats are frequently frustrated, as appears from a multitude^pf obser- vations. Nor is perhaps too great stricture of the belly to be le ss feared, which is obviated by suitable emetics, or the milder laxa- tives. For even genuine cathartics ought to be considered as insuf- ficient, which merely perform their usual offices, unless by stimulat- ing the organs, they make them more yielding, and the morbid humors being removed from the parietes of the intestinal canal, by previous coction, become more obedient to purgation, which rarely happens, as we have above hinted, before the fourteenth day. Moreover, diluents, temperants, refrigerants, and nitrous medicines deserve the greatest praise, by which the belly is fre- quently gready loosened. Nor are the antiseptic acids, both mineral and vegetable, less to be esteemed, since nothing, per- haps is found more effectual to prevent alkalescency of the hu» 30 ARDENT OR BURNING FEVER. mors, which, laying aside all hypothesis, shews itself by indu- bitable marks in this disorder, and differs altogether from the fabled putridity. p In manv cases near the end of the disease, the use4 ot the; Pe- ruvian Bark is of great advantage, by which the powers of the organs, worn down by disease, are restored. Sometimes even cardiacs and diaphoretics are useful, when the endeavours of na- ture to overcome the morbific matter appear ineffectual. Narco- tics are to be used with the greatest caution, lest they throw a kind of cloak over the disorder: But Camphor may be given more safely, which, besides its power of blunting the force of the animal spirits, preserves the blood and humors from a kind of putridity. If, lastly, symptoms arising from diseased brain, are long protracted, through the course of the disorder, or rage beyond measure ;* animals cut open alive, and applied to the head, are of benefit, or with the same view let the feet be bathed in warm water, which topical remedies ought not to be despised, because experience testifies that many have enjoyed their good effect. But perhaps nothing sooner relieves the head, than si- napisms or blisters to the legs or soles of the feet. There is the same benefit from cupping, which, I know not why, is almost out of use. ARDENT OR BURNING FEVER. IT is called Causus by the ancients, and sometimes also Leipt- r i a . To mention other names, we have thought would be futile and unsuitable. Ardent fever is not widely distant from putrid. Yet the above-mentioned diseases are easily distinguished, although bordering on each other, if the marks proper to each are not su- perficially attended to. The fever we now treat of, besides the more severe symptoms by which it is marked, is attended by intense heat, with which the intestines are roasted as it were. Besides, the disease is more acute, or runs its course more quick- ly, as may be discovered about the seventh day, and even soon- er; and is rarely protracted to the fourteenth. But it is proper to remark, that various symptomatic fevers occur, to wit, bili- ous, inflammatory, vulnerary, &c. which in some measure re- semble the ardent fever, of which however there are other fore- runners. It makes a different progress, and its cause is found * This barbarous practice has now become obsolete, and with good reason, m artificial heat answers all the purposes of natural. T. ARDENT OR BURNING FEVER. 31 to be quite different, as by the following sketch of ardent fever, abundantly appears. This Species of Fever commences with shivering and chill, or a tremulous coldness; intense and biting heat, especially in- ternal, follows this, state : and. at times while this encreases, the- surface of the body is cold; from which symptom sprang the Febris Leipyria of the Ancients. The pulse is observed at first to be hard and frequent, and in a little time irregular and weak, with loss of strength. The daily exacerbations are greater on alternate days, and for the most part, come on with a previ- ous kind of chill, so that they appear to present the type of a double Tertian, insomuch that many have not falsely suspected that there is a certain affinity between both disorders, as, in some epidemic constitutions, the ardent fever does not manifest itself un- til after several preceding intermittent paroxysms. In the mean time, to return to our subject, a thirst rages, that cannot be quench- ed by any refrigerants, the burning mouth is affected with bitter- ness, the tongue and lips become dry, and by degrees contract black- ness, and are disfigured by various fissures. The patients are tortured with excruciating head-ach, and most obstinate wakeful- ness, and oppressed with delirium, comatose affections, epilep- tic fits, and other grievous symptoms. Some vomit, or discharge by stool a kind of rusty bile, and it passes with such a kind of impetus both ways, that this evacuation becomes like the cholera morbus, yea, the bile becoming more acrid and hot, as it were, burns away the oesophagus and anus, like a caustic. Hence it is plain, of how much consequence it is to remove this humor, lest by its detention, or mixing with the blood, it occasion the great- est damage. From this source appear to arise heart-burn and anxieties not to be appeased by art, distressing swoonings, ob- stinate hiccough, fatal inflammations of the stomach and intesti- nal canal, as well as of the liver, lungs, &c. In some a difficulty of breathing prevails, the hypocondria labour, and the whole abdomen swells. Some are afflicted with wandering pains both internal and external. From the vehement force with which the blood rolls itself along, haemorrhages arise, which are either fa- tal or frequently return. The urine is red and lateritious, or like what is evacuated in jaundice. The skin, which, in malig- nant fevers, is livid, is here found to be yellowish, for the most part wet with sweat, affording no relief, and marked with various efflorescences, and exanthemata. Violent passions of the mind, long protracted watching, im- moderate labour, food that is high seasoned, or of a keen taste, wine and ardent spirits, &c. usually pre-dispose to this disease; vigorous youth, choleric temperament, the constitution of the'air. 32 ARDENT OR BURNING FEVER. and time of year, each contributing a share. The ardent feverseems sometimes to run into a genuine malignant, or the malignant, on the first days, has the appearance of ardent fever. Vomiting and purging occurring about the fourth or seventh day, are con* sidered healthy and critical. The judgment by the urine is doubtful, as it rarely deposits a sediment, nor are more certain in- dications of the event drawn from sweats and haemorrhages. Lastly, convulsions, delirium, lethargy, impeded deglutition, tu- mor of the parotids, bloody spittle, anxiety, hiccough, urine black- ish or tinged with blood, sweating of the face, &c. are by com- mon consent, numbered among the fatal symptoms. Most of the patients die on the third or fourth day, but rarely on the seventh. If the disorder is lengthened beyond this, there is great hope of a recovery, especially in youth, who bear the severity of this disease better than old persons. Nor is the case always out of danger, after the course of the disorder is finished, for sometimes it creates a spurious intermittent, scarcely to be re- covered from; or slow fever, which portends the sufferings of the sick, and often leads them to the close of life. To mention appearances on dissection, many things remarka- ble occur in the head, when the brain is uncovered, namely in- flammations, purulence and putridity, as well in the substance of the cerebrum, as in its involucra. The Plexus Choroides ap- pears vascular, distended, and varicous; finally, a serous or san- ious colluvies is met with, both in the windings and in the other recesses of the cerebrum. The breast is affected in the same manner. There are doubtless discovered ichorous and purulent stagnations, not only in both chambers of the breast, but even in the pericardium itself, which is otherwise injured in various ways. The lungs are found affected with blueness, stuffed up, and strewed with gangrenous spots, and adhering to the surrounding parts. The heart wrinkled, and as it were decayed, its thalami and auricula filled with feculent, congealed, or as it is called, poly- pous blood; hence it is that this viscus often swells to a great size. On opening the abdomen, the liver is found full of pus, and pu- trid, contaminated with gangrene, sometimes dyed of a saffron colour within and without, and very much enlarged, so that the diaphragm being pushed upward, the cavity of the breast be- comes narrower. At other times this viscus shews itself schirr- ous, hard, contracted, wrinkled, blackish, or of a leaden colour, to say nothing of its morbid adhesions to the neighbouring parts. The gall bladder is sometimes empty, sometimes unusually turg- id with greenish or black bile, and defiling the neighbouring parts by its transuding fluid; finally, it sometimes contains stones of different sizes. The same mischief, but more rarely, is observ- ARDENT OR BURNING FEVER. 33 ed in the kidneys and other viscera, as also very loathsome stag- nations. Lastly we generally see the vessels running to the vena porta, loaded with very black blood, like pitch. Venesection is useful on the first day of invasion, if nothing forbid, but not to be practised afterward, unless inflammation and plethora demand; because repeated bleedings, as the illus- trious Vansweiten remarks, are apt to bring on more vehem- ent symptoms, or convulsions themselves, as has happened in my own observation, even before the flow of blood was stopped. It is therefore best to avoid them, notwithstanding what some practitioners adduce to the contrary, who are used to accommo- date themselves to the whims of the byestanders, and are never deterred by the unhappy event of things, so long as they can keep the confidence of the sick. Here by the bye we may note, that they shamefully mistake, who persuade themselves, that by blood-letting, they answer the end of spontaneous and critical flows of blood, because it has been observed an hundred times, that in every disease, a certain critical haemorrhage is of more service than frequent blood-letting i besides that a haemorrhage in this species of fever is for the most part dangerous. Eme- tics, although more beneficial, ought to be given with the great- est caution, and the milder ones are to be preferred, and washed out with copious draughts, otherwise the blood at length be- comes heated by this stimulus, the solids become prone to spas- modic contractions, and in a word, a spur is added to the disor- der already impetuous. For the same reason, if on account of exuberant bile there be need of purging, manna, cassia and tam- arinds in whey, or chicken broth, take the lead of other cathar- tics. Stimulant injections are not safe, but rather demulcents alone, with milk, butter, oil of sweet almonds, whey, &c. ought to be used. Opiates, which at first view would seem to be proper, on account of the sweet serenity of mind with which the waking patients are affected, are here to be avoided as worse than a serpent. The same may be said of cordials, although the strength be prostrated, which in this case is not deficient, but as it were oppressed. I am aware that many have written of the happy success, with which they have exhibited the above remedies. But it is become customary, as I have often incul- cated, for those who are seeking popularity, always to refer the happy termination of a disorder to any, even the most preposter- ous remedy; for no one is ignorant that many patients overcome both the disease and the incongruous method of cure, by the powers of nature alone. Finally, in the cure of this fever, dilu- ents, demulcents, refrigerants, and acids, are of great value, the salutary effects of which may be easily explained. Nor are ni- 34 MALIGNANT FEVER. trous medicines of small account, which as sedatives, are conve- niently brought to our aid. Whey or chicken water, which are usually taken before any other drink on the first days, give present help. Nor ought we to despise acid julaps, lemon juice diluted with water, emulsions, &c. and magnesia alba, and other absorbents afford some aid, which allay the fierce motions of the bile raging in the Abdomen. MALIGNANT FEVER. WHAT authors mean by Malignant Fever, can scarce be known from their diffuse writings: nor can we understand them more clearly by their practice, since they designate by this name, according to their own whim and pleasure, various fevers of an obscure nature, if only they be attended with dangerous symptoms. So that this disease may be considered as a mere problem, of ve- ry different solution. Yet from accurate observation of its signs and symptoms, the genuine character of this very malignant dis- order is easily known. We may admit the name, Malignity, al- though absurd, lest we get out of the beaten track, but far be it from us to give the name after the manner of Empirics, to eve-< ry disorder of a bad type which occurs, or is attended with unu- sual or alarming symptoms, or degenerates through preposter- ous management, since a mode of cure for the most part origin- ates from the pre-conceived opinion, highly injurious to the sick. For Sydenham has justly remarked that this assumed word, Malignity, has perhaps been more fatal to mortals, than the dis- covery of gun-powder. Nevertheless, in the opinion of the an- cients, it was right to call fevers thus, in which the powers of na-< ture were oppressed, so that neither the velocity of the pulse, nor vehemence of the symptoms were answerable, to the des- tructive nature of the disorder, which as it were lays secret snares for the life ; for which cause it is no wonder if many pa- tients are hurried to death by the fearless practitioner. But yet all malignant fevers are not of this kind (commaJ for many oc- cur which exert their malignity at the onset, as the Camp Fever, or Hungary Fever, and some violent epidemics, which shew themselves with more intense heat and stronger pulse, and va- rious symptoms exciting the greatest terror. We have just taught that ardent fever sometimes puts on the same appear- ance, whence it is not to be wondered at, if many of the inexpe- rienced have taken one for the other. For the period of these MALIGNANT FEVER. 35 fevers is unlike, the ardent fever sooner runs its course, and is mostly confined to seven days, while the Malignant Fever never ends before the twenty-first, and is mostly protracted to the forti- eth. Moreover this last comes on as an Epidemic, and is propa- gated by contagion, from which the Plague seems to differ but a grade, the history of which, for the sake of clearer method, we shall presently treat of apart. It seems fixed beyond doubt, that the Malignant Fever has its principal seat in the Brain and Nerves, the offices of which never continue clear during its prevalence ; nor under any other view can they be rightly distinguished from other fevers. Yet, to say the truth, other fevers, when arrived to a certain grade, do not spare the nervous system, but injuries arising from them are slight and temporary, or merely symptomatic, while through- out the Malignant Fever, they are constant. An argument for the truth of this may be brought from the patients themselves, most of whom were affected with sadness and anguish, or oppressed with want and other difficulties, before they were affected with this disorder. ]Nor need we wonder if, with the mind sunk, or distracted, they should be more prone to this species of fever. At other times we may tell the evident causes, namely a loose way of living, the foul air of Hospitals, Prisons and Ships, pu- trid effluvia of ponds &c. by which the system of the nerves is variously affected, or drawn into Sympathy. The Malignant Fever rarely invades suddenly, but spontaneous lassitude, or stupor of the members, heavy pain of the head, wakefulness or disturbed sleep, foul mouth, with a tongue covered with mucus and whitish nausea, anxiety, changes of heat and cold, 8cc. are commonly the forerunners of this fever; and indeed continue thus for many days, while the disorder lurks concealed or shews itself by doubtful and obscure signs; until at length it discovers itself openly, and the sick are forced to lie down. At that time, as is usual in almost all fevers, the most are seized with shivering and cold, a frequent pulse follows this trembling chill, with mild heat, so that the danger of the disease might as yet be hidden, if the epidemic constitution of malignity did not excite suspicion. Yet sometimes the first invasion strikes the greatest terror, which more serious symptoms attend, namely, faintings, comatous affections scarce differing from an apoplectic fit; convulsions, cholera, and most severe pains of the bowels, which resemble hepatic or nephritic colic. In some Epidemic seasons the Malignant Fever does not shew itself, unless after various paroxysms of intermittent or remittent fever, recurring without order, or extending beyond its usual period. We add nothing concerning its other modes of invasion, as an accurate 36 MALIGNANT FEVER. enumeration of them would rather obscure than elucidate our history, as is plain from the writings of those who seem to have entirely exhausted this subject. As the disease proceeds, the strength is prostrated, pains both acute and dull, are felt throughout the whole frame. The head affected with the poison, totters ; an excessive head-ach follows, with troublesome pulsation of the carotids, tremor of the head, and dimness of sight. Some are perplexed with most severe pain in the bottom of the orbit, or other solitary pain creeping through the different parts. The eyes destitute of their bright- ness, can not bear the light: The face has a livid, leaden, and, dirty colour, and a haemorrhage of the nose, sometimes breaks out, scarcely to be restrained. In the mean time the mind is beclouded, or disturbed by the fear of death. The wakeful pa- tients hold up false likenesses of things, and babble absurdities, yea, becoming mad, are obliged to be confined with cords. Some fall into a stupor and lethargy, so that they cannot speak intelli- gibly; others are seized with tremor and convulsions. The tongue, at first covered with a white mucus, becomes dry and rough, and black, as if burnt; is seen all in gaps, and tremu- lous. The mouth is foul and foetid, the lips are parched, the rough fauces prevent swallowing; the salivary glands are over- charged, respiration is impeded, heart-burn becomes severe, followed by faintings, palpitations of the heart, most troublesome tossing of the body, &c. The pulse is, for the most part, Ian* guid, weak, unequal, or disordered, with subsultus tendinum, Sometimes it scarcely recedes from its natural state, or is found more active. Exacerbations arise once or twice on each day, but not at stated times. The abdomen, rarely, without pain, is prominent through-. out the disorder, and the hypocondria are often greatly distend- ed. The Urine one while flows abundantly, again scarcely passes through its proper strainers, or is confined to the bladder. In some persons it varies none from the natural colour, in others, it is thin, whitish, of a flame colour or highly red, blackish and muddled. Sometimes it exhales a very offensive odour, but very seldom settles. It is well to note, by the bye, that from accurate examination of it, nothing certain can be determined. The Bile degenerates from its proper quality, or becoming hot, occasions various disturbances in the abdomen, whence arise nausea, vomiting, purging, heart-burn, anxiety, hiccough, tor- mina, &c. The alvine evacuations take place without the know- ledge of the patients; lastly, the stools are foetid, and sometimes contain lumbrici ought, Epidemic and fatal Dysentery to be enumerated among the attendants on Malignant Fever ? or is it MALIGNANT FEVER. 57 a disease per se, inclining to malignity ? This question has been much controverted, and still remains to be decided. But I can easily believe, (not to be thought indifferent) that this implicated disease is mere dysentery attended with aggravated symptoms, or as they say, partaking of malignity. For it is well known, that Small-pox, Measles, Catarrhal Fever, &c. have the same marks in some constitutions. Sweats, rarely salubrious, break out so abundantly in some, that many practitioners, de- ceived by this symptom, rashly refer the fever we are now treat- ing of, to the Sudor Anglicus, or sweating Fever : these sweats emit a foetor in many, and at times they are cold, &c. Other circumstances worthy of observation, are discovered in the skin, namely, petechiae or small spots, not rough nor prominent, but very much like flea-bites, which are spread over the whole body, except the face and hands. Sooner or later these spots break out, and after three days they gradually become ex- tinct and vanish, they often occupy the breast and back in such crouds, that the skin is covered with an uniform intense redness: But these afford no signs either of health or death, yet if they become broader, livid, and black, the case is dangerous. There is another kind of eruption which is called Miliary, there are cer- tain small vesicular or crystalline pustules, dispersed over the whole body, at first pellucid, afterwards whitish, which has given them the unsuitable name of (pour-pre blanc) White Spot- ted Fever. The above-mentioned spots mostly follow these sweats, and later than the petechial spots; or observing no order, are produced through the course of the disease. They are itch- ing and have a serous humor, they are protracted longer than the petechial, and may recur frequently in the course of the disorder. Lastly, in some epidemic constitutions, miliary pus-> tules, and febrile exanthemata, are produced, either together or alternately. From what has been said we may learn, that nothing can be inferred relative to the nature of the disease, from these febrile eruptions; and therefore that it is imprudent to distinguish, spot- ted, petechial, and miliary fevers from other malignant fevers: but rather these symptomatic efflorescences would seem to depend on a certain degree of heat and profuse sweating, or some other cause, hid from our research; since, as we have noticed above they do not affect the face and hands, which are more exposed to the cool air; while on the contrary, those essential eruptions which give the character of a disease, such as, small-pox, mea- sles, scarlet fever, and Erysipelas, not only appear over the whole body, but assail the hands and face in great abundance. Moreover, we all know, that petechial and miliary eruptions, oc- 38 MALIGNANT FEVER. cur in other diseases, or those without fever, and that each is often met with in small-pox, ardent, dysenteric, and catarrhal fever. It is moreover known that miliary pustules are familiar in lying-in women, when recovering from a tedious disease, &c. Nor are the symptoms of malignant fever as respects the skin, confined to these limits, for some patients complain of an itching while no efflorescence appears. In others, there arise erysipelas, exanthemata with little bladdery pustules, or of another kind, gangrenous spots, &c. Lastly, inflammation of the parotids, which suppurate with great difficulty, corrosive blotches, &c. These are the more common phaenomena of this fever, by which, if well attended to, the nature of the disease is discovered. We have above inculcated, that Malignant Fever is of longer duration than other acute fevers, but the term of this disease can be submitted to no computation, as the commencement and termination can often scarcely be discerned. Yet nothing for- bids the assertion, that this species of fever is never completed before the twenty-first day, and commonly later, namely, to the fortieth, sixtieth, and even beyond: whence they mistake who assert, that they have seen a Malignant Fever of seven days, which was perhaps nothing else than an ardent fever, attended with aggravated symptoms. The anguish of the patients is often ex- acerbated as the disorder abates, for if the fever about this latter period is more obstinate than usual, and refuses to yield, there is fear, lest, after the manner of retroverted tumours, the re- mains of morbific matter should fall upon the viscera, and de- posit a purulent congestion on the lungs, liver, mesentery, &c Other evils threaten, even after the disorder is removed; for some are deprived of memory, and forget even their own names, while others lose the recollection of all that happen to them in their sickness. Some are insane for some time, or even all their life, many are afflicted with deafness, or blindness. Some fall into hectic fever, and others, chronic complaints, difficult of cure, and troublesomely tedious. Besides, in some constitutions, the Malignant Fever is followed by intermittent, simple or double tertian fever, not readily yielding to the usual remedies. Finally, none who recover from this disorder are restored in a short time to their former health, but are afflicted with insuperable weari- ness, and constant distress of mind; nor are there wanting, some who, although safe, despair of life, having felt no fear while death was at the door. Lastly, another danger may succeed, which is the recurrence of the disorder, especially in those who, at the return of health, deviate from the temperate mode of living. MALIGNANT FEVER. d9 That a right prognosis may be established in so doubtful an affection, while we bear the foregoing in memory, we must es- timate the degree of strength both of mind and body. The less they are debilitated, the brighter the hope of health. But an unfavourable omen is obtained from fearfulness and terror, or an unconquerable fear of death. A different presage is gathered according to the varied condition of the body, discovered by a fault in the blood and humors. For this fever is considered more dangerous if it attack one subject to scurvy. Cachectics, &c. scarce recover from it. These general observations being premised, we come to a more accurate investigation of symptoms. The vision beclouded, tremor of the tongue, difficult deglutition, livid apthae, &c. betoken the danger and long continuance of the disorder. Deafness portends nothing bad, which spontaneously goes off in process of time. Nor is blindness a more unfavoura- ble omen; but many never recover their sight. A ptyalism i9 favourable, as also, at the decline of the disorder, pustules break- ing out about the lips. A prognostic of health is falsely derived from a mild heat, from the pulse becoming natural, from citron coloured urine, not unlike that of healthy persons, because many thus affected are suddenly taken off. They are in great danger who make water unconsciously, who night and day talk non- sense, pick down as it were from the bed-clothes, or draw them together, &c. The belly either very loose, or costive, is cause of much fear: dysenteric, bloody, blackish, or unusually foetid stools, occasion great difficulty to physicians. Petechia?, or miliary dark coloured pustules or eruptions, earlier than com- mon, are causes of dread, but death is threatened by their sud- den retrocession. Haemorrhages happening at any time, presage an unhappy event, as confirmed by various unfortunate cases. Lastly, no one is ignorant that hiccoughs, faintings, convul- sions, obscure and sad delirium, disordered motions of the hands, comatose affections, &c. are symptoms bordering on death. As to the Crisis, all practitioners know that the efforts of nature to bring this about, are inadequate in this disorder, whatever like it may be observed in some about the seventh day. But this work, although attempted, is never completed, which notwithstanding, does not hinder, but that a diarrhoea not exceed- ing its proper limits, and urine yielding a sediment, afford the greatest help in some epidemics. The same may be said of sweats, especially if the skin be moist, with a dewy vapour of perspiration. Nor is there less encouragement from inflamed parotids, concerning which it is worthy of remark, that these tumors tending to resolution, while the Malignant Fever is pre- vailing, are, contrary to the usual order, more favourable than 40 Malignant fever. others. Abscesses bursting outwards, often supply the place of crisis; but internal ones, in proportion to their situation, are mostly grievous, unless the matter find an outlet through the trachea, intestinal tube, and bladder. But this is the work of nature alone, and is not to be promoted by art. From all which, taken together, we may collect, that patients recover from this disease, not without the greatest difficulty. The Examination of Bodies after Death supplies few observations, since for the most part nothing occurs worthy of notice. Even the dissection of bodies must be performed with great haste, on account of the extreme fcetor, or the fear of con- tagion. Nevertheless, the head when opened often exhibits ab- scesses, both in the interior chambers of the brain, and about the surface of this viscus, and also sanious and purulent stagnat- ions in the windings of the cerebrum, as in the other recesses. The same injuries, but more rarely, are found in the breast* The lungs, changing from their natural colour, exhibit various livid and gangrenous spots, and being sometimes affected with putridity, are easily broken by the touch. The Heart seems sound, but the blood accumulated in the ventricles, auricles and greater vessels, is found sometimes very fluid, and as if dissolv- ed; sometimes thick and in a concrete form, becoming polypous, as some say. The abdominal viscera are more frequently found diseased, the omentum is presented to yiew, affected with putridity, which is not unfrequently communicated to the liver, spleen, and the other viscera with which it is connected. The stomach and intestinal tube mostly swell to a very great size, affected with spots like gangrene: in some subjects the miserable intestines are torn, and afford an outlet to the alvine faeces. Lastly, the bodies of such as die of this disorder, swell exceedingly, and are disfigured after death by dark purple spots, very broad. They putrify in a short time, and emit a very offensive odour. Hence it is no wonder, if, after very hasty examination of the viscera, the bodies are left for im- mediate burial. As the attack of Malignant Fever is obscure, so the sick be- ing ignorant of their imminent danger, seldom apply for aid on the first days, or not until a certain advancement of the disorder, which is the cause why so many are defrauded of preventatives, by which the disease is sometimes smothered, as it were in the beginning. For multiplied experience has convinced us, that many, as this species of fever was coming on, being warned by the abovementioned forerunners of the disorder, have by very spare diet, change of air, or by the mere simple and general remedies, escaped the threatening disease, and have evidcndy MALIGNANT FEVER. 4t come off safe. We hasten to the remedies which are efficacious, when the Malignant Fever has commenced its attack : yet one and the same method of cure does not suit all, as frequently we must accommodate it to the urgency of the symptoms. For a long time the custom has prevailed, that the treatment of this fever begin with blood-letting, concerning which, however, au- thors differ. We think this chiefly beneficial, if the strength will bear it, but that it ought not to be repeated without the great- est caution, although inflammation, acute pains, delirium, and difficulty of breathing, seem to persuade to it, as we have often observed that from a repetition of it the disorder becomes more fatal, yea, that death is hastened. It is a very common opinion that the oppressed head is relieved by opening the Saphena, but Sydenham, Vansweiten, and other experienced practitioners deny it, with whom agrees that most accurate scrutineer of dis- eases, Pringle, who says that numerous venesections do no good in delirium, but rather often excite it, as well in malignant as in other species of fever. If we might say any thing on this subject, we would not hesitate to assert from repeated experi- ence, that delirium is frequently excited by opening the Saphena, and never removed by it; but to oppose a pre-conceived and bor- rowed opinion, in a doubtful case, appears arduous and diffi- cult, which is the reason that some physicians, consulting their own reputation, rather than the health of their patients, (what- soever they may think on the subject) without hesitation, vilely and basely suffer themselves to be subject to the prejudices of byestanders, and fear not to commit the life of their wretched patients to the greatest risk. Vomits, after the first invasion of the disorder, next to blood- letting, are to be considered among the best remedies, by the help of which the saburra lodging in the primee viae are carried off, which otherwise in a short time with the chyle serving as a vehi- cle, gets to the blood, is distributed through the whole circuit of the vessels; and in the course of the disorder occasions the greatest injury. We have often had opportunity of observing in hospitals, during the prevalence of Malignant Fever, what difference there was between the exhibition or withholding of this remedy, which, to say the truth, exceeds all belief. And indeed Sydenham did not doubt that an emetic, even after this favourable time: or in any stage of the disorder, even to the tenth or twelfth day and later, was of use. Nor are ex- perienced practitioners ignorant, that many patients affected with drowsiness, about the height of the disorder, have through this remedy, escaped the jaws of death, when every other hope was cut off. And it is of great moment in this very urgent case, G 42 MALIGNANT FEVER. when the stomach is insensible to this stimulus, that a greater dose be given, or presently repeated, till it produce its effect. This is the Herculean Club by which this dire species of fever is frequendy overcome. Nor do the judicious physicians forsake this most successful method, unless some peculiar or uncommon appearance of the disease as it advances, evidently forbid; which the illustrious De Ha en asserts that he sometimes saw in cer- tain epidemics. Laxatives, to wit: cassia, tamarinds, manna with cre- mor tartar, may be frequendy used after the seven first days, but we must cease from them when any eruption appears, or when there are any signs of threatening inflammation in the ab- domen; never omitting emollient injections, which are of bene- fit through the whole course of the disease. But the strong cathartics are never to be given, unless when the disorder is abat- ing, at which time, even if repeated, they are advantageous* There are not wanting some, however, who are of a different sentiment, and glory in reversing the most ancient precepts of medicine. Absorbents and anthelmentics are useful, if acid saburra? or worms be suspected. But throughout the disorder diluents, temperants and nitrous medicines are much esteemed, which allay the violence of the bad humors, and become the vehicle of carrying off various matter to be excreted. Lastly, acidulous and antiseptic medicines are highly recommended, such as water, or ptisan impregnated with sulphuric acid, than which perhaps nothing can be found more effectual to allay the alkaline state of the blood, and putridity of the humors. While about these last remedies it may be proper to note that the use of vinegar was formerly very common and wholesome among the Roman soldiers, for keeping off the diseases of camps, which, before this preventative was discovered, used to be very destructive to their armies. To prosecute our design: Cardiacs and Alexiterials, are much extolled in the cure of Malignant Fevers; of this kind are, generous wine, theriac, and other confections of the like nature, the lilium of Paracelsus, volatile salts prepared from the family of animals, &c. These remedies deserve praise in some fevers of a bad nature, they are apt to carry off the morbific matter through the pores of the skin, but they do not suit all, as the silly lower class of people imagine; they are often happily joined with cathartics, or the kermes mineral is used, which has the effect of both. As a paregoric and antiseptic of the best kind, Camphor is much esteemed, es- pecially if conjoined with acids. The sedative salt, does wonders in delirium. But narcotics are to be cautiously used, even when pains are severe, and diarrhsea urgent. Besides, by the MALIGNANT FEVER. 43 use of these in this state of things, we have already hinted, that the force of the spirits is very rarely subdued; and that deliri- um is even exacerbated. The Peruvian Bark is greatly extolled by some, among whom the great De Haen takes the lead, and not only an antiseptic power is ascribed to it, but also an alexi- terial and diaphoretic; yet by others it is laid aside as hurtful. If this dispute were left to the test of our own experience, we should not hesitate to assert, that this remedy rarely succeeds in our climate, unless it be used by the most skilful hand. It may certainly do the greatest good, when gangrene threatens, while the blood is not more heated than is proper, otherwise it is best to use it with caution, nor do I think that any among us, will dare to try this method often; unless the Malignant Fever should after the twentieth day pass into a legitimate intermittent, or being protracted beyond the fortieth day, and become mild- er, should, as to the order of its exacerbations, resemble inter- mittents. It is well known that both have been observed in some epidemic constitutions. I should do a manifest injury to a celebrated author, if I should express a doubt of the histories of diseases which he has candidly and honestly delivered, but whether a happy event after the exhibition of an astonishing dose of Peruvian Bark, while the Malignant Fever was at its height, ought to be referred to this remedy, rather than to others, or than the powers of nature: may, if I mistake not, justly be doubted. As to external remedies : Vesicatories, so long as the bile is not over-heated, applied behind the ears, to the scapulae, the thighs or legs, deserve no little praise, since many who were given up for dead, have been restored from the grave as it were by the help of these; for they seem to invite the morbific matter from the head, thus preventing delirium and drowsiness. But we must use every endeavour that the discharge of matter from these be long continued, and by the best means keep open the wound when once inflicted, otherwise such topical applications afford but litde aid : to which may be added scarifications, with the application of cups over the orifices. Both these remedies seem especially beneficial, after the recession of febrile eruptions, by which we all know, that the disorder is aggravated, and greater alarm excited; in which circumstances Van Sweiten proposes the internal exhibition of camphorated vinegar, some- what sweetened, concerning which, see the Medicina Castrensis of this author. Leeches applied to the temples, allay the vio- lent head-ach sooner and more safely than venesection itself, Pediluvia may have the same effect, as also stimulant cataplasms to the soles of the feet. Lastly, it is well known that pains THE PLAGUE. raging in the tumid abdomen, are assuaged by the most usual topical emollients. To crown all, we may add, that nothing hin- ders more the cure of Malignant Fever, or others of a bad kind, than impure air : hence it is evident, of how great moment it is, that it be often renewed, or by some mode or other improved. THE PLAGUE. THIS Distemper, horrible on account of its destruction, and of a most hidden character, which many consider as a judgment from Heaven; is sufficiently distinguished from other acute diseases, by contagion the most terrible, and by eruptions of a peculiar appearance. The Plague puts on various forms, not only in divers epidemic constitutions, but also in one and the same, so that it is very arduous and difficult to give an accurate description of it. This is abundantly evident from the history of the Plague, which in a direful manner depopulated Mar- seilles, and went through almost the whole Province of Gaul, in the year 1720, which the illustrious Senac, one of the first Medical Characters, published by order of Lewis XV. The most common opinion is, that this beastly disorder, infecting whomsoever it meets, and threatening war against the hu- man race, was brought to us from the regions of the East, by infected bales of goods, cloths, cottons, and other merchan- dize. Nevertheless, many even of the first note, deny this to be so, induced by these reasons, that amazing swarms of cankerworms, locusts, and other insects, and scarcity of provisions, &c. have mostly been the forerunners of this ca- lamity ; so that we may conjecture its origin to be mutually owing to both. If the origin of Plague is obscure, its genuine character is equally so, nor is the right method of cure more apparent, whence it is no wonder, if physicians, even the most experi- enced, who have fearlessly exposed themselves to the fury of the Plague, should remain in the dark concerning this most in- tricate disease. The Plague shews Itself by signs perhaps more evident than malignant fever, and during its prevalence has often been ob- served to silence almost all other disorders. With how much terror they are struck, who are affected with this disorder, is more easily conceived than expressed. Want of appetite, nau- sea, spontaneous lassitude, prostration of strength, vertigo, &q THE PLAGUE. 45 announce its approach; but, mostly the patients are seized with sudden shivering, with entire dejection of mind, which in a short time brings on delirium, or sleep. At this time many complain of pains in the axillae or groins, and indeed in the glands thereabouts, swellings are to be seen, more or less con- spicuous. The Plague, in some epidemics, has the appearance of inter- mittent fever, the third paroxysm of which takes the patients off. Moreover, an aggravated pain of the head, disordered eyes, dimness of sight, pains of the back and breast, tremor and con- vulsions, anxieties in which the patients are constantly tossing the body, fainting almost to death, hiccough, and other symp- toms of malignant fever frequently accompany the Plague. Some vomit up a blackish green and offensive saburra, or dis- charge worms both ways. Sometimes the mouth is highly fe- tid, the tongue covered with a quantity of mucus, is sometimes black. The sick are tormented with intense thirst, a biting heat of the praecordia, and most distressing tightness of the breast, with sweats of the worst and most offensive odor, by which all the utensils for the sick are contaminated. The urine is some- times bloody, nor is the expectoration rarely of the same kind. The pulse in some, scarce different from natural, or languid, weak and contracted, in others is found more vehement, quick, irregular and unequal. The fever at length, with differ- ent degrees of heat, takes on innumerable forms from milder to more intense; at one time it is contained within four or five days, at another it reaches the twelfth or fourteenth, but is never ex- tended further, unless by other accidental causes, among which tumors have the first place, which often suppurate with difficul- ty. They deviate from the true path, who consider fever as the proper symptom of Plague, wherefore heat frequency and velo- city of pulse are expected: But we may observe that this apy- rexia is fallacious, as we have above remarked, in malignant fever, small-pox, and some other diseases of a bad kind, which yet physicians with one voice, confess, always to be accompani- ed with fever—hence it seems that there is no Plague without some attendant fever. Exanthemata and pustules of divers kinds, and parotid in- flammation, break out more rarely in the Plague, than in malig- nant fever: But buboes and carbuncles occur more frequently; the first attack the inguinal, axillary, cervical and other glands over the body. Buboes one while immediately follow the attack of the disease, again they appear at other stages of it, and even after the termination of fever. They sometimes suppurate very soon, at other times not till after the twentieth or thirtieth day. But now and then they end in resolution, to the greatest dan- 46 THE PLAGUE. ger of the patients. Erysipelatous or phlegmonoid carbuncles, at- tack indiscriminately all parts, and even not unfrequently take place within the fauces : sometimes the buboes are prominent, like a furuncle, and elevated to a point; sometimes they ap- pear in the form of pustules heaped together, which have a phlegmonoid areola at the base. Finally, there are not wanting some which grow to a great mass, or exceed the size of an egg. A sphacelus, with which these tumors are seized, without sup- puration, gives their character. Carbuncles require a long time to heal, whence it happens that the entire cure of a pestilential disease is delayed on their account for months. These are the salutary efforts of nature, by which she gradually throws off the virulent miasmata of the Plague, as also in the small-pox, and therefore we understand why, during the prevalence of the Plague, a prognosis of health is obtained from this favorable depuration of the blood. Although this fierce disease, which is communicated not only by contact, but by coming near the sick, spares no one, yet it is beyond a doubt, that the courageous who are not affrighted by the contagion, as also those who live abstemiously, and study cleanliness, are rarely attacked by it. By many it is said that persons who are lean, phthisical, gouty, or subject to the piles, and have issues or old ulcers, &c. seldom have this disorder. On the other hand the contagion threatens the timorous, glutton-. pus, fat and luxurious, &c. Almost all authors have told us that the more robust when seized with the disease are in the greatest danger, and that gravid and puerperal women seldom get over it. Moreover the pulse stronger, and symptoms more vehement, which are of no account in malignant fever, denote a fatal termination in the Plague. Nevertheless, the fallacious hal- cyon state is not without danger, since by numberless histories it is proved, that many who have had the brightest hopes from these milder symptoms, have departed in a short time; while oth- ers who were threatened with death from the extreme violence of the disorder, have been restored to the number of the living. Nature rarely effects a critical evacuation during the progress of the Plague: But there are for the most part fatal haemorrhages. A diarrhoea brings almost all to the grave. If spontaneous sweats about the fourth day promise a happy issue, at other times they are of no benefit, even when they break out on the first days; if delirium succeed, there is but a short time to prepare for death. A tremor of the tongue and hands, fiery and grim eyes, hoarseness, chills recurring without regularity, &c. are so many symptoms bordering on death. But a stupor of mind and body and frequ.-nt deliquium animi exclude almost all hope of health, THE PLAGUE. 47 to which may be added, obstinate sneezing, and hiccough un- manageable by art, which may also be considered as harbingers of death. Nothing is to be inferred from efflorescences of the skin, which shew themselves under the most common appear- ances, but if they grow black, death is at hand. Buboes are thought very favourable, but if carbuncles appear, the case is doubtful: the latter cause great dread, if they appear before the fourth day. The violent fever, and aggravated symptoms, re- mit after the eruption of buboes, carbuncles and parotids; but the hope of health is greater, if these tumors shew themselves af- ter the other symptoms have abated. When buboes arise on the fourth day, we may predict a happy event; but the case is other- wise if they break out later. Carbuncles are more to be dreaded, especially if they are formed upon buboes. Tumors of the neck, whether buboes or carbuncles, portend greater danger; especi- ally if violent fever, or other grievous symptoms should hinder their eruption. If they recede, we may mourn, unless the urine after this retrocession, deposit some purulent matter, which all authors testify to have seldom happened. Lastly, persons seiz- ed with the Plague die at all times of the disorder, but they are more often taken off within two days, nor are there wanting some who have not struggled with death more than six hours, or have suddenly expired, as it would seem, with no previous illness. It is known from an accurate history of dead subjects, that the internal parts are diseased in the same manner; there are seen for instance, as well in the viscera as in the membranes, purple and blackish livid spots. Tumors and abscesses are dis- covered, little differing from external carbuncles and buboes. There are found inflammations, gangrenous and sphacelated spots. Sometimes the size of the heart and liver is found very much enlarged : their receptacles and vessels swelled with very black feculent, and grumous blood. The bile is found rusty and of a blackish green, collected in greater quantity, not only in the gall- bladder and biliary tubes, but also in the stomach and intestinal canal. Moreover, various bodies of those that die of this dis- order, are disfigured with very broad and black spots, as if they had been killed with clubs. Lastly, many are found which ex- hale a loathsome and poisonous odour, so that none can attempt the dissection of them without detriment of his health; for I have known some surgeons, who suffered this penalty of their curiosity in the last Plague at Marseilles. To these we may add, that there have not been wanting bodies, which, although diligently examined, both within and without, have exhibited nothing remarkable. 48 THE PLAGUE. From the foregoing prognosis of this most cruel evil, it is plain to any one, of how much moment it is to persevere in the preventative means, which merit principal attention. With thi* view, the impure air or atmosphere, filled with pestilential mi- asmata, is purified by various fumigations, with gun-powder, vinegar, tobacco, amber, sulphur, and different aromatic sub- stances, with which it is commonly thought the contagion can be repelled or extinguished. Diemerbroeck, from his own experience, highly extolled the smoke of tobacco drawn in and discharged through the mouth by the common pipe, which he says, has very great effect in keeping off the most virulent mias- mata of the Plague. The odor of the prophylactic vinegar, commonly called, Vinegar of the four Thieves, is more esteem- ed ; simple vinegar, or impregnated with rue, may also defend from the noxious effluvia. The internal use of lemon, or citron juice is highly spoken of among the Orientals, and is^not a little esteemed among us; and perhaps the drinking of vinegar is bet- ter than all, according to Sylvius Deleboe, who relates that he has kept off the contagion by this remedy alone, and of its very great efficacy many have been convinced, in the recent Plague of Marseilles. Nor are theriacs, mithridates, and other com- mon antidotes and alexiterials to be despised, among which the garlic perhaps holds not the lowest grade; by the help of which, we know that many have averted or blunted the shafts of Plague. But nothing more prevents the contagion, than a mind free from care, solicitude and fear, and a life of temperance; and cleanli- ness, and neatness, both of body and. house. During this ca- lamity, clothing of skins is not undeservedly recommended. Finally, the cautery applied to the arms and legs is highly com- mended by many, and perhaps excels the other preventatives: because the pestilential miasmata affecting the blood, find an outlet through the open issue, together with the matter, before they reach the viscera. We come now to the treatment of it when present, which is never righdy undertaken, without first attending to the nature of the prevailing pestilence, which by reason of the various epi- demic constitutions, in the opinion of the most eminent practi- tioners, differs very much. Indeed by numberless histories it appears that physicians, even skilful in the healing art, when first visiting those affected with the Plague, have mostly gained their experience with loss of life; so that it is often better to wait and to forbear, than to attack this most potent enemy with un- certain weapons. That maxim of Hippocrates, §>uo natura vergit, eo ducere oportet is of great utility amidst these diffi- culties, which they ought to keep deeply in mind, to whom THE PLAGUE. 49 these offices are entrusted. For upon this spontaneous effort well observed, the hinge of cure ought to turn, since it is evi- dent from almost innumerable observations, that this disorder terminates more happily, by eruptions yielding pus, which the laws of the animal economy alone promote, than by any other evacuation. Wherefore nothing is to be done without the con- sent of the whole system, that the poison mixed with the blood, may be carried to the surface of the body, and this is the prin- cipal object of cure. A great apparatus of remedies is superflu- ous, and even fatal, the more simple and common are only re- quired ; among which experience recommends diaphoretics; for besides the very favourable sweats they excite, they are also at- tended by healthy eruptions. And in truth, from this continued sweat alone, kept up as Well by the heat of the bed, as by the powers of nature; histories prove that many who have been de- prived of medical aid, but addicted to a regular mode of living, have come off safe. Having premised these general remarks, it may be well to treat of the remedies singly which the experienced have more successfully used, amongst which, at the commencement of the disease, blood-letting, emetics, and cathartics do some good, while the strength produces and bears eruptions, but they are administered at other times, not without danger. And indeed they are altogether forbidden by Diemerbroeck, even while in- flammation prevails, and diarrhoea. Diluents do wonders while the bowels areYtoo much relaxed, also temperants, nitrous and anti-putrid remedies: nor are absorbents to be omitted, if the case demand. But cardiacs and alexiterials are too much, even beyond measure extolled, to which a kind of specific quality is attributed by the vulgar. Yet these medicines do not agree with all, but even do harm, if the blood be unusually heated: in which case judicious practitioners accommodate themselves to the prejudices of the vulgar, qualifying them with acids both vegetable and mineral. Lilium, theriacs, and the well known confections, powder of vipers, theriacal vinegar, &c. are thought useful and efficacious, especially if they be given at the com- mencement. We say nothing of Bezoardics, because their use, formerly highly commended, is now not undeservedly obsolete. Camphor has beed very beneficial to many, which besides its antiputrid and diaphoretic power, allays the inordinate motions of the spirits: But narcotics are to be cautiously used: yet these were very common, perhaps too much so in the last Plague. But they afford some relief in diarrhaea, so long as the milder ones are prescri- bed ; of which are diascordium, diacodum, and others of the same kind. Cathartics suit well at the end of the disorder, otherwise they H 50 SUDOR ANGLIC US, are forbidden by experienced physicians. Blisters and cupping gi\e present relief, by the help of which the poison is kept down, or a part of it carried off, And by their help it appears that many have escaped death, Diemerbroeck proposes another topical remedy, a bag filled with hot sand, applied to the groins, axilla and feet, which truly is of some merit. In investigating the most approved method of cure, we can- not conceal that many practitioners of the first note have candid- ly declared that medicines have been inadequate to overcome this distemper; the nature of which the All wise Creator has involved in darkness, so that it may be doubted whether the convalescents from this most cruel disease (which scarcely suffers itself to be discomfited by these combined forces,) owe their health to art, or to the powers of nature. Besides it is evident, as we have just hinted, that many who were destitute of all aid, have happily escaped. Sanctorius relates, that pa- tients who wanted nothing but medical aid, more happily escaped death, than others who were treated according to the rules of medicine; which those physicians, who were constantly engaged in administering, at the utmost hazard of life, testified, while living, to have often happened amidst the ravages and mortality of the Plague at Marseilles. To crown all, we may add the caution of some eminent men, against this distemper both stick- ing in imported goods, and lurking in the air, as on both sides there is the same danger; to wit, that every one who is free from public cares, should seek his safety by a speedy and timely flight: which advice, far exceeding the most salubrious formula; of physicians, is expressed in this little verse; mox, longe, tarde, cede, recede, redi. Thus Englished, " Quickly depart—remove far off, And don't return too soon!" SUDOR ANGLICUS. SWEATING SICKNESS. AMONG the acute diseases, and of short duration, perhaps the S. A. is the most dangerous, and for the most part is not continued beyond the space of twenty-four hours. Hence it is not improperly defined the Ephemeral Pestilential Fever, which some without judgment refer to the class of putrid fevers. About the fifteenth century, according to Willis, (who yet never happened to see it) this disease sui generis and before un- heard of, appeared in England, which, in a few years being SWEATING SICKNESS. 51 transmitted to us, I know not how, had the very same appear- ance. It never spread far by contagion, and the epidemic con- stitution of the atmosphere rarely lasted beyond three months. Hence it is far from occasioning such destruction as the plague, although perhaps it is more unmanagable, as it takes off almost half the patients seized with it, especially if they be committed to the care of inexperienced persons. Those are considered most prone to this disease, who are of a vigorous constitution, and are convalescent from inflammatory fever. It suddenly and frequendy attacks the robust, youthful, and women of a masculine make: but it rarely affects infants, aged, lean and weak persons. This strange and doubtful disease, originates among us, in an entire prostration of strength, or deliquium animi. Some, at the onset, are struck with rigor or spasmodic trembling, al- though the internal parts are seized with hidden fire. Plentiful sweats follow every attack, which discern the character and fa- tal nature of this disease, and the patients often very soon, or within twenty-four hours, are sent to that bourne whence no traveller returns. Yet even when the disease is protracted lon- ger, it is not altogether void of danger, but in general it is judg- ed favourable, especially if it reach the fourth, fifth, or even seventh days. Those who are seized with it, being soon depriv- ed of bodily and mental strength, are tormented with vehement heat, and are flowing in sweat. They complain of pain of the loins, and are tormented with intense thirst, and finally are op- pressed with difficult breathing, and anxiety. Some labour un- der grievous palpitations of the heart, most are plagued twith heart-burn, and are exhausted with anxieties and frequent faint- ings. The pulse, in this state of things, undergoes various changes, one while it is found rapid and full, again slow and ob- scure, and mosdy irregular. Meanwhile the wretched sufferers are distressed with fear of death, until reduced to extremity, they fall into delirium, or fatal stupor. The blood rarely issues from the nose and mouth, in the course of this dreadful malady; but often there appear various efflorescences of the skin, not un- like the pustules of small-pox. Lastly, some, after the disor- der is removed, are not restored to entire health, but are kept for many months with night sweats, which are often accompani- ed by divers eruptions of the skin, proceeding from the slightest cold, without any danger threatening. We have above hinted that a kind of fever has been observed, by which also the body flows with copious sweats: this has been rashly taken for the true Sudor Anglicus, by inexperienced persons, deceived by the resemblance; but the aforesaid disorders, differ very much in 52 INTERMITTENT FEVER. the manner of invasion,"process, and termination, nor docs the same method of cure agree with them. We may see an accu- rate history of this species of fever in the Medical Journal of April 1760. The method of cure ought to have a tendency to promote the sweats for twenty-four hours, and it is well to excite them when they remit, lest the pestilent humor, attempting an outlet through the pores of the skin, should strike inward. With this view, all drink is forbidden for the first two or three hours, after- which it is allowed, and nothing else attempted through the whole day. Then properly assisting with blankets, let the pa- tients be laid warm in bed, and let them not be removed from a suitable position, nor feel the cold air, not suffering even the hands, for the sake of comfort, to be exposed, and let them avoid sleep by every means, to which they yield not without the greatest hazard. If the sweat does not flow to our wish, we must solicit it, by frictions with warm towels or flannels, to this end also the best diaphoretics and cardiacs are to be taken. Venesection is of little service as all agree, nevertheless Boyer a very experienced physician of Paris, seems to assert that this was repeated very successfully in a certain epidemic at Beauvais. Nevertheless, when better informed, he candidly declared that the aforesaid epidemic was of a different character. It is never allowable to urge cathartics before the entire solution. But af- ter this disease, let the patients dread the slightest cold for some time, more than a serpent: for many, by neglecting this caution, have been seized with a dangerous diarrhaea, or have- relapsed into the same disorder, more severe than before, INTERMITTENT FEVER. THE Intermittent Fever is well known to every one however unlearned and inexperienced, it has several variations, nor are we ignorant that gapings, stretchings, and spontaneous lassitude, coldness, with paleness of the extremities, anxieties and nausea are the forerunners of this fever. Many suffer chills with which they shake in every joint, and some are seized with such cold- ness, that the legs are insensible to fire applied to them. In the mean time the pulse, which was obscure during the febrile shivering is by degrees evolved, heat is diffused over the whole body, the head and other membranes are pained, and other symptoms arise either milder or more severe, until by a sweat INTERMITTENT FEVER. 52 breaking out, all things are restored to the halcyon state. When the paroxysm decreases or is overcome, the urine is turbid, or leaves a sediment, very much like to brick dust. This is the most common process of essential intermittent. But sympto- matic fevers and some of another kind, often appear in the same manner: for instance, catarrhal, hysterical and worm fevers, fevers from concealed pus, from obstructions; and many others, concerning which we have elsewhere treated, are sometimes of the same habit, so that even the more experienced are deceived, and many mournful errors are committed with the miserable pa- tients. The genuine Intermittent, also puts on various forms, and often changes as to appearance with another disorder, whose periods nevertheless, recur in the usual order of Intermittents. Of this class are cephalalgia?, pains of the eyes or other parts, ophthalmia?, comatose or convulsive fits, diarrhae, &c. It is proper to remark, that the paroxysms of these well known dis- eases, returning at stated times, are often marked by no con- spicuous febrile heat. Lastly, some authors of credit testify that they have observed certain partial fevers, to wit. in one half of the head, in one or other arm, &c. There are other differences of Intermittents very remarkable; for none is ignorant, that the fever returning on any particular dajif is either a Quotidian, or Double tertian, or Triple quartan : and that the fever invading or alternate days is called a Tertian. But if the accession of this last, is observed to be double on the stated days, it constitutes another and more rare species of dou- ble tertian. When the paroxysm rises, for instance, on the third day, the fever is named a Quartan. But if one of the three days is free from fever, it gives an example of a Double quartan. Lastly, the fever coming on daily, and double on alternate days, is called Hemitritis or Semitertian. In fine it must not be omit- ted that authors have made mention of other species, which recur on the fifth, sixth, seventh, or eighth days, or return every month, or year. But these we have purposely left out, as being strange and foreign from the general order of things. The proximate cause of Intermittents is hid from our scrutiny, but all are aware that this genus of disease for the most part takes its rise from immature or summer fruits, from misty air, or rainy wind, from marshy places, &c. The first paroxysms of fever are generally mild, but acquire force as they continue; and as we have above remarked, gapings, stretchings and lassi- tudes precede them, with pains of different parts, paleness of the hands and lips, blueness of the nails, coldness of the nose and extremities, chilliness and shivering; followed by febrile heat, and terminated by a sweat more or less conspicuous. Yet 54 INTERMITTENT FEVER. there are not wanting febrile accessions, commencing with no previous heat, while others terminate without sweat, and even with dry skin. Many patients, as the paroxysm becomes more violent, are plagued with nausea and vomiting; others are kept dosing, or tormented with pains of the bowels. The urine, in great part, during either the encrease or diminution of the sweat, is of a lateritious colour. Sometimes there occur very alarming febrile symptoms, not only with most severe rigor, lasting many hours, followed by extreme heat, but also with the most griev- ous pain of the head, delirium, and other aggravated symptoms. We have above hinted that Intermittents are often observed, like the continued, to be inordinate or irregular, so that we can scarcely trace their character; unless we closely attend to the manner of invasion, to the particular type of paroxysms, and other antecedent or conjunct symptoms, which properly con- sidered, may give the nature of the fever. But it is well to know, that irregular Intermittents are commonly spurious, or merely symptomatic; such as scorbutic fevers, those which pro- ceed from the formation of pus, or other affection of the viscera; nocturnal fevers attended with very copious sweats, and others which we have already mentioned. Lastly, Intermittents at times associated with other affections, whence arise diseases, im- plicated and almost inextricable, which give great trouble to practitioners. Legitimate Intermittents, not deviating from their proper character: such for instance as, according to the usual custom, begin with a chill and end in a sweat, are void of danger, unless the patients are very old, or affected with some chronic disease? and indeed they are often thought salutary, when some long continued affections are suspended or evidently banished, by their accession. The hyemal and vernal, are shorter than the summer and autumnal Intermittents, and are justly esteemed more easy of cure. The first, which seem to delight in a pecu- liar disposition, flee when the latter shew themselves, and these in return are driven off by the others. Yet the vernal are more obstinate, and eveh change their type, and put off their first ap- pearance, if the summer be cooler or moister; but the autumnal gain strength from a very warm winter. The paroxysms short, and coming on at stated hours, indicate, that the disorder will soon go off. The same may be said if a more moderate par- oxysm follow a second or fourth very severe accession; for then it is usual to see the end on the fourth or seventh. The inflation of the abdomen in children, swelling of the legs in adults, pus- tules about the lips, &c. are preludes of health. We cannot pre- dict a perfect cure after the cessation of fever, unless after twenty INTERMITTENT FEVER. S3 days, or an entire month; for it frequently returns in conse- quence of unsuitable regimen, ill-timed cathartics, foggy air, inhaling evening vapours, &c. Moreover, if the paleness of valetudinaries, after the fever, remains the same, if the appetite is not restored, nor the strength recovered, if the head achs, or night sweats break out, &c. we may conjecture that the cause of the disease has not been properly extirpated: hence we under- stand why the fever is wont to return after fourteen or twenty days without any manifest cause. Sometimes the worst svmp- tom of Intermittent Fever, is the forerunner of appoplexy in old persons, who are even brought to the point of death by the feb- rile rigor. It is well known that obstinate Intermittents, and those in which the order of accession is disturbed, run into jaun- dice, dropsy, or other chronic affections. Intermittents, espe- cially autumnal, do not seldom degenerate into fevers of a con- tinued or bad kind, and on the other hand, continued pass into Intermittents; and we have above noticed that malignant fevers put on the appearance of Intermittents. Lastly, Intermittents undergo many other changes, but of less moment; for instance, the simple legitimate tertian often runs into the double tertian, the simple or double quart^an, which seems evidendy to prove that all the species of Intermittents are of the same character, or are mere modes of one and the same affection. The dissection of bodies has exhibited nothing besides morbid products, either to my own observations, or those of other strict examiners of nature. In this account may be included a black and thick blood, filling the receptacles and larger vessels of the heart, of those who die in the cold fit. After tedious Intermit-* tents and their attendant affections, schirrous obstructions and abscesses are found chiefly in the liver; but rarely in the pan- creas and mesentery. The spleen has various appearances, sometimes dry and wrinkled, sometimes much enlarged, with its proper capsule in gaps, at other times affected with putridity, and becoming fluid when handled, like the lees of wine. Some- times the viscera are met with very much contracted, or reced- ing from their native colour, and as it were burnt. But the epiploon as to its principal part, is seen consumed by putrefac- tion. The vena porta? for the most part is turgid with blood, the biliferous vessels are filled beyond measure with a blackish green liquor. Lastly, among other things worthy of notice, there are found a kind of stones in the gall-bladder, flatulencies and constrictions in the intestinal canal, prominent tumors in the peritonaeum, and mesentery; various stagnations, &c. The Cure of Intermittents is not to be hastened, but rather avoided; they who, impatient of delay, attempt a check of the 56 INTERMITTENT FEVER. fever, suffer an early punishment. Wherefore we ought not to use even the most noted specific until after the third or fourth paroxysm, so that by first properly examining the process of the fever, there may be no doubt of its character. Nor is this delay futile, for at that time after premising venesection and an emetic, or cathartic, let diluents and temperants be freely used, not omitting a suitable regimen as to diet. The use of a specific ia not only safer after these have been premised, but often the fever subsides before this remedy is used. Yea, and it has often hap- pened to my observation, that the most simple water drank for three days and more, abundantly, or to six or eight pints every day; has removed not only recent fevers like a charm, but also those of long standing, and which could not be mastered by any other means. Hence it is not improperly observed that hunger is a famous remedy for this fever. Therefore (a venesection being premised, if the strength will bear it, which sometimes in case of plethora may be repeated) an emetic given at the proper time, has often, by extirpating the cause of the disease, remov- ed every care, especially if the gall-bladder be emptied by the evacuation, from the abundance of porraceous and rusty bile; which perhaps conceals the genuine seed of the disease, as I re- member to have observed a hundred times. This remedy is so much esteemed by the experienced, that it is for the most part repeated, while autumnal fevers prevail, or where the tongue covered with mucus, bitterness of the mouth, and nausea indi- cate it. We must abstain from venesection and vomits in the height of the paroxysm, whatever others may say, who glory in leaving the beaten track, that they may gain the admiration of fools. Yet at that time, we may open a vein if the heat be in- tense, or the pain of the head violent, or other symptoms of the like kind, urge it while there is plethora, nor must we then for- bid emetics, if the patients complain of much nausea. Other- wise nothing is to be attempted, during the hot fit, but the heat of the blood is to be allayed by diluents, temperanKnts and ni- trous medicines; after these have been sedulously gone through, we may begin with the specific, if the case require it. The Peruvian Bark has the preference above all other febri- fuges, which have now almost altogether gone into disuse, but it does not suit in all cases, nor is it thought innocent, if given at a wrong time. This medicine, (the Quinquina) is rarely ne- cessary in vernal fevers, which mostly yield to proper diet and diluents: as to the rest, this febrifuge is not safely prescribed, until after several fits, by which the febrile humor is, as it were, scattered; for if this caution is neglected, the medicine not only does no good, but becomes hurtful, although the fever should INTERMITTENT FEVER. 57 be moderated. Those who are skilled in the art, know that many patients have fallen into serious disorders, by the prema- ture or ill-timed use of the bark; namely, into jaundice, and obstructions, dropsy, asthma, comatose and convulsive affec- tions, and others more obstinate and dangerous than the fever to be removed: so that it is frequently better to recal the fever in this case, to which end some prescribe the spirit of sal ammoni- ac. Moreover this approved specific is not given with safety, as the paroxysm comes on or prevails, nor does it agree better, a little before the invasion of fever. If this method has done well with many, it has, in the opinion of Sydenham, been very hurtful to others. We ought never to doubt that the blood and humors, are gradu- ally freed from the febrile matter, by the help of sweats: hence we understand why, from the untimely use of the Peruvian Bark, many disorders arise much more dangerous than the fever for which it was prescribed: This is the opinion of the more cele- brated practitioners, which, notwithstanding borrowed experi- ence, is daily proved. Nevertheless we may sometimes vary from this rule of practice, yea, it is necessary, for instance, when the patients already reduced by violent fits, or advanced in years, are brought into imminent danger; in which state of things, it is advisable to try as they say, a doubtful remedy, or without delay, to call in a more powerful one. In other cases the cele- brated febrifuge is not safely exhibited until after three or four {>aroxysms. Even the Quinquina ought to be given with certain imitations: lest through the mischievous custom of quacks, who continue the use of this bark even during the fever, the situation of the patients should become worse. We can scarcely prescribe with safety more than two or three ounces, in divided doses, through the course of this disorder. Otherwise, as we have of- ten seen, from the immoderate use of this febrifuge, various chronic diseases have arisen, such as obstructions, dropsy, haemoptisis, &c. Wherefore when the fever will not yield to the designated dose, we must try another method, to wit, have recourse to other bitter vegetables, to aperients, to preparations of iron, mineral waters, &c. There is nothing yet established with respect to the regimen of the sick, while using the Peruvian Bark, since authors run into contrary sentiments on the subject: some direct a full diet for the patients, some think the abstemi- ous ought to be persisted in. We consider it as certain that each method has happily succeeded, but doubt not that the latter is the more safe. In treating of exotic febrifuges, to which camphor is often favourably added, it is well to observe, that this is frequently 58 INTERMITTENT FEVER. given to no purpose, if the febrile paroxysms are protracted longer than is common, or recur later than usual; it is also thought to be inert, against febrile accessions without chills and sweats. In both cases temperants are beneficial, namely, suc- cory, dock, hartstongue, crystallis mineralis, sal glauber or vitriolated tartar, and the like; by which, given at proper times, the powers of the febrifuge are not at all lessened. Nor does the Peruvian Bark always succeed to our wish, in legitimate In- termittents, although given with a judicious hand; which makes it necessary to recur to other febrifuges: namely, camomile flowers, sal ammoniac dissolved in warm water, an infusion of sage or Virginian snake-root in white wine, or any other of the same quality, which are truly esteemed exquisite remedies, if they are repeated hourly or every two hours. Also lemon juice diluted with water, theriac, whole pepper corns, powder of vi- pers, &c. are much esteemed. No one is ignorant that gentian, the lesser wormwood, and other bitter plants, which were in very common use before the quinquina was known, are not with- out success. In the same class may be mentioned the urine of a boy or young man, which when given in the dose of a wine glass full every day, has not perhaps its equal, in eradicating obstinate fevers, and is a remedy which I have oftentimes known to be effectual. Lastly, mineral waters, as well cold as hotr have a place here, which, after other remedies have been given in vain, have mostly effected a happy cure. The ash bark pleases some, to which they add sal absynth: but there is little confidence to be placed in this febrifuge, as also in numberless others, with which books abound. Yet some- times it is of use to know every thing of every sort, since, as occasion requires, one or other may be successfully used by men of experience. If there should follow a febrile rigor, as sometimes happens, it threatens death to the old and infirm: nothing, should delay the preventing or moderating of it, by large draughts of tepid water for two or three hours before the chill. With the same view is administered a ptisan of Sarsaparilla, a decoction of borage and burdock, and other diaphoretics, which when opportunely giv- en, have snatched many from the jaws of death. A narcotic also merits notice, if nothing forbid the draught a full hour before the febrile rigor, which when thus administer- ed, is enumerated by some among the most excellent remedies. Oil of cinnamon may be of no littie service in those difficult cases, or oil of cloves, which may be applied to the scrobiculus cordis in the form of liniment. Yet this is to be remarked, concerning stimulants exhibited as the disorder advances, that they some- INTERMITTENT FEVER. 59 times convert intermittent into continued fevers. The same misfortune may be the consequence of heating the surface of the body with pans of coals and blankets, by which the patients are as it were preposterously buried. Nor does obstructed perspi- ration from taking cold, occasion greater mischief, by which the fever becomes more obstinate and dangerous: which is often ex- perienced by those who, before a complete diaphoresis can dis- pel the febrile matter, rise impatiently from the bed, sooner than is proper. But cathartics ought not to be given without caution after the fever is removed, lest it return, and the patients suffer a relapse; which Sydenham and other eminent authors testify to have frequently happened, with whom our own experience forbids us to deny assent. Many also have thought that injec- tions could not with safety be applied in this situation: Yet both remedies ought to be thought innocent, if the fever cease spon- taneously, or a febrifuge be carefully administered, to which purgations per ahum may be added. If, lastly, an Inter- mittent should pass into a continued or remittent fever, it will recover its former type by venesection or a cathartic. Moreover the Peruvian Bark, like other febrifuges, is no less suitable in disguised Intermittents, which are hid, as it were, under the appearance of another disease; than in those that are apparent at first view; provided that the manner of treatment of the most conspicuous disease be not neglected; to wit, by mixing the remedies indicated in this last with Peruvian Bark or its substitutes; that is to say, cephalics in comatose affections, antispasmodics in convulsions, pectorals in lesions of the lungs, cordials in faintings, demulcents in the various fits of the cholic, as also for pains of the other parts, which also require anodynes, venesection &c. To these remedies, used as occasion requires, the addition of the Peruvian Bark, (while the general indications are premised and usual cautions attended to) has a wonderful ef- fect : and indeed it is necessary that in some cases a febrifuge be given very freely, to wit, for preventing or lessening the oppres- sive symptoms attacking the heart and brain, and on this account to be sometimes considered as forerunners of death. Forasmuch as children refuse the Peruvian Bark because of its ungrateful taste, a certain dry extract is prepared from it, which has the name of Sal de la Garraye, and is given, as a suc- cedaneum, in a less dose; or a syrup is made of it, more agree- able to their palate, and having nearly the same effect. Lastly, if these medicines of whatever kind, are obstinately refused to be taken by the mouth, it is proper to have recourse to febrifuge injections, which seem to possess the same powers. Nor ought these to be considered useless for some adults, who cannot bear 60 QUOTIDIAN FEVER. the Peruvian Bark, as they may thus receive a whole ounce of this bark, injected three or four times a day, until the fever is subdued; which being driven off, the use of them is to be con*- tinued, according to the usual method, to prevent a return of the paroxysm: so that for an entire cure, a pound and a half of this bark ought to be used. Garlic bruised and bound on the wrists, and soles of the feet, is highly extolled by some. Final- ly, it is known that there are numberless empirical topicats, ap- proved of by the ignorant vulgar, which physicians despise: yet they are not without medical virtues, and sometimes it is evident they have done good. It may be doubted whether they have not borrowed their virtue from the firm confidence which the sick have placed in them. For we have seen some carrying a litde paper folded up and marked, upon which (placed before and having a kind of ridiculous appearance) was inscribed a sen- tence taken by chance from some poet; restored beyond expecta- tion to their former health. Moreover it is universally knownv that joy, anger, terror, and other passions of the mind, in addi- tion to the other causes, have dispelled this fever. Experience proves that a fall from a height, or other misfortune, has some- times had the same effect. And indeed, no wonder! since every- physician knows what effect perturbations of the mind have on the animal oeconomy. Nor is it of small service, that practition- ers should investigate these phenomena of nature, although foreign from the general order of things, that by well attend* ing to them, the judgment of their cure might be directed. QUOTIDIAN FEVER. HAVING premised what respects intermittent fever general- ly, it remains that we mention the most common and remarkable species. In this class the Quotidian Fever or that which recurs every twenty-four hours, has rashly been placed; since from the manner of its appearance, it is vastly different from genuine intermittents, and discovers the cause to be more obstinate, namely a depraved diathesis of the blood, or diseased viscera*' But nothing forbids us to follow the order that is most acceptable to all. The legitimate Quotidian, which appears most commonly in the spring, and sometimes prevails as an epidemic, occurs more rare- ly than other intermittents. Returning with equal paroxysms, and at a stated hour, it sufficiently differs from the Double tertian and Triple quartan* Indeed it is well known, that the first, third, QUOTIDIAN FEVER. 61 and fifth paroxysm of the Double tertian are in the same ratio, and observe the same order as the first, fourth, and seventh of a Double quartan. Moreover the Quotidian commences with a light chill, succeeded by milder heat, and a less active pulse, and ending with little sweat. The paroxysms mostly short, rarely double, continuing from the sixth to die seventh hour in the morning; are sometimes followed by pain of the head, heart- burn, inflation of the abdomen, &c. This species of fever is protracted to months and years, yea, it is said, that a certain person who died at ninety-five years of age, had laboured under it sixty years. It is proper to remark that the Quotidian often comes on in disguise, to wit: under the form of pain of the head, gout, rheumatism, colic, &c. &c. and that its accessions continue sometimes twelve or fifteen hours, or longer. Some say that the quartan sometimes runs into the Quotidian. It may be doubted if they have not mistaken the Triple quartan for the Quotidian: Since we have already declared, that there is no af- finity between them. Certain symptomatic fevers, namely, from hysteria, suppressed menses, &c. also imitate the Quotidian, but their paroxysms do not arise at stated hours, and recur without order. The Quotidian, although of longer duration than other inter- mittents, is mostly void of danger; unless through preposter- ous treatment, transcending its proper limits, it runs into a continued or slow fever: hence it is necessary to delay and su* percede it, by a suitable method of living, until we can ascertain its genus or kind. From a view of the phenomena of this fever, we may conjecture that its fomes, as above hinted, is concealed in the prima? viae, or in the viscera subservient to digestion. Wherefore the saburra lodging in the stomach and intestinal tube, is first during its clear intervals to be removed by vomits and cathartics, notwithstanding the opposition of those who boast of their success by venesection* Yet bleeding is not to be forbidden, when the Wood is hot and abundant in the vessels: But it remains the judgment of wise practitioners, that otherwise it is to be omitted. After the depraved relics of digestion are carried off, let aperients and preparations of iron fill every interval, the virtues of which emu- late and even exceed tonics. Stomachics and bitters are also called in to our aid, nor is the Peruvian Bark to be lightly es- teemed, observing to administer it according to medical rules, which, besides its febrifuge virtue, appertaining but little to this species of fever, obviously possesses a stomachic and roborant quality. But those have never yet dreamed of the legitimate 62 TERTIAN FEVER. mode of cure, who preposterously persist with this febrifuge Bark, aftftr the mode of treating other Intermittent fevers. — ——— TERTIAN FEVER. THIS most common of fevers of the same kind, does not clearly manifest itself until after the third day; since it scarcely differs from others in the manner of invasion, or often imitates a more serious disorder. It comes on every other day, or every third day from the first attack at stated times, or a litde earlier, and most frequently returns in the early part of the day. Its paroxysms, preceded by a chill, are completed in from six to twelve hours, by the breaking out of a sweat, yet it is sometimes protracted to twenty and even thirty hours. The fourth pa- roxysm is generally observed to be more violent and longer, but the following ones for the most part become milder and shorter. The stronger and more feverish paroxysms are succeeded by genuine apyrexia or intermission; but if they be weak, the pulse seems somewhat feverish in the intermediate time. The short- er they are, the more freely the sweat breaks out, but it is less or even deficient after longer ones. We have already noticed that malignant fever is often produced in the form of Tertian— this is dangerous, when the fits recur without any order, and are extended beyond their prefixed bounds; and especially if the sick complain on the intercalary days of head-ach, anxiety, loss of strength, &c. when no vestige of fever remains. Moreover, many symptomatic fevers, such as hysteric, verminous, and others as above mentioned, resemble Tertian: but each of these species of fever has its peculiar forerunners, which being righdy attended to, save the judicious from error. The paroxysms re- curring on alternate days produce the Legitimate Tertian, but when they return every day, they are called Double Tertian. Two fits arising within the space of twenty-four hours, with an intercalary day, give another species of double Tertian. Tul- pius, who may be credited, mentions another, the paroxysms of which come on twice every day, hence called the Quadruple Tertian. Moreover, among the fevers of the same kind is enumerated the Semttertian or Hemitritis, which if but a slight attention is given to the return of accessions, will appear to con- sist of quotidian and simple Tertian, since the accession returns on a certain day, and becomes double on alternate days. But that species of fever is seen plainly to recede from the character TERTIAN FEVER. 6;3 of Tertian: and rather, on account of the terrible symptoms with which it is attended, resembles malignant or pestilential fe- ver: add to this, that it is propagated by contagion, and this Herculean disorder often prevails as an epidemic in Italy and Germany: but is very rare in our country. The legitimate Tertian, and especially the vernal, terminating in seven revolutions for the most part, and the morbific matter of which is carried off with the usual degree of heat, is not only void of danger, but often salutary; for by its help are sometimes rooted out, obstructions, cachexy, convulsions, and other chronic affections even not to be subdued by the most powerful reme- dies. The paroxysms later than usual denote the going off of the fever: if they come on sooner than common, there is fear lest the Tertian, departing from its own character, should run into the continued. We have above noticed, that the attacks being longer and irregular, with restless intermissions, are cause of no less apprehension. Sweat is looked upon as a purely criti- cal evacuation in this species of fever, which being checked or impeded, the future paroxysm exerts greater severity. Vomit-r ing and diarrhaea sometimes serve the purpose of sweating, but the urine rarely answers this end. Pustules breaking out about the lips are preludes of health, chiefly in vernal fevers. Lastly, a long continued Tertian, or one that has been improperly treat- ed, frequently leaves behind it chronic affections. The Double Tertian is thought more difficult of solution, on account of the shorter intermissions allowing less time to exhibit remedies. The hemitritis or semitertian evidently almost equal to malignant fever, which mostly is accompanied with inflammation, and the paroxysms of which last twenty-four or thirty hours, and longer; is justly numbered with the fatal diseases. If the sick recover, beyond expectation from this dire affection, let them beware lest the usual return of it elude the art of medicine. The viscera of those who die of this disorder exhibit, on dissection, nothing but obstructions, inflammations, putridity and mortification. The Cure of this species of Tertian, begins for the most part with venesection, if the strength will admit, then we must attend to the prima? viae with emetics, and the next day, unless a par- oxysm prevent, we use cathartics, that the sordes lodging in the receptacles of digestion, may be thoroughly carried oft By the exhibition of a specific afterwards, the fifth or sixth paroxysm is easily checked. Besides the Peruvian Bark, and other bitter febrifuges, which possess peculiar efficacy against this fever, other remedies are used, to wit: tonics, diaphoretics, aperients, and diuretics; among which nitrous medicines hold no mean place: but-all these ought to be deemed superfluous in legitimate 64 QUARTAN FEVER. and vernal Tertian, which commonly ceases of itself, or yields to general remedies. If the Tertian tends to malignant fever, the other method above treated of is to be recurred to; nor does the semitertian, a fever, as above mentioned, related to malignant, require a different treatment. Having premised what is neces- sary, temperants, antiseptics, and nitrous medicines; diapho- retics, absorbents, cathartics, and others above described, are beneficial. It is found, from observation, that the Peruvian Bark is inefficacious or hurtful against this last. To conclude, we may add that simple water, affords a wonderful succedaneum for this remedy: this taken for every drink, or abundantly used for three or four days, will overcome a simple or double Ter- tian, sooner and safer than the Bark itself, even the very best. Besides Quinquina of inferior quality, or preposterously admin- istered, is of no little damage; but water, unless the strength evidently fails, ought always to be considered innocent. Last- ly, no practitioner is ignorant that by the use of this specific Bark, the fever only lies dormant, and will afterwards return: but they are in no danger of its return, who are cured by the help of water. But alas! what pity, that a remedy the most common, and of no price, suits but few! nor are there wanting some who, without experience, think that this very slender diet cannot be administered with any safety for many days, to whom we will add nothing, but the saying of Pliny : " §>ui volunt de~ dpi, decipiantur." QUARTAN FEVER. TO what has been above delivered concerning this very ob- stinate species of fever we may add, that the paroxysm, not very violent, as to the chill or hot fit, returns every third day, mostly in the afternoon, and is not extended beyond six hours, indeed it ends in a shorter space of time, so that it is sometimes con- tained within one hour, and ends with litde or no sweat. Yet it is expedient to note that some patients, after the seventh paroxysm complain of sweats every night, which are rarely protracted be- yond a month. Moreover the Quartan, by reason of the great appetite for food with which it is attended, becomes incurable. Nor must we omit that blood drawn by venesection is covered with whitish or yellowish crust, which we may observe as we go along, is rashly considered a sign of inflammation. We have noticed above, that the paroxysms of the double Quartan come QUARTAN -FEVER. 65 on the first and second days, the fourth and fifth, the seventh and eighth, and so on, afterwards: but in the triple ^iiartan, there is an accession every day, but in both fevers the paroxysm invading on the fourth day answers to the first; and every third day in the same manner, it returns to the last; and by this mark the triple Quartan is rightly distinguished from the Quo- tidian. It is known that the Quartan is sometimes protracted to many years, jet with many lucid intervals, especially in the.aged and melancholic, for Blaw testifies that he saw a Quartan of twen- ty years duration. Hence it is no wonder, if both patients and physicians become impatient of its long continuance. They af- firm that this species of fever does not attack twice in the course of ones life; which does not contradict experience. Yet the Quartan is divided into longer intermissions of two or three weeks, and more, which frequently deceive the patients, who are led to believe themselves safe. Moreover, the series of parox- ysms is very easily interrupted, or longer intermissions obtain- ed; but sooner or later, from various accidents, or from neglect of a proper rule of living, the fit returns. It appears, from a number of practitioners, that child-bearing, haemorrhoids, perip- neumony, small-pox, or any acute disease, frequently drives off the Quartan. But if many diseases are remedies of Quartan, this in turn eradicates epilepsy, hypochondriasm, nephritis, gout, and other incurable diseases. Lastly, it is commonly said that Quartan promises long life: yet this fever, during the chill, takes off many that are debilitated, or advanced to extreme age, con- trary to the antiquated adage of the Provincial Gauls, which runs thus. " Febre cartano n'a jamai fa souna campano" or a Quartan fever never brought any one to the grave. Nevertheless this species of Fever, to which the cachectic and melancholic are obnoxious, draws after it various evils, such as jaundice, dropsy, schirrous obstructions, chronic cough, asth- ma, &c. The same may be said of the double and triple Quar- tan, which are considered to be even more obstinate species, unless they recover their pristine form, to wit: of simple Quar- tan. Sydenham says, that he never saw a Quartan in England cured before seven months; but we do not hesitate to assert, from experience, that it is otherwise in our climate. Yet we must not hasten the cure, nor is the Peruvian Bark to be ex- hibited without the utmost caution, which may cause the greatest mischief in this fever, especially if, as often happens, the liver is affected. Nor does this febrifuge agree better with the symp- tomatic Quartan, which has its origin from lues venerea, scurvy, 66 REMITTING FEVER. cachexy, and other disorders, &c. requiring a dissimilar treatment. As to the legitimate Quartan, we must first attack it with diet- ing, diluents and temporants. Venesection rarely agrees, but an emetic gives instant relief, the efficacy of which is wonderfully favoured by a cathartic draught on the followiug day: nor are these evacuations to be repeated throughout the disorder unless necessity urge. As respects the Peruvian Bark, we think this ought not to be used, until after the seventh paroxysm at least, nor to be discontinued when the fever ceases, but rather to be ad- ministered some time afterward. Yet we must confess that its return is not prevented by this febrifuge alone, whence it is ne- cessary to use other remedies, to wit: roborants and aperients. Among the first are sage, betony, southernwood, sweetflag, cin- namon, and others of this kind: But the Cascarilla excels all these, which has the title of a specific in this fever. Of all the officinal aperients, which it would be fastidious to recount in this place, the best are mineral waters, both cold and hot, by the help of which the matter of disease is carried out of the intimate recesses of the vessels, and the cure is completed; so that the patient by this means is freed from the fear of a re- lapse. When other remedies fail, it is expedient to recur to these, as to a sacred anchor. Nor are other articles wanting which have their own merit, namely antimony, calomel, and other mercurial preparations; sal ammoniac, magnesia, and other absorbents; bitters and diaphoretics, of which above; which not only suit in the genuine Quartan but also in the double and triple. Lastly, considerable benefit is derived from bathing, farming, travelling, &c. To crown all, we may add, that if the whole business of cure is committed to nature, this fever will sooner or later terminate by the powers of the animal economy alone: which happy event patients have sometimes enjoyed, while in the use of inert remedies, to which nevertheless this spontaneous cure is often attributed. Hence so many silly and spurious observations with which books are filled. REMITTING FEVER. VARIOUS names are given to this, for by some the Remit- tent is called subintrans, by others continens. It holds a middle place between continued and intermittents, but seems to tend more to the latter, since from closely observing the order of remissions we discover the tertian, double tertian, quartan type, REMITTING FEVER. 67 «c. besides, that intermittents often run into remittents, and these last into intermittents. Yet some fevers, concerning which presently, seem to follow the character of continued, so that we can scarcely refer them to their proper genus, unless the exami- nation of the urine come into our aid, the lateritious colour of which discovers the nature of intermittents. The remitting fever commences with a slight chill, and the following fever, rarely intense, is terminated by a sweat more or less conspicuous. In some, while the paroxysm proceeds, a ptyalism breaks out, but for the most part they evacuate a flame coloured urine, which deposits a kind of sediment at the time of remission. This kind of fever is attended with vomiting, diarrhaea, cholera, con- vulsions, &c. especially if the periods are irregular. It is also accompanied with pains fixed in one or other part, and scarcely differing from those of pleurisy, colic, rheumatism, &c. The Legitimate Remittent, when it has its own course, is com- monly not more dangerous than the intermittent, but the irregu- lar and anomalous is doubtful, the paroxysms not submitting to any order as to time. When epidemic, it is often accompanied with inflammation, yea, as some say, it is allied to malignity. The Remittent in the type of a quartan, is thought more obsti- nate and dangerous, since it often runs into hectic fever; or marasmus, dropsy, &c. follow it. Remittent fever is not with- out its critical evacuations, for it appears from numberless his- tories that sweats breaking out, or saliva flowing, afford no little ease, and indeed the urine depositing a sediment, is some- times of benefit. To come to the Cure* A venesection and vomit being pre- mised, it is favourably treated with bland remedies, such as di- luents and temperants. For what great injury a tumultuous administration of remedies occasions is fully proved by multipli- ed experience. Antiseptics are often opportunely used, bitters and stomachics not unfrequently relieve, nor does experience forbid the milder diaphoretics; but these remedies ought to be given with a judicious hand. Lastly, the Peruvian Bark joined with temperants, commonly succeeds to our wishes, provided the bowels are kept open as is necessary, with laxative draughts, or suitable injections. But if these observations concerning in- termittent and Remittent fevers should seem more contracted than is right, we may have reference to an anonymous treatise on this subject, lately published at Tourney (Tornassianis Typis evulgatum) the author of which, second to none in extensive fame, has strenuously endeavoured to promote the cause of me- dicine. 68 PLETHORA. PLETHORA. FULNESS OF THE VESSELS. IT is obvious to all, that a life of idleness and retirement, the long continued and free use of exquisite dainties, in which they mostly indulge, who seek to excel others in debauchery; are the chief causes of Plethora in early age. But it proceeds sometimes from another cause, unless it be congenital, namely, from the suppression of daily or accustomed discharges, as well spontane- ous as those caused by art; by the help of which perhaps the consent is kept up between the solids and fluids, which being de- ficient, the viscera appear inadequate rightly to perform their offices. But we will not longer tarry with these matters which are hid in dark obscurity, and only mentioned in a transitory manner. To return therefore to our design: Besides the fore- going, from the proper attention to which, there arises no light suspicion of Plethora, the blood shews itself by other marks to predominate in the body, by the amplitude of the veins, accord- ing to the various degree of corpulency, being more or less con- spicuous ; by the florid colour of the skin, by the heat of the whole body, by a propension to venery, by a redness diffused over the countenance, and inflamed eyes; by more profound sleep, and encreased pain of the head, by difficulty of breathing, which is encreased on ascending steep places, or any other motion; by numbness of the joints and spontaneous lassitude; for the powers are overwhelmed by luxuriant blood: and lastly, by a disposition to fever, inflammation, haemorrhage, &c. A fuller habit of body ought to be considered as a doubtful sign of Ple- thora, since it often happens that fat persons do not so easily bear loss of blood, as lean ones; because the sanguiferous vessels, immersed in fat, cannot keep their proper consistence or density, by reason of the surrounding compression: nor can we more rely on the florid colour of the skin, which sometimes seems to depend on a peculiar or rather unusual constitution of body, than on too much blood. For a true Plethora, which does not take place except by a gradual encrease, is to be distinguished from the spurious, or that turgescence of the vessels as it were sudden, owing to the existing effect of the rarefaction of the various flu- ids, which last, every one knows, arises frequently from febrile heat, insolation, running, or rather excessive motion of the body; from gluttony, or drinking liberally of ardent spirits, which tipp- lers drink under various names. Ought Plethora to be ranked among diseases, or only in the list of their causes ? This we leave to the decision of others: But it is incum- bent on us, to give an accurate history of the symptoms which FULNESS OF THE VESSELS. 69 accompany this condition of the body. In this number we in- clude vertigoes, convulsive fits, apoplexy, cephalalgia, obstinate ophthalmy, fever, inflammation, haemoptysis, and other haemorr- hages ; suffocative catarrh, palpitation of the heart, gout, and other disorders arising from congestion or stagnation; which, -al- though they have a peculiar and difficult character, yet require much the same method of cure, which especially has a view to lessen the mass of blood. The Cure of Plethora turns upon this hinge alone, which is performed not only by blood-letting, but also by a strict regi- men, namely, by low living, labour or other motion of the body, short sleep, &c. These are principally useful, if the increase of the mass of blood has occasioned no injury to the viscera, or this fluid has not burst forth from its proper vessels. But when it is the consequence of any suppressed evacuation, it is of the greatest moment, that by all means and without delay, it be res- tored thoroughly. Yet venesection is not to be defrauded of its due, by which, as it were instantly the receptacles of the blood, swelled beyond measure, are emptied, and thus the ex- cess of this fluid is obviated'—this is chiefly serviceable in young and pregnant patients: but it is not to be too often repeated, lest the vessels, through the contexture of the solids being broken, should offer but weak resistance to the impelling fluid; by which means, the humors, robbed of their accustomed elaboration, be- come unable to perform their offices. Therefore let those be- ware who indulge in that worst of habits, very numerous bleed- ings, lest they promote other diseases, distressing to the wretched patients. Nor does venesection suit all plethoric cases, as many occur, even of athletic habit, who cannot bear the loss of any quantity of blood: nor are there wanting some, who so much dread it, that they faint at the sight of a bleeder. In both cases leeches may be applied, by the help of which blood may be taken at pleasure, without any succeeding disadvantage. The quan- tity of blood being lessened by every means, cathartics, diure- tics, diaphoretics, and other evacuations are not altogether use- less; by which some part of the confused humors of the blood are subdued, and the vessels emptied by the same means: but these medicines are administered in vain, unless the wav be opened by venesection, diluents and suitable regimen. If, last- ly, the excess of blood should be filled with a depraved diathesis of humors, it is evident that there is something of cachexy. We add nothing concerning the treatment of spurious Plethora, since it is manifest, that this is easily removed by diluents and temperants, nor requires any other cure. 70 JESTUS MORBOSUS. ^ESTUS MORBOSUS. MORBID HEAT. THIS kind of sickness is most common to youth, neverthe- less nothing has been said by authors on the subject. It fre- quently invades persons of a sanguineous or bilious habit; as also those of very warm passions. It sometimes preceeds the ephemeral fever, and like this species is called by the vul- gar courbature; nor is this state of the body unlike that which the Provincial Gauls, and Occitani call, mour foundamen. It is commonly supposed that this disorder arises from mere heat of the blood, often equal to that of a fever, but it does not escape the experienced, that the nervous system has much effect in pro- moting it. Lying out at night, or immoderate study, the prac- tice of feasting, and the use of exquisite dainties, drinking freely of wine or ardent liquors, immoderate exercise, arduous and excessive labour, profound meditations, close study, venery, &c. are so many evident causes of this affection. This ill health is scarcely discerned when subsisting within certain limits, so that they who are seized with it, scarcly seeming to be sick, seldom call a physician. The case is different if it rises to a certain height. This state is attended with spontaneous lassitude, pain of the head, interrupted sleep, &c. In the mean time the head and bowels grow hot, or burn with internal fires ; but this heat rarely extends over the whole body. Hence it is no wonder if it be not noticed, when a thermometer is applied to the armpits or groins, which nevertheless does not hinder fire from being struck out of various parts of the skin, and little sparks to flash. The tongue is sometimes observed to be dry, and many have great thirst. The pulse is in a middle state, between the natu- ral and febrile. Many complain of night sweats, from the vio- lent heat. In some there is diarrha?a, and the urine is voided of a flame colour. The appetite mostly languishes, or is quite lost, and digestion becomes slow and troublesome. Finally, va- rious efflorescences often break out on the skin, and the blood it- self bursts from the lungs, kidneys, and other inclosures. Al- though the JEstus Morbosus may be considered as the first grade, or forerunner of ephemeral fever, as we have hinted, yet the solution is not undeservedly thought more difficult: for an ephemeral fever portends nothing bad when following the jEs- tus Morbosus, and indeed is mostly salutary, since by its means the first disease is as it were terminated, which otherwise is thought more obstinate, and not without danger : for it is prov- ed by hundreds of histories, that from a neglected ^Estus Mor- bosus, not only the affections already enumerated, take their LOSS OF STRENGTH. 71 rise, but also various inflammatory fevers, or diseases of an- other kind, which endanger the lives of the sick. This how- ever does not hinder a favorable judgment of this species of dis- ease, if a proper and timely method of cure be adopted, or the whole business, with a suitable diet, be left to nature. Blood letting obtains an eminent place among the more effica- cious remedies, nor are the milder laxatives of little use, if giv- en with the same caution, or, we may persist in the use of hu- mectants, refrigerants, temperants, obtundents, and even depu- rants, if there be any suspicion of latent morbific matter. It is well known that from these are prepared ptisans, apozems, gru- els, emulsions, &c. by frequent draughts of which the disease is as it were smothered in the cradle. Among the rest, plants of the cichoraceous kind, nitrous and acid substances, are justly extolled. Whey is also much praised, or milk itself, unless a weak stomach hinder. Nor are the mineral waters above men- tioned given with less success, which seem to emulate or even excel the virtues of other medicines. Sometimes sedatives, and even narcotics, do good, provided they are not given until after the remedies generally premised. Lastly, cooling clysters, fre- quently injected, are of no little benefit, nor are bathings omit- ted by the experienced, with which the remaining cure is often, as it were, completed. ----«B,0«—---- LOSS OF STRENGTH. ALTHOUGH this disease seems scarcely to differ from the last, and is often implicated with it, yet by establishing a proper diagnosis, it is easily distinguished; for the one comes on by slow degrees, and not without a gradual encrease, while the other may be contracted in a short time, from recent causes. Besides, Loss of Strength is ominous of danger, and requires a different cure. Nor does that symptomatic prostration of strength coincide with it, which attends faintings, paralysis, and other serious disorders ; since the exhausted powers now treat- ed of, constitute a disease per se, as it is called. Want of food, excessive loss of blood, great discharges by the bowels, kidneys, skin, &c. great journeys, hard labour, immoderate study; the passion of love changed as it were into rage, onanism or that depraved custom which is always kept secret with the most baneful subtilty, he. usually bring on Loss of Strength, which in proportion to the source and degree are cither void of danger, 72 LOS& OF STRENGTH. or of serious and doubtful issue, or even fatal and bordering on death. Although from a view of the causes just mentioned, the ge- nus of this sickness is plainly discovered, it is also known by pe- culiar marks, which are as follows. Those who are seized with this malady can scarce stand upon their feet, or go in a stagger- ing way, their minds are gradually confused, and the joints af- fected with a kind of numbness. They fall into various species of fever, attended with delirium, fainting, and other alarming symptoms. Sleep by which the strength is renewed, is driven away: .the organs of respiration are impeded; the belly mostly remains costive, and the other excretions-'are performed with difficulty. Hemorrhages are not unfrequent from the, nose, mouth, &c. scarcely to be stopped. I remember to have ob- served in a certain debauchee a dropping of the same kind thro' the urethra, occasioning alarm by reason of its duration. In this calamitous state of things it is easily gathered that the blood is deprived of its balsamic particles, and that death is at hand. Nor are instances wanting of patients who before the disease was formed, have been suddenly taken off by Syncope. Lastly, some, after the disorder has been brought to its crisis, being constantly bed-ridden, drag out a life of uneasiness and afflic- tions, and in the course of time descend to the grave. Yet sometimes those who have been reduced to the greatest extre- mity, and given up for dead, have been recalled as it were to the number of the living: this hope of cure brightens, if the viscera have contracted no damage. Hence it remains by con- sequence that the prognosis must be various, according to the degree of disease and difference of phcenomena. Besides noth- ing certain can be determined concerning the event, unless there be a right idea of the remote cause, which notwithstanding is often immersed in very great obscurity, by the wilful secrecy of the patients. This affection ought to be treated with the milder remedies: Wherefore, in this case there is little benefit from cordials, analeptics, and other well known stimulants, or roborants high- ly extolled by the vulgar, which rather provoke than restore the strength; but almost the whole business, with a suitable regi- men, is to be committed to nature. Rest of mind and body pro- motes this, which is not undeservedly recommended to restore the strength. Nor is change of air to be lightly esteemed, as is proved by frequent experience, by the help of which many have been restored to their former health, without any other remedy. In the mean time the weary are to be sustained by aliments of easy digestion; but fever and a depraved disposi- LOSS OF STRENGTH. 73 tion of the stomach often prevent, so that the first duty at such times is, to mitigate the fever with diluents and temperants, and to carry off the sordes lodging in the stomach, by mild ca- thartics, and then the tone of it may be restored by the use of suitable stomachics. It is well known that the richest aliments, are, broths or juice expressed from boiled flesh, gellies, a species thereof called Cibus Albus, and hundreds more, belong- ing rather to the culinary than medical art: But many are not aware, that this species of aliment is not always rightly digest- ed in the stomach, on account of a deficiency of saliva, which is drawn out by mastication alone; so that many can eat bread and flesh without disadvantage, whose stomachs loathe broth it- self, which it is expedient to remember. Hence it is evident of how great moment it is properly to ob- serve the powers of the stomach, and select aliments best suited to it, lest by preposterous cookery we make the condition of the patient worse. Nor does one and the same method suit the lean and the fat, for the first can scarcely bear the evacuations, which have the best effect on the others. Besides the aliments, called Euchyma are given with advantage to the emaciated, which rarely benefit the fat. Experience teaches that milk alone, all other circumstances suiting, is of advantage to both. But ana- leptics taken from the shops, and especially cardiacs, which only have momentary effect, are of little use to either. For these stimulants are calculated to encrease the heat of the blood, and hence do much hurt, unless skilfully administered. Neverthe- less, when the causes and phoenomena of the disease are rightly traced, and a suitable diet instituted, the aforesaid remedies may lend a helping hand, especially in phlegmatic and aged patients, whose blood may be supposed less liable to effervescence. But here it may not be concealed that preparations of iron, and even the Peruvian Bark have been highly extolled by the celebrated Tissot, who was well skilled in the practice of medicine; for this excellent author, who has ofen brought his opinion on this subject to the test of experience, asserts that these have often been of service in this affection, contracted by too great expenditure of semen. Yet concerning the virtues of these remedies, with deference to this approved author, we think that further enquiry should be made. As to venesection there is no doubt that it is hurtful in this disease, wherefore it is for- bidden by the experienced, unless great pain of the head, vehe- ment fever, or obstinate haemorrhage, demand it. Cathartics are not less to be feared, which may yet be given in urgent cases, for as we have hinted, these last are of service in depraved di- gestion, which all practitioners know, becomes some times al- H SCARCITY OF BLOOD. arming, when the strength is exhausted. Lastly, if the9e cau- tions are neglected, it is obvious to any one that even an approv- ed and rational mode of living will be futile. SCARCITY OF BLOOD. THIS affection, concerning which authors have been silent, is nothing else than an emptiness of the blood-vessels. This genus of disease not unfrequently, indeed almost always, lies conceal- ed, which is brought to light by dissection: nor have we brought what we have to say on this subject from any other) source. We suppose this very intricate disease, from conjecture alone, to be the consequence of unaccustomed fasting, or immoderate loss of blood, either by venesection or haemorrhage; but these marks are doubtful and fallacious, since it sometimes happens, by rea- son of a peculiar constitution of body, by which all the excre- tions are as it were checked, that after long protracted hunger, fevers arise which yield only to venesection; which indeed would seem to argue, that the receptacles of the blood, in this case had not been depleted or emptied beyond measure. Nor is it more certain, that this disorder consists in an excessive loss of blood, as it is sometimes found by accurate observation, that from the greatest loss of this fluid, not only the mass is not lessened, but on the contrary encreased; and a plethora follows, the cause of which we have above explained. From which we may infer, that even after a deficiency of aliment, or long continued loss of blood, this disease does not necessarily follow. On this account the disease will be involved in thick darkness, unless the causes particularised precede; and that it depends on a vi- tiated state of the blood, I have more than once observed in some cachectics, and especially in chlorotic girls, in whom. the catamenia have been suppressed. Which is well worthy of observation. Hence it is plain, with what difficulties the diagnosis of this disease is surrounded, so that often there would need an AldipUQ to decide. Amidst such straits, we will candidly open some things drawn from our own store, which, if they do not satisfy the mind of the enquirer after truth, may at least afford a hint of this latent affection. Wherefore those affected with this hidde? disorder, are gradually deprived of strength, and complain of obstinate hissing of the ears; the appetite languishes or is want- ing, and the gaily of the countenance is often obscured. Many afflicted with diarrhaea, or diabetes, others have profuse sweats SCARCITY OF BLOOD. 75 day and night; some who are apt to faint, are suddenly taken off. Sometimes the ancles swell, and a serous fluid is poured into the cavity of the breast and abdomen. As the complaint ad- vances, the patients are in general deprived of sleep, sigh deep- ly, and give up almost all hope of recovery. Nor are there wanting some, who being overcome with grief, or oppressed with perpetual fear of death, become deranged; until sooner or later they bid a last farewell to terrestrial things. If in this state of things the disorder proceeded from hunger, or profuse dis- charge of blood, we might with some truth infer that the vessels were empty: But sometimes, to say the truth, these signs are wanting; and even the forerunners are absent, so that this fatal disease is then concealed, and escapes the most scrutinizing. What we have frequently observed in examining the dead bo- dies after this disorder,' would exceed belief. We have seen some as if without blood, so that on opening even the head, tho- rax or abdomen, not even a drop of blood has escaped, just as if the parts dissected were composed of mere wax. The small vessels being diligently examined were found altogether empty, and the larger appearing half empty. Both have been met with, turgid with flatus, which was easily seen through the pellucid veins and arteries of the brain. Moreover, it has not escaped the notice of those who have had numerous dissections, that air has often been found in the aforesaid receptacles. We saw scarce a vestige of blood in the brain of a certain virgin, who died suddenly; and who had been bled an hundred times with- in a year, I know not for what reason. We have observed al- most the same phoenomena not many years ago, in the body of a Nobleman, of florid age, who died of a sudden fainting fit, after he had been nearly restored to health from peripneumony; in which he suffered numerous venesections; for after the usual dissections, not even a drop of blood distilled, and the vessels of the brain appeared turgid with mere air. Yea, the ventricles of the heart, strange indeed to tell, afforded scarce a vestige of blood. It is of little use to mention the remedies, which, while living, they took who died of this disease. But among those who got safely through, there is nothing established concerning the char- acter of the disease, since want of blood never discovered itself by evident marks; so that we can advance nothing certain on this subject. Taught by various observations, we hesitate not to assert, that most remedies are futile, if we except those that respect di- gestion, and may gendy restore the tone of the vital organs, among which rhubarb and preparations of iron hold the first place, which, when all other things agree, ought not to be thought 76 RETROCESSION of EVACUATIONS ineffectual. But sinCe the above-mentioned remedies are un- equal to the restoring the mass of blood, aliments of easy diges- tion are to be brought in to our aid, therefore care must be taken to select suitable ones and give them in due quantity; for on this depends the chief cure—since every one acknowledges that in this case, more is to be attributed to the mode of living, than to Pharmacy. Moreover, pleasant walks, very agreeable jour- nies, and other delightful exercises of any kind, which by exhila- rating the mind, strengthen the digestive and blood-creative or- gans, have been of the greatest service. To conclude: We may add that the disease is rarely simple, but mostly implicated with others: Hence the greater difficulty of cure. — - ^b^——- RETROCESSION OF EVACUATIONS AND ERUP- TIONS. EVERY practitioner is aware, of what great consequence itis, to be rightly acquainted with this most familiar kind of com- plaint. It embraces, as appears from the title, the suppressed natural evacuations, the checked morbid humors, to wit, bloody, purulent, or of any other sort, and the retrogression of tumors and eruptions of different kinds. Whereforcfevers arise from impeded perspiration, mostly ephemeral; pains, defluxions or inflammations in various parts, diarrhaea, &c. Confined expec- toration, as well in acute as in chronic complaints, brings on se- rious symptoms, which is very easy to be understood. Sup- pressed urine is no less dangerous; obstructed biliary glands are the forerunners of various affections. Translation of milk oc- casions various uncomfortable feelings. The retention of the blood usually discharged by catamenia, piles, and haemorrhages, has violent effects in the body. Reabsorbed Lochia occasion very great mischief, or the revolsion of purulent matter from the ac- customed sources; and so of other distillations and transudations from the eyes, nose, ears, mouth, genitals, anus, head, axillae, feet, &c. from the Impeding or repelling of which arises a host of disorders, to remove which we strive in vain, if we attend not to the nature of their genuine cause, which nevertheless is mostly unobserved by the unskilful. Whereas it was thought adviseable to treat separately of checked perspiration, of cos- tiveness, of suppressed spitting, urine, haemorrhoids, milk, men- ses, and lochia; we have therefore enumerated those species of AND ERUPTIONS. 77 disorders only, which pertain but little to the articles mentioned; in which class are the cessation of accustomed haemorrhage, the drying up of long continued ulcers, either spontaneous or arti- ficial; the suppression of various oozings or distillings from different parts; and lastly, the retrocession of tumors or other eruptions of the skin. If haemorrhages which have become habitual, such as haemorr- hoids and menses, do not return at stated times, there arises gradually a plethora, from which frequently are generated acute fevers, pain of the head, ophthalmia, true and spurious angina, erysipelas, difficulty of breathing, haemoptysis, internal inflamma- tions, and especially pleurisy, peripneumony, and other affec- tions of a bad kind, which bring the patients into hazard of life* Every one must see that in this case venesections are of great service, as also a suitable diet, diluents also have their share, and the milder cathartics, gentle diaphoretics and other evacu- ants, which are to be selected and administered as occasion re- quires. From exhausted ulcers proceed serious misfortunes, which even threaten death, if without delay the former discharge is not promoted, or a new ulcer opened; that the matter mixed in the blood, may be driven out from the vessels, and the humor turned into this channel, which otherwise is apt to run in upon the liver, lungs, brain, &c. This most destructive and fatal consequence may be prevented by blood-letting, since practition- ers have rightly observed, that spontaneous haemorrhages have been of great service: But these purposes are more happily ob- tained by cathartics and diuretics, being more agreeable to na- ture ; as it has often been observed that purulent matter deviating; and mixing with the blood will find an outlet, merely through an effort of the animal oeconomy, by stool and urine. But transudations which partake neither of blood nor matter, when repelled, are less dangerous, though they require the same cure, which consists of venesections, cathartics, diuretics, di- aphoretics, and salivants; by means of which the morbifioijat- ter, arriving at the various strainers, is drawn out of the vessels. But they go more safely to work, who by every means attempt the return of the former discharges, as other remedies are often found ineffectual, which I have frequently observed after an im- prudent suppression of the perspiration of the feet, by the ill- timed application of astringents, which preposterous method was immediately followed by vertigo, tinnitus aurium, difficulty of breathing, heart-bum, pains in different parts, by which the dis- tressed patients are vexed, until the former transudation is entire- ly removed. In a word: all prudent practitioners have this view in every suppressed evacuation, namely, to bring them 78 PAINS. back, or attempt some other purgation, which may answer in- stead of the suppressed flow, and to this end they are persuaded that depurants are beneficial. A method very similar is to be practised after the retrogression of cutaneous eruptions, or repelled tumors. It is known that the recess of the former is of dangerous tendency in acute dis- eases ; to wit, in measles, small-pox, erysipelas fever, scarlet fever, petechial fever, &c. unless the patient be instantly reliev- ed by diaphoretics, warm bath, blisters, &c. Although the re- gress of chronic eruptions, namely scald head, scab or itch, tet- ter, &c. does not threaten immediate danger, yet it is not void ef risk, since various effects may follow, which give great trou- ble in the cure; to wit, ill-conditioned fevers, furious delirium, epilepsy, convulsions, head-achs, blindness, deafness, suffoca- tions, sharp pains of the bowels, Sec. to prevent and remove which, every endeavour should be used, by the administration in proper time, of the remedies just mentioned, namely, vene- sections, cathartics, diuretics, &c. not omitting caustics to the skin, the efficacy of which is confirmed by the practice of the most celebrated physicians. Almost every one knows what great danger threatens from the retrocession of tumors, such as paro- tids, buboes, carbuncles, &c. for which reason every thing must be attempted to prevent a metastasis, and the morbific matter must be determined to all the outlets of the body, to which end, the helps above mentioned are of use, the method of giving which is similar. PAINS. PAINS are different in degree, and spare no part of the living bocjy. For instance, the most severe rage in the teeth, ears, stomach, intestinal canal, kidneys, &c. they exercise less tyran- ny in the liver, lungs, spleen, and other viscera of the same structure. They are multifarious in fleshy and membranous parts, which are often the seats of rheumatism, gout, lues ve- nerea, hypocondriasis, scurvy, cachexy. Moreover this troublesome sensation, in whatsoever part it fixes, is different in its manner, for one is heavy, another pulsating, pungent, lancinating, eating or ulcerous, hot or burning, itch- ing, &c. the heavy pain often attacks the head, kidneys, and other abdominal viscera; the pulsating rages about the compages of the cranium, and in all parts where pus is formed, and by PAINS. 79 this mark especially we guess at internal abscess. Membranous parts are torn by lancinating and pungent pains, and are more severe where there is the greatest tension—of this kind are pleu- ritic, sciatic, colic pains, spina? ventosae, as they are called, &c. The eroding or eating pain accompanies ulcers, and affects the lungs, kidneys, uterus, &c. The burning pain attends erysipelas, lastly, the itching pain affects the skin. To these we may add that obscure sense of pain about the precordia, or that tightness of the breast called anxiety. Moreover all are acquainted with those spasmodic pains, or that most troublesome torpor, common- ly xalled cramp. Nor are we to omit that obscure and tedious sensation in those parts, which is not unfrequent, and called restlessness at night, or chatouillement; caused by a tittilation of the soles of the feet, or the spurious costae of the loins, al- though it often excites immoderate laughter. There are, lastlv, pains from compression, contusion, distension, a wound, burn- ing, cold, &c. which assume innumerable fbrms. Hence we may learn, that pains are distinguished into two kinds, to wit, from the nature of the irritating cause, and from the peculiar contex- ture ot the part. Pain, without any external cause, upon whatsoever part it falls, is seldom essential, inasmuch as it principally depends on some primary acute or chronic disease. If it attack the trunk or joints, in acute diseases, it denotes some critical motion: But a con- tinued pain of the breast and abdominal viscera, threatens inflam- mation, suppuration or gangrene. Nothing forbids the conjec- ture, that this pain indiscriminately invading the healthy and sick, affecting every part, which intermits, or creeps from one place to another, arises from some spasmodic affection of the nerves. But we must bear it in mind, that those familiar pains with which both valetudinarians and healthy are afflicted, for the most part proceed from a fourfold source, often deeply hidden, to wit, from rheumatic, gouty, scorbutic and venereal, of which enough and more has been said in its place. Nor are pains of the same kind wanting, which have another origin, or proceed from passions of the mind, convulsive affections, or impeded perspiration. Last- ly there occur a host of pains of another kind, from obstructions, tumors, or other injury of the viscera, from some matter, from extraneous bodies, &c. concerning which elsewhere. Since the genuine nature of pains often lies hidden in obscuri- ty, it is no wonder if nothing certain can be said of the event. Yet sometimes it is allowable to predict. For instance, pains of the head, back and joints, during fever, are considered free from danger, as they mostly cease when the disorder goes off, or in- dicate an approaching, crisis, for they denote a salutary haemorr- 60 PAINS. hage, when they affect the eyes, temples or neck. Evacuations of a serviceable kind, often follow internal wandering pains. When pains affect the loins, they usually indicate the menses, haemorhoids, or flow of urine. Very great pains of the head, having no respite, presage delirium or coma. If violent in- ternal pains, in obstruction of the viscera, inflammation and ab- scess, suddenly vanish, there is no little suspicion of gangrene. Wandering and intermitting pains are rarely ominous, but those which do not intermit, and are obstinately fixed on any part, are of doubtful prognostic. Lastly, metastases of pains in spuri- ous pleurisy, gout and rheumatism are not void of fear. We add no more on this subject, as they will be treated of here and there in this work, in order that we may offer some observa- tions on the seat of pain. Wherefore, the genuine nature of va- rious pains is not only involved in great darkness, but also fre- quently little appears as to the part affected, so that we can scarcely trace them by conjecture, for it is expedient to note that the disease has not always its seat in the part pained, for pain of the head frequently depends on depraved digestion. From dis- ease of the lungs, the glottis is drawn into sympathy; from ob- struction in the abdominal viscera, proceed pains of the back and breast; patients laboring under calculus of the bladder, or in- flammation of the prostate, complain of pain of the penis; vari- ous affections of the intestines, very remote from the anus, occa- sion tenesmus ; to say nothing of innumerable other examples taken from dissection. From the foregoing it is gathered, that the cure is to be di- rected to the cause of the disease, which nevertheless is very ob- scure, and indeed, is often the cause of much difficulty to physi- cians ; but most practitioners slighdy attending to this investiga- tion, or entirely overlooking the inextricable cause of the dis- ease, turn their attention to a merely palliative, or general treat- ment, until the disease becomes more evident, or is termi- nated by the spontaneous efforts of nature. With this view, venesection merits no small praise, which notwithstanding, is not suitable in all cases: but in all pains, diluents and demulcents freely taken, are usually required. Anodynes, and even cathar- tics are useful, while there are no marks of obstruction, inflam- mation or gangrene. But their use is forbidden, as well exter- nal as internal, in arthritic and rheumatic pains : otherwise nar- cotics merit no little praise, either internally or externally us- ed. We have noticed above, that intermitting pains are frequent- ly subdued by the help of Peruvian Bark, or any other febri- fuge, but this specific is not to be given without the greatest cau- tion, since there want not fevers, subsiding at intervals, which CATARRHAL AFFECTIONS. 81 will not bear to be treated with this remedy, but are rather ex- asperated or prolonged, which those who are entrusted with the health of their patients, ought to retain carefully in mind. But nothing does more good in the management of various pains than revulsion, by which the motion of the blood, humors, or nervous fluid is directed to another part, which effect is produc- ed by evacuasion and irritation. Wherefore, besides venesec- tion, which is often prescribed with this view, leeches, dry cups, or with scarification, vesicatories, and caustics may be used : nor, is the actual cautery, composed of moxa, to be despised : the most ancient use of which the Chinese, and other orientals very much extol. The simple warm pediluvium, often affords considerable relief in obstinate head-ach, when other remedies have been without effect. Nor is friction of the joints, in this case without its virtues. Finally, nothing is of benefit in the cure of pains, as we have already inculcated, unless we have first a knowledge of the natural cause. For instance, we must examine whether the pains are owing to any organic injury, whether they may be referred to any other primary disease, as scurvy, lues venerea, &c. whether some part may not be re- moved out of its natural place, as in distortions, luxations, frac- tures, hernia, &c. from the close attention to, and examination of which, the judgment is to be formed. CATARRHAL AFFECTIONS. DEFLUXIONS of humors are known by manifest signs when affecting the head, neck, nose, ears, lips, teeth, fauces, glot- tis, larynx, bronchia and lungs : But they do not shew them- selves clearly, or they resemble another disease, when they pre- vail in other parts; even although they be attended with a fever sui generis. Hence it is that many, deceived by a spurious ap- pearance, begin the cure of this disease, by unsuitable remedies. But genuine Catarrhal Affections take their rise with light chill, recurring at intervals, followed by a continued or intermittent fever, mild or violent, attended with want of appetite, anxieties and spontaneous lassitude, and is moreover usually protracted to many days. In the mean time arise pains, which not only at- tack the parts first affected, but also extend to others, even re- mote. If the humor fall upon pervious parts, suppose the nos- trils, trachea and bronchia, there is occasioned a discharge, by which the morbific matter finds an outlet: but if otherwise, ob- 31 SSJ CATARRHAL AFFECTIONS. structions arise, more or less conspicuous, or swellings tending to inflammation. There are perceptible defluxions of the eyes, nose, fauces and lips; Catarrhal Affection of the larynx and lungs, is known by cough and hoarseness. Stuffing and pains of the head, neck, ears, &c. are complained of by the patients. Swellings of the face, head, neck, ears, are evident to the sight, or touch. Although the first stages of Catarrhal diseases, which are contained within two days, are never alarming, yet they are not without danger. Catarrhal Fever is not rarely protracted to many days, namely twelve or fourteen. Beside those very simple and common Catarrhal defluxions of which we have just treated, there are others of a worse na* ture. Of this kind are Catarrhal Fevers of malignant charac- ter, inflammatory or gangrenous quinsy, stuffings of the lungs bordering on inflammation, erysipelas of the face, rheumatic defluxions, apoplectic fits, and numberless others which put on the appearance of a different disease, by which to be sure the more judicious or experienced are not deceived; seeing they always have Catarrhal Fever accompanying them; and by this mark may be distinguished from similar ones. Moreover, suffocative Catarrh is to be expunged from the list of defluxions, which, although it requires the same nomenclature, differs vast- ly from the species enumerated. They commonly suppose the access of cold air, by which perspiration is impeded, to occasion all the natural species of Catarrhal Affections. But we may truly doubt, whether they may not rather be referred to the entrance of some heteroge- neous matter lurking in the air, through the pores of the skin, and lungs, than to the mere check of an innocent humor which can easily find exit, as daily experience proves, through the kidneys, stool, or other outlets of the body. Nor do those Catarrhal Affections alarm one, which, frequendy in- vade those who expose themselves when very warm, to the cold air, especially if the chills are easily removed by a good fire, since the type and degree of this disease are of a different na- ture. Besides it is well known, that Catarrhal Affections some- times prevail, and become epidemic, even in the hottest time of summer; and that this disease also does not spare the fearful, even though shut up in a warm room, and even confined to bed, which argues beyond all doubt, if I am not deceived, that sup- pressed perspiration is falsely accused as the cause. From this we may infer, that this disease for the most part depends on a peculiar constitution of the air, never to be discovered by the thermometer. Yet we do not deny, that this heterogeneous mat- ter whatever it be, with which the air is filled, gathers some CATARRHAL AFFECTIONS. 83 force from cold, arid that its effects at that time, are more ob- stinate and severe. Besides, malignant Catarrhal Fevers, gan- grenous quinsey, fatal defluxions of the lungs, &c. have a cer- tain deleterium, which taken by the pores of the skin and lungs, and mixed with the blood, usually occasions great damage, which it would be absurd to refer to the coolness of the air alone, clos- ing the pores of the body. Besides various phenomena of epi- demic constitutions seem to oppose this opinion, although gene- rally accepted, by which it appears that the morbific matter, per- haps otherwise invincible, is carried off by evacuation alone, to wit, running of the nose, expectoration, a flow of sweat, or looseness of the bowels, to which we may add the urine, which often, in this case, is found to be a relief to the patients, when it is thick and turbid. Wherefore, if Catarrhal Affections arise from a certain matter in the air, taken in through the pores of the skin, or any other perv ious part, an evacuation through the same spiracula, seems likely to be the more salubrious. This is attempted by the spon- taneous efforts of the animal ceconomy, or the milder diaphore- tics are exhibited, joined with diluents and demulcents, by means of which a certain insensible perspiration is promoted, until a bland sweat breaks out, which, by whatever cause it be excited, the patients may favor if they keep their beds, and observe the rules of diet. Besides all know, that vapour baths and steam- ings are serviceable to the same end. Nor are evacuations by stool to be thought useless, whether natural or artificial, but this evacuation is to be cautiously directed, lest it hinder ano- ther. Emetics are also recommended in some epidemic consti- tutions, by which the disease is wonderfully smothered in its commencement. Sometimes theriacs are of benefit, or cardiac and anodyne confections of the same nature. Nor must we omit narcotics, While the prima? viae are freed from obstruction oth- erwise they are forbidden by the skilful, as nauseous and hurtful. Hypnotics are also thought hurtful, if the head be pained, or the bowels costive : Lastly, the aged must be cautiously treated with these remedies, lest they die with untimely drowsiness. There is much controversy among physicians concerning vene- section, while the Catarrh is prevalen-, and perhaps the dispute is yet undecided; yet from repeated experience it is our opinion, that this species of sickness, when epidemic, is longer protract- ed in many, after blood-letting; and indeed sometimes becomes dangerous: but is never checked and lessened thereby ; so that we can not use this remedy without the greatest caution, even when fever rages, and difficulty of breathing is urgent, or other more aggravated symptoms come on, whatever they may babble 84 CACHEXY. to the contrary, who insist that it is highly necessary at the de- cline of the hot fit. Lastly, the work would grow to an im- mense size, if we should annex all the medicines usually exhib- ited against Catarrhal fever. It would indeed be empty and su- perfluous, since the design of this work requires me to treat of peculiar defluxions separately in their place. CACHEXY. IT is well known that by this name is designated that dyscra- sy of the blood and humors, or depraved condition of them, which. is known by a loathsome colour of the skin. The young and old are thought obnoxious to it, as also those who are recovering from tedious disorders. That is called Essential, which takes its rise from foul air, from bad victuals, and from a peculiar vitiated state of the humors. But symptomatic, which is the consequence of any disease, to wit, scurvy, schirrous infarctions of the viscera, putridity, purulent congestion, or any other kind, or of some fault of the viscera as well pectoral as abdominal. But this difference is often scarcely discerned in practice. Im- moderate haemorrhages and very numerous venesections are apt to bring on Cachexy: and the like effect follows the suppression of sanguineous discharges, and preposterous treatment of inter- mittents, or untimely stopping of a quartan, &c. It is univer- sally acknowledged that Cachexy is bordering on Leucophleg- masia, but it differs much from chlorosis, which has nearly the same appearance, since the yoke with it is soon broken, and on the contrary it exasperates the other. Even the jaundice is of another nature, although it is very often attended with a vitiated crasis of the blood, since this royal disease may be subdued in a short time, and Cachexy does not yield, unless to a long con- tinued cure. Nor do they judge more properly who refer scur- vy to Cachexy, or consider it as the last grade of this disease, since there are scorbutic patients evidently free from Cachexy; and many cachectics, who- have never had a scorbutic taint. Yet it is well to note, that the aforesaid diseases have often been implicated with this very one: and here is perhaps the genuine source of error. A livid colour of the face, or greenish or leaden, a paleness of the whole body, leanness or slight swelling of the skin, more conspicuous in the face, eyelids, and extremities, which some- times retain the marks of the fingers pressed on them; are sp CACHEXY. 85 many signs of Cachexy. The sick have frequent chills, and complain of difficulty of breathing from any motion of the body. The pulse is found slow and compressed, a slight fever coming on towards evening: it is sometimes found unequal and inter- mittent, with palpitation of the heart. Want of appetite and fla- tulency follow these, with tormina, and swelling of the hypo- condria; from the same source proceed belching and discharge of flatus downward, especially after having taken food, with a various and unequal state of the bowels. In the mean time the urine is turbid and whitish, in this unhealthy state. Spontaneous lassitudes come on, the joints are numb and swelled throughout the body. The mind as it were beclouded, and the sleep becomes very profound. The legs swell in the evening, then oedema takes its place in the morning. In some, lastly, the sweats are foetid, and various efflorescences of the skin break out, which although they often refuse to be mastered, yet give little trouble. This disease seldom threatens death, if the viscera be fault- less, otherwise they scarce admit of cure. For it is obvious to even the rude and inexperienced, that this /eludes everv art of physicians, if it proceed from any incurable defect there. Be- sides the more slow the progress has been, the more obstinate it is esteemed. But this disease when contracted from an ill-cured quartan, or other intermittent, is removed by the return of fever alone, after the choicest remedies have been used to no purpose. Lastly, Cachexy continuing till old age, even when the viscera are restored, draws after it marasmus and dropsy, or shews the type of these fatal disorders. From anatomical observations, as well my own, as those taken from the writings of others, we learn, that the larger vessels, especially the hepatic are turgid with concrete, black and feculent blood, nor are the diversified affections of the intestines de- rived from any other source; for the viscera are found to be af- fected with livor dry, wrinkled, schirrhous, putrid, and filled with tubercles or small hydatids, abcesses and anomalous tumors are discovered, with caries of the ribs and vertebrae. Lastly, there occur stagnations either serous, purulent, foetid, &c. This general view of enjuries being premised, let us come to the pe- culiar ones, or those proper to each part. The Liver for instance, is seen discoloured, whitish, leaden, covered with spots; or rough with granulations and tubercles, of great size. It is at times very large, again contracted, and having congestions of divers kinds, and sometimes filled with hydatids. Its vesicula bilis distended, sometimes with green and very acrid fluid, sometimes watery and without any saltish 86 CACHEXY. taste, and containing a sort of gall-stones. The spleen in some is found large, in others compressed and wrinkled, and hard as a stone. The omentum varying in size, stuffed and adhering to the neighbouring parts, or putrid. The pancreas and mesentery are tainted with the same diseases, as also the kidneys, which are met with filled with calculi. The breast not unfrequently exhibits the same injuries, to wit, stuffing, purulence, putridity, and morbid adhesions, the pericardium in some, filled with a lim- pid or sanious fluid, the heart is seen very much enlarged, al- though its thalami and auricles are deprived of blood. The small branches of the arteries and the valvule themselves are seen filled with a kind of cartilage, stone or bone. Lastly the cover- ing of the cerebrum being taken off, there are sometimes found, as well in its windings, as in the other recesses, bloody and sanious stagnations; hydatids growing to the vascular net-work, &c. all which however do little good when seen, unless the acu- men of the mind be directed to the phenomena of the disease. A cachexy which is occasioned by any other primary disease requires no peculiar treatment, since when the original disease is removed, the crasis of the blood is restored in a short time; but when it depends on no other affection, or arises after it is past, it demands a peculiar method of cure. Wherefore, if it arises from suppressed menses, haemorrhoids, or other accus- tomed discharges of blood, every effort should be used to res- tore these evacuations, to supply which, venesections are advan- tageously employed. But on the other hand if it originate from immoderate flows, the whole business almost is to be left to na- ture; after checking them, and attending to a suitable diet. For experience has generally taught that remedies have not only been inert, in this state of things, but have been often hurtful. If, lastly, Cachexy takes its rise from the itch, or any other efflores- cence on the skin being repelled, it is expedient to have recourse to the method of cure above described. From the foregoing it is clear, of what importance it is, in curing the dyscrasy of the blood and humors, that strict regard be had to the first passages. With this view, emetics and cathar- tics are first prescribed, as well the milder, as the hydragogues, and afterwards stomachics. These being premised, and not omitting diet, temperants, hepatics and bitters are exhibited, as also depurar ts and antiscorbutics; which very much oppose this vitiated crasis of the blood. Nor are aperients, diuretics, and sudorifics of less service, which occasion the molecula? of the hu- mors to be more easily excreted. Those especially recommend- ed and frequently used, are rhubarb, cremor tartar, arcanum duplicatum, diaphoretic antimony, and the antihecticum of Pot- SCURVY. 87 ter. But the martial and roborant medicines take the palm, which if administered in time, and after the proper things have been premised, perform the office of the most exquisite aperi- ents. To restore the crasis of the blood, the various mineral waters are not unsuccessfully brought to our aid; as also the cold martial water, which, traversing the interior recesses of the body, have the power to repair the dyscrasy of the humors. Lastlv, pure air in a sunny situation, agreeable excursions, &c. are much recommended. And to conclude, it is of service to add, that Cachexy rarely yields to a tumultuous method of cure, and therefore there need only the more bland medicines, together with a suitable diet, to which more is to be attributed than to the pharmaceutic art, especially if this affection be kept up by any latent organic disease. Hence they err, who, blinded by their own hypothesis, think that this affection must be attacked with cathartics and diuretics alone, and see nothing else in the cure than to turn the morbific matter to the intestinal outlet or direct it to the kidneys. This is the notion of the medical vulgar, which many of the sick have to bewail. — @>«—---- SCURVY. THIS species of putrid cachexy as they call it, prevails among the northern nations, and the inhabitants of marshy countries;. and frequently invades sailors, soldiers, and others of the lower class of people, who want wholesome food, and the other con- veniences of life. Yet the rich and the noble who live sump- tuously; ought not to be considered free from it, nor does it spare infants themselves. The Scurvy is most easily contracted after serious diseases. The learned and studious are disposed to it, and grief and sadness, and heavy cares bring it on. More- over it is esteemed by many of the most eminent physicians, as the last grade of hypocondriac affection; whether properly or no, let those judge who are aware that Scurvy may even be propa- gated by contagion, or by various well known causes, to wit, bad food, impure air, &c. besides that infants, evidendy free from melancholy, have often been attacked by this disease. Euga- lenus, no mean author, to whom however we must give cau- tious credit, laboured much in seeking out from almost all dis- eases the seeds of latent Scurvy: some practitioners embrace with both arms, his hypothesis which makes fools of the unskilful; these delight to call every disease they meet with by this title, 88 SCURVY. where they are ignorant of its nature. But the illustrious Lind has opposed this opinion with powerful arguments, and from re- peated experience plainly denied that this affection was so fami- liar as was commonly supposed. He appears to have almost exhausted this subject, lest physicians, deceived by their affinity, should rush precipitately into error often the most fatal. There arises another doubt, concerning this scorbutic constitution, of which, if I mistake not, Riverius makes the first mention, which frequently attacks those who live high and at their ease. We can scarce conceive this condition of the body to differ in degree from that kind of Scurvy, which is contracted at sea, and disappears immediately on returning to shore. But there is a certain disease having nearly the same marks, to wit, both af- fections shew themselves by sores of the mouth, and exanthemata, and seem to require the same remedies. But if these said simi- lar diseases are subjected to more accurate examination, and their evident causes rightly weighed, it will readily be believed that they have a very different nature, but we will leave this doubt to be, solved by those who have more leisure. It is com- monly thought that Scurvy is sometimes hot, at other times cold; but this very recent division arises from no other source than age and temperament. For it is taken to be hot in youth, and in the sanguineous and bilious, but cold in old, melancholic, and pituitous persons. Hence appears a rational method of cure, and we understand why refrigerants do not agree in all cases. The genuine Scurvy appears with soreness of the gums, pe- culiar efflorescences of the skin, and shooting pains diffused through various parts. But in some these marks are wanting, or occur in a doubtful way. Whence it is necessary to inquire into other circumstances, from the concurrence of which a diag- nosis of this disease may be discovered. To mention the evi- dent marks: Almost all who are seized with Scurvy, complain of insuperable sadness, and are oppressed with fear of death, they are kept wakeful, or have a sleepy vertigo. Many are apt to faint, and complain of very severe head-ach, and weakness, tor- por and tremor of the joints. In the mean time the face is puffed and pale, the mouth is foetid, the teeth become loose, and the tu- mid gums project beyond the row of teeth, lose their natural colour, suffer the blood to ooze out, and are eaten by exulcera- tion or putridity. Nor does this destruction spare other parts of the mouth, hence it is no wonder if the salivary glands sympa- thise, and therefore afford greater extent to this foul distemper, stinking and filled with sanies, which gives no little trouble to the patients. Tlien, as the disease advances, the putrid sore- ness of the mouth creeps through the trachea to the lungs, and SCURVY. 89 from this additional cause there is a very disagreeable fetor of the breath. The pulse is found slow in some, unequal and in- termitting, sometimes it becomes more frequent, and a fever which is called scorbutic follows, which returning in no order, shews a doubtful type; during this there sometimes appear ex- anthemata, very much resembling flea bites, and vanishing in a short time, which by the ignorant or careless are called by the name of petechia:. This fever mosdy shews itself under the form of intermittent, but the paroxysms return more frequently, and not at stated hours. To proceed. Many patients complain of constant palpitation of the heart, tightness of the breast, or acute pains of the sternum, ribs, and back, like those of pleurisy. The scorbutic virus ex- erts its greatest rage in the abdominal viscera—foetid belchings and hiccough arise from too great injury of the stomach, and unusual swellings of the epigastric region, or of the whole ab- domen after eating. In some the oesophagus is so constricted, that food and even drink can scarce get to the stomach. The spleen is very often diseased, hence heavy or acute pains, of the left hypocondrium, often swelling, which mostly creep to the other side. Amongst various tormina of the belly, a most se- vere colic pain exercises the greatest tyranny, which sometimes resembles a nephritic fit, sometimes the colic from lead. The belly in the greatest number of patients is loose, with putrid or dysenteric stools. The urine is foetid and lateritious, nor are die sweats of a sweeter smell. In the mean time wandering pains affect especially the joints and legs, and not unlike venereal pains, are worst at night, and encreased as the fever encreases. Some authors have treated of these pains under the title of wandering gout, and scorbutic; others have declared them to be related to rheumatic pains. Have not both been deceived by the affinity of the two, and been wide of the mark ? We leave this to be set- tled by wiser heads. In the mean time the scorbutic patients can scarcely stand on their feet, walk with difficulty, and even go lame, until the legs fairly give out, as well from atony as from retraction of the muscles, or from swelled and stiff knees, which particularly happens to infants. In some the connections of the bones are deprived of their synovial liquor, which causes a crepitus in a certain motion of the part. Yea, many have said that even the vertebrae are affected with this disorder. The skin of scorbutic patients, except the face and hands, is marked with red, purple, livid, or black spots, sometimes very small, and as we observed above, like petechias, are very nu- merous. But more frequently they are broader, even to the di- mension of the pa}m pf die hand,, nor are they wanting on the 90 SCURVY. legs, of much greater extent. Sometimes pustules break otify especially in infants, while the aged are vexed with an itching scarcely to be allayed. In some there are swellings equalling the size of a pidgeon's egg, which for the most part affecting the" head, recede after two or three days, and frequently retunw The legs are infested with ulcers spreading far and wide, and very obstinate, discharging nothing but sanies, and in which proud flesh grows up, and prevents their healing. At length the blood, scarcely to be restrained, often breaks forth as well from the ul- cers as from the nose, mouth, stomach, intestines, &c. concern- ing which, by way of conclusion we may add, that whether it flow spontaneously or be drawn by venesection, it has a livid, greenish or black colour, and sticks so to the cloths, that they -can with difficulty be washed out with ley. These are the principal signs or symptoms, usually observed in scorbutic diathesis, which differ little from those which ac- company lues venerea, wherefore it is no Wonder if the diagno- sis of either disease, should often occasion great difficulty to even the most judicious and experienced. Yet if the antecedent re- marks are sedulously and sagaciously attended to, and the man- ner of invasion brought to mind; if the diseased state of the mouth and other parts are subjeeted to examination, we may trace the character of each disease from nature herself. For the Scurvy, to begin from the mouth, attacks the teeth and gums, but the lues venerea invades the uvula, tonsils and palate: scor- butic pains creep from one part to another, nor seem deeply fix- ed ; on the contrary, venereal pains stick longer in the parts affected and are deeper: the Scurvy affects the abdomen vari- ously; the lues venerea chiefly attacks the head and limbs. Lastly, scorbutic ulcers seem more sordid and moist than sy- philitic, &c. But it is easily gathered from the foregoing, that the diagnosis of either is involved in great darkness, if, as often occurs, the foregoing affections are complicated. My experience proves that the Scurvy is propagated by contegioriy and that when contracted in this way it exerts its principal se- verity : and the most experienced authors assert the same, which nevertheless some of no mean character plainly deny: So diffi- cult it is to extricate truth from falsehood. The more ancient the Scurvy, the more difficult the cure, but it causes greater trouble to physicians, if associated with lues venerea. An ad- ventitious Scurvy, such for instance as depends on any slight or accidental cause, is quieted and removed in a short time by the help of art, but when rooted and congenital, or originating from a peculiar constitution of the body, it commonly eludes the pow- ers of the choicest remedies. Physicians know well that in this SCURVY. 91 state they often occur in hysterical and hypocondriac patients. No danger is to be apprehended from spots on the skin, so long as they do not tend to a livid or black colour. It is said that the haemorrhoidal discharge is beneficial. Among the dangerous symptoms, difficulty of breathing is numbered. Nothing certain can be said concerning a diarrhaea, since to some it is beneficial, to others of no advantage. Very violent tormina in the intesti- nal canal, cause fear of gangrene; tumors quickly rising and de- creasing threaten palsy of the members, scorbutic ulcers are thought most obstinate; contraction of the knees is scarcely curable, gangrene conspicuous to the view is truly very difficult to stop: Lastly, deep rooted Scurvy, draws after it the dropsy, marasmus, paralysis and convulsions; and some scorbutics, who as above noticed, are subject to fainting, are suddenly given up to the jaws of death. The dead bodies are disfigured with spots of a blackish purple colour and very broad, and soon putrify, which makes it neces- sary to open them hastily; yet when subjected to close examina- tion, they discover the greatest destruction in the abdominal viscera, with sanious stagnations, morbid adhesions, &c. But if the parts are singly explored with care, the liver is found di- versely affected, to wit, dry, schirrous, and stony, and its sur- face rough with various tubercles. The spleen is found in many contracted, wrinkled, and as it were cartilaginous, or swoln, and of immense size, and not seldom putrid. It is expedient to note of this viscus, that by many it is falsely considered the seat of the disease, since it is frequently found free from fault and altogeth- er blameless. The sanguineous vessels of the abdomen, and es- pecially the hepatic and splenic, sometimes contain tartareous concretions. The mesentery is presented to. view, stuffed up, schirrous and covered with pus, and its vessels for the most part varicose. The omentum scarcely ever appears unaffected, but is plainly seen to be seized with putridity. The stomach and in- testines* are marked with gangrenous spots. The viscera of the breast often contract the same diseased appearances, but in most patients they are found unhurt. Lastly, the bones exhibit many things remarkable, to wit, their connections dried, their epiphyses broken, the ligaments eaten through; luxations, the ribs removed from their cartilages, &c. and, what is wonderful, the bones become soft and as it were cartilaginous. But many think that this is not an unfrequent phaenomenon in lues venerea: but exostoses and caries, very common in this last disease, are verv seldom observed in Scurvy. The work would grow to an immense size, and become sick- ening, if I were here X% annex all the remedies prescribed by the 92 SCURVY. host of writers, who have left nothing untouched, of the inex- haustible fountain of the materia medica et pharmaceutica. The design of this work obliges me to cleanse this Augean stable; Wherefore, dismissing the useless articles, and such as are pre- pared for mere ostentation, I have mentioned those more select and approved. All are acquainted with nasturtium, cress, horse radish, and other antiscorbutics, which have rightly gained the name of specifics, but many are not aware that these plants have often been given without effect, or have done harm, unless their doses have been regulated by the precepts of wisdom. For the blood is heated by the long continued use of antiscorbutics, whence arise slow fever, phthisis, marasmus, &c. Hence it ap- pears why the cure is promoted oftentimes by other remedies. These are diluents and temperants, and especially pure water drank abundantly. These views are answered by succory, fu- mitory, and slightly bitterish plants of the same nature. Vitri- olated tartar affords no little benefit, nor is nitre of less merit, especially when haemorrhage threatens. Lemon juice, and other vegetable acids are not only powerful in removing the present disease, but also take the first place among the prophylactics, which seamen are well aware of. The young shoots of the fir, and tar water are also much recommended. Diaphoretics are of service, while the pains are severe, and exanthemata are com- ing out. Among which the principal are, diaphoreticum mine- rale, antihecticum poterii, sal volatile succini, spiritus salis am- moniaci, elixirium proprietatis, &c. When the necessary reme- dies have been premised, the preparations of iron, have some- times done good, but they seldom are of use, contrary to the usual order of things, when the viscera are obstructed. Lastly, the cold mineral waters are often used, as also milk, whey, &c. It may be beneficial to give cathartics pro re nata, but they are to be cautiously exhibited, and the milder ones are to be selected. By some the Peruvian Bark is praised, and not undeservedly, yet it is well to note, that the long continued use of thia Bark, in the cure of intermittents, has not hindered the convalescents from falling into Scurvy. Narcotics cannot be given without danger, but if the sick are restless, or pains are predominant, they may be given to relieve the urgent symptoms. The same may be said of venesection, it is not less to be dreaded. There- fore it ought to be banished, unless aggravated and violent symp- toms require it. Mercury does the greatest mischief, especially if it excite salivation, therefore laid aside by the more judicious, although some contend that by this remedy they have removed the Scurvy, who, it is fair to suppose, have taken lues venerea for Scurvy. Nevertheless the cure is to be undertaken with anti- LUES VENEREA 93 venereal remedies, if the foregoing symptoms are mixed with them, but to be managed with the greatest care in this, case, lest we should rouse a hornet's nest. *."*'' Amongst external remedies, the best are gargarisms prepared from specifics, detergents and astringents, to wit, nasturtium, water cresses, hyssop, Columbian seed, pomegranate flowers, red roses, the wood of guaiacum, and mastich, pomegranate rind, or Winter's bark, camphor, amber; sal ammoniac, alum, and other mineral acids—to which may be added tincture of gum lace or myrrh, spiritus cochlearioe, &c. Some are fond of honey and barley water, others give nasturtium, cochlearia, sorrel, berberries, &c. to be chewed. Camphor is exhibited ex- ternally to prevent gangrene. Lastly, for contracted joints, that species of lesser houseleek called vermicular, is much approved both for internal and external use. Marine salt is applied with success, warm to the legs, and the hot baths, near the end of the disease, usually complete the cure. LUES VENEREA. THISproteiform affection, which is sometimes rendered more tedious, and is brought to light, both by the internal and external use of warm water, appears in the form of almost all diseases; but it is well to remark, that this experiment has not succeeded in all. The Lues Venerea discovers itself by almost innumer- able signs, or, is attended with such a troop of symptoms, that we can scarcely, for order's sake, confine within proper limits, even a sketch of it. Yet this genus of disease appears more re- miss, and less violent and distressing in our times; or as some think, its virus is exhausted by time; or by the discovery of a safer method of cure, a few years past, is more easily and gene- rally removed, so that those who are seized with it, can more confidently have recourse to well tried remedies, before the dis- ease become deep rooted, and bring on certain destruction. It is commonly said, that the Lues Venerea, till then unheard of, was about the end of the fifteenth century, brought by the Spaniards from America into Europe. It is true indeed, that this disorder was first openly known in our country about this time, but whether it was formerly taken for leprosy, then very common, although now rare, is a doubt, which we leave for others to solve. 94 LUES VENEREA The first sign of Lues Venerea, is best learnt from the can- did relation of the patients, not desiring to conceal their wicked- ness.* For this disease putting on so many appearances, is more clearly understood when we have an open confession; but other- wise its diagnosis is very intricate, which thus shews itself. This affection for the most part appears a short time after em- bracing an infected woman; but sometimes does not become manifest until after many months, and even years, lurking^for a long time in the blood without harm. Yet most patients com- plain after an impure coition, of heat of the genitals with stran- gury, and about three days afterwards a gonorrhaea comes on, of which we shall treat below. The prepuce and sometimes the glans penis, is seized with inflammation, little ulcers, pustules, tubercles, and fleshy excrescences, &c. and the penis incurs dan- ger of a much greater degree, to wit, an inflammation, which after arriving to a certain height, threatens gangrene. In many the testicles swell with inflammation, and from this source pro- ceed at length hydrocele, sarcocele, and varicocele: buboes swell out, concerning which in their place. The anus is infested with fici, mariscae, condylomata, rhagades, and scissurae, or even fistula itself. The haemorrhoidal vessels swell exceeding- ly, and often run into suppuration, or take the nature of callous carcinoma. These are the visible signs of Lues Venerea, which however are not infallible, since it does not seldom happen that gonorrhaea, buboes, pustules, and ulcers of the genitals, stuffing of the testicles, &c. proceed from another source. But the above symptoms afford no little suspicion of the latent virus, if they do not yield to the usual remedies; or if they recur a short time after being removed by any means. The Lues Venerea is some- times attended with anomalous ftver, acute, slow, contined, or intermitting. Lastly, to end these general symptoms, some com- plain of a heat in the palms of the hands and soles of the feet, when otherwise free from fever. The Venereal virus exerts its rage chiefly in the head, for it produces very severe head-achs, convulsions, vertigoes, tre- mors and palsies. There appear in the face and scalp, as well as in the alae nasi and corners of the lips, pustules sui generis, the series of which affords a kind of evidence of the existence of the disease. From the pericranium there arise cystic tumors, which affect the loins underneath with caries. There.take place pthalmiae, lippitude and various other affections of the eyes. The ears are subject also to injuries, such as tinnitus, deafness, pain, inflammation, and ulcers. But the mouth gives more cer- tain signs of the latent virus, for the fauces, uvula, tonsils, palate, and though rarely, the gums, are eaten off by wid« LUES VENEREA. 95 spreading ulcers. Nor do the nostrils escape, which are also dug out irt the same manner, with caries of the subjacent bones, in the same places creep out polypi, sometimes callous, sometimes having the nature of cancer. As the disease advances, the bony fornix of the palate is eaten off in some: Hence arises a hole that no art can close up, and the voice thereby becomes, as it is cal- led, nasal. It is easy to suppose that from these diverse defe- dations of the mouth and nose, a most foetid halitus must pro- ceed. A disease of the lungs also favours this fetor, which is known with ease by hoarseness, haemoptisis, phthisis and asth- ma. Nor does the heart remain unaffected in this state of things, as we may well conjecture from palpitations and faintings fre- quently recurring. The abdominal viscera rarely sympathise, if we except the uterus and other organs of both sexes, which are variously dis- eased, for instance, with stuffings, inflammation, schirrous ex- ulcerations, &c. Moreover, as we have hinted, the inguinal glands often swell, whence buboes occur in this disorder very commonly. The virus seldom attacks the cervical or axillary glands. But from this stock proceed cystic tumors of different size, and appearing in different parts as well as in the head, and lastly, tubercles affect the tendons and ligaments. Many are af- flicted with very severe pains of the joints, which are so deep, that they seem to reach the bones, and are worse at night. They mightily tear one part or other, or are scattered over various parts, very dissimilar. In the mean time, there break out in many, soft exostoses, or elastic, indolent, or painful, by which the surrounding parts are injured. The bones are also infected with^caries^ whence are produced the most fetid and obstinate ulcers. There are great chops in the palms of the hands and soles of the feet—the toes are lamed by paronychia?, the nails, hair, eye-brows, &c. fall off; Lasdy, the skin is variously affected, to wit, eaten by phage- denic ulcers, and marked with diversified spots of a blackish, purple, or livid colour, it is also spoiled by scab, herpes, and other pustules, either dry, humid, squamous, &c. Here it is right to observe, that all these signs or phenomena usual in this disorder, never all appear in the same persons, but they each vary in the patients severally, according to innumerable circum- stances. We have already spoken of the difference which occurs be- tween scurvy and Lues Venerea, from the concurrence of signs or congeries of symptoms: but it may be of service to add to these, the parts through which the siphilitic contagion is propa- gated, to wit,the genitals of both sexes, after an impure coition. 96 LUES VENEREA* and the lips of the dalliers and whores tainted with their fervent kisses, the mouth of sucking infants, the nipples of nurses, and lastly, the skin of the fcetus, which has contracted this taint through the womb of the mother, affected with little ulcers, pus- tules, or in some other way. In this class are included go- norrha?a, and swelling of the testes and buboes, which occupy the neighbourhood of the pudenda. Infants are doubtless very often affected by the virus of the mother or nurse, but there is some doubt of other modes of contracting it. Although various histories are in circulation, of mid-wives who received the in- fection by the hand applied to the womb, or by being otherwise engaged in the chambers of the diseased. It is incumbent in noticing the signs heretofore mentioned, to have respect to the state of the genitals of both sexes. But others occur peculiar to the women, to wit, cancerous tumors of the breasts, suppression of the catamenia?, or an immoderate flow of it; stuffing of the uterus, ulcers, &c. and many moreover become barren, and mis- carry, or bear children covered over with erysipelaceous redness, and spotted with different pustules or little ulcers. From the foregoing observations it is evident, that Lues Ve- nerea is almost without danger, if it create no pain, nor obstruct any functions; but on the contrary it is to be considered danger- ous, when the internal parts are injured, and there arise numer- ous and grievous symptoms. It admits of difficult cure, if im- plicated with scurvy or scrophula, where it has by length of time become deeply rooted, it can scarcely be removed. Lasdy it is thought incurable if the principal viscera or vital organs have be- come tainted. The case is of a dangerous nature in infants and old persons. Lues is of little damage to women who menstru- ate, but it brings a host of bad symptoms where menstruation is wanting at the stated times. Lues, finally, if left to itself, or to the powers of nature alone, mostly ends in dropsy or ma- rasmus. From the history of dissections it is learnt, that the muscles are imbued with a kind of pituitous fluid, that the involucra of the organs, as well as the other membranes, are overspread with various pustules or tubercles, that the viscera are obstructed in different ways, and contaminated by a certain collection of mat- ter, that the cavities and recesses are filled with serous or sani- ous stagnations. When the head is opened by the saw, and subjected to accurate examination, caries is detected in the bones of the cranium, face and ears. Exostoses are found in the inter- nal surface of the skull, acrid tumors of the dura mater and parts adhering are obvious. The vessels are distended with concre- tions called polypous, the plexus choroides varicose, and filled LUES VENEREA- 97 with hydatids; lastly, they are here and there found to be puru- lent and putrid, &c. The breast also exhibits many things re- markable, when subjected to the anatomical knife, to wit, the lungs stuffed up and schirrous, filled with tubercles and abscesses, ulcerated, putrid and gangrenous. The trachea and bronchia as if eaten with caries, the thymus gland also affected in like manner, which often brings the aesophagus into consent. The abdomen shews no little injury, for when the glands are attentive- ly considered, the mesenteric especially, they are found stuffed up, callous or covered with putridity. The lymphatic vessels, creeping about here and there, appear to the naked eye knotty. Every where occur hydatids, phlogoses, abscesses, exulcerations, schirrus, anomalous tumors, &c. Besides, in some the liver, spleen, and pancreas are infected, but with these affections, the uterus, ovaria, vesicula? seminales, prostates, and other parts of generation, are more frequently infested. Many of the bones are found carious, both of the trunk and limbs, which reaching to the marrow itself contaminates it. There are found some ex- ostoses or aspereties, which had been hid before. Various au- thors have mentioned mollities ossium ; but we have above doubt- ed whether this rare phenomenon is to be referred to Lues Ve- nerea rather than to scurvy. Nor are the ligaments free, which like the bones, are swelled and carious. Lastly, quicksilver is met with, in those especially who have died while under a mer- curial course, not only in the concave base of the cranium, but even in the capsular ligaments of the joints, and in the cavity of the bones, which indeed is well to bear in mind. To come to the method jf cure: It is well known that mer- cury, penetrating to the secret recesses of the body, is a specific remedy of Lues Venerea, and in most general use; whether it reach the blood through the pores of the skin, as by the help of ointments, plaisters, or fumigation; or is taken inwardly by the mouth, in the form of ptisan, powder, pills, &c. Hence spring numerous methods of cure, which have their respective merits, provided the object be, that the mercury being diffused in the blood, may be retained a long time within the vessels, and be gently carried to the intimate recesses of the body. Care must be taken that it operate without force, lest it occasion ptyalism or diarrhaea, for these evacuations ought studiously to be avoid- ed, since a thousand observations prove, that they are not only useless and vain, but hinder the entire evacuation of the virus, by carrying off the principal part of the mercury, by the mouth or belly. From the various methods of cure above noticed, that seems to have no equal which is performed bv the application of Un- O 98 LUES VENEREA. guentum Nedpolitanum, carried by friction into the pores of the skin, at proper times—but nothing is to be attempted, until the way be prepared for the tainted humors to yield to the powers of the mercury. With this view, having premised venesection and cathartics, temperants are prescribed, milk, whey, warm bath, &c. nor ought the aforesaid cautions to be neglected in other me- thods of cure, which would otherwise become inert or hurtful. Nevertheless we may sometimes deviate from this rule, if the case being very urgent will not suffer any delay of preparation. But we must always attend to diet: and that a milk diet, if nothing forbid, is more suitable I have learned by repeated ex- perience. About two ounces of mercury, from which four or six ounces of ointment are prepared, ought to be used for the whole anoint- ing, having regard to the strength, and indeed sometimes this dose is lessened, but rarely increased. Frictions, to be repeat- ed every third day, ought not to be used more than twelve or sixteen days through die whole course of the cure, which is mostly performed in forty or fifty days. This unguentum Nea- politanum is to be applied to the back and joints: for instance, the feet are first to be anointed, afterwards the legs, then the knees, &c. nor are the clothes to be changed during the prescrib- ed administration of the mercury. If the medicine fall upon the mouth, or occasion any great disadvantage, it is best to super- cede the anointings, and indeed clean cloathes must be put on, as well of the bed as the body, &c. which change not succeeding we must have recourse to cathartics, that the humors which fly to the head may be diverted to the feet. We must abstain from friction during the catamenia or pregnancy. For tender infants, when infected, the blood of the nurses ought to be impregnated with mercury, that an antivenereal milk may be afforded them, and by this remedy alone many have been restored. Neverthe- less mercury given in whatever form, is sometimes inadequate to remove the complaint—this is the reason why judicious prac- titioners, after administering mercury, take to sudorifics, which complete the cure, namely to guaiacum, china root, and sarsa- parilla, which being omitted, the disorder frequently returns, and must again be treated with mercury, though rarely with suc- cess : which those who consult the health of their patients, ought not to forget. When soreness of the skin prevents mercurial frictions, we may try the virtue of fumigations, but with caution, that the head may be guarded from the smoke, which is offensive to the eyes, teeth, and lungs. To this end, are exhibited cinnabar, aethiops mineral, mercury killed by sugar, or other mercurial pre- LUES VENEREA. 99 parations, some add to these olibanum, amber, storax, mastich, turpentine, &c. from which are prepared lozenges, troches, &c. The time of fumigations is from three or four minutes to a quar- ter of an hour, according to the strength of the sick, and for each fumigation may be taken one or two drachms of cinnabar, interposing three or four days, so that for every term of cure, which is contained within forty or even fifty days, not more than two ounces of cinnabar may be used. It is now ascertained by numberless experiments that this method of cure is not without danger, nor safer than anointing: it is however not to be reject- ed, since sometimes, in respect of circumstances and accidents, it excels the other methods of cure. It is principally useful in cutaneous foulnesses, and in these cases has been of service to many: but it is a maxim with the experienced that it is often fruitless labour against infected viscera. The weak and lean do not well bear fumigations, phthisical patients cannot admit them without harm. We must by all means guard against the access of the smoke to the breast. And indeed experience proves that some that submitted to this mode, whose lungs had been previ- ously unhurt, have fallen into phthisis. In the mean time, both methods are often thought unequal to overcome the morbific matter, even after the second or third ex- periment, wherefore it is necessary to try another, which is two- fold, and consists in mercury under different forms taken by the mouth; or vegetable sudorifics. From both of these sources the mountebanks and empirics, more daring than physicians, take their liquors, ptisans, powders, pills, and other arcana,, which sometimes answers the expectations of the sick. Nor do these strollers despise some obsolete remedies, the use of which, formerly most noted and approved, I know not by what means has become neglected. Of the greatest esteem are panacea, ar- canum, corallinum, aquila alba, turpethum minerale, precipi- tatum rubrum, and numberless other preparations discovered by chemists, which taken inwardly, get to the blood through the lacteal vessels, and exert their force against the venereal vi- rus, often resisting mercury sent in by the skin, but evidendy overcome by these. The manner of using them is simple. The panacea for instance, which is like all the rest, is exhibited eve- ry day, premissis premittendis, first, in a small dose for instance from four to six grains, this dose may be gradually increased until it become a scruple, and then by little and little diminish- ed in the same ratio, so that the last dose shall not exceed the first. About six drachms of the panacea is commonly us- ed to perform a cure, during which we must be very cauti- ous, in repsect of the doses, also in other modes of cure, lest a 100 LUES VENEREA. ptyalism be promoted, especially if some signs of this c\cre- sion be observed in the mouth; for this is the compass which directs the steps of the judicious. Moreover this mode is not more expeditious than the others, and requires the same cau- tions and preparations. This is proper to remark, concerning any administration of mercury, that we can not ascertain exact- ly the necessary quantity for extirpating the Lues, nor telljthe exact number of days, to which the cure is to be limited or ex- tended, since the Venereal Virus is sometimes easily, some- times more difficultly to be overcome. But the judgment of the cure must be directed by close attention to the strength of the patients, their age, sex and temperament, the duration and de- gree of the disorder, the misfortunes and accidents; not neg- lecting the accurate observation of all the symptoms as they van- ish in process of time. Yet be careful lest the poison, laid asleep as it were, should sooner or later return, which it is not un- known to any practitioner, has often happened, even when all things have appeared to succeed properly, and in those who have not exposed themselves to any danger of a new infection. Among the various mercurial preparations, no one scarcely denies that the corrosive sublimate is mostly to be dreaded, since it holds almost the first place among caustic poisons. Yet the very celebrated Van Swieten brought this hitherto neglected remedy into familiar and very successful use, and now it is plain from very numerous observations, that this article, other- wise the most noxious, affords in a skilful hand, the most ex- quisite and innocent anti-venereal, so that this eminent author did not hesitate to give it the preference of the rest. Nor is the manner of using it difficult; to wit, twelve grains of corro- sive sublimate are dissolved in two pints of rye liquor once rec- tified ; let one or two table-spoons full of this solution be given night and morning, drinking at each dose, one pint of a decoc- tion of barley, with a third part of milk, which decoction af- fords a common drink. This remedy is not to be used without the necessary premises, and observing the usual cautions, which is to be continued until the symptoms of Lues disappear, and things return to their halcyon state. If the disease occurs of a light nature, and not deeply rooted, it ought not to be used be- yond three weeks, beginning with the prescribed smallest dose. But when we have to contend Avith Lues more virulent, and of longer date, the dose must be encreased, and the cure extended longer. Lastly, in this method, as well as in the others, ptya- lism must be avoided—Hence there must be an armistice when {his threatens. LUES VENEREA. 101 The use of sudorifics, formerly very celebrated, has now be- come obsolete, and undeservedly laid aside; such as guaiacum, sassafras, China root, and sarsaparilla: for their efficacy in the extirpation of Lues Venerea is established by almost number- less and very accurate observations. Nor are the more judici- ous practitioners ignorant, that by this remedy alone, at this day rashly omitted, the syphilitic poison has many times been eradicated, after mercury has been unsuccessfully and repeat- edly administered. And indeed, as we have just hinted, it is often brought into use by the experienced, for the safer comple- tion of the cure begun by mercury, or where it seems to have been performed. Guaiacum excels the others of the same na- ture, and therefore is preferred before them by the greater part of physicians : Nor is the manner of using it difficult, for in- stance, a decoction of it, in the quantity of two or three wine- glasses full is taken every day, for forty or fifty days, and longer, as the case may require, with which the most abstemious diet is to be used, and the patient ought not to rise from his bed. Another decoction of this wood, which is called Bochet, is pre- pared like a ptisan, for ordinary use, and it is continued beyond the term mentioned, or even a whole month after the cure is per- formed. Yet it is well to remark, that the lean and debilitated can not bear the force of sudorifics, hence the necessity in this case, of giving the dose cautiously, and in small portions. Bo- erhaave relates that he cured a young man of aphrodisiac Lues, with carious bones, after the best mercurials had been given to no purpose, by the decoction of Guaiacum alone given as an ordinary drink, sweats also being promoted by the vapour of spirit of wine, and very low diet assisting. It is expedient to know, that some symptoms even after the disease had been eradicated by either method, have been delay- ed, and sometimes remained : but experienced practitioners are apprehensive of no relapse, since when the fomes of the disease is extinguished, they are dispelled with the greatest ease, and cease spontaneously in process of time. The Gonorrhoea among other remains seems more troublesome, but by the help of milk or other demulcents, it is removed with little trouble; as also by mineral and martial waters, and lastly by balsamics and ro- borants. Pains also sometimes elude the force of anti-venereals, but at last vanish by milk diet; temperants and mineral waters also assisting : all which being of no avail, diaphoretics are pro- fitably administered, nor are topical emollients, demulcents and anodynes to be omitted, which at least cause a truce, until other remedies complete the cure. If scab, herpes, ulcers, caries of the bones, &c. remain, which, however rarely happens, they re- 102 SCROPHULA. quire nothing but slight treatment, having no regard to their primary cause. These are the remedies, perhaps too much contracted, which we were to treat of in Lues Venerea. Those who desire more, may read the treatise of the skilful and learn- ed Astruc, who has spared no pains in the deep investigation of this matter. SCROPHULA. THE Scrophulous Virus, like that of the venereal, often lurks a great while in the body, or is complicated with other disorders, so that its diagnosis is involved in darkness. Be- sides that the Scrophula (les Ecrouelles) appears to resemble lues venerea, unless they be the mere product of this last affec- tion. For it has often been observed that syphilitic and even scorbutic parents have had Scrophulous children. Moreover, the specific remedies for lues venerea, to wit, mercurials and su- dorifics, agree also very well with Scrophulous patients. Last- ly, the said diseases sometimes present the same appearance, or are plainly attended with like symptoms, so that we can say nothing certain concerning their difference. Yet the lineage of Scrophula shews itself different, for it is the judgment of physi- cians, that this often owes its rise to bad food, or to foul and putrid water, to the milk of a nurse that is pregnant &c. Be- sides it seems placed beyond all doubt, that Scrophula is pro- pagated from one to another, or is contracted by simple conta- gion, from whence we learn, that this affection is sometimes con- genital, sometimes adventitious, and it is of the greatest mo- ment to attend to it in this double point of view. The Scrophula shews itself mostly by tumors breaking out, which have been called among the vulgar, Humeurs ou Tumeurs froides, (cold humors or tumors) yet the internal parts are not considered free, and especially the mesenteric glands, as will abundantly appear from dissections, to be treated of hereafter. Sometimes the disease comes on in disguise, before it discovers itself in tumors, which affect the lymphatic, salivary, and thy- roid glands. These prominences even besiege the joints, and attack the cranium, which is not rarely eaten by caries, and they swell out very thickly in the neck, near the ears, below the in- ferior maxillary bone, and above the trachea which is also affect- ed with caries. It frequently invades the axillae, groins and breasts, nor does it spare the eyes, nose, lips, elbows, hams, SCROPHULA. .103 knees, hands, feet, fingers and toes. These tumors grow upon the membranes, tendons, ligaments and even bones themselves, which on that account swell and become carious : whence arise the most severe pains, and that terrible symptom, very fami- liar in the Scrophulous diathesis, barbarously denominated spi- na ventosa. Scrophulous tumors which seem to possess an intermediate nature between phlegmon and schirrus, adhere firmly and are mostly immoveable. One while they rise to a certain mass of unequal surface, and appear conglomerated; at other times they are disseminated like a chain about the neck, mostly of the same colour with the skin, they with difficuly inflame or suppurate, but very often they become callous, and sometimes are like stones for hardness. Ulcers of a bad kind arise from thence, and by their long continuance infants fall into hectic fever and marasmus: they not unfrequently take the nature of cancer, or degenerate into the most loathsome fistula?. The prominences and inner edges of these ulcers are painful and callous, and are with difficulty brought to heal; but if after long and tedious la- bour they are closed, the cicatrices remain whitish; these are very conspicuous, and are indelible by any art. There occurs another genus of these tumors, viz. the cystic which contains matters of various kinds, or mere limpid and inodorous water,, In this class is also to be taken bronchocele, occupying the thy- roid glands, which by its size often compresses the trachea, and even the aesophagus. Yet far be it from us to say that all ano- malous tumors, which have the name of Gouetres, and affect the larynx or other parts, are to be considered Scrophulous, as some rashly imagine, since it appears clearly that these proceed from numberless other causes. They do not judge more pro- perly trho think that rachitis, deffluctions on the joints, or aedema- tous swellings of them, fistulous ulcers, achores, &c. (some- times to confess the truth, symptoms of Scrophula?) always and indiscriminately proceed from the same source, which indeed contradicts reason and experience. Nor is the Lues Scrophulosa contained within these limits, as we have already hinted, but, also produces sublingual tumors, infarction of the tonsils, polypus and ozoena of the nose, opthal- mies and oegilops, or incipient fistula lachrymalis, and other in- juries of the eyes. It often also falls upon the breast, hence sar- coses in the trachea and bronchea, haemoptisis, phthisis, asthma, &c. Nor does it spare the abdomen, for the most part swelling it, besides also the mesentery, which is rightly supposed to be the principal seat of the disorder. It affects the liver, spleen, omentum, &c. Under these afflictions the sick grow tabid, and 104- SCROPHULA. are rarely free of fever, or fall into dropsy or paralysis, which last diseases when arrived to a certain grade, bring many to the grave. The Scrophula usually invades infants from four years of age, and adults, but rarely extends beyond puberty. If it pass these limits it is followed by cachexy or gout, or other chronic dis- ease, mostly eluding medical art. When Scrophula takes its rise from waters, aliments and contagion, or from any other ex- ternal and evident cause, it is generally thought favourable. But it becomes otherwise, if it be congenital or with heriditary taint; of which kind soever it be, it is hard to remove. Many have supposed that those infants were more obnoxious to this affection, who were of premature genius, nor does expe- rience contradict this. The cure may be successful when the tumors are soft and recent, moveable and free of pain; nor is there less hope, if disposed to inflammation, and not averse from suppuration. But those that are immoveable, schirrous, pain- ful and livid, are most inveterate and obstinate; those affecting the trachea and larger vessels, as also the tendons, ligaments, and bones, are very troublesome. Lastly they are fatal when partaking of the nature of cancer. The ulcers arising from hence, being sordid and virulent, are very difficult of cure; or if by in- cessant labour they heal, the suppressed virus breaks out at ano- ther part, and there a new ulcer is formed, very much like the first. Lastly—caries of the bones of the hands and feet, max- illae, &c. create the utmost trouble. Finally, to contract all these into one, our prognosis ought to be derived from the duration of the disease, as well as from the nature of the parts affected; otherwise it is always dangerous, if the virus pent up in the vis- cera brings on marasmus or dropsy. In the external tumors when subjected to the anatomical knife* there is found a fluid ichor, somewhat bloody, or having yellow dregs; in the neighbourhood of these is seen a matter as if fatty, concrete and fleshy, sometimes very much resembling lard, such is often observed in cancers, with the subjacent bones affect- ed with caries. There is discovered a series of lesser glands heaped up as it were in bunches, which sooner or later become the germs of so many seeds of Scrophula, Stc. It is plain from examining the viscera, that the internal parts contract no les9 injury ; for when the abdomen is opened, the mesenteric glands are found much enlarged, which sometimes are as large as a walnut, and even a man's fist; they are observed schirrous, cal- lous, and almost stony, or like anomalous tumors, contain a kind of sebaceous, cheese like or purulent matter. The lacteal ves- sels are drawn into consent, the receptaculum VEqVET-ianum, SCROPHULA. 105 and thoracic duct, which are injured in a variety of ways. There occur polypous sarcomata in the stomach, and intestinal tube, adhering inside and outside ; the bladder, though rarely, exhibits the like appearance. The liver is discovered wrinkled, dry and contracted, or schirrous, and full of tubercles, and like a stone; also it is of very ample size, and contain? abscesses fill- ed with whitish or bloody matter. Lastly, in some it is seen deformed, and receding from its natural situation, with the gall-bladder distended beyond measure. The spleen is diseas- ed in like manner, which is even changed into pus, so that it flows out like pap, and indeed it is found quite decayed. The omentum, pancreas, uterus, ovaria, &c. suffer the same defe- dations, which is the cause why stagnations either serous, sani- ous, purulent or foetid are found very commonly in the abdo- men. Nor does the virus spare the internal part of the breast; for the thymus in almost all, is found schirrous and of stupen- dous size. The involucrum of the lungs is met with thick and callous. The substance of this viscus is schirrous, full of ^tu- bercles, purulent and putrid, yea, and in some persons one or other lobe of this viscus is quite decayed, the vacuum being filled with a kind of whitish or gypseous matter. Moreover, ex- ulcerations of the pleura present themselves to view, tumors also growing upon the membrane, with caries of the neighbour- ing rib. The pericardium shews the same vitiated state, which otherwise is annexed to the surface of the heart, or swelled with water. Nor are there wanting morbid adhesions, and stagna- tions of different sorts, to wit, serous, lixivial, muddy, and in- termixed with particles of blood, &c. floating round the said viscera. We add nothing concerning tumors, caries, and other injuries above noticed. The principal point of cure turns on aperients, incidents and sudorifics. But these medicines are found to be inert or hurt- ful, unless venesection be premised, if nothing hinder, and af- ter clearing the prima? viae, we must repair the diathesis of the blood by the help of whey, and other diluents, temperants, de- purants and mildly opening antiscorbutics. Aliments of milk often have an excellent effect with this view, but do not agree with all. To the same end are much recommended the roots of wild myrtle, scrophularia, and polypody, as also the leaves of coltsfoot, rue, muraria, nasturtium, cochlearia, &c. Ipeca- cuana is recommended in the first place in this state of the cure; but cathartics frequently repeated, have in many cases been ex- ceedingly useful throughout the course of the disease. Which being premised, we come to more efficacious medicines, among which are millepedes, martial, gummy and saponaceous articles, 106 SCROPHULA. magnesia, and other absorbents ; bitters, and especially Peru- vian Bark are much spoken of by some. Calomel, panacea, cetheops mineral, and other mercurial preparations are much approved, which used for that purpose, a long time and in re- peated doses, have done mueh good to many. To these we may add lime water, which cautiously exhibited has been held in esteem. Among the more select sudorifics are enumerated vipers, sassafras, antihecticum Poterii, and other things of the same kind. Nor are the various mineral waters te be neglected; calcined sponge in the quantity of about one drachm, evening and morning, is among the number of choice specifics. Pumice and other absorbents, seem to promise the same virtues. Also the remedy called Rotrou is much recommended, which howe- ver is used by few, on account of its difficult preparation, whence it is wanting in the greater part of the shops. There are some who prefer the most common mercurial ointments, but this method ought to be the last recurred to, which we have seen to succeed not happily. The virtues of plantain externally ap- plied have very lately been much extolled, and nothing hinders that they should be tried. Lasdy the cautery and seton have helped many. As respects the Scrophulous opthalmy, it re- quires the usual remedies, to wit, venesections, cupping, leeches, blisters, &c. concerning which in their place. We will leave the other symptoms of Scrophula in silence, since they do not de- mand any particular method. External Tumors require a particular cure, which consists in resolvents and maturants. From a proper view of the ap- pearances, physicians betake themselves to one or other method: yet the first attempts are chiefly made with resolvents. A- mong the innumerable articles which are used at pleasure for each, the best are thought to be the leaves of the dwarf elder, cooked under the ashes, calaplasms of the roots of briony and wild cucumbers, fomentations of lime water, the fumes of oli- banum, karab and tacamahaca, diachylon plaster with gums, (de vigo) of cicuta, diabotanum, &c. which having been tried in vain, on account of the tumor refusing resolution, maturants ought to be used, to wit, the more common emollients and di- gestive cataplasms, by the help of which the matter is some- times ripened, and an abscess formed, the opening of which, even if mature and fluctuating, ought not to be hastened, that by the detention of the matter the Scrophulous glands may be entirely eaten out. for a similar reason the healing of the ulcer is not to be hurried, but rather cathartics must be exhibited, among which the solution of corrosive sublimate in plantain wa- ter is recommended. These last remedies associated with di- gestives and detergents will eradicate the Scrophulous remains, ARTHRITIS. 10: which otherwise continuing after the uniting of their edges, are again without doubt re-produced. Nor do experienced practi- tioners omit even caustics themselves, which if they reach the genuine fomes, do great service. But if the said tumors either whole or open, with tumid veins about their surface, put on the nature of cancer, they defy all the most powerful topicals. Wherefore, nothing can then be given but demulcents and ano- dynes, unless we can take them out with the knife, which ope- ration requires the skill and dexterity of a surgeon. Nor is it void of danger, if the glands affected, although moveable, should adhere to the neighboring nerves, and greater vessels. It will be safer indeed to attempt those that are prominent with simple liga- ture : but when they are deeply fixed, both methods of cure are clearly forbidden. It is well to add, before I take pen from pa- per, that this very troublesome cure of Scrophula is mostly ex- tended to years ; since this disease is rarely subdued, unless by puberty, beyond which it is often protracted through the whole course of life, under different forms, ARTHRITIS. THIS disease, the Gout, is evident to all if it fall upon the feet or hands with swelling, pain and heat. But it is otherwise in lighter attacks, which are scarcely discovered except by ex- perienced patients. The diagnosis becomes more intricate, if the Gouty matter affects other parts, and especially the viscera, without any previous paroxysms, under the appearance of ano- ther disease, which the incautious, without the least suspicion of its real nature, often treat with unsuitable remedies. The Gout rarely attacks children under puberty, and those who are castrated, it spares the weaker sex before the menses ap- pear, except chlorotics, who are liable to it—-but its greatest fre- quency is among the old, especially the opulent who grow grey in early life, and often affects hypocondriacs and hysterical persons, especially if the haemorhoids or catamenia have been suppressed. An idle and domestic life, high living and delica- cy, daily feastings, and the liberal use of wine and ardent li- quors, and lastly venery. Every one knows that calculi are ge- nerated from the same causes, and that both these diseases pro- ceed from the same source, whence it happens that many are alternately excruciated with Gout and nephritis, and aged per- sons are mostly afflicted with both diseases. Rheumatic and 108 ARTHRITIS. sciatic pains come the nearest to those of Gout, but scorbutic and venereal pains are of a different kind, often, however resem- bling the arthritic and rheumatic, and so imitate their type, that even the more skilful may be deceived. The Gout, fixing on the tendons and ligaments, exerts its rage in the feet, hands, knees, and elbows: yet it does not con- tinually tear the patients, but recurs by paroxysms rarely with- out fever: The affected part painful and swelling, is now seized with slight inflammation, attended with heat, redness, and a sort of pulsation; and again it appears aedematous and as it were fla- tulent, with torpor and cessation of the pains; hence the division of Gout into hot and cold. The pain therefore appears under, -i various grades, one while mild and obscure, of which the sick ;. scarcely complain, again it is most violent and exerts itself like a tyrant, so that it is in a wonderful manner exacerbated by the slightest touch of the clothes. About day-break it mostly abates J and ceases, so that it does not become worse by any inattentive. motion. The arthritic matter more frequently leaves the part af- fected, first, that it may rush upon another part, namely the knees, hands, &c. and the distress of the patients is protracted, until an itching coming on, there is hope of the paroxysm soon terminating. Attacks of Gout upon the feet, are not continued beyond about fourteen days, in the young and vigorous; but become longer, and are extended to many months in the aged and weak—but in proportion to their living, and other numberless circumstances, they suffer various ways, in respect of duration and severity/-., n There is no certainty concerning the intervals of accession, or intercalary days, but mostly they return at stated times, unless their accustomed periods are interrupted by the passions of the •mind, or a loose manner of living. There is great likelihood of there being obliterated in chronic Gout, when the pains, although ;'u mild, become continued, unless the dog-days should give them a kind of cessation. As the disease advances, the fingers and toes become stiff, crooked and variously distorted, and unable ; to perform their offices. Callosities protrude from the phalanges, occasioned by a certain cretaceous matter, impacted on the liga- ments and involucra of the tendons. For which reason the Gout is called ^notfty—which tubercles sometimes opening, afford an outlet to the aforesaid concretions. Yet the Gout invading old persons for the first time, is not attended with severe pains, nor subjected to the ordinary peri- ods. It is«well to add that, when this affection at any age, is associated with its relation rheumatism, as often happens, this last disease seems to obtain the predominance. ARTHRITIS. 109 It is the universal opinion that Gouty persons are subject to belchings and flatulency, to costiveness and piles, to strangury, &c. But the greatest misfortunes follow from a metastasis of the gouty matter, which receeding from the joints, threatens the viscera; wherefore if it be transmitted to the cerebrum, there arise head-achs, delirium, vertigo, lethargy, apoplexy, palsy and trembling. If it attack the external parts of the head, there fol- low opthalmia, ear-ach, tooth-ach, quinsy, &c. If it fall upon the breast, it excites catarrhs and inflammations, phthisis and haemoptisis, asthma, anxielies, faintings, &c. If it affect the abdominal viscera, there arise nausea, vomiting, loss of appe- tite, diarrhaea, dysentery, heat of the stomach, or most severe heartburn, colic and nephritic pain, &c. in persons thus affected, the urine when at rest, lets fall a kind of gypseous sediment. Besides many complain of a certain tightness about the ilia and hypocondria, or a troublesome sensation in the bowels. When the Gout is concealed under these appearances, the nature of the disease is easily discovered after the most usual attack is past, but it lurks obscurely, unless there has been a previous accession in the feet or hands, which, it is well known to physicians, has often happened, in advanced age. Congenital Gout, or contracted in childhood, is thought in- curable: the adventitious when recent may sometimes be sub- dued. But the chronic and deeply rooted, from whatever cause it proceed, is with difficulty put to flight. Sydenham, in truth the Prince of his cotemporary physicians, who has minutely des- cribed this disease under which he laboured, may serve as an example. For this great man candidly asserts, that having tried all remedies for thirty years unsuccessfully, he, together with those, who'denied remedies, or for fear of expence, employed no physician, was still afflicted with most obstinate Gout. Moreover, we every where meet with those who have complained of Gout through the whole course of their lives. As it respects the paroxysm, the most acute pains betoken the shortest and clearest interval, so that they have been esteemed as the salutary efforts of nature, even in those who avoid deli- cacies. We may also augur well concerning a swelling of the pained part, soon running to inflammation, which like a critical defluxion, promises the first intermission; thick, turbid, and muddy urine also predict the end of a paroxysm; the examina- tion of which the ancients did not despise in all the affections of the joints. Gout becomes weaker by age, but its paroxysms are longer, so that the sick are evidently without the usual inter- missions. It is proved by multiplied experience, that an attack of Gout has been of service in quartan fever, asthma and dropsy, 110 ARTHRITIS. and that old Gouty persons have been longlived. This kind of sickness is not dangerous, if the morbid matter affects the joints only; but the thing is more doubtful, if the viscera, namely the heart and lungs are reached. There is less danger, if the disease falling on the primae viae occasions vomiting, diarrhaea, or even dysentery. Since a number of observers testify, that these evacu- ations have been frequently salutary. Anatomical examination exhibits in the articulating knobs of the bones a certain cretaceous or sandy matter, by which, not on- ly the tendinous involucra and the ligaments are covered, but, .also the bones themselves removed from their proper situation, are invested. Yet it is of use to remark, that none are found in the ligamentous capsules of the joints. Stony formations are found in the brain, heart, lungs, &c. and small sand and calculi in all the receptacles of the urine. The kidnies are presented contracted and wrinkled, the spleen callous, the liver grants lous, &c. to say nothing of other appearances common to almost all diseases. There are not wanting remedies for Gout, of a prophylactic and palliative nature, which otherwise, as already hinted, is with difficulty removed, especially in old persons, the contracted pores of whose skin, denies egress to the usual effluvia of perspi- ration. It is best to abstain from every cure during a paroxysm, and the whole business must be left to nature, or very low diet, unless the violence of the pain should require lenients and emol- lients. I can easily believe that venesection cannot be attempt- ed without danger, at the commencement of the attack, for that this is rarely of service in plethoric cases, and often prolongs the f tage of the disease, and not rarely brings the sick to their end, is plain from hundreds of histories. I am aware, that blood-let- ting during the paroxysm, has sometimes dispelled pain from the affected foot like a charm. But whether this rash method, in opposition to the efforts of nature be free of danger, we leave for examination to those who are not ignorant, that many sick of divers diseases, have at last paid by death for this ill-timed relief. Cathartics ought not to be prescribed, unless in case of urgent necessity. But nothing forbids the keeping of the bowel? free by enemata. By the use of narcotics, which Sydenham was perhaps too much addicted to, daily practice testifies, that the Gout becomes more obstinate: but far be it from us to im- peach those, who, following the footsteps of this eminent au- thor, ^omply with it when very urgent, during the violence of the pains. It is not allowable indiscriminately to use the topicals which are proposed against the Gout, for by the untimely use of reper* ARTHRITIS. Ill cutients and narcotics, the morbific matter leaves the joints; hence arise metastases, from which are gathered prognostics of death. But emollients and resolvents must not be omitted, among which the most approved is a cataplasm partaking of the vir- tues of both, prepared of milk, crumb of bread, and elder, or chamomile flowers* By some physicians of credit, the leaves of burdock are recommended, they are assisted by ashes applied hot. Vesicatories not unfrequently afford immediate help. Lastly, the actual cautery prepared from the Chinese Moxa ap- pears to excel the rest: which I have known by experience to nave succeeded very well. Lint, or other vegetable matter prepared in the same manner, for this purpose, were used by the ancients; who without dispute have given this kind of burning its due praise. When the paroxysm CEASES,nothing is more necessary for the physician than to prevent its return. They may attain this wish- ed for point, who indulge in a diet suitable to reason, and abstain from flesh and wine. It is proved by repeated experiment, that a milk diet alone takes the palm from all other prophylactics. A certain nobleman about sixty years of age, given up to every kind of delicacy, and now tormented with Gout, so that he could neither stand on his feet, nor take hold of any thing with his hands, through Divine Influence, resolved to abandon his depraved manner of life, and come out from the mire of his lusts; and believed it necessary to follow a life of virtue, that he might be reconciled to the offended Deity, and might make amends for his wickedness by even a late repentance. Therefore discarding his pleasures and desires, he allowed himself nothing but pheasants boiled with no condiment, bread, and water, as his only aliment: by which mode of living, he not only receiv- ed a foretaste of eternal salvation, through the mercy of Him who searches the recesses of the human heart, but gradually re- pelled this now inveterate and knotty Gout, and without think- ing, entirely eradicated it. It is also recorded in various histo- ries, that some Gouty persons who had formerly lived high, being reduced by adverse fortune to the greatest want, so that nothing but bread and water- was given them, have exchanged their Gout for poverty. Of so much avail is thin and spare diet, to drive away affections of long standing. To return to our subject. Soap ought to be ranked among die best remedies, and for reaching the deep recesses of the body, and mildly clearing the obstructed vessels, has jiot per- haps its equal, while a suitable regimen may prevent any hurtful effect from it. Bitters and stomachics are advantageously given, among which are the IVruvian Bark, charosedris, rhamiepitis, 112 ARTHRITIS. epithymum, and theriac. Nor ought sudorifics and antimonials to be omitted, which when given judiciously, have happily suc- ceeded with some. For some time past, the internal and ex- ternal use of the warm mineral waters, has been in no little es- teem. Moreover a certain degree of exercise of the body has done much good, nor are frictions without their use. Cloathfes* made of flannel have been much esteemed. I have seen them answer very well in some, while they used day and night, socks or shoes made of hairy skins. A bath prepared of grape-husks, has done good to many Gouty persons. A sudden sousing of the warm mineral upon the part has done good. Lastly, some have been fond of a liniment made of oil of turpentine, and mu- riatic acid. As to the general remedies, although they have reference to my method, I will add nothing. There are other ways of cure to be employed for metastasis of the morbid matter, called anomalous Gout, vulgarly Goute re- montee. We have already mentioned that local narcotics, and repercutients, riotous living, anger, and other aggravated pas- sions of the mind, promote this misfortune. There is no pact of the body either internal or external, to which this wandering matter may not fix itself, whence is derived a host of diseases, but it more frequently attacks the brain, lungs, stomach and in- testinal canal, kidnies, &c. which when they attend the primary disease, occasion great apprehension for the patients. Where- fore every thing must be tried, to invite the Gouty humor mixed with the blood, back to the joints: with this view let a vein be immediately opened, and especially of the foot, for we have more than once known from experience, that by the section of the saphena, the devious matter has returned to its pristine seat; which plainly argues that it is unsafe when the Gout rages. Cathartics give immediate relief, by the help of which the mor- bific matter is carried off by the intestines, wherefore, when these succeed properly, physicians care litde about the return of the Gout to the joints, who besides are aware, that purging, a3 well during the paroxysm, as in the intercalary days, has been beneficial to the greater part of Gouty persons. Diaphoretics taken from the three kingdoms may supply thi place of purgatives. Roborants have the same effect, as well aromatic as bitter, to wit, nutmeg, zedoary and Peruvian Bark, which seem to excel the others. Musk is also recommended by some, when the Gouty matter attacks the stomach. Yet some- times alkool martiale, and numberless other medicines, which are given firo re nata, and for different symptoms, yield their share of benefit, all which being taken together, are not equal to ano- dynes, which nevertheless ought to be banished, if die mind is RHEUMATISM. 113 beclouded, and the organ of respiration impeded. Local stimu*- lants do not yield to these, to wit, vesicatories if the case be ur- gent, sinapisms and other vellicants of that kind. There are some who apply burgundy pitch alone, which often mildly and without pain answers the purpose of blisters. Others dip their feet in hot water, or wrap them up in skins of sheep or other beasts, fresh from the slaughter. Nor ought we to omit leeches to the hemorrhoidal vessels, which I remember to have often done wonders. Yet when these have been ineffectual, I know of nothing safer than to persist in repeated cathartics. RHEUMATISM. ALTHOUGH authors do not separate Rheumatism from gout, appearing as relations to depend on one and the same cause, or joint neighbors, as they say, to this disease, yet they ought tp be righdy distinguished, as well on account of the part affected, as in respect of the event and cure. The Rheumatism, as falling upon the membranes and involucra is more easily sub- dued ; but the gout as affecting the ligaments, becomes more ob- stinate ; but one very easily runs into the other, or both exert their force at the same time, in the same subject. Whence arises a kind of anomalous gout, which among us is called Rheuma- tisme gouteux. The disease of which we are now treating, af- fects the joints, neck, back, maxilla, scapulae, breast and abdo- men, one while it seizes the whole muscular compages, or sud- denly passes through them, again it fixes on a peculiar part, which when it leaves, it invades another; this* last has the vul- gar barbarous name of torticolis, if it affect the muscles of the neck; it is called pleuretis spuria, fausse pleuresie, if it fall on the pectoral muscles. When fixed on the lumbar muscles, it is called Lumbago; and it is known by the title of Ischiades, if it occupy the part of the same name, or the coxa and neighboring parts. Taking cold when the body is warm, houses that are damp or recently built, a lazy idle life, gluttony and venery, the suppression of the menses or piles, or other usual discharge of blood, repelled eruptions, &c. are so many causes of Rheuma- tism. Sydenham was of opinion that those who indulged long in the use of Peruvian Bark were more prone to this disease: but experience contradicts this. Rheumatic Pains, like those of gout, are subjected to va- rious grades. When thev are verv intense, the muscles be- Q 114 RHEUMATISM. come unable to perform their offices, or excite dread by every motion, lest the pains should become excruciating. This disease is called frigid by some, if it have no fever at- tending it; but hot, if with fever, which by the bye it is well to remark. For the most part however it takes its rise with shiver- ing and fever, nor do the pains come on until the second or third day, which, sometimes suddenly fall upon all the parts,-'or only affect one part, and often moveable are propagated from one part to the other, so that in the same paroxysm it wanders through many parts, which it is well known, does often take place in youth. Rheumatism partaking of gout shews also the same type, which is therefore by some denominated arthritis vaga, wan- dering gout, in which the part affected swelling up, is covered with redness, as with genuine gout. The Rheumatic fever, from which the slight attacks are free, is mild or vehement, continu- ed or intermittent, and lasts a short time; but the pains are lon- ger protracted, and often exacerbated after the fever is gone off, and do not leave the part till after thirty or forty days, and indeed are extended to vears, or through the whole course of life. Rheumatic pains, like those of the venereal and scorbutic kind, are most severe in the night, if we except that lumbago is per- haps more fierce, which, therefore by some incautious persons is taken for nephritis, especially if from any other cause the patients should vomit. It may be noted, however, that these affections are not seldom associated, which to be sure is not to be wonder- ed at, when we reflect on the affinity between gout, Rheumatism, and calculus. Moreover, it is expedient to know, that the most inveterate Rheumatic pains are for the most part kept up by the venereal or scorbutic virus, and that pains of this kind are often lurking under the form of very obstinate Rheumatism, which inexperienced physicians ought to bear deeply in mind. Lastly, for the more accurate diagnosis of Rheumatism, we may add, that blood drawn from a vein is covered with a greenish crust, as in pleuresy: from this similitude has arisen the grossest er- ror, for which many of the sick have suffered dearly: for many have persuaded themselves that Rheumatism was an inflamma- tory disease, to be subdued only by repeated blood-letting, and physicians adhered to this preposterous method of cure, so long as this now obsolete hypotheses prevailed. The Rheumatism is commonly void of danger, unless from an improper diet, or preposterous means, the morbific humor, leav- ing its genuine seat, should fall upon the brain, lungs or other viscera: whence have proceeded symptoms, which as in anoma- lous gout, occasion no little fear. It is often terminated by 4 RHEUMATISM. 115 sweat, and sometimes by cutaneous eruptions; or the flow of urine, menses, or haemorrhoids, betoken a crisis. It is thought more obstinate, if it fix upon any peculiar part, but rarely por- tends any evil. A cessation of either, or intermission, indicate the disease to be more easily cured; but it happens otherwise, if they be wanting. When the disorder becomes inveterate, in the same manner as from gout, the fingers are bent by the dry and shortened muscles, and are twisted into protuberant knots, yea the bones are sometimes moved out of their proper situation, or become agglutinated: hence it is plain why the joints become unable to perform dieir offices, and are altogether without mo- tion, and some patients are obliged to betake themselves to bed. Lastly, the Rheumatism, as we have above inculcated, is more easily cured than gout; for although the Rheumatism is more familiar, yet all know that old arthritic pains are more apt to recur. • The bodies when dissected, exhibit the muscles so contracted and dry, that they look like tendons. There occurs a kind of matter gelatinous, sandy, and growing upon the membranes and aponeuroses. The bones present to view, grown together, or ad- hering, and even pushed out of their sockets. Other injuries of which we spake, when treating of arthritis, we have purposely omitted. Yet it ought carefully to be remembered, that what has been said should be understood of chronic Rheumatism; but in the recent there appears no injury, or if any, it eludes the keen- est sight, which is the cause, why the joints afford nothing wor- thy of note, even when subjected to accurate examination. The cure during the fever, is to be undertaken by blood-let- ting, especially when the parts diseased are affected with tension and redness, and it is to be repeated whenever this occurs, with- in three or four days from the first invasion, beyond which it is best to abstain from it, lest the disorder should be protracted, nor ought the blood to be too freely drawn, within these constituted limits; since opening a vein three or four times at most, is suffi- cient, whatever they may say against it, who rashly think that blood is to be drawn so long as the fever- remains, and pains are severe; induced by this reason, because the Blood taken shews an inflammatory disease, which we have already declared is but a mere notion. Marqjjetus, an author of credit, relates that he had, like others, for a long time used very frequent venesec- tions against Rheumatism, but that by experience he knew, that this disease treated by this method was lengthened to months and years, wherefore being better taught, he betook himself to cathartics and sudorifics: by which means, discarding venesec- 116 RHEUMATISM. tions, the disorder before most obstinate, fled in a few days; which is truly worthy of observation. Sometimes it is expedient, after the first bleeding, to promote vomiting, that the saburra lodging in the stomach, may quickly be carried out per viam regiam. Cathartics, if necessity do not urge, must belaid by until the end of the disease; excepting the milder laxatives, which, together with enemata, lubricate the bow- els, which is of the greatest moment in this disease, as is plain from observations repeated over and over. While the paroxysm lasts, we may profitably use diluents, temperants and refriger- ants, to wit, whey, nitrous ptisans or apozems, pulvis tem- perans, &c. Nor are diuretics, depurants, and the milder dia- phoretics of less service, but the stronger ought not to be administered without the greatest caution especially while the fever continues, lest we disturb the hornets, or lest the Rheumatic fever become inflammatory, which authors record as having} often taken place, from the confused application of terpentine, diaphoretic antimony, spiritus cornu cervi, vipers, and other stimulants of that nature; with which, from experience we freely assent. As to anodynes, they seem to be not more suitable in Rheuma*: tismthan in gout, although they assuage the pains, and comfort the sick; for they do sometimes interrupt the powers of nature, < while preparing a critical excretion, and thereby protract the disease; and indeed, sometimes favour the impetus of the mor^ bific matter to the brain, not without the greatest danger to the patients. Nevertheless, camphor, \,hich has a place among the sedatives, may safely be given; nor has it undeservedly obtain- ed great praise among practitioners of the first note, since besides^ its anodyne virtues it is capable of promoting diaphoresis, and restoring the strength of the organs. Lasdy, crabs eyes, prepared hartshorn,, and other absorbents may sometimes be given with benefit, which answer the purpose of other medicines, in some of the symptoms, with which the paroxysms are attend-'» ed. But chronic Rheumatism demands other remedies, whether continued or intermittent, among which the principal are demul- cents, roborants, aperients, incidents and sudorifics: namely milk diet, rhubarb, Peruvian Bark, juniper berries and tar water, soap and calomel, and lastly vipers broth, &c. which act as so many prophylactics. Concerning the root of burdock, which some re- commend as a specific, we shall enquire by and bye. Finally, other remedies are used, which are known to be serviceable in the cure of Rheumatism. External applications have their own uses, in the list of which are cold baths, which are spoken of by some as the most efficaci- RHEUMATISM. 117 ous for dispelling a recent Rheumatism. We hesitate not how- ever to assert, from sufficient experience, that it has not been beneficial to all. Nor are there wanting some, who believed that it could not be used without danger. Among the most common local applications ought to be enumerated, animal fats, deers marrow, ointment of althaea, oil of bays, earth worms and cam- momile, poultices of bread crumbs, &c. Nor are animals cut open alive and applied to the pained part rejected.* Bladders half filled with warm milk, tin flasks filled with hot water, &c. But when the pains are raging, we may fly to some soothing bal- sam, or other external narcotics, but with caution. If, lastly, the swelling and redness of the part do not abate from venesec- tions, leeches are to be applied, which perhaps suck out the morbific matter, together with the blood. Blisters may also effect this, than which nothing is believed to be discovered more effi- cacious and speedy. Respecting the internal treatment of chronic Rheumatism, let cloths be worn of the softest flannel: sweating medicines are very highly extolled, and not undeservedly: baths of the warm mineral waters of various denominations are exhibited with suc- cess, the sick are immerged in lees of wine, the mud of mineral waters is applied, frictions with hot towels and cloths are cele- brated. Nor must we omit cauteries and setons, which have often produced wonderful effects. Finally, if the disease is fix- ed on any part, there is perhaps no better present remedy than the voluntary motion of the part affected; by which, to be sure the pains are exasperated, but the humor being rubbed by the muscular contraction, is for the most part soon dispelled, while the disease is in its infancy. When adhering in the muscles of the neck, it is easily allayed and removed, by heat itself applied with moist wool, or in any other way, or fumigations of oliba- num, karab, &c. To conclude; it is proper to add, that when Rheumatic pains proceed from the suppression of some dis- charge, or the repulsion of some eruption, every means must be used to bring back the accustomed evacuations, and pristine efflorescence, which, if they recur, relieve from all care: this ought to be well remembered by those who carefully examine the evident causes of diseases, and for the most part labour in vain by attacking the imaginary fomes of the disease with un- suitable remedies. * This practice is now rejec'.cd. T. HYPOCHONDRIASIS. IT is very well known that this affection takes its name from the hypochondria, which are supposed to be the genuine seat of the disease, and especially are implicated the origin of the veins, which take up the refluent blood from all the viscera concerned in chylification, and collect it in the vena porta? connected with the liver. Whatever doubts there may be about this, it remains fixed among all authors, that this disorder ought to be received in- to the class of spasmodics, which not only agitates the whole body, but even does not spare the mind: From whence itis that physicians who catch at popularity, and are not ashamed to impose on fools, avoid the proper name as indecent and opprobrious, and desig- nate by the most vague and silly title of vapours, the Hypochondri- asis, a disease allied to Hysteria. This disorder frequently comes on from the twentieth to the fiftieth year of age, beyond which it seems to end in scurvy or gout. Hypochondriacs are generally of a disposition prone to meditation, and scarcely per- mit themselves to be taken off from serious things; given to sad- ness, they tremble all over at bad tidings, and avoid the company of men, even their familiar acquaintance; anxious for themselves, they are tormented with the fear of some great impending dis- tress, or are continually oppressed with the fear of death. This kind of sickness is never propagated by parents to their children; but commonly has its rise from difficulties in family matters, from heavy cares, and various misfortunes; from intense study or excessive labour, so that it is considered as the wretched attend- ant of literary characters; from the exhausted powers both of mind and body. Nor does it spare those who lead a life free of cares, since the idle and indolent, gluttons and loose livers also bring on this disease. It is contracted by the immoderate use of emetics, cathartics, and anodynes. Lastly, it is caused by the retention of the semen, by suppressed gonorrhaea, a checked diarrhaea, and the ill-timed stopping of intermitting fevers. Flatulencies, troubling chiefly the stomach and oesophagus, by which the hypochondria swell, and the whole abdomen is in- flated with rustling of the intestines, and the throwing off of wind upwards and downwards, excite the first suspicion of Hy- pochondriac affection. There takes place in some, who are fre- quently spitting, a vomiting of mucous and foetid matters, and of an acrid and sour nature, which last, as also belchings of the same kind, injure the teeth. A pulsation in the abdomen, which is usually referred to the Caeliac artery, is perceptible to the touch in some. Almost all complain of pains about the edge of the HYPOCHONDRIASIS. 119 false ribs, and indeed, jometimes of excrutiatipg pains of the in- testines, recurring like paroxysms, which resemble in situation and severity the intestinal, hepatic, or nephritic colic. Anxieties and fear of fainting affect many patients. The urine of a whitish colour, is made oftener than usual, and not seldom with stran- gury. The breast is confined by a certain spasmodic constric- tion. The heart is attacked with palpitation and tremor. The pulse is found small and low, intermitting and tremulous. The head is oppressed with pain and torpor, and distressed with ver- tigo. Sleep is either very troublesome or altogether deficient, and some who not sleeping till day light, refuse to go to bed, or scarcely lye down with their clothes off. The mind is often beclouded and disturbed, so that the sick being overcome with grief, shed tears, groan, and continually cry out, that they shall die of anxiety: or disposed for merriment, shake themselves with laughter. One while they become impatient of their pains, and fearless of death; again they are fearful, and perpetually complain of their clouded brain, and rashly torment themselves with fear of death, which they think is threatening. To these succeed torpors of different parts, convulsions, tremors, pal- pitations of the muscles, &c. The hearing is dulled by tinnitus aurium, or creaking, or-a noise like that of a rivulet. The pharynx and oesophagus are so spasmodically constricted, that deglutition is impeded, or becomes difficult. Some have wandering fever, and complain of cold and heat alternately; as also of various pains, which are spread to different muscular parts, and are called vernacularly, points de cote, if they affect the external breast. Haemorrhoids, sometimes dry, sometimes flowing, which often discharge a large quantity of blood, by which the sick are gradually emaciated, bring up the rear of this troop of signs or symptoms. To the above may be added that this disease sometimes returns, or lifts its head under the ap- pearance of alarming accessions. Afterwards, according to the various diseases with which it is associated, numerous symp- toms arise, which have inconsiderately been ascribed by writers to Hypochondriasis. From this source have proceeded their swelling descriptions, filled with vanities and inconsistencies, ac- cording to which the Hypochondriasis would seem more like a host of diseases than one.—Whence we may understand how difficult it is to extricate the proper signs and phoenomena of this disease from the notions concerning it. The Hypochondriasis, not unlike Hysteria, (since there is a close affinity between both diseases) when confined within certain limits, is rather a tedious than dangerous pain, and occasions false dread in the patients. It is with difficulty cured, even 120 HYPOCHONDRIASIS. When recent, but where it has become deeply rooted it cannot be removed by art, so that both the sick and their physicians be- come unable to bear with patience its long continuance. Yet it is not without danger when its course is very often disturbed, or it runs into scurvy, cachexy, dropsy, asthma, slow fever and marasmus. It appears from various observations that the haemorrhoidal fever taking place, has been useful to some, nor has a vomiting of blood been considered by physicians of the first rank as of less advantage, although, otherwise dangerous. Moreover it is cer- tain that Hypochondriacs have been free from epidemic diseases, even the plague itself. But this good fortune has little benefit- ed them, since from their bitterness of mind and perpetual fear of death, they drag a miserable life, in which they are distressed so long as they are in their senses. In dissecting those who die of this disease, the vessels passing into the vena porta? are found choaked and turgid. I remember to have seen it dilated and enlarged to that degree, that it attain- ed the size and appearance of a genuine intestine. Besides, there are observed obstructions, schirri, purulences, putridity and sphacelus in the liver, spleen, pancreas, omentum, mesen- tery and kidnies. Sometimes there occur calculi in the gall bladder. The spleen is found sometimes turgid and of very great size, and deformed by the surrounding adhesions, some- times so contracted, that it would scarcely weigh an ounce, and indeed, it is said to be wanting in some. Concerning this vis- cus it is well to remark, that there is no room to doubt of it be- ing diseased in Hypochondriacs generally; but it is believed, among the searchers of nature, that it is not seldom found unhurt and faultless, although the other organs appear contaminated in various ways, which plainly argues that this viscus has unde- servedly been considered the fomes of the disease. To return to the place from whence we digressed: The pylorus appears schirrous and cartilaginous; the stomach for the most part in- flated, and containing a blackish and foetid saburra. The colon in some beyond measure dilated, the other intestines rarely suffer a like extension. Lastly, there occur every where in the abdo- men anomalous tumors, seated especially in the mesentery. When the breast is opened, it exhibits the lungs corrugated, choaked, and scarcely to be separated from the neighbouring parts without laceration. The heart contracted, dry, and grown to the pericardium, its ventricles black and turgid with concrete blood, or filled with a serous and foetid matter, to say nothing of supposed polypi. Abscesses are discovered in the auricles, an- eurisms are evident in the aorta and its branches. On opening the HYPOCHONDRIASIS. 121 head, the vessels passing through the brain appear filled with black and thick blood, various purulent and putrid defcdations, stagnations of a serous, sanious and mucous nature, &c. More- over, a serous colluvies poured into various recesses of the body; hydatids collected in heaps, and other injuries belonging to the diseases which hypochondriasis brings with it, are purposely omitted. The principal point of cure turns here, that the thickness of the blood with difficulty performing its circuit, may be diluted; that flexibility may be restored to the rigid vessels, and too vi- bratile nerves, lasdy, that the distracted mind may be composed to cheerfulness. Venesection, unless urgendy indicated, ought to be considered useless or hurtful, besides that many Hypochon- driacs dread the loss of blood. Vomits and cathartics often do good, but they ought to be exhibited cautiously and opportune- ly, especially rhubarb and polypody, which usually bind the bowels already too dry, which indeed is known to every prac- titioner ; besides, they sometimes irritate the stomach, and occasion gripings and flatus, on which account many patients can not make use of them, lest they make bad worse. Ne- vertheless, some of the laxatives are not forbidded, such as damascene plumbs, Epsom or Sedlitz salts dissolved in a large quantity of water, solution of cassia, and others of the like kind. Nor are lubricating and emollient clysters to be omitted, as well in the paroxysm as in the intercalary days, by means of which the bowels are gendy loosened. Diluents and temperants are mostly recommended, and not undeservedly, of which the most commonly used are whey, and succory, capillary herbs, fumito- ry, water cresses, river crabs, Sec. Moreover, milk diluted with Sedlitz waters answers every purpose, or is given as aliment al- together. Preparations of iron are useful, when given in small repeated doses, and followed by plentiful draughts, and walking up and down. The milder aperients are not without merit, which are fitted without trouble to open the obstructed vessels : where- fore we must lay aside the berries of the winter cherry, mille- pedes, antimonials and mercurials. Bitters are serviceable to some. But the cortex Peruvianus and aloes, although fre- quently given, agree with few. Magnesia and other absorbents afford help, especially if mixed with cathartics, stomachics do good, namely the root of elecampane, cascarilla, catechu, ex- tract of juniper, orange flower-water, &c Antispasmodics im- part relief, to wit, the roots of valerian and piony, the leaves of balm and mint, the flowers of the lime tree and madder, pulvis egutteta, and others of that sort, which act by a kind of seda- 122 HYPOCHONDRIASIS. tive virtue, weak to be sure, but innocent. The thing is other- wise as it respects the use of narcotics, so mightily craved by some patients, which are not seldom observed to be hurtful to the head. Camphor may supply the virtues of' these without danger, and which I know by experience to have had excellent effects with many. Lastly, among the choice remedies ought to be ranked the mineral waters. Concerning the observations on the virtues of hellebore we add nothing, since we shall treat more than sufficiently of them in the Materia Medica. There is another mode of cure while the paroxysm is violent: viz. we must use our endeavour first to allay the wild motions of the animal spirits. With this view various externals are usual- ly prescribed, for instance, the sharpest vinegar, rue, castor, asafcetida, compound water of balm, spirit of sal ammoniac, oil of amber, sal Anglicanum, and other volatiles, which applied to the nostrils have been of much service. In like manner may be used the smoke of paper, feathers, old leather, &c. Sometimes the immersion of the legs in warm water removes the fit, and friction of them has the same effect: which not succeeding, we must use the more efficacious, namely internal medicines. The more approved are camphor, orange flower water, tincture of castor, gutta? Anglicanae, volatile spirit of sal ammoniac, or Eau de Luce, which although milder comes nearer to it; volatile. salts, and many others usually given in hysteric affection, which is nearly allied to Hypochondriasis. These are the remedies, among numberless others with which books abound, that are called into use by the more celebrated practitioners. But we ought not here to conceal that these rare- ly do good, and mostly turn to disadvantage, nor is it a secret to some who are wiser than the vulgar, that this disease, not improperly called the scourge of physicians, in many will noj; suffer itself to be subdued, and indeed it is oftener exasperated by this senseless farrago of remedies. For writers of unblemj ished credit do say, and it is clear to us from thirty years ex- perience, that innumerable Hypochondriacs, have just so long contended with death, as they have religiously obeyed the advice of their physicians, and indulged in every kind of medicament; and that they have been better, yea and have been restored to health, when, wearied out with their tedious cures, they have bid farewell to them all, or have declined even to sip the most simple. For which reason, there is perhaps nothing more efficacious, (the tedious remedy being more troublesome than the disease) than suitable regimen, aqueous drinks very freely taken, pleas- ant exercises, as well of the. mind as the body. Especially using every endeavour to remove from the sick all sadness, by inspir- DROPSY. 123 mg them with a hope of getting better. Let solicitudes, which are worse than a serpent, be driven away; in a word, let them commit the whole cure to nature, or, according to Montanus' advice, let them avoid physicians and medicines: But I know not from what misfortune, or whether it is a symptom of the dis- ease, they repose every hope under the shadow of medicine, so that they not only believe in every physician they come across, but confide even in barbers and strollers, which, to speak within bounds, I have remarked a thousand times. DROPSY. A serous colluvies diffused through the whole habit of body shews itself openly. The ascites is also manifest—There is a watery encysted tumor perceptible to the touch, affecting the peri- tonium, ovariei, &c. and growing to a certain size: But Dropsy of the breast and pericardium, is with difficulty known, and a col- lection of water in the brain and medulla spinalis is veiled inob- scurity. It is our duty in this place to treat of general Dropsy, or leucophlegmasia, for we shall discourse of the other species according to order elsewhere. Persons who lead a sedentary life, and inhabit marshy places, are thought to be liable to serous colluvies or Dropsy: Intemperate eaters and drinkers are thought to be prone to it. It is common to the female sex, nor does it spare infants, as we shall shew in the proper place. The ardent and malignant fevers, the small-pox, measles, and other acute diseases are followed by this; it accompanies also obstruction cachexy, jaundice, scurvy, gout, quartan fever and other chron- ic diseases. Moreover, the Dropsy follows close at the heels of large haemorrhages, both spontaneous and artificial, and men- struation continued beyond the accustomed limits of the natural period. Long continued diarrhaea, or other immoderate evacu- ations produce the same effect, and even the sudden stopping of these when habitual, threatens the same misfortune. Lastly, the Dropsy takes its rise from the premature cure of intermittent fevers; from repelled efflorescences or cutaneous eruptions; from the drying up of ulcers and fistula?, from ischuria and dy- sury, to say nothing of tumors, schirrus, abscesses, internal ulcerations and putridity, which very commonly give origin to this disease. Anasarca or leucophlegmatia, arising from a depraved state of the humors, follows cachexy, as is common in every species 124 DROPSY. of serous colluvies. At the commencement of the disease,- and towards evening the JEdema surrounds the ancles, which disap- pears in the morning. Respiration is not freely performed, es- pecially when going up an ascent. Some complain about this time of thirst and slight cough. As the disorder advances, an aedematous swelling occupies the feet entirely, and is gradually diffused to the legs, then to the thighs and other parts, as if pro- pagated by grafting, (traduce) Mdema of the legs is not to be considered as a certain sign of Dropsy, for persons broke down by very long journeys on horseback are subject to it, as also those who stand longer than proper on their feet. The swelling is familiar to those advanced in years: it often happens to chlo- rotic and pregnant women, and in these cases portends nothing bad. Nor yet does anasarca always take its rise from aedema of the lower extremities, for if it owes its source to ascites or any! disease of the viscera, it sometimes invades the external abdo- men, loins, surface of the breast, face and arms, before it ap- pears in the legs and feet. In both cases the scrotum swells to an immense size, the penis is affected in like manner, the pre* puce of which often swells to such a degree that micturition is impeded. During the disease the urine flows in less quantity, deposits a lateritious sediment, especially when the liver is af- fected, or any stagnation lurks in the abdomen. The sweat at this time is either deficient, or breaks out more sparingly. Lucophlegmasia having its origin from too great a flow of blood, or other temporary cause, is easily overcome; but it is thought more obstinate when it takes its rise from the suppression of some usual evacuation, or from the recess of cutaneous crop-* tions. It becomes easy of cure if it follow asthma, acute or in- termittent fever. But the case is dangerous if it arise from a chronic affection and diseased viscera, although it appears to yield to the usual remedies, nevertheless it sooner or later re- turns. There is no little hope of cure in youth or vigorous age, but it happens otherwise in old age. Moreover, the Dropsy por- tends death, if the tongue be dry, the cough frequent, and the respiration so impeded as to endanger suffocation; if the pulse be weak and the strength deficient: if, lastly, the urine and sweat recede more than usual from the natural quantity. Nothing is to be feared from diarrhaea in the early part of the disease, but the case is different, after it has continued a length of time, especi- ally if it have no intermissions, since it cannot prevent the effu- sion of serum about the injured viscera of the abdomen or breast, Lastly, as we have already hinted, an oedematous swelling of the legs is thought free from danger, when happening by chance. It is not dangerous in convalescents, since when the strength re* DROPSY. 125 covers, it vanishes spontaneously ; nor does a swelled face por- tend any thing bad in acute diseases, though it has often occasi- oned needless fear to the inexperienced. Beside the various internal marks of destruction, which eve- ry where occur in examining the bodies of those who die of this disease, the viscera are discovered to be deprived of their na- tive colour, obstructed, schirrous, dry, containing pus, putrid, &c. Cystic and vesicular tumors are detected, of different forms and sizes, grown to various parts. In the abdomen, there ate found schirrous tubercles, adhering to the hepatic and splenic vessels, the veins turgid with black, and as it were burnt blood, in which at times are concealed sandy concretions. The liver is observed sometimes contracted, sometimes of very great size, discolored, whitish, or without blood, black, lead coloured, as if roasted, marked with various spots of an unequal surface, gra- nulous, rough with tubercles and hydatids, schirrous, dry, of a stony hardness, putrid, containing abscesses, and heaps of hy- datids, &c. The gall bladder in many is turgid with blackish green bile, or is filled in some with a limpid, milky, tasteless matter, whh" bilious concretions, &c. The spleen meets the view, sometimes very much diminished, sometimes of prodigii- ous size, and so putrid as to fluctuate when handled, like a thin pap; schirrous and filled with tubercles somewhat stony. The omentum appears at one time very thick and schirrous, at another emaciated and putrid. The intestines are seen inflamed, schir- rous, ulcerated and mortified, and received one into another, The mesentery, kidnies, uterus and ovaria undergo the same evils. Lastly, the abdomen exhibits other remarkable appear- ances, namely, anomalous tumors, purulent or putrid, growing to the vertebrae, which are eaten by caries; hydatids of various size, excrescences rising from the liver, pancreas, or some other viscus. On opening the Breast, the lungs are found aedematous or uninflated, choaked up, or containing tubercles or abscesses, agglutinated to the pleura, or befouled by tabes, or putridity, &c. The heart is seen sometimes small, sometimes of stupendous size; in many it is found empty, in others full of blood, and contains concretions named polypous. The arterial valvulae of both ventricles in some acquire a hardness, resembling carti- lages, bones or stones. An abscess is rarely noticed on the sur- face of the heart and auricles, but the pericardium is observed containing a great quantity of water and fetid serum, or evident-, ly dry, and even agglutinated to the heart and auricles. Some authors say that they have seen, as well in leucophlegmasia, as in dropsy of the breast and abdomen, the thoracic duct torn off: 126 DROPSY. which I do not remenber to have noticed. Concerning the head, which exhibits nothing but a morbid product, practical Anato- mists have cared but little : Yet, in this, if attentively examined, there are often found feculencies and putrid appearances, as well in the brain itself as in its involucra. The vessels of the plexus choroides swelled, varicose, and intermixed with hyda- tids ; or there are detected serous, sanious and foetid stagna- tions in all the recesses of the brain ; the meninges grown to- gether, &c. We may safely begin the cure with venesection, if the piles or other accustomed flow of blood be suppressed; nor is it thought ineffectual at the commencement of the disease, in vig- orous or youthful age, otherwise I should think it could not be practised without danger. To be sure it causes a respite to the urgent difficulty of breathing, but in the judgment of physici- ans of the first rank, it is afterwards exasperated and becomes more stubborn. Yet we must not conceal, that diere are not want- ing some examples of cure performed by repeated venesections or spontaneous haemorrhages, but that by this unsuitable reme- dy death has been hastened in many, is also more"than suffici- ently known. Emetics, in the infancy of the disease are used with success, they may also afford some relief after it has attain- ed some age, while the strength will admit, otherwise, they may do die greatest harm. For it is proved by various histories, that some hydropic patients have expired while vomiting. Ne- vertheless, it is plain from accurate observation, that many have been restored to health by repeated emetics, or spontaneous vomitings. Among these difficulties, the judgment of the cure is to be directed, by rightly looking into, and scrutinizing every circumstance. Cathartics, and especially hydragogues are in much estimation inforo medico exhibited through the course of the disease; by which the latent humors may be carried from the parietes of the intestines ; nor can we doubt that many by the help of these medicines have been snatched from the jaws of death: yet they rarely do good, if the disease has been deeply rooted, and there be stagnations in the breast or abdomen. Un- der these doubts, we hesitate not from repeated experience, to assert concerning this matter, that these remedies would be dan- gerous, if no relief were experienced in their use, in such case it has appeared more adviseable to cease from them, lest by their ill-timed stimulus the intestines should be seized with inflamma- tion or gangrene, which from hundreds of histories appears to have frequently happened. Among those more generally used, are rhubarb, jalap, orris-root, and elder-bark, gamboge, elate- DROPSY. 127 rium, diacrydium, sal polycrest, calomel, syrup of cathartic buckthorn, aqua vita? Germanica, &c. Hepatics or aperients have their share of merit, which are useful to restore the dyscrasy of the blood, to open the obstruct- ed vessels, and cleanse the kidnies. But if the disease attain a certain grade, these medicines are for the most part found in- ert, of which the more approved are- hartstongue, and the ca- pillary herbs, cichoraceous plants, fumitory, agrimony and pim- pinella ; the roots of parsley and wild asparagus, fennel, maU- der, eryngo, butcher's broom, rest-harrow, &c. But diuretics, without any controversy, take the palm from the rest: Among these are rape seed, briony and squills, the fruit of alkikengi, nitre, lixivial salts, or the ley itself from the ashes of genis- ta, wormwood and juniper, arcanum duplicatum, terra foli- ata tartari, wine or oxymel of squills, woodlice, turpentine, &c. The powder of toads has had excellent effect with some, when exhibited in the dose of a scruple and more, in white wine. Nor ought the powder of cantharides be dreaded, if the case be very urgent, from the fourth part of a grain, to one or two grains; by which if nothing hinder, the urine is voided copiously. For it is proved that this remedy sold by some stroller, has recalled many from the grave. Wherefore I think, that none, who in imminent danger, has tried all the others in vain, ought to refuse to try this. Many in whom we can place confidence, relate, that they have observed happy success from the use of sudorifics. Lastly, it is said that spontaneous ptyalism has been beneficial to some ; but whether this evacuation promoted by art might be equally serviceable, is doubtful. From what has been said we may gather, that these differ- ent modes of cure are to be admitted, cum grano salis. In truth, having been taught by various experiments on the subject, we candidly declare, that we have seen no hydropic patients cured by means of internal sudorifics, a few by the help of cathartics, but a good many by the timely use of diuretics : whose virtues perhaps are equalled and even exceeded by roborants, namely bitters, stomachics, and preparations of iron, of which the best are the leaves of wormwood and lesser centaury, the roots of elecampane and angelica, cassia lignea, juniper berries, catechu, alkohol martiale and other chalybeates, elixir proprietatis, &c. By some the garlic is much recommended, nor perhaps unde- servedly, since it emulates the virtues of tonics. Besides which, the mineral waters both hot and cold, are not to be omitted, which nevertheless, although they complete the cure of many other chronic affections, often are useless in this disease when of long standing. Although anodynes do not reach the cause of 128 DROPSY. this disease, yet they are sometimes called into use, to encreast the force of other remedies, or to promote sweat, if nature seems to tend that way. We add nothing of anti-scorbutics, as they refer to Dropsy of a scorbutic nature. When all the remedies of which we have treated, have been tried in vain, abstinence from drink of any kind has been of great use to many; and this regimen has been' protracted to many months, or to a year, in which time, if the thirst is urgent, ifc-is usually allayed with toasted bread moistened with aqua vita?, and applied to the tongue, or by any other means, so as no liquid is swallowed. Various histories testify, that this mode of living has not only been serviceable in anasarca, but also in ascites and other species of Dropsy. We remarked above, that sweats excited by internal medicines, have done little good, but it is otherwise, when they are promoted by external means, to wit, by the warm air of stove rooms; a bath of warm mineral water; applications of salt, sand, bran, &c. heated by the rays of the sun or by furnace ; frictions with very soft cloths impreg- nated with the fumes of benzoin, frankincense, mastich, amber, &c. Lastly, severe bodily exercise, by which the stagnant hu- mors may be excited, and carried out through the pores of the skin. But it appears consistent with reason and experience, that all these become altogether useless, if the viscera are diseased. We can not pass over in silence that the skin of the legs swell- ed beyond measure, is often ruptured, and through these fis- sures there takes place a kind of stillicidium of the water stag- nating within the contexture of the parts, by which not only some patients are relieved, but even restored to their former health. The same effect may follow a wound from burning, or inflicted by any other mode, which I remember once to have seen in a poor woman, who after all things had been used in vain, was hastening to her unavoidable fate, when having had her legs burnt, by the carelessness of the person warming her bed, there followed wounds, through which the serum, diffus- ed through the whole surface of the body found itself an outlet i by which discharge she in a short time was recalled to.life, be- yond the expectation of all. Instructed by such observations as these, physicians have attempted to bring about a similar flow, as well by the most simple scarifications, as by vesicatories, and the cautery itself. But I know not by what misfortune, it has happened otherwise ; for the wounded part has frequently been seized with gangrene, and hence this mode of cure has been discontinued by almost all; which nevertheless we think ought not to be altogether rejected, where the disease resisting the other remedies, refuses to yield, and the sick, are reduced to ex- STAGNATION of BLOOD and PUS. 129 tremity of"danger ; since in difficulties~Kke;these, it.is better (says Celsus) to try a doubtful remedy than none. Besides, these wounds are less to be dreaded, if they be inflicted on skin which is of a more relaxed and flexible nature, namely of the thighs and scrotum, and the threatening danger of gangrene be averted by the well known remedies. By way of finish we may add to the foregoing, that all the remedies of every sort, hereto- fore treated of, and successfully used in the cure of dropsy, are also effectual in guarding against its return. For no practiti- oner is ignorant that many convalescents, after the disorder was removed to appearance, have mostly suffered a relapse, sooner or later. Hence the more judicious physicians, and those who consult the health of their patients, used to direct all their atten- tion to prevent this misfortune, by the cautious administration of the medicines above treated of. The same cathartics, aperients, diuretics, &c. are prescribed with this view. But instructed by multiplied experience, I know of nothing more effectual in this state of things, than tonics or roborants, which by strengthen- ing the contexture of the solids, tend more safely to prevent a new stagnation of water. These remarks on serous colluvies may suffice, concerning which the illustrious Monro, has with unexhausted labour collected and abridged the best monuments of the ancients and moderns. STAGNATION OF BLOOD AND PUS. BOTH these diseases mostly incurable, rarely manifest them- selves, unless from dissection of the bodies : indeed to give any history of them would be vain and useless, if they did not some- times become known, and relieved by timely remedies. No one is ignorant that blood extravasated in the recesses of the brain, becomes instantly fatal, and that those who are taken off by san- guineous apoplexy, die from no other cause; as is abundandy manifest from investigating the history of anatomical practice: Also, that blood rushing in a stream into the cavity of the breast or Pericardium is dangerous, as well from a disruption of con- spicuous vessels, as from the dilaceration of an aneurism ; but there is some hope from a stagnation of blood in the abdomen, if there be an evident tumor, or a fluctuation when handled. The species of stagnation above mentioned, are considered less fatal, if they proceed from transudation of the vessels, or ero- sion of the very fine capillaries, as under these circumstances, the disease being more gradual, is longer protracted, and hence s 130 STAGNATION of BLOOD and PLS. remedies may be applied with advantage, so long as there be any suspicion of concealed matter, and the seat of the disease do not deprive of all hope of cure. Moreover, stagnant blood is found in the bony sinuses of the head, in the internal ear, in the stom- ach, and intestinal tube, in the bladder and uterus, in cystic tu- mors, and especially in hydrocele. It is sometimes poured be- tween the cellular texture. I remember to have detected it in great plenty, even to above three pints, between the lamina? of the abdominal muscles, in the body of one who died of another disease, who, while living, scarcely complained of the obscure pain in the part affected. Lastly, there is no part of the living body, in which, after wounds, contusions, strokes, or falls from a height, the blood may not be sooner or later effused. Stagnations of a purulent or sanious nature, filthy and foetid, on account of their detention, are well known to even the least experienced. They originate from an abscess bursting in the cavity of the head, breast, or abdomen, or in the peculiar wind- ings of the viscera or other parts, while previous marks of in- flammation or suppuration lead to a suspicion of them. But some other stagnations of foul matter, are very obscure, which are owing to another cause, to wit, a peculiar exudation of the viscera, without pain, with no previous inflammation conspicu- ous, nor any pre-existing abscess, or without any kind of exul- ceration, which I have frequently met with, while engaged in dis- sections, in the surface of the brain, heart, lungs, intestines, &c. This collection of Pus when confined within certain limits, is rarely distinguished from other species of stagnation; and for the most part is brought to light, only by dissection. It is acknowledged by all practitioners, that serum lodging in any part of the body, is frequently re-absorbed by the little pores of the vessels. But we can not predict so happy a termi- nation in a stagnation of Blood or Pus; so that no other way of cure occurs, beside the evacuation of the confined fluid, which if not effected by the powers of nature, can only be obtained by art. Yet this is often discharged by the spontaneous efforts of the animal economy, into pervious parts, as the ears, frontal sinuses, lungs, stomach and intestines, bladder and uterus, &c. But when these fluids lodge in the bony covering of the head, in the cavity of the abdomen, and other impervious parts, we must have recourse, if nothing forbid, to surgical aid altogether. Of the various species of stagnations, and of the method of cure, to be treated of in its proper place, it has seemed most advisable to add nothing to the general observations, lest I should serve up the same dish twice. L OBSTRUCTION AND SCHIRRUS. OBSTRUCTION of the viscera, although very common, is mostly obscure, unless it be brought to light by advancing to a certain degree. Nor is the character of the disease more dis- tinct, without the aid of dissections, from the history of which, as well as from my own Observations, I have thought that it would not be amiss to present somewhat to the reader. For, from these well examined, we have learned, that Obstructions occurring every where, both in the breast and abdomen, have different natures; some appearing merely sanguineous, and others lymphatic, The first, indeed, is rightly thought (setting aside all conjecture) to proceed from a stoppage of the blood- vessels, but the others are commonly thought to owe their rise to the lymphatic tubes of both kinds being obstructed. Sangui- neous Obstructions, to which the young and plethoric are liable, originating frequently from the suppression of some flow of blood, for the most part affect the lungs and liver, come on sud- denly, and are attended with pain and heat, sometimes they commence with evident Apyrexia, sometimes they are attend- ed with fever, and sometimes they run into genuine inflamma- tion, the first grade of which, perhaps they exhibit. Lympha- tic Obstructions arising from lymph or other fluid, are common to the melancholic, phlegmatic, cachectic, and scrophulous and scorbutic, they often attack persons confined with the quartan fever, or other chronic disease : and indeed they sometimes are occasioned by sanguineous Obstruction, or inflammation itself. Infarctus, commonly known by the tide of Obstructions, when without pain at first, or attended with obscure pain, proceed slowly, and for the most part cause little uneasiness. But it they continue very long, and attain a certain increase, they pass into schirrus, the forerunners of which they are justly considered. It is well known, that the viscera and glands are most prone to this species of Infarctus. These are the general distinctions of Obstructions, which shew themselves with sufficient clearness, not only from examination of dead bodies, but, also from the various effects which they usually produce. But some occur of an intricate nature, and partaking of both, which by reason of the temperament of the patient, and preposterous treatment, now put on the appearance of Phlogosis, to which they are al- lied, again run into mere schirrus, as I have collected from my own observations, both anatomical and clinical. 132 OBSTRUCTION AND SCHIRRUS. The blood in the vessels being redundant, or more heated than usual; excessive bodily labour; eating food too warm; feasting too long; the too free use of wine, &c. are so many causes of sanguineous Obstructions. Lymphatic ones proceed from another source, to wit, from a dvscrasy of the humors, either congenital, or transmitted through the parents ; from an idle life ; from great cares: deep thoughtfulness; and from an irregular manner of living. Lastly, they may be occasioned by the checking of accustomed evacuations, as well natural as mor- bid, by the receding of cutaneous eruptions, &c. Concerning internal Obstructions, to be treated of presently, I have purposely omitted whatsoever belongs to inflammations or schirrous affections of the mouth, salivary glands, neck, breast, groins, axilla?, and other external parts, I shall discourse of each of them elsewhere in order. The diagnosis of sanguineous Obstructions is obscure, thfe signs of which are little different from the marks of inflamma- tion, especially, if a mild inflammation be followed by no severe symptoms ; but the invasion of these affections is different, for the sanguineous infarction or Obstruction may be resolved with- in two days, or sooner ; which never happens in genuine phlo- gosis. Besides this may terminate by resolution or suppuration before the seventh day ; the other although shorter, yet is not seldom more obstinate. Recent Obstructions are very frequent- ly immersed in the greatest obscurity, nor are those of older date sometimes more distinct; for although obstructed viscera in many become larger and harder, yet they do not always be- come evident when examined with the fingers, especially in the corpulent and fat: this mischief is also concealed, or presents obscurely, if the affected viscus be deep, and depart but little from the natural size. Finally, whatsoever has been said by the generality of physicians in the investigation of this subject, is often fallacious. Yet the liver and spleen are easily perceived by the touch, in lean persons ; but the pancreas, mesentery, &c. are with difficulty detected. Moreover, obstructed or schir- rous viscera, do not always become prominent from enlarge- ment, but rather are sometimes contracted and wasted: which very often takes place in the liver itself, as every anatomist knows. Hence we learn that examination by the touch alone is often of little use, and that therefore it is necessary to have re- course to other signs, taken from various injuries, to be men- tioned hereafter. Nor is there greater certainty of the genuine seat 'of the disease, although it present to the touch, on account of varions parts more or less immerged, which meet the press- ing finger. Besides, it is doubtful, whether the resisting body OBSTRUCTION AND SCHIRRUS. 133 be the affected organ, or a certain tumor growing on it, or form- ed before it, in the cellular substance, all which we have often- times to discover by mere conjecture. From the foregoing may be gathered, that the marks are very often ambiguous, as taken from examination by the fingers, we must then sedulously look for other signs which Obstruction and Schirrus afford, that we may establish something certain from their concurrence. Wherefore, besides the troublesome and dull sensation which is exacerbated by the touch, and seems in ma- ny to be excited by a heavy or pressing substance, the belly is prominent, the face pale and tumid, the feet are swelled so as to obliterate the ancles, the breathing is sometime hindered, and cough excited, not only from Obstructions of the lungs, but also from affections of the liver and spleen, To which we may add anxieties, palpitations of the heart, loathing of food, dryness of the mouth, bad digestion, flatulence, belchings, and inflation of the stomach; the belly for the most part loose, and lastly, whit- ish urine, Meanwhile, as the disease advances, the strength is prostrated, sleep is deficient, and fever takes place, which is en- creased after eating. These are the general marks, by which Obstruction both of the breast and abdomen shews itself; but other peculiarities occur, which discover the seat of the disor- der ; to wit, impeded deglutition excites suspicion of a Schirrus tumor affecting the pharynx or aesophagus; urgent suffocation shews Obstruction of the lungs. The jaundice denotes impend- ing mischief of the liver. Signs of scurvy with heaving of the right hypochondrium point to the spleen. The mesentery is suspected by diarrhaea and atrophy, especially in infants; con- tinued vomiting mostly arises from injury of the stomach, pylo- rus, or pancreas: We are apt to suppose the intestinal tube to be diseased when there is violent ileum and dysentery, &c. Res- pecting the nature of the disease it is necessary to enquire, whe- ther there be any virus lurking in the blood, to wit, venereal, scorbutic, scrophulous, cancerous, &c. for of how great moment it is to evolve these common causes of chronic diseases as much as possible, must be obvious to all. Although sanguineous Obstructions may be easily remedied, and indeed often disappear spontaneously, yet they are not al- ways free from danger, if they are superficially or preposter- ously treated, for as above hinted, not only inflammations im- mediately follow from them, but also Obstructions and Schirri, which plainly proves these disorders to have affinity with them ; \ although in process of time they appear to differ much one from the other. It is well known that old Obstructions, and particu- larly Schirri, are generally incurable, or if removed, do often 134. OBSTRUCTION AND SCHIRRUS. recur unexpectedly; but recent Obstructions are easily van- quished, provided they are soon discovered to the physician, which I candidly confess has seldom happened. No wonder if the case should be otherwise, when they have already become deeply rooted, or have contracted such hardness, as to be im- pervious by even the best of remedies; for it does not escape the notice of those who have been engaged in numerous dissec- tions, that the viscera, both within and without, have been fre- quently found tuberculous, cartilaginous, sandy and indeed brit- tle, which to be sure, when thus affected, must evidently resist all remedies. Obstructions and Schirri after attaining a certain size, by pres- sure on the neighboring parts, cause inflammation, purulence, putridity and gangrene, which taking place, it follows that every thing must end in destruction. Nevertheless, it is proper to remark, that many whose viscera are Obstructed and Schirrous, being well in other respects, have by suitable diet, protracted their lives considerably. For there occur every where patients of both sexes, afflicted with Obstructions, who have enjoyed life for fifteen or twenty years, and more. Yet the prognosis ought not to be established, unless the seat of the disease be discovered : for it is known that Obstruction of the spleen caus- es slight fever; and that the liver when affected with this mis- chief, is much more dangerous ; that Obstruction of the mesen- tery is considered highly alarming, and often the effect of scro- phulous virus. Schirrous Obstructions in which the size of the part is encreased, are more easily eradicated, than in those which experience a different effect namely, the emaciated. There is some hope of cure while they are painful, but they are thought incurable, if without sensation. Nevertheless, Schirri that af- fect the uterus and other pervious viscera, have very exquisite sensation, and soon acquire the nature of cancer. Lastly, Schir- rous Obstructions, whatever part they affect, often bring on atrophy and dropsy. Concerning the inspection of the dead bo- dies, from which, what I have now said 'is taken, I will add nothing. The treatment of sanguineous Obstructions, usually begins with venesection, which may even be repeated, if nothing forbid, and the strength will bear it, but diluents, demulcents and tem- perants, afford the greatest benefit, nor are laxatives to be omit- ted. Yet many patients by spare diet, and plentiful draughts of water, with rest, have overcome the disease. But it is other- wise with respect to Obstructions and Schirri, which the powers of nature are inadequate to subdue, unless they are aided by jimely remedies, having regard to the part affected. Although OBSTRUCTION AND SCHIRRUS. 135 these kinds of Obstructions ought often to be considered as the product of a previous or existing disease, yet nothing ought to concern the physician so much as to remove it, and to direct the principal scope of cure to this end. Wherefore he must let blood, if the catamenia or haemorrhoids be suppressed. Sometimes even in other circumstances venesection is of use, at the com- mencement of the disease, but it is thought useless or hurtful when the Obstruction is of long standing, or become Schirrous. Cathartics afford not the least relief, and indeed usually exaspe- rate the disease, yet they may do good in an urgent case, if there be sordes lodging in the prima? via?, but in such case die milder ones ought to be employed. Diluents, temperants, hepatics and aperients are used with ad- vantage through the whole course of the disease, among which are preferred, whey, the roots of dock, elecampane, asparagus, parsley, butchers broom, eringo and celandine, the herb suc- cory, hartstongue, maidenhair and nasturtium, rhubarb and aloes, borax, sal ammoniac, vegetable alkali, vitriolated or chalybeat- ed tartar, sal de duobus, woodlice, &c. by the help of which it is reasonable to believe that the thick juices may be diluted and reduced, so that being rendered more fluid they may find their accustomed outlet, and thus the obstructed organs be opened; whether they exert their action on the vascular contexture of the viscera, is doubtful. These desultory observations may suffice, concerning their modus agendi, which, to confess the truth, is immersed in dark obscurity, notwithstanding what sciolists chatter, who indulge more than is proper in these scholastic sweepings. To return to the subject. Incidentia, which appear to pervade all parts, are not undeservedly extolled by the most experienced. The most approved are the gums, soaps, antihecticum Poterii, and lastly, panacea or aquila alba. These are what are in most use, and by entering the most intimate recesses of the body, are of great efficacy, so long as they are used with the greatest cau- tion, and with proper regard to the viscera diseased, for differ- ent kinds are suited to the lungs, liver, uterus, &c. The custom, moreover, has prevailed, not without reason, as to the use of Incidentia, that diluents, demulcents, and tem- perants be mixed with them, in order that they may preserve the sound viscera from injury. And indeed, in this way intermis- sions are procured, which prevent the blood already too hot, from becoming more heated, by its motion being accelerated be- yond measure. , But mineral waters, by penetrating every part, afford an excellent substitute for both, since they have the fir^t place among diluents, temperants, hepatics, aperients, audeven 136 OBSTRUCTION AND SCHIRRUS. incidents. Both the cold and hot mineral waters are recom* mended, and it is acknowledged by all, that by the help of these, the diseases of this nature, resisting other remedies of every kind, even the most exquisite, have often been eradicated. In the decline of the disorder, tonic and martial preparations are much esteemed; which nevertheless when inadequate to subdue the morbid Obstruction, do no good, or become hurtful; which those ought to bear deeply in mind, who blinded by the prejudices of the vulgar esteem iron as a polychreston. Lastly, sedatives, and especially narcotics are rejected by the experienced, which, by alleviating pain, and procuring sleep, wear the mask of health, but have death in their train. From this vast apparatus of remedies, it is not to be inferred that many are to be administered, but rather it is necessary to select them as occasion requires, and according to the patients constitutions. Nor must we adhere too long to the most power- ful, since their virtues are lost by constant use. New ones are then to be often thought of, and to supercede the customary onesj for many remedies, which formerly were of service, are found in time to be ineffectual, and even hurtful; wherefore it is ex- pedient to betake ourselves to others, which may be taken from those mentioned above. Whatsoever remedies be given, the senseless farrago of them are to be avoided, which are often op- posed one to the other: but we must have regard to a suitable mode of living, by an error in which, it is well known to prac- titioners that the most troublesome symptoms very often are oc- casioned. I may add, before I take pen from paper, that the manner of cure turns principally on accurately searching after a certain poison, frequently hidden, to wit, venereal, scorbutic, scrophulous, or of some other kind, for instance, by mixing with the remedies above mentioned, the specifics for these disor- ders : by the union of which the disease, unless it be evidently incuiable, is not only subdued, but even rooted out. Finally, baths and semicupia must not be omitted, nor emollient fomen- tations, by means of which some help is obtained: but topical resolvents, even the best, are considered by judicious practition- ers as altogether inert, and whatever has been advanced con- cerning their famous virtues has been thought by many to be mere notions, or old wives' stories, which nevertheless I think ought to be received cum grano salts. TUMORS. INTERNAL TUMORS, sometimes becoming prominent ex- ternally, are perceptible to the sight and touch; at other times, being hid within the intimate recesses of the body, they cannot be brought to view but by anatomical examination: they very of- ten have their seat in the abdomen, sometimes lie concealed with- in the breast; but are rarely contained within the bony case of the head, or the sheath of the spinal marrow. They are of dif- ferent natures, for they are schirrous, or sarcomatous; cystic, or anomalous, and lastly aneurismatic, to say nothing of inflamma- tion and abscess, of which hereafter. There are certain schirrous tumors of a fleshy nature differing as to color and hardness, in the viscera, membranes, vessels, &c. attached to, or growing upon the cellular substance, attended with no pain, unless on ac- count of the parts over which they lie, or which they compress. These tumors do not escape the fingers when examining them in the abdomen, unless they lie very deep; but they are often with difficulty distinguished from obstructed viscera. Yet there are not wanting some marks derived from my own observations as well clinical as anatomical, which may discover both affections, and are as follow. Obstruction of the viscera, not differing from a solitary tumor, and perceived by the touch, never attains this grade without previous long continued sickness, which is justly considered its cause: but tumors more rapidly commence and. encrease, and beyond all expectation, frequently become evi- dent, as it would seem without injury to the health. Moreover obstruction of the viscera for the most part is attended with pal- lid and swelled face, or attacks cachectic patients; but schirrous Tumors generally affect those of a florid complexion, and who seem to enjoy vigorous health; which I remember to have seen a few years ago, in a certain Helvetian of great stature and bulk, and not above twenty years of age, whose Tumor being attend- ed with most extreme pains, on account of the tearing of the mesentery to wbich it had grown, rose to such a size in a short time, that it was perceptible even to the sight, which on dissec- tion I found to be tainted widi a collection of matter, and pu- trid. Cystic Tumors are not clearly known, as they grow slowly and are annexed to various parts, and differ little from the most common external ones, sometimes free from pain, sometimes raging with mott o.t rutkning, and recurring at intervals like T 138 TUMORS. paroxysms, £y reason of the inflammation which they contain, and communicate to the neighbouring parts, which also in pro- cess of time usually put on the nature of cancer. We have above noticed that schirrous obstructions of the viscera are often borne for twenty years and more, but it is otherwise with solitary Tu- mors, both schirrous and anomalous, which encrease more rapid- ly, and thereby bring on inflammation, purulence, putridity, gangrene, stagnations, &c. Internal Tumors of both kinds generally proceed from a peculiar and hidden virus, but some- times they originate from a well known preceeding disorder. Last- ly, whatever the pedigree of either may be, they are considered as dangerous and incurable. It is obvious therefore, that all the aperients and incidents, even the choicest, become futile and superfluous, and as experience proves, afford not the least aid. Specifics against the virus it- self are not more efficacious, for they not only have little power on the part affected, but are thought even unequal to the subdu- ing of the disease. Hence the more skilful physicians adopt a merely palliative cure, as well by proper diet, as by the admin- istration of general remedies. Nor would there be more hope from the surgical art, by which alone this melancholy disease couldbe eradicated, unless they on whom this weighty burden de- volves, could forget themselves; for it is proper to remark as we go along, that new and unheard of, yea rash experiments have often happily succeeded in fatal diseases, when there has appeared no other way of cure. On which account Celsus re- marks, that temerity sometimes effects what prudence could not do. In these difficulties, cauteries on the neighbouring parts may afford some relief, by means of which somewhat of the morbific matter is carried off, which being taken away, the Tu- mor encreases more slowly, if it is not evidently exhausted by the salutary powers of the animal oeconomy: which however I do not remember to have ever seen or read of. Nevertheless, there is no harm to be feared from this remedy. Aneurisms, mostly conspicuous, are not more easily remov- ed, for, as all know, they admit only of palliative cure. This species of Tumor, as it were coated, I have over and over re- marked, arises from a dilatation of the arteries, for they are fill- ed with various coats of dry and compact blood, lying one upon the other, or lamellated like an onion, having a canal pervious at both ends, remaining in the middle or axis of the Tumor, con- taining after death black or grumous blood, through which ca- nal this fluid had free circulation. It is truly wonderful, that the covering of the arteries attacked with the disease, although ex-< pundcd beyond measure, gain greater firmness and thickness, TUMORS. 139 and even sometimes contract the hardness of cartilages, or bones themselves. Aneurisms sometimes attain to a stupendous size, for there occur some which fill almost half the breast, or reach from the superior part of the sternum to the maxilla. The most approved division of aneurisms is into true and spurious, as res- pects the external, of which in its place., Internal Aneurisms, concerning which I am now treating, commonly originate from some violent exertion in lifting a heavy weight, or in calling aloud, coughing, carrying, child-bearing, &c. Falls from a height, or other contusions may also occasion this dire effect. Some au- thors have injudiciously mentioned Aneurism of the heart, tak- ing the liberty to designate by this title, the very common dila- tation of the ventricles, which differs vastly from genuine Aneu- rism, because the crustaceous lamella? of concrete blood, lying one over the other, which give the character of this species of Tumor, are plainly deficient. Besides this dilatation of the heart is attended with symptoms evidently dissimilar, which also proceeds and terminates in another way. The coronary arteries of this viscus, are alone affected with this disease, and but very rarely, from which I do not hesitate to assert, after multiplied anatomical examination, the organ of circulation itself is altogether free. Aneurisms have their seat most commonly in the breast, from which they are sometimes propagated to the parts superior, and often manifest themselves by swellings conspicuous outwardly, as well in the neck, as in the anterior part of the breast, and even the posterior, insomuch that the neighbouring bones and carti- lages being broken and diminished, or affected with caries, make as it were an outlet to them. Hence in most patients there is a prominent Tumor of different size, and of thexolour of the skin, soft and yielding to the touch, attended also with a pulsation synchronous with the strokes of the heart, and of a circumscrib- ed surface. By these marks Aneurisms of the carotids, sub- clavian, intercostals, and superior aorta are known. But Aneu- risms of the inferior aorta and iliacs are mostly concealed, by which last even the vertebrae are rendered carious. Those who are afflicted with this disease in the breast, or in the neighbour- hood of the lungs, complain of an incessant difficulty of breath- ing, and dread.lying down for fear of suffocation, many swallow with difficulty, and lastly, some are seized with fainting by the least motion of the body. Internal Aneurism, though rarely double, excites most acute pains, which being sometimes exacerbated like paroxysms, re- duce the miserable patiepts to extreme danger, to the terror of the bystanders: many feel the pulsation of a Tumor within. In the HO PHL0G0SIS, OR INFLAMMATION. mean time the pulse is observed to be contracted, labouring, con-- \'ulsive, and intermitting, especially in the arm nearest the part affected. As the disease advances, there come on palpitations with frequent faintings. But if the veins which carry the re- flugent blood from the head, are compressed, there follow head- achs, vertigoes, convulsions, delirium, &c. The melancholic, often without any evident previous cause, are prone to this terri* ble disease, which every one knows to be fatal, inducing maras- mus, gangrene, cachexy, and dropsy, especially of the breastj unless the sick are carried off by premature death, namely, from rupture or dilaceration of Aneurism seated in the breast, by which the blood rushes in a full stream into the cavity of the breast or pericardium, as 1 have often observed in examining the bodies after death. Nevertheless this disease mostly lasts for years, but it cannot be subdued by art, and is considered by all as evidently incurable. No other method therefore can be taken beside the palliative; this consists in venesections occasionally repeated, and a most accurate diet, by attending well to which, the more oppressive symptoms are guarded against, and threat- ening death put off for a little while. PHLOGOSIS, OR INFLAMMATION. I HAVE thought it adviseable to premise some general ob- servations on internal Inflammations, which shall be treated of separately or under so many heads—these may not only apply to the inflammatory affections to be mentioned in their places, but also to some others affecting parts without the viscera. No one denies, that besides the more noble and principal organs of the body, the glands, membranes, and especially the cellular substance are liable to Inflammation: nor are the abdominal mus- cles free from it, as I have sometimes had an opportunity to ob- serve. Immoderate exercise, arduous labour, the retrocession of erysipelas, anamolous gout, the matter of rheumatism devi- ating and mixed again with the blood, the suppression of accustom- ed sanguineous discharges, eating warm food and delicacies, the too free use of wine, the use of ardent liquors, usually occasion this affection. Sometimes emetics, cathartics, drastic purges and poisons, bring on the same. It is excited by strangulated in- testinal hernia, by compression, contusion, &c. This kind of affection is common to the plethoric; often attacks the young and PIILOGOSIS, OR INFLAMMATION. 141 persons of a sanguineous temperament, nor does it spare the bilious. Internal Inflammation, unless very limited, is always at- tended with Fever, mostly with pain, either mild, acute, or pungent, sometimes lancinating and beating, according to the structure of the part, the increase, and spread of the disease; and lastly, it has a tendency to suppuration. Infiammatory pain sometimes ceases, but its truces are fallacious, and sooner or later it rages afresh. The sick complain of heat and pain about the seat of the disease, frequently suffer slight chills, especially if from impatience they change their situation in bed. Blood drawn in the first stage scarcely loses its native fluidity, but as the disorder advances, it seems to acquire thickness, and when congealed and settled, a yellowish and greenish crust is formed in the cup. Yet this morbid constitution of the blood ought not to be considered as a certain sign of Inflammation, since in some it is deficient through the whole course of evident Inflammation. Nor does the disease even there become more dangerous, as some have persuaded themselves. Besides, blood of the same kind, or covered with the aforesaid crust is often drawn with- out even the slightest suspicion of Inflammation, which ought to be remembered by those who heedlessly put confidence in the opinions of the vulgar. Inflammatory Fever, to return from my digression, often differs little from ardent fever, and even com- mences with shivering and chill. The pulse is found to be strong, hard, and often unequal. The head aches, there is great thirst, with dry and somewhat blackish tongue: to which may be ad- ded a heat in the neighbourhood of the part affected, anxiety of the praecordia, want of sleep, delirium, and other distressing- symptoms of fever, which become more severe, if membranes, to wit, the pleura, mediastinum, diaphragm, stomach, intestines, mesentery, &c. are affected with inflammation. Internal Inflammations, as already noticed, are often with difficulty discovered, if we except peripneumony, which shews itself by bloody expectoration, but sometimes Inflamma- tion of abdominal and other parts skulk^ clandestinely, and is only traced by mere conjecture. Yet Inflammation of some of the viscera is known by some signs presently to be enumerated, but other Inflammations of the abdomen shew themselves by doubtful marks. From throbbing of the abdomen, and pain at- tended with fever, we may well suppose present or threatening Inflammation, but it is often difficult to find out what part is af- fected. Inflammation of the stomach shews itself with sufficient clearness by most severe pain in the epigastrium, difficulty of swallowing, vomiting and hiccough, very great restlessness and 142 PHLOGOSIS, OR INFLAMMATION. anxiety, and coldness of the extremities. From acute pain about the navel, tumid and throbbing abdomen, vomiting and costive- ness, we may conjecture that the intestines are inflamed. Heavy pain about the loins, with other attendant signs, excite suspicion that the mesentery is affected: if more acute pain occupy the same part we are reminded of the kidnies. Inflamed liver is discovered by the touch; by the same method we may distin- guish an affection of the spleen. But it is otherwise if the pan- creas and other parts of the abdomen are inflamed, and indeed Inflammation of the viscera or cellular substance is often ob- scurely known from that of the abdominal muscles, under which last—the sick complain of excrutiating pain, especially in cough- ing and performing the offices to which these organs are sub- servient. I shall treat of the signs of peripneumony and pleu- risy elsewhere. Head-ach so violent as scarcely to be described, accompanies Inflammation of the meninges and brain; as also delirium, by which the sick are driven to madness, and other terrible symptoms. But they are shamefully mistaken, who, in- duced by mere hypothesis, refer even febrile delirium to In- flammation of the brain and its involucra; which dissections daily prove to be false. Internal inflammations are never without danger, unless they be confined to narrow limits, but they are to be considered more or less ominous according to the part affected or severity of the symptoms, and soon run their course, unless they pass into some chronic disease, to wit, genuine schirrus, from which proceed slow fever and marasmus. There is scarcely any hope of cure without resolution, if an impervious viscus be affected with inflammation: it is otherwise with the lungs, stomach, and intestinal canal, kidnies, and others which have an outlet through their respective ducts. Haemorrhages and sweats breaking out about the seventh day afford some relief, but in many they are mere symptoms which answer no good purpose. The urine de- positing a sediment about the fourth or seventh day sometimes denotes a salutary termination, otherwise nothing certain can be gathered from examining it. Diarrhaea is serviceable to some, but if a blackish saburra be evacuated by stool or vomiting, we may think bf death. In Inflammation refusing resolution, pus is mostly formed, and hence proceeds abscess or ulcer; or it brings on gangrene, which in a short time terminates the patients' life. Suppuration takes place between the fourth and seventh days. If the pus, whether in an abscess or ulcer, be able to make itself an outlet, in respect of the structure and situation of the part affected, there is some hope of health, otherwise death is threatening. A slight chill recurring frequently and irregular- PHLOGOSIS, OR INFLAMMATION. 143 ly, and pulsating pains, with the other signs, are the most com- mon marks of abscess. A lancinating pain denotes an ulcer or erosion. Burning and acute pain indicates gangrene. The sudden cessation of pain declares this fatal event, while the fe- ver and other grievous symptoms rage. If, lastly, the time of suppuration being past, and no previous indication of purulence, the patients complain of obscure, heavy and dragging pain, it is reasonable to infer that the infiammatory obstruction has become a schirrous. All these we learn from anatomical examina- tion. Inflammation of the pleura, liver, and uterus, is considered as the worst, but perhaps that of the stomach is more terrible, and really more frequent than is commonly supposed, this mostly in- duces gangrene about the third or fourth day, a fatal event pre- saged indeed, and confirmed by various miseries : or it assumes the nature of schirrus, from whence arises most obstinate and incurable vomiting, although medicines can be closely applied to the affected part. Pus is rarely formed there, to be carried out by vomiting, stool, or bursting of the abscess, an ulcer only be- ing left which is with difficulty subdued. From Inflammation of the mesentery, there arises not unfrequently an abscess, the matter of which is sometimes carried off by the intestinal tube, at other times is effused into the cavity of the abdomen, and fluctuating about the viscera, affects them with fatal disease. I have noticed above, that Inflammation of the lungs, kidnies, and other pervious viscera is less to be feared, by reason of the free egress of the pus ; but we prognosticate a happy event in other parts from resolution alone, which a few days put beyond doubt. Although every hope of health, as to parts which have no outlet, depends on resolution, yet in other cases even the most favourable, we must spare no pains in applying timely remedies. With this view a vein must be forthwith opened, and bloodletting often repeated, but concerning this most useful remedy it may be remarked, that it ought to be held within certain limits, lest by taking away more blood than is proper, gangrene be brought on, especially if membranous parts are affected, which I have often observed in practice. Wherefore I do not scruple to as- sert from multiplied experience, that venesection ought not to be 1 tpeated beyond three, four, or at most six times. Nor ought it to be indiscriminately used, as is the mischievous custom, at all times of the disease, since it is thought by the more experi- enced, to be useless or hurtful after the third or fourth day, un- less an urgency require it. Besides there is no doubt that it hinders the formation of pus: as for this purpose a certain effoit 144 PHEOGOSTS, OR INFXAMMATION. oFthe arteries is requisite, of which these vessels are evidently deprived, when depleted too much. Wherefore it is no wond&, if from the too great detraction of this fluid, this kind of deptf. ration is with difficulty effected, or altogether wanting, andlfc fwmguhieous obstruction should degenerate into a mere schirrus, which is proved by the history of dissections. To this we Tasty add, that blood is to be drawn with a more sparing hand in In- flammation, which is a symptom of the putrid and malignant fevers of adults, and indeed frequently in this case we ought not to bleed, notwithstanding the clamor of the ignorant, who will never suffer themselves to be removed from a practice which they have rashly adopted. An emetic at the commencement of the disease, after one or two venesections, has often been of surprising benefit, but it is to be avoided as worse than a serpent, if the belly be swelled and painful, lest-we rouse hornets. Nor are cathartics more safe, although it is proper cautiously to use laxatives, to wit, cassia, manna, tamarinds, oil of sweet almonds, &c. Meanwhile the belly ought to be kept free during the continuance of the disor- der, by means of enemata, which may supply the place of laxa- tives when forbidden. Diluents, demulcents, and temperants do much good, among which are, chicken water, whey* the •most common emulsions, the herb succory, flowers of mallow and althea, linseed, &c. Yet we must not continue too long With refrigerants, lest the heat necessary for resolution or sup- puration should be destroyed. The milder diaphoretics,, as borage, bugloss, scorzonera, scabious, carduus benedictus, &c. are much recommended—of this class seems to be goats blood prepared, which may not only be given with advantage in perip- neumony, but also in inflammation of other parts. Among in- ternal resolvents, the chervil seems to be the best, if we may believe some writers. Absorbents are commended by some, but whether from conjecture, we leave the experienced to de- termine. Narcotics are rejected by the wiser practitioners, be- cause they usually impart torpor to the vital organs effecting a solution of the disease, and cover it with a kind of veil. More- over they cannot be given without danger, where there is the slightest fear of gangrene, but paregorics, to wit, nitrous pre- parations, Sedative salt, camphor, mineral anodyne liquor, &c. are often advantageously used. As to external remedies, fomentations and emollient cata- plasms, may do some good, bladders half filled with warm jmilk, animals opened alive, their skins while retaining the natu- ral heat, &c. which, besides their virtue of. relaxing the more rigid partsy^tid-thereby'appeasing pain, seem-to possess as oc- PURULENCE, OR SUPPURATION 145 casion requires, the quality either of resolvents or maturants. Sometimes leeches applied to the vessels of the anus are ser- viceable, especially if they bring on an accustomed haemorrhoidal discharge. Vesicatories on the neighbourhood of the affected part, have obtained no little praise, by the help of which some part of the morbid matter is carried off. These topical applica- tions answer these purposes, especially inpleurisy and peripneu- mony, as is well known to every physician. Lastly, narcotics applied outwardly are no less forbidden, than exhibited inter- nally ; nor may we fly to these comforts except in most urgent cases. PURULENCE, OR SUPPURATION. THE formation of pus, usually follows inflammation; such is the affinity between these two diseases, that one scarcely takes place without being closely followed by the other. That inter- nal Purulence is most common, concerning which I am now treating, cannot escape the notice of those who think it no trou- ble to examine dead bodies ; and this is the source from which I have taken what I have to say on this subject, discarding all opinions concerning this effort of nature, with which books a- bound, and which, by permission of the illustrious men who have sweated in this contest, savour more of superfluity and empti- ness, than genuine learning. From my own observations, as well clinical as anatomical I find, that there occur four species of internal Suppuration, an abscess exhibits the first, which is pus contained in a kind of follicle of its own; an ulcer gives the second, the third is manifest from a certain whitish, and as it were gelatinous crust, which, as it would seem, covers the un- injured viscus, but the fourth is nothing else but a Purulent ob- struction of the viscera. To begin with the first and most remarkable species of Suppu- ration : I have already said that pus is formed from the fourth to the seventh day of the infiammatory disease, but it is proper to add, that this office of nature sometimes commences prematurely about the third and even second day of the inflammation; which must be carefully remembered, lest it be disturbed by ill-timed re- medies. No one is ignorant, that when putrid and malignant fevers, small-pox and measles prevail, collections of pus often in a very short time fall upon the lungs, liver, mesentery, &c. without any previous mark of inflammation. Besides this misfortune is U 146 PURULENCE OR SUPPURATION. very common from metastasis, namely, when from exhausted ex- ternal ulcers, the purulent matter being again mixed with the blood, falls upon some part or other, without any warning given, as has been over and over observed. Sometimes anomalous or cystic tumors run into Suppuration, and contain not only pus, but diverse other matters, such as stones, bones, cartilages, scales, &c. Every one understands that the size of internal ab- scesses varies, according to the structure of the part, or cause of the disease. I remember once to have seen a person, with liver of stupendous magnitude, which contained eight pounds of pus, of no bad appearance. The poor woman affected with this dis- ease was of low stature, and while living was oppressed with the greatest difficulty of breathing, on account of the diaphragm pushed against the third rib, counting from the clavicles, so that it excited wonder how the heart and lungs could be confined within this very narrow space, and preserve life. I have observ- ed another abscess, perhaps larger, in the same viscera, the matter of which being feculent and very foetid, made itself a pas- sage by the diaphragm and lungs, through the bronchia, and with such force did this deluge rush to the mouth, that the patient, al- though of athletic habit, died from suffocation. The second species of Suppuration is less frequent, if we ex- cept wounds, to which it also belongs—and the seat of the dis- order seems to differ from the first, for if pus is formed on the surface, or confines of the viscera, or even in their cavity, it erodes the covering proper to the viscera, or the membrane lin- ing the cavity; hence having overcome this hindrance, the pus unable to be collected, is poured out, whence arises an ulcer, which sometimes is widely diffused, or destroys some part of the viscus, and even, horrid to be seen, consumes the whole: which is known by those who have been engaged in many dis- sections, to have frequently happened in one or other of the lungs. The whole heart has often been found ulcerated, but the erosion creeping upon the surface alone, does not reach the inferior contexture of the viscus. Almost in a similar manner is the internal surface of the larynx injured, as also the bronchia?, kidnies, and bladder, stomach and intestinal canal, uterus, &c. which viscera, by reason of their excretory ducts, afford a pas- sage to the purulent matter. The third species of Suppuration is performed by transudation alone without abscess, or existing ulcer. The pus as it were mild and free from acrimony, is expressed from the viscus; sometimes when fluid, it gives rise to purulent stagnation, as in other species of Suppuration, sometimes viscid and gelatinous,' it adheres to the surface of the part injured, like a glutinous crust, PURULENCE OR SUPPURATION. 147 which being removed, the viscus is seen entire, yet with evident marks of inflammation. This species of inflammation and Sup- puration not only respects acute diseases, but is often observed after chronic ones, in the lungs, heart, intestines, &c. on which account some have doubted of the true nature of this matter. Nor, to say the truth, could we be certain of this effect of inflam- mation, unless the above-mentioned concrete substance had been often found intermixed with fluid pus, and very well marked, both in stagnations and in abscesses themselves, which, if I mis- take not, sufficiently evinces its nature. Lasdy, the fourth species of Suppuration is more frequently observed, since the whole texture of the viscera is impregnated or imbued with the matter, without any conspicuous erosion, and mosdy without any existing abscess, unless we give this name to numberless litde receptacles every where to be met with, which contain very little matter. This is the first gride of pu- tridity, to which the lungs, liver, spleen and pancreas are liable: and the omentum itself is very often consumed by it. Viscera that are compact, when affected with this disease often appear at first view sound; but when the knife is passed into them, the pus collected within their substance immediately bursts out, and flows on all sides. These are such as are discovered by dissec- tion of those who die of those affections, and are often very ob- scure during the patients' life. Besides the marks of inflammation already mentioned, a col- lection of pus is known by a pulsating, shooting and heavy pain, and by a kind of feverish shivering recurring irregularly. If the abscess occupy the breast, the difficulty of breathing is encreased, and the cough excited: if it be concealed in the head after a fall from a height or other contusion, most severe head-ach is excit- ed, with mental torpor, apoplectic fits, convulsions, &c. Ab- scess in the abdomen is more difficultly ascertained, unless we are aided by examination with the finger, otherwise it is often so hidden as never to be suspected. As the abscess advances, or comes to maturity as it is called, the symptoms commonly be- come milder, and the pulse more yielding, unless the pains are exasperated by the size of the tumor compressing the adjoining parts; or from the erosion of pus, which works itself cavities be- tween the parts endued with exquisite sensibility. Abscesses from metastasis of purulent matter, for the most part putrid and sanious, rarely partake of pain or excite fever, no wonder, there- fore, if they should be brought to view only by the examina- tion of dead bodies. It is otherwise with those formed near the last stage of fevers of a bad kind, which are followed by pain and throbbing if they invade the liver, mesentery, and 148 PURULENCE OR SUPPURATIONS other abdominal viscera, and they exdte cough and suffbcationf if they affect the lungs. No one is ignorant that ulcers most. Commonly proceed from the bursting of abscesses, but others*' as just hinted, are formed -withoutJany previous collection of pus. .-.:.. Ulcers having their seat in hollow viscera are easily known; by the evacuation of pus. - We trace others by mere conjecture^ although they are not without their marks, of which number areJ shooting pain with burning in the affected part, slow fevtoy? chronic sweats, tabes, &c As to other,, species of Purnlency,; concermng which authors have been entirely silent, they haved hitherto manifested themselves by no certain marks, nor can I say any thing positively on this subject, from my own observa^i tions taken from the sole inspection of bodies,; on which account J .they cannot be suspected unless irom a close attention to antece*j dent symptoms. palms of the hands, the cheeks become^red, the tongue dry ando covered with a whitish mucus. Meanwhile chills come on atir- I regular intervals; or the sick complain of simple and momentary J coolness of the extremities. The appetite fails, or hunger is exw'J cited, the sleep is deficientor disturbed, the strength languishes, ; the sick are gradually emaciated, the temples fall in, the belly :j is contracted as if empty, the urine is frequently observed to be, i fatty and thick, or putrid. Lastly, sweats, especially during sleep, breaking out profusely, colliquative stools, to be checked by; no ■ remedies, dry and squalid skin; acute nostrils, hollow eyes, . falling, off of the hair, &c, are considered the harbingers- of «■ death. It sometimes happens that abscess of the breast or of the abdomen is prominent externally, from which happy and unsuspected event it is obvious to any one that we may reasonably hope for a recovery. Besides pus,- in whatever part it may be collected, is not unfirer PURULENCE OR SUPPURATION^ ms. quently carried off by expectoration, vomiting, stool, and urine; nor is this happy event confined only to Suppuration of the lungs, stomach, intestinal canal, and kidnies, but even to abscesses of im- pervious viscera, the purulent matter of which, by eroding the neighbouring parts, makes itself a passage into the cavities of the above-mentioned emunctories^ orby the spontaneous motions of nature, being again mixed with the blood, or re-absorbed, reaches these strainers by the law of the circulation. Nor must we alto-" gether despair in abscess concealed within the bony cranium, the matter of which, by eating through the covering of the brain and bones themselves, finds an outlet through the nose and ears. Lastly, it is-expedient to note that the purulent matter, seeredy collected in any part, during the continuance of the fever, or brought hither by metastasis from an exsiccated ulcer, mostly tends to putridity, in a short time transmitted to the parts adjacent, in which case we may send for the mourners. Internal abscess arising from genuine, inflammation portends less danger, for besides the ways of evacuation hinted at, pus of the best kind, and collected in small quantity sometimes loses its fluidity, and becomes a hard substance, which in the end occa- sions slight inconvenience, and is lodged there without danger; this dissection teaches. /.Even the most skilful can with difficulty cure ulcers seated in the bronchia, stomach, intestines, kidnies, bladder and uterus: but those are thought altogether incurable which have no outlet. Bpth are attended with hectic fever, which is followed by sweats and diarrhaea, by which the body as it were melts away. Hence marasmus which is not rarely succeeded by dropsy. These ul- cers often seem to put 'on the nature of cancer, especially those ofithe hollow viscera, i But it has been customary tok designate by this name those only that affect the uterus. Ulcers of the limgs, kidnies, uterus, and other pervious viscera do not hinder the protraction of life for many years, on account of the free efflux of matter: but where there is no outlet, death is soon the consequence. That species of Suppuration which is formed by exudation, does not perhaps preclude all hope of cure, but I can adduce nothing certain on this subject, since this kind of sick- ness is never known till after death. For a similar reason the event ought to be considered doubtful from a lodgment of-pus within the contexture of the viscera, yet this disease ought to be considered far more dangerous, which, as above hinted, exhibits the first grade of putridity} and is always fatal. It is well to^ add, that this last species of Suppuration, brings the neighbour- ing parts into consent, unless die sick are talcen off by sudden?- death. All which-may^beseea^by aT^OTnical dieseciionsz asi)-;—Z 150 PURULENCE OR SUPPURATION. From what has been said, we may collect that there rarely appears any way of cure for internal Suppuration, not only be- cause remedies are inadequate to overcome this affection, but also because they are mostly hidden, and do not enter the mind of the physician. It is acknowledged by all both physicians and surgeons, that venesections prevent the formation of pus, it does not follow from this that they are suitable when pus is formed in a part that is not pervious, and therefore denying all hope of fu- ture egress; since they tend in this case, to bring on gangrene, or to favour the formation of schirrus, which disorders excite more fear of death, than pus collected in even an impervious part, which, as already remarked, can make its way by the in- testinal canal and other receptacles of the body, or may be re- absorbed, and by the help of the circulation reach the organs of excretion, which double outlet is altogether denied to the for- mer diseases. The milder laxatives, if sordes lodge in the prima? viae, may safely be used, but they have no effect on the principal disease. Diluents and demulcents are beneficially given, the best of which are whey or milk itself, rice, barley, sago, and others of this class, which by covering or blunting acrimony, are of use in seconding the efforts of nature. Vulne- raries, detergents, and balsamics are of no small benefit, among which are pervinca, speedwell, ground-ivy, self-heal, St John's wort, and lady's mantle, honey of Narbonne, balsam of Peru, or Canada balsam, China terpentine, tar water, Lucatellus' bal- sam, and others of that kind, which have been of service to many. Nor are the numerous mineral waters impregnated with balsamic substances to be omitted. Concerning the virtues of acids, which are proposed by some, there is some doubt. As to external remedies, there is no room to doubt that emol- lients and maturants are of great service, if the abscess point externally, or a fluctuation be discovered by the fingers. Nor is the efficacy of detergent injections less manifest, if they can be thrown into the affected part of the ulcer. But it is the opinion of practitioners of the first rank, that cauteries far excel other remedies, for in observing the frequent metastases of Purulent matter, it is easy to understand how the motion of the pus when deviating and mixing with the blood, is directed toward this kind of oudet; or it may be favoured by the salutary efforts of nature, which daily experience testifies. Cauteries have no effect against Purulent stagnations of the abdomen, breast and head, which cannot be re-absorbed, by reason of the thickness contracted by retention; wherefore it is expedient to recur to another method, which consists in promoting the evacuation by the surgical art, if nothing forbid, for that this has been fatal to some, is known to GANGRENE. 151 physicians, especially as respects the breast. Sometimes when one or other of the lungs is altogether destroyed, the pus fills the former seat of this viscus, in which case I think no one would dare to make the experiment. GANGRENE. FROM examining the history of dead bodies, it is abundant- ly evident that the internal parts, as well as the surface of the body, are liable to Gangrene, nor is it less obvious that this dread- ful disease, attacking either part, is followed by sphacelus or mortification; by which the part, altogether deprived of its na- tural heat, becomes black, soft, foetid, and putrid. No one is ignorant that Gangrene which is conspicuous externally, is either dry or humid, and we may discover nearly the same difference in the more inward recesses of the body, which, although doubt- ful, I have thought it best to admit, lest some expressions should occur, which, according to the new nomenclature, might be ob- scure. The first or dry, on dissection, is known by livid or blackish spots, which not unfrequently attack the pleura, peri- toneum, mesentery, stomach and intestines, or other membran- ous parts, having the nature of involucra, or lining the sides of the cavities. The second or humid, being the commencement of putrid dissolution, is perceived in the very texture of the viscera; the lungs, liver, spleen, pancreas, omentum, &c. are very often found affected with this mischief. It is reasonable to believe that both species of Gangrene running into sphacelus, proceed from one and the same cause, which produces either ef- fect according to the structure of the part. Another species of Gangrene, if 1 mistake not, is brought to view in dissection, and seems to differ much from the rest; it shews itself under the form of a whitish pellicle, which is easily torn off like an eschar, and adheres to the surface of the viscera. The heart, above all other viscera, is found to be liable to this kind of disease, yet it occurs not rarely in the stomach and intestines, nor does it spare the liver and other viscera. The above-mentioned marks, like spots, projecting scarce beyond the surface of the viscus, shew themselves at first view, and are observed to be sometimes very small, and sometimes widely spread; in some they are solitary, in others very numerous, which last infest the heart in great abundance, so that they may be taken for exfoliation or desqua- mation of this viscus, concerning which it is to be remarked by 152 GANGRENE. the bye, that these membranous filaments proceed from no other source, which are thrown off coughing, or are carried out by stool or urine, which it is justly conjectured are nothing else than pieces of the membrane of the internal trachea, bronchi*, intestinal tube, and bladder, separated by this disease. The first species or dry Gangrene, mostly arises from inflam- mation, pressure, too great dilatation or tearing of parts. At tJther times it is a disease as if suigeneris, although it does not exist primarily or per se, since it is altogether produced by a vi- tiated state of the humors or blood. The small-pox, malignant fevers, and other acute disorders are often attended with this species of Gangrene. The same is also met with in the bodies of those who die of scurvy, phthisis, dropsy, or other chronic affection. Lastly, a similar species is produced by the depressing passions of the mind, air rendered impure by poisonous exhal- ations, poison taken internally, or mixed with the blood by the bite of animals, &c. The second or humid species, is most frequently produced by purulent obstructions, as already remarked, but it is also brought on by other causes, which have hitherto escaped our researches. The cause and character of the third species, differing altogether from the rest, are hid in thick darkness; nor can the event be foreseen, although the viscera affected with it, both in acute and chronic diseases, seem not unequal to the performance of their offices: On which account we must enquire further concerning this matter. Burning and acute pain indicates threatening Gangrene, the sudden cessation of which denotes the presence of this disaster or of sphacelus. It mostly arises from inflammation, but we cannot doubt that it also proceeds from various other causes, which are either beyond our view, or only reached by mere con- jecture. Internal Gangrene not unfrequently draws external parts into sympathy, and by this mark, if other circumstances agree, we may jusdy suspect it; which indeed has not escaped the notice of physicians, to have often happened in old age. But where these conspicuous marks are wanting, the diagnosis of this disease may be obtained from attending well to preceeding symptoms. Nothing certain can be inferred from weak and in- termitting pulse, anxiety, prostration of strength, cold sweats, &c. with which it is attended, for these symptoms have refer- ence to almost all diseases. From black, schirrous and very foetid stools, if the other signs have preceeded, we may easily learn that the intestinal tube is infested with Gangrene and mor- tification, when pains have ceased. It is abundantiy manifest that membranous viscera affected with this disease incur great INSECTS and EXTRANEOUS BODIES. 153 fdanger of laceration, for I remember tp have sometimes obsery- Jjjjt'ytie ileum burst from this cause, and fronrthe ruptured intes- tine the remains of aliments rushed out, which collecting by de- grees in the cavity of the abdomen, pressed down the inferior intestines, occasioning a.vomiting which no art could appease, $nd which deprived the patient of life. Another rare case, and ,not less to be dreaded; I have committed to my book of notes, ]which consists of dilaceration of the stomach and adjacent 'diaphragm, by which their contents rushing into the breast, .brought'on such a suffocation that die patient instantly de- parted. Int^rjjal Gangrene is very difficult to ascertain, and not mpre easy of cure. No one is ignorant that roborants, cardiacs, alexiterials and.diaphoretics are much esteemed in foro medico, against external Gangrene. It appears consonant with reason ,Hthat we should attack internal Gangrene with the same means. But antiseptics talce the "palm, which although of a different character, are not without specific virtues, but it is not easy to explain their genuine mode of action. Those most approved and generally used, are camphor, Peruvian Bark, and spiritus salis dulcis, which, when timely exhibited, and with a skilful hand have snatched many from the grave, before the disease became incurable by attaining to its last grade. But, to confess ' the truth, those medicines have rarely been given to advantage against the disease attacking clandestinely, and not known before it be deeply rooted, which finally becomes known in many, not > until after death, by dissection. ^ °* . INSECTS AND EXTRANEOUS BODIES. ii ..WE shall .treat hereafter of lumbrici, and other species..of /Worms lodging in the fir>t passages, as also of cutaneous worms, \ which especially affect children, concerning which in their prop- er place. We have therefore thought it well worth the trouble to say something at present, concerning those multiform Insects, .which may be met with every where in the human body, yet perhaps omitting numberless ones which escape the keenest eye. We must receive with some abatement the immoderately numer- ous, observations on this subject, which are extant, since many have been. adduced from the mere whimsies of those who are gaping after filthy lucre, that they may be celebrated, and . make themselves admire^ by their dupes. Nor are there want- 154 INSECTS and EXTRANEOUS BODIES. ing silly women who by subtle artifice, feign or contrive mon- strous things, that wonders may be told about them. On this account it becomes difficult to discern truth from falsehood; yet we cannot doubt that worms are propagated, or certain animal- cula resembling them, in all parts of the living body. For they lurk in the brain, and excite most violent head-ach, delirium and convulsions, &c. When they infest the sinuses of the ears and nostril?, they excite the greatest pain. Those which are produced in the bronchia and lungs become the most troublesome, unless they are thrown out by expectoration. Among the more rare and noxious are considered those which are found in the very ventricles, and auricles of the heart, and in the pericardi- um. The most common and least to be feared, are those lodged in the liver, spleen, pancreas, mesentery, kidnies and bladder, as also in various tumors, follicles, &c. As to the form and size of these insects, it appears from their history that some are smooth, others hairy; some have feet, which are denied to others. With respect to magnitude they are mostly very small, but sometimes they are found of great size. Lastly, according to various authors, in whom we may put confidence, some are met with very much like millepedes, leeches, beetles, scorpions, frogs, lizards, snakes, &c. It is wonderful to observe that among these the more dignified are evacuated, as they tell us, by vomiting and stool, which to be sure excites no little suspicion of fraud. Moreover there are discovered smaller animalcula of another sort, not only by the microscope, but also by the naked eye, in the blood, saliva, urine, &c. Yet these little bodies are not found alive, if we except the spermatic vermiculi, dis- covered in this fluid when recently ejected, but they are to be seen only after some delay, or a kincrof putrefaction. Hence it follows that such as these have had no existence, as some pre- tend, in the blood-vessels and other receptacles of the living body. They are not less deceived who affirm that little thick worms have crept out, through a wound made in blood-letting: But these wondrous fables please those who are unwary or igno- rant of the arts of mountebanks; nor are there wanting some who do not blush to vend their charms and nostrums, and give credit to their stories. There is no greater certainty in some histories related of stones and extraneous substances, although there is no room to doubt that these concretions occur every where in the human body, to say nothing of calculus of the kidnies and bladder, concerning which in its place. Stones are frequently found in the various recesses of the brain; the pineal gland is mostly found gravelly, and indeed it has often happened, that I have observed in dissec- INSECTS and EXTRANEOUS BODIES. 155 tions, the whole brain filled with little grains of sand, which vitiated constitution of the brain, I have thought could not have occasioned death. But stones of a certain size, ought to be considered fatal in any part of the brain, as from these arise most severe head-achs, delirium, lethargy, vertigo, convulsions, blind- ness, &c. Sandy concretions are more frequent in the lungs, or bronchia, which by means of coughing are often thrown out; nor are they to be thought less dangerous, when they occasion hoarseness or unconquerable cough, difficulty of breathing, haemoptisis, and other symptoms which bring on pulmonary con-' sumption or marasmus. The heart itself is oppressed with even stony concretions situated about the valvulae, from which origi- nate, especially in old age, palpitation of the heart and faint- ing. Stones are not unfrequently met with in the belly, they are even formed in the substance of the liver and in its surface, from whence proceed parns, and other phoenomena common to various diseases, so that often this kind of sickness is altogether latent, or never enters the mind of the practitioner. The diagnosis of bilious concretions is equally difficult, unless when slipping from the gall-bladder, they wound the ductus choledochus, and by hindering the free flow of bile, occasion the colic which they call hepatic. Nor do these false stones grow in the gall-bladder alone, but they are often formed in the intestinal canal, which attain the size of a pidgeon's or hen's egg, and are carried off by stool. Stones of another appearance are sometimes found in the spleen and pancreas, more rarely in the mesentery, unless by this name we improperly call.those schirrous obstructions which sometimes resemble stones in hardness. To pursue my plan: Very numerous are the observations con- cerning lithiasis, or stone, in the first passages, which is gene- rally known by stones issuing from the mouth or anus; but be- ware of the arts of the fraudulent. There is no doubt concerning stones formed in the testes, vesicula? seminales^ uterus and pla- centa ; it is no less certain that they are sometimes hid within the cellular substance and muscles themselves, nor are the blood- vessels to be thought safe from them. Moreover, stones grow in the margins of the eye-lids, in the nostrils, and are collected in their little caverns, they are implanted in the root of the tongue, and infest the other parts of the mouth. Sandy sweats break forth in some phthisical patients. The gouty and rheumatic matter impacted on the joints seems altogether gravelly. Lastly, in some anomalous tumors and abscesses there are found stones of many forms, as also bony and cartilaginous sub- Stances. In the same are met with, extraneous substances that were 156 INSECTS and EXTRANEOUS BODIES. swallowed, or taken into the body by some other way: to wit, needles, hails, leaden bullets, seeds of plants, nuts, grains of corn, twigs, splinters of wood, bones, fins of fishes, leathers, &c. The tales exceed all belief, which some tell, of whole knives, forks, and such like things found also in abscesses. By way of overweight I may add that stones are also generated in the bodies of different animals, for there are in the museums of the curious, innumerable bezoardic substances, taken out of ori- ental and western goats, deers, and other foreign quadrupeds. Even toads, serpents, and river crabs have them, the like are rarely found in the ox, the ram, the horse, the stag, &c. to say nothing of the balls of hair rolled up in the stomachs of oxen and goats. Nor are there wanting histories of plants growing in the bodies of animals, which therefore, like a little world, seems to contain the rudiments of animal, vegetable, and mineral sub- stances. These are the phoenomena of sportive nature, in the explanation of which, the subtilty of the human mind in vain may try its powers. It is plain from what has been said, that the cure of the multi- form affections arising from Insects and Extraneous Bodies, is very difficult, and ought chiefly to be left to nature. It is true that by timely remedies, insects attacking the ears, frontal si- nuses, eye-lids, teeth, &c. may be destroyed. By the well- timed efforts of nature, these inhabitants of the bronchia, stom- ach, intestines, kidnies and bladder may be scattered: but vain are the endeavours of art and nature against those animalcula at- tacking the brain, heart, liver, and other impervious organs. The same may be said of stones and other extraneous substances, lodged in the different parts of the living body: to be sure by the help of cough, gravelly concretions of the lungs sometimes find exit through the trachea; the very small calculi of the kidnies and bladder often yield to the impetus of the urine; the mouth and anus allow passage for stones and other matters lodging in the first passages: but there is very little hope, if these concre- tions be locked in the brain, liver, pancreas, spleen, &c. Nev- ertheless we must not altogether despair in each of these cases, since we are allowed to try the virtues both of anthelmintics and lithontriptics, which, although they seem unequal to the subdu- ing of the morbific matter, yet through the favour of the Su- preme Being, may, beyond the expectation of all, be successfully administered. POISONS. POISONS, as well as medicines, are taken from the three- fold kingdom, and seem to differ one from the other only in the manner of administering them : since the more formidable Poi- sons, namely cicuta, corrosive sublimate, cantharides, &c. are daily brought into medical use by practitioners of the first note, but in very small doses. The grade of Poisons is various,'not to mention those which respect the bites of animals, of which elsewhere. Some of the worst kind excite symptoms of the most dreadful nature, which shortly or instantly kill; others more slow, do not shew their effects till after some days, months or years, so that for a long time, these last silently lay their snares for life, and resemble a most intricate and slow disease, which in time grows more violent, until having exhausted the strength, and consumed the flesh, it reduces the miserable patients, already worn down with afflictions, to the close of life. From the very prompt and amazing effect which is produced by the arrows of the Indians of both worlds, which are imbued with poison, we may understand that these barbarians are very well versed in this nefarious art; but far be it from us to envy them in this des- tructive business. What the genuine character of Poisons is, it is difficult to find out, and we can argue nothing certain on this subject, from the various experiments made on the bodies of ani- mals, since one and the same poison has different effects in dif- ferent animals: for example, bitter almonds, and parsley, which are enumerated among aliments, will kill birds; which on the contrary fatten as it is said, on cicutra and hellebore. Hogs also feed on cicuta without harm. Spurge, which goats feed on with avidity, is fatal to fishes and